Pediatrics Final Review 2023 Study Guide, Exams of Nursing

Download Pediatrics Final Review 2023 Study Guide and more Exams Nursing in PDF only on Docsity! Pediatrics final review 2023 study guide 1. Steps in administering enema to a child, positions i. Gather supplies (enema bag, lubricant, enema solution). ii. Wash hands and apply gloves. iii. Position the child:• Infant or toddler on abdomen with knees bent• Child or adolescent on left side with right leg flexed toward chest iv. Clamp the enema tubing, remove the cap, and apply lubricant to the tip. v. Insert the tube into the rectum:• 2.5 to 4 cm (1 to 1.5 inches) in the infant• 5 to 7.5 cm (2 to 3 inches) in the child vi. Unclamp the tubing and administer the prescribed volume of enema solution at a rate of about 100 mL per minute. Recommended volumes:• 250 mL or less for the infant• 250 to 500 mL for the toddler or preschooler• 500 to 1,000 mL for the school- age child vii. Hold the child’s buttocks together if needed to encourage retention of the enema for 5 to 10 minutes. 2. Select all, appendicitis Appendicitis, an acute inflammation of the appendix, is the most common cause of emergent abdominal surgery in children. Signs and symptoms include; • Vague abdominal pain in the initial stages, localizing to the right lower quadrant over a few hours • Nausea and vomiting (which usually develop after the onset of pain) • Small-volume, frequent, soft stools, often confused with diarrhea • Fever (usually low grade unless perforation occurs, which results in high fever) • Child looks anorexic and ill • Upon palpation, maximal tenderness occurs for the McBurney’s point in the RLQ. Assess the abdomen for acute peritonitis, as indicated by diffused abdominal tenderness or distension. If a child’s abdominal pain is suddenly relieved without intervention, suspect perforation and notify MD immediately. 3. Post op care for a tracheoephageal atresia Esophageal atresia and tracheoesophageal fistula are gastrointestinal anomalies in which the esophagus and trachea do not separate normally during embryonic development. Esophageal atresia refers to a congenitally interrupted esophagus where the proximal and distal ends do not communicate; the upper esophageal segment ends in a blind pouch and the lower segment ends a variable distance above the diaphragm. Post op care include: ✓ Closely observing all of the newborn’s body systems to identify any complications. ✓ Expect to administer total parenteral nutrition (TPN) and antibiotics until the esophageal anastomosis is proven intact and patent. ✓ Then begin oral feedings, usually within a week after surgery. ✓ Keep the parents informed of their newborn’s condition and progress. ✓ Closely assess the newborn during feeding and report any difficulty with swallowing. ✓ Provide parent teaching. Demonstrate and reinforce all teaching prior to discharge. 4. Hemolytic uremic syndrome (HUS)- caused by a verotoxin producing strain of E.coli from contaminated beef, and fecal oral route. Defined by three features— ❖ Hemolytic anemia, ❖ Thrombocytopenia, ❖ Acute renal failure. Typical HUS features an antecedent diarrheal illness. Other causes of HUS include idiopathic, inherited, drug-related, association with malignancies, transplantation, and malignant hypertension. Watery diarrhea progresses to hemorrhagic colitis, then to the triad of HUS. The features of HUS, as well as effects on other organs, are caused primarily by microthrombi and ischemic changes within the organs. The thrombotic events in the small blood vessels of the glomerulus lead to occlusion of the glomerular capillary loops and glomerulosclerosis, resulting in renal failure. Hypoalbuminemia results in a change in osmotic pressure, and fluid shifts from the bloodstream into the interstitial tissue (causing edema). This decrease in blood volume triggers the kidneys to respond by conserving sodium and water, leading to further edema. 9. steps for procedure for longterm catherization at home- the teaching for catherization is similar for the adults. Teach proper techniques and use for sterile techniques. 10.Spina bifida- is a term used often to describe all neural tube disorders that affect the spinal cord. • Spina bifida occulata is a defect of the vertebral bodies without protrution of the spinal cord or meninges. The defect is usually invisible. It is often benign and asymptomatic. The defect is located in the lumbosacral area and there may be noticeable dimpling, abnormal patches of hair or discoloration of the skin at the defect site. • Meningocele- it is less severe form of spina bifida cystica, which occurs when the meninges herniates through a defect in the vertebrae. If the skin covering the sac is intact and the child has normal neurologic functioning, surgical correction may be delayed. However, as in a child with myelomeningocele, immediately report any evidence of leaking cerebrospinal fluid (CSF) to ensure prompt intervention to prevent infection. Nursing management will be supportive. • Myelomeningocele- the most severe form of neural tube defect. In myelomeningocele, the spinal cord often ends at the point of the defect, resulting in absent motor and sensory function beyond that point. Therefore, the long-term complications of paralysis, orthopedic deformities, and bladder and bowel incontinence are often seen in children with myelomeningocele. The presence of neurogenic bladder and frequent catheterization puts the child at an increased risk for urinary tract infections, pyelonephritis, and hydronephrosis, which may result in long-term renal damage if managed inappropriately. Due to the improper development and the downward dis-placement of the brain into the cervical spine, CSF flow is blocked, resulting in hydrocephalus. The lower the deformity is on the spine, the lower the risk of developing hydrocephalus. Due to frequent catheterizations, these children are at an increased of developing latex allergy. Use only latex-free catheters and gloves for catheterization of children with myelomeningocele and/or neurogenic bladder, as these children exhibit a high incidence of latex allergy. 11.Anaphylactic reaction- risk factors: Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life- threatening. In addition to nuts, shelfish, eggs, and bee or wasp stings, drugs such as penicillin and NSAIDs, radiopaque dyes, and latex are the leading causes of anaphylaxis. The reaction is severe and usually starts within 5 to 10 minutes of exposure, though delayed reactions are possible. • Therapeutic management focuses on assessment and support of the airway, breathing, and circulation. Epinephrine is usually required, and intramuscular or intravenous diphenhydramine is used secondarily. Late-onset reactions can be prevented with corticosteroids. 12.Intraoperative anaphylaxis- ABC 13.Myasthenia gravis- all s/s • Myasthenia gravis is an autoimmune disease that may be inherited as a rare genetic disease, may be acquired by infants born to mothers with myasthenia gravis, or may develop later in childhood. • The acetylcholine receptor at the neuromuscular junction is affected, inhibiting normal neuromuscular transmission. The result is progressive weakness and fatigue of the skeletal muscles. Signs and symptoms ✓ Fatigue and weakness; difficulty chewing, swallowing, or holding up the head; or pain with muscle fatigue. In the verbal child, note complaints of double vision. Observe the child for ptosis (droopy eyelids) or altered eye movements from partial paralysis. The neonate may display inadequate suck, weak cry, droppy extremities, and, possibly, respiratory insufficiency. Note increased work of breathing. Laboratory testing may involve the edrophonium (Tensilon) test, in which a short-acting cholinesterase inhibitor is used. ✓ Signs and symptoms of myasthenic crisis include severe muscle weakness, respiratory difficulty, tachycardia, and dysphagia. Signs and symptoms of cholinergic crisis include severe muscle weakness, sweating, increased salivation, bradycardia, and hypotension. 14.Care for child with spinal cord injury ▪ Immobilization of the spine is essential until full evaluation of the injury is complete and spinal cord damage is ruled out. Promote bladder and bowel elimination; promote adequate nutrition; prevent complications such as contractures, atrophy etc; and provide pain management. ▪ Additional education topics include bicycle, sports, and recreation safety; prevention of falls; violence prevention including gun safety; and water safety, including the risk of diving. This education can help decrease the incidence of spinal cord injury in children 15.Hydralazine- vasodilating agent Lioresal (Baclofen) central-acting muscle relaxant- don’t stop abruptly, lidocaine- anesthetic agent, Inderal (propranolol)- betablocker. 16.Cerebral palsy- implications and teaching ❖ Cerebral palsy is a term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function. The majority of causes occur before delivery, but can also occur in the natal and postnatal periods. ❖ Primary signs include motor impairments such as spastiicty, muscle weakness, and ataxia, which is lack of coordination of muscle movements during voluntary movements such as walking or picking up objects. Complications include mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus. ❖ Children known to have cerebral palsy are often admitted to the hospital for corrective surgeries or other complications of the disease, such as aspiration pneumonia and urinary tract infections. dislocation, meaning that the acetabulum is not fully seated within the hip joint. ✓ A higher-pitched “click” may occur with flexion or extension of the hip. When assessing for DDH, do not confuse this benign, adventitial sound with a true “clunk.” ✓ A) Assess for asymmetry of thigh and gluteal folds. (B) Assess for unequal knee height related to femur shortening. (C) Notelimitation in hip abduction. (D) Positive Trendelenburg sign: note pelvis/hip drops when leg is raised. (E) Feel for “clunk” when adduction and depression of femur dislocates hip (Barlow’s test). Assess for “clunk” when the dislocated hip is abducted and relocated (Ortolani sign). ✓ CARING FOR A CHILD IN A PAVLIK HARNESS • Do not adjust the straps without checking with the physician or nurse practitioner first.• Until your physician or nurse practitioner instructs you to take the harness off for a period of time each day, it must be used continuously (for the first week or sometimes longer).• Change your baby’s diaper while he or she is in the harness.• Place your baby to sleep on his or her back.• Check skin folds, especially behind the knees and diaper area, for redness, irritation, or breakdown. Keep these areas clean and dry. Once the baby is permitted to be out of the harness for a short period, you may bathe your baby while the harness is off.• Long knee socks and an undershirt are recommended to prevent rubbing of the skin against the brace.• Note location of the markings on the straps for appropriate placement of the harness.• Wash the harness with mild detergent by hand and air dry. If using the dryer, use only the air fluffing setting (no heat).• Call the doctor if:• Your baby’s feet are swollen or bluish.• The harness appears too small.• Skin is raw or a rash develops.• Your baby is unable to actively kick his or her legs. 21.Different forms of scolosis- Scoliosis is a lateral curvature of the spine that exceeds 10 degrees. ➢ Idiopathic- Unknown cause Infantile: occurs in the first 3 years of life Juvenile: diagnosed between age 4 and 10 years, or prior to adolescence. Adolescent: age 11 to 17 years ➢ Neuromuscular- Associated with neurologic or muscular disease such as cerebral palsy, myelomeningocele, spinal cord tumors, spinal muscular atrophy, muscular dystrophies ➢ Congenital- Results from anomalous vertebral development 22.Tineas- capitis- all and areas, treatments and education Disorder Findings Treatment Tinea corporis (ring Annular lesion with Topical antifungal cream worm) raised peripheral scaling is required for at least 4 and central clearing weeks. (looks like a ring) Tinea capitis Patches of scaling in the Oral griseofulvin for 4 to scalp with central hair 6 weeks.• Selenium loss• Risk of kerion sulfide shampoo may be development (inflamed, used to decrease boggy mass that is filled contagiousness (adjunct with pustules) only).• No school or day care for 1 week after treatment initiated. Tinea versicolor Superficial tan or Apply selenium sulfide hypopigmented oval shampoo all over body scaly lesions, especially (from face to knees) on upper back and and allow to stay on chest and proximal skin overnight, rinsing in arms• More noticeable the morning, once a in the summer with week for 4 weeks (this tanning of unaffected may cause skin areas irritation).• Topical antifungals in the imidazole family may be used instead. Tinea pedis (athlete’s Red, scaling rash on Topical antifungal foot) soles and between the cream, powder, or toes spray.• Appropriate foot hygiene. Tinea cruris Erythema, scaling, Topical antifungal maceration in the preparation for 4 to 6 inguinal creases and weeks. inner thighs (penis/scrotum spared) Nursing implications: Comfort measures, such as antipyretics and antipruritics• Air-borne and contact precautions in the hospitalized child for a minimum of 5 days after onset of rash and as long as vesicular lesions are present• For those with exposure to susceptible persons, air-borne and contact precautions, from 8 to 21 days after exposure• Children may return to school or child care once lesions have crusted. • Mumps- Mumps, a contagious disease caused by Paramyxo-virus, is characterized by fever and parotitis (inflammation and swelling of the parotid gland). Mumps is spread via contact with infected droplets. • Roseola – caused by HSV-6 -Prodromal phase: usually asymptomatic but may include upper respiratory signs• Clinical illness: high fever ranging from 37.9°C to 40°C (101°C to 106°F) for 3 to 5 days; resolves abruptly; rash appears 12 to 24 hours later, lasting about 1 to 3 days. Rash is pinkish red, flat or raised spots that blanch when touched Nursing management:- Comfort measures, such as antipyretics, antipruritics• Standard precautions are sufficient in the hospitalized child. • Fifth diseases- s/s and causes Caused by human parvovirus B19• Transmitted by large droplet spread from nasopharyngeal viral shedding or percutaneous exposure to blood and blood products. Also transmitted from mother to fetus Nursing management Comfort measures, such as antipyretics, antipruritics• Droplet precautions are required in the hospitalized child.• Inform pregnant women (including health care workers) of the potential risks to the fetus and preventive measures to decrease these risks (strict infection control practices, not caring for those likely to be contagious). The CDC does not recommended routine exclusion from a workplace where an outbreak is occurring. 28.Pertussis- nursing measures Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The highest incidence is seen in children younger than 1 year of age, and children younger than 6 months of age are at greatest risk for severe disease and death Nursing management Nursing care will focus on providing a high-humidity environment and frequent suctioning to mobilize secretions. Observe for signs of airway obstruction. Encourage fluids to keep secretions thin and maintain adequate hydration. Offer reassurance to the child and family; the coughing episodes can be very frightening. Droplet precautions along with standard precautions are necessary for the hospitalized child. 29.Communicable diseases- rubella- , caused by rubella virus• Transmitted by direct or indirect contact with droplets. Nursing management Maternal rubella during pregnancy can result in miscarriage, fetal death, or congenital malformations. Comfort measures such as antipyretics, antipruritics, and analgesics for joint pain• Droplet precautions for the duration of the illness in the hospitalized child• Avoid exposure to pregnant women. 30. scarlet fever- precautions for them- Scarlet fever is an infection resulting from group A streptococci. It usually occurs with a group A streptococci throat infection (i.e., strep throat). ➢ Symptoms of scarlet fever begin abruptly. The health history may reveal a fever greater than 101°F, chills, body aches, loss of appetite, nausea, and vomiting. Inspect the pharynx, which is usually very red and swollen. The tonsils may have yellow or white specks of pus, and cervical lymph nodes may be swollen. Inspect the skin for the most striking symptom of scarlet fever, which is an erythematous rash appearing on the face, trunk, and extremities. The rash is typically absent from the palms and soles of the feet. ➢ Early in the illness the tongue develops a thick coat with a strawberry appearance. The tongue will later lose the coating and become bright red ➢ Encourage fluid intake to maintain adequate hydration due to fever. Teach parents ways to provide com-fort for the child. A cool mist humidifier can soothe the child’s sore throat. Soft foods, warm liquids like soup, or cold foods like Popsicles may also be helpful. If the child is hospitalized, droplet precautions, along with standard precautions, are necessary 31.Blood borne pathogens- Hep B, C, HIV- standard precaution 32.Lymes diseases- caused by a tick.- bulls-eye rash- Borrelia burgdorferi Rocky mountain spotted fever- caused by a bacteria- carrying tick (Rickettsia ricketsi) 33.PID -Pelvic inflammatory disease is an inflammation of the upper female genital tract and nearby structures. The fallopian tubes, ovaries, or peritoneum may be involved, and endometriosis may also be present. The most common causes of PID are Chlamydia trachomatis and Neisseria gonorrhoeae, 34.Mannitol – Osmotic diuretic- Increase plasma osmolality, therefore inducing diffusion back into plasma and extravascular space/reduces ICP. 35.Select all- neurologic assessment- postures- decorticate, decerebrate ➢ The Pediatric Glasgow Coma Scale is a popular scale used to standardize degree of consciousness. It consists of three parts: eye opening, verbal response, and motor response ➢ A) Decorticate posturing occurs with dam-age of the cerebral cortex and includes adduction of the arms, flexion at the elbows with arms held over chest, and flexion of the wrists with hands fisted. Lower extremities are adducted and extended. (B) Decerebrate posturing occurs with damage to the midbrain and includes extension and pronation of the arms and legs. 36.Types of seizures- epilepsy, daydreaming- interventions ✓ Absence (formerly petit mal) Type of generalized seizure; occurs more frequently in girls than boys. Uncommon before age 5 Sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. Complex absence seizure consists of myoclonic movements of the face, fingers, or extremities and possible loss of body tone. Lasts less than 30 seconds. Child may experience countless seizures in a day. Not associated with a postictal (after seizure) state. May go unrecognized or mistaken for inattentiveness because of subtle change in child’s behavior ✓ Tonic-clonic (formerly grand mal ) :Extremely common generalized seizures. Most dramatic seizure type Associated with an aura. Loss of consciousness occurs and may be preceded by a piercing cry. increased intracranial pressure, such as vomiting, which may indicate CNS involvement. 48.what goes into peripheral blood stem cell transplant Peripheral blood stem cell transplantation is a new technique in which stem cells are obtained from a patient's blood and used in bone marrow transplantation. The stem-cell preparation is infused into a vein and, once there in the blood stream, the stem cells act like homing pigeons and head straight for the bone marrow space. • Before the transplant is done, the patient receives high-dose chemotherapy and/or radiation therapy to destroy diseased cells (the leukemic cells, lymphoma cells, solid tumor cells, the diseased immune system cells in scleroderma, etc.) The stem cells are then returned to the patient, where they can produce new blood and immune cells and replace the cells destroyed by the treatment. 49.total body radiation and bone marrow transplant- select all • Radiation causes damage to the cells in a localized area, which may include normal cells in addition to the cancerous ones. • Assess the child’s skin daily, particularly at the treatment site. • Provide good hygiene, but perform this care gently. Encourage moisture retention in the skin by applying aqueous creams or moisturizers. • Do not apply deodorants or perfumed lotions on the radiation treatment site. • Avoid the use of heat or ice packs at the site. • Instruct the child and family that clothing should fit loosely so as not to irritate the site. • During, and for 8 weeks after, the radiation treatment, the skin will be more photosensitive. • Explain the importance of protecting the skin with a high-SPF (30 or above) sunscreen. 50.different between a graft and host disease with acute myeloid leukemia and bone marrow transplant The posttransplant phase is also a time of high risk for the child. Monitor closely for symptoms of GVHD such as severe diarrhea and maculopapular rash progressing to redness or desquamation of the skin (especially palms or soles). If GVHD occurs, administer immunosuppressive drugs such as cyclosporine, tacrolimus, or mycophenolate (which place the child at further risk for infection) 51.Retinoblastoma- it is a congenital, highly malignant tumor that arises from embryonic retinal cells. It accounts for 5% of cases of blindness in children. Retinoblastoma may be hereditary or nonhereditary. ✓ Complications include spread to the brain and the opposite eye, as well as metastasis to lymph nodes, bone, bone marrow, and liver. Secondary tumors, most often sarcomas, may also occur in children who have been treated for retinoblastoma. ✓ The goals of treatment are to eradicate the tumor, preserve vision, and provide a good cosmetic outcome. Retinoblastoma may be treated with radiation, chemotherapy, laser surgery, cryotherapy, or a combination of these treatments. ✓ Parents are often the first to notice the “cat’s eye reflex” or “whitewash glow” to the child’s affected pupil. Obtain the health history, determining when other associated symptoms such as strabismus, orbital inflammation, vomiting, or headache began. ✓ If the eye is enucleated, observe the large pressure dressing on the eye socket for bleeding. Dressing changes to the socket may include sterile saline rinses and/or antibiotic ointment application. If disease occurs outside of the eye or if metastasis is present, inform the parents that chemotherapy will be necessary. 52.Testicular cancer-to get into the habit of screening for testicular lumps, encourage adolescent boys to begin performing testicular self- examinations monthly • TESTICULAR SELF-EXAMINATION• Perform the examination once a month, after a shower.• Be familiar with the size and weight of your testicles.• Roll the testicle between your fingers. The small rope-like structure is the epididymis; this is normal.• Report any lump, swelling, or heaviness of one testicle to your physician or nurse practitioner. 53.Wilm’s tumor- Wilms tumor is the most common renal tumor and the fourth most common solid tumor in children. It usually affects only one kidney. • Elicit the health history, noting when the mass was discovered. Note abdominal pain, which may be related to rapid tumor growth. Document history of constipation, vomiting, anorexia, weight loss, or difficulty breathing. Determine risk factors such as hemihypertrophy of the spine, Beckwith-Wiedemann syndrome, genitourinary anomalies, absence of the iris, or family history of cancer. • Avoid palpating the abdomen after the initial assessment preoperatively. Wilms tumor is highly vascular and soft, so excessive handling of the tumor may result in tumor seeding and metastasis. • To avoid injuring the remaining kidney, children with a single kidney should not play contact sports. 54.Sickle cell anemia - Complications of sickle cell anemia include recur- rent vaso-occlusive pain crises, stroke, sepsis, acute chest syndrome, splenic sequestration, reduced visual acuity related to decreased retinal blood flow, chronic leg ulcers, cholestasis and gallstones, delayed growth and development, delayed puberty, and priapism (the sickled cells prevent blood from flowing out of an erect penis). • The therapeutic management of children with sickle cell anemia focuses on preventing sickling crisis and infection as well as other complications. • Treatment of sickle cell crisis focuses on pain control. Oxygen administration is necessary during episodes of crisis to prevent additional cell sickling. Adequate hydration with intravenous fluids is critical. Close monitoring of Hgb, Hct, and reticulocytes determines the point at which transfusion of packed red blood cells becomes necessary. Electrolyte analysis is also necessary to ensure that appropriate amounts of electrolytes are present in the serum. When RBCs are administered, there is the potential for hemolysis of the cells, thus increasing the potassium level in the serum. Antibiotic therapy is necessary when infection is present. • Immediately report symmetric swelling of the hands and feet in the infant or toddler. Termed dactylitis, aseptic infarction occurs in the metacarpals and metatarsals. Occurrence before age 1 year is predictive of severity of illness • Test for chromosomal abnormality, neural tube defects, or specific genetic conditions of the fetus. Performed if considered high risk for a genetic disorder or abnormal ultrasound. Most common prenatal test used to diagnose chromosomal and congenital anomalies. 66. Kleinefelter’s syndrome ✓ Klinefelter syndrome is the most common sex chromosomal abnormality. ✓ Males present with some female-like physical features that are caused by testosterone deficiency. 67. Neurofibromatosis- Albrights disease- Neurofibromatoses are neurocutaneous genetic disorders of the nervous system that primarily affect the development and growth of neural cell tissues. If more than six café-au-lait spots are present, neurofibromatosis should be suspected ✓ CLINICAL SIGNS OF NEUROFIBROMATOSIS :Diagnosis is made if two or more of the following are present:• Six or more café-au-lait macules (light brown spots) >5 mm in diameter in children and >15 mm in diameter in adolescents and adults• Two or more neurofibromas (benign tumors) or one plexiform neurofibroma (tumor that involves many nerves)• Freckling in the armpit or groin• Presence of an optic glioma (a tumor on the optic nerve)• Two or more growths on the iris of the eye (Lisch nodules or iris hamartomas)• Abnormal development of the spine (scoliosis), the temple bone of the skull, or the tibia• A first-degree relative (parent, sibling, or child) with neurofibromatosis 68. Mafan’s syndrome- it is a disorder of the connective tissue ➢ Autosomal dominant inheritance; caused by a mutation in the gene fibrillin-1, which results in changes in connective tissue ➢ Signs and symptoms include: Tall stature with long slim limbs, minimal subcutaneous fat, muscle hypotonia, loose joints, long and narrow face, abnormalities of skeletal system (e.g., pectus excavatum [funnel chest] or pectus carinatum [pigeon breast]), ocular system (e.g., enlarged cornea or lens subluxation), and cardiovascular system (e.g., dilation of the aorta or mitral valve prolapse)Delayed achievement of gross and fine motor milestones may occur 69. ADHD- DIAGNOSIS OF ATTENTION DEFICIT/HYPERACTIVITY DISORDER (Ritalin is first line of treatment) Presence of six or more of the following: • Failure to pay close attention • Careless mistakes on schoolwork • Difficulty paying attention to tasks or play • Doesn’t listen • Doesn’t follow through • Doesn’t complete tasks • Doesn’t understand instructions • Poorly organized • Avoids, dislikes, or fails to engage in activities requiring mental effort • Loses things needed for task completion • Easily distracted • Forgetful Presence of six or more of the symptoms of hyperactivity or impulsivity: • Fidgety or squirmy • Often out of seat • Activity inappropriate to the situation • Cannot engage in quiet play • Always on the go • Talks excessively • Blurts out answers • Has difficulty waiting his or her turn• Often interrupts or intrudes on others. 70. FAS- FETAL ALCOHOL SYNDROME • Results from in utero alcohol exposure • Typical facial features include low nasal bridge with short upturned nose, flattened midface, long philtrum with narrow upper lip • Poor coordination, skeletal abnormalities • Microcephaly • Failure to thrive • Hearing loss 71. Oppositional defiant disorder • Excessive arguing with adults • Frequent temper tantrums • Active defiance • Revenge-seeking behaviors • Frequent resentment or anger • Touchiness; easily annoyed • Noncompliance with adult requests or limits • Blaming of others for misbehavior or mistakes 72.Burns 73. Substance abuse in adolescence- education, priorities 74. Select all- adolescence suicide- 3rd cause of death in adolescent. Promote safety 75. Tourette’s disorders - Tourette syndrome consists of multiple motor tics and one or more vocal tics occurring either simultaneously or at different times. Children are not tic-free for longer than 3 months. Tics are defined as sudden rapid recur-rent stereotypical movements and/or sounds over which the child appears to have no control. 76. Cognitive disorder, dyslexia, dyscalculia ✓ Children with dyslexia have difficulty with reading, writing, and spelling. ✓ Children with dyscalculia have problems with mathematics and computation. ✓ Children with dyspraxia have problems with manual dexterity and coordination. ✓ Children with dysgraphia have difficulty producing the written word (composition, spelling, and writing). 77. Eating disorders- Eating disorders include pica, rumination, anorexia nervosa, and bulimia 78. Severe depression and what neurotransmitters that are affected- and medications target site- serotonin 79. Know ABCs 80. s/s and teaching for a child with respiratory distress syndrome The onset of RDS is usually within several hours of birth. The newborn exhibits signs of respiratory distress, including tachypnea, retractions, nasal flaring, grunting, and varying degrees of cyanosis. Auscultation reveals fine rales and diminished breath sounds. If untreated, RDS progresses to seesaw respirations, respiratory failure, and shock. 89. Initial newborn assessment- v/s – HR=, APGAR scores, acrocyanosis 90. Stages of cancer- terminal cancer- select all 91. Math 2 92. Anemia- Fe- select all ✓ For appropriate growth to occur in adolescence, increased amounts of iron must be consumed and absorbed. ✓ Observe the child for fatigue and lethargy. Inspect the skin, conjunctivae, oral mucosa, palms, and soles for pallor. Note spooning of the nails (concave shape). Obtain a pulse oximeter reading. ✓ Educate on dietary sources of iron; such as green leafy vegetables 93. Immunities types- natural, active, acquired • Passive immunity is produced when the immunoglobulins of one person are transferred to another. This immunity lasts only weeks or months. Passive immunity can be obtained by injection of exogenous immunoglobulins. It can also be transferred from mothers to infants via colostrum or the placenta. • Active immunity is acquired when a person’s own immune system generates the immune response. Active immunity lasts for many years or for a lifetime. 94. Otitis media- due to short and widened Eustachian tube in children The most common complications of AOM include:• Hearing loss• Expressive speech delay• Tympanosclerosis (scarring of the tympanic membrane; usually has no effect on hearing)• Tympanic membrane perforation (acute with resolution or chronic)• Chronic suppurative otitis media (chronic drainage via perforation or tympanostomy tubes)• Acute mastoiditis (infection of the mastoid process)• Intracranial infections, including bacterial meningitis and abscesses 95. Vision problems, • Astigmatism- In astigmatism the cornea’s curvature is uneven, which results in an irregular quality of vision because the light rays are refracted unevenly. Sometimes the lens is irregularly shaped, having the same result. • strabismus - Strabismus refers to misalignment of the eyes. Therapeutic management of strabismus may include patching of the stronger eye or eye muscle surgery. Corrective lenses are also used for strabismus. Complications of strabismus include amblyopia and visual deficits. 96. Cystic fibrosis- cystic fibrosis is an autosomal recessive disorder The epithelial cells fail to conduct chloride, and water transport abnormalities occur. This results in thickened, tenacious secretions in the sweat glands, gastrointestinal tract, pancreas, respiratory tract, and other exocrine tis-sues. The increased viscosity of these secretions makes them difficult to clear. The sweat glands produce a larger amount of chloride, leading to a salty taste of the skin and alterations in electrolyte balance and dehydration • Management of cystic fibrosis focuses on minimizing pulmonary complications, promoting growth and development, and facilitating coping and adjustment by the child and family. 97. Asthma- select all- priorities and actions Asthma is a chronic inflammatory airway disorder characterized by airway hyperresponsiveness, airway edema, and mucus production. ▪ Current goals of medical therapy are avoidance of asthma triggers and reduction or control of inflammatory episodes. ABC 98.Ventricular septal defects- select all