Pedia Lecture

Growth is a REGULAR process

Direction of Growth include:

- CEPHALOCAUDAL- PROXIMODISTAL- GENERAL TO

SPECIFIC

Every individual grow at its OWN RATE

Growth and development are influenced by MANY FACTORS

Development CONTINUES Throughout LIFE

I’m a Tattooist sir, not a MICRO-surgeon!

“ D ont W et D baby!”

“BEAT-

BREATHE-

FLEX-

REFLEX-

COLOR-”

SIGN 0 1 2

1.Heart Rate absent < 100 >100

2. Respiratory effort

absent Weak cry Strong Cry

3. Muscle toneLimp,flaccid

Some flexion Well flexed

4. Reflex Irritability

No response

Weak cry Strong cry

5. ColorPale, blue Blue

extremitiesPink body

Pink all over

0-Intensive RESUSCITATION

4-SUCTIONINGOXYGENATION

7-BEST POSSIBLE HEALTH

Baby Maria, a neonate is born with heart

rate of 130 bpm, with well- flexed extremities, and her body is pink but the extremities are blue. She’s crying strongly.

APGAR score?Interpretation?

PRESENCE OF:

o LANUGO

o VERNIX CASEOSA

o MONGOLIAN SPOTS

o MILIA

oMOTTLING

o DRYNESS/ PEELING

COLOR: ACROCYANOSIS

FONTANELLES- CLOSURE?

-BULGING?- SUNKEN?

CAPUT SUCCEDANEUM VS. CEPHALHEMATOMA

Normal:

Helix (top of the ear) on same plane as eye Abnormal:

Low-set ears: Normal:

•EPSTEIN PEARLS

Abnormal:

•ORAL THRUSH:

Normal:

ENGORGEMENT:

WITCH’S MILK

RHYTHM:

- Shallow and irregular

- Diaphragmatic

- Periodic breathing

Infants may have 5-15 second period without respiration!

•CYLINDRICAL shape•LIVER•KIDNEYS•Umbilical Cord

Infants are at risk for bleeding and dehydration!

NormalBRICK RED DUST•Female : PSEUDOMENSTRUATION•Male : Testes in Scrotal sac

Central urethral opening

Normal:

10 fingers, 10 toesNo fractures and paralysis

Abnormal:

•With extra digits:•Fused digits:

BEST DONE: 72 hours after birth BUT before the 6th day

TECHNIQUE:Heel-stick method

Congenital Hypothyroidism

•Congenital Adrenal Hyperplasia

•Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency •Galactosemia (Gal)

•Phenylketonuria (PKU).

2. Complete ALL information.

3. Hatched area indicates safe areas for puncture site

4. Warm site with soft cloth, moistened with warm water

1. Gather Equipments

5. Cleanse site with alcohol prep. Wipe DRY with sterile gauze pad.

6. Puncture heel.

7. Lightly touch filter paper to LARGE blood drop.

9. Dry blood spots on a dry, clean, flat non-absorbent surface.

10. Mail the collection.

•Do not contaminate filter paper circles

•Warm the heel of the baby:3-5 minutes

•Do not Pinch!( VERY GENTLE intermittent pressure may be applied to area surrounding puncture site)

• Mail collection within 24 hours!

- WEIGHT LOSS10 % of birth weight during the 1st 7-10 daysdue to loss of ECF and meconium

-DOUBLES AT 6 MONTHS-TRIPLES IN 1 YEAR

2nd to 10th DAY OF LIFESun ExposureDecrease Breastfeeding

2nd to 4th DAY OF LIFENormal LossesDHN

WITHIN 24 HOURS: PATHOLOGIC JAUNDICE

WITHIN 24 HOURS: NEONATAL SEPSIS

RAISES HEAD SLIGHTLY FROM PRONE

HOLDS HEAD IN MIDLINE, LIFT CHEST OFF TABLE

SUPPORTS ON FOREARMS IN PRONEHOLDS HEAD UP STEADILY

ROLLS FRONT TO BACK

ROLLS BACK TO FRONT

GRASP OBJECTS AND BRING TO MOUTH

TRANSFERS OBJECTS

Keep small objects out of reach

Raise side rails

SITS UPRIGHT WITH PELVIC

SUPPORT

SITS, LEANING FORWARD ON BOTH

HANDS

SITS STEADILY WITHOUT SUPPORT

6

CRAWLS•GOOD HAND-MOUTH

COORDINATION•NEAT PINCER GRASP

WALK WHEN LED W/ BOTH HANDS

WALK WHEN LED W/ ONE HAND

HELD

WALKS WITH MINIMAL HELP

SOLITARY

•Cuddly toys•Rattles•Teething rings

Stranger Anxiety

•POUNDING PEGS

•PUSH-PULL TOYS

PARALLEL

Separation Anxiety

•Fingerpaints•Housekeeping toys•Coloring books•Playground Equipment

ASSOCIATIVE

Body Mutilation

•Video Games•Collecting Objects•Board Games•Puzzles

Competitive

• Intrusion of Privacy•Death

EXCESS FLUID IN THE CRANIUM

Altered CSF -Flow-Absorption-Product

TYPES-Communicating-Non-

communicating

TYPES-Communicating-Non-

communicating

It's because the liquid that is in my head does not drain correctly then

I must be treated!

abnormal increase in head circumference

bulging fontanelles dilatation of the

veins on the surface of the cranium

vomiting sunsetting eyes

Skull X-RayTRANSILLUMINATION

CSF SHUNTING

The liquid must be removed, but not too

much; then I will no longer

suffer from headaches!

Vital signs Proper positioning:

Meticulous Skin Care and Eye Care

Observe for signs of IICP

Observe for signs of Infection

a. Prodromalb. Aurac. Tonicd. Clonic

- Loss of consciousness

a. Prodromalb. Aurac. Tonicd. Clonic

- Loss of consciousness

a. Loss/ change of muscle tone

b. Loss of consciousness

- Appears to be daydreaming

a. Loss/ change of muscle tone

b. Loss of consciousness

- Appears to be daydreaming

a. Sudden momentary loss of muscle tone

b. Loss of consciousness

a. Sudden momentary loss of muscle tone

b. Loss of consciousness

- TEMPORAL seizure- Periods of altered

behavior that the client is not aware of

- loss of consciousness

- TEMPORAL seizure- Periods of altered

behavior that the client is not aware of

- loss of consciousness

- seizure confined to specific area

- NO loss of consciousness

- seizure confined to specific area

- NO loss of consciousness

DURINGEnsure airway patencyEase the child on the floorPlace pillows under the

headLoosen restrictive clothingClear area of any hazards

AFTERSuctionOxygenateDocument

SURGERYWITHIN 24-48 HOURS

Prevent infection and RUPTURE of the sac

Replace contents that are replaceable, close the skin defect

PROTECT THE SAC!

- POSITION: Prone-Cover with sterile, moist, non-adherent

dressing- Change every 2 hours

OBSERVE FOR SIGNS OF INFECTIONRednessPurulent dischargeFever Irritability

disability that affects movement and body position.

comes from brain damage that control BODY MOVEMENTS

At birth a baby with cerebral palsy is often limp and floppy

Slow development

Feeding problems

Communication difficulties

• Hearing and sight

• He may not use his hands

SPASTIC

ATHETOSISHand or the toes may move for

no reason.

yperactiveypertonicyperirritableyperelastic

ATAXIAhas difficulty beginning to sit and stand

Priority: SAFETYPrevent FALLSProvide safe environment

Provide Good NutritionPlace food at back of the

tongueFinger foods

1. Nurse Kris is performing an admission assessment on baby James with a diagnosis of meningomyelocele. The nurse assesses for a major symptom associated with this type of spina bifida when the nurse:

a.Checks for responses to painful stimuli from the torso downward.

b.Palpates the abdomen for massesc.Checks the capillary refill of the

nailbeds of the upper extremitiesd.Tests the urine for blood

2. Baby James is now scheduled for surgical closure of the sac. In the preoperative period, the priority nursing action of Nurse Kris would be to monitor the:

a.Blood pressureb.Anterior fontanel for depressionc.Moisture of the normal saline dressing

covering the sacd.Specific gravity of urine

3. Nurse Marc has provided discharge instructions to the parents of an infant who had a (VP) shunt. Which statement if made by the parents indicates correct understanding of the presence of a shunt malfunction?

a.“If the infant has a high-pitched cry, I should call the doctor.”

b.“I should position my infant on the side with the shunt when sleeping.”

c. “My infant will pass urine more often now that the shunt is in place.”

d.“I should call my doctor if my infant refuses baby food.”

4. In the plan of care of a child with tonic-clonic seizure, the Nurse Gabby initiates seizure precautions and documents that which items need to be placed at the child’s bedside?

a.Suctioning equipment and Oxygenb.Oxygen with a tracheotomy setc.Emergency chartd.Airway and a tracheotomy set

5. The parents of the child with cerebral palsy ask the nurse about the disorder. Nurse Sharon bases her response on the understanding that cerebral palsy is:

a.An infectious disease of the central nervous system

b.A chronic disability characterized by impaired muscle movement and posture

c.An inflammation of the brain as a result of a viral illness

d.A congenital condition that results in moderate to severe retardation.

6. Nurse Sharon develops a plan of care for the child with cerebral palsy. The nurse includes interventions in the plan of care, understanding that a primary goal is to:

a.Eliminate the cause of the disorderb.Prevent the occurrence of emotional

disturbancec.Maximize the child’s assets and

minimize the limitations caused by the disorder

d.Cure the disorder

foreign object lodged in eye

eyes are struck by a blunt object

objects penetrate

corrosive chemicals burn the delicate tissues of the

eye

pain tear production redness impaired visual acuity

signs of injury

•Remove offending body •Patch the affected eye

•cold compress •head should be elevated

NEVER REMOVE a penetrating object !

Flush with water

Frequent swimming

Formula Fed Insertion of objects Acute Respiratory

Infection

ET are:ShorterWiderStraighter

signs of infection -fever-irritability

-pain-purulent discharges

hearing

POPPING SENSATION

AntibioticsAnalgesicsMyringotomy

Blowing of noseSwimming

Ear plugs

HEALTH TEACHINGS

Feed infants in upright positionProvide local heatTreat respiratory infections

promptlyDrug administration:

• Antibiotics – emphasize that 10-14 day period is necessary to eradicate organisms

• Otic medications

persistent sore throat difficulty in swallowing unpleasant mouth odor fever

Tonsillectomy & Adenoidectomy

PRE-OPAssess – active infection

- bleeding/clotting- loose tooth

Atropine Sulfate : secretions

POST-OP Position : Prone/Side lying Monitor signs of hemorrhage

- FREQUENT SWALLOWING- pallor- BP, PR

Icecream : vasoconstriction carbonated drinks

red liquids milk products suctioning

1. The nurse provides discharge instructions to the parents regarding the administration of the antibiotics to a child with otitis media . Which of the following statements indicates that the parents understood the instructions?

a. “Administer the antibiotics if the child has a fever.”

b. “Administer the antibiotics until the child feels better.”

c. “Administer the antibiotics until they are gone.”

d. “Begin to taper the antibiotics after 3 days of a full course.”

2. A nurse provides discharge instructions to the mother of a child after a myringotomy. Which of the following is not included in the instructions?

a.Be sure the child uses soft tissues to blow his nose

b.Place earplugs with petroleum jelly in the ears during baths and showers

c.Swimming in deep water is prohibitedd.Swimming in lake water needs to be

avoided

3. A nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which of the following laboratory values is most significant to review?

a.Prothrombin time (PT)b.Sedimentation ratec.Blood urea nitrogen (BUN)d.Creatinine

4. After a tonsillectomy, a nurse reviews the physician’s postoperative orders. Which of the following physician’s orders does the nurse question?

a.Clear, cool liquids when awakeb.No milk or milk productsc.Monitor for bleedingd.Suction every 2 hours

5. After Tonsillectomy, a child begins to vomit bright red blood. The most appropriate initial nursing action would be to:

a.Administer the prescribed antiemeticb.Turn the child to the sidec.Notify the physiciand.Maintain a nothing-by-mouth (NPO)

status

Nasal Flaring Cough Retractions Restlessness Cyanosis/ Pallor

ack in tentack in tentnsure accurate O2 Concentration!nsure accurate O2 Concentration!ot allow clothing- WETot allow clothing- WET

ent: CLEARent: CLEAR

Thoracentesis Oxygen Antibiotics Suction

RESCUE MEDS Albuterol (Ventolin) Terbutaline Sulfate (Bricanyl)

Short-acting beta 2 agonist Aminophylline

Side effect: HYPOTENSION Monitor for BP

Used at home to measure gross changes in peak expiratory flow rate over time

Method: Take adeep breath Place meter in the mouth Blow as hard as possible

Interpretation Green: Best Yellow: Caution Red: ASTHMA

Eliminate allergens Use of nebulizer, MDI Increase OFI Adequate rest, sleep and

balanced diet

Bronchodilators, Antibiotics

CPT Pulmozyme ThAIRapy vest

device

1. Baby Venice is placed in a cool mist tent. Mother Ruffa becomes concerned because the child is consistently crying, and trying to climb out of the tent. The most appropriate nursing action would be to:

a. Call the physician and obtain an order for a mild sedative

b. Tell the mother that the child must stay in the tent

c. Place a toy in the tent to make the child feel more comfortable

d. Let the mother hold the child and direct a cool mist over the child’s face

2. An ER nurse is caring for a child diagnosed with epiglottitis. Assessing the child, the nurse monitors for which indication that the child may be experiencing airway obstruction?

a.Nasal flaring and bradycardiab.The child is leaning backward,

supporting himself with the hands and arms

c.A low-grade fever and complaints of a sore throat

d.The child is leaning forward with the chin thrust out

3. A 10-year-old child with asthma is treated for acute exacerbation in the emergency room. A nurse reports which of the following knowing that it is not an indication that the condition is improving?

a.Increased wheezingb.Decreased wheezingc.Warm, dry skind.A pulse rate of 90 beats per minute

4. The mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that the pain reliever is not very effective. The nurse most appropriately tells the mother to:

a. Increase the dose of the pain relieverb. Increase the frequency of the pain relieverc. Encourage the child to lie on the right sided. Encourage the child to lie on the left side

5. A sweat test is performed on a child with a suspected diagnosis of cystic fibrosis (CF). The nurse reviews the test results and determines that which of the following is a positive result for CF?

a.Chloride level of 20 mEq/Lb.Chloride level of 30 mEq/Lc.Chloride level of 40 mEq/Ld.Chloride level of 10 mEq/L

6. Which of the following respiratory conditions is always considered a medical emergency?

a) Laryngotracheobronchitis (LTB)b) Epiglottisc) Asthmad) Cystic Fibrosis (CF)

- Provide Blood flow to the pulmonary arteries from left or right subclavian artery

A physician has prescribed oxygen PRN for an infant with Tetralogy of Fallot. In which situation would the nurse plan to administer the oxygen to the infant?

a.During the feedingb.When the mother is holding the infantc.When changing the infant’s diaperd.When drawing blood for electrolyte

values

MAJOR S/SxJ-ointsO- shaped heartN-odulesE-rythema marginatumS-t. Vitrus dance

MAJOR S/SxJ-ointsO- shaped heartN-odulesE-rythema marginatumS-t. Vitrus dance

MINOR S/SxF-everE-lectrocardiogram abnormalitiesE-vidence of Group A Strep. InfectionL-ab abnormalities P-revious RF/Heart Disease A-rthralgia

•Foul Aftertaste•Black stools•Constipation

•CUTTING OF CORD•GUM BLEEDING•EPISTAXIS•HEMATURIA

1. A clinical instructor asks a nursing student to describe the cause of the clinical manifestations that occur in sickle cell disease. The student responds correctly by telling the instructor that:

a. Sickled cell increase the blood flow through the body and cause a great deal of pain

b. Sickled cell mix with the unsickled cells and cause the immune system to become depressed

c. Bone marrow depression occurs because of the development of sickled cells

d. Sickled cells are unable to flow easily through the microvasculature and their clumping obstructs blood flow

2. A nurse instructs the mother of a child with sickle cell disease regarding the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?

a.Infectionb.Traumac.Fluid overloadd.Stress

3. A nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. The nurse tells the mother to:

a.Administer the iron through a strawb.Administer the iron at mealtimesc.Add the iron to the formula for easy

administrationd.Mix the iron with cereal

4. A nurse is providing home care instructions to the mother of a 1o-year-old child with hemophilia. Which of the following activities would the nurse suggest that the child could safely participate in with peers?

a.Basketballb.Swimmingc.Soccerd.Field hockey

5. A nurse instructs the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement if made by parent indicates a need for further education?

a.“I will perform proper handwashing techniques.”

b.“I will take a rectal temperature daily.”c.“I will inspect the skin daily for

redness.”d.“I will inspect the mouth daily for

lesions.”

6. A 4-year-old child with leukemia is admitted to the hospital because of pneumonia. Which of the following is the most likely cause of his current condition?

a) Anemiab) Thrombocytopeniac) Leukopeniad) Eosinophilia

After feedings, place your baby on his/her stomach with the upper body elevated at least 30 degrees

Add rice cereal to feeding (thicken feedings)

Burp your baby several times during bottle feeding or breastfeeding. Your baby may reflux more often when burping with a full stomach.

Make sure your baby's diaper is loose.

1. A nurse provides instructions to the mother of an infant of cleft palate regarding feeding. Which statement if made by the mother indicates a need for further instructions?

a.“I will use a nipple with a small hole to prevent choking.”

b.“I will stimulate sucking by rubbing the nipple on the lower lip.”

c.“I will allow the infant time to swallow.”

d.“I will allow the infant to rest frequently to provide time for swallowing what has been placed in the mouth.”

2. An infant has just returned to the nursing unit following a surgical repair of a cleft lip located on the right side of the lip. The nurse places the infant in which most appropriate position?

a.On the right sideb.On the left sidec.Proned.Supine

3. A nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On admission assessment, which data would the nurse expect to obtain when asking the mother about the child’s symptoms?

a.Vomiting large amounts of bileb.Watery diarrheac.Increased urine outputd.Projectile vomiting

4. A nurse provides home care instructions to the parents of a child with celiac disease. The nurse teaches the parent to include which of the following food items in the child’s diet?

a.Riceb.Rye toastc.Oatmeald.Wheat bread

5. A clinic nurse is taking care of a patient with Hirschsprung’s disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant?

a.Diarrheab.Projectile vomitingc.Regurgitation of feedingsd.Foul-smelling ribbon-like stools

6. A newborn’s failure to pass meconium within the hours after birth may indicate which of the following?

a) Hirschsprung diseaseb) Celiac diseasec) Intussuceptiond) Abdominal wall defect

1. Baby James is diagnosed with Wilms’s tumor. During assessment, the nurse expects to detect:

a) Gross hematuriab) Dysuriac) Nausea and vomitingd) An abdominal mass

2. A nurse has provided discharge instructions to the mother of a 2-year-old child who has had an orchiopexy to correct cryptorchidism. Which of the following statements made by the mother of the child, indicates that further teaching is necessary?

a. “I’ll check his temperature.”b. “I’ll let him decide when to return to his play

activities.”c. “I’ll give him medication so he’ll be

comfortable.”d. “I’ll check his voiding to be sure there’s no

problem.”

3. A nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When the nurse is analyzing the results of the urinalysis, which of the following would the nurse most likely expect to note?

a.Hematuriab.Proteinuriac.Bacteriuriad.Glucosuria

4. A nurse is reviewing a treatment plan with the parents of a newborn infant with hypospadias. Which statement by the parents indicates their understanding of the plan?

a.“Circumcision has been delayed to save tissue for surgical repair.”

b.“Catheterization will be necessary when the infant does not void.”

c.“Caution should be used when straddling the infant on a hip.”

d.“Vital signs should be taken daily to check for bladder infection.”

5. A nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse plans to:

a.Cover the bladder with petroleum jelly gauze

b.Keep the bladder tissue dry by covering it with dry sterile gauze

c.Cover the bladder with a nonadhering plastic wrap

d.Apply sterile distilled water dressings over the bladder mucosa

6. When caring for a child awaiting surgery for Wilms’ tumor, which of the following nursing actions would be most important?

a) Handling the child with care, particularly during bathing

b) Placing the child on low blood count precautions and isolation.

c) Monitoring bowel sounds for vincristine-induced ileus

d) Placing the child in high Fowler position to facilitate breathing.

STRUCTURALNONSTRUCTURAL

1. A 1-month-old infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. A nurse assess the infant, knowing that which of the following findings would not be noted in this condition?

a. An apparent short femur on the affected sideb. Limited range of motion (ROM) in the

affected hipc. Asymmetric adduction of the affected hip

when the infant is placed supine with the knees and hips flexed

d. Asymmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

2. A clinic nurse provides instructions to the parents of an infant with hip dysplasia regarding care of the Pavlik harness. Which of the following does the nurse include in the instructions?

a.The harness should be worn 12 hours a day

b.The harness needs be removed for diaper changes and for feeding

c.The harness should be removed only to check the skin and for bathing

d.The infant should not be moved when out of the harness

3. A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which of the following is not a component of the instructions given to the parents?

a.Apply lotion under the brace to prevent skin breakdown

b.Encourage the child to perform prescribed exercises

c.Avoid the use of powder because it will cake under the brace

d.Have the child wear soft-fabric clothing under the brace

4. A 2-year-old child is placed in Bryant traction for treatment of a fractured femur. The nurse develops a plan of care for the child. Which of the following is not a component of the plan?

a.Place the child in a supine positionb.Place the child supine with the legs

flexed slightly less than 90 degreesc.Ensure that the sacrum is resting on

the mattressd.Ensure the use of a footplate to keep

the traction straps away from the child’s ankles

5. The nurse provides instructions to the mother regarding cast care for the child. Which of the following statements, if made by the mother, indicates a need for further education?

a.“The cast may feel warm as the cast dries.”

b.“If the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast.”

c. “A small amount of white shoe polish can touch up a soiled white cast.”

d.“I can use lotion or powder around the cast edges to relieve itching.”