pediatric nursing review 2
TRANSCRIPT
PEDIATRIC NURSING
Review
ERICKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT
Infancy (0 – 1 year) Toddler (1 – 3 year)
Preschool (3 – 6 years)
School (6 – 12 years)
Adolescent (12 – 18 years)
Trust vs. Mistrust Autonomy vs.
Shame and Doubt Initiative vs. Guilt Industry vs.
Inferiority Identity vs. Role
Diffusion
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Sensorimotor Reflexes (0 – 2 years)
Pre-operational/Pre-conceptual (3 – 5 years)
Reliance on reflexes to interact with environment
Increase use of language; unable to put self in another’s place; does not understand relationship of size, weight, volume
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Intuitive (5 – 7 years)
Concrete Operations (8 – 13 years)
Magical thinking; egocentric; tendency to center attention on one feature
Inductive reasoning (specific to general); conservation-ability to understand things are essentially the same even though its shape and arrangement are altered
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
Formal Operations (13 – 16 years)
Capable of introspection, deductive reasoning; able to formulate hypothesis
PHYSICAL ASSESSMENT By what age should the anterior fontanel be
closed?
a. 2 weeks b. 6 months
c. 12 months d. 18 months d. 18 months diamond shapedPosterior triangle in 2 monthsTells hydrationShould be sitting up
PHYSICAL ASSESSMENT Posterior fontanel closed when?
A. 2 weeksB. 2 months
C. 8 monthsD. 12 months
PHYSICAL ASSESSMENTRespiratory
Are young children thoracic or abdominal breathers?
Chest shapeRespiratory 1st vital signs on kids is what we do!!Boys are thoracicGirls stay abdominal
Are young children thoracic or abdominal breathers?A-p diameter is less than transverseChest shape
Infants – shape is roundChildren & adolescents – transverse diameter to anteroposterior
diameter changes to 2:1
WEIGHT Birth weight doubles by 6 months Birth weight triples by 12 months
IQ
IQ = Mental age/Chronological age x 100
GROSS MOTOR SKILLS 2-3 months 3 months
4 months 5 - 6 months 6 months
6 – 8 months 9 months 12 months
Holds head up Holds head and chest
up when prone Rolls front to back Rolls back to front Holds head steady
when sitting Sits unsupported Sits pull self 2 standing Stands (alone & holding
on)
FINE MOTOR Circle by 3 years Cross by 4 Square by 5 Triangle by 6
Social development 2 month smile 3 month breast milk, 6 month stranger
anxiety 9 months waves bye bye 12 months comes when
called speaks one word 15 months jargon
babbles 18 month copies parents 2 yr. two words
FINE MOTOR Bring hand together Look for items
dropped from view Rake finger food 6
months Bang toys together –
9 months
Grasp Transfer object by
hand – 6 months Use thumb to grasp
– 9 months Nesting 1 object
inside another – 12 months
PEDIATRICS FEEDING AND PLAY 0-1 yo breast milk 4-6 mo iron fortified 6-8 mon yellow
veggie
Play Infants solitary play Toddler parallel play Preschool
associative or cooperative play
School-age competitive play
HEALTH ASSESSMENT Birth – 3 year old
pull the pinna down and back
After 3 pull the pinna up and back
PAIN MANAGEMENT A 10 year old child has
just had an appendectomy which of following tools is appropriate a VAS visual analogue Scale
Faces for at least 3-6 year old!!!
Kindergarten count to 100, know shapes, skip jump walk backward walk a straight line
Waiting for pain management “if you let the pain get too bad, the medication will not work as well” is what a nurse says
Give pain meds around the clock
Reevaluate or evaluate the effectiveness of pain med
EXPLORE a primary care
provider prescribes 240 mg of Cefuroxme bid PO for a 3 year with OM. The medication is available in a 200mg/5 suspension
How much mLs should the child receive with each dose?
Feeding tube Check placement
first Flush tubing before
and after medication Dissolve tab in
premeasured amt. of fluid mea
Push slowly
IMMUNIZATION Vastus lateralis site for
infants and children less than 2 years
After 2 year, the ventral gluteal both of these sites can accommodate fluid up to 2 ml
The deltoid site has a smaller muscle mass and can only accommodate up to 1 ml of fluid because size
PLAY ACTIVITIES & SEPARATION ANXIETY Birth -3 mo visual &
auditory 3-6 months
noisemaking objects and soft toys
6-9 months teething toys and social interaction, stack, build cause they sitting up
9-12 months push pull, popcorn popping, large blocks pull apart
Separation Anxiety Parents at hospital
are toddler Begins 9 months
and peaks at 18 months
Isolation washable toys
NUTRITIONSolids introduced to infant doubles his birth
weight (5 to 6 months)Are able to sit up at this age!!!
• First, give iron-fortified cereals.
• Next, give pureed or strained foods one at a time to assess for food allergies.
• Finally, breast milk/formula should be decreased as intake of solid foods increase.
NUTRITION Preterm infants < 37 weeks & < 2,500 g 50-60 kcal/kg/daily parenteral 75 kcal/kg/daily orally Breast milk Dentition 6-8 teeth w/in 1st year
NUTRITION 0 – 1 year 4 – 6 months
6 – 8 months
8 to 10 months After 12 months
Breast milk or formula
Iron-fortified cereal, such as rice cereal
Yellow vegetables, fruits
Meat While milk, eggs,
strawberries, wheat, corn, fish, and nuts
NUTRITION Toddlers—1-3 year Finger food “picky” 3 meals & 2 snacks daily Small portions—healthy Limit fruit juice—4-6
oz/day d/t sugar Preschooler—3-5 years Certain food for a period
of time 3 meals & 2-3
snacks/daily all areas food pyramid
Schooler—5-12 years Depends on activity Balanced diet Likes to be included in
meal planning & preparation
Adolescent—12-20 years
Growth spurts Fast food healthy
difficult 2,000—3,000 kcal/daily
PLAY Infants Toddler Preschool School-age
Solitary Play Parallel Play Associative or
Cooperative Play Competitive Play
INFANT PLAY ACTIVITIES Birth – 3 months
3 – 6 months
6 – 9 months
9 – 12 months
Visual and auditory stimuli
Noise-making objects and soft toys
Teething toys and social interaction
Large blocks, toys that pop apart, and push and pull toys
SEPARATION ANXIETY
Begins at 9 months and peaks at 18 months.
IM MEDICATION ADMINISTRATION The vastus lateralis site for infants and
children < 2 years.
After age 2, the ventral gluteal site can be used. Both of these sites can accommodate fluid up to 2 ml.
The deltoid site has a smaller muscle mass and can only accommodate up to 1 ml of fluid.
MEDS ADMINISTRATION
MEDICATION ADMINISTRATIONA primary care provider prescribes 240 mg of
Cefuroxime BID PO for a 3 year old with Otitis Media. The medication is available in a 200 mg/5 ml suspension. How many mLs should the child receive with each dose?
5ml x 240 mg = 1200 = 6 mL200 mg x 1 200 Or D/A x Q240/200 x 5 = 6
MEDS ADMINISTRATION List 3 intervention, with rationales, that a nurse can
use to decrease the risk of medication errors when administering medications
Interventions Have 2nd nurse verify dose calculation Obtain accurate weight of child Mix medication with small amounts or liquid or soft foods
Rationale Adult meds forms may be used requiring calculation of
very small doses Dosages are usually based on weight or BSA If med is mixed in large amounts of liquid or foods, the
child may refuse to finish the dose
PAIN MANAGEMENT Effectiveness of treatment evaluation
15 min after IV 30 min after IM 30-60 min after Orally & nonpharm. Therapy
Older children can give report Physiologic changes BP, HR, RR are temporary
changes produced by anxiety associated with pain. Initially, elevated VS will return to normal despite persistence of pain
Self report using pain scales is useful in children over 7 year
Children 3-7 can comprehend how to use pain rating scale—assess their ability & validate w/parents
PAIN MANAGEMENT FLACC Behaviors 0-2 2-7 months 0/10 10 worst
CHEOPS 4/13 13 worst 1-5 years
FACES Use Drawing 3-older VAS Scale numbered 7-older or as
y/4.5 0-10 point to #
MEDICATION ADMINISTRATIONWhen administering oral medications to a child with a
feeding tube, the nurse knows to:
a. Flush the tubing with NS before and after administration of the medication.
b. Dissolve tablets in a premeasured amount of fluid, measure into a syringe, and give slowly into the side of the mouth to prevent clogging the feeding tube.
c. Push slowly on the plunger of the administration syringe to gently administer the medication through the feeding tube.
d. Check tube placement, administer medication by gravity flow, flush adequately, and clamp tubing.
OTIC ADMNISTRATIONBirth to 3 years – Pull the pinna (auricle) down
and back.
After 3 years – Pull the pinna (auricle) up and back.
PAIN MANAGEMENTA 10-year-old child has just had an
appendectomy following a ruptured appendix. A nurse is monitoring the child’s response to antibiotics, postoperative healing, and pain control Which of the following tools is most appropriate for assessing the child’s pain?
a. FLACC (Faces, Legs, Activity, Cry, Consolability Scale)
b. FACES pain rating scalec. Children’s Hospital Eastern Ontario Pain
Scales (CHEOPS)d. Visual Analogue Scale (VAS)
PAIN MANAGEMENTA nurse suspects that a 15-year-old adolescent
is experiencing pain. The nurse asks if the adolescent would like her pain medication. The adolescent tells the nurse that she will wait until the pain worsens. Which of the following statements by the nurse is most appropriate in response to the adolescent’s pain?
a. “If you let the pain get too bad, the medication will not work as well.”
b. “Just let me know when you are ready.”c. “You need to take your pain medication
now.”d. “Are you sure you don’t want anything
now?”
PAIN MANAGEMENTThirty to 60 minutes following the
administration of an oral pain medication to a child, it is important that a nurse
a. Document the child’s pain on a rating scale.b. Evaluate the effectiveness of the pain
medication.c. Assess the child for bowel sounds.d. Massage the child’s painful area.
HOSPITALIZATION Infant
Toddler
Preschooler—separation anxiety too
School-age--seeks information for a way of control, sense when not being told the truth, stress related to separation from peers and regular routine
- Adolescent--aintain composure,
embarrassed about losing control, worries about outcome, may not be compliant if it makes them appear different from peer group
Experiences stranger anxiety Experiences separation anxiety Harbors fear of bodily harm;
fears hospitalization is a punishment will ask for a Band-Aid!!!! They think they did something wrong
Fear loss of control
Body-image disturbance; feelings of isolation from peers
7YEAR OLD IN HOSPITAL APPROPRIATE NEEDS Answer: provide
play activities that foster a sense of normal routine
Girl like arts and craft
Boys like things to build
Toddler no small lago’s because choking
Friction toys not near oxygen
AGE-RELATED INTERVENTIONS
Infant
Toddler
Preschooler
School Age
Adolescent
Near nursing station, consistent caregivers
Parent to provide regular routine, appropriate choices—autonomy, consistent caregivers
Explain procedures, encourage independence—self care, validate feelings, express feelings, toys to allow for expression, “Do you want your med in a cup or spoon, younger children to handle equipment
Provide factual information, express feelings, maintain normal routine—time for school work, encourage to contact peer group
Factual information, include in planning of care for powerlessness, encourage contact peer group
HOSPITALIZATIONWhich of the following nursing interventions is
most appropriate for the needs of a 7-year-old child being hospitalized for an extended time?
a. Bring security items such as a toy and blanket
b. Provide play activities that foster a sense of normal routine
c. Limit choices whenever possibled. Restrict family visiting hours
DEATH AND DYINGWhich of the following nursing interventions is
the most appropriate when working with a school-age child who has a terminal disease?
a. Give factual explanations of the disease, medications, and procedures
b. Perform all care for the patientc. Tell the child that everything will be okayd. Reinforce that being in the hospital is not a
punishment for any thoughts or actions
HYPOXEMIA
Tachypnea Tachycardia Restlessness Pallor of the skin
and mucous membranes
Elevated blood pressure
Work of breathing
Confusion and stupor
Cyanosis of skin and mucous membranes
Bradypnea Bradycardia Hypotension Cardiac
dysrhythmias
Early Late
BRONCHIAL (POSTURAL) DRAINAGE Schedule treatments 1 hour before meals or
2 hours after meals to decrease the likelihood of the child vomiting or aspirating.
Bronchial drainage is more effective if other respiratory treatments (e.g., bronchodilator medication and/or nebulizer treatment) are performed 30 minutes to one hour prior to postural drainage.]
Give a treatment first if they are getting a treatment and CPT
SUCTIONING Suction should take no longer than 5
seconds. Suction catheters should be one-half the
size in diameter of the child tracheostomy tube.
It is no longer the standard of practice to instill sterile saline into the tracheostomy tube prior to suctioning.
HYPOXEMIAWhen assessing a child removed from an oxygen
tent, a nurse recognizes which of the following signs and symptoms as an early indication of hypoxemia?
a. Nonproductive coughb. Hypoventilationc. Nasal flaringd. Nasal stuffinessRationale: signs of hypoxemia early! Nonproductive cough, hypoventilation and nasal stuffiness are signs and symptoms of oxygen toxicity plus sub-sternal pain, N/V/Fat/H/sore throat
OXYGEN TOXICITYWhich of the following is the most appropriate
nursing interventions for a child experiencing oxygen toxicity?
a. Immediately discontinue oxygen administration
b. Increase humidification of oxygenc. Use lowest possible flow rate of
oxygend. Monitor oxygenation with a pulse oximeterRationale: interventions include using lowest level necessary to maintain adequate SaO2 levels. O2 should be discontinued gradually, should be humidified.
OXYGEN SATURATION Normal values Acceptable values Emergency value Life-threatening
value
95 to 100% 91 to 100% Less than 86% Less than 80%
OXYGEN ADMINISTRATIONA child with cystic fibrosis is hospitalized with
an acute episode of pulmonary manifestations. Which of the following nursing interventions is contraindicated for this child?
a. Perform chest physiotherapy three times daily
b. Administer oxygen at an increased flow rate
c. Deliver aerosolized medication to open bronchi
d. Teach the child to use a flutter mucus clearance device
ASTHMA Manifestations of asthma
Mucosal edema Bronchoconstriction (from bronchospasm) Excessive secretion production
Expiratory wheeze Prolonged expiratory phase Nonproductive, hacking cough know if having
asthma attack you hear Wheezes can be audible Appearance may show enlarge chest wall
anteroposterior diameter
ASTHMA Treatment
Beta 2 adrenergic agonists are bronchodilators Albuterol Salmeterol Terbutaline
Glucocorticoids Prevent inflammation Suppress airway mucus production Promote use of beta2 receptor Beclomethasone QVAR use low dose, difficulty speaking, hoarseness
candidiasis Prednisone Pulmicort Flovent
Leukotriene Antagonist Singulair Mast cell stabilizer Cromolyn Sodium Monoclonal Antibodies Xolair B before C Beta agonist then Corticoid No CPT during an asthma attack.
ASTHMAA child is exhibiting suspected clinical
manifestations of asthma. The mother asks the nurse what tests will be necessary to diagnose her child. Which of the following diagnostic procedures should the nurse tell the mother is most accurate for diagnosing asthma?
a. Arterial blood gasesb. Chest x-rayc. Pulmonary function testsd. Allergy tests
ASTHMAA child experiencing an acute asthma attack
presents to the ED. Which of the following medications should a nurse prepare to administer to the child as an intervention for an acute asthma attack?
a. Terbutaline (Brethine)b. Beclomethasone dipropionatec. Prednisoned. Albuterol (Proventil) is expensive Proventil
albuterol is cheaper
INHALED STEROIDS Side Effects
Difficulty speaking Hoarseness Candidiasis
TONSILLITIS Tonsils filter viruses and bacteria. Lymph tissue. Highly vascular.
Tonsillitis caused by group A beta-hemolytic streptococci (GABHS) Chronically infected tonsils may pose a potential threat to other parts of the
body. Some children who have frequent bouts with severe tonsillitis may develop other diseases, such as rheumatic fever and kidney infection.
In younger children d/t immature immune systems Tonsillectomy pre-op – CBC (anemia & infection) RN intervention Tonsillitis (symptomatic—viral: rest, fluids, warm salt water
gargles, Tylenol or ibuprofen for pain, NPO if surgery!
Tonsillectomy – post-op Side lying position initially with HOB up when fully awake Nothing sharp in mouth, no straws, no sharp food Look for frequent swallowing, clearing throat, restlessness, bright red emesis,
tachycardia and/or pallor Provide ice collar and throat moist Clear liquid, soft, bland foods—no fruit punch Avoid red colored foods and milk initially Discourage coughing, throat clearing, and nose blowing Limit strenuous activity for 2 weeks Notify MD if bright red bleeding occurs, increase pain, lack of oral intake
TONSILLECTOMY Discharge—must be able to tolerate oral fluids
and soft foods, & void prior Instructions Call doctor if difficulty breathing, bright red
bleeding, lack of oral intake, increase in pain and/or signs of infection
Not to put anything sharp in mouth No spicy food or hard, sharp foods like corn chips Limit strenuous activity and physical play w/no
swimming for 2 weeks Full recovery occurs usually within 10 days – 2
weeks!
RESPIRATORY INFECTIONS
Respiratory infections are less common in infants from birth to 3 months of age because maternal antibodies offer protection.
CROUP SYNDROMES Bacterial Epiglottitis
Medical emergency Caused by Haemophilus influenzae Dysphonia, Dysphagia, Drooling Inspiratory stridor Sore throat, high fever Tripod positioning Racemic epinephrine Prepare for intubation Corticosteroids Antibiotics DO NOT EXAMINE THE CHILD’S THROAT WITH A
TONGUE BLADE OR TAKE THROAT CULTURES.
CROUP SYNDROMES Croup or Acute Laryngotracheobronchitis
(LTB) Causative agents: RSV, influenza A and B, and
Mycoplasma pneumoniae Barky cough Inspiratory stridor Low-grade fever URI Racemic epinephrine Corticosteroids Use of warm or cold mist Possible need for emergency airway DO NOT EXAMINE THE THROAT
RSV
Diagnosis of Respiratory Syncytial Virus (RSV) is accomplished througha. Collection of a sputum specimenb. A throat culturec. Nasal aspirationd. Obtaining blood for a CBC
RSV
What are nursing interventions that would be expected for a child hospitalized for pneumonia caused by RSV?
Antipyretics for fever O2 w/cool mist for comfort IV &/or oral fluid therapy Postural drainage and CPT
RESPIRATORY ILLNESS Viral infections more common in toddler and
preschooler. Incidence decreases by age 5. GABHS and Mycoplasma pneumoniae rates
increase after age 5. RSV more common during winter and
spring. Mycoplasma pneumoniae more common in
autumn and early winter.
CYSTIC FIBROSIS Hereditary; autosomal recessive trait;
both parents must carry the trait Dysfunction of exocrine glands, causing
glands to produce thick, tenacious mucus Thick mucus obstructs respiratory
passages; also, obstructs secretory ducts of the pancreas, liver, and reproductive organs
Sweat and salivary glands excrete excessive amounts of sodium and chloride
Bronchiectasis and emphysema may develop with pulmonary fibrosis (these are two most common the are sterile too reproductive wise)
CYSTIC FIBROSIS
Diagnostic Tests Sweat chloride test Absent pancreatic enzymes Stool analysis indicating steatorrhea
(undigested fat) and azotorrhea (foul-smelling from protein)
Pulmonary function Sputum C & S—infection Abdominal X-ray—detects meconium ileus
CYSTIC FIBROSIS Interventions
Bronchodilators then CPT (do 1 hour before meals or 2 hours after meals)
Flutter mucus clearance device Pulmozyme nebulizer to decrease viscosity of
mucus Pancreatic enzymes with meals and snacks High-caloric, high protein diet Multiple vitamins, including water-soluble
forms, of vitamins A, D, E, and K
CYSTIC FIBROSISAll of the following are assessment findings
seen in a child with cystic fibrosis except for:a. Wheezy respirationsb. Clubbing of fingers and toesc. Barrel-shaped chestd. Rapid growth spurts
CHD Key points Present @ birth because anatomic
abnormalities Result primarily in HF and hypoxemia Prevent normal blood flow Any structural lesion in heart or blood vessel
that is directly proximal to the heart = CHD Many defects spontaneously close Diagnosed in 1st yr. of life
CHANGES AT BIRTH
FIG. 25-1 Changes in circulation at birth. A, Prenatal circulation. B, Postnatal circulation. Arrows indicate direction of blood flow. Although four pulmonary veins enter the LA, for simplicity this diagram shows only two. RA, Right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle.
RA3 mm Hg72-80%
RV25/0-5 mm Hg72-80%
Ao115/80 mm Hg95% PA
25/15 mm Hg72-80% PV
9 mm Hg95%LA
5-10 mm Hg95%
LV120/0-10 mm Hg95%
ATRIAL SEPTAL DEFECT
Figure 25-1 ASD
VENTRICULAR SEPTAL DEFECT
Figure 25-2 VSD
ATRIOVENTRICULAR CANAL DEFECT
Unn Figure 25-3 Atrioventricular canal defect
PATENT DUCTUS ARTERIOSUS
Figure 25-4 PDA
COARCTATION OF THE AORTA
Figure 25-5 Coarctation of the aorta
COARCTATION Increased blood pressure in the UE. Increased saturation in the UE. Weak or absent pulses in the LE Nosebleeds Headaches Leg pain Weak or absent LE pulse (indicate decreased
CO)
AORTIC STENOSIS
Unn Figure 25-6 Aortic stenosis
PULMONIC STENOSIS
Unn Figure 25-7 Pulmonic stenosis
TETRALOGY OF FALLOT
Unn Figure 25-8 TOF
TOF Pulmonary Stenosis VSD Overriding Aorta Right ventricular hypertrophy
Polycythemia Squatting position Clubbing of fingers Murmur Severe dyspnea Hypercyanotic spells Acidosis FTT Growth retardation
TRICUSPID ATRESIA
Figure 25-9 Tricuspid atresia
TRANSPOSITION OF THE GREAT ARTERIES, OR TRANSPOSITION OF THE GREAT VESSELS
Figure 25-11 Transposition of great vessels
TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
Figure 25-12 Total anomalous pulmonary venous connection
TRUNCUS ARTERIOSIS
HYPOPLASTIC LEFT-SIDED HEART SYNDROME
Unn Figure 25-14 Hypoplastic left-sided heart syndrome
IMPLEMENTATION/ASSESSMENT Palpate peripheral pulses, noting rhythm
irregularities and decreased strength or inequality
Palpate extremities for slow cap refill Auscultate HR & rhythm, Assess for bradycardia, tachycardia, or
dysrhythmias, heart sounds, murmurs or extra sounds
Palpate and percuss abdomen for enlarged liver and/or spleen
IMPLEMENTATION/ASSESSMENT
Sign & symptoms of HF Impaired myocardial function Tachycardia Diaphoresis decreased UOP Fatigue Pale & cool extremities Weak peripheral pulses Cardiomegaly FTT Anorexia
IMPLEMENTATION/ASSESSMENT
Sign & Symptoms of Pulmonary Congestion Tachypnea Dyspnea Retractions Nasal flaring Exercise intolerance Stridor Grunting Recurrent respiratory infections
IMPLEMENTATION/ASSESSMENT
Sign & symptoms of Systemic Venous Congestion hepatomegaly Peripheral edema Ascites Neck vein distention (not seen in infants)
Signs & Symptoms of Hypoxemia Cyanosis Clubbing Polycythemia Squatting Chest deformities Hypercyanotic spells (blue or “Tet”) = acute cyanosis
and hyperpnea!
IMPLEMENTATION Improve cardiac function
Administer Digoxin (check K, double check dose with another RN, apical for one minute)
Afterload reduction Monitor BP (before & after ACE inhibitors, assess for
↓BP, monitor electrolytes) Decrease cardiac demands
Rest, cluster care, minimize crying, etc. Reduce respiratory distress
↑HOB, O2
Maintain nutritional status Need ↑calories d/t ↑metabolic demands
Promote fluid loss Diuretics, I & O, weight, electrolytes, hydration, fluid
restriction Support child/family
MANAGEMENT OF HYPOXEMIAChildren with heart defects can have
hypercyanotic “Tet” spells which can result in severe hypoxemia.
Immediately place the child in the knee-chest position, attempt to calm the child, and call for help.
CARDIAC CATHETERIZATIONIf bleeding occurs at the insertion site after the
cardiac catheterization, the first action the nurse should implement is to
a. Apply pressureb. Administer vitamin Kc. Call the surgeond. Apply a tighter pressure dressing
DIGOXIN Administer one hour before or two hours
after feedings. If the child vomits, do not re-administer
the dose. If a dose is missed by more than 4 hours,
withhold the dose and do not double the next dose.
Observe for signs of digoxin toxicity: slow pulse, decreased appetite, N/V
EPISTAXIS
Active bleeding from nose Restlessness & agitation Have child sit up with head tilted slightly
forward to promote drainage out of nose instead of down the back of the throat.
Apply pressure to the lower nose. Cotton or tissue can be packed into the nares
that is bleeding. Ice across bridge of nose. If bleeding last longer than 30 min., see
medical care.
LEUKEMIA Most common cancer of childhood Bone marrow dysfunction Causes an increase of immature WBCs
(blasts) to be produced Deficient RBCs cause anemia Deficient mature WBCs (neutropenia)
increase risk for infection Deficient platelets (thrombocytopenia) cause
bruising Invasion of CNS causes increased ICP Invasion of bone marrow causes bone bain
LEUKEMIA NURSING INTERVENTIONS Good oral care. Soft brushes. Avoid rectal temperatures. Soft, bland diet. High fiber diet. Stool softeners/laxatives as needed. Weigh daily. Encourage fluids. Prepare for hair loss.
LEUKEMIA Low grade fever Pallor Increased bruising and petechiae Listlessness Enlarged liver, lymph nodes and joints Constipation Headache N/Anx Low platelet & RBC Increased immature WBC Late manifestations
Hematuria Ulceration in mouth Enlarged kidneys and testicles Increased intracranial pressure
IRON DEFICIENCY ANEMIA Most prevalent nutritional and mineral
deficiency in the US. Common in ages 6 months to 2 years and in
adolescents 12 to 20 years. Hgb requires iron. Iron deficiency will result
in decreased Hgb levels Can decrease oxygen to tissues Cause growth retardation and developmental
delays. Whole milk is not a good source of iron.
IRON DEFICIENCY ANEMIA SOB Pallor Fatigue Brittle fingernails Systolic murmur
Labs: CBC RBC RETICULOCYTE COUNT FERRITIN
NURSING INTERVENTIONS
Preterm or LBWI require iron supplements Breastfeed younger than 4—6 months Iron-fortified formula Modify diet—high iron, Vit. C & protein Allow frequent rest periods Restrict milk intake in toddlers. Give only 1 qt. per day Avoid until after a meal Don’t carry bottle or cups of milk
NURSING INTERVENTIONS Restrict milk intake in toddlers. Give iron 1 hour before or 2 hours after milk or
antacid. Give on empty stomach. Give iron with vitamin C to help increase
absorption. Give with straw to avoid staining teeth. Rinse
mouth out with water. Stools may be tarry. Increase fluids to prevent constipation. Dietary sources: dried legumes, nuts, green
leafy vegetables, red meat, foods iron fortified Use Z track for parenteral injection—Don’t
massage
BLOOD STUDIES
2 months
6 to 12 years
12 to 18 years
Hbg: 9 to 14 g/dL Hct: 28 to 42% Hbg: 11.5 to 15.5 g/dL Hct: 35 to 45% Hbg: 13 to 16 g/dL
(male) Hbg: 12 to 16 g/dL
(female) Hct: 37 to 49% (male) Hct: 36 to 46 (female)
Age Hgb/HCT
IRONA nurse is administering parenteral iron
dextran to a child by the Z-track method. Which of the following strategies is correct when using the Z-track method to administer iron?
a. Watch the child carefully for an allergic reaction after administration.
b. Use the deltoid muscle for administration in school-age children.
c. Massage the injection site for comfort after administration.
d. Administer no more than 3 ml of iron into one site at a time.
SICKLE CELL DISEASE Autosomal recessive genetic disorder. Promote REST OXYGEN Pain management: Tylenol or ibuprofen, opioids for
severe pain. Warm packs to painful joints. Maintain fluids. Blood products/exchange transfusion. PROM to prevent venous stasis. Prevent infection—hand washing, prophylactic penicillin Complications: CVA and Acute Chest Syndrome
Seizures, abnormal behavior, slurred speech, change in vision, vomiting, severe headache
CVA: blood transfusions Q3-4weeks prevention Chest syn.—chest pain, fever 101.3 F or higher, congested
chest, tachycardia, dyspnea, retractions, decreased O2 sat
SICKLE CELL DISEASE LABS:
Screening CBC Sickledex (detects HbS) HGB electrophoresis (definitive dx)
Diagnostics: Transcranial Doppler (TCD)
Assess intracranial vascular flow/detects CVA Annually 2-16 yrs
HEMOPHILIA X-linked recessive disorder. Hemophilia A
Deficiency of factor VIII Classic hemophilia Accounts for 80% of cases
Hemophilia B Deficiency of factor IX Christmas disease
HEMOPHILIA Labs: aPTT Factor specific assays Platelets Prothrombin Whole blood clotting time
Diagnostic: DNA
NURSING INTERVENTIONS Avoid rectal temperatures. Avoid unnecessary skin punctures. Apply pressure for 5 minutes to injection
sites. Monitor urine, stool, and nasogastric fluid for
occult blood. Rest and immobilize affected joints
(hemarthrosis). Arthrocentesis! Elevate and apply ice to affected joints. Soft toothbrush. Medic Alert bracelet.
HEMOPHILIA DDAVP—vasopressin increase factor VIII, not
effective for Hem. B Factor VII Corticosteroids NSAID’s
Complications Uncontrolled bleeding Joint deformity—rest, immobilize, elevate, ice,
ROM after bleeding, ideal wt., exercise encourage
HEMOPHILIA
True or False:
Aspirin and ibuprofen are the best choices for pain relief in a child with hemophilia.
RHEUMATIC FEVER Inflammatory disease of connective tissue
which can include the connective tissue of the heart, joints, CNS, and subq tissue.
Rheumatic fever can cause RHD which can result in cardiac valve damage.
Usually occurs within 2 to 6 weeks following an untreated upper respiratory infection (GABHS).
RHEUMATIC FEVER Major Criteria
Carditis Polyarthritis Chorea – involuntary muscle movements, muscle
weakness, etc. (this is transitory & will resolve) Subq nodules Rash (erythema marginatum) – pink macular
rash on trunk and abdomen (not on face) Minor Criteria
Fever Arthralgia
NURSING INTERVENTIONS Penicillin (erythromycin if child allergic to PCN)
Assess for allergic response (hives, rash, anaphylaxis) Assess for N/V/D
Aspirin for anti-inflammatory effect (rheumatic fever is bacterial and not viral in origin) Bed rest
Assist w/ADL’s if chorea prevent the child from bathing, feeding School work arranged
Chorea is self-limiting Follow prescribed prophylactic treatment
2 daily doses of 200,000 penicillin Monthly IM of 1.2 mill units of penicillin Or Daily PO dose of 1 g of Sulfadiazine Obtain prophylaxis therapy FOR ALL DENTAL WORK & INVASIVE
PROCEDURES ARRANGE medical follow-up Q5years
Elevated or rising serum antistreptolysin-O (ASO) titre – most reliable
IMMUNIZATIONS Contraindications
Moderate to severe illness Allergies (e.g., specific medications, eggs,
gelatin, or any vaccine) Serious reaction following vaccine administration
in the past History of seizures or other neurological
condition Immunosuppression (e.g., cancer, HIV, chronic
steroid use) Blood transfusion, immunoglobulin, or recent TB
test Pregnancy
Vaccination Drug Contraindications Ages
DTap Adacel & Boostrix.
Encephalopathy, seizures 2, 4, 6 months 15-18 months
Td Hib allergic reaction latex, gelatin,
thimerosal (mercury)2, 4, 6, 12-15 months
RV rotavirus RotaTeq,
Rotarix
Diarrhea, vomiting, HIV 3 doses: 6 weeks 4-10 wks. apart2 doses: 6 weeks then 4 wks. later
IPV (Poliovirus) Ipol allergic formaldehyde, neomycin, streptomycin, or polymyxin B
2, 4, 6-18 months 4-6 years
MMR Pregnancy, neomycin, gelatin 12-15 months, 4-6 yrs.
Varicella Pregnancy gelatin neomycin 12-15 months, 4-6 yrs.
PCV pregnancy 2, 4, 6, 12-15 months
Hep A pregnancy 12 months
Hep B Baker’s yeast 12 hrs after birth, 1-2 months,6-8 months
Flu eggs TIV: Annually 6 months LAIV: @ 2 yrs. nasally
MCV4 Guillain-Barre 11-12 yrs.
HPV2 HPV4 Yeast, pregnancy HPV2: 11-12 yrs (9 minimum)HPV4: males (9 yrs.)
COMMUNICABLE DISEASES Varicella (Chickenpox)
Varicella-zoster virus VZV No longer contagious once lesions have crusted over Contagious 1 day before lesions to 6 days after first lesions appear Very itchy Direct contact, droplet, Incubation 2-3 weeks
Rubella (German Measles) Low-grade fever mild rash lasting 2 to 3 days Rash begins on face, spreading down trunk Prevent exposure to pregnant women 14-21 day incubation Contagious 7 days b4 to 5 days after rash appears
Measles (Rubeola) High fever Koplik spots Rash begins at hairline and spreads down body Respiratory tract, urine, blood, 1-20 day incubation, Contagious 4 days b4 to 5 days after rash appears
Pertusis (Whooping Cough) Nighttime cough; may have mucous plug Droplet Isolation Direct contact, indirect contact w/contaminated articles 6-20 days incubation, contagious during catarrhal stage b4 onset of paroxysms
Mumps Swollen parotid glands; earache with chewing Paramyxovirus, contagious immediately b4 & after swelling begins Saliva of infected person, direct contact, droplet, 14-21 day incubation
Infectious Mononucleosis Restrict activities for 2 to 3 months
OTITIS MEDIA Lower incidence in breastfed infants. Hearing difficulties and speech delays if OM becomes a chronic
condition. Myringotomy and placement of tympanoplasty tubes may be indicated
for the child with multiple episodes Tubes usually come out by themselves in 6 to 12 months. IgA in breast milk—protect against infection Acetaminophen 10—15 mg/kg Q4 Ibuprofen 10 mg/kg Q6 Amoxicillin is 1st Choice 4 OM
Give high dose amoxicillin 80-90 mg/kg/day
Augmentin & azithromycin are 2nd line 10-14 days course Observe for allergic reaction (rash, difficulty breathing etc.)
Discourage use of Decongestants or Antihistamines Sit upright Avoid smoke, people w/viral or bacterial respiratory infections Up to date immunizations
WILM’S TUMOR (NEPHROBLASTOMA) Malignancy that occurs in the kidneys or
abdomen. Metastasis is rare. Avoid preoperative palpation of Wilm’s tumor. Treatment involves:
Preop chemotherapy or radiation to decrease size of tumor
Surgical removal of the tumor and affected organs
Chemo from 6 to 15 months.
NEUROBLASTOMA Malignancy that occurs in the adrenal gland,
the sympathetic chain of the retroperitoneal area, head, neck, pelvis, or chest.
Presents as asymmetrical, firm, nontender mass in the abdomen. This mass crosses the midline.
Treatment involves: Surgical removal of tumor. Radiation in an emergency to decrease the size
of a tumor that is compressing the spinal cord. Radiation to decrease the size of the tumors and
palliation for metastasis.
BONE MARROW DEPRESSION RESULTING IN ANEMIA, NEUTROPENIA, AND/OR THROMBOCYTOPENIA
Monitor blood counts for anemia, neutropenia, & thrombocytopenia.
Monitor VS, low-grade temp. may be sign of infection. Protect from sources of infection. Avoid invasive procedures. Avoid ASA/NSAIDs. Administer filgrastim (Neupogen) to stimulate WBC
production. Administer epoetin alfa (Procrit) to stimulate RBC
formation. Administer interleukin-11 to stimulate PLATELET
formation. Soft toothbrush. Rest periods.
A CHILD WHO IS 2 DAYS POSTOPERATIVE SURGICAL REMOVAL OF A WILM’S TUMOR IS SOBBING AND REPORTING ABDOMINAL PAIN. THE CHILD WAS MEDICATED 30 MIN. AGO, AND THE NURSE OBSERVES THAT THE CHILD’S ABDOMINAL GIRTH HAS INCREASED BY 6 CM FROM 2 HR PREVIOUSLY. THE CHILD’S SKIN IS COOL AND MOIST. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKE FIRST?A. ASSESS VITAL SIGNS AND DRESSINGB. PROVIDE DIVERSION FOR 30 MORE MINUTES TO ALLOW MEDICATION TO TAKE EFFECTC. REPOSITION THE CHILD INTO THE SEMI-
FOWLER’S POSITIOND. PROVIDE THE CHILD WITH A QUIET ENVIRONMENT
HIV/AIDS Viral infection—infects the T-lymphocytes,
causing immune dysfunction. CD4+ T-lymphocyte count determines the level
of immuno-suppression. Pregnant women with HIV are usually given
antiviral medications during pregnancy. Retrovir (Zidovudine)
14 wks. Gestation, thru out, & before onset of labor or C-section
Don’t breastfeed Give 4 6 wks. After delivery at least 30 minutes before or 1 hour after a meal
LAB: Enzyme immunoassay (antibody screen) Confirmed by + Western Blot Testing
HIV/AIDSWhich of the following infections indicates that
a child with AIDS is severely ill?a. Oral-pharyngeal candidiasisb. Otitis mediac. Pneumocystis carinii pneumonia (PCP)d. Herpes simplex virus
BURNS First Degree
Superficial Sunburn Pain
Second Degree Partial thickness Extremely painful Scalds
Third Degree/Fourth Degree Full-thickness Nerve endings destroyed = no pain Lava burn
BURNS Signs of inhalation injury may include mouth
and nose. Maintain airway. Stop the burning process. Flush with water. Remove clothing. Cover burn with clean cloth. Provide warmth. Obtain tetanus prophylaxis. Moderate to severe burns: fluid replacement. Pain management prior to wound care. Wet dressing prior to removal.
SKIN INFECTIONSMatch the following skin disorders with their
cause.
____Impetigo contagiosa A. Fungal infection____Scabies B. Bacterial
infection____Lyme disease C. Viral infection____Cold sore, fever blister D. Spirochete____Ringworm E. Burrowing mite
ECZEMAWhich of the following medications can be
used for children with eczema?
CorticosteroidsAccutanePeroxideAntihistaminesCalamine lotion
HOW IS CRADLE CAP TREATED?
GASTROINTESTINAL Rotavirus is a common cause of diarrhea in
young children. Metronidazole (Flagyl) is used for the child
who is symptomatic of C. difficile. Mild dehydration is 5% weight loss in infants. Moderate dehydration is 10% weight loss in
infants. Severe dehydration is 15% weight loss in
infants.
PINWORM (ENTEROBIUS VERNICULARIS)
Parasitic worm whose eggs when inhaled or swallowed can cause perianal itching.
To assist in diagnosis: transparent tape is placed over anus of child at night. Remove tape prior to child awakening, toileting or bathing. Tape sent to lab.
Wash bed linens and underwear in hot water and dry in hot clothes dryer daily for several days.
Cleanse toys and child care areas thoroughly to prevent further spread of disease.
Treat with PinX
ORAL REHYDRATION THERAPY (ORT) Foods and fluids to avoid:
Fruit juices, carbonated sodas, and gelatin, which are all high in carbohydrates, low in electrolyte content, and have a high osmolality.
Caffeine, due to its mild diuretic effect. Chicken broth or beef broth, which has too
much sodium and not enough carbohydrates. Bananas, rice, applesauce, and toast (BRAT
diet). This diet carries low nutritional value, high carbohydrate content, and low electrolytes.
PICAPica should be considered in which of the following children presenting to the health clinic?a. 7-year-old with nausea and vomiting
for the past 3 days.b. 4-year-old with history of celiac disease
presenting with anemia and abdominal pain.
c. 2-year-old who is still drinking from a bottle and presents with anemia.
d. 4-month-old who presents with crying, irritability, and reddish-colored stools.
GIWhich of the following is the term used to describe impaired motility of the GI tract?a. Malrotationb. Obstructionc. Abdominal distentiond. Paralytic ileus
HIRSCHSPRUNG Congenital aganglionic megacolon Males > Females Impaired colonization of ganglion distal
portion of GI tract Internal sphincter fails to relax d/t missing
inhibitory neurotransmitter (NO) Obstruction d/t preventing evacuation of
stool, gas, liquids Enterocolitis Stool accumulates Absence of peristalsis
HIRSCHSPRUNG
HIRSCHSPRUNG Diagnostic: rectal biopsy, barium enema
Failure 2 pass meconium w/in 24-48 hours Refusal 2 feed Bilious vomiting Abdominal distention FTT Constipation Ribbon-like foul stools
HIRSCHSPRUNG Surgical removal aganglionic portion of bowel 1st 2 temporary ostomy proximally 2nd corrective surgery (wt. approx. 9kg) Soave endorectal pull-through procedure Ostomy closed 2 time of pull-through
RN INTERVENTIONS
Bonding Coping Consent saline enemas, low fiber, high
calorie high protein diets, TPN, oral antibiotics, fluid & electrolytes
Restriction of food & fluid prior 2 anesthesia
Atraumatic drugs administration (PO or existing IV) Versed
Wear loose-fitting gown w/underpants or PJ’s
Depends on Preop goals: hygiene, prep removing jewelry, x-ray, ht. wt., check teeth, NPO, voiding recording last void, allergies, check labs, fall & identification precautions, VS
Postop teachings
Crib ready IV equipment ready ABC, O2, IV, malignant hyperthermia
immediate postop Stay @ bedside until gag reflex return O2 sat. Suction available Temp 4 hypothermia apply warm
blankets Baseline VS, LOC & activity Pain Check dressing: Bleeding Foley cath care Skin color & characteristic Check bowel sounds, turning
requirements Observe 4 shock, abd. Distention Assess bladder distention Observe 4 dehydration Detect infection
Preop care: Postop care:
FASTING REDUCING PULMONARY ASPIRATION
Ingestion Fasting hoursClear liquids 2Breast milk 4Infant Formula 6Non-human milk 6Light meal 6
HIRSCHSPRUNG DISEASETo confirm the diagnosis of Hirschsprung disease, the nurse prepares the child for which one of the following tests?a. Barium enemab. Upper GI seriesc. Rectal biopsyd. Esophagoscopy
GIThe passive transfer of gastric contents into the esophagus is termed:a. Esophageal Atresiab. Meckel diverticulumc. Gastritisd. Gastroesophageal Reflux
PYLORIC STENOSISWhat are features & assessments of a patient with this diagnosis?
PYLORIC STENOSIS Olive-shaped mass in RUQ of abdomen and
possible observation of peristalsis when lying supine.
Vomiting that occurs 30 to 60 minutes after a meal and becomes projectile as obstruction worsens.
Constant hungry. Weight loss, signs of dehydration. Diagnosed by ultrasound.
INTUSSUSCEPTIONAl, age 5 months, is suspected of having intussusception. What clinical manifestations would he most likely have?a. Crying during abdominal exam,
vomiting, currant jelly-appearing stools
b. Fever, diarrhea, vomiting, and lowered WBCc. Weight gain, constipation, and refusal to eatd. Abdominal distention, periodic pain,
hypotension
MECKEL’S DIVERTICULUM Remnant of a fetal duct, which in most
newborns has resolved completely. More common in boys. Most symptoms occur in children less than 2
years, but may occur in children up to 10 years.
May have abdominal pain, bloody stools without pain, bright red mucus in infant stools.
Diagnosed using a radionucleotide scan.
CHILD IN A CAST 4 categories of immobilization
Upper—wrist, elbow Lower—ankle, knee Spinal & Cervical—spine Spica cast—hip, knee
CAST Gauze strips & bandages impregnated Plaster cast mold closely to body part 10-72
hrs drying Synthetic casting dries 5-30 minutes
CAST APPLICATION Dx: fear of bodily harm, loss of extremity
Use plastic doll or stuffed animal 2 explain procedure
During application—distraction Bubbles, pets, activities at school “this will help your arm get better”—futile
Extremities checked for abrasions, cuts, skin alterations, rings causing
constriction from swelling Gore-Tex liner under hip spica cast prevents
exposure 2 moisture
CAST APPLICATION Dry rolls of casting material
Immersed in pail of H20 Wet rolls
Put on in bandage fashion & molded 2 extremity Plaster cast
Underlying stockinet pulled over rough edges Secured w/layer of wet plaster below rim
(padding) Petaled protected edges (wn/no stockinet form)
Synthetic casts Usually don’t require padding on edges
NURSING CONSIDERATIONS H20 evaporation can take 24-48 hrs Fiberglass dries w/in minutes Cast uncovered 2 dry inside out Turn every 2 hours—help drying of body cast Regular fan or cool air hair dryer Heated fans or dryers contraindicated (remain wet beneath or burns) Wet plaster cast—supported by pillow covered with plastic handled w/palm
of hands Dry plaster of paris cast—hollow sound when tapped Hot spot felt—infection, report, window made to observe site Chief concern—extremities may continue 2 swell, circulation compromised,
neurovascular complication Body part elevated 2 reduce compromise—increase VR
Edema—casts a bivalve (cut A to P halves held 2gather w/elastic bandage) Always check NEUROVASCULAR INTEGRITY (6 P’S INCLUDE
PRESSURE, SENSATION, MOVEMENT, CIRCULATION, TEMP, EDEMA) Absorbent diaper under perineal
NURSING CONSIDERATIONS No alterations 2 car seats Hip Spica cast—fed infants supine head
elevated w/hips & legs supported on pillow @ the side; children prone easier from small table
AMPUTATION Congenital absence Traumatic loss Osteosarcoma
Part Reattachment Rinse limb gently w/NS Loosely wrap in sterile gauze Place wrapped limb in watertight bag Cool bag in ice H20 (no freezing, no
packing) Label name, date, time then transport
w/child
AMPUTATION Goal: surgical amputation or repair focuses
on constructing adequately nourished stump
Smooth, healthy, padded, free of nerve endings Prosthesis fitting Subsequent ambulation
With no vascular or neurologic deficit—cast applied 2 stump immediately after procedure & pylon metal extension & artificial foot attached
NURSING CONSIDERATIONS Stump shaping postop elastic bandaging figure 8 Figure 8 decreases edema, controls hemorrhage
& aids developing contours 2 bear wt. Stump elevation during 1st 24 hours Monitor proper body alignment Older children/adolescent
Arm exercises, bed pushups, parallel bars 4 prosthesis training, full ROM above amputation daily several times
Teach stump hygiene—soap & H20 every day, check skin irritation, breakdown or infection, DRY!
Phantom limb—teach preop, increasing limb pain with ambulation should be evaluated (4 neuroma)
CONGENITAL CLUBFOOT Deformity of ankle & foot
Forefoot adduction Midfoot supination Hindfoot varus Ankle equinus
Described by position
CONGENITAL CLUBFOOT Talipes
Varus—inversion or bending inward Valgus—eversion or bending outward Calcaneus—dorsiflexion (toes > heel) Equinus—plantar flexion (toes < heel)
Most common talipes equinovarus! TEV Plantar flexion w/bending inward
Unilateral > bilateral May occur isolated defect May occur association w/chromosomal
aberrations, orthrogryposis, CP, Spina Bifida
CONGENITAL CLUBFOOT
CONGENITAL CLUBFOOT Classification
Positional Transitional, mild, postural Intrauterine crowding May correct spontaneously Responds 2 simple stretching & casting
Passive Serial
Syndromic Teratologic Associated w/congenital anomalies Usually require surgical correction high incidence of recurrence Often resistant 2 treatment
Congenital Idiopathic “True clubfoot” Almost always require surgical intervention (d/t bony abnormality) In otherwise normal child
CONGENITAL CLUBFOOT
CONGENITAL CLUBFOOT DX:
Apparent Prenatal ultrasound or @ birth Radiograph 4 bone placement
Therapeutic Management Painless plantigrade & stable foot 3 stages
Correction of deformity Maintenance of correction until normal muscle balance Follow up observations
Serial casting Manipulation & casting repeated 4 rapid growth (Denis Brown splint) Maximum correction w/in 8-12 weeks Radiograph or ultrasound evaluates bone relationship Failure of alignment by 3 mons. (surgery) between 6-12 months of age Foot/feet immobilized 6-12 postop walks after cast removed Passive exercise
NURSING CONSIDERATION Same as with cast Passive exercise Neurovascular checks Watch for compartment syndrome VS Allow for drying Skin integrity Circulation! Teach importance of regular cast changes Reinforce & clarify orthopedist’s explanations &
instructions Teach cast care, potential problems, encourage
parents 2 facilitate normal development
OB COMPREHENSIVE FOCUSED REVIEW Day One Review
COMPLICATIONS OF NEWBORN Complication of newborn: Hypoglyclemia Risk factors Assessment
Under 40 Get them on breast poor feeding Hypothermia Diaphoresis Weak shrill cry Lethargy Flaccid Seizures Irregular respiration Cyanosis
Labs: plasma glucose less 40 mg/dL
HYPOGLYCEMIA Obtain blood per heel stick for glucose Provide frequent oral and gavage feeding
HYPOGLYCEMIA CONTINUES LGA
Greater than 4000 gram Above 90% tile
Risk factor Post term Maternal DM Fetal cardiovascular disorder of transposition Genetics
Assessment Weight first indication SQ fat Signs of hypoxia Birth trauma Sluggishness Hypotonia of muscles Hypoactivity Tremors from hypocalcemia
CONT’D Monitor glucose Initiate early feeding Monitor thermoregulation Identify and treat birth injuries Surfactant for lung maturity
CIRCUMCISION PAIN MANAGEMENT NPASS Give oral Tylenol
BREASTFEEDING Education Feed 2-3 hrs 8-12 times in 24 hours Colostrum day 1-3 provides passive
immunity Educate on the benefits Reduces the risk of infection Promotes rapid brain growth d/t large
amounts of lactose Has water Protein and nitrogen
ATTACHMENT OF MOTHER-INFANT Assessment:
Looking at baby Comparing the baby Face to face Smiles Talks to Response Identifies characteristics