Pediatric Basics

Question 1

Alterations in Health > Respiratory Disorders > Cystic Fibrosis Treatment Nursing Care

Answer

Cystic Fibrosis Tx: Medications: Bronchodilators, anticholinergics, dornase alfa, mucolytics, antibiotics (for pulmonary infections), pancreatic enzymes (pancrelipase) with meals and snacks, fat-soluble vitamins (A, D, E, K). Procedures: Chest physiotherapy (uses percussion, vibration, postural drainage, and breathing exercises to loosen respiratory secretions). Schedule treatments before meals or several hours after meals to avoid vomiting. Use bronchodilator 30 min – 1 hr before treatment. NC: Administer oxygen. Encourage ↑ fluids, high–fat, high–calorie, high-protein diet. Facilitate referral to pulmonologist.

Question 2

Principles of Pediatric Nursing > Types of Families Nuclear Blended Extended Single-Parent Binuclear

Answer

Types of Families Nuclear: Household consists of two parents and their children. Blended: Household includes parents with biological children from previous marriages. Extended: Households with parents and grandparents present. Single-Parent: Head of the household is widowed, divorced, or unmarried. Binuclear: Post-divorce family with co-parenting by mother and father. Children are members of two households.

Question 3

Principles of Pediatric Nursing > Family Theories Family Systems Theory Family Stress Theory Family Development Theory

Answer

Family Theories Family Systems Theory: Family is an interdependent unit. Any change or stressor experienced in one family member affects the entire family. Family Stress Theory: Focuses on the family’s response and coping strategies to routine and unexpected stressors. Family Development Theory: Defines 8 stages of a family life cycle that include predictable steps families experience over time.

Question 4

Principles of Pediatric Nursing > Types of Parenting Authoritarian Authoritative Permissive Indifferent/Passive

Answer

Types of Parenting Authoritarian: “Strict”. High control, low warmth. Inflexible rules, little communication with child. Authoritarian = “Tarrible” parenting style. Authoritative: Moderate-high control, high warmth. Flexible rules, open communication with child. IDEAL. Permissive: “Indulgent”. Low control, high warmth. Few constraints. Indifferent/Passive: “Neglectful”. Low control, low warmth. No limits, lack of affection.

Question 5

Principles of Pediatric Nursing > Piaget’s Theory of Cognitive Development Stages Age Ranges Characteristics

Answer

Piaget’s Theory of Cognitive Development Stage Age Range Key Characteristics Sensorimotor Birth – 2 years old Learn through their senses and movement. Develop object permanence (something continues to exist when it is out of sight). Preoperational 2 – 7 years old Engage in symbolic thought, magical thinking (child’s thoughts or wishes cause events to occur), animism (treat inanimate objects as alive). Concrete Operational 7 – 11 years old Engage in logical thought, have a more accurate understanding of cause and effect. Learn conservatism (matter does not change when its form is altered). Formal Operational 11 years – adulthood Develop ability to engage in abstract thought. Engage in deductive reasoning, logic based problem-solving.

Question 6

Principles of Pediatric Nursing > Erikson’s Theory of Psychosocial Development Stages Age Ranges Psychosocial Crises

Answer

Erikson’s Theory of Psychosocial Development Stage Age Range Psychosocial Crisis Infancy Birth – 1 year Trust vs. Mistrust: Infant gains a sense of trust when basic needs are met (e.g., food, comfort). Toddler 1 – 3 years Autonomy vs. Shame and Doubt: Toddler becomes increasingly independent. Allow choices and encourage autonomy. Preschooler 3 – 6 years Initiative vs. Guilt: Preschooler interacts socially and initiates play activities. Provide opportunities for play and creative expression. School-Age 6 – 12 years Industry vs. Inferiority: School-age child learns new skills, gaining a sense of pride and accomplishment. Adolescence 12 – 18 years Identity vs. Role Confusion: Adolescent forms a sense of self. “Who am I? How do I fit into society?”

Question 7

Principles of Pediatric Nursing > Child Safety Car Seats

Answer

Car Seats Car Seat Types: Adhere to height and weight limits of the car seat. Rear-facing: Birth to 2 – 4 years old. Front-facing: Age 2 to 5 years old. Booster seat: Age 5 until seat belts fit properly (~ 9 to 12 yrs old). Key Points: For rear and front-facing car seats, use 5-point harness. Position straps at or below the child’s shoulders for rear-facing, at or above the child’s shoulders for front-facing. Chest clip needs to rest at nipple or armpit level (not on abdomen). If possible, use LATCH system (lower anchors and tethers for children) to secure car seat, NOT seat belts. Keep children ≤ 12 years old in the back seat. Place child in the center seat if possible (safest from side impact). Never place a rear-facing car seat in front of an air bag.

Question 8

Principles of Pediatric Nursing > Child Safety Drowning Prevention

Answer

Drowning Prevention Fence off swimming pools. Ensure kids wear life jackets in and around bodies of water. Learn how to swim and perform CPR. Supervise child in and around water, including bathtubs. Close toilet lids, and don’t leave young children unsupervised in the bathroom. Child locks can be used on bathroom doors. Be sure all containers (e.g., buckets) with liquids are emptied immediately after use. If a near-drowning incident occurs, always bring the child to the hospital (fatalities can occur hours later).

Question 9

Principles of Pediatric Nursing > Child Safety Burn Prevention

Answer

Burn Prevention Install smoke alarms (at least one per level of the home, outside bedrooms), test monthly, replace batteries every 6 months. When cooking, use farthest burners possible, turn pot handles to the back of the stove, and don’t leave stove unattended. Set water heater temperature ≤ 120°F. Test water temperature prior to immersing child. Avoid heating foods in microwave due to potential for superheated areas that can scald. Use safety caps to block unused electrical outlets. Choose pajamas made with fire-resistant fabric.

Question 10

Principles of Pediatric Nursing > Child Safety Poisoning Prevention & Treatment

Answer

Poisoning Prevention & Treatment Lock up medications, cleaning products, and chemicals. Have the poison control number readily available (1-800-222-1222). Always call them first before doing anything else! Advise parents NOT to use ipecac syrup to induce vomiting. Interventions may include use of activated charcoal, acetylcysteine (for acetaminophen overdose), chelation therapy (for iron or lead overdose), or gastric lavage.

Question 11

Principles of Pediatric Nursing > Child Safety Choking: Prevention Signs/Symptoms Interventions

Answer

Choking Prevention: Supervise children during mealtime. Avoid choking hazards (anything round or requiring lots of mastication): Hot dogs, nuts/seeds, chunks of meat/cheese/peanut butter/raw vegetables, whole grapes, hard/sticky candy, popcorn, chewing gum. S/S: Wheezing, stridor, coughing, dyspnea, clutching neck with hands, inability to speak, cyanosis. Interventions: Use back blows and chest thrusts for children under 1 year old, use abdominal thrusts for children over 1 year old. Do NOT perform blind finger sweep, as this may lodge the object farther into the airway! If the child becomes unconscious, begin CPR.

Question 12

Principles of Pediatric Nursing > Abuse Types of Abuse Risk Factors

Answer

Abuse Types of Abuse: Physical: Intentional use of physical force (e.g., hitting, kicking, shaking, burning). Emotional: Behaviors that harm a child’s self-worth or emotional well-being (e.g., name-calling, shaming, rejection). Sexual: Forcing a child to engage in sexual acts (e.g., fondling, penetration). Neglect: Failure to meet a child’s basic physical needs (e.g., housing, food, education, access to medical care). RF: Children < 4 years old, children with special needs (e.g., disabilities). Family history of mental health issues or substance abuse. Inconsistent, transient, or non-biological caregivers. Parents with low income/education, teen age, single, having many other young children.

Question 13

Principles of Pediatric Nursing > Abuse Signs of Abuse Reporting Requirements

Answer

Abuse Signs of Abuse: Incompatibility between the story and the injury. Inconsistent story between child and caregiver. Injuries that are extremely unlikely given the child’s development (e.g., a 2 month old who “crawled off the bed and hit his head”). Injuries that should have been avoided with basic parental supervision. Reporting: Nurses are required to report suspicion of abuse (i.e., facts and circumstances that lead them to suspect a child has been abused/neglected). They do not have the burden of providing proof!

Question 14

Principles of Pediatric Nursing > Abuse Signs of Physical Abuse Signs of Shaken Baby Syndrome

Answer

Abuse Signs of Physical Abuse: Multiple injuries in various stages of healing. Bruises on the cheeks, neck, genitals, buttocks, or back (accidental bruises are typically found over bony prominences, such as the knees or elbows). Bruises in the shape of the causative object (e.g., belt). Burns in the clear shape of a hot object, or forced immersion burn patterns. Spiral fractures – indicative of a twist injury! Signs of Shaken Baby Syndrome: Poor feeding, irritability, lethargy, vomiting, seizures, periods of apnea, retinal hemorrhage.

Question 15

Principles of Pediatric Nursing > Abuse Signs of Emotional Abuse Signs of Sexual Abuse Signs of Neglect

Answer

Abuse Signs of Emotional Abuse: Extreme behavior (e.g., overly compliant or demanding behavior, extreme passivity or aggression). Delayed physical or emotional development. Signs of Sexual Abuse: Difficulty walking or sitting. Exhibits advanced sexual understanding or behavior for their age. Sexually transmitted and/or frequent urinary tract infections. New onset nocturnal enuresis (bedwetting). Signs of Neglect: Frequently absent from school. Begs or steals food or money. Unclean clothes, body odor, poor dental health. Dresses inappropriately for the weather.

Question 16

Principles of Pediatric Nursing > Pediatric Assessment Key Components

Answer

Pediatric Assessment General Appraisal: Observe the child’s appearance and behavior, assess for signs of abuse. Health History: Obtain additional information vs. adult health history, including: birth, immunization, and growth and development history. Order of Vital Signs: Count respirations prior to touching the child, then apical HR, then BP if indicated, and finally temperature. Pain Assessment: Use age-appropriate pain scale . Physical Growth and Development: Measure length/height, weight, head circumference. Assess fine and gross motor skills. For anthropometric data: Plot measurements on proper growth chart based on age, sex, ethnicity. < 5th percentile or > 95th percentile needs further investigation. The TREND is most important, not the number. Cognitive Development: Assess communication, thinking, problem-solving. Psychosocial Development: Assess play, temperament, communication.

Question 17

Principles of Pediatric Nursing > Pediatric Assessment Expected Vital Signs for Infants & Children

Answer

Pediatric Assessment Vital Sign Infants Children Temperature 97.4 – 99.6 °F (36.3 – 37.6 °C) 97.4 – 99.6 °F (36.3 – 37.6 °C) Pulse 100 – 160 BPM 70 – 120 BPM Respirations 30 – 60 breaths/min 20 – 30 breaths/min Blood Pressure SBP: 65 – 90 mmHg DBP: 45 – 65 mmHg SBP: 90 – 110 mmHg DBP: 55 – 75 mmHg Pulse and Respirations are FASTER in children vs. adults. Blood Pressure is LOWER in children vs. adults.

Question 18

Principles of Pediatric Nursing > Pain Assessment Pediatric Pain Scales: Age Ranges Scoring

Answer

Pain Assessment Pain Scale Age Range Scoring CRIES Neonates (preterm and full-term) Score of 0 to 2 for each component: Crying, Requires O2, Increased Vital Signs, Expression, Sleepless FLACC 2 months – 7 years Score of 0 to 2 for each component: Face, Legs, Activity, Cry, Consolability FACES ≥ 3 years Six drawings of faces to rate pain on a scale of 0 to 5 Oucher 3 – 13 years Six photographs to rate pain on a scale of 0 to 10 Numeric ≥ 8 years Pain level rated on a scale of 0 to 10

Question 19

Principles of Pediatric Nursing > Pediatric Vaccine Schedule Birth – 6 Years Old

Answer

Pediatric Vaccine Schedule

Question 20

Principles of Pediatric Nursing > Pediatric Vaccine Schedule 7 – 18 Years Old

Answer

Pediatric Vaccine Schedule

Question 21

Principles of Pediatric Nursing > Immunizations General Contraindications

Answer

Immunizations Contraindications: Severe allergic reaction (e.g., anaphylaxis) following vaccination OR to a component of a vaccine. Live vaccines for immunocompromised or pregnant patients. Vaccine-specific contraindications . Children can still get vaccines EVEN if they have a low-grade fever or minor illness (e.g., cold, cough, ear infection).

Question 22

Principles of Pediatric Nursing > Immunizations Vaccine-Specific Contraindications & Precautions

Answer

Immunizations Vaccine Contraindications Hep B, HPV Hypersensitivity to yeast. Hep B…for Baking with yeast…yeast allergy. DTaP, Tdap Neurologic disorders (e.g., epilepsy), encephalopathy within 7 days of previous dose, or GBS within 6 weeks of previous dose. RV History of intussusception, Severe Combined Immunodeficiency. IPV Streptomycin, polymyxin B, or neomycin allergy. MMR* Immunodeficiency, pregnancy, neomycin allergy. Varicella* Immunodeficiency, pregnancy, neomycin or gelatin allergy. Influenza Egg allergy, GBS within 6 weeks of previous dose. In flew (“influ-enza”) a chicken…chicken egg allergy. *Denotes live virus vaccines

Question 23

Principles of Pediatric Nursing > Immunizations Pain Management Administration Documentation Family Teaching

Answer

Immunizations Pain Management: Encourage pain-relieving measures: breastfeeding, swaddling, pacifier, sucrose, topical anesthetic agent. Administration: Administer IM vaccines in the vastus lateralis or deltoid muscle. Use vastus lateralis for infants < 12 months old. Administer most painful vaccine last. Documentation: Document vaccine type, date of administration, manufacturer, lot number, route, dose, site, name/title of person who administered, date on vaccine information statement (VIS), and date VIS given to parent/guardian. Family Teaching: Mild side effects after vaccine administration may include: pain at the injection site, rash, or fever. Use cool/damp cloth for soreness at the injection site. ONLY give the child non-aspirin pain relievers.

Question 24

Principles of Pediatric Nursing > Health Care Decisions Informed Consent Assent

Answer

Health Care Decisions Informed Consent: Formal authorization from the child’s parent/guardian for an invasive procedure or participation in research. Exceptions: Emergencies (to preserve life or limb) do not require consent. Emancipated minors can give informed consent. Mature minors (14 – 18 years old) can provide consent for limited conditions (STI testing and treatment, contraception services, substance abuse help, mental health services). Assent: Child’s voluntary agreement to accept treatment or participate in research. Parents make the final decision.

Question 25

Principles of Pediatric Nursing > Medication Administration Oral Medications: Best Practices for Children

Answer

Medication Administration Use a calibrated device (dropper, syringe, medication cup), NOT a kitchen teaspoon! Measure liquids at eye level for accuracy. Never call a medication “candy”! Do not blow in face (risk for aspiration). If authorized by provider, medication can be mixed with a SMALL (1 tsp.) amount of liquid or soft food (e.g., applesauce). Do NOT mix medication in a whole baby bottle. Flavorings may be available, check with provider/pharmacist. Infants: Hold baby in semi-upright position, gently press chin to open mouth, position dropper/syringe on side of mouth along gum, stroke side of neck to stimulate swallowing. Special dosing nipple can also be used.

Question 26

Principles of Pediatric Nursing > Hospitalization of Children Best Practices for Nursing Care

Answer

Hospitalization of Children Encourage parental presence and participation for younger children. Administer topical anesthetics (e.g., EMLA) and preprocedural sedation as ordered. Note: EMLA cream should be applied 1 hour prior to procedure and covered with occlusive dressing. Explain procedures using age-appropriate language. Allow choices when possible. Use therapeutic play techniques for younger children (e.g., a doll to demonstrate procedures, casting the doll’s arm, etc.). Allow child to touch medical equipment. Encourage peer interaction for school-age children and adolescents. Perform painful procedures in a treatment room so the child’s room is a relatively pain-free site.

Question 27

Principles of Pediatric Nursing > Concept of Illness & Death Infants/Toddlers Preschoolers School-Age Children Adolescents

Answer

Concept of Illness & Death Infants/Toddlers: No concept of death. May exhibit separation anxiety. Keep a consistent routine! Preschoolers: See death as temporary. Experience magical thinking (thoughts/actions caused the illness or death). May exhibit regression (e.g., enuresis). School-Age Children: Understand death is permanent at ~ 6 years old. May exhibit disruptive behavior. Adolescents: Adult understanding of death. May experience body image issues. Peer influence and contact is important.

Question 28

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Physical Growth & Development Weight Length Head Circumference

Answer

Infants – Physical Growth & Development Weight: Infant initially loses weight, but should be back to birth weight by 1 week of age. Weight doubles by 4 – 6 months, triples by 12 months. Length: Length increases ~ 50% in the first year. Length increases ~ 1 inch/month in the first 6 months, then ~ ½ inch/month in the second 6 months. Head Circumference: Normal head circumference of full-term infants is 32 – 38 cm (~ 2 cm larger than chest circumference). Head ≈ Chest circumference at 1 year.

Question 29

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Physical Growth & Development: Fontanelles Definition

Answer

Infants – Physical Growth & Development Fontanelles: Posterior fontanelle closes between 6 – 8 weeks. Anterior fontanelle closes between 12 – 18 months. Just as the baby is on their back first then turns onto their front later, posterior (back) fontanelle closes first then anterior (front) closes later. Dentition: Tooth eruption begins ~ 6 months, usually starting with the bottom front teeth followed by the top front teeth. Infants will have ~ 6 – 8 deciduous (baby) teeth by 12 months, and a total of 20 deciduous teeth by age 3. Age of child in months – 6 ≈ total number of teeth (up to age 24 months).

Question 30

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) – Reflexes Moro/Startle Walking/Stepping Rooting Sucking

Answer

Infants – Reflexes Reflex Age Reflex Disappears Description Moro/Startle 2 mos. Infant’s response to lack of support (falling). Baby extends arms then bends and pulls them in toward the body with a brief cry. Walking/Stepping 2 mos. Takes steps when both feet are placed on a surface with body supported. Rooting 4 mos. When cheek or mouth are stroked, infant turns head and opens mouth. Sucking 4 mos. Infant begins to suck when lips are touched. Note: Premature babies may have a weak sucking reflex. Note: All primitive reflexes normally present at BIRTH.

Question 31

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) – Reflexes Palmar Grasp Tonic Neck Reflex Plantar Grasp Babinski

Answer

Infants – Reflexes Reflex Age Reflex Disappears Description Palmar Grasp 5 – 6 mos. When a finger is placed in the baby’s palm, infant closes hand and grips finger. Tonic Neck Reflex 5 – 7 mos. When head is turned, infant extends arm/leg on same side while the opposite arm/leg flexes inward. Fencing position! Plantar Grasp 9 – 12 mos. Infant flexes/curls toes when the sole of the foot is touched near the base of the toes. Babinski 12 mos. When the lateral plantar aspect of the foot is stroked, infant’s toes dorsiflex/fan outward. Note: All primitive reflexes normally present at BIRTH.

Question 32

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Physical Growth & Development: Expected Gross Motor Milestones

Answer

Infants – Gross Motor Milestones Age Gross Motor Skills Birth – 1 mo. May lift head briefly when prone, but head lag present (poor head/neck control). 2 – 4 mos. Turns from back to side, and side to back. When prone, holds head up and supports weight on arms. Head control by 4 mos. 4 – 6 mos. Turns from front to back by 4 mos., then back to front by 6 mos. 6 – 8 mos. Sits unsupported by 8 mos. 8 – 10 mos. Crawls or creeps. Pulls to standing or sitting position by 10 mos. 10 – 12 mos. Stands alone, walks holding onto furniture, sits down from standing.

Question 33

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Physical Growth & Development: Expected Fine Motor Milestones

Answer

Infants – Fine Motor Milestones Age Fine Motor Skills Birth – 1 mo. Holds hand in fist. 2 – 4 mos. Holds rattle when placed in hand. 4 – 6 mos. Reaches and picks up small objects. Holds bottle. 6 – 8 mos. Transfers objects from one hand to the other. 8 – 10 mos. Picks up small objects using a pincer grasp. 10 – 12 mos. Places objects in containers through holes. Tries to build a 2 cube tower (unsuccessfully).

Question 34

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Cognitive Development Psychosocial Development

Answer

Infants – Cognitive & Psychosocial Development Cognitive Development: Sensorimotor stage. Language: Understands the word “no” by 9 months. Combines syllables by 10 months. 3 – 5 words with meaning by 1 year. Normal Behaviors: Starting at ~ 6 months old. Stranger Anxiety: Distress when held by an unfamiliar person. Separation Anxiety: Distress when the parent is not present. Psychosocial Development: Trust vs. Mistrust. Age-Appropriate Play: Solitary Play (playing by themselves). Play “pat-a-cake”, “peek-a-boo” with baby. Talk, sing, read to baby. Toys: Rattles, colorful picture board books, balls, blocks.

Question 35

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Family Teaching: Nutrition

Answer

Infants – Nutrition Breastmilk or formula for the first 12 mos. Do not prop bottles up! No supplemental water or other fluids without an order until 6 mos. No honey or cow’s milk until 12 mos. Introduce solids at ~ 4 – 6 mos., when baby has good head control and can sit up with little/no support. Start with iron-fortified infant rice cereal. Introduce each new food one at a time. Wait 3 – 5 days between each new food to rule out allergies. Provide mashed or pureed foods. After several foods have been successfully tolerated, introduce common allergens such as eggs and small tastes of peanut butter. Introduce soft finger foods ~ 9 – 10 mos. (coincides w/ pincer grasp). Avoid choking hazards .

Question 36

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Family Teaching: Sleep Safety

Answer

Infants – Sleep Safety Place baby on back for ALL sleep, including naps. Room share, but do not bed share with babies. Use a firm, tight-fitting mattress, covered ONLY by a fitted sheet. Keep soft bedding such as blankets, pillows, bumper pads, and soft toys OUT of the baby’s sleep area. Crib slats should be < 2 ⅜ in. (6 cm) apart. Set crib mattress at its lowest position before baby learns to stand. Remove mobiles when the baby is able to get up on his hands and knees (or is 5 mos. old, whichever comes first). Don’t place a crib near a window or heat vent. Remember the ABCs of safe sleep: Alone, on their Back, in a Crib!

Question 37

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Family Teaching: Dental Health

Answer

Infants – Dental Health Schedule first dental appointment at 1 year old (or within 6 months after the first tooth erupts). Wipe teeth/gums with damp washcloth before progressing to toothbrushing. For difficulty with teething (e.g., crying, sleeping issues), offer safe teething toys or gently rub the baby’s gums with a clean finger.

Question 38

Normal Growth & Development > Infants (Birth to 1 Year) > Infants (Birth to 1 Year) Family Teaching: Vaccinations

Answer

Infants – Vaccinations Age Vaccines Birth Hep. B., Vitamin K “oKay, you’re Born!” 2 mos. Hep. B. (between 1 – 2 mos.), DTaP, RV, Hib, IPV, PCV “B. DR. HIP” 4 mos. DTaP, RV, Hib, IPV, PCV “DR. HIP” 6 mos. Hep. B. (between 6 – 18 mos.), DTaP, RV, Hib, IPV, PCV (between 6 – 18 mos). “B. DR. HIP” *Plus annual influenza vaccine starting at 6 mos.

Question 39

Normal Growth & Development > Toddlers (1 to 3 Years Old) > Toddlers (1 to 3 Years Old) Physical Growth & Development: Weight & Height Gross & Fine Motor Skills

Answer

Toddlers – Physical Growth & Development Weight: Gains 4 – 6 lbs per year. Weight is 4 times the birth weight at age 2 ½ years. Height: Grows ~ 3 in. per year. Gross Motor Skills: 15 mos: Walks without help. 18 mos: Jumps in place with both feet, throws ball overhand. 2 yrs: Climbs stairs, kicks ball. Fine Motor Skills: 15 mos: Builds tower of 2 cubes. 18 mos: Builds tower of 3 – 4 cubes, uses spoon without rotation. 2 yrs: Builds tower of 6 – 7 cubes. 2 ½ yrs: Builds tower of 8 cubes, draws a circle.

Question 40

Normal Growth & Development > Toddlers (1 to 3 Years Old) > Toddlers (1 to 3 Years Old) Cognitive Development Psychosocial Development

Answer

Toddlers – Cognitive & Psychosocial Development Cognitive Development: Sensorimotor stage. Language Development: Holophrases (one word sentences) at 1 year. More than 50 words and 2 – 3 word phrases by age 2. Normal Behaviors: Ritualization: Provides a sense of comfort. Negativism (automatically saying “No”) and temper tantrums. Egocentric (“I want”; can’t see situation from another’s point of view). Psychosocial Development: Autonomy vs. Shame & Doubt. Age- Appropriate Play: Parallel Play (playing independently next to other children). Toys: Push-and-pull toys, wooden puzzles, blocks, balls.

Question 41

Normal Growth & Development > Toddlers (1 to 3 Years Old) > Toddlers (1 to 3 Years Old) Family Teaching: Nutrition

Answer

Toddlers – Nutrition Whole milk should be introduced after the age of 12 months. Change to 2% at 2 years of age. Supplement with calcium-rich and high fat foods if cow’s milk is contraindicated. Limit milk intake to 2 – 3 servings/day to prevent iron-deficient anemia. Limit juice to 4 – 6 oz. daily. Offer water several times a day. Supervise child during meal time, avoid choking hazards . Physiologic anorexia (“too busy to eat”) is common. Encourage grazing on small amounts of healthy foods throughout the day.

Question 42

Normal Growth & Development > Toddlers (1 to 3 Years Old) > Toddlers (1 to 3 Years Old) Family Teaching: Toilet Training Sleep Dental Health

Answer

Toddlers – Family Teaching Toilet Training: Readiness indicated when the child: Recognizes and communicates the need to eliminate. Wakes up dry from nap/bedtime. Stays dry for 2 hrs during the day. Sleep: 11 – 12 hrs/day. Maintain a consistent bedtime routine. Dental Health: Do NOT give a bottle of milk/juice at bedtime. Parents need to brush/floss the child’s teeth (child can participate). Schedule biannual (2x/year) dental visits.

Question 43

Normal Growth & Development > Toddlers (1 to 3 Years Old) > Toddlers (1 to 3 Years Old) Family Teaching: Vaccinations

Answer

Toddlers – Vaccinations Age Vaccines 6 – 18 mos. Hep. B (3rd dose), IPV (3rd dose) 12 – 15 mos. MMR, Hib, PCV, Varicella 12 – 23 mos. Hep. A 15 – 18 mos. DTaP 1 – 3 yrs. Annual influenza vaccine

Question 44

Normal Growth & Development > Preschoolers (3 to 6 Years Old) > Preschoolers (3 to 6 Years Old) Physical Growth & Development: Weight & Height Gross & Fine Motor Skills

Answer

Preschoolers – Physical Growth & Development Weight: Gains 4 – 6 lbs per year. Height: Grows ~ 3 in. per year. Gross Motor Skills: 3 yrs: Rides a tricycle, balances on one foot, jumps off bottom step. At 3 years old, the child can ride a bike with 3 wheels (i.e., tricycle). 4 yrs: Hops on one foot, catches a ball, skips. 5 yrs: Jumps rope and skates. Fine Motor Skills: 3 yrs: Draws circle, no stick figure (just circle w/facial features). 4 yrs: Uses scissors, adds 3 parts to stick figure, draws square. 5 yrs: Ties shoelaces, draws diamond and triangle, adds 7 – 9 parts to stick figure.

Question 45

Normal Growth & Development > Preschoolers (3 to 6 Years Old) > Preschoolers (3 to 6 Years Old) Cognitive Development Psychosocial Development

Answer

Preschoolers – Cognitive & Psychosocial Development Cognitive Development: Preoperational stage. Language Development: Telegraphic speech: 2 – 4 word sentences (e.g., noun + verb). Lots of questioning (“Why?”). Normal Behavior: Animism (attribution of human characteristics to inanimate objects). Magical thinking (thoughts can make actual events happen). Egocentrism (inability to see someone else’s perspective). Incomplete concept of time. Associate time with daily events (e.g., “after nap”), not with hours or days. Psychosocial Development: Initiative vs. Guilt. Age-Appropriate Play: Associative play (playing together without much organization). Dramatic play (pretend, use of props to act out normal life activities). Toys: Simple games, puzzles, dolls, dress-up clothes, puppets.

Question 46

Normal Growth & Development > Preschoolers (3 to 6 Years Old) > Preschoolers (3 to 6 Years Old) Family Teaching: Nutrition/Activity Sleep Vaccinations

Answer

Preschoolers – Family Teaching Nutrition/Activity: Encourage good quality food over the quantity of the food. Food portions ≈ ½ an adult’s portion. 5-2-1-0 Framework: ≥ 5 servings of fruits and vegetables per day, ≤ 2 hours of screen time per day, ≥ 1 hour of physical activity per day, 0 (or limited) sugar-sweetened beverages. Sleep: ~ 12 hours/night expected. Consistent bedtime routine is important. Vaccinations: 3 – 6 yrs: Annual influenza vaccine. 4 – 6 yrs: Varicella, DTaP, IPV, MMR. My preschooler is afraid of the dark, so I keep the lights Very DIM.

Question 47

Normal Growth & Development > School-Age Children (6 to 12 Years Old) > School-Age Children (6 to 12 Years Old) Physical Growth & Development: Weight & Height Dentition Gross & Fine Motor Skills

Answer

School-Age Children – Physical Growth & Development Weight: Gains 2 – 3 kg (4.4 – 6.6 lbs.) per year. Height: Grows 5 cm (2 in.) per year. Dentition: All deciduous teeth are lost during this stage. First permanent teeth erupt ~ 6 years old. Gross Motor Skills: Bicycling, jump rope, skating. Fine Motor Skills: Crafts, card games, board games.

Question 48

Normal Growth & Development > School-Age Children (6 to 12 Years Old) > School-Age Children (6 to 12 Years Old) Cognitive Development Psychosocial Development

Answer

School-Age Children – Cognitive & Psychosocial Development Cognitive Development: Concrete Operational stage. Uses concrete terms to explain what, how, and why. Able to view things from another person’s perspective. Psychosocial Development: Industry vs. Inferiority. Age-Appropriate Play: Cooperative Play (e.g., organized sports). Peer interactions are important. Toys/Activities: Board games, computer games, playing a musical instrument, collections.

Question 49

Normal Growth & Development > School-Age Children (6 to 12 Years Old) > School-Age Children (6 to 12 Years Old) Family Teaching: Sleep Sports Safety Vaccinations

Answer

School-Age Children – Family Teaching Sleep: ~ 11.5 hours/night at 5 years old, 9 hours/night at 11 years old. Sports/Bicycle Safety: Sports: Properly fitted helmet, eye protection, mouth guards, protective pads. Bicycles: Ride with traffic, single file, use hand signals, proper lights, and reflectors. Vaccinations: 6 – 12 yrs: Annual influenza vaccine. 11 – 12 yrs: Tdap, HPV (2 doses), MenACWY (1st dose). Tada! Human Men.

Question 50

Normal Growth & Development > Adolescents (12 to 20 Years Old) > Adolescents (12 to 20 Years Old) Physical Growth & Development: Growth Spurt Timing Weight/Height Gain Maturational Changes

Answer

Adolescents – Physical Growth & Development Females Males Growth Spurt Timing ~ 9 ½ – 14 ½ yrs old ~ 10 ½ – 16 yrs old Weight Gain 7 – 25 kg (15 – 55 lbs) 7 – 29.5 kg (15 – 65 lbs) Height Gain 2.5 – 20 cm (2 – 8 in.) 11 – 30 cm (4.5 – 12 in.) Maturational Changes First change: Breast budding. Other changes: Pubic hair, axillary hair, menstruation. First change: Testicular enlargement. Other changes: Pubic hair, penile enlargement, facial/axillary hair, voice changes, nocturnal emissions (“wet dreams”). Note: There is variation in the order of sexual maturation; refer to your text.

Question 51

Normal Growth & Development > Adolescents (12 to 20 Years Old) > Adolescents (12 to 20 Years Old) Cognitive Development Psychosocial Development Vaccinations Family Teaching

Answer

Adolescents – Development & Family Teaching Cognitive Development: Formal Operational stage (11 – 15 years). Capable of abstract thought, scientific reasoning, and formal logic. Psychosocial Development: Identity vs. Role Confusion. Susceptible to peer pressure. Body image concerns. Believe they are invincible. Sexual identity is formed. Vaccinations: 12 – 20 yrs: Annual influenza vaccine. 16 yrs: MenACWY (2nd dose). 16 – 18 yrs: MenB (2 doses). FT: Be aware of and sensitive to privacy needs. Teach monthly TSE & BSE, abstinence/safe sexual practices. Monitor for depression, self harm, substance abuse. Reinforce motor vehicle safety (seat belts, NO cell phone use, NO drinking).

Question 52

Alterations in Health > Respiratory Disorders > Otitis Externa Pathophysiology Risk Factors Signs/Symptoms Diagnostics Treatment Family Teaching

Answer

Otitis Externa Inflammation of the ear canal or external structures (“swimmer’s ear”). Patho: Persistent moisture in the external ear leads to bacterial (or fungal) overgrowth and inflammation. RF: Age (7 – 14 yrs.), swimming, foreign object insertion (e.g., cotton swabs, earbuds). S/S: Ear pain, discharge, itching, erythema, edema, tinnitus. Dx: Clinical presentation, visual examination. Tx: Otic combination drops (antibiotics and steroids). FT: Proper administration of ear drops (lie with affected side up, instill drops warmed to body temperature, remain side-lying for 3 – 5 min.). Prevention: Use 1:1 solution of isopropyl alcohol and white vinegar after swimming or showering, frequently sanitize earbuds, avoid use of cotton swabs (risk of eardrum puncture).

Question 53

Alterations in Health > Respiratory Disorders > Otitis Media Pathophysiology Risk Factors Signs/Symptoms Diagnostics Treatment Family Teaching

Answer

Otitis Media Viral, bacterial, or coinfection of the middle ear. Patho: An upper respiratory infection causes congestion and inflammation, leading to obstruction of the eustachian tube and accumulation of fluid in the middle ear. RF: Age (6 – 24 mos.), recent upper respiratory illness, cigarette smoke exposure, daycare, bottle-fed babies, family history. S/S: Drainage from affected ear(s), fever, pulling at affected ear(s), ↑ crying or irritability, sleep disturbances, bulging/red tympanic membrane. Dx: Clinical examination, otoscopy. Tx: Acetaminophen or NSAIDs for pain, antibiotics (e.g., amoxicillin), myringotomy (tube placement) for recurrent ear infections. FT: Avoid smoke exposure, get seasonal influenza vaccination.

Question 54

Alterations in Health > Respiratory Disorders > Acute Streptococcal Pharyngitis (Strep Throat) Pathophysiology Risk Factors Signs/Symptoms Labs/Diagnostics Treatment Family Teaching

Answer

Acute Streptococcal Pharyngitis Highly contagious infection of the oropharynx spread via respiratory droplets. Patho: Infection with group A beta-hemolytic streptococcus (GABHS) leads to airway inflammation. Left untreated, can lead to rheumatic fever or acute glomerulonephritis. RF: Close contact with infected persons, school-aged children. S/S: Sore throat, pain with swallowing, fever, cervical lymphadenopathy, foul breath odor, tonsillar erythema and exudate (white patches). Labs/ Dx: “Rapid strep” throat culture. Tx: Antibiotics, acetaminophen (for throat pain, fever). FT: Encourage use of salt water gargles, oral rehydration via ice chips or frozen juice pops. Wash toothbrush thoroughly, or replace.

Question 55

Alterations in Health > Respiratory Disorders > Tonsillitis Pathophysiology Risk Factors Signs/Symptoms Labs/Diagnostics Treatment Nursing Care Family Teaching

Answer

Tonsillitis Inflammation of the palatine tonsils. Patho: Bacterial or viral infection (most common) causes tonsil inflammation. RF: Age (5 – 15 yrs), frequent exposure to germs (e.g., daycare or school). S/S: Fever, sore throat, enlarged tonsils, peritonsillar exudate or white patches on the tonsils, difficulty breathing (if tonsils obstruct airway), lymphadenopathy. Labs/ Dx: ↑ WBCs, throat culture (check for GABHS). Tx: Antibiotics, antipyretics, surgical tonsillectomy (for airway obstruction or chronic tonsillitis). NC (for tonsillectomy): Assess for family history of bleeding disorders. Obtain PT/PTT prior to surgery to rule out bleeding disorders. Provide patient with ice collar post-operatively. Assess for frequent swallowing or throat clearing, as this may be a sign of bleeding! FT (for tonsillectomy): Avoid red foods/liquids, spicy foods, straws, coughing, and blowing nose forcefully.

Question 56

Alterations in Health > Respiratory Disorders > Epiglottitis Pathophysiology Risk Factors Signs/Symptoms Diagnostics Treatment Nursing Care Family Teaching

Answer

Epiglottitis Life-threatening inflammation of the epiglottis and surrounding structures. Patho: Acute viral or bacterial illness causes edema of the epiglottis and supraglottic structures, can lead to airway compromise. RF: Age (2 – 5 yrs.), current or recent illness, refusal of vaccinations (especially HIB). S/S: High fever, sore throat, hoarse or muffled voice, drooling, tripod position, anxiety, dysphagia, respiratory distress. Dx: Clinical suspicion (oropharyngeal exam is a risk). Tx: Secure airway with intubation, antibiotics, corticosteroids. NC: Keep pt and family calm as possible. Do not obtain throat cultures, use a tongue depressor, or insert anything into the mouth. Do not lay the patient flat (supine)! Assist with intubation. FT: Encourage compliance with vaccine schedule.

Question 57

Alterations in Health > Respiratory Disorders > Acute Laryngotracheobronchitis (Croup) Pathophysiology Risk Factors Signs/Symptoms Diagnostics Treatment Family Teaching

Answer

Acute Laryngotracheobronchitis (Croup) Inflammation of the larynx, trachea, and bronchioles. Patho: Viral infection (e.g., parainfluenza) causes inflammation of the lower respiratory structures, leading to dyspnea. RF: Age (6 mos. – 6 yrs.), sex (male). S/S: Barking cough, inspiratory stridor, tachypnea, respiratory distress. Dx: Clinical presentation with barking cough. Tx: Nebulized epinephrine, corticosteroids, intubation if severe. FT: Prevent patient agitation (can worsen symptoms), keep patient hydrated. Use cool mist humidifier. Obtain recommended vaccinations.

Question 58

Alterations in Health > Respiratory Disorders > Bronchiolitis (RSV) Pathophysiology Risk Factors Signs/Symptoms Labs/Diagnostics Treatment Nursing Care

Answer

Bronchiolitis (RSV) Common viral lung infection in children. Patho: Respiratory Syncytial Virus (RSV) is spread via droplets, causing bronchiole inflammation and ↑ mucus production. RF: Premature infants, heart or lung disorders, age (< 2 yrs.). S/S: Cough, sneezing, fever, wheezing, deep or rapid breathing, prolonged expiration. Labs/ Dx: Clinical presentation, nasopharyngeal swab. Tx: Supportive care. Mechanical ventilation and antivirals for severe cases. NC: Nasal suctioning for excessive secretions. Keep patient hydrated and calm. Admininster oxygen.

Question 59

Alterations in Health > Respiratory Disorders > Pertussis (Whooping Cough) Pathophysiology Prevention Risk Factors Signs/Symptoms Labs/Diagnostics Treatment Nursing Care

Answer

Pertussis (Whooping Cough) Highly contagious respiratory infection spread via respiratory droplets. Patho: Bordetella pertussis bacteria adhere to cells in the respiratory tract, causing inflammation. Prevention: DTaP vaccine. RF: Close contact with infected person, immunodeficiency, lack of vaccination. S/S: Low-grade fever, rapid coughing followed by high pitched inhalation with characteristic “whoop” sound, vomiting, cyanosis. Labs/ Dx: Nasopharyngeal swab. Tx: Oxygen therapy, suctioning, antibiotic therapy. NC: Maintain droplet precautions, position patient in High Fowler’s during periods of coughing.

Question 60

Alterations in Health > Respiratory Disorders > Influenza Pathophysiology Prevention Risk Factors Signs/Symptoms Labs/Diagnostics Treatment

Answer

Influenza Common contagious viral respiratory infection. Patho: Influenza virus is spread through droplets and infects the respiratory tract mucosa. Prevention: Annual influenza vaccine starting at 6 mos. old. RF: Age (< 2 yrs.), immunocompromised, chronic illness. S/S: Fever, chills, cough, sore throat, myalgia, headache, fatigue. Labs/ Dx: Nasopharyngeal swab. Tx: Antiviral medications (e.g., oseltamivir) – begin within 2 days of onset of symptoms. ↑ Fluid intake, acetaminophen or ibuprofen for fever (no aspirin, due to risk for Reye’s syndrome). Initiate droplet precautions.

Question 61

Alterations in Health > Respiratory Disorders > Pneumonia Pathophysiology Prevention Risk Factors Signs/Symptoms Labs/Diagnostics Treatment

Answer

Pneumonia Infection of the lung(s). Patho: Viral (most common), bacterial, or fungal infection, or aspiration of a foreign substance causes the alveoli to fill up with fluid or pus. Prevention: Pneumococcal vaccine (PCV). RF: Age (< 2 yrs.), immunocompromised, daycare. S/S: Chest pain, fever, chills, cough, abnormal lung sounds (crackles, ↓ breath sounds), respiratory distress (nasal flaring, retractions), pallor/cyanosis, fatigue. Labs/ Dx: Chest x-ray, ↑ WBCs, ↓ SpO2, sputum/blood cultures. Tx: Antibiotics, antivirals, or antifungals (depending on causative agent). Oxygen, IV fluids, antipyretics.

Question 62

Alterations in Health > Respiratory Disorders > Asthma Pathophysiology Risk Factors

Answer

Asthma Chronic inflammatory disorder of the airway, intermittent and reversible. Patho: Triggers (environmental allergens, smoke, cold air, exercise) cause inflammation and airway hyperresponsiveness, which leads to bronchoconstriction and airway obstruction. Intermittent: Daytime symptoms < 2 days/week, nighttime symptoms ≤ 2 days/month. Mild persistent: Daytime symptoms ≥ 2 days/week, but not every day. Nighttime symptoms 3 – 4 days/month. Moderate persistent: Daily symptoms. Nighttime symptoms > 1 time/week, but not every day. Severe persistent: Continual symptoms throughout the day, frequent nighttime symptoms. RF: Family history, race (African Americans), poverty, pollution.

Question 63

Alterations in Health > Respiratory Disorders > Asthma Signs/Symptoms Diagnostics Treatment Nursing Care Family Teaching

Answer

Asthma S/S: Wheezing, shortness of breath, cough, chest tightness, anxiety, use of accessory muscles. Dx: Pulmonary function tests (FVC, FEV1, PEF), allergy testing. Tx: Oxygen, bronchodilators (albuterol – short-acting, salmeterol – long-acting), inhaled corticosteroids, anticholinergics, leukotriene modifiers, xanthines. NC: Coordinate referral to asthma or allergy specialist. Monitor for status asthmaticus (asthma exacerbation unresponsive to treatment). FT: Proper use of peak flow meter (use highest of three readings, not the average!) and inhaler. Medication regimen (rescue vs. controller medications). Avoid triggers if possible.

Question 64

Alterations in Health > Respiratory Disorders > Cystic Fibrosis Pathophysiology Risk Factors Signs/Symptoms Labs/Diagnostics

Answer

Cystic Fibrosis Genetic disorder that severely impairs lung function and causes dysfunction in other organs/tissues that make mucus or sweat. Patho: Autosomal recessive disorder causes obstruction of NaCl transport, causing abnormally thick and sticky mucus that plugs organ ducts and leads to organ failure. RF: Both parents are carriers of the mutated gene. S/S: Respiratory: Wheezing, coughing, clubbing, chronic respiratory infections, barrel-shaped chest. GI: Meconium ileus at birth, prolonged neonatal jaundice, abdominal pain, steatorrhea (fatty, malodorous stools), failure to thrive, delayed puberty, cholelithiasis, fat-soluble vitamin deficiency. Skin: Excessively salty sweat, saliva, tears. Labs/ Dx: Sweat chloride test, genetic testing, PFTs, stool analysis.

Answer 65

Apnea of Prematurity A pause in breathing in a premature baby. Patho: Immature respiratory control centers in the medulla leads to central apnea. RF: Premature birth (< 37 weeks gestation). S/S: A cessation of breathing > 20 seconds, or a shorter period of apnea accompanied by bradycardia or O2 desaturation. Dx: Clinical evaluation, rule out other causes. Tx: Theophylline, caffeine, CPAP, blood transfusion. NC: Stimulate baby when apnea noted. Perform “car seat challenge” prior to discharge to ensure no apneic spells.

Answer 66

Bronchopulmonary Dysplasia (BPD) Breathing disorder that primarily affects premature newborns. Patho: Abnormal development of lung tissue due to prenatal causes (e.g., maternal infection), or postnatal causes (e.g., lung immaturity, oxygen injury). RF: Premature birth, low birth weight, mechanical ventilation or high levels of oxygen. S/S: Respiratory distress (grunting, nasal flaring, subcostal retractions, cyanosis, tachypnea), difficulty feeding, apnea. Labs/ Dx: Clinical evaluation, chest x-ray, ABG. Tx: CPAP, mechanical ventilation, oxygen. Medications: Diuretics (furosemide), bronchodilators (albuterol), caffeine, corticosteroids. NC: Provide small, frequent feedings. ↑ Calories and protein intake using human milk fortifiers.

Answer 67

Respiratory Distress Syndrome (RDS) Breathing disorder caused by immature lungs. Patho: Insufficient lung surfactant does not allow alveoli to fully inflate, leading to impaired ventilation. RF: Prematurity, maternal diabetes, infection, multiparity. S/S: Tachypnea, nasal flaring, subcostal retractions, grunting, cyanosis, difficulty feeding. Labs/ Dx: L/S < 2:1 prior to birth (indicates immature lungs), ABG, pulse oximetry, chest x-ray. Tx: Surfactant, oxygen therapy, CPAP, mechanical ventilation, nitric oxide, orogastric feedings or TPN. NC: Assess for distress, suction when necessary, collaborate with respiratory therapy, frequently assess vitals.

Answer 68

Respiratory Distress/Failure Inability of the respiratory system to sufficiently oxygenate the blood. Patho: Respiratory disorder/infection or CNS issue results in inadequate ventilation and/or oxygenation, leading to hypoxemia. S/S: Early (Respiratory Distress): Restlessness/agitation, tachypnea, dyspnea (nasal flaring, retractions, grunting, adventitious breath sounds, use of accessory muscles), tachycardia, pallor, diaphoresis. Late (Respiratory Failure): ↓ LOC, bradypnea, bradycardia, cyanosis. Labs/ Dx: ABG (↓ PO2, ↑ PCO2), SpO2 < 95%. Tx: Secure airway, oxygen, CPAP, BiPAP, mechanical ventilation, CPR.

Answer 69

BRUE or ALTE Sudden onset of breathing difficulty, color or muscle tone changes, and/or decreased responsiveness in an infant < 12 months old. Patho: Unknown. Changes caused by underlying medical conditions are not considered BRUEs/ALTEs. RF: Prior episodes of BRUEs/ALTEs, prematurity, age (< 2 mos.). S/S: Brief episode of apnea, dyspnea, cyanosis, pallor, hyper or hypotonia, ↓ LOC. Labs/ Dx: Low-risk infants: observation with pulse oximetry. High-risk infants: EKG, diagnostics based on individual symptoms. Tx: Outpatient observation by guardians, close follow-up by the primary pediatrician. FT: Sleep safety guidelines, avoid smoke exposure, CPR training for caregivers.

Answer 70

Sudden Infant Death Syndrome (SIDS) Unexplained and unexpected death of an infant < 12 months old. Patho: Unknown. Prevention: ABCs of safe sleep: Alone, on their Back, in a Crib. Use firm mattress, no loose blankets or toys, encourage pacifier use, prevent overheating during sleep. Breastfeeding. Avoid smoke exposure (during pregnancy and after birth). Prenatal care. Routine health checkups and immunizations after birth. RF: Sleeping on stomach, toys/blankets in crib, smoke exposure. Dx: Autopsy to investigate the cause of death. NC: Therapeutic communication to families experiencing loss of a child. Facilitate referrals for mental health services and support groups.

Answer 71

Laboratory Studies Lab Value Infants Children Red Blood Cells (RBCs) 3.5 – 5.5 million/uL 4.5 – 5.5 million/uL Platelets 200,000 – 475,000/mm³ 150,000 – 400,000/mm³ Hemoglobin (Hgb) 10 – 17 g/dL 11.5 – 15.5 g/dL Hematocrit (Hct) 35 – 50% 35 – 45%

Answer 72

Cardiac Catheterization Invasive procedure used to diagnose and repair some congenital heart defects. Catheter inserted into the femoral artery and threaded up to the heart. NC: Pre-procedure: NPO 6 – 8 hrs prior to procedure. Assess for allergy to contrast dye, iodine, shellfish*. Assess kidney function (BUN, creatinine). Assess and mark distal pulses for easy comparison post-procedure. Post-procedure: Check insertion site for bleeding. Check extremity distal to puncture site for: pulse, capillary refill, temperature, color. ↑ Fluid intake. Keep affected extremity straight for 4 – 6 hrs (or per facility policy). *Recent evidence suggests that allergies to shellfish do not increase the risk of reaction to IV contrast more than any other allergies, however, for testing purposes defer to your instructor, textbook, and/or facility.

Answer 73

Congenital Heart Defects (CHDs) Anatomic abnormality of the heart that results in altered blood flow. Patho: Fetal heart does not develop normally due to genetic and environmental factors, resulting in blood flow abnormalities. RF: Genetics, teratogens, maternal smoking/alcohol use, maternal medical conditions (e.g., diabetes, rubella). S/S: Heart failure , hypoxemia , murmurs. Dx: Echocardiogram, EKG, cardiac catheterization, MRI, chest x-ray. Tx: Surgical repair, repair w/cardiac catheterization, medications (for certain CHDs and HF), heart transplant. NC: Provide frequent rest periods, small/frequent meals, oxygen, high calorie formula as prescribed. For cyanotic episodes, bring child’s knees up to chest (knee–chest position).

Answer 74

Congenital Heart Defects (CHDs) Increased Pulmonary Blood Flow (L → R shunt): Defects: Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Atrioventricular Canal Defect (AV Canal Defect), Patent Ductus Arteriosus (PDA). Decreased Pulmonary Blood Flow (R → L shunt): Defects: Tetralogy of Fallot (TOF), Tricuspid Atresia. Obstruction of Blood Flow (stenosis): Defects: Coarctation of Aorta (COA), Aortic Stenosis, Pulmonary Stenosis. Mixed Blood Flow (complex abnormalities): Defects: Transposition of Great Arteries (TGA), Total Anomalous Pulmonary Venous Connection (TAPVC), Truncus Arteriosus, Hypoplastic Left Heart Syndrome.

Answer 75

Congenital Heart Defects (CHDs) ASD: A hole in the septum between the left and right atria. S/S: Asymptomatic, HF, systolic murmur with wide, fixed splitting of S2. Tx: Closure during cardiac catheterization, surgical patch closure. VSD: Hole in the septum between left and right ventricles. S/S: HF, loud holosystolic murmur at the left sternal border. Tx: Surgery to suture or patch hole.

Answer 76

Congenital Heart Defects (CHDs) AV Canal: Large hole in the center of the heart that allows blood to flow between all 4 chambers. One AV valve forms instead of 2 separate valves (tricuspid and mitral). S/S: HF, loud systolic murmur. Tx: Surgical patch closure and valve reconstruction. PDA: The fetal ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth. S/S: “Machine–hum” murmur, bounding pulses, wide pulse pressure (> 20 mmHg). Tx: Indomethacin. Coils to occlude PDA during cardiac catheterization. INdomethacin goes IN da hole and closes it!

Answer 77

Congenital Heart Defects (CHDs) TOF: Combination of 4 defects (PROVE that you know all 4!): Pulmonary Stenosis, Right Ventricular Hypertrophy, Overriding Aorta, Ventricular Septal Defect. S/S: Cyanosis (hypercyanotic or “Tet” spells), systolic murmur. Tx: Surgical repair in first year of life. For hypercyanotic episodes, bring child’s knees up to chest (knee–chest position). Tricuspid Atresia: Tricuspid valve fails to develop, blood flows through an ASD or VSD. S/S: Cyanosis, tachycardia, dyspnea, clubbing. Tx: Multiple surgeries (shunt placement, Glenn procedure, Fontan procedure).

Answer 78

Congenital Heart Defects (CHDs) COA: Stenosis (narrowing) of the aorta, obstructing blood outflow from the left ventricle. S/S: Upper extremity hypertension/bounding pulses, poor lower extremity perfusion (pallor, cool skin, weak pulses), HF. Tx: Balloon angioplasty, stents. Surgical removal of coarctation segment and anastomosis to normal aorta. Manage hypertension with blood pressure medications. Aortic Stenosis: Narrowing of the aortic valve, obstructing blood flow to the body. S/S: Hypotension, ↓ pulses, tachycardia, poor feeding, exercise intolerance, HF. Tx: Balloon dilation, valvotomy. Pulmonary Stenosis: Narrowing of the pulmonary valve, obstructing blood flow to the lungs. S/S: Systolic ejection murmur, cyanosis, cardiomegaly, HF. Tx: Balloon dilation, valvotomy.

Answer 79

Congenital Heart Defects (CHDs) TGA: The aorta and pulmonary artery connections to the heart are reversed. Survival of this defect requires a PDA or septal defect. S/S: HF, SOB, cardiomegaly, cyanosis, hypoxia, murmur, fatigue, poor growth. Tx: Prostaglandins (to keep the PDA open), surgery within the first week of life to switch and correct the transposition. TAPVC: Pulmonary veins connect to the right side of the heart instead of the left atrium. Survival with defect requires an ASD. S/S: Cyanosis, dyspnea, poor feeding. Tx: Surgical repair to connect pulmonary veins to the left atrium.

Answer 80

Congenital Heart Defects (CHDs) Truncus Arteriosus: A single vessel exits the heart instead of two (aorta/pulmonary artery). S/S: HF, murmur, cyanosis, poor feeding. Tx: Surgical repair within the first few months of life. Hypoplastic Left Heart Syndrome: Left side of heart and associated structures are small/underdeveloped, including the aortic valve, mitral valve, ascending aorta, and aortic arch. Survival with defect requires a PDA. S/S: Cyanosis, HF, cold extremities, lethargy. Tx: Prostaglandins to keep PDA open, surgery in three stages: Norwood procedure, Glenn Shunt, Fontan procedure.

Answer 81

Heart Failure Inability of the heart to adequately supply blood to meet the body’s needs. Patho: Congenital heart defect, cardiomyopathy, or other cardiac abnormality results in volume overload on the heart muscle and/or pump failure. S/S: Poor feeding, diaphoresis, tachycardia, activity intolerance, pallor, weak pulses, fatigue, cardiomegaly (↑ size of heart as a compensatory measure). Pulmonary congestion (Left-sided HF): Tachypnea, dyspnea, nasal flaring, retractions, wheezing. Left affects the Lungs. Systemic congestion (Right-sided HF): Peripheral edema, ascites, hepatomegaly, jugular (neck) vein distention (JVD). Right affects the Rest of the body.

Answer 82

Heart Failure Labs/ Dx: Echocardiogram, EKG, chest x-ray, ↑ hBNP. Tx: Cardiac glycosides (e.g., digoxin) to increase contractility, diuretics (e.g., furosemide) to reduce congestion, ACE inhibitors (e.g., captopril), beta blockers (e.g., carvedilol). NC: Elevate head when feeding, use nipple with enlarged opening (to ↓ energy required), use high-calorie formula. Provide frequent rest periods, decrease stimuli. Take apical pulse before administering digoxin. Hold for pulse < 90 bpm for infants and < 70 bpm for older children (or per orders). Monitor for S/S of toxicity: nausea/vomiting, bradycardia, dysrhythmias. Monitor digoxin serum levels (therapeutic level 0.8 – 2 ng/mL). Closely monitor I&Os and electrolyte levels.

Answer 83

Hypoxemia Inadequate amount of oxygen in the blood, which can lead to hypoxia (inadequate oxygen supplied to tissues). Patho: Congenital heart defects allow desaturated blood to enter systemic circulation without passing through the lungs. Can also be caused by respiratory disorders and anemia. S/S: Cyanosis, tachypnea, dyspnea, clubbing, polycythemia (↑ in RBCs as a compensatory measure). Labs/ Dx: Pulse oximetry, ABGs. Tx: Oxygen, morphine, IV fluids. NC: For cyanotic episodes, bring child’s knees up to chest (knee–chest position).

Answer 84

Infective Endocarditis Infection of the endocardial surface (inner lining) of heart. Patho: Bacteria (usually streptococcus or staphylococcus aureus) adhere to the heart and form vegetative growth on heart valves and/or endocardium. RF: Valvular heart disease, congenital heart disease. S/S: Fever, malaise/lethargy, loss of appetite, splinter hemorrhages, petechiae, murmur, muscle/joint pain. Labs/ Dx: Blood cultures, echocardiogram, ↑ ESR/CRP. Tx: IV antibiotics via PICC line 2 – 6 weeks, valve repair/replacement. FT: Prophylactic antibiotics needed prior to dental/surgical procedures.

Answer 85

Rheumatic Fever Inflammatory disease of the heart, blood vessels, and joints. Patho: Abnormal immune response to Group A beta-hemolytic streptococcus (GABHS) infection causes widespread inflammation. May lead to long-term cardiac damage (Rheumatic Heart Disease). RF: Partially–treated or untreated GABHS infection. S/S: Jones Criteria signs/symptoms (modified for 2015, see next card). Labs: Positive throat culture for GABHS, ↑ antistreptolysin–O titer, ↑ CRP/ESR.

Answer 86

Rheumatic Fever Dx: Jones Criteria (2 Major criteria or 1 Major and 2 Minor criteria indicate high probability of Rheumatic Fever). Major Criteria: Carditis (murmur, pericardial friction rub, cardiomegaly, congestive heart failure, arrhythmias). Polyarthritis (painful swelling of large joints). Erythema marginatum (non-pruritic rash on trunk and medial sides of extremities). Chorea (involuntary muscle movements). Non-tender subcutaneous nodules. Minor Criteria: Fever, arthralgia (joint pain), ↑ CRP/ESR, prolonged PR interval. Tx: Long-term penicillin administration, bed rest.

Answer 87

Kawasaki Disease Systemic inflammation of blood vessels (vasculitis). Patho: Unknown etiology; possibly due to an exaggerated immune response to an infectious agent in a susceptible child. S/S: Acute Phase: High fever (> 102° F) over 1 – 2 weeks & unresponsive to antipyretics. REDNESS (erythema) in the following: eyes (no drainage), chapped/cracked lips, tongue, oral mucus membranes, palms/soles (w/swelling). Think RED Kawasaki motorcycle. Arthritis, enlarged cervical (neck) lymph nodes, cardiac symptoms (dysrhythmias, myocarditis). Subacute Phase: Resolution of fever, arthritis, peeling skin around nails, palms, or soles. Think peeled skin after the rider fell off his motorcycle. Convalescent Phase: No clinical manifestations. Abnormal lab values present.

Answer 88

Kawasaki Disease Labs: ↑ ESR/CRP, ↓ albumin. Dx: Criteria – Fever > 5 days and 4 out of 5 of the symptoms below. My motorcycle got CREAMed in that accident. C= Conjunctivitis (without exudate). R = Rash. E = Extremity changes (edema/erythema of hands/feet in acute phase, peeling of hands/feet in subacute phase). A = Adenopathy (enlarged cervical lymph nodes, > 1.5 cm). M = Mucosal changes (erythema of lips, strawberry tongue). Tx: Intravenous Immunoglobulin (IVIG), high–dose aspirin. ASpirin for KawASaki. NC: Monitor cardiac function, daily weights, I&Os. FT: Avoid live immunizations for 11 months.

Answer 89

Iron-Deficiency Anemia ↓ Hemoglobin due to insufficient iron intake or absorption. Patho: Inadequate intake of iron-rich foods or malabsorption disorder results in ↓ iron, an essential component of hemoglobin. RF: Excess intake of cow’s milk (low in iron). S/S: Fatigue, pallor, shortness of breath, tachycardia. Labs/ Dx: ↓ Hbg/Hct, RBC, MCH, MCV, ferritin. Tx: Iron supplementation (oral: ferrous sulfate, IV: iron dextran). NC: For IM iron, use Z–track method and do not massage. FT: ↑ Intake of iron-rich foods (green vegetables, meat, raisins, iron-fortified foods). Vitamin C ↑ absorption of iron, calcium ↓ absorption of iron. Take with OJ, not milk/antacids! Use straw and brush teeth after taking iron to prevent stained teeth. Green or “tarry black” stools are expected.

Answer 90

Sickle Cell Anemia Genetic disorder that causes chronic anemia, pain, infection, and organ damage. Patho: Autosomal recessive disorder characterized by abnormal hemoglobin (Hgb S), resulting in RBC sickling and ↓ RBC lifespan. Leads to occlusion of small blood vessels, tissue hypoxia, and organ damage. RF: Family history, race (African Americans), Middle Eastern or Mediterranean descent. S/S: Pain, fatigue, swollen hands/feet, jaundice. Infection, stress, and/or dehydration may trigger a sickle cell crisis: Vaso-occlusive crisis (most common): Severe pain, swollen joints, abdominal pain. Splenic sequestration crisis: Splenomegaly, severe anemia, hypovolemia, shock. Aplastic crisis: Severe anemia, pallor.

Answer 91

Sickle Cell Anemia Labs: ↓ Hct, ↑ reticulocytes (immature RBCs), ↑ bilirubin, ↑ WBC. Dx: Newborn screening, hemoglobin electrophoresis. Tx: Opioid analgesics (on a schedule), antibiotics (for infection), hydroxyurea. NC: Administer IV fluids, blood products, O2 as ordered. FT: Ensure adequate fluid intake and rest. Reinforce the importance of hand hygiene to prevent infection. Obtain routine immunizations. Take penicillin prophylaxis as ordered. Seek immediate medical attention for fever or illness.

Answer 92

Thalassemia Group of genetic disorders characterized by defective Hgb formation and anemia. Patho: Autosomal recessive disorder results in faulty synthesis of alpha or beta chains of hemoglobin. This impairs the oxygen-carrying ability of RBCs. S/S: Pallor, jaundice, ↓ appetite and growth rate, hepatosplenomegaly, deformed facial bones. Labs/ Dx: CBC (↓ Hgb, ↓MCV), genetic testing. Tx: Blood transfusions, iron chelation therapy, folic acid supplementation, stem cell transplant. FT: Avoid infection (e.g., hand hygiene, vaccinations) and excess iron intake.

Answer 93

Hemophilia Severe inherited hemorrhagic disorder. Patho: X-linked recessive disorder results in a deficiency of clotting factors. Hemophilia A: Deficiency of factor VIII. Hemophilia B: Deficiency of factor IX. S/S: Excess bleeding/bruising, joint pain/swelling, ↓ ROM. Labs/ Dx: ↑ aPTT, ↓ factor VIII or IX. NOTE: Platelet count and PT not affected! Tx: Factor replacement, desmopressin, aminocaproic acid. FT: Prevent bleeding (avoid NSAIDs and aspirin, avoid IM injections). Engage in physical therapy to maintain ROM, avoid contact sports. For acute bleeding, RICE (rest, ice, compression, elevation).

Answer 94

Epistaxis Nosebleed. Patho: Rupture of blood vessels within the nasal mucosa due to trauma, a bleeding disorder, dry air, allergies, medications (e.g., NSAIDs). Tx: Lean child’s head forward (NOT back) to prevent swallowing of blood. Pinch soft part of nose w/thumb and forefinger, maintain pressure for 10 minutes. Advise child to breathe through the mouth. Apply ice pack to bridge of nose. For persistent bleeding, nasal packing with epinephrine or cauterization can be performed by the provider. FT: Keep nostrils lubricated, utilize cool mist humidifier, avoid blowing nose forcefully.

Answer 95

Electroencephalogram (EEG) Electrodes placed on the scalp to record electrical activity in the brain. Used to identify seizures, sleep disorders, and other neurological disorders. NC: Pre-Procedure: Instruct patient to wash hair prior to procedure, arrive sleep deprived, avoid stimulants (e.g., caffeine) and sedative medications prior to procedure. NPO not needed. During Procedure: Hyperventilation or strobe lights may be used to ↑ likelihood of seizure activity.

Answer 96

Lumbar Puncture Cerebral Spinal Fluid (CSF) sample is taken from the spinal canal for analysis. Used to diagnose meningitis and neurological disorders. NC: Pre-Procedure: Evaluate for contraindications (e.g., known/suspected ↑ ICP, coagulopathy). Apply EMLA cream over area ~ 1 hour prior to procedure. Have child empty bladder. Position child on their side in a fetal position, or stretched over a table while sitting (so the back is arched). Post-Procedure: Ensure child lies flat for several hours. Monitor for CSF leak, which can cause a severe headache (epidural blood patch may be necessary).

Answer 97

Intracranial Pressure (ICP) Monitoring Monitoring of ICP through a device surgically inserted into the cranial cavity. High risk of infection. Indications: Patient in a coma (i.e., Glasgow coma scale of < 8), traumatic brain injury, following some brains surgeries. Early S/S of Increased ICP: Infants: Irritability, bulging fontanel, separated cranial sutures, high-pitched cry, poor feeding, “setting sun” sign (i.e., eyes appear driven downward). Children: Headache, nausea/vomiting, seizures, lethargy. Late S/S of Increased ICP: Bradycardia, abnormal respirations, ↓ LOC, coma.

Answer 98

Conjunctivitis Inflammation of the conjunctiva. Patho: Infection (viral or bacterial) or allergies cause conjunctival redness and swelling. Newborn exposure to chlamydia/gonorrhea during birth can cause conjunctivitis and severe ocular damage (ophthalmia neonatorum). S/S: Redness, itching, swollen lids, crusting of eyelids, purulent drainage w/bacterial conjunctivitis, watery drainage w/viral or allergic conjunctivitis. Dx: Clinical assessment, culture of drainage if needed. Tx: Ophthalmic antibiotic drops. Viral conjunctivitis is self-limiting, no treatment required. Antihistamines for allergies. FT: Clean eyes from inner canthus outward (away from the other eye). Remove crusts with warm/moist compresses.

Answer 99

Retinopathy of Prematurity (ROP) Eye disorder characterized by abnormal blood vessel growth in the eyes of premature infants. Patho: Abnormal blood vessels cause scarring of the retina and may lead to retinal detachment. RF: Preterm infants, low birth weight, supplemental oxygen. S/S: Abnormal blood vessel growth in the eyes, white pupils, unusual eye movements, detached retina, vision loss. Dx: Ophthalmic examination. Tx: Surgical treatment (e.g., cryotherapy, laser photocoagulation). NC: Maintain oxygen saturation within defined limits, assist with ROP screening of newborn.

Answer 100

Visual Impairment Partial sight loss to total blindness. Patho: Visual impairment caused by genetics, infection, or underlying disorders. Common impairments include: Myopia: Nearsightedness. I’m so nearsighted I can only see Myself! (Myopia). Hyperopia: Farsightedness. Astigmatism: Unequal curvature of cornea or lens. Amblyopia (“lazy eye”): ↓ Visual acuity in one eye. Strabismus: Misalignment of eyes (inward or outward deviation). S/S: Dizziness, headache, squinting, excessive tearing, rubbing eyes, photophobia, diplopia (double vision), difficulty reading/poor school performance.

Answer 101

Visual Impairment Labs/ Dx: Vision screening: Snellen, picture, or tumbling E chart. Child stands 10 feet away. Misalignment testing (for strabismus): Cover test, corneal light reflex test. Color vision screening: Ishihara test. Peripheral vision check. Ophthalmoscopic examination. Tx: Contact lenses, eye glasses, laser surgery. Occlusion therapy (eye patch) of the strong eye for strabismus. NC: Provide adequate lighting, orient to surroundings, promote independence.

Answer 102

Hearing Impairment Mild to severe hearing loss. Patho: Conductive hearing loss: Issue with transmission of sound to the cochlea, most common. Usually due to recurrent otitis media. Sensorineural hearing loss: Damage to the inner ear or auditory nerve. Due to congenital defects, infection, ototoxic medications, excessive noise. S/S: Infants: Lack of startle reflex, no babbling, indifference to sound, failed newborn hearing assessment. Children: Speech delay, monotone voice, yelling, withdrawn, shy, inattentive.

Answer 103

Hearing Impairment Dx: Newborn hearing screening, audiometry. Tx: Conductive: Antibiotics for otitis media, myringotomy, hearing aid. Sensorineural: Cochlear implant. NC: Provide referral to speech therapist and audiologist. Assist with lip reading, sign language. FT: Yearly hearing screenings, avoid hazardous noises, provide proper ear protection.

Answer 104

Seizures Uncontrolled electrical discharge of neurons in the brain. Epilepsy is ≥ 2 unprovoked seizures. Patho: Disease, injury, or unknown cause results in hyperexcitability of neurons and ↓ inhibition of neuron activity. May be partial (involves a small part of the brain) or generalized (involves both hemispheres of the brain). RF: Fever, cerebral edema, infection (e.g., meningitis), toxin exposure, head trauma, hypoxia, electrolyte imbalances, brain tumor, hypoglycemia.

Answer 105

Seizures Tonic Clonic: May be preceded by aura. 3 phases: Tonic episode: Stiffening of muscles, loss of consciousness. Clonic episode: ~1 – 2 min of rhythmic jerking of extremities. Postictal phase: Confusion, sleepiness, agitation. Absence: Loss of consciousness for a few seconds. Resembles “day dreaming”. Key features: blank staring, eye fluttering, lip smacking, picking at clothes. Myoclonic: Brief jerking/stiffening of extremities. Atonic: Loss of muscle tone, results in falling. Individual typically reamins conscious. Also known as a drop seizure. Status Epilepticus: Prolonged seizure (> 5 min) or failure to regain consciousness between seizures. Medical emergency.

Answer 106

Seizures Dx: EEG (electroencephalogram) to identify origin of seizure . Tx: Medications: Antiepileptics (e.g., phenytoin). Procedures: Vagal nerve stimulator, craniotomy to remove brain tissue causing seizures. NC: Seizure precautions (pad side rails, suction/oxygen equipment at bedside). Monitor serum levels of antiepileptics! During seizure: Lower patient to bed or floor if standing/sitting. Turn patient to the side. Loosen restrictive clothing. Do not put anything in the patient’s mouth. Do not restrain patient. Note onset and duration of seizure. Post-seizure: Check vital signs, neurological status. Reorient patient, determine possible trigger, NPO until fully awake.

Answer 107

Febrile Seizures Most common seizure disorder in children. Patho: Seizure is caused by a sudden spike in body temperature > 38°C (100.4°F), without an underlying seizure-provoking cause or disorder (e.g., CNS infection). RF: Age (6 mos. – 5 yrs.), family history. S/S: Loss of consciousness, uncontrollable shaking of the arms/legs, rapid return to baseline. Labs/ Dx: Rule out other causes (e.g., meningitis). Tx: Typically not required. For prolonged seizures: benzodiazepines, antiepileptics. FT: For seizures lasting > 5 min, call 911.

Answer 108

Head Injury Head trauma resulting in injury to the scalp, skull, brain, or blood vessels. Patho: Primary injury: Acceleration or deceleration injury results in shearing, injury/destruction of brain tissue, skull fracture, and/or hemorrhage. Secondary injury: Reactive processes after the initial injury (hypoxia, ↑ ICP, cerebral edema) further damage brain tissue. RF: Falls, sports-related injury, motor vehicle accidents, abuse (shaken baby syndrome). S/S: Mild: Headache, confusion, dizziness, blurred vision, lethargy. Severe: S/S of ↑ ICP , ↓ LOC, pupil abnormalities, retinal hemorrhage, weakness, unsteady gait, seizures.

Answer 109

Head Injury Dx: CT/MRI, neurologic assessment. Tx: Concussion (temporary alteration in brain function) is usually self resolving in 1 – 3 weeks. Rest and gradual return to activities. Severe head injury treatment includes: Medications: Mannitol (↓ ICP), hypertonic NaCl, phenobarbital (induces coma, ↓ metabolic demands), anticonvulsants, opioid analgesics. Procedures: Mechanical ventilation, ICP monitoring, craniectomy to relieve pressure inside the skull. NC: Emergency Care: Stabilize cervical spine, maintain patent airway. Monitor: Vital signs, LOC, EKG. Decrease ICP: Reduce hypercapnia (hyperventilate patient), avoid suctioning, HOB 30°, head midline.

Answer 110

Head Injury Brain Herniation: Downward movement of brain tissue due to cerebral edema. S/S: Fixed, dilated pupils, ↓ LOC, abnormal respirations and posturing, hypertension. Hemorrhage/Hematoma: Epidural hematoma: Arterial bleeding between the dura and skull. Subdural hematoma: Venous bleeding between the dura and arachnoid. Intracerebral hemorrhage: Accumulation of blood within the brain tissue. Hydrocephalus: ↑ CSF volume due to impaired reabsorption or issue with CSF outflow.

Answer 111

Meningitis Inflammation of the meninges (membranes around the brain and spinal cord). Patho: Infectious organisms enter the CNS through the bloodstream or directly (e.g., trauma). Prevention: Hib and PCV vaccines (given to infants), meningococcal vaccine (given to students living in dorms). S/S: Fever, headache, nausea/vomiting, irritability, nuchal (neck) rigidity, photophobia, positive Kernig’s and Brudzinski’s signs, seizures, petechiae. Infants: Poor feeding, bulging fontanels, high-pitched cry. Labs/ Dx: Lumbar puncture with CSF analysis. Bacterial: Cloudy, ↓ glucose, ↑ protein and WBCs, positive gram stain. Viral: Clear, normal glucose and protein, slightly ↑ WBCs, negative gram stain.

Answer 112

Meningitis Tx: Antibiotics (bacterial), anticonvulsants, analgesics. Viral meningitis typically resolves without treatment. NC: Implement droplet precautions for suspected/confirmed bacterial meningitis during the first 24 hrs of antibiotic therapy. Think of the song “It’s raining men!” to remember that MENingitis is droplet (rainDROP) precautions. Implement seizure precautions. Monitor neurological status, S/S of ↑ ICP . Minimize increased ICP . Provide quiet room, dim light.

Answer 113

Reye’s Syndrome Non-inflammatory encephalopathy and fatty changes in the liver. Patho: Hepatic mitochondrial injury causes ↑ ammonia levels. RF: Recent viral infection (especially influenza), use of aspirin. S/S: Vomiting, confusion, coma, seizure, death. Labs/ Dx: Liver biopsy, ↑ AST, ALT, bilirubin, ammonia. Lumbar puncture/CSF analysis to rule out meningitis. Tx: Mainly supportive. Monitor for ↑ ICP, intubation and mechanical ventilation. NC: Elevate HOB to 30°, seizure precautions, monitor I&Os, prevent hemorrhage (due to impaired liver function). FT: Avoid use of salicylates (aspirin) in children!

Answer 114

Lead Poisoning Excess lead exposure, leading to multiorgan damage including neurocognitive disease. Patho: Lead interferes with normal cell functioning. RF: Pre – 1978 housing, home renovation. S/S: Cognitive impairment (↓ IQ scores), impaired hearing, growth delays, anemia, vomiting, fatigue. Labs/ Dx: Serum lead level > 3.5 mcg/dL. Tx: Chelation therapy (for serum lead level > 45 mcg/dL). NC: Obtain environmental history to assess RF. FT: ↑ Child’s intake of calcium and iron to ↓ lead absorption. Wet mop floors, check for peeling/chipping paint, frequently wash toys/pacifiers.

Answer 115

Spina Bifida Neural tube defect of the spine and spinal cord. Patho: Incomplete development and closure of the neural tube, leading to spinal cord and nerve vulnerability/damage. RF: Insufficient folic acid intake during pregnancy, maternal diabetes, maternal drug use. S/S: Spina bifida occulta: No herniation (skin covers malformation). Abnormal tuft of hair, dimple, and/or birthmark at site of defect. Meningocele: Protrusion of cyst with meninges and CSF. Myelomeningocele: Protrusion of cyst with meninges, CSF, and spinal cord.

Answer 116

Spina Bifida Labs/ Dx: Prenatal – ultrasound, ↑ alpha-fetoprotein. Postnatal – x-ray, CT, MRI. Tx: Early surgical closure of defect. NC: Protect exposed cyst prior to surgery. Cover sac with sterile, saline–moistened, non–adherent dressing. Place infant in prone position with hips flexed. Avoid pressure on sac. FT: Provide education on complications (hydrocephalus, latex allergies, ↑ risk of pressure injuries and burns due to lack of sensation, bladder dysfunction requiring intermittent catheterization, ↑ risk of fractures).

Answer 117

Cerebral Palsy Neurological disorder that affects body movement and muscle coordination. Patho: Abnormal intrauterine development of the brain or hypoxic brain injury damages the cerebral cortex and impairs motor function. S/S: Ataxia, spasticity, muscle weakness, impaired gait, swallowing/speech/vision/hearing difficulties, tremor, reflex abnormalities, intellectual disability, seizures. Dx: Ultrasound, CT/MRI. Tx: Botulinum toxin, intrathecal baclofen, PT/OT, speech therapy, assistive devices, orthopedic surgery. NC: Provide safe environment, monitor for aspiration, have suction equipment available.

Answer 118

Trisomy 21 (Down Syndrome) Chromosomal disorder causing physical and developmental delays. Patho: Failure of chromosome 21 to separate during gametogenesis, resulting in an extra chromosome in all body cells. RF: Family history, advanced maternal/paternal age. S/S: Features: Epicanthal folds, protruding tongue, broad flat nose, single uninterrupted palmar crease, short neck, low set ears, hypotonia. GI disorders: GER, Hirschsprung disease, constipation, celiac disease. Other: Seizures, hypothyroidism, hearing/vision issues, respiratory tract infections, congenital heart defects, intellectual/developmental disabilities. Labs/ Dx: Prenatal screening/testing (MSAFP, amniocentesis), genetic testing. Tx: Management of symptoms, no cure. FT: Educational materials, information on support groups and counseling.

Answer 119

Fragile X Syndrome Chromosomal abnormality causing intellectual disability and autism. Patho: X-linked dominant genetic disorder causes a mutation (“fragile site”) on the X chromosome. RF: Family history, sex (male). S/S: Features: Long face, prominent forehead, protruding ears, hypotonia. Cognitive impairment, speech abnormalities, poor eye contact, hyperactivity. Labs/ Dx: Prenatal screening/testing, genetic testing. Tx: No cure, management of symptoms (antidepressants, antipsychotics, ADHD medications). NC: Provide referrals for speech, behavioral, occupational therapy.

Answer 120

Duchenne’s Muscular Dystrophy Hereditary neuromuscular disease causing muscle degeneration and weakness. Patho: X-linked recessive disorder causes progressive weakness and atrophy of the skeletal and heart muscles. RF: Family history, sex (males). S/S: Delayed motor movement and speech, cognitive impairment, muscle weakness, waddling gait, calf enlargement, cardiomyopathy. Labs/ Dx: ↑ Creatinine Kinase (CK), muscle biopsy, genetic testing. Tx: No cure. Glucocorticoids, ACE inhibitors or beta blockers for cardiomyopathy, palliative care. Death usually occurs in 20s (due to respiratory muscle weakness and cardiomyopathy). FT: Encourage ROM exercises and activity.

Answer 121

Attention Deficit Hyperactivity Disorder (ADHD) Psychiatric condition characterized by inattentiveness, hyperactivity, impulsivity. Patho: Diffuse abnormalities in the brain cause cognitive and functional deficits. S/S: Easily distracted, inattentive, hyperactive, immature, impulsive. Impaired social and academic functioning. Dx: Clinical assessment, informants (teachers and parents), rule out other disorders. Tx: CNS stimulants (amphetamines, methylphenidate), cognitive behavioral therapy. NC: Monitor child’s weight and growth (as meds ↓ appetite). FT: Maintain structured environment, consistent rules. ↓ Distractions. Provide meds with or after meals, in the morning (to prevent insomnia). Periodic drug “holidays” may be appropriate to ↑ growth and ↓ side effects during those times. Classroom: teach academic subjects in morning, provide regular/frequent breaks.

Answer 122

Autism Neurological disorder that causes behavioral and psychological problems. Patho: Unknown; related to genetic and environmental factors. RF: Family history, sex (male). S/S: Impaired social interactions, repetitive behavior, lack of eye contact, speech delay, cognitive impairment, trouble adapting to routine changes. Dx: Clinical assessment, rule out underlying neurological causes. Tx: No cure; early intervention services to improve functioning. NC: Provide referrals for speech, occupational, and behavioral therapy. FT: Provide structured environment, decrease stimuli, give notice before implementing changes to routine.

Answer 123

Positional Plagiocephaly Cranial asymmetry. Patho: Prolonged pressure on one side of the skull causes it to flatten over time. RF: Supine sleeping position. S/S: Bald spot, misshapen skull, facial asymmetry. Dx: Clinical assessment, rule out craniosynostosis (birth defect where the cranial sutures close too early, requires surgery). Tx: Repositioning, helmet therapy (worn up to 23 hrs/day for ~ 3 months). FT: “Tummy time” ≥ 3 times a day, 10 – 15 min each time. Avoid excessive time in the car seat or swing. Place baby on back to sleep, but alternate head position.

Answer 124

Scoliosis S or C-shaped curvature of the spine. Patho: Idiopathic. Congenital or acquired deformity results in abnormal lateral curvature and spinal rotation. S/S: Asymmetry of shoulder height, scapular shape, and/or hip height. Ill-fitting clothes. Dx: Adam’s forward bend test (showing asymmetry of ribs and flanks), x-ray, scoliometer to measure truncal rotation. Tx: Bracing, surgery (spinal fusion). NC (post-op): Perform neurologic assessments, turn patient by log rolling, administer opioid analgesics on a schedule. FT: Brace should be worn at all times, except when showering. Wear a thin t-shirt or tank top underneath brace to protect skin.

Answer 125

Developmental Dysplasia of the Hip (DDH) Dislocation or instability of the hip joint, present at birth or early childhood. Patho: Abnormal development of the hip joint in utero results in misalignment of the femur and acetabulum. RF: Sex (female), breech position, family history. S/S: Leg length asymmetry, asymmetric inguinal or gluteal skin folds, limited hip joint ROM, asymmetrical gait. Dx: Positive Barlow and Ortolani maneuvers, ultrasound, x-ray. Tx: Pavlik harness for infants < 6 months, surgical reduction with hip spica cast for children > 6 months. NC: Neurovascular and skin checks, cast care , Pavlik harness teaching .

Answer 126

Pavlik Harness Soft brace used to keep an infant’s legs in a flexed, abducted position, promoting normal hip joint development. Most common treatment for Developmental Dysplasia of the Hip. FT: Harness is worn ≥ 23 hours/day for ~ 6 – 12 weeks. Skin care: Assess skin 2 – 3 times/day, gently massage under straps, avoid lotions/powders, have child wear undershirt and socks under harness. Place diaper under straps. Do not adjust the harness yourself! Follow up visits every 1 – 2 weeks for evaluation/adjustment. The former practice of double or triple diapering is NOT recommended for DDH.

Answer 127

Legg-Calve Perthes Avascular necrosis of the femoral head. Patho: Idiopathic. Disruption of blood flow to the femoral epiphysis (possibly due to trauma, inflammation, or coagulation defects) results in necrosis. RF: Age (3 – 12 yrs), sex (male). S/S: Painless limp, hip pain/stiffness (↑ with activity), ↓ hip ROM, leg length discrepancy (affected leg shorter). Dx: X-ray, bone scan, MRI. Tx: Activity restriction, limited weight–bearing, physical therapy, NSAIDs, surgery (osteotomy).

Answer 128

Clubfoot Genetic disorder causing deformity of the foot. Patho: Genetic or environmental factors cause a shortened achilles tendon. RF: Family history, sex (male), maternal smoking/alcohol use, maternal infection or diabetes. S/S: Affected foot is turned sharply inward, smaller calf muscle on affected leg. Dx: Visual inspection (prenatal ultrasound or newborn screening). Tx: Serial casting and bracing, surgical repair. NC (post-op): Perform neurovascular checks, cast care and teaching . Reinforce the need for compliance with bracing to prevent recurrence.

Answer 129

Osteogenesis Imperfecta Genetic disorder that causes brittle bones. Patho: Abnormality in the synthesis of collagen causes impaired bone mineralization and severe fragility of bones. S/S: Bone deformity and fractures, blue sclera, hearing loss, short stature. Dx: Bone biopsy, X-ray, CT, MRI. Tx: Bisphosphonates (e.g., alendronate), bracing, physical therapy, surgical stabilization. NC: Handle child gently, provide educational material and resources to parents.

Answer 130

Rickets Bone loss due to vitamin D deficiency. Patho: Inadequate vitamin D decreases calcium absorption and impairs bone mineralization. RF: Insufficient sunlight exposure, ↓ dietary intake of vitamin D, disorder that disrupts vitamin D production or absorption (e.g., celiac disease or cystic fibrosis). S/S: Bone deformities (e.g., “bow legs” or “knock knees”), bone pain and fractures. Labs: ↑ Alkaline phosphatase (ALP) and ↓ vitamin D. Tx: Vitamin D supplementation. FT: Encourage ↑ sun exposure (w/sunscreen), ↑ intake of vitamin D rich foods (fish, eggs, fortified foods).

Answer 131

Juvenile Idiopathic Arthritis Chronic, autoimmune disorder causing joint inflammation. Patho: Idiopathic. Body’s immune system targets the joint synovium and surrounding tissue, causing inflammation and damage to the articular cartilage. S/S: Joint swelling, pain and warmth, ↓ joint ROM, morning stiffness, rash, lymphadenopathy, hepatosplenomegaly, serositis. Labs: ↑ESR, ↑ CRP, positive ANA. Dx: Diagnosis of exclusion, x-ray, MRI, ultrasound. Tx: NSAIDs, intra-articular and systemic corticosteroids, DMARDs (e.g., methotrexate), PT/OT, splints. FT: Encourage moist heat to relieve pain/stiffness, firm mattress. Educate on correct use of splints.

Answer 132

Osteomyelitis Bone infection. Patho: Infectious organism causes tissue inflammation, edema, and ↓ blood flow to the bone, resulting in bone necrosis. RF: Recent trauma (e.g., open fracture), bacteremia, orthopedic surgery, circulatory disorders. S/S: Bone pain, erythema, edema, fever. Labs/ Dx: X-ray, bone scan, ↑ WBCs. Tx: Long-term antibiotic therapy, surgical debridement of bone, hyperbaric oxygen therapy.

Answer 133

Fractures Fracture Classification: Closed/simple: Does not break skin surface. Open/compound: Breaks skin surface, ↑ risk of infection. Types of Fractures: Transverse: Fracture occurs across the long axis of bone. Impacted (compression): Two or more bones are crushed together due to loading force. Comminuted: Fracture results in two or more pieces. Oblique: Fracture occurs at an angle (slanted). Spiral: Fracture from twisting motion (sign of abuse!). Greenstick: Partial fracture (only one side is broken).

Answer 134

Fractures S/S: Pain, edema, ecchymosis, crepitus, deformity in extremity. Dx: X-ray, CT, MRI. Tx: Meds: Antibiotics (prophylactic), analgesics. Procedures: Closed reduction and immobilization (splint, cast, traction). External fixation – pins attached to external frame. Open reduction and internal fixation (ORIF) – pins, plates, screws, rods used internally.

Answer 135

Fractures Emergency Care: Cut clothing away, remove jewelry, control bleeding, immobilize fracture by splinting. Neurovascular Checks: Assess pain level, sensation (numbness, tingling, lack of sensation), skin temperature, skin color, capillary refill, pulses, movement. Monitor for Compartment Syndrome: ↑ Pressure within the muscle compartment of an extremity that impairs circulation. S/S: Hard/swollen muscle, intense pain unrelieved by medication and/or pain with passive movement. 5Ps: Intense Pain, Paresthesia, Paralysis, Pallor, Pulselessness. Tx: Fasciotomy, amputation. Avoid use of cold, do NOT elevate affected limb.

Answer 136

Casts NC: Elevate cast and apply ice for the first 24 hrs. Handle plaster casts using your palms (not fingertips, to avoid denting) until the cast is dry. Use moleskin around rough edges. FT: Do not insert objects inside the cast. Blow cool air from a hair dryer under the cast to relieve itching. Report the following symptoms to provider: hot spots, ↑ drainage, malodor, ↑ pain, cool digits, change in distal extremity color. For Hip Spica cast, monitor for constipation. ↑ Child’s fiber and fluid intake.

Answer 137

Immobilization Devices Skin Traction: Weights are attached to the patient’s skin to immobilize the area, ↓ muscle spasms, and realign bones. Bryant traction: Used for hip dysplasia in children. Legs are flexed at 90 degree angle with buttocks raised slightly off the bed. Buck’s traction: Used for pre-op immobilization or to correct deformities/contractures. Legs are in an extended position. Skeletal Traction: Screws are inserted into the bone. Used for long bone fractures. Halo Traction: Used for cervical bone fractures.

Answer 138

Immobilization Devices Weights: Do not lift or remove weights. Do not let weights rest on floor (should be hanging freely). Muscle Spasms: Muscle spasms are expected and should be treated with medications (analgesics, muscle relaxants), repositioning, heat, or massage. Report unrelieved muscle spasms to the provider. Halo Traction: Move patient as a unit, do not apply pressure to rods. Make sure wrench/screwdriver are attached to the vest to release patient from device in an emergency. Pin Site Care: Monitor for pin loosening and S/S of infection (↑ drainage, erythema, skin tenting at pin site). Provide pin site care as ordered. Clean pins using a new cotton tip swab for each pin. Do not remove crusting at pin site.

Answer 139

Precocious Puberty Sexual maturity that begins earlier than normal (before age 8 for females and age 9 for males). Patho: Premature puberty causes early appearance of secondary sex characteristics due to early release of GnRH and/or sex hormones. Usually idiopathic, but may be secondary to a tumor. S/S: Females: Pubic hair, breast development, menstruation. Males: Pubic and facial hair, enlargement of testicles and penis, muscle growth, deepening of the voice. Labs/ Dx: GnRH stimulation test. ↑ LH, FSH, testosterone, or estradiol. MRI of brain. Tx: Treatment often not required. GnRH analog therapy (e.g., monthly injections of leuprolide). Surgical excision of tumor.

Answer 140

Growth Hormone Deficiency Decreased release of Growth Hormone (GH) from the anterior pituitary gland. Patho: Congenital defect, pituitary tumor, or trauma interferes with the production or release of GH. S/S: Delayed growth (but normal birth weight/length), hypoglycemia, micropenis, slow tooth eruption, truncal obesity, high-pitched voice. Labs/ Dx: ↓ Insulin-like growth factor (IGF-1), x-ray to determine bone age, GH stimulation testing. Tx: Growth Hormone replacement therapy (e.g., somatropin) via subcutaneous injections. Discontinue therapy once epiphyseal fusion has occurred. NC: Monitor growth.

Answer 141

Growth Hormone Excess (Gigantism) Excess release of Growth Hormone (GH) from the anterior pituitary gland before epiphyseal plate closure. Patho: Pituitary gland tumor/lesion (most common) or hypothalamus dysfunction results in overproduction of GH. This causes ↑ growth of bone/cartilage and ↑ protein synthesis. S/S: Excessive height, delayed puberty, vision issues, prominent forehead and jaw, headache, ↑ sweating, large hands/feet. Labs/ Dx: ↑ Insulin-like growth factor (IGF-1), GH suppression test, CT/MRI of pituitary gland. Tx: Surgical removal of tumor, radiation, medications to ↓ GH levels (e.g., octreotide, bromocriptine).

Answer 142

Diabetes Insipidus (DI) Insufficient ADH released from the posterior pituitary gland (or inadequate response to ADH) results in kidneys being unable to concentrate urine. Patho: Neurogenic DI (e.g., hypothalamus or pituitary tumor) causes ↓ ADH release. Nephrogenic DI (e.g., kidney infection) causes inadequate kidney response to ADH. S/S: Large amounts of dilute urine, polydipsia, S/S of dehydration , hypotension, anorexia. Labs: Urine: ↓ Specific gravity (< 1.005), ↓ osmolality, ↓ sodium. Blood: ↑ Osmolality (> 295 mOsm/L), ↑ sodium. Dx: Water deprivation test. Tx: Vasopressin, desmopressin. NC: Monitor I&Os, urine specific gravity, daily weight.

Answer 143

SIADH Excess release of ADH from the posterior pituitary gland. Patho: Brain tumor, head injury, or infection (e.g., meningitis) causes excess secretion of ADH, which causes ↑ reabsorption of water in the kidneys. S/S: Small amounts of concentrated urine, S/S of fluid volume excess (tachycardia, hypertension, crackles, JVD, weight gain), headache, confusion, seizures. Labs/ Dx: Urine: ↑ Specific gravity (> 1.030), ↑ osmolality, ↑ sodium. Blood: ↓ Osmolality (< 275 mOsm/L), ↓ sodium. Tx: Treat underlying condition, fluid restriction, diuretics, hypertonic saline (3% NaCl). NC: Monitor I&Os, daily weight, neurologic status (due to hyponatremia). Implement seizure precautions.

Answer 144

Diabetes Mellitus Metabolic disorder characterized by chronic hyperglycemia. Type 1 DM: Patho: Autoimmune dysfunction causes destruction of beta cells in the pancreas, leading to a lack of insulin secretion. Patients are insulin-dependent. RF: Family history, age (children, young adults). Type 2 DM: Patho: Insulin resistance and ↓ insulin production develops slowly over time. RF: Obesity, hypertension, hyperlipidemia, genetics, race (African American, American Indian, Hispanic), inactivity.

Answer 145

Diabetes Mellitus S/S: 3 Ps (polydipsia, polyphagia, polyuria), warm/dry skin, dehydration (weak pulses, ↓ skin turgor), fruity breath odor, Kussmaul respirations (↑ rate and depth), n/v, weakness, lethargy. Warm and dry…sugar’s high! Labs/ Dx: Two abnormal test results: Casual blood glucose > 200 mg/dL Fasting blood glucose > 126 mg/dL Glucose > 200 mg/dL with OGTT HgbA1C > 6.5% Tx: Insulin. Goal (per ADA): HgbA1C < 7%. FT: Blood sugar monitoring, insulin administration, illness care , management of hypoglycemia .

Answer 146

Diabetes Mellitus – Illness Care Monitor blood glucose every 2 – 3 hours (or as directed). Test urine for ketones every 4 hours (or as directed). Do NOT skip insulin when sick. Prevent dehydration (drink plenty of fluids). Obtain daily weight. Check temperature every morning and night. Notify provider for: temperature > 101°F, urine positive for ketones, inability to keep fluids down for > 4 hours, inability to keep food down for > 24 hours.

Answer 147

Hypoglycemia Blood glucose < 70 mg/dL. S/S: Hunger, irritability, confusion, diaphoresis, headache, shakiness, blurred vision, pale/cool skin, ↓ LOC, seizure/coma. Cold and clammy…need some candy! FT: Conscious child: Provide ~ 15 g of a quickly absorbed carbohydrate (e.g., 4 – 6 oz juice/soda, 8 oz milk), recheck blood glucose in 15 min, repeat if necessary. Follow with snack containing a complex carbohydrate and protein. Unconscious child: Administer IM or subcutaneous glucagon. Once the patient is conscious (and can swallow safely), have the patient consume a carbohydrate snack.

Answer 148

Diabetic Ketoacidosis (DKA) Life-threatening condition with high blood glucose levels and ketones in the blood and urine. Rapid onset. More common with Type 1 DM. RF: Infection/illness, untreated or undiagnosed type I DM, missed insulin dose. S/S: 3 Ps (Polyuria, Polydipsia, Polyphagia), weight loss, fruity breath odor, kussmaul respirations, GI upset, dehydration. Labs/ Dx: Blood glucose > 250 mg/dL, ketones in blood and urine, metabolic acidosis, hyperkalemia. Tx: Treat underlying cause (e.g., infection), IV fluids and insulin, bicarbonate for severe acidosis only. NC: Monitor blood glucose hourly. Closely monitor VS, electrolytes (especially potassium!), I&Os. Monitor for S/S of cerebral edema. The K in DKA reminds you to monitor K!

Answer 149

Pheochromocytoma Hypersecretion of catecholamines from the adrenal gland. Patho: Adrenal medulla tumor causes excess release of epinephrine and norepinephrine, which ↑ sympathetic response in the body. S/S: Tachycardia, hypertension, diaphoresis, headache, SOB. Labs/ Dx: 24-hour urine test (for vanillylmandelic acid, metanephrine, and catecholamines), clonidine suppression test. CT/MRI to locate tumor in the adrenal gland. Tx: Surgery: Tumor excision, adrenalectomy. Medications: Antihypertensives until surgery. NC: Do not palpate abdomen, can cause a sudden release of catecholamines and trigger severe hypertension!

Answer 150

Cleft Lip (CL) & Cleft Palate (CP) Birth defect characterized by incomplete formation of the lip (Cleft Lip) or the roof of the mouth (Cleft Palate). Patho: Unknown etiology. RF: Smoking, gestational diabetes, use of certain meds (e.g., phenytoin, steroids) and lack of folate during pregnancy. S/S: CL: Opening in the upper lip, size varies (small slit, or large opening into the nose). CP: Opening in part or all of the palate (roof of the mouth). Dx: Prenatal ultrasound, visual examination of oral cavity at birth. Tx: Surgery (CL – within the first 3 – 5 months, CP – within first 12 months). NC: Provide referrals to manage complications associated with CL/CP, which include feeding, hearing, speech, and dental issues.

Answer 151

Cleft Lip (CL) & Cleft Palate (CP) Feeding: CL: Use nipple with wide base, squeeze cheeks together during feeding. CP: Position infant in upright position, use bottle with one-way flow valve and specialty nipple to ↑ flow, burp infant frequently. Post-op: Apply petroleum jelly to operative site as directed. Utilize elbow immobilizers to protect the site. Feeding with a syringe or dropper may be recommended. Avoid use of pacifiers (sucking can disrupt sutures).

Answer 152

Esophageal Atresia & Tracheoesophageal Fistula Birth defects that cause malformation of the esophagus and trachea, causing a high risk for aspiration pneumonia and respiratory distress. Patho: Esophageal Atresia: Upper esophagus does not connect to the lower esophagus and stomach. Tracheoesophageal: Esophagus and trachea are abnormally connected. RF: Polyhydramnios (excessive amniotic fluid) w/prenatal ultrasound. S/S: Choking, respiratory distress during feeding, cyanosis, abdominal distension. Dx: Chest x-ray, bronchoscopy. Tx: Surgical repair. NC (Pre-op): Maintain patent airway, suction to prevent aspiration, NPO, administer IV fluids and antibiotics.

Answer 153

Gastroesophageal Reflux Regurgitation of gastric contents into the esophagus. Patho: Excessive relaxation of the lower esophageal sphincter (LES) allows reflux to occur. S/S: Infants: Spitting up, crying, arching of back, failure to thrive, respiratory difficulties. Children: Dyspepsia (indigestion), regurgitation, chest pain, dysphagia, chronic cough. Dx: History, clinical exam, upper GI series (barium swallow), esophageal pH monitoring, EGD.

Answer 154

Gastroesophageal Reflux Tx: Self-resolving for most children by 1 year old. Therapy for respiratory complications or failure to thrive. Medications: H2 receptor antagonists (e.g., ranitidine), proton pump inhibitors (e.g., pantoprazole), prokinetics (e.g., metoclopramide). Surgery: Fundoplication (fundus of stomach is wrapped around the esophagus to restrict backflow of contents). FT: Infants: Thicken formula, feed in upright position. Children: Avoid fatty, fried, citrus, spicy foods. Eat smaller meals, remain upright after meals. Elevate HOB. Lose weight (if applicable).

Answer 155

Hypertrophic Pyloric Stenosis Thickening of the pyloric sphincter, causing an obstruction of the pyloric canal. Patho: Hypertrophy of the pylorus narrows the canal between stomach and duodenum, causing gastric dilation. S/S: Projectile vomiting, palpable olive–shaped mass in the RUQ, visible peristaltic waves, S/S of dehydration . Labs: Hypokalemia, metabolic alkalosis. Dx: Ultrasound. Tx: IV fluids and electrolytes, pyloromyotomy (enlarges the opening at the pylorus).

Answer 156

Meckel’s Diverticulum Most common GI congenital defect that causes diverticulum (outpouching) in the small intestine. Patho: Vitelline duct (provides nutrition from yolk sac to embryo) fails to atrophy during pregnancy, leading to diverticulum that contains gastric or pancreatic cells. Gastric cells secrete acid, which causes ulceration and bleeding in the small intestine. S/S: Painless rectal bleeding, “currant jelly” stool, abdominal pain, anemia. Dx: Meckel radionuclide scan, CT, MRI. Tx: Surgical removal of diverticulum. Pre-op: IV fluids, blood transfusion, oxygen. NC: Monitor for rectal bleeding and S/S of hypovolemic shock (e.g., hypotension, tachycardia, pallor).

Answer 157

Intussusception Condition that causes part of the intestine to fold into the section next to it, causing an obstruction. Patho: Proximal segment of the bowel “telescopes” into the distal segment (usually the ileum into the cecum). Resulting obstruction causes ischemia. RF: Cystic fibrosis, sex (male), age (< 18 mos.). S/S: Abrupt, severe abdominal pain (child drawing knees up into chest), sausage–shaped mass (RUQ), bloody mucus stools (i.e., “currant jelly”), fever, vomiting, lethargy, weight loss. Labs/ Dx: Ultrasound (showing “bullseye”), air enema (diagnosis AND treatment). Tx: Enema (most common), surgery (reduction or bowel resection). NC: NG tube for decompression, IV fluids, monitor stool.

Answer 158

Short Bowel Syndrome Decrease in small bowel length and surface area, causing malabsorption. Patho: Resection of the intestine due to an underlying disease results in rapid intestinal transit time and malabsorption of nutrients. RF: Necrotizing enterocolitis, Crohn’s disease, volvulus (obstruction from twisting of the intestines). S/S: Malnutrition, weight loss, diarrhea, steatorrhea, dehydration. Labs: Electrolyte and acid/base imbalances, vitamin and mineral deficiencies. Dx: History & physical, stool & blood tests, x-ray, CT, endoscopy. Tx: Parenteral nutrition, enteral nutrition, oral rehydration solutions, diet modifications.

Answer 159

Celiac Disease Autoimmune disorder that causes gluten intolerance. Patho: Ingestion of gluten results in damage to the small intestine, leading to malabsorption. RF: Immune dysfunction. S/S: Diarrhea, steatorrhea, lethargy, failure to thrive, weight loss, anemia, abdominal pain and distension. Labs/ Dx: Serological tests, duodenal mucosal biopsy. Tx: Strict gluten-free diet. Think BROWN: Barley, Rye, Oats, Wheat – Nope! FT: Substitute grains with corn, rice, or millet.

Answer 160

Omphalocele & Gastroschisis Congenital defects of the abdominal wall at or near the umbilicus, allowing for herniation of abdominal organs. Patho: Omphalocele: Umbilical ring defect with herniation of abdominal organs covered with peritoneum. Gastroschisis: Abdominal wall defect to the right of the umbilicus with herniation of bowel and NO peritoneum protecting the contents. S/S: Protruding sac/organs. Labs/ Dx: Prenatal ultrasound and ↑ MSAFP, clinical examination. Tx: Surgical closure of defect, IV fluids/electrolytes, antibiotics. NC: Protect exposed bowel prior to surgery. For gastroschisis, place lower half of infant in clear, sterile plastic bowel bag (provides protection, visualization, ↓ heat/moisture loss). Place OG tube to decompress stomach.

Answer 161

Appendicitis Inflammation of the appendix. Patho: Opening of the appendix becomes obstructed by a fecalith, tumor, or infection. Results in inflammation, ischemia, and bacterial overgrowth. S/S: RLQ pain (McBurney’s point), rebound tenderness, loss of appetite, N/V, fever. You will Really (RLQ pain) feel the Burn (McBurney’s point) with appendicitis! Labs/ Dx: CT, ↑ WBCs. Tx: NPO, IV fluids, IV antibiotics. Surgery: Appendectomy (removal of the appendix). NC: Monitor for complications – perforation/rupture (sudden relief of pain), peritonitis (stiff, tender abdomen).

Answer 162

Hirschsprung Disease Birth defect with missing ganglion cells (nerve cells which promote peristalsis) in segments of the colon. Patho: Lack of ganglion cells results in ↓ motility and mechanical obstruction of the bowel. S/S: Failure to pass meconium in first 48 hours of life, abdominal distension, ribbon–like stool, constipation, vomiting bile, anorexia, failure to thrive, palpable fecal mass. Labs/ Dx: Contrast enema, rectal biopsy, anorectal manometry. Tx: Surgical removal of aganglionic section, colostomy. NC: Monitor for enterocolitis (fever, bloody diarrhea, abdominal pain). FT: Post-op: Ostomy care education (if indicated).

Answer 163

Failure to Thrive (FTT) Inadequate weight gain in a pediatric patient. Patho: Growth delay due to insufficient calorie intake, insufficient calorie absorption, or excess calorie expenditure. RF: Low birth weight, low socioeconomic status. S/S: Weight < fifth percentile, developmental delays, withdrawn behavior. Labs: ↓ Prealbumin. Dx: Food intake journal, identify any underlying medical conditions. Tx: Treat underlying cause. ↑ Caloric density of feedings, nutritional supplements. Severe cases may require tube/IV feeding. FT: Nutritional requirements and recommended feeding methods (meal times, routines). Minimize fruit juice consumption.

Answer 164

Colic Inconsolable infant crying and screaming without an obvious cause. Patho: Unknown, genetic and environmental factors. S/S: Continual crying/screaming unrelieved by traditional means (e.g., soothing), red-faced, legs drawn up, tense abdomen. Dx: Rule of 3’s: Episodes lasting ≥ 3 hours daily, ≥ 3 days a week, for ≥ 3 weeks with NO failure to thrive, fever, illness, external irritant. Usually starts around 3 wks of age! Tx: Supportive, e.g., swaddling, massage, quiet/dark environment, probiotics, strict maternal hypoallergenic diet (if breastfed). FT: Colic usually starts/self-resolves within 4 months of age. Teach coping strategies to prevent caregiver frustration and injury to infant (e.g., lay crying infant safely in crib and walk away).

Answer 165

Acute Infectious Diarrhea Increase in stool frequency and loose/watery stools caused by a virus, bacteria, or parasite. Common Causes: Rotavirus: Viral infection, most common cause of diarrhea in children < 5 years old. Transmitted via fecal/oral route. Prevention with rotavirus vaccine. E. coli: Bacterial infection, leading cause of traveler’s diarrhea. Transmitted via fecal/oral route and via contaminated food. Shiga toxin-producing E. coli can cause bloody diarrhea and hemolytic uremic syndrome . Salmonella: Bacterial infection. Transmitted via contaminated food (e.g., undercooked meat). Giardia: Protozoan infection. Transmitted via contact with infected people/animals or unfiltered water.

Answer 166

Acute Infectious Diarrhea RF: Recent travel history and/or antibiotic use, poor hygiene, crowded living conditions, poor sanitation and lack of clean water, raw/undercooked/contaminated food. S/S: Loose/watery stools, cramps/abdominal pain, vomiting, fever, dehydration . Labs/ Dx: History/physical exam, stool culture, electrolyte and acid base balance, ↑ urine specific gravity. Tx: Oral rehydration solution (ORS), IV fluids/electrolytes, probiotics, antiemetics. NC: Monitor daily weight, I&Os. FT: Prevention & treatment of infectious diarrhea .

Answer 167

Dehydration S/S: ↓ Skin turgor, dry mucous membranes, sunken fontanelles, ↓ BP, ↑ HR, ↑ RR. Clinical S/S Mild Moderate Severe Weight Loss 3 – 5% 6 – 10% > 10% LOC Alert, thirsty Irritable Lethargic or coma Capillary Refill ≤ 2 sec. 2 – 4 sec. > 4 sec. Urine Output Normal Decreased Oliguric or anuric Eyes Normal Slightly sunken, ↓ tears Deeply sunken, no tears

Answer 168

Infectious Gastrointestinal Disorders Prevention: Hand hygiene (before eating/handling food, after using bathroom). Proper food preparation and storage. Avoid unsafe water, drink only treated water. Use super-absorbent diapers (to prevent leaking). Wear gloves when handling diapers/stool of infected child. Cover sandboxes when not using. Treatment: Provide ORS in small, frequent intervals. Avoid fruit juices, caffeine, soda, gelatin, broth. Avoid BRAT diet (bananas, rice, applesauce, toast). Best way to monitor hydration status for infants and young children: Count number of wet diapers per day!

Answer 169

Enterobiasis (Pinworms) Helminthic infection from E. vermicularis. Patho: Transmission of eggs occurs via fecal-oral route (e.g., eating after touching a contaminated item). Adult worms deposit eggs in the perianal area, causing pruritus. RF: Crowded environments (e.g., daycare), poor hygiene. S/S: Intense perianal itching (worse at night), poor sleep, irritability. Dx: Tape test showing ova or worms. Tx: Albendazole, pyrantel pamoate. Treat ALL household members. FT: Place adhesive side of transparent tape on perianal skin first first thing in morning when child awakens. Perform on 3 consecutive mornings.

Answer 170

Nephrotic Syndrome Kidney disorder that causes massive loss of protein in the urine. Patho: Immune disorder, genetic defect, or inflammation causes ↑ glomerular permeability. S/S: Weight gain, frothy urine, anorexia, periorbital and generalized edema. Think of “neFROTHy syndrome” to remember frothy urine is a key sign! Labs: Massive proteinuria (> 2+), hypoalbuminemia, hyperlipidemia, hemoconcentration. Dx: Ultrasound, renal biopsy. Tx: Corticosteroids, 25% albumin, diuretics. NC: Monitor I&Os, daily weight and abdominal girth. Fluid restriction, ↓ sodium, and moderate protein. Prevent skin breakdown and infection.

Answer 171

Acute Glomerulonephritis (AGN) Inflammation of the glomeruli, often following a streptococcal infection (strep throat). Patho: Antigen-antibody complexes collect in the glomeruli, causing inflammation and ↓ GFR. RF: Recent strep throat infection . S/S: Oliguria, brown (cola-colored) urine, S/S of hypervolemia (hypertension, dyspnea, crackles, edema). Labs/ Dx: Blood: ↑ Creatinine, BUN, WBCs, ESR. Positive ASO titer. Urinalysis: Hematuria, proteinuria, ↑ urine specific gravity. Throat culture: Positive for group A beta-hemolytic streptococcus. Tx: Antibiotics, diuretics, anti-hypertensives, corticosteroids. NC: Strict I&Os, daily weight. ↓ Fluids, sodium, protein.

Answer 172

Acute Kidney Injury (AKI) Sudden loss of kidney function; usually reversible. Patho: Underlying causes include: prerenal (↓ blood flow to kidneys), intrarenal (direct damage to kidneys), postrenal (obstruction of urine outflow). S/S: Oliguria followed by diuresis, edema, dysrhythmias (from hyperkalemia), seizures (from hyponatremia), tachypnea (from metabolic acidosis), hypertension. Labs: Hyperkalemia, hyponatremia (dilutional), hypocalcemia, metabolic acidosis, anemia, ↑ BUN and creatinine. Dx: Non-contrast CT. Tx: Treat underlying cause, diuretics, antihypertensives, medications to ↓ potassium levels, dialysis. NC: Seizure precautions, monitor I&Os, daily weight. Diet low in potassium, sodium, and phosphorus.

Answer 173

Chronic Renal Failure Gradual, irreversible loss of kidney function. Patho: Chronic and sustained nephropathy leading to kidney fibrosis and destruction. RF: Kidney birth defects, hereditary diseases (e.g., polycystic kidney disease), infections (e.g., glomerulonephritis), nephrotic syndrome, systemic diseases (e.g., lupus). S/S: ↓ Appetite, headache, n/v, edema, hypertension, uremic frost (crystallized urea deposits on the skin), pruritus, poor growth. Labs/ Dx: ↑ Creatinine, BUN, potassium, phosphorus. ↓ Sodium, calcium, Hgb/Hct. Tx: Diuretics, epoetin alfa, phosphorus binding agent, antihypertensives, calcium, vitamin D, dialysis, renal transplant. NC: Monitor I&Os, daily weight. Limit fluid, sodium, potassium, phosphorus, and protein intake.

Answer 174

Hemolytic Uremic Syndrome Disorder causing thrombocytopenia, acute renal impairment, and hemolytic anemia. Patho: Gastrointestinal infection with E. coli O157:H7 causes the release of toxins that result in the destruction of RBCs, damage to blood vessels in the kidneys, and a ↓ in platelets. RF: Ingestion of improperly prepared or raw foods, recent illness (e.g., gastroenteritis). S/S: Abdominal pain, bruising/abnormal bleeding, fever, nausea, vomiting, bloody diarrhea. Labs/ Dx: Anemia (↓ Hgb/Hct), thrombocytopenia (↓ platelets), ↑ creatinine. Hematuria, proteinuria. Tx: IV fluids, PRBCs for anemia, plasmapheresis, dialysis. FT: Thoroughly cook all food.

Answer 175

Vesicoureteral Reflux Backflow of urine from the urinary bladder into the ureters. Patho: Anatomic abnormality (in the ureter, urethra, or bladder neck) or nerve damage allows for urinary backflow. Common cause of UTIs and pyelonephritis (kidney infection). S/S: Dysuria, frequent UTIs. High fever, vomiting, chills with pyelonephritis. Dx: Abdominal ultrasound, voiding cystourethrogram. Tx: Continuous low-dose antibiotic prophylaxis, surgical correction of anatomic abnormality. FT: Urine cultures every 2 – 3 months and with any fever.

Answer 176

Exstrophy of the Bladder A congenital abnormality causing the infant’s bladder to be inside out and exposed. Patho: Caused by malformation of abdominal wall in utero. RF: Sex (male). S/S: Exposed bladder with continuous urine leakage, epispadias, undescended testicle(s), inguinal hernia. Dx: Prenatal ultrasound, clinical examination after birth. Tx: Series of surgeries which will require bed–bound immobility of the patient for several weeks. NC: Pre-op – Apply sterile non–adherent dressing over exposed bladder. Post-op – Keep patient calm, provide analgesia to ↓ crying, pressure injury prophylaxis, strict I&O.

Answer 177

Urinary Tract Infection (UTI) Infection in any part of the urinary tract. Patho: Contamination of the periurethral area with bacteria results in colonization of the urethra and urinary bladder. RF: Sex (female), uncircumcised males, vesicoureteral reflux, anatomic abnormalities, constipation, poor toilet hygiene. S/S: Poor feeding, irritability, vomiting, urinary frequency, painful urination, malodorous urine, fever. Labs: Urine positive for bacteria, WBCs, blood, leukocyte esterase, nitrites. Dx: Urinalysis (catheterization may be necessary). Tx: Antibiotics, surgery to correct anatomic abnormalities. Complications: Pyelonephritis, urosepsis.

Answer 178

Prevention of UTIs Females – wipe front to back. Uncircumcised males – clean under foreskin. Wear cotton underwear, avoid tight clothing. Avoid bubble baths. Empty bladder regularly. Avoid constipation – ↑ fluid and fiber intake.

Answer 179

Hypospadias & Epispadias Abnormal placement of the urethral meatus. Patho: Congenital defect, unknown etiology. RF: Sex (male), family history. S/S: Hypospadias: Urethral opening located on the ventral surface (underside) of the penis. Epispadias: Urethral opening located on the dorsal surface (top) of the penis, short/wide penis with abnormal curve. Dx: Clinical examination. Tx: Intervention is based on severity. Surgical reconstruction if indicated. NC (post-op): Administer analgesics, anticholinergics (e.g., oxybutynin) to ↓ bladder spasms, antibiotics to prevent infection. FT: Delay circumcision, as the foreskin may be needed for reconstruction.

Answer 180

Gynecomastia Enlargement of male breasts. Patho: Typically idiopathic or due to hormonal imbalances. RF: Recreational drug use (e.g., anabolic steroids), pharmaceuticals (e.g., spironolactone, cimetidine, ketoconazole). S/S: Enlargement of the breast tissue. Labs/ Dx: No testing unless other symptoms are present. Ultrasonography, serum hormone studies, biopsy. Tx: No treatment needed in most cases, surgical intervention for cosmetic reasons may be indicated. NC: Be sensitive of psychosocial concerns based on developmental age.

Answer 181

Ambiguous Genitalia Variations in sex characteristics, deviating from typical expressions of male or female sex organs. Patho: Gene mutation affects the sexual development of the fetus. RF: Maternal exposure to androgens during pregnancy. S/S: Genitalia with atypical appearance, cryptorchidism, hypospadias, clitoromegaly. Labs/ Dx: Genetic karyotyping, serum hormone evaluation, MRI/ultrasound to view internal structures. Tx: In most cases, no treatment is required unless the infant’s ability to void is impaired. Reconstructive surgery to preserve sexual functioning and fertility, hormone replacement therapy. NC: Do not use terms such as “hermaphrodite,” as these are antiquated and offensive.

Answer 182

Cryptorchidism One or both testicles absent from the scrotum. Patho: Alterations in temperature or hormonal deficiencies leads to lack of testicular descent. RF: Premature birth, low birth weight, congenital disorders. S/S: Testicle(s) not present nor palpable in the scrotum. Labs/ Dx: Ultrasound/MRI to confirm testicle location and differentiate cryptorchidism from retractile testes or anorchism (absence of a testicle). Tx: Surgery to correct testicular location (orchiopexy). Complications: Infertility, testicular cancer, disturbed self-image.

Answer 183

Testicular Torsion Twisting of the testicle and spermatic cord. Patho: Ischemia results from the testicle twisting around the spermatic cord, potentially leading to necrosis. RF: Congenital abnormalities, testicular trauma. S/S: Swelling, abrupt onset of severe unilateral testicular pain, nausea, inguinal pain. Labs/ Dx: Ultrasound. Tx: Manual detorsion, emergency surgical intervention. NC: Keep patient calm, administer analgesics as ordered.

Answer 184

Epididymitis Inflammation of the epididymis. Patho: Inflammation caused by bacterial infection (most common) or trauma. RF: Sexually transmitted infection, urinary tract infection. S/S: Gradual onset of unilateral scrotal pain and swelling, dysuria, urethral discharge, tenderness upon palpation, inguinal lymphadenopathy. Labs/ Dx: Urinalysis, urethral swab with culture, ultrasonography, CT. Tx: Antibiotics, ice (↓ swelling), rest, scrotal support.

Answer 185

Varicocele Enlargement of the veins within the scrotum. Patho: Impaired venous blood flow in the scrotum leads to vascular congestion and edema. S/S: Testicle swelling, subjective report that scrotum feels like a “bag of worms”, bluish discoloration. Labs/ Dx: Ultrasound, thermal imaging. Tx: Analgesics, scrotal support, varicocelectomy. Complications: Most common cause of low sperm count and ↓ sperm motility, can lead to infertility.

Answer 186

Phimosis Excessively tight foreskin leading to difficult retraction. Patho: Physiological abnormality, or pathological as in balanitis (a dermatological condition). RF: Absence of circumcision, age (2 – 4 yrs.). S/S: Ballooning of the foreskin, difficult foreskin retraction. Dx: Clinical examination. Tx: No treatment necessary for physiological phimosis. Topical steroids, circumcision for pathologic phimosis. FT: Do not force retraction! Forced retraction can result in paraphimosis (i.e., retracted foreskin cannot be replaced), which is an urologic emergency.

Answer 187

Chickenpox Contagious disease caused by the Varicella-zoster virus (VZV), preventable with Varicella vaccination. Patho: Highly contagious airborne disease. Incubation period: 2 wks. Leads to lifelong immunity. Virus remains dormant in body, can later become reactivated to cause Herpes Zoster (Shingles). S/S: Fever, myalgia, anorexia, vesicular rash on body, pruritis. Dx: Clinical presentation. Tx: Acetaminophen for fever, topical calamine lotion and antihistamines for pruritis, antivirals (e.g., acyclovir). NC: Initiate airborne precautions and contact precautions. FT: Keep child’s nails short or use gloves to prevent scratching. Child is contagious until all lesions have crusted over.

Answer 188

Fifth Disease (Erythema Infectiosum) Common viral infection caused by parvovirus B19. Patho: Contagious disease spread through respiratory droplets. Incubation period: 5 – 10 days. S/S: Fever and malaise, followed by “slapped cheek” rash on face, then maculopapular rash on trunk. FIFTH’s: Think of FIVE fingers slapping the cheek. Dx: Clinical presentation. Tx: Acetaminophen or NSAIDs for pain and fever. NC: Initiate droplet precautions.

Answer 189

Roseola Common viral infection of childhood caused by human herpesvirus 6. Patho: Contagious disease transmitted primarily through saliva via respiratory droplets. Incubation period: 9 – 10 days. S/S: High fever followed by rose-pink maculopapular rash after resolution of fever, which begins on trunk and spreads to the face and extremities. Dx: Clinical presentation. Tx: Acetaminophen or NSAIDs for fever. NC: Encourage fluid intake. Monitor for febrile seizures.

Answer 190

Measles (Rubeola) Highly contagious viral illness, preventable through MMR vaccination. Patho: Viral illness spread via airborne route. Incubation period: 7 – 18 days. S/S: High fever, cough, runny nose, red/watery eyes. Koplik spots (white spots in the mouth), followed by a maculopapular rash that appears on the face and spreads downward to the rest of the body. Dx: Clinical presentation. Tx: Acetaminophen or NSAIDs for fever and pain. Vitamin A may be used to ↓ severity and length of virus. NC: Initiate airborne precautions and continue for 4 days after onset of rash.

Answer 191

Rubella (German Measles) Contagious viral illness, preventable with MMR vaccination. Patho: Viral illness spread via respiratory droplets. Incubation period: 12 – 23 days. S/S: Asymptomatic or low-grade fever and malaise, followed by a rash that starts on face and neck, then spreads to the rest of body. Disappears in same order. Dx: Clinical presentation. Tx: Usually mild, self-limiting. NC: Initiate droplet precautions. Maternal infection can cause serious birth defects. Contact with pregnant women should be restricted.

Answer 192

Mumps Contagious viral illness caused by paramyxovirus, preventable through MMR vaccination. Patho: Viral illness spread via respiratory droplets. Incubation period: 7 – 21 days. S/S: Fever, headache, anorexia, swelling of the testes and the parotid glands. Mumps causes Neck Lumps & Testicular Bumps. Dx: Clinical presentation. Tx: Acetaminophen or NSAIDs for fever and pain. NC: Initiate droplet precautions. Encourage use of warm or cool neck compresses. Monitor for complications: hearing loss, meningitis, encephalitis.

Answer 193

Hand, Foot, & Mouth Disease Common viral infection caused by coxsackie virus. Patho: Viral illness spread through respiratory secretions and via fecal-oral route. Incubation period: 3 – 5 days. S/S: Malaise, low-grade fever, anorexia, mouth and/or throat pain, painless and non-pruritic vesicular rash on hands, feet, and around mouth. Dx: Clinical presentation. Tx: Acetaminophen or NSAIDs for fever and pain. FT: Encourage fluid intake and soft foods to avoid exacerbating mouth pain.

Answer 194

Mononucleosis Communicable illness caused by the Epstein-Barr Virus. Patho: Spread via bodily fluids, especially saliva. RF: Close contact with infected persons, teenagers, and young adults. S/S: Sore throat, lymphadenopathy, fever, extreme fatigue, splenomegaly, rash. Labs/ Dx: Monospot blood test, atypical and ↑ WBC count, ↑ AST/ALT. Tx: Rest, fluids, antibiotics if accompanying strep infection. FT: Avoid contact sports due to the risk of splenic rupture.

Answer 195

Retinoblastoma Most common intraocular cancer in childhood. Patho: Gene mutation causes retinoblasts to develop into cancer. Both heritable and non-heritable forms of retinoblastoma exist. RF: Age (< 3 yrs), family history (heritable retinoblastoma). S/S: Leucocoria (white pupillary reflex), strabismus, ↓ visual acuity, orbital edema, pain, redness of the eye. Dx: ophthalmic examination, ultrasound, CT, MRI. Tx: Chemotherapy, cryotherapy, laser therapy, radiation, enucleation (i.e., surgery to remove eye) with prosthesis. FT: Ocularist will provide instructions on removal, insertion, and cleaning of the prosthesis.

Answer 196

Neuroblastoma Cancer of the sympathetic nervous system, most frequently found in the adrenal gland. Patho: Cancer develops in immature nerve cells (neuroblasts) and often metastasizes prior to diagnosis. RF: Age (< 5 yrs). S/S: Fever, fatigue, ↓ appetite, weight loss, lump or swelling in the abdomen, bone pain. Labs/ Dx: Ultrasound, CT/MRI, bone scan, PET scan, biopsy. Tx: Chemotherapy, surgical tumor removal, radiation, stem cell transplant.

Answer 197

Wilms Tumor Most common renal cancer of childhood (nephroblastoma). Patho: Unknown; related to genetic alterations in embryonic genitourinary development. RF: Age (< 5 yrs.), sex (female), race (African American). S/S: Firm, painless abdominal mass, fever, fatigue, hypertension, hematuria. Labs/ Dx: Ultrasound, CT/MRI, chest x-ray (to check for metastasis to the lungs), biopsy. Tx: Nephrectomy, chemotherapy, radiation. High survival rate with early diagnosis. NC: Do not palpate the abdomen, may cause cancer to spread. Post “Do not palpate abdomen” signs in the patient’s room.

Answer 198

Testicular Cancer Cancer of the testicle(s), most common malignancy in men ages 15 – 45. Patho: Unknown; tumor usually originates in germ cells and becomes invasive due to hormonal changes r/t puberty. RF: Age (15 – 45 yrs.), race (white), cryptorchidism, family history. S/S: Lump or painless swelling of the testicle. Labs/ Dx: Ultrasonography, serum tumor markers. Tx: Surgery (radical orchiectomy), radiation, chemotherapy. FT: This is a highly survivable cancer. Perform monthly TSE in the shower. Consider banking sperm due to ↑ risk of infertility.

Answer 199

Osteosarcoma Most common pediatric bone cancer. Patho: Cancer arises from bone-forming mesenchyme, most frequently occurs near the metaphysis of the long bones. RF: Teen years (growth spurt), sex (male), race (African American), ethnicity (Hispanic). S/S: Bone pain/swelling, bone fractures, limp when walking, ↓ ROM. Labs/ Dx: X-ray, MRI, CT, biopsy. Tx: Chemotherapy, radiation, limb salvage (surgical tumor resection and limb reconstruction with prosthetic replacement), limb amputation.

Answer 200

Leukemia Cancer of the bone marrow. Patho: Cancer in the bone marrow causes overgrowth of abnormal/immature WBCs, which prevents the growth of RBCs, platelets, and normal WBCs. Most common pediatric cancer. S/S: Fever, bruising, petechiae, joint/bone pain, pallor, fatigue, ↓ appetite, shortness of breath. Labs/ Dx: CBC (↓ RBC and platelets, ↑ “blasts” or immature WBCs), bone marrow biopsy, lumbar puncture. Tx: Chemotherapy, radiation, stem cell transplant, targeted therapy. NC: Prevent infection and bleeding, due to neutropenia and thrombocytopenia!

Answer 201

Lymphoma Cancer of the lymphatic system. Patho: Lymphocytes mutate into cancerous cells that multiply and crowd out normal white blood cells. Types: Hodgkin’s: Reed-Sternberg cells, local/regional. Non-Hodgkin’s: NO Reed-Sternberg cells, disseminated spread. S/S: Lymphadenopathy, fever, night sweats, fatigue, shortness of breath, ↓ appetite, weight loss. Labs/ Dx: Biopsy, imaging (e.g., CT, MRI). Tx: Chemotherapy, radiation, targeted therapy, immunotherapy, stem cell transplant.

Answer 202

Congenital Dermal Melanocytosis Gray/blue discoloration of the skin present from birth. Patho: Persistent melanocytes in the dermis leads to hyperpigmentation. RF: Race (African American, Asian), Ethnicity (Hispanic). S/S: One or multiple large, irregularly shaped gray, blue, or blue-green hyperpigmented lesions on the lumbar, sacral, or gluteal regions at birth or soon after. Lesions are painless and present without itching. Dx: Clinical presentation. Tx: No treatment needed. NC: Document the location to alert future providers that these are pre-existing and not signs of abuse! FT: Spots may fade with time, but may never fully disappear. Previously known as Mongolian spots, but this term should be avoided.

Answer 203

Cradle Cap A common type of seborrheic dermatitis affecting the scalp. Patho: Chronic non-inflammatory skin condition related to overactive sebaceous glands and presence of Malassezia (i.e., type of yeast). RF: Age (< 1 yr.), family history of atopic dermatitis or asthma. S/S: Scaly, greasy, non-painful, non-pruritic yellow patches found on the scalp of an infant that do not come off easily. Dx: Clinical presentation. Tx: Typically self-limiting. Topical antifungal or steroid cream. FT: Apply an emollient (e.g., baby oil) to the affected area and allow it to sit for a prolonged period, followed by gentle removal of the scales with a soft toothbrush or cradle cap comb. Use mild baby shampoo to clean the infant’s hair daily to prevent recurrence.

Answer 204

Thrush (Candidiasis) Opportunistic infection caused by the fungus candida. Patho: Overgrowth of normally occurring candida due to a disruption in the host’s immunity or normal flora. RF: Infancy, antibiotic or steroid use, immunocompromised. S/S: Oral thrush: Yellow or white plaques on the tongue and mucus membranes that cannot be scraped off. Vulvar thrush: Red, pruritic, painful rash with satellite lesions. Thick, white “cottage–cheese” type discharge. Dx: Clinical presentation. Tx: Antifungals (e.g., nystatin or fluconazole). FT: Oral candidiasis may be passed back and forth between infant and breastfeeding mother, so both must be treated. For vulvar thrush, keep area dry and allow the child to go without a diaper when possible.

Answer 205

Impetigo Highly contagious skin infection common in childhood. Patho: Infection of the epidermis by S. aureus (most common). RF: Hot/humid climates, age (2 – 5 yrs.), contact with infected person. S/S: Vesicles/pustules that rupture and form yellow or “honey–colored” crusts, especially around the mouth and nose. Labs/ Dx: Clinical presentation, culture of the lesions. Tx: Topical antibiotics (e.g., mupirocin), systemic antibiotics. FT: Avoid other children during active outbreaks, cover sores with bandages to prevent spread. Wash hands, linens, clothes that have come in contact with infected fluid.

Answer 206

Acne Most common inflammatory skin disorder during adolescence. Patho: Hair follicles become clogged with sebum (i.e., oil) and dead skin cells, leading to bacterial colonization and inflammation. RF: Puberty, sex (male). S/S: Comedones (blackheads, whiteheads), erythema, pustules. Dx: Clinical presentation. Tx: Topical: Retinoids (e.g., tretinoin), antibiotics (e.g., clindamycin), benzoyl peroxide. Systemic: Antibiotics (e.g., doxycycline), isotretinoin, oral contraceptives. NC: Gentle cleansing twice a day, balanced diet, no picking/squeezing. Isotretinoin is teratogenic – effective birth control is needed to prevent pregnancy! Benzoyl peroxide may have a bleaching effect on sheets, towels, or clothes.

Answer 207

Diaper Dermatitis Irritation of the perineal area in children who wear diapers (“diaper rash”). Patho: Irritation of the skin due to moisture, friction, and contact with urine and feces. RF: Diaper use, infrequent diaper changes, loose stool (more irritating to the skin). S/S: Painful perineal/perianal erythematous lesions. Dx: Clinical presentation. Tx/FT: Clean the area with plain water and mild soap or alcohol-free cleansing wipes. Change diapers frequently, and apply barrier cream (e.g., zinc oxide) to the newly cleansed area. Use ultra–absorbent diapers to draw moisture away from skin. Let child go without a diaper when possible to expose area to air.

Answer 208

Atopic Dermatitis Common chronic inflammatory skin disease commonly referred to as “eczema”. Patho: A defect in the skin’s barrier mechanisms ↑ susceptibility to allergens and environmental irritants. S/S: Dry/scaly skin, severe pruritus, patches, papules, vesicles, crusting, excoriation and lichenification. Labs/ Dx: Clinical presentation, confirmation with biopsy if needed. Tx: Identify and avoid triggers. Topical steroids, antihistamines (e.g., diphenhydramine). FT: Daily skin care – tepid bath with mild soap, apply emollient right after. No bubble baths or harsh soaps. Wear soft clothing, wash clothes in mild detergent. Minimize scratching – keep fingernails short and clean.

Answer 209

Dermatophytosis Contagious fungal skin infection. Patho: Direct contact with infected person/animal or item causes: tinea capitis (head), tinea corporis or ringworm (body), tinea cruris (jock itch), tinea pedis (athlete’s foot). Capitis – Cap on your head. Pedis –Pedal with your feet. RF: Shared personal items, locker rooms, warm/moist skin. S/S: Itchy, red, scaly, cracked skin. Hair loss with tinea capitis, ring-shaped rash with tinea corporis. Labs/ Dx: Clinical presentation, KOH (potassium hydroxide) test. Tx: Topical or oral antifungals, selenium sulfide shampoo. FT: Keep skin clean and dry, don’t share personal items, wash hands after playing with pets. Treat infected pets.

Answer 210

Bites & Stings A sting or a bite from an insect or other animal. RF: Time spent outdoors, environment (rural vs. urban). S/S: Insect bite/sting: Pain, erythema, edema, pruritis, anaphylaxis with severe allergy ( S/S: dyspnea, wheezing, hypotension, urticaria, angioedema). Animal bite: Pain, bleeding, numbness, tissue damage. Tx: Insect bite/sting: Analgesics, topical antihistamine or steroid cream. Immediate medical attention, intramuscular epinephrine injection for anaphylaxis. Animal bite: Antibiotics, tetanus booster, rabies prophylaxis. FT: Seek care for animal bites. If known hypersensitivity, carry EpiPen at all times.

Answer 211

Scabies Contagious skin infection caused by mites. Patho: Mite burrows into the skin and lays eggs. RF: Skin-to-skin contact with infected person (common in families or those who cohabitate). S/S: Severe pruritus, papules, burrows (grayish-white lines, often found between the fingers and in skin folds). Dx: Clinical presentation. Tx: Scabicide lotion (e.g., permethrin 5%), apply to the entire body and leave in place for 8 – 14 hrs. Reapply 1 week later. FT: The whole family should be examined/treated. Wash linen and clothes in hot water and dry with high heat.

Answer 212

Pediculosis Capitis (Lice) Lice infestation of the hair and scalp. Patho: Contact with infected person leads to transmission of the parasite from one individual to another. RF: Sharing of clothes or hats, close contact with infected person. S/S: Pruritis of the scalp, visible lice or nits (lice eggs) in hair. If it looks like rice, it could be lice! Dx: Clinical assessment. Tx: Permethrin 1% or other pediculicide shampoo, removal of nits with nit comb, repeat in 7 – 10 days. FT: Examine/treat whole family. Wash linens and clothes in hot water and dry with high heat, seal non-washable items (e.g., pillows) in a plastic bag for two weeks.

Answer 213

Lyme Disease Tick-transmitted infection caused by the spirochete Borrelia burgdorferi. Patho: Bite from an infected deer tick initially causes local infection/inflammation. Left untreated, infection spreads to other organs. Prevention: Wear long sleeves, long pants, closed shoes, and hat in wooded/grassy areas. Check body for ticks when returning inside. S/S: Stage I (early localized): Erythema migrans (ring–shaped, bullseye lesion), flu-like symptoms (e.g., malaise, fever, body aches). Stage II (early disseminated): Multiple smaller erythema migrans lesions, fever, dizziness, headache, carditis, facial palsy. Stage III (late disseminated): Arthritis, cognitive impairment. Labs/ Dx: Serologic testing for serum antibodies to B. burgdorferi. Tx: Antibiotics (e.g., doxycycline), analgesics (NSAIDs).

Answer 214

Burns: Assessment of Injury Depth of Injury Characteristics Superficial (First degree) Damage to epidermis only, pink/red color, dry, no blisters, moderate pain, heals without scarring. Example: sunburn. Superficial Partial-Thickness (Second degree) Damage to superficial dermis, red color, wet, blisters, severe pain, heals with minimal scarring. Deep Partial-Thickness (Second degree) Damage to deeper dermis, yellow/white color, dry, minimal pain, heals with scarring. Full-Thickness (Third degree) Damage to subcutaneous tissue, white or black/brown color, dry/leathery appearance, minimal to no pain, requires skin grafting. Deep Full-Thickness (Fourth degree) Damage extends beyond subcutaneous tissue (muscle, tendon, bone). Black color, no pain, requires skin grafting.

Answer 215

Burns: Assessment of Injury Estimating Burn Percentage: Use Lund and Browder chart (more accurate than the “Rule of 9s” for children). Each arm is 10%. Anterior trunk and posterior trunk are 13% each. Percentage for head and legs varies based on the patient’s age. Abuse Assessment: Abuse should be considered in patients presenting with symmetrical burns, burns in the shape of objects (e.g., cigarettes), or when the explanation of what happened is not consistent with the burn injury.

Answer 216

Burns: Emergent Phase Stop the burning process. Maintain patent airway. Assess for smoke inhalation (soot around nares, sooty sputum, singed eyebrow hair), provide oxygen or ventilatory support as needed. Start large-bore IV in unaffected area. Provide IV fluid resuscitation with Lactated Ringers. Insert foley catheter to carefully monitor fluid status. Maintain a urine output of 1 – 2 mL/kg/h for children < 30 kg, 0.5 – 1.0 mL/kg/hr for children ≥ 30 kg. Administer IV opioids for pain. Maintain body temperature (keep child warm). Maintain NPO, insert NG tube. Administer tetanus vaccine (if applicable).

Answer 217

Burns: Acute Phase Assist with wound healing interventions Debridement: Surgical, chemical, mechanical. Skin grafts: Elevate and immobilize graft site. Monitor for infection. Topical medications: Silver sulfadiazine, mafenide acetate. Prevent infection. Provide antibiotics, utilize aseptic technique, restrict visitors. No fresh plants/flowers, no raw foods. Maintain mobility. Provide active/passive ROM exercises to prevent contractures. Ensure adequate nutrition. Increase calorie and protein intake. Supplement with TPN or enteral feedings as ordered.

Pediatric Basics

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