Pregnancy Risk:

Infections TORCH TO

Toxoplasmosis Transmitted Through Raw Meat Or Cat Litter Can Cause

Spontaneous Abortion In 1st Trimester

Pregnancy Risk:
Rubella (German Measles) Teratogenic (Causing Malformations) In 1st
Infections TORCH - R Trimester Congenital Defects Of Eyes, Heart, Ears, And Brain If Not
Immune (Titer Less Than 1:8), Vaccinate In Postpartum Wait 1 - 3 Months
Before Becoming Pregnant
Pregnancy Risk:
Cytomegalovirus Low Birth Weight Intrauterine Growth Restriction
Infections TORCH - C Enlarged Liver And Spleen Jaundice Blindness Hearing Loss Seizures
Pregnancy Risk:
Infections TORCH H

Herpes Simplex Virus Vaginal Examinations If Active Herpes Lesions Are

Present C-Section If Lesions Are Visible Contact Precautions

Maternity: Once
Membranes Have
Broken...

The Baby Should Be Delivered Within 24 Hours, Otherwise Chorioamnionitis

Can Occur.

Process Of Labor:
Four P's

Four Major Factors That Interact During Normal Childbirth; They Are
Interrelated And Depend On Each Other For A Safe Delivery Powers
Passageway Passenger Psyche

Process Of Labor:
Four P's - Powers

Uterine Contractions 1. Forces Acting To Expel The Fetus 2.

Effacement: Shortening And Thinning Of The Cervix During The 1st Stage Of
Labor 3. Dilation: Enlargement Of Cervical Os And Canal During 1st Stage
Of Labor 4. Pushing Efforts Of Mother During 2nd Stage

Process Of Labor:
Four P's Passageway

The Mother's Rigid Bony Pelvis And The Soft Tissues Of The Cervix, Pelvic
Floor, Vagina, And Introitus (External Opening To The Vagina)

Process Of Labor:
Four P's Passenger

The Fetus, Membranes, And Placenta

Process Of Labor:
Four P's - Psyche

A Woman's Emotional Structure That Can Determine Her Entire Response To

Labor And Influence Physiological And Psychological Functioning; The
Mother May Experience Anxiety Or Fear.

Process Of Labor:
Attitude

Normal Intrauterine Attitude Is Flexion, In Which The Fetal Back Is Rounded,

The Head Is Forward On The Chest, And The Arms And Legs Are Folded In
Against The Body. The Other Attitude, Extension, Tends To Present Larger
Fetal Diameters.

Process Of Labor:
Lie

Relationship Of The Spine Of The Fetus To The Spine Of The Mother

Longitudinal/Vertical- Fetal Spine Is Parallel To Mothers And In Breech Or
Cephalic Presentation Transverse/Horizontal - Fetal Spine Is At A Right
Angle/Perpendicular, To Mother's Spine, Presenting Part Is The Shoulder,
Delivery By C-Section Is Necessary

Process Of Labor:

Portion Of Fetus That Enters The Pelvic Inlet First Cephalic: Head First,

Presentation

Most Common, And Has Four Variations (Vertex, Military, Brow, And Face)
Breech: Buttock's First, C-Section May Be Required, Three Variations (Frank,
Full "Complete", And Footling) Shoulder: Fetus In Transverse Lie, Or Arm,
Back, Abdomen, Or Side Could Present, C-Section May Be Required If Fetus
Does Not Turn Or Cannot Be Manually Turned

Process Of Labor:
Position

ROA (Facing Left Of Mothers Spine) LOA (Facing Right Of Mother Spine)
ROP (Facing Left Side Of Mothers Stomach) LOP (Facing Right Side Of
Mothers Stomach)

Process Of Labor:
Station

Station 0: At Ischial Spine Minus Station: ABOVE Ischial Spine (Still Up

There) Plus Station: BELOW Ischial Spine (On Its Way Out)
Engagement: Widest Diameter Of Presenting Part Has Passed The Inlet;
Usually Corresponds To A 0 Station

Mechanisms Of
Labor: KNOW THE
ORDER!!!

KNOW THE ORDER!!! ED FIEREE (Think Of How The Scottish Would Say
Fury) E-Ngagement D-Escent F-Lexion I-Nternal Rotation E-Xtension REstitution E-Xternal Rotation E-Xpulsion

Mechanisms Of
Labor: Order With
Explanation

Engagement This Is Also Called Lightening Or Dropping The Fetus

Nestles Into The Pelvis Descent This Process Starts From The Time Of
Engagement Until Birth And Is Assessed By The Station. The Fetal Head
Undergoes As It Begins Its Journey Through The Pelvis. Flexion The Fetal
Head's Nodding Forward Toward The Fetal Chest While Descending
Through The Pelvis, The Fetal Head Flexes So That The Fetal Chin Is
Touching The Fetal Chest. This Functionally Creates A Smaller Structure To
Pass Through The Maternal Pelvis Internal Rotation With Further
Descent, The Occiput Rotates Anteriorly And The Fetal Head Assumes An
Oblique Orientation. In Some Cases, The Head May Rotate Completely To
The Occiput Anterior Position. Extension It Begins After The Head Crowns
This Means That The Fetal Chin Is No Longer Touching The Fetal Chest. It
Enables The Head To Emerge When The Fetus Is In A Cephalic Position The
Extension Of Labor Is Completed When The Head Passes Under The
Symphysis Pubis And Occiput And The Anterior Fontanel, Brow, Face And
Chin Pass Over The Sacrum And Coccyx And Are Over The Perineum
Restitution After The Head Emerges, The Fetal Head Becomes In A
Realignment External Rotation The Shoulder Of Fetus Externally Rotates
After Head Emerging And Restitution The Shoulder Is In The
Anteroposterior Diameter Of The Pelvis. Expulsion This Is The Birth Of
Entire Body.

Mechanisms Of
Engagement: Lightening Or Dropping Descent: Assessed By The
Labor: Engagement Station Flexion: Nodding Of The Fetal Head Forward Toward The Fetal
- Expulsion
Chest Internal Rotation: Internal Rotation Of The Fetus From The LOT Or
ROT Position At Engagement Extension: Begins After The Head Crowns
And Is Complete When The Head Passes Over The Perineum Restitution:
Realignment Of The Fetal Head With The Body After The Head Emerges
External Rotation: Shoulders Externally Rotate So That They Are In The
Anterioposterior Diameter Of The Pelvis Expulsion: Birth Of The Entire
Body

Mechanisms Of
Labor: Nesting, True
Labor, And False
Labor

Nesting: Sudden Burst Of Energy 24 - 48 Hours BEFORE Onset Of Labor

True Labor: Contractions Occur Regularly, Become Stronger, Last Longer,
And Occur Closer Together; May Manifest As Back Pain And Resemble
Menstrual Cramps; Dilation, Effacement, And Descent Occur False Labor:
Dilate, Efface, Or Descend; Contractions Are Irregular, Without
Progression; Walking Often Stop Contractions Or Pain

Leopold's
Maneuvers

Palpation To Determine Presentation And Position Of The Fetus And Aid In

Location Of Fetal Heart Sounds. Head=Hard, Round, Movable Object
Buttocks=Soft And Irregular Shape Back=Smooth, Hard Surface Felt On
One Side Of The Abdomen Irregular Knobs And Lumps On Opposite Side Of
Abdomen May Be Hands, Feet, Elbows, And Knees

Fetal Monitoring

Baseline FHR Is Measured Between Contractions Normal FHR Is 120 160 Bpm Internal Fetal Monitoring: Client Must Be Dilated 2 To 3 Cm
To Perform Fetal Bradycardia: FHR <120 Bpm For 10 Minutes Or Longer
Fetal Tachycardia: FHR >160 Bpm For 10 Minutes Or Longer If Fetal
Bradycardia Or Tachycardia Change The Position Of The Mother, Give
O2, And Assess The Mothers Vital Signs, Then Notify The Physician

Variability

Decrease Variability Can Result From Fetal Hypoxemia, Acidosis, Or

Certain Medications Absent Or Undetected Variability Is
Nonreassuring A Temporary Decrease May Occur If Fetus Is In A
Sleep State (Does Not Usually Last Longer Than 30 Minutes)

Accelerations

Brief, Temporary Increases In FHR Of At Least 15 Beats More Than Baseline

And Lasting At Least 15 Second- (Same Parameters As Nonstress Test)

Early Decelerations Decreases In FHR Below Baseline; The Rate At The Lowest Point Of The
Deceleration Usually Remains Greater Than 100 Bpm Occur During
Contractions As The Fetal Head Is Pressed Against The Mothers Pelvis
Tracing Shows A Uniform Shape And Mirror Image Of Uterine Contractions
NOT Associate With Fetal Compromise And Requires No
Intervention
Late Decelerations

Nonreassuring Patterns That Reflect Impaired Placental Exchange

Or Uteroplacental Insufficiency Interventions Include Improving
Placental Blood Flow And Fetal Oxygenation

Variable
Decelerations

Restrict Flow Through The Umbilical Cord The Shape, Duration,

And Degree Of Decline Below The Baseline FHR Are Variable; These Fall And
Rise Abruptly With The Onset And Relief Of Cord Compression

VEAL CHOP FLOP

V-Ariable Decels C-Ord Compression E-Arly Decels H-Ead Compression, Okay

A-Ccelerations O-Kay!!! L-Ate Decels P-Lacental Insufficiency Placental
Insufficiency: F-Luids L-Ateral Position O-Xygen, O2 On P-Itocin Off

Four Stages Of
Labor: Stage 1

Effacement And Dilation Of Cervix Three Stages - Latent, Active, And

Transition Mother Is Talkative And Eager In Latent Phase, Becoming Tired,
Restless, And Anxious As Labor Intensifies And Contractions Become
Stronger Assess FHR Before, During, And After Contractions, Noting That
The FHR Is Between 120-160 Bpm Assess The Color Of The Amniotic Fluid

If The Membranes Have Ruptured Because Meconium Stained Fluid Can

Indicate Fetal Distress
Four Stages Of
Labor: Stage 1, 3
Phases

3 Phases: Latent, Active, Transition Latent: Longest Phase, Dilation 1-4 Cm,
Contractions Every 15 To 30 Min, 15 To 30 Sec In Duration, Mild Intensity
Active: Dilation 4-7 Cm, Contractions Every 3 To 5 Min, 30 To 60 Sec In
Duration, Moderate Intensity Transition: Dilation 8-10 Cm, Contractions
Every 2 To 3 Min, 45 To 90 Sec In Duration, Strong Intensity

Four Stages Of
Labor: Stage 2

Expulsion Of Fetus Pushing Stage Mother Has Intense Concentration

On Pushing With Contractions; May Fall Asleep Between Contractions

Four Stages Of
Labor: Stage 3

Separation Of Placenta Expulsion Of Placenta Mother Is Relieved After

Birth Of Infant; Mother Is Usually Very Tired Contractions Occur Until The
Placenta Is Expelled

Four Stages Of
Labor: Stage 4

Physical Recovery 1-4 Hr After Expulsion Of Placenta Mother Is Tired,

But Eager To Become Acquainted With Her Newborn BP Returns To
Prelabor Level HR Is Slightly Lower Than During Labor Fundus Remains
Contracted, In The Midline, 1 Or 2 Fingerbreadths BELOW The Umbilicus
Monitor Lochia Discharge. Lochia May Be Moderate In Amount And Red In
Color

Anesthesia: Lumbar Injection In The Epidural Space At L3 To L4 May Cause Hypotension,

Epidural Block
Bladder Distention, And A Prolonged Second Stage
Anesthesia:
Subarachnoid
(Spinal) Block

Injection In The Spinal Subarachnoid Space At L3 To L5 May Cause

Postpartum Headache, Hypotension Mother Must Lie Flat For 8 To 12 Hrs
After Spinal Injection

External Version

Turning Of Fetus From An Abnormal Position Into A Normal Presentation

Indicated For An Abnormal Presentation That Exists After Week 34 IV
Fluids And Tocolytic Therapy To Relax The Uterus And Permit Easier Turning
Of Fetus US Is Used During Procedure Abdominal Wall Is Manipulated To
Turn And Direct The Fetus After Procedure: Nonstress Test, Assess For
Bleeding, Rupture Of Membranes

Episiotomy

Relieve Pain Ice Packs During First 24 Hrs Sitz Baths Analgesic Spray
Or Ointment Perianal Pad Perineal Care, Using Clean Technique, Wipe
Front To Back, And Blot/Pat Area Rather Than Wipe

Cesarean Delivery
Postoperative

Vital Signs Pain Relief Encourage Turning, Coughing, And Deep

Breathing Ambulate Burning And Pain On Urination May Indicate Bladder
Infection A Tender Uterus And Foul-Smelling Lochia May Indicate
Endometritis A Productive Cough Or Chills May Indicate Pneumonia Pain,
Redness, Or Edema Of An Extremity May Indicate Thrombophlebitis

Problems With L&D: Fetal Heart Monitor Shows: Variable Decelerations Or Bradycardia After
Prolapsed Umbilical Rupture Of Membranes. Place In Trendelenburg, Modified Sims, Or KneeCord
To-Chest Position Give O2 Stay With Client And Ask Other Nurse To Get
Physician Use Two Gloved Fingers To Apply Pressure To The Cervix And
Lifting Upward On The Presenting Part If Umbilical Cord Is Felt DO NOT

Remove Fingers Until Physician Says To, Which May Be While Baby Is Being
Delivered
Problems With L&D: PPP=Placenta Previa Painless Placenta Is Partially Disconnected From The
Placenta Previa
Uterine Wall And The Fetus Is Not Getting Enough Oxygen Or Circulation
Sudden Onset Of Painless, Bright Red Vaginal Bleeding That Occurs In The
Last Half Of Pregnancy Uterus Is Soft, Relaxed, And Nontender Prepare
For US To Confirm The Diagnosis Do Vaginal Examinations Or Any Other
Actions That Would Stimulate Uterine Activity
Problems With L&D: Dark Red Vaginal Bleeding PAIN PAIN PAIN Uterine Tenderness And
Abruptio Placentae Rigidity Causes: Using Cocaine, 35 Years Or Older, And/Or Having Twins Or
Triplets
Problems With L&D: Placenta Accreta - Abnormally Adherent Placenta (A Placenta That
Placental
Remains Attached To The Uterine Wall Beyond The Normal Time After Birth
Abnormalities
Of The Fetus) Placenta Increta - Occurs When The Placenta Penetrates The
Uterine Muscle Itself Placenta Percreta - When The Placenta Goes All The
Way Through The Uterus Assessment: HEMORRHAGE Immediately After
Birth Because The Placenta Does Not Separate Cleanly. Intervention:
Hysterectomy If A Large Portion Of The Placenta Is Still There And Monitor
For Hemorrhage And Shock.
Problems With L&D: After 20 Weeks, But Before The 37th Week Focus On Stopping Labor
Preterm Labor
Bedrest And Lateral Position Ensure Hydration
Problems With L&D: Labor Lasting <3 Hours Have A Precipitous Delivery Tray Available
Precipitous Labor
(Hemostats, Scissors, And Cord Clamp) Try To Keep The Fetus From
And Delivery
Being Delivered Have Client 'Pant' Between Contractions Rupture
Membranes When The Head Crowns, If They Have Not Already Ruptured If
Delivery Is Necessary Before HCP Arrives, Deliver The Infant Between
Contractions, Checking For The Cord Around The Neck
Problems With L&D: Escape Of Amniotic Fluid Into The Maternal Circulation The DebrisAmniotic Fluid
Containing Amniotic Fluid Deposits In The Pulmonary Arterioles And Is
Embolism
Usually Fatal To The Mother Abrupt Onset Of Respiratory Distress And
Chest Pain Cyanosis Seizures HF And PE Give 8 To 10 L Of O2 Via
Face Mask Or AMBU Bag
Maternity: Nursing
Care In The
Postpartum Period
(BUBBLE HE)

B-Reast U-Terus B-Leeding B-Owel (Bladder) L-Ochia E-Pisiotomy (REEDA

-Redness, Edema, Ecchymosis, Drainage, Approximation- To Assess) HOman's Sign E-Motional

Postpartum:
Maternal Changes

Fundus Steadily Descends Into The Pelvis Fundal Height About 1

Fingerbreadth (1 Cm) Per Day By 10 Days Postpartum, The Uterus Cannot
Be Palpated Abdominally Flaccid Fundus = Uterine Atony = Massage Until
Firm Tender Fundus = Infection

Postpartum: Amount Scant: < 2.5 Cm (<1 Inch) On Menstrual Pad In 1 Hour Light: < 10 Cm (<4
Of Lochia
Inches) In 1 Hour Moderate: < 15 Cm (<6 Inches) In 1 Hour Heavy:
Saturated In 1 Hour Excessive: Saturated In 15 Minutes To Most Accurately

Determine Amount Weigh The Pad Before And After And Count How Many
Pad Changes There Are
Postpartum: Lochia Rubra = Bright Red, From Delivery - 3 Days Serosa = Brownish-Pink, Day 4 Color
10 Alba = White, Day 11 - 14
Postpartum: NonBreast Feeding
Mother

AVOID Nipple Stimulation Apply A Breast Binder Wear A Snug-Fitting

Bra Apply Ice Packs Mild Analgesic Engorgement Usually Resolves
Within 24 To 36 Hours After It Begins

Postpartum: Breast Continues To Secrete Colostrum For The First 3 Days Breast Become
Distended With Milk On The 3rd Day
Postpartum: GI Tract Hungry After Delivery Constipation Can Occur With A Bowel Movement
By The 2nd Or 3rd Day
Postpartum: Vital
Signs

Temp Is Elevated For The First 24 Hours From Dehydration HYDRATE

Postpartum:
Interventions With
RhoGAM

Give RhoGAM Within 72 Hours Postpartum To An Rh-Negative Client Who

Gave Birth To An Rh-Positive Infant

Postpartum:
Apply Ice Packs To The Perineum During The First 24 Hours To Reduce
Perineal Discomfort Swelling After 24 Hours, Apply Warmth With Sitz Baths
Interventions
Postpartum: Breast Encourage Use Of Ice Packs Between Feedings, Because The Breast May
Discomfort And
Leak Encourage The Use Of Warm Soaks Or A Warm Shower Before
Engorgement
Feeding
Interventions
Postpartum:
Constipation
Interventions

2000 Ml/Day High-Fiber Diet Ambulate

Postpartum: Breast - L-Atch Achieved By Infant A-Udible Swallowing T-Ype Of Nipple CFeeding LATCH
Omfort Of Mother H-Elp Given To Mother For Nursing
Postpartum: Breast - Use Soap On The Breast If Cracked Nipples, Expose To Air For 10 - 20
Feeding
Minutes After Feeding, Rotate The Position Of The Infant For Each Feeding,
And Ensure Infant Is Latched On To The Areola, Not Just The Nipple
Caloric Intake By 200 - 500 Calories Include Additional Fluids, And
Prenatal Vitamins If Prescribed
Postpartum
Complications:
Hematoma

Predisposing Complications Include Operative Delivery With Forceps And

Injury To A Blood Vessel SEVERE Pain Ice Pack On Hematoma
Analgesics Foley Cath If Client Is Unable To Void Antibiotics Because
Infection Is Common After Hematoma Prepare For Incision And Evacuation
Of Hematoma If Necessary

Postpartum
Complications:

Bleeding Of 500 ML Or More After Delivery Interventions For Signs Of

Bleeding Or Shock Is To Massage The Fundus For Uterine Atony, With Care

Hemorrhage

Not To Overmassage

Postpartum
Complications:
Mastitis

Good Handwashing Apply Heat Or Cold To Site As Prescribed Continue

To Breast Feed Manual Expression Of Breast Milk Or Breast Pump Every 4
Hours Wear A Supportive Bra Analgesics

Postpartum
Complications:
Pulmonary
Embolism S/S

Sudden Dyspnea And Chest Pain Tachypnea And Tachycardia Cough

And Lung Crackles Hemoptysis (Coughing Up Blood) Feeling Of
Impending Doom

Postpartum
Complications:
Subinvolution

Incomplete/Failure Of The Uterus To Return To Its Normal Size And Condition

Uterine Pain On Palpation Uterus Larger Than Expected More Than
Normal Vaginal Bleeding ELEVATE Legs For Venous Return Monitor H&H
Methergine - Used To Prevent Or Treat Bleeding From The Uterus That Can
Happen After Childbirth Or An Abortion, Increases The Tone, Rate, And
Amplitude Of Rhythmic Contractions

Postpartum
Complications:
Thrombophlebitis
Interventions

NEVER Massage The Leg AVOID Cross The Legs AVOID Prolonged
Sitting AVOID Constrictive Clothing AVOID Pressure Behind Knees
Know How To Apply TED Hose Give Anticoagulants (Heparin If In Femoral
Or Pelvis To Prevent Further Thrombus Formation) ELEVATE Affected Leg
HOT Packs Or Moist Heat To Affected Site Analgesics Antibiotics

Care Of The
Newborn: Initial
Care

Monitor For: Nasal Flaring Grunting Retractions Abnormal

Respirations Such As A Seesaw Respiratory Pattern

Care Of The
8 - 10: No Intervention 4 - 7: Gently Stimulate; Rub Back; Administer O2
Newborn: Apgar
0 - 3: Newborn Requires Resuscitation
Score Interventions
Care Of The
Newborn: Vitals

HR: 100 - 160 Bpm Auscultate Apical At 4th Intercostal Space For 1 Full
Minute Resp: 30 - 60 Breaths/Min BP: 73/55

Care Of The
Anterior Soft, Flat, Diamond-Shaped Closure Between 12 - 18 Months
Newborn: Fontanels Posterior Triangular; Between Occipital And Parietal Bones Closure
Between Birth And 2 - 3 Months
Care Of The
Newborn: Ears

Low Set Ears Are Associated With Down Syndrome

Care Of The
Newborn: Skin

Vernix Caseosa - Cheesy White Substance All Over Body And Between
Skin Folds Lanugo - Fine Hair, Especially On Back Milia - Small White
Sebaceous Glands On Forehead, Nose, And Chin Acrocyonosis Extremities Are Blue, Normal For First Few Hours Of Birth And Intermittently
For The Next 10 Days

Care Of The
Has 3 Vessels --- 2 Arteries And 1 Vein
Newborn: Umbilical
Cord
Care Of The

Pseudomenstration, Caused From The Withdrawal Of The Maternal Hormone

Newborn: Female
Genitals

Estrogen, Is Possible (Blood-Tinged Mucus)

Care Of The
Newborn: Male
Genitals

Testes Are Decended, But May Retract With Cold

Care Of The
Newborn: Hepatic
System

Normal Physiological Jaundice Appears After The First 24 Hours In Full-Tem

Newborns And After The First 48 Hours In Premature Newborns; Jaundice
Occuring Before This Time (Pathological Jaundice) May Indicate Early
Hemolysis Of RBCs And Must Be Reported To The Physician.

Care Of The
Given IM ,To Prevent Hemorrhagic Disorders, In The Lateral Aspect Of The
Newborn: Vitamin K Middle Third Of The Vastus Lateralis Muscle
Administration
Care Of The
Newborn: Renal
System

Monitor I/O By Weighing Diapers (1g Of Diaper Weight = 1mL Of Urine)

Assess For Dehydration (Dry Mucous Membranes, Sunken Eyeballs, Poor
Skin Turgor, Sunken Fontanels)

Care Of The
Newborn: Immune
System

Give Eye Medication Withing 1 Hour After Birth To Prevent Ophthalmia

Neonatorum

Care Of The
Wash Newborn Via Sponge Bath Until The Cord Falls Off (Within 2 Weeks)
Newborn: Cord Care
Care Of The
Newborn: Passage
Of Stool And
Meconium

Meconium - Greenish-Black, Thick, Sticky, Tar-Like, Usually Passed Within

The First 24 Hours Transitional - Greenish-Brown, Looser Than Meconium
Seedy-Yellow Stools - Noted In Breast-Fed Newborns Pale Yellow To Light
Brown Stools - Seen In Formula Fed Newborns

Care Of The
Head Size Is Proportionally Larger Than That Of An Adult Because Of Brain
Newborn:
Growth
Neurological System
Care Of The
Newborn: Thermal
Regulatory System

EVAPORATION - Dry And Well Wrapped In Blanket RADIATION - Keep

Away From Cold Objects And Outside Walls COVECTION - Shield Newborn
From Drafts CONDUCTION - Perform All Treatments On A Warm, Padded
Surface Prevent Cold Stress Newborns DO NOT Shiver To Produce Heat
Newborns Have Fat Deposits, Which Produce Heat Cold Stress Causes
Oxygen Consumption And Energy To Be Diverted From Maintaining Normal
Brain Cell Function And Cardiac Function Resulting In Serious Metabolic And
Physiological Conditions Take Temp Every 4 Hours For The First 24 Hours
And Then Every Shift

Care Of The
Touch Newborns Lip, Cheek, Or Corner Of The Mouth With A Nipple
Newborn: Reflexes - Newborn Turns Head Toward The Nipple And Opens Mouth, Takes Hold Of
Sucking And Rooting Nipple, And Sucks Disappears After 3 - 4 Months, But May Persist For A
Year
Care Of The

Occurs Spontaneously After Sucking And Obtaining Fluids Newborn

Newborn: Reflexes - Swallows In Coordination With Sucking Without Gagging, Coughing, Or

Swallowing Reflex
Vomiting
Care Of The
While Newborn Is Falling Asleep Or Sleeping, Gently And Quickly Turn The
Newborn: Reflexes - Head To One Side As Newborn Faces The LEFT Side, The LEFT Arm And Leg
Tonic Neck Or
Extend Outward While The RIGHT Arm And Leg Flex Same Occurs To The
Fencing
Opposite Side If The Head Is Turned To The RIGHT Disappears Within 3 - 4
Months
Care Of The
Place A Finger In The Palm Of The Newborn's Hand And Then Place A
Newborn: Reflexes - Finger At The Base Of The Toes The Newborn's Fingers Curl Around The
Palmar-Plantar
Examiner's Finger, And The Newborn's Toes Curl Downward PalmarGrasp
Lessens In 3 - 4 Months Plantar- Lessens In 8 Months
Care Of The
Assessed By Lifting The Newborn's Body Slightly Above The Crib, Followed
Newborn: Reflexes - By Suddenly Lowering The Body And Observing For Bilateral Arm Extension
Moro Reflex
And Leg Flexion. Thumbs And Forefinger's In A "C" Position "Embrace"
Position (Legs Follow A Similar Pattern) No More Than 6 Months
Care Of The
Examiner Makes A Loud Noise Or Claps Newborns Arms Adduct While
Newborn: Reflexes - Elbows Flex Hands Stay Clenched Disappears Within 4 Months
Startle Reflex
Care Of The
While Newborn Is In The Supine Position Pull Them Up By The Wrist Head
Newborn: Reflexes - Lags Until Newborn Is In An Upright Position Then The Head Is Level With
Pull-To-Sit Response The Chest And Shoulders Momentarily Before Falling Forward Head Then
Lifts For A Few Minutes
Care Of The
Use A Finger To Stroke The Heel Stroking Upward Along The Lateral Aspect
Newborn: Reflexes - Of The Sole Then Move The Finger Along The Ball Of The Foot Toe's
Babinski Sign:
Hyperextend, While The Big Toe Dorsiflexes Disappears At 1 Year
Plantar Reflex
Care Of The
Hold Newborn In The Vertical Position, Allowing One Foot To Touch A Table
Newborn: Reflexes - Surface Newborn Simulates Walking, Alternately Flexing And Extending
Stepping Or Walking The Feet Present For 3 To 4 Months
Care Of The
Place Newborn On The Abdomen Newborn Begins Making Crawling
Newborn: Reflexes - Movements With The Arms And Legs Disappears After 6 Weeks
Crawling
Care Of The
Newborn: Preterm
Newborn

Born Before 37 Weeks Body Temp Extremities Are Thin, With Minimal
Creasing On Soles And Palms Extends Extremities And Does Not Maintain
Flexion Lanugo- On Skin And In The Hair

Care Of The
Newborn: Post Term Newborn

After 42 Weeks Hypoglycemia Parchment-Like Skin (Dry And Cracked,

Lanugo) Long Fingernails, Extended Over Ends Of Fingers Profuse
Scalp Hair Long And Thin Body

Care Of The
Below The 10th Percentile On The Intrauterine Growth Curve
Newborn: Small For Hypoglycemia Fetal Distress Maintain Airway And Cardiopulmonary
Gestational Age
Function Provide Stimulation, Such As Touch And Cuddling

(SGA)
Care Of The
90th Percentile On The Intrauterine Growth Curve Hypoglycemia
Newborn: Large For Monitor Blood Glucose Levels Early Feedings Provide Stimulation, Such
Gestational Age
As Touch And Cuddling
(LGA)
Care Of The
Newborn:
Respiratory Distress
Syndrome

Serious Lung Disorder Caused By Immaturity And Inability To Produce

Surfactant, Resulting In Hypoxia And Acidosis Nasal Flaring Expiratory
Grunting Retractions Seesaw Respirations Hypothermia Prepare To
Administer Surfactant Replacement Therapy (Via ET Tube)

Care Of The
Aspiration Can Occur In Utero Or With The First Breath Respiratory
Newborn: Meconium Distress Is Present At Birth Tachypnea Cyanosis Retractions Nasal
Aspiration
Flaring Grunting Crackles Ronchi Nails, Skin, And Umbilical Cord May
Syndrome
Be Stained A Yellow-Green Color Suctioning Must Be Done Immediately After
The Head Is Delivered And Before The First Breath Is Taken; Vocal Cords
Should Be Viewed To See If The Airway Is Clear Before Stimulation And
Crying
Care Of The
Jaundice Bilirubin Enlarged Liver Lethargy Poor Sucking Reflex
Newborn:
No Matter What The Bilirubin Level Is, If Appearance Of Jaundice Within The
Hyperbilirubinemia First Day Of Life = Pathological Jaundice
Care Of The
Newborn:
Phototherapy

Cover The Genital Area And Monitor For Skin Irritation Or Breakdown
Loose Green Stools And Green Urine Monitor For Bronze Baby Syndrome,
A Grayish Brown Discoloration Of The Skin Reposition Every 2 Hours

Care Of The
Newborn:
Erythroblastosis
Fetalis

Destruction Of RBCs That Result From An Antigen-Anti-Body Reaction ABO

Incompatibility Is Usually LESS Severe Give RhoGAM To The Mother During
The First 72 Hours After Delivery If The Mother Is Rh-Negative And Newborn
Is Rh-Positive But Remains Unsensitized

Care Of The
Newborn: Fetal
Alcohol Syndrome

Hypoplastic Philtrum - Upper Lip Indentation Is Flat Thin Upper Lip Flat
Midface Low Nasal Bridge Short, Upturned Nose Abnormal Palmar
Creases - Hand Creases, Lacking; 1 Long Line

Care Of The
Transmission: Breast Milk Interventions: Clean Skin Carefully Before Any
Newborn: Newborn Invasive Procedure, Such As The Administration Of Vitamin K, Heel Sticks,
To Mother With HIV Or Venipuncture's Newborns At Risk For HIV Infection Need To Receive All
Recommended Immunizations At The Regular Schedule.
Care Of The
Newborn: Newborn
Of A Diabetic
Mother

Excessive Size And Weight As A Result Of Excess Fat And Glycogen In The
Tissues Hypoglycemia Twitching Apnea Difficulty In Feeding
Lethargy Seizures Cyanosis Hyperbilirubinemia Respiratory Distress:
Tachypnea, Cyanosis, Retractions, Grunting, And Nasal Flaring

Care Of The
Newborn:
Hypoglycemia

Hypoglycemia (<40 In First 72 Hours) Or (<45 After The First 3 Days Of

Life) Normal Blood Glucose Level: 40 - 60 In A 1 Day Old Newborn 50 90 In A Newborn Older Than 1 Day Old Prevent Low Blood Glucose Levels
Through Early Feedings

Maternity &
Newborn
Medications:
RhoGAM

Given At 28 Weeks Gestation And AGAIN Within 72 Hours After Delivery

Given To Rh-Negative Mother Who Is Having An Rh-Positive Child RhoGAM
Is Of No Benefit When The Client Has Developed A Positive Antibody Titer To
The Rh Antigen

Maternity &
CNS Depressant And Anticonvulsant Causes Smooth Muscle Relaxation
Newborn
Used To STOP Preterm Labor Contractions Used For Preeclamptic Clients
Medications:
To Prevent Seizures Adverse Reactions: Respiratory Depressions,
Tocolytics
Depressed Reflexes, Flushing, Hypotension, Extremem Muscle Weakness,
(Magnesium Sulfate) Decreased Urine Output, Pulmonary Edema, And Elevated Magnesium
Levels Continous IV Infusions Can Cause Magnesium Toxicity In The
Newborn IV Administration Should Not Be Used For 2 Hours BEFORE
Delivery BEFORE GIVING: Respirations >16 And Patellar Reflexes Must Be
Present Antidote: Calcium Gluconate
Maternity &
Newborn
Medications:
Tocolytics (Indocin)

Indomethacin (Indocin) - Prostaglandin Inhibitor: Relaxes Uterine Smooth

Muscle Adverse Reactions/Interventions: (Maternal) Nausea, Vomiting,
And Dyspepsia, Dizziness - Use Only When All Other Methods Fail And If
Gestational Age Is <32 Weeks (Fetal) Premature Closure Of Ductus
Arteriosus - Not Used In Clients With Bleeding Potential, Peptic Ulcer
Disease, Or Oligohydraminos

Maternity &
Newborn
Medications:
Tocolytics
(Nifedipine)

Procardia Calcium Channel Blocker Relaxes Smooth Muscles, Including

The Uterus Adverse Reactions: (Maternal) Tachycardia, Hypotension,
Dizziness, Headache, Nervousness, Facial Flushing, Fatigue, Nausea
(Newborn) Hypotension

Maternity &
Newborn
Medications:
Tocolytics
(Terbutaline)

Brethine 2-Selective Adrenergic Agonist Relaxes Smooth Muscles

Inhibiting (STOPPING) Uterine Activity And Causing Bronchodilation
Adverse Reactions: (Maternal) Tachycardia, Papitations, Pulmonary
Edema, Chest Pain, Myocardial Ischemia, Hypotension, Tremors,
Hypokalemia, Hypoglycemia (Newborn) Tachycardia, Hypotension, Ileus,
Hypocalcemia, Hyperbilirubinemia, Hyperinsulinemia With Hypoglycemia
Notify Physician If There Are Adverse Reactions

Maternity &
Corticosteroids Production Of Surfactant To Accelerate Fetal Lung
Newborn
Maturity And Reduce The Incidence Or Severity Of Respiratory Distress
Medications:
Syndrome Keeps Aveoli Open
Betamethasone And
Dexamethasone
Maternity &
Stimulates The Smooth Muscle Of The Uterus And Force, Frequency,
Newborn
And Duration Of Uterine Contractions Promotes Milk Letdown Induces
Medications: Uterine Labor Controls Postpartum Bleeding Manages An Incomplete Abortion
Stimulants
Adverse Reactions: Allergies, Dysrhythmias, Changes In BP, Uterine
(Oxytocics):
Rupture And Water Intoxication Uterine Hypertonicity Postpartum
Oxytocin (Pitocin)
Hemorrhage Use In Client With Active Genital Herpes Interventions:
Vital Signs Q15 Min (BP, HR, Weight, I/O, LOC, And Lung Sounds)
Frequency, Duration, And Force Of Contractions Q15 Min FHR Q15 Min
Leave Client During Infusion Monitor For Hypertonic Contractions Or A

Non-Reassuring FHR And Notify Physician If This Occurs STOP, Turn Client
On Side, NS Rate, And Give O2 If Above Occurs
Maternity &
Give Subcutaneously Give If Rubella Titer Is < 1:8 Contraindicated
Newborn
With Egg Allergy DO NOT Give If Client Or Family Member Is
Medications: Rubella Immunocompromised AVOID Pregnancy For 1 - 3 Months After
Vaccine
Immunization, Use Contraceptives
Maternity &
Newborn
Medications: Lung
Surfactant

Beractant, Calfactant, Poractant Alfa *-ACTANT* Replenishes Surfactant

And Restores Surface Activity To The Lungs To Prevent And Treat RDS
Given Via INTRATRACHEAL Route Used To Treat And Prevent RSD In
Premature Infants Avoid Suctioning For 2 Hours After Given Monitor For
Bradycardia And Decreased O2 Monitor Respiratory Status And Lung
Sounds

Maternity &
Newborn
Medications: Eye
Prophylaxis For The
Newborn

Required By Law Prevents Opthalmia Neonatorum Ophthalmis Forms

Of Erythromycin Or Tetracycline (Bacteriostatic And Bacteriocidal) Fights
Against: Gonorrhea And Chlamydia Interventions: Clean Newborns Eyes
Before Instilling DO NOT Flush Eyes After Instilling Medication Instillation
Can Be Delayed For 1 Hour After Birth To Facilitate Eye Contact And ParentNewborn Attachment And Bonding

Maternity &
Newborn
Medications:
Vitamin K

Newborns Are Deficient In Vitamin K For The First 5 To 8 Days Of Life

Because Of The Lack Of Intestinal Bacteria Uses: Prophylaxis And
Treatment Of Hemorrhagic Disease Of The Newborn Adverse Reaction:
Can Cause Hyperbilirubinemia In The Newborn Interventions: Protect
Medication From Light Give In Lateral Vastus Lateralis Of Thigh Muscle
Monitor For Bruising At Injection Site And Bleeding From Umbilical Cord
Monitor For Jaundice/Hyperbilirubinemia

Pentoxifylline
(Trental): Uses

- Used To Improve The Symptoms Of A Certain Blood Flow Problem In The

Legs/Arms (Intermittent Claudication Due To Occlusive Artery Disease). PVD

Cliostazol (Pletal):
Uses

- Used To Treat Intermittent Claudication In People Who Have Peripheral

Arterial Disease (PAD).

Growth And
Development:
Erickson's Stages

Trust Vs Mistrust (Birth - 18 Mon) Autonomy Vs Shame/Doubt (18 Mon 3 Yrs) Initiative Vs Guilt (3 - 6 Yrs) Industry Vs Inferiority (6 - 12 Yrs)
Identity Vs Role Confusion (12 - 20 Yrs) Intimacy Vs Isolation (20 - 35 Yrs)
Generativity Vs Stagnation (35 - 65 Yrs) Integrity Vs Despair (65 And
Older)

Growth And
Development:
Erickson's Stages Trust Vs Mistrust

Task: Attachment To Mother Successful: Trust In Persons; Faith And Hope

About The Environment And Future Unsuccessful: General Difficulties
Relating To People Effectively; Suspicion; Trust-Fear Conflict, Fear Of The
Future

Growth And
Development:
Erickson's Stages Autonomy Vs

Task: Gaining Some Basic Control Over Self And Environment Successful:
Sense Of Self-Control And Adequacy; Will Power Unsuccessful:
Independence - Fear Conflict; Severe Feelings Of Self-Doubt

Shame/Doubt
Growth And
Development:
Erickson's Stages Initiative Vs Guilt

Task: Becoming Purposeful And Directive Successful: Ability To Initiate One's

Own Activities; Sense Of Purpose Unsuccessful: Aggression-Fear Conflict;
Sense Of Inadequacy Or Guilt

Growth And
Development:
Erickson's Stages Industry Vs
Inferiority

Task: Developing Social, Physical, And Learning Skills Successful:

Competence; Ability To Learn And Work Unsuccessful: Sense Of Inferiority;
Difficulty Learning And Working

Growth And
Development:
Erickson's Stages Identity Vs Role
Confusion

Task: Developing Sense Of Id-Entity Successful: Sense Of Personal Identity

Unsuccessful: Confusion About Who One Is; Identity Submerged In
Relationships Or Group Memberships

Growth And
Development:
Erickson's Stages Intimacy Vs
Isolation

Task: Establishing Intimate Bonds Of Love And Friendship Successful: Ability

To Love Deeply And Commit Oneself Unsuccessful: Emotional Isolation,
Egocentricity

Growth And
Development:
Erickson's Stages Generativity Vs
Stagnation

Task: Fulfilling Life Goals That Involve Family, Career, And Society
Successful: Ability To Give And Care For Others Unsuccessful: SelfAbsorption; Inability To Grow As A Person

Growth And
Task: Looking Back Over One's Life And Accepting Its Meaning Successful:
Development:
Sense Of Integrity And Fulfillment Unsuccessful: Dissatisfaction With Life
Erickson's Stages Integrity Vs Despair
Developmental
Stages

Infants (0-1 Year Of Age) Toddlers (1-3 Years Of Age) Preschoolers (3-5
Years Of Age) School Age (6-12 Years Of Age) Adolescents (12-20 Years
Of Age) Young Adult (20-35 Years Of Age) Middle Adult (35-65 Years Of
Age) Old Adulthood (+65 Years Of Age)

Developmental
Separation Anxiety Fear Of Injury And Pain: Affected By Previous
Stages: Hospitalized Experiences, Separation From Parents, And Preparation For The Experience
Infant And Toddler Provide Cuddling And Touch And Talk Softly To The Infant Provide Toddler
With Favorite Comfort Object For Hospitalized Toddler, Provide Routines
And Rituals As Close As Possible To What He/She Is Used To At Home Use
Short, Concrete Terms With Toddlers Use PLAY For Demonstrations Use
Visual Aids Such As Picture Books, Puppets, And Dolls For Toddlers Allow
Toddler To Handle Equipment Or Instruments; Explain What The Equipment
Or Instrument Does And How It Feels
Developmental

Child Imagines Things To Be Much Worse Than What They Are Believe

Stages: Hospitalized They Are Ill Because Of Something They Did Or Thought Place With Other
Preschooler
Children Of Same Age If Possible Allow Wearing Of Underpants
Encourage Rooming-In Or Leaving Favorite Toy Allow Mobility And Provide
Play And Diversional Activities
Developmental
Fears Bodily Injury And Pain Associates His/Her Actions With The Cause
Stages: Hospitalized Of Illness Encourage Rooming-In Allow To Wear Underpants Use
School-Age Child
Medical PLAY Techniques Use Photographs. Books, Dolls, And Videos To
Explain Procedures Explain In Clear Terms
Developmental
Separation From Friends Is A Source Of Anxiety Use Body Diagrams To
Stages: Hospitalized Prepare For Procedures Encourage Communication/Contact With Peer
Adolescent
Groups
Developmental
Stages: Fontanels

Anterior: Closes By 12 - 18 Months Posterior: Closes By The End Of The 2nd

Month

Developmental
Infant: HR: 120 - 140 RR: 30 - 60 (Avg. 40) BP: 73/55 1 Year Old: HR:
Stages: Vital Signs 90 - 130 RR: 20 - 40 BP: 90/56
For Newborn And 1
Year Old
Developmental
Stages: Infant
Nutrition

Infant May Be Breast Fed Or Bottle Fed (With Iron-Fortified Formula),

Breast-Feeding Is The Preferred Form Of Nutrition During The First 6 Months.
All Infants Should Receive Daily Vitamin D (200 IU) Starting In The First 2
Months Of Life To Prevent Rickets And Vitamin D Deficiency If Infant Is
Only Breast-Fed, Iron-Fortified Cereal Is Needed Solid Foods May Be
Introduced At 5 To 6 Months, One At A Time Between 4 To 5 Days To Check
For Allergies Eggs Can Be Introduced At 1 Year Of Age Fruit Juice From A
Cup At 12 To 13 Months Old

Developmental
Stages: Play

Solitary Play A Child Is In A Room Full Of Other Children, But He/She Is

Playing Alone And Not Paying Attention To Anyone. Parallel Play Children Are
Playing The Same Game Or Activity. They Are Playing Next To Each Other,
But They Are Not Talking Or Doing The Same Activity. Associative Play
Children Are Playing The Same Game, But They Are Not Working Together
Or Connecting With One Another. Cooperative Play Children Are Working
Together To Play A Game.

Developmental
Stages: Toddler
Vitals

HR: 80 - 120 RR: 20 - 30 BP: 92/55

Developmental
Stages: Toddler
Physical

Avg. Weight: 22 - 27 Pounds Height: 3 Inches Per Year (Avg. Height: 34

Inches At 2 Years Old) Toddler Should See Dentist Soon After First Teeth
Eruption, Usually Around 1 Year Of Age And Oral Hygiene Measures Should
Be Instituted Never Allow To Fall Asleep With Bottle Containing Milk, Juice,
Soda, Sweetened Water, Or Any Other Sweet Liquid For Risk Of Nursing
(Bottle-Mouth) Caries

Developmental
Stages: Toddler

Offer Finger Foods And Avoid Concentrated Sweets And Empty Calories
Toddler Is At Risk For Aspiration Of Small Foods With Seeds, Raisins,

Nutrition

Popcorn, Grapes, Nuts, And Hot Dog Pieces

Developmental
Stages: Toddler
Skills

Toddler Often Uses The Word "No" Even When They Mean "Yes" To Assert
Independence

Developmental
Stages: Toddler
Toilet Training

Able To Stay Dry For 2 Hours Waking Up Dry From A Nap Able To Sit,
Squat, And Walk Able To Remove Clothing Recognizes The Urge To
Defecate Or Urinate Expresses Willingness To Please A Parent Is Able To
Sit On The Toilet For 5 To 10 Minutes Without Fussing Or Getting Off

Developmental
Push-Pull Toys Blocks Sand Finger Paints Bubbles Large Balls
Stages: Toddler Toys Crayons Trucks Dolls Containers Play-Doh Toy Telephones Cloth
Books Wooden Puzzles
Developmental
Stages:
Preschooler's Vital
Signs

HR: 70 - 110 RR: 16 - 22 BP: 95/57

Developmental
Regular Dental Care Is Essential By Age 4, Has Daytime Control Of
Stages: Preschooler Bowel And Bladder But May Experience Bed-Wetting Accidents At Night
Because Of Their Magical Thinking, They May Believe Daring Feats Seen In
Cartoons Are Possible And May Attempt Them Teach A Preschooler And
School-Age Children To Leave An Area Immediately If A Gun Is Visible And To
Tell An Adult Teach Them To Never Point A Toy Gun At Another Person
Developmental
HR: 60 - 100 RR: 18 - 20 BP: Average, 107/64
Stages: School-Age
Child's Vital Signs
Developmental
Regular Dentist Visits Enjoys Drawing, Collecting Items, Dolls, Pets,
Stages: School-Age Guessing Games, Board Games, Listening To The Radio, TV, Reading,
Watching Videos Or DVDs, And Computer Games Children Should Wear A
Helmet When Riding A Bike Or Using In-Line Skates Or Skateboards Teach
Preschooler And School-Age Child That If Someone Touches Their Body In An
Inappropriate Way, An Adult Should Be Told Teach Them To Avoid
Strangers And Never Accept Rides, Toys, Or Gifts From Strangers
Developmental
HR: 55 - 90 RR: 12 - 20 BP: 121/70
Stages: Adolescents
Vital Signs
Developmental
Careful Brushing And Care Of Teeth, Many Adolescents Need To Wear
Stages: Adolescents Braces 8 Hours Of Sleep A Night Is Recommended, They Tend To Stay Up
Late And Try To Sleep In To Get In Those 8 Hours Calcium, Zinc, Iron, Folic
Acid, And Protein Are Important Nutritional Needs Enjoy Sports, Videos,
Movies, Reading, Parties, Dancing, Hobbies, Computer Games, Music,
Communicating Via The Internet, And Experimenting, Such As Makeup And
Hairstyles Adolescents Are Risk Takers Reinforce Teaching About The
Dangers Related To Cigarette Smoking, Caffeine, Alcohol, And Drugs
Ensure They Wear A Seat Belt Instruct About The Consequences Of A MVA

And The Injuries You Can Get Instruct About The Complications With Body
Piercings And Tattoos Complications Of Sun Tanning Discuss Issues Such
As Date Rape, Sexual Relationships, And STDs Dangers Of Internet
Related Communicating And Setting Up Meeting (Dates) With Unknown
Persons
Developmental
Stages: Early
Adulthood

Lifestyle Habits Such As Smoking, Stress, Lack Of Exercise, Poor Personal

Hygiene, And Family History Of Disease Increases The Risk Of Future Illness
They Give Much Attention To Occupational And Social Pursuits To Improve
Socioeconomic Status Person Has The Emotional Maturity To Develop
Mature Sexual Relationships At Risk For STDs Physiological Changes
Often Have An Impact On Self-Concept And Body Image Psychological
Changes May Include A Child Moving Away From Home Or Death Of A Close
Friend

Developmental
Stages: Car Seats

1 Year Old And 20 Pounds, Car Seat Can Face Forward, ,Up Until Child Is 40
Pounds Booster Seat For Shorter Than 4' 9" And Weighs More Than 40
Pounds (Typically 4 - 8 Years Old) Regular Back Seat Ages 8 - 12 Years Old
And Reaches 4' 9" Stays In Back Seat Until 13, Shoulder Strap Should Be
Away From The Neck And Face

Developmental
Stages: Using
Utensils And Cups

2 Yrs Old: Can Use A Cup And Spoon Correctly, But With Some Spilling 3
- 4 Yrs Old: Begins To Use Fork End Of Preschool Period: Child Should Be
Able To Pour Milk Into A Cup And Begin To Use A Knife For Cutting

Adventitious
Sounds:
Crackles/Rales

Description: Popping; Discontinuous; May Be Affected By Coughing. More

Prominent On Inspiration Conditions: CHF, Atelectasis, Pneumonia,
Interstitial Fibrosis Intervention: Ask Patient To Cough

Adventitious
Sounds: Wheezing

Description: Musical, High-Pitched; Continuous; May Be Affect By Coughing

Conditions: Asthma, Cardiac Asthma Interventions: Ask Patient To Cough
Mild Wheeze: Going Through Water And Bird/Whistle After Moderate
Wheeze: Battery Dying In Appliance Severe Wheeze: Yelling Under Water

Adventitious
Sounds: Rhonchi

Description: Snore, Gurgle. More Prominent On Expiration Conditions:

Pneumonia Rhonchi: Gurgling In Stomach

Adventitious
Sounds: Stridor

- Abnormal, High-Pitched, Musical Breathing Sound Caused By BLOCKAGE In

The Throat Or Voice Box (Larynx) - Heard On Inspiration *** SEE THIS
CLIENT FIRST!!! BLOACKAGE & UNABLE TO BREATHE!!!***

Adventitious
Description: High-Pitched, Scratching, Squeaking; Continuous; NOT Affected
Sounds: Friction Rub By Cough. Inspiratory And Expiratory Conditions: Pleuritis, Pleurisy Friction
Rub: Moving Stethoscope Around
Cranial Nerves

I. Olfactory (S) - Sense Of Smell II. Optic (S) - Vision III. Oculomotor (M) Pupillary Constriction, Upper-Eyelid Elevation, And Most Eye Movement IV.
Trochlear (M) - Downward And Inward Eye Movement V. Trigeminal (S&M) Sensations In The Cornea, Nasal, And Oral Mucosa, And Facial Skin, And
Mastication VI. Abducens (M) - Lateral Eye Movement VII. Facial (S&M) Movement Of The Face And Taste Sensations VIII. Acoustic (S) - Hearing And
Vestibular Function IX. Glossopharygeal (S&M) - Swallowing, Sensations In

Pharyngeal Soft Palate And Tonsillar Mucosa, Taste Perception On The

Posterior 3rd Of The Tongue, And Salvation X. Vagus (S&M) - Swallowing And
Phonation, Sensation In The Exterior Ear's Posterior Wall, And Sensation
Behind The Ear; Controls Sensation In The Thoracic And Abdominal Viscera.
XI. Spinal Accessory (M) - Strength In Neck And Shoulder Muscles XII.
Hypoglossal (M) - Tongue Movements Involved In Swallowing And Speech
Pediatric Nursing:
Atresia

Absence/Closure Of A Body Orifice

Pediatric Nursing:
Prodromal

Early Symptoms That Mark The Onset Of The Disease

Peds - Neuro, Cog,

And Psych: Autism

Lack Of Imaginative Play Self-Injurious Behaviors Produces Repetitive

Body Movement Such As Rocking Or Head Banging Infatuated With
Spinning Objects (Spin Top)

Peds - Neuro, Cog,

And Psych: Child
Abuse

Lack Of Crying (Older Infant, Toddler, Or Young Preschool Child) When

Approached By A Stranger Coining & Cupping Is NOT Child Abuse!!! - Used
To Get Rid Of Disease - Cultural Practice In South East Asia

Peds - Neuro, Cog, Open - When There Is A Fracture Of The Skull Or Penetration Of The Skull
And Psych: Head
By An Object Closed - The Result Of Blunt Trauma (This Is More Serious
Injury - Open/Closed Than An Open Head Injury Because Of The Chance Of Increased ICP In A
"Closed" Vault); This Type Of Injury Can Also Be Caused By Shaken Baby
Syndrome
Peds - Neuro, Cog,
And Psych: Head
Injury - Early Signs

Early Signs: - Slight Change In LOC Infant: - Irritability - High-Pitched Cry

- Bulging Fontanel - Head Circumference - Dilated Scalp Veins - Macewen's
Sign - Cracked-Pot Sound On Percussion Of The Head - Sun Setting - Sclera
Visible Above Iris (Looks Like They Are Looking Down As Far As The Eyes
Can Go) Child: - Headache - Nausea - Vomiting - Visual Disturbances
(Diplopia) - Seizures

Peds - Neuro, Cog,

And Psych: Head
Injury - Late Signs

Late Signs: Decorticate (FLEXION - Bringing Arms Into The Core) Posturing:
ADDUCTION Of Arms At The Shoulders; Arms Are FLEXED On The Chest With
The Wrist FLEXED And The Hands FISTED, And The Lower Extremities Are
EXTENDED And ADDUCTED; Seen With Severe Dysfunction Of Cerebral
Cortex Decerebrate (EXTENSION, Has More E's In The Name - Digging
Grave) Posturing: Rigid EXTENSION And PRONATION Of The Arms And Legs;
Sign Of Dysfunction At The Level Of The Midbrain LOC HR
(Bradycardia) Motor And Sensory Responses Alterations In Pupil Size
And Reaction Cheyne-Stokes Respirations: Breathing Can Be Very Deep
And Rapid, Followed By Periods Of Slow Shallow Breaths, Or Episodes Of
Apnea, Often Seen In The Last Days Of Life Coma

Peds - Neuro, Cog,

And Psych:
Hydrocephalus

Monitor Vital Signs And Neurological Signs Position The Child On The
UNOPERATED Side To Prevent Pressure On The Shunt Valve Keep The Child
Flat As Prescribed To Avoid Rapid Reduction Of Intracranial Fluid Observe
For ICP; If ICP Occurs, Elevate The HOB To 15 To 30 Degrees To Enhance
Gravity Flow Through The Shunt

Peds - Neuro, Cog, Bacterial Meningitis - Can Be Caused By Haemophilus Influenza Type B,
And Psych: Bacterial Streptococcus Pneumonia, Or Neisseria Meninditidis; Meningococcal
& Viral Meningitis
Meningitis Occurs In Epidemic Form And Can Be Transmitted By DROPLETS
From Nasopharyngeal Secretions Viral Meningitis: Associated With Viruses
Such As Mumps, Paramyxovirus, Herpesvirus, And Enterovirus
Peds - Neuro, Cog,
And Psych:
Meningitis S/S

+ Kernig's Sign: Inability To Extend The Leg When The Thigh Is FLEXED
Anteriorly At The Hip + Brudzinski's Sign: Neck FLEXION Causes
ADDUCTION And FLEXION Movements Of The Lower Extremities (These Two
Are Seen In Children And Adolescents, NOT SEEN In < 1 Year Of Age) (These
Two Are Also Seen In SUBARACHNOID HEMORRHAGE/BLEED) Petechial Or
Purpuric Rashes (Meningococcal Infection) Fever Chills Headache
Vomiting Diarrhea Nuchal Rigidity Poor Or High Shrill Cry Bulging
Anterior Fontanel In An Infant

Peds - Neuro, Cog,

And Psych:
Meningitis Dx And
Interventions

Testing CSF Via Lumbar Puncture Cloudy WBC Protein Glucose

Interventions: - Respiratory (AIRBORNE) Isolation - Isolation For At Least 24
Hours After Antibiotics Are Initiated - Antibiotics (ASAP After Lumbar
Puncture) - Antipyretics - Antiseizure

Peds - Neuro, Cog,

And Psych: Reye's
Syndrome

An Acute Encephalopathy That Follows A Viral Illness And Is Characterized

Pathologically By Cerebral Edema And Fatty Changes In The Liver; A
Definitive Dx Is Made By A Liver Biopsy - Give Aspirin To Children,
Because It Causes This Syndrome - Acetaminophen (Tylenol) Is The
Medication Of Choice For Pediatric Clients Interventions: -Rest - Stimuli Liver Function Tests

Peds - Neuro, Cog,

And Psych:
Interventions For
Seizures

Ensure Airway Patency Suction Equipment And O2 Available Time The

Seizure Episode If Standing Or Sitting, Ease Them To The Floor In A SideLying Position Place Head On A Pillow, Folded Blanket, Hands, Or In Your
Lap Loosen Restrictive Clothing Remove Eyeglasses Clear Area Of
Hazards Restrain Remain With Them Through Entire Seizure
Observe For Incontinence Document The Occurrence *** NEVER Place
Anything Into The Mouth Of Someone Experiencing A Seizure ***

Peds - Neuro, Cog,

And Psych: Spina
Bifida Description

Spina Bifida Means "Cleft Spine" CNS Defect, Neural Tube Does Not Close
During Embryonic Development. Associated Deficits Include: - Sensorimotor
Disturbance - Dislocated Hips - Talipes Equinovarus (Clubfoot) Hydrocephalus

Peds - Neuro, Cog,

And Psych: Spina
Bifida Occulta

Occulta Is The Mildest And Most Common Form In Which One Or More
Vertebrae Are Malformed. The Name "Occulta," Which Means "Hidden,"
Indicates That The Malformation, Or Opening In The Spine, Is Covered By A
Layer Of Skin. Posterior Vertebral Arches Fail To Close In The Lumbosacral
Area Spinal Cord Remains Intact And Usually Is Not Visible Meninges Are
Not Exposed On The Skin Surface Neurological Deficits Are Not Usually
Present

Peds - Neuro, Cog,

And Psych: Spina
Bifida Cystica

Protrusion Of Spinal Cord, Meninges, Or Both Incomplete Closure Of The

Vertebral And Neural Tubes, Resulting In A Sac-Like Protrusion In The
Lumbar Or Sacral Area Defect Can Include: - Meningocele -

Myelomeningocele - Lipomeningocele - Lipomeningomyelocele

Peds - Neuro, Cog, Protrusion Involves Meninges And A Sac-Like Cyst That Contains CSF In
And Psych: Spina
The Midline Of The Back, Usually In The Lumbosacral Area Spinal Cord IS
Bifida - Meningocele NOT Involved Neurological Deficits
Peds - Neuro, Cog,
And Psych: Spina
Bifida Myelomeningocele

Protrusion Of The Meninges, CSF, Nerve Roots, And A Portion Of The

Spinal Cord The Sac (Defect) Is Covered By A Thin Membrane Prone To
Leak Or Rupture Neurological Deficits Are Evident

Peds - Neuro, Cog,

And Psych: Spina
Bifida S/S

Depends On Spinal Cord Involvement Visible Spinal Defect Flaccid

Paralysis Of The Legs Altered Bladder And Bowel Function Hip And Joint
Deformities Hydocephalus

Peds - Neuro, Cog, Monitor For ICP (Might Indicate Hydrocephalus) Measure Head
And Psych: Spina
Circumference Assess Anterior Fontanel For Fullness Protect Sac; Cover
Bifida Interventions With STERILE, MOIST (Normal Saline), Nonadherent Dressing To Maintain
Moisture Change Sac Dressing On A Regular Schedule Or When It
Becomes Soiled Early Signs Of Infection: Temp (Axillary), Irritability,
Lethargy, And Nuchal Rigidity PRONE POSITION With Head Turned To One
Side For Feeding *** HIGH RISK: Allergy To Latex And Rubber Because Of
Frequent Exposure To These During Care ***
Peds - Eye, Ear, And "Lazy Eye Or Squint" Normally Found In A Young Infant, Should NOT Be Seen
Throat: Strabismus After 4 Months Of Age Impaired Depth Perception Frequent Headaches
Diplopia Photophobia Instruct Parents Regarding Patching (Occlusion
Therapy) Of The "GOOD EYE" To Strengthen The Weak Eye (Forces Muscles
In The Bad Eye To Work) - Botox Injections Now Being Used To Help
Peds - Eye, Ear, And "Pinkeye"; An Inflammation Of The Conjunctiva Itching Burning
Throat:
Scratchy Eyelids Redness Edema Discharge *** Chlamydial
Conjunctivitis
Conjunctivitis: If Child Is Too Young Or Not Sexually Active Assess For
SEXUAL ABUSE *** Interventions: - Keep Child Home From School Until
Antibiotics Have Been Given For 24 Hours
Peds - Eye, Ear, And "Middle Ear Infection" Blocked Eustachian Tube Loss Of Appetite Rolling
Throat: Otitis Media Head From Side To Side Pulling Or Rubbing Ear Crying Irritability Red,
Opaque, Bulging, Immobile Tympanic Membrane On Otoscopic Examination
Interventions: - Cold/Heat To Relieve Discomfort - Lay With AFFECTED EAR
DOWN - Tylenol Or Motrin For Fever And Pain - SOFT DIET - DO NOT
IRRIGATE *** Child < 3 Pull "Ear Lobe" DOWN And BACK *** *** Child > 3
Pull "Pinna" UP And BACK *** - Myringotomy: Surgical Incision Into Tympanic
Membrane To Drain Purulent Fluid Of The Middle Ear - Tympanoplasty: Tubes
Inserted Into Middle Ear To Allow Continued Drainage And To Equalize
Pressure And Allow Ventilation
Peds - Eye, Ear, And Persistant/Recurrent Sore Throat Enlarged, Red Tonsils, May Be Covered
Throat: Tonsillitis
With White Exudate Difficulty Swallowing Mouth Breathing With An
And Adenoiditis
Unpleasant Odor Interventions: - PRONE Or SIDE-LYING POSITION - Suction
Equipment Available - Frequent Swallowing = Bleeding, Notify Physician -

DISCOURAGE Coughing, Clearing Throat, And Blowing Nose - Ice Collar Analgesics (Tylenol) - Antiemetics *** AVOID Red, Purple, Or Brown Liquids
*** *** AVOID Milk, Ice Cream, And Pudding; It Coats The Throat And Causes
Coughing Or Clearing Of Throat *** *** NO Straws, Forks, Or Sharp Objects
That Could Be Put Into The Mouth ***
Peds - Eye, Ear, And "Nosebleed" Apply Continuous Pressure To The Soft Lower Portion Of The
Throat: Epistaxis
Nose With The Thumb And Forefinger For At Least 10 Minutes If Bleeding
Persists, Cotton Or Wadded Tissue Should Be Placed Into Each Nostril, And
Ice Or A Cold Cloth Should Be Applied To The Bridge Of The Nose
Repeated Episodes Of Bleeding For More Than 30 Minutes Indicates
Evaluation For A Bleeding Disorder
Peds - Respiratory
Disorders:
Epiglottitis
Description

- Bacterial Form Of Croup - Inflammation Caused By Haemophilus Influenza

Type B Or Streptococcus Pneumoniae - Children Immunized With Hib
Vaccine Are At Less Risk For Epiglottitis - Onset Is Abrupt, And The Condition
Occurs Most Often In The Winter - EMERGENCY SITUATION Because It Can
Progress Rapidly To Severe Respiratory Distress

Peds - Respiratory
Disorders:
Epiglottitis S/S

Sore, Red, And Inflamed Throat (Large, Cherry Red, Edematous Epiglottis)
Pain With Swallowing NO Spontaneous Cough Drooling Retractions
Stridor (Inspiratory) Aggravated By The Supine Position Tachypnea
Hypoxia Hypercapnia Respiratory Acidosis LOC TRIPOD
POSITIONING: While Supporting The Body With The Hands, The Child Leans
Forward, Thrusts The Chin Forward And Opens The Mouth In An Attempt To
Widen The Airway

Peds - Respiratory - Assess Temp By AXILLARY ROUTE, Do An Oral Temp - Avoid Supine
Disorders: Epiglottis Position - Do Not Restrain - IV Antibiotics, Followed By Oral Antibiotics Interventions
Analgesics And Antipyretics (Tylenol) Or (Motrin) For Fever And Pain Corticosteroids To Decrease Inflammation - Nebulized Epinephrine (Racemic
Epinephrine): Causes Mucosal Vasoconstriction And Reduces Edema In
Severe Cases - COOL MIST O2 - Ensure Child Is Up To Date With
Immunizations, Including Hib Conjugate Vaccine *** If Epiglottitis Is
Suspected, DO NOT Visualize The Posterior Pharynx, DO NOT Obtain A
Throat Culture, Or DO NOT Take An Oral Temp. Spasm Of The Epiglottis Can
Occur Leading To Complete Airway Occlusion ***
Peds - Respiratory CROUP - Inflammation Of The Larynx, Trachea, And Bronchi - Common
Disorders:
Cause: Parainfluenzae Virus, Types 1 And 2 Respiratory Syncytial Virus
Laryngotracheobron (RSV) Mycoplasma Pneumoniae Influenza
chitis (LTB) Croup
Description
Peds - Respiratory Seal Bark And Brassy Cough (Croup Cough) Stridor (Inspiratory)
Disorders:
Irritability Restlessness Nasal Flaring Sternal Retractions
Laryngotracheobron
chitis (LTB) Croup
S/S
Peds - Respiratory

- Maintain A Patent Airway - Assess Respiratory Status (Pulse Oximetry) -

Disorders:
Laryngotracheobron
chitis (LTB) Croup
Interventions

Monitor For Nasal Flaring, Sternal Retractions, And Stridor (Inspiratory) Elevate HOB - Provide Rest - Humidified O2 Via A Cool Air Or Mist Tent - Use
Cool Air Vaporizer At Home - COOL AIR: Take Them Into An Open Freezer,
Outside If Cool Night, Or In A Cool Garage - HOT AIR: Take Them Into The
Bathroom With A Steamy Shower

Peds - Respiratory
Disorders:
Bronchiolitis & RSV
Description

Bronchiolitis: Inflammation Of Bronchioles That Causes Thick Mucus That

Occludes Bronchi RSV: Causes An Acute Viral Infection And Is A Common
Cause Of Bronchiolitis. Although It IS NOT Airborne, It Is Highly
Communicable And Is Transferred By Direct Contact With Respiratory
Secretions At-Risk Children Include Children > 1 Year Of Age Who Have A
Chronic Or Disabling Condition Prevention Measures Include: - BreastFeeding - Avoid Tobacco Smoke - Good Handwashing - Give Palivizumab
(Synagis) - A Monoclonal Antibody, To High-Risk Infants. IM Injection Monthly
For 5 Months (Usually From November - March) *** DO NOT ASSIGN A
NURSE WHO HAS CHILDREN AT RISK OR PREGNANT ***

Peds - Respiratory Rhinorrhea Eye Or Ear Drainage Pharyngitis Coughing Sneezing

Disorders:
Wheezing Intermittent Fever Signs Of Air Hunger Tachypnea
Bronchiolitis & RSV Retractions Periods Of Cyanosis
S/S
Peds - Respiratory
Disorders:
Bronchiolitis & RSV
Interventions

- Hospitalized Child With RSV, Isolate In A Single Room Or Place With

Another Child With RSV - Nurse Caring For Child With RSV, Make Sure They
Are Not Caring For Other High-Risk Children - CONTACT And STANDARD
PRECAUTIONS - Good HANDWASHING And Wear Gloves And Gowns - Give
Ribavirin (Virazole): Antiviral, Via INH (Inhalation Route) - *** RIBIVIRIN:
CONTRAINDICATED To Assign ANY Pregnant Woman Or Father Who Has A
Pregnant Wife, Causes HYDROPS (Meneiere's Disease) *** - Cough
Suppressants Are Administered With Caution Because They Interfere With
The Clearance Of Respiratory Secretions

Peds - Respiratory
Disorders: Asthma
Triggers

Allergens From Outdoor And Indoor Irritants: Smoke, Odors, Sprays

Exercise Cold Air Change In Weather Or Temperature Environment
Changes: Moving To A New Home, Starting A New School Colds And
Infections Animals Medications Strong Emotions Conditions: GERD Or
TEF Foods Endocrine Factors: Menses, Pregnancy, Thyroid Disease

Peds - Respiratory Avoid Exposure To What Causes The Allergies Recognize Symptoms
Disorders: Asthma Know How To Administer Medications Teach How To Use MDI, Nebulizer, Or
Triggers Home Care Peak Expiratory Flow Meter
Measures
Peds - Respiratory - Autosomal Recessive Trait Disorder - Exocrine Gland Dysfunction - Chronic
Disorders: Cystic
Multisystem Disorder - CFTR (Cystic Fibrosis Transmembrane Conductance
Fibrosis Description Regulator) Gene Is Located On The 7th Chromosome And Is Responsible For
Regulating Salt And Water Movement Between Cells - If CFTR Gene Is NOT
Working It DOES NOT Move Mucus, Sweat, Tears, Saliva, Or Digestive
Enzymes - Common Symptoms Are Associated With Pancreatic Enzyme
Deficiency And Pancreatic Fibrosis Caused By Duct Blockage, Progressive
Chronic Lung Disease As A Result Of Infection, And Sweat Gland Dysfunction

Resulting In Increased Sodium And Chloride Sweat Concentrations

Peds - Respiratory
Disorders: Cystic
Fibrosis Respiratory System

Symptoms Produced By The Stagnation (Stopping) Of Mucus In The

Airway, Leading To Bacterial Colonization And Destruction Of Lung Tissue
Emphysema And Atelectasis Occur As The Airways Become Increasingly
Obstructed Pneumothorax From Ruptured Bullae And Hemoptysis From
Erosion Of The Bronchial Wall Occur As The Disease Progresses Wheezing
Coughing Dyspnea Cyanosis Clubbed Fingers And Toes Barrel Chest
Repeated Episodes Of Bronchitis And Pneumonia

Peds - Respiratory Meconium Ileus In The Newborn Is The EARLIEST SIGN (Not Passing Dark
Disorders: Cystic
Green Or Black Stool) Stools Are Frothy And Foul-Smelling Deficiency In
Fibrosis - GI System Fat-Soluble Vitamins: A, D, E, And K, Which Can Result In Easy Bruising,
Bleeding, And Anemia Pancreatic Fibrosis Can Occur And Places The Child
At Risk For Diabetes Pancreas Releases Digestive Enzymes: - Amylase Lipase - Tripsin (ALT) - These Breakdown Carbs, Fats, And Proteins
Peds - Respiratory
Disorders: Cystic
Fibrosis Integumentary
System

Infant Tastes "SALTY" When Kissed

Peds - Respiratory
Disorders: Cystic
Fibrosis Dx Test

Quantitative Sweat Chloride Test: - Production Of Sweat Is Stimulated With

Pilocarpine - Sweat Is Collected And Sweat Electrolytes Are Measured (More
Than 75 Mg Of Sweat Is Needed) - Normal Level: < 40 MEq/L - Positive: > 60
MEq/L (> 40 In Infants < 3 Months Is +) Chloride Concentrations Of 40 - 60
Are Highly Suggestive Of CF And Require A Repeat Test Stool, Fat, Enzyme
Analysis: 72-Hour Stool Sample Is Collected To Check The Fat Or Trypsin
Content - Food Intake Is Recorded During Collection

Peds - Respiratory
Disorders: Cystic
Fibrosis Respiratory System
Interventions

Goals Of Treatment Include Preventing And Treating Pulmonary Infection By

Improving Aeration, Removing Secretions, And Giving ANTIBIOTIC
Medications Chest Physiotherapy (Percussion And Postural Drainage On
Awakening And In The Evening, More Frequently During Pulmonary
Infections) Flutter Mucus Clearance Device (Small Hand-Held Plastic Pipe
With A Stainless Steel Ball Inside Which Could Be A Choking Hazard If Not
Stored Away Properly) Hand-Held Percussors Or Special Vest (Provides
High-Frequency Chest Wall Oscillation) Positive Expiratory Pressure Mask
(Uses "Huffing", An Expiratory Technique To Mobilize Secretions)
Bronchodilator Medication (By Aerosol), Administer Before Chest
Physiotherapy

Peds - Respiratory
Disorders: Cystic
Fibrosis - GI System
Interventions

Goal Of Treatment Is To Replace Pancreatic Enzymes; Pancreatic Enzymes

Are Given Within 30 Minutes Of Eating And Given With All Meals And All
Snacks (DO NOT GIVE ENZYMES IF NPO) HIGH-CALORIE, HIGH-PROTEIN,
And WELL-BALANCED DIET Needs Multivitamins And Vitamins A, D, E, And
K Ensure Child Receives The Recommended Immunizations On Schedule;
Additionally, ANNUAL INFLUENZA VACCINE For Children 6 Months And Older
*** An Alteration In Respiratory Status Can Be Frightening For The Child And

Parent. Use A Calm And Reassuring Nursing Approach ***

Peds - Respiratory
Disorders: Cystic
Fibrosis S/S

Mucus Is Sticky And Thick CANNOT Cough Up Mucus On Their Own

DOES NOT Pass Meconium Within First 24 Hours

Peds - Respiratory 25% Get Disease 50% Carriers 25% Normal

Disorders: Cystic
Fibrosis - Autosomal
Recessive Trait
Percentages
Peds - Respiratory
Disorders: Foreign
Body Aspiration
(Choking) Foods

Most Common Foods Are Round In Shape: Hot Dogs Candy Peanuts
Popcorn Grapes

Peds - Respiratory
Disorders:
Tuberculosis

S/S: Malaise Fever Cough Weight Loss Anorexia Dx: - Mantoux Test
- Sputum Culture - CXR Medications: - INH - For Latent Or Active; 9 Months
Or 12 Months If Child Has HIV - ACTIVE: Rifampin, INH, And Pyrazimide Daily For 2 Months, Then INH And Rifampin Twice Weekly For 4 Months
ACTIVE = RESPIRATORY/ AIRBORNE ISOLATION Until Medications Have Been
Initiated, Sputum Culture Show A Diminished Number Of Organisms, Cough
Is Improving - Use N95 Or N100 Mask

Peds - Respiratory
Disorders:
Tuberculosis
Mantoux Test
Interpretation

High-Risk/Immunosuppressive/HIV: (+) If 5mm Or More <4 Years Old: (+) If

10mm Or More > 4 Years Old: (+) If 15mm Or More

Peds - CV Disorders:
Congestive Heart
Failure (CHF)
Description

- Infants And Children, A Combination Of LEFT-SIDED And RIGHT-SIDED HF Is

Usually Present Goals Of Treatment Are To: - Improve Cardiac Function Remove Accumulated Fluid And Sodium - Decrease Cardiac Demands Improve Tissue Oxygenation - Decrease Oxygen Consumption

Peds - CV Disorders: Monitor Apical Pulse (Count For 1 Full Minute) Monitor For Dysrhythmias
CHF Interventions
Strict I/O, Weigh Diapers Monitor Daily Weight For Fluid Retention A
Weight Gain Of 0.5 Kg (1 Lb.) In 1 Day Is Caused By Fluid Accumulation
Elevate HOB To Semi-Fowlers Provide Rest Stimuli Organize
Activities To Allow Uninterrupted Sleep Feed When Hungry And Soon After
Awakening, To Conserve O2 Supply Give Digoxin (Lanoxin): Positive
Inotropic Effect- Rate, Force, And Cardiac O/P - Hold Digoxin If HR < 90
- 110 In Infants And Young Children, And <70 In Older Children - Infants
Rarely Receive More Than 1mL (50mcg Or 0.05 Mg) In One Dose - If Child
Vomits DO NOT Give 2nd Dose Monitor For Dig Toxicity: - Anorexia - Poor
Feeding - Nausea - Vomiting - Bradycardia - Dysrhtmias - Dig Level Is Higher
Than 2 Give Angiotensin-Converting Enzyme Inhibitors (Releases SODIUM
And H2O, Then Holds POTASSIUM) - Monitor For Hypotension Give
Diuretics, Lasix - Monitor For S/S Of Hypokalemia: ST Depression, T
Inversion, U Wave Give Potassium Supplements And Provide Dietary

Sources Of Potassium
Peds - CV Disorders: Crackles Cough Cyanosis (Periods Of) Dyspnea Grunting (Infants)
Left-Sided HF
Head Bobbing (Infants) Nasal Flaring Orthopnea Retractions
Tachypnea Wheezes
Peds - CV Disorders: Ascities Dependent Edema Hepatosplenomegaly Jugular Vein
Right-Sided HF
Distention Oliguria Peripheral Edema Periorbital Edema Weight Gain
Peds - CV Disorders: Defect With Increased Pulmonary Blood Flow - Abnormal Opening Between
Atrial Septal Defect Atria And Right Side Of Heart - Increased Flow Of Oxygenated Blood Into
Right Side Of Heart - Defect May Be Closed During A Cardiac
Catheterization
Peds - CV Disorders: Defect With Increased Pulmonary Blood Flow - Patent = Opening - Failure Of
Patent Ductus
The Ductus Arteriosus To Close Within The First Week Of Life - Artery
Arteriosus
Connecting The Aorta And Pulmonary Artery - Machinery-Like Murmur
(Speaking Over The PDA System At School) - Widened Pulse Pressure Bounding Pulses - Prostaglandin E Keeps The PDA OPEN, By Dilating The
Vascular Muscles - Indocin: Prostaglandin Inhibitor To CLOSE PDA In
Premature Infants (DO NOT GIVE TO PREGNANT CLIENT) - Closed During
Cardiac Cath
Peds - CV Disorders: Defect With Increased Pulmonary Blood Flow - Abnormal Opening Between
Ventricular Septal
The Right And Left Ventricles - Closure During Cardiac Cath
Defect
Peds - CV Disorders: Obstructive Defect Coarctation = Narrowing - Narrowing Near The Insertion
Coarctation Of The Of The Ductus Arteriosus - BP In Upper Extremities, Than The Lower
Aorta
Extremities - Bounding Pulses In Arms - Weak Or Absent Femoral Pulses Cool Lower Extremities - Signs Of CHF In Infants - S/S Of Decreased Cardiac
O/P - Children May Experience: Headaches, Dizziness, Fainting, And
Epistaxis From HTN - Management Done Via Balloon Angioplasty In Children
Peds - CV Disorders: Defects With Decreased Pulmonary Blood Flow - Includes Four Defects: VSD,
Tetralogy Of Fallot
Pulmonary Stenosis, Overriding Aorta, And Right Ventricular Hypertrophy Tet Spells/Blue Spells - Acute Cyanosis And Hypoxia (Hypercyanotic Spells),
Occurs When The Infant's Oxygen Requirements Exceed The Blood Supply,
Such As During Periods Of Crying, Feeding, Or Defecating - Increasing
Cyanosis - Squatting (DROP) - Clubbing Of Fingers - Poor Growth Squatting
Is A Compensatory Mechanism To Facilitate Increased Return Of Blood Flow
To The Heart For Oxygenation D-Isplaced Aorta R-Ight Ventricular
Hypertrophy (Enlargement Of Right Ventricle) O-Pening Between Ventricles
P-Ulmonary Stenosis Management- Palliative Shunt *** Newborn: Put In
Knee-Chest Position ***
Peds - CV Disorders: Defect With Decreased Pulmonary Blood Flow - Blood Flows Through An ASD
Tricuspid Atresia
Or A Patent Foramen Ovale To The Left Side Of The Heart And Through A
VSD To The Right Ventricle And Out To The Lungs - The Defect Often Is
Associated With Pulmonic Stenosis And Transposition Of The Great Arteries The Defect Results In Complete Mixing Of Unoxygenated And Oxygenated

Blood In The Left Side Of The Heart, Resulting In Systemic Desaturation,

Pulmonary Obstruction, And Decreased Pulmonary Blood Flow
Peds - CV Disorders: Tiny LEFT Ventricle And Cardiac O/P - Underdevelopment Of The Left Side
Hypoplastic Left
Of The Heart Occurs, Resulting In A Hypoplastic Left Ventricle And Aortic
Heart Syndrome
Atresia - Mild Cyanosis And Signs Of CHF Occur Until The Ductus Arteriosus
Closes; Then Progressive Deterioration With Cyanosis And Decreased
Cardiac Output Are Seen, Leading To Cardiovascular Collapse - The Defect Is
Fatal In The First Few Months Of Life Without Intervention - Continuous
Infusion Of Prostaglandin E1 To Maintain Ductus Patency, Ensuring Adequate
Systemic Blood Flow
Peds - CV Disorders: Surgical Management: The Arterial Switch Procedure Re-Establishes Normal
Transposition Of The Circulation With The Left Ventricle Acting As The Systemic Pump And
Great
Creation Of A New Aorta
Vessels/Arteries
Peds - CV Disorders: Place Infant In A Knee-Chest Position Administer 100% O2 Give
Actions To Take If A Morphine Sulfate - Bronchodilates
Hypercyanotic Spell
Occurs In An Infant
Peds - CV Disorders: Mitral Valve Affected Most Serious Complication Is Rheumatic Heart
Rheumatic Fever
Disease, Which Affects The Cardiac Valves, Particularly The Mitral Valve
Description
Rheumatic Fever Manifests 2 To 6 Weeks After An Untreated Or Partially
Treated Group A Beta-Hemolytic Streptococcal Infection Of The Upper
Respiratory Tract Pt Has Strept, Mother Doesn't Give All The Medication,
Infection Then Lies Dormant.
Peds - CV Disorders: Low-Grade Fever *Spikes Late In The Afternoon* Antistreptolysin O
Rheumatic Fever S/S Titer ESR = Infection C-Reactive Protein = Inflammation Aschoff
Bodies (Lesions): Found In The Heart, Blood Vessels, Brain, And Serous
Surfaces Of The Joints And Pleura Chorea- Involuntary Movements Of The
Extremities And FaceAffects Speech (Like A Seizure, SEIZURE
PRECAUTIONS) Carditis Erythema Marginatum (Rash)- Lesions On Trunk
And Spreading Peripherally Polyarthritis Subcutaneous Nodules- Small,
Nontender Swellings Over The Joints Abdominal Pain Fever
Peds - CV Disorders: - Ask About A Recent Sore Throat Because Rheumatic Fever Manifests 2 To 6
Rheumatic Fever
Weeks After An Untreated Strept Infection - Bed Rest During Acute Febrile
Interventions
Stage - Antibiotics (Penicillin) - Give ASPIRIN (Salicylates) - AntiInflammatory Agents
Peds - CV Disorders: - AKA Lymph Node Syndrome - Cardiac Involvement Is The MOST SERIOUS
Kawasaki Disease
Complication - Aneurysms Can Develop
Description
Peds - CV Disorders: Acute Stage: - Fever (LONG TIME, Lasting At Least 5 Days - Conjunctival
Kawasaki Disease
Hyperemia (Sclera Is EXTREMELY Red) - Red, STRAWBERRY TONGUE
S/S
Subacute Stage: - Cracking Lips And Fissures - Desquamation Of The Skin
On The Tips Of The Fingers And Toes (PEELING) - Joint Pain - Cardiac

Manifestations (ANEURYSMS) Convalescent Stage: - Child Appears Normal,

But Signs Of Inflammation May Be Present
Peds - CV Disorders: Give ASPIRIN For Its Antipyretic And Antiplatelet Effects Anticoagulants If
Kawasaki Disease
Aneurysms Are Present Immunoglobulin IV AVOID Giving MMR Or
Interventions
VARICELLA Vaccine To The Child For 11 Months After IV Immunoglobulin
Therapy (AVOID LIVE VACCINES)
Peds - GI Disorders: Metabolic Alkalosis Monitor For S/S Of Dehydration: - Sunken Fontanels Vomiting
Nonelastic Skin Turgor - Dry Mucous Membranes - Decreased Tear
Production - Oliguria
Peds - GI Disorders: Metabolic Acidosis
Diarrhea
Peds - GI Disorders: More Prominent In Native American Males Second Most Common In
Cleft Lip & Cleft
Asian Males Cleft Lip Closure At 3 To 6 Months Cleft Palate Closure At 6
Palate
To 24 Months Special Feeding Techniques: Obturators (Prosthetic Palate)
And Special Nipples And Feeders Teach Parents The ESSR Feeding Method"
- Enlarged Nipple - Stimulate The Sucking Reflex - Swallow - Rest To Allow
Infant To Finish Swallowing Elbow Restraints So Infant Doesn't Irritate
Surgical Site Remove Restraints Q2 Hours Assess Skin And Circulation
And For Exercising Arms AVOID: Suctioning Or Placing Objects In The
Mouth (Tongue Depressor, Thermometer, Straws, Spoons, Forks, Or
Pacifiers)
Peds - GI Disorders: 3 C's - Coughing - Choking (During Feedings) - Cyanosis (Unexplained)
Esophageal Atresia Replogle Tube- Used To Decompress The Stomach In Premature Newborns
&
And It Is Kept On Low-Intermittent Suctioning
Tracheoesophageal
Fistula
Peds - GI Disorders:
GERD Description,
Tx, S/S, And
Complications

Backflow Of Gastric Contents Into The Esophagus As A Result Of Relaxation

Or Incompetence Of The Lower Esophageal Or Cardiac Sphincter Tx: Diet,
Positioning, Medications, Surgery S/S: Passive Regurgitation Or Emesis
Complications: Esophagitis, Esophageal Strictures, Aspiration Of Gastric
Contents, And Aspiration Pneumonia

Peds - GI Disorders:
GERD Positioning,
Diet, Medications,
And Surgery

Positioning: Supine While Sleeping And Prone When Awake, Children Older
Than 1 Year Elevate HOB Diet: Thickened Formula With Rice Cereal - CrossCut Nipple - Burp Frequently - Toddlers: Solids First, Then Liquids - AVOID:
Fatty Foods, Chocolate, Tomato Products, Carbonated Liquids, Fruit Juices,
Citrus Products, Spicy Foods Medications: Antacids - Proton Pump Inhibitors
- Histamine 2 (H2) Receptor Antagonists - To Decrease Gastric Acid
Secretion - Prokinetics To Accelerate Gastric Emptying Surgery:
NISSEN/FUNDOPLICATION - To Wrap The Stomach Fundus Around The Distal
Esophagus (Restores The Competence Of The Lower Esophageal Sphincter)

Peds - GI Disorders: "TZAP" Tagamet- Crosses Blood-Brain Barrier And Causes CNS Problems
H2 Antagonist
Zantac Axid Pepcid
"TZAP"

Peds - GI Disorders: Hypertrophy (Enlargement) Of The Muscles Causing Narrowing Of The

Hypertrophic Pyloric Pyloric Canal Between The Stomach And The Duodenum Stenosis Usually
Stenosis
Develops In The First Few Weeks Of Life Projectile Vomiting Dehydration
Metabolic Alkalosis Failure To Thrive Peristaltic Waves Are Visible
Olive-Shaped Mass (Just Right Of The Umbilicus) Interventions: Daily
Weights Prepare Child And Parents For Pyloromyotomy (Otomy = Opening)
Pyloromyotomy: Incision Through Muscle Fibers Of The Pylorus; May Be
Performed By Laparoscopy
Peds - GI Disorders: GERD Is Lower/Distal Pylorix Stenosis Is Proximal They Are Similar EXCEPT
GERD And Pyloric
Pyloric Stenosis = Projectile Vomiting, Also Pyloric Stenosis Client Will Have
Stenosis
Metabolic Alkalosis
Comparison
Peds - GI Disorders: AKA "Gluten Enteropathy Or Celiac Sprue" - Intolerance To Gluten (BROW =
Celiac Disease
Barley, Rye, Oats, Wheat) Risk Of Developing Malignant Lymphoma Of The
Small Intestine And Other GI Malignancies If Diet Not Followed
Interventions: - Gluten-Free Diet - Instruct About Lifelong Gluten-Free Diet Give Mineral And Supplements: Iron, Folic Acid, Fat-Soluble Vitamins A, D, E,
And K
Peds - GI Disorders: Meats: Beef, Pork, Poultry, And Fish Eggs Milk Dairy Products
Gluten-Free Diet,
Veggitables Fruits RICE CORN Gluten-Free Flour Puffed Rice
Foods Allowed
Cornflakes Cornmeal
Peds - GI
Disorders:GlutenFree Diet, Foods
Prohibited

Commercially Prepared Ice Cream Malted Milk Pudding Grains:

Barley, Rye, Oats, Wheat, Bread, Rolls, Cookies, Cakes, Crackers, Cereal,
Spaghetti, Macaroni Noodles Beer/Ale

Peds - GI Disorders: Pain In RLQ Pain Is Most Intense At McBurney's Point (1/3 Between The
Appendicitis
Right Anterior Iliac Spine And UmbilicusAn Inch Below The Hip Bone Go
1/3 Towards The Umbilicus Diagonally) Peritonitis - Results From Perforated
Appendix Perforated Appendix - SUDDEN PAIN RELIEF, Followed By A
Subsequent Increase In Pain With Guarding Appendectomy: - Right- Side
Lying Or Low To Semi-Fowlers - AVOID Application Of Heat To The Abdomen AVOID Laxatives And Enemas
Peds - GI Disorders: AKA "Congenital Aganglionosis" Or "Aganglionic Megacolon" - May Be A
Hirschsprung's
Familial Congenital Defect Or May Be Associated With Other Anomalies,
Disease
Such As Down Syndrome And Genitourinary Abnormalities TX: - For Mild Or
Moderate Disease Is Relieving Constipation With Stool Softeners And Rectal
Irrigations - Moderate To Severe Involves Two-Step Surgical Procedure S/S:
Newborn - Failure To Pass Meconium Stool - Refusal To Suck - Abdominal
Distention - No Bowel Sounds - Bile-Stained Vomit Children - Failure To Gain
Weight - Delayed Growth - Abdominal Distention - Constipation Alternating
With Diarrhea - RIBBON-LIKE / FOUL-SMELLING STOOLS Interventions: - LowFiber, High-Calorie, High-Protein Diet - Stool Softeners - Daily Rectal
Irrigations With NS - Measure Abdominal Girth Daily - AVOID Rectal Temp Surgery Typically Done When Child Is About 20 Pounds

Peds - GI Disorders: H-Elp I-M R-Eally S-Eriously C-Onstipated H-Aving S-Tool "RIBBON-LIKE" PHIRSCHSPRUNGS
Lease Give R-Ectal Irrigations N-Ormal Saline (NO TAP WATER) G-Anglion
Cells Are Missing (Which Are For Peristalsis) S-Igmoid
Peds - GI Disorders: Telescoping Of One Portion Of The Bowel Into Another Portion Obstruction In
Intussusception
The Passing Of Intestinal Contents S/S: - Colicky Abdominal Pain - Child
Screams And Draws Knees-Abdomen (Similar To Fetal Position) - Bile-Stained
Fecal Emesis - CURRANT JELLY STOOL Containing Blood And Mucus Sausage-Shaped Mass In RUQ Interventions: - Monitor For Passage Of
Normal Stool Which Indicates Intussusception Has Reduced Itself Hydrostatic Reduction If No Signs Of Perforation Or Shock Occur (Air Or Fluid
Is Used To Fix Problem) - Monitor For Return Of Normal Bowel Sounds, For
Passage Of Barium, And Normal Bowel Movement ** If Brown Stool Is Being
Passed NOTIFY PHYSICIAN Because The Status Has Changed, Even Though
It Is Good ** ** BARIUM Is Used To DX And FIX The Problem **
Peds - GI Disorders:
Abdominal Wall
Defects Gastroschisis

Occurs When The Herniation Of The Intestine Is Lateral To The Umbilical

Ring No Membrane Covers The Exposed Bowel Exposed Bowel Is
Covered LOOSELY In SALINE-SOAKED PADS, And The Abdomen Is LOOSELY
WRAPPED In A PLASTIC DRAPE; Wrapping Around The Bowel Is
Contraindicated Because If The Exposed Bowel Expands, Wrapping Could
Cause Pressure And Necrosis Pre-Op: - NPO - IV Fluids For Hydration And
Electrolyte Balance - Monitor For Signs Of Infection - Handle Infant Carefully
To Prevent Rupture Of The Sac Post-Op: - Most Infants Develop Prolonged
Ileus - ... Require Mechanical Ventilation - ... Need TPN - Otherwise, Control
Pain, Prevent Infection, Hydrate, Electrolytes, And Ensure Adequate
Nutrition

Peds - GI Disorders: If It Starts With A Vowel It Comes From The Bowel (A, E) A,E: Poop
Hepatitis
(Fecal/Oral) And Cooking Food B,C: Blood/Semen/Saliva D: Can Only Get If
You Have Hep B A And B: HAVE VACCINATIONS C, D, And E: NO
VACCINATIONS AVAILABLE A: LEAST Serious - DO NOT Share Utensils
Peds - GI Disorders: Dust And Soil Contaminated With Lead May Be A Source Of Exposure
Lead Poisoning
Lead Enters The Child's Boy Through Ingestion Or Inhalation Or Through
Placental Transmission To Un Unborn Child When The Mother Is Exposed
Most Common Route Is Hand To Mouth From Contaminated Objects LOOSE
PAINT CHIPS Pottery Ceramic Ware Coupled With INHALATION OF LEAD
DUST When Lead Enters The Body, It Affects The Erythrocytes, Bones,
Teeth, Organs, Tissues; Including The Brain And Nervous System. The Most
Serious Consequences Are The Effects On The CNS Intervention: Chelation
Therapy
Peds - GI Disorders: - Removes Lead From The Blood, Organs, And Tissues - DOES NOT
Chelation Therapy COUNTERACT (Fix) ANY EFFECTS OF THE LEAD Medications: - Calcium
Disodium Edetate (CaNa2EDTA) - Succimer (Chemet) - British Anti-Lewisite
(BAL, Dimercaprol)- Used In Conjunction With EDTA (Lead) British-Anti
Lewisite Is CONTRAINDICATED In Children ALLERGIC TO PEANUTS Because It
Is Prepared In Peanut Oil Solution; Also CONTRAINDICATED In Children With
GLUCOSE 6-PHOSPHATE DEHYDROGENASE (G6PD), And Should Not Be

Given With Iron

Peds - GI Disorders: - Toxic Dose Is 150 Mg/Kg Or Higher In Children Antidote: Mucomyst - Dilute
Acetaminophen
Antidote In Juice Or Soda Because Of Its Offensive Odor
(Tylenol)
Peds - GI Disorders: Expectorant Antidote To Tylenol Nephro Protectant With Contrasts
3 Actions Of
Mucomyst
Peds - GI Disorders: - Acute: Severe Toxicity With 300 To 500 Mg/Kg - Chronic: Ingestion Of More
Acetylsalicylic Acid Than 100 Mg/Kg Per Day For 2 Days Or More
(Aspirin)
Peds - GI Disorders: Giardiasis (Back Packers/Hikers) - Diarrhea - Vomiting - Anorexia - Failure To
Intestinal Parasites - Thrive - Abdominal Cramps With Intermittent Loose Stools And Constipation
Giardiasis
- Steatorhhea - Resolves In 4 To 6 Weeks Spontaneously - Stool Specimens
From 3 Or More Collections For DX Medications: Flagyl Tindamax Alinia
Albenza
Peds - GI Disorders: Pinworms - Intense Perianal Itching - Irritability - Restlessness - Poor
Intestinal Parasites - Sleeping - Bed Wetting Interventions: Visual Inspection Of Anus With A
Pinworms
Flashlight 2 To 3 Hours After Sleep Tape Test To DX Medications: - Vermox Pin-Rid - Antiminth - Albenza Medication Regimen May Be Repeated In 2
Weeks To Prevent Reinfection
Peds - Metabolic &
Endocrine: Fever

Aspirin (Acetylsalicylic Acid) Should NOT Be Given, Unless Specifically

Prescribed, Because Of Reye's Syndrome - Exceptions Are For Rheumatic
Fever And Kawasaki Disease Retake The Temperature 30 To 60 Minutes
After The Antipyretic Is Administered

Peds - Metabolic & Isotonic Dehydration: Electrolyte And Water Deficits Occur In Approximately
Endocrine: Types Of Balanced Proportions Hypertonic Dehydration: Water Loss Exceeds
Dehydration
Electrolyte Loss Hypotonic Dehydration: Electrolyte Loss Exceeds Water
Loss ***For Severe Dehydration, Maintain NPO Status To Place The Bowel At
Rest And Provide Fluid And Electrolyte Replacement Via IV; If Potassium Is
Prescribed IV, Ensure That The Child Has Voided Before Giving***
Peds - Metabolic &
Endocrine:
Phenylketonuria
Description

Phenylketonuria - Can Cause Brain Damage Description: - Genetic Disorder

(Autosomal Recessive Disorder) That Results In CNS Damage From Toxic
Levels Phenylalanine (An Essential Amino Acid - In Milk) In The Blood Normal In Newborn: 1.2 - 3.4 - Normal If Older: 0.8 - 1.8 - Abnormal: > 20 All 50 States Require Routine Screening Of All Newborns For
Phenylketonuria

Peds - Metabolic & S/S: All Children - - Musty Odor Of The Urine - Mental Retardation Older
Endocrine:
Children - - Hypopigmentation Of The Hair, Skin, And Irises - Hyperactive
Phenylketonuria S/S Behavior
Peds - Metabolic &
Endocrine:
Phenylketonuria

Interventions: - Screening Of Newborn Infants: The Infant Should Have

Begun Formula Or Breast Milk Feeding Before Specimen Collection - If Initial
Screening Is Positive, A Repeat Test Is Performed, And Further Diagnostic

Interventions

Evaluation Is Required To Verify The Diagnosis - Rescreen Infants By 14 Days

Of Age If The Initial Screening Was Done Before 48 Hours Of Age - If
Diagnosed Restrict Phenylalanine Intake; High-Protein Foods ( Meats And
Dairy Products) And Aspartame Are AVOIDED Because They Contain Large
Amount Phenylalanine

Peds - Renal &

Urinary:
Glomerulonephritis
Description And
Cause

Description: - Functioning Units Of Kidneys - Loss Of Kidney Function

Develops Cause: - Antecedent Group A Beta-Hemolytic Streptococcal
Infection Of The Pharynx Or Skin - History Of Pharyngitis Or Tonsillitis 2 To 3
Weeks Before Symptoms

Peds - Renal &

S/S: - Cloudy, Smoky, Brown-Colored Urine (Hematuria) - DX Feature Urinary:
Azotemia (Waste Products) - BUN - Creatinine - Antistreptolysin O Titer
Glomerulonephritis (ASO)
S/S
Peds - Renal &
Urinary:
Glomerulonephritis
Interventions

Inventions: - Foods High In Potassium Are Restricted During Periods Of

Oliguria - Urinary Output - Report Signs Of Bloody Urine, Headache, Or
Edema - Do The Appropriate Treatment For Infections, Specifically For Sore
Throats, Upper Respiratory Infections, And Skin Infections

Peds - Renal &

Urinary: Nephrotic
Syndrome
Description

- Kidney Disorder Characterized By Massive Proteinuria, Hypoalbuminemia

(Hypoproteinemia), And Edema - Objectives Of Therapeutic Management
Are To Reduce The Excretion Of Urinary Protein, Maintain Protein-Free Urine,
Reduce Edema, Prevent Infection, And Minimize Complications

Peds - Renal &

Urinary: Nephrotic
Syndrome S/S

Classic Signs: - Massive Proteinuria - Hypoalbuminemia - Edema Others Are:

- Leg, Ankle, Labial, Or Scrotal Edema - Protein (Hypoproteinemia) - Lipid
Level

Peds - Renal &

Urinary: Nephrotic
Syndrome
Interventions

- Monitor Urine Specific Gravity And Protein - Monitor For Edema - Diet:
Regular W/O Added Salt, Sodium Is Restricted During Periods Of Massive
Edema (Fluids May Also Be Restricted) - Plasma Expanders Such As SaltPoor Human Albumin May Be Prescribed For A Severely Edematous Child
Albumin = Plasma Volume Expander, If Plasma Volume Is Then Cardiac
Output Is

Peds - Renal &

Urinary: Enuresis

Bed Wetting At Night

Peds - Renal &

Urinary:
Cryptorchidism

*Higher Risk For Testicular Cancer* - Testes Fail To Descend - Testes Are Not
Palpable Or Easily Guided Into The Scrotum - Surgical Correction, If Needed,
Is Done By ORCHIOPEXY Before The Child's 2nd Birthday (Between 1 And 2
Years Of Age) If The Testes Do Not Descend Spontaneously

Peds - Renal &

Epispadias: Urethral Orifice (Opening) On The Dorsal Surface Of The Penis
Urinary: Epispadias (On The Top) Hypospadias: Urethral Orifice (Opening) Below The Glans Penis
& Hypospadias
Along The Ventral Surface (Underneath/On The Bottom Of The Penis)
***WATCH FOR INFECTION*** - Surgery Is Done Before The Age Of Toilet
Training, Between 16 And 18 Months ***Circumcision Is NOT Performed
Because The Foreskin May Be Used In Surgical Reconstruction*** - The Child

Has A Pressure Dressing And May Have Some Type Of Urinary Diversion Or
A Urinary Stent (Used To Maintain Patency Of The Urethral Opening) While
The Meatus Is Healing
Peds Integumentary:
Eczema

- Associated With Family History Of The Disorder, Allergies, Asthma, Or

Allergic Rhinitis S/S: - Itching - Minute Papules (Firm Elevated Lesions <1 Cm
In Diameter) And Vesicles (Similar To Papules, But Filled With Fluid)
Interventions: - Antihistamines - Topical Corticosteroids (Apply In Thin Layer
And Rub Into Area Thoroughly) - PREVENT OR MINIMIZE ITCHING; Keep Nails
Short And Clean, And Place Gloves Or Cotton Socks Over The Hands Eliminate Conditions That Increase Itching, Such As Wet Diapers, Excessive
Bathing, Ambient Heat, Woolen Clothes Or Blankets, And Proximity To Rough
Fabrics Or Furry Stuffed Animals - EXPOSURE TO LATEX SHOULD BE
AVOIDED - Monitor For Lesion Infection (Honey-Colored Crusts With
Surrounding Erythema) And Seek Immediate Medical Help If Such Signs Are
Noted

Peds Integumentary:
Impetigo

CONTACT ISOLATION Description: - CONTAGIOUS BACTERIAL INFECTION

Caused By Streptococci Or Staphylcocci, Or Both - Occurs Mostly During
Hot, Humid Months - Lesions Begin As Vesicles Or Pustules Surrounded By
Edema And Redness

Peds Integumentary:
Pediculosis Capitis
(LICE)

- Can Return To School After Treatment Is Initiated - Use A Pediculicide (NIX)

- Siblings May Also Need Treatment - Grooming Items Should NOT Be Shared
- Bedding And Clothing Should Be Changed Daily And Washed In HOT Water
With Detergent, And Dried In A HOT Dryer For 20 Minutes; CONTINUE
PROCESS FOR 1 WEEK - Nonessential Bedding And Clothing Can Be Stored
In A Tightly Sealed Bag For 2 Weeks And Then Washed - Furniture And
Carpets Need To Be Vacuumed Frequently And The Bag From The Vacuum
Should Be Discarded After Vacuuming

Peds S/S: - SHORTENING Of The Limb On The AFFECTED Side (Galeazzi's Sign,
Musculoskeletal: Hip Allis' Sign) - ABDUCTION Of The Hip On The AFFECTED Side When Infant Is
Dysplasia S/S
Placed Supine With Knees And Hips Flexed - Asymmetry Of Gluteal And
Thigh Folds - POSITIVE ORTOLANI'S TEST: Assesses For Hip Instability.
Examiner ABDUCTS The Thigh And Applies Gentle Pressure FORWARD OVER
THE GREAT TROCHANTER. A "CLUNKING" Sensation Indicates A Dislocated
FEMORAL HEAD Moving INTO The ACETABULUM - POSITIVE BARLOW'S TEST:
ADDUCTS The Hips And Applies Gentle Pressure Down And Back With The
Thumbs. Examiner Can Feel The FEMORAL HEAD Move OUT Of The
ACETABULUM - POSITIVE TRENDELENBURG's SIGN: Child Stands On One
Foot And Then The Other Foot, Holding Onto A Support And Bearing Weight
On The Affected Hip; The Pelvis Tilts Downward And The Normal Side
Instead Of Upward, As It Would With Normal Stability
Peds Birth To 6 Months Of Age: Splinting Of Hips With PLAVIK HARNESS To
Musculoskeletal: Hip Maintain FLEXION, ABDUCTION, And EXTERNAL ROTATION (Worn
Dysplasia
Continuously Until Hip Is Stable In About 3 To 6 Months) Age 6 To 18
Interventions
Months: Gradual Reduction By Traction Followed By Closed Reduction Or
Open Reduction (If Necessary) Under General Anesthesia; Child Is Then

Placed In A Hip SPICA CAST For 2 To 4 Months Until The Hip Is Stable, And
Then A Flexion-Abduction Brace Is Applied For Approximately 3 Months
Peds Musculoskeletal:
Fractures

Fractures In Infancy Is Rare And Warrants Further Investigation To Rule Out

Possible Child Abuse.

Peds - Used To Stabilize A Fractured Femur Before Surgery - Similar To Buck's

Musculoskeletal:
Traction, But Provides A Double Pull Using A Knee Sling That Pulls At The
Russell Skin Traction Knee And Foot
Peds - Used With Skin Or Skeletal Traction To Approximate Fractures Of The
Musculoskeletal:
Femur, Tibia, Or Fibula - Produced By A Counterforce Other Than The Child Balanced
Provide Pin Care If Pins Are Used With The Skeletal Traction
Suspension Traction
Peds - Lower Leg Is Supported By A Boot Cast Or A Calf Sling - Skeletal
Musculoskeletal: 90- Steinmann Pin Or Kirschner Wire Is Placed In The Distal Fragment Of The
Degree -- 90-Degree Femur, Allowing 90-Degree Flexion At The Hip And The Knee
Traction
Peds Musculoskeletal:
Traction
Interventions

Ensure Weights Hang Freely Neurovascular Assessment Is Performed In

The Extremity Monitor For S/S Of Immobilization, Such As Constipation,
Skin Breakdown, Lung Congestion, Renal Complications, And Disuse
Syndrome Of Unaffected Extremities Provide Therapeutic And Diversional
Play

Peds Hematological:
Sickle Cell Anemia

Insufficient Oxygen Causes The Cells To Assume A Sickle Shape, And The
Cells Become Rigid And Clumped Together, Obstructing Capillary Blood Flow
It Is Caused By The INHERITANCE OF A GENE - 25% Normal - 50% Being A
Carrier - 25% Getting Sickle Cell Anemia Situations That Precipitate
Sickling Include: - Fever - Dehydration - Emotional Or Physical Stress - Any
Condition That Increases The Need For Oxygen S/S: - Gallstones (Bilirubin Is
In RBC's And They Are Being Broken Down) - Bilirubin - Priapism Prolonged Erection Interventions: HOP (Not In This Specific Order) - H-Ydrate
- O-Xygenate - P-Ain Management (Analgesics Around The Clock) - Blood
Transfusions May Also Be Needed To Increase Tissue Perfusion ***DO NOT
Give DEMEROL For Pain, Risk For SEIZURES***

Peds Give Iron Supplements Between Meals For Maximum Absorption Give
Hematological: Iron Iron With A Multivitamin Or Fruit Juice Because VITAMIN C ABSORPTION
Deficiency Anemia DO NOT GIVE WITH MILK OR ANTACIDS, This Will ABSORPTION ***Liquid
Iron Stains Teeth, Take Liquid Iron Through A Straw And Brush Teeth After***
Peds Hematological:
Hemophilia

***Transmitted MOTHER To SON*** Most Common Types: - Factor VIII

Deficiency (Hemophilia A Or Classic Hemophilia) - Factor IX Deficiency
(Hemophilia B Or Christmas Disease) Females Pass Defect To Son

Peds - Oncological:
Leukemia

Affects The Bone Marrow, Causing: - Anemia From Decreased Erythrocytes

- Infection From Neutropenia - Bleeding From Decreased Platelet Production
(Thrombocytopenia) Eliminate RAW FRUITS And VEGETABLES From The
Diet DO NOT Allow FRESH FLOWERS In The Child's Room DO NOT Leave

STANDING WATER In The Child's Room AVOID Invasive Procedures Such As

Injections, Rectal Temps, And Urinary Caths
Peds - Oncological:
Hodgkin's Disease

- Characterized By The Presence Of REED-STERNBERG CELLS Noted In A

Lymph Node Biopsy Specimen

Peds - Oncological:
Nephroblastoma
(WILM'S TUMOR)

- Sits In The Kidney - Palpate May Manifest Unilaterally And Localized Or

Bilaterally, Sometimes With Metastasis To Other Organs S/S: - Swelling Or
Mass Within The Abdomen ( Mass Is Firm, Nontender, Confined To One Side,
And Deep Within FLANK) - Urinary Retention - Hematuria - HTN (Caused By
Secretion Of Excess Amounts Of RENIN In The Tumor) Interventions: - DO
NOT PALPATE ABDOMEN - Place A Sign At The Bedside That Says "DO NOT
PALPATE ABDOMEN" - Be Cautious When Bathing, Moving, Or Handling The
Child - Rupture Of The Tumor Can Cause The Cancer Cells To Spread
Throughout The Abdomen, Lymph System, And Bloodstream

Peds - AIDS: Care Of Caretaker Instructions: - Wash Hands Frequently - Assess Child For : Fever
The Child With HIV Malaise Fatigue Weight Loss Vomiting Diarrhea Altered Activity
Level Oral Lesions - Notify Physician Is Any Of These Occur DX: - ELISA Western Blot Do These Tests When The Child Is > 18 Months Old Antiviral
Medications: - Protease Inhibitors - Inhibits (STOPS) Enzymes Required For
HIV Replication - ANY MED THAT ENDS WITH "-NAVIR"
Peds - Infectious &
Communicable
Diseases: Erythema
Infectiosum (FIFTH
DISEASE)

Agent: Human Parvovirus B19 Incubation Period: 4 - 14 Days; May Be 20

Days Communicable Period: Uncertain, But Before The Onset Of Symptoms
In Most Children Source: Infected Person Transmission: Unknown, Possibly
Respiratory Secretions And Blood S/S: - Erythema Of The Face (SlappedCheek), Develops And Disappears By 1 - 4 Days - Rash Disappears, But May
Reappear If The Skin Becomes Irritated By Sun, Heat, Cold, Exercise, Or
Friction Interventions: - Pregnant Women Should AVOID THE INFECTED
INDIVIDUAL, Baby Can Get HYDROPS FETALIS

Peds - Medication
Newborns And Infants Have An Immature Liver And Immature Kidneys, So
Administration And Metabolism And Elimination Of Medication Is Delayed
Calculations: Oral
Medications
Peds - Medication
Administration And
Calculations:
Parenteral
Medications

The Safe Use Of Injection Sites Is Based On Normal Muscle Development

And The Size Of The Child The Preferred Site For Intramuscular Injections
In Infants Is The Vastus Lateralis Usual Needle Length And Gauge For
Pediatric Clients Are To 1 Inch And 22 To 25 Gauge Needle Length Can
Be Estimated By Grasping The Muscle Between The Thumb And Forefinger
Half The Resulting Distance Would Be The Needle Length