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-what are the risk factors for IE?
-an infection of the inner lining of the heart and valves
1. indwelling catheters
2. Congenital or acquired heart disease
nursing care for ineffective endocarditis?
-administer antibiotics parenterally for an extended length of time (2-8 weeks) usually via PICC line
-kids will need prophylactic antibiotics prior to dental and surgical procedures
-need good oral care
-educate families on s/s of infection
s/s of ineffective endocarditis?
*in neonates: feeding problems, respiratory distress, tachycardia, HF, septicemia
Digoxin in children:
1. when do you hold it for infant/child
2. What is toxicity?
1. Monitor pulse and withhold medication as prescribed
-infant pulse < 90/min = hold
-child pulse <70 =hold |
2. toxicity: N/V, anorexia, dysrhythmias, bradycardia
nursing interventions for a child with HF
-Conserve the child's energy: frequent rest periods, cluster care, provide small, frequent meals, bathing PRN, and keep crying to a minimum
-I&O's and daily weights
-allow child to sleep with several pillows, maintain semi-fowlers when awake
-allow the infant to rest during feedings, taking approximately 30 minutes to complete feeding
-administer humidified oxygen
-monitor o2 saturation Q 2-4 hours
-suction airway as needed
-gavage feed the infant as needed, use a high calorie formula
-teach s/s of worsening HF: increased sweating, decreased urinary output
-inflammatory disease that occurs as a reaction to group A-beta hemolytic streptococcus infection of the throat
what is a risk factor for rheumatic fever?
-usually occurs within 2-6 weeks following an untreated or partially treated upper respiratory infection (strep throat)
what is the Jones criteria?
-used to diagnose rheumatic fever.
-the child should demonstrate the presence of two major criteria OR the presence of one major and two minor criteria following an acute infection with GABHS
-subcutaneous nodules (nontender, over bony prominences)
-rash (erythema marginatum: pink, not itchy)
-chorea (abnormal involuntary movement)
-acute systemic vasculitis
what are the three phases of Kawasaki?
1. Acute phase:
-onset of high fever, unresponsive to anti-pyretics (greater than 102) lasting 5 days
-red eyes without drainage
-bright red, chapped lips
-red oral mucus membranes with inflammation
-bilateral joint pain
-enlarged lymph nodes
-cardiac: myocarditis, pericardial effusion, mitral regurgitation
2. Subacute phase:
-resolution of fever and gradual subsiding of other manifestations
--> irritability, peeling skin around nails, palms, and soles, temporary arthritis
-no manifestation seen expect for altered lab values
-resolution in 6-8 weeks after onset.
what is treatment for Kawasaki?
-administer IV fluids to prevent dehydration
-offer clear liquids and soft foods
-administer IV gamma globulin
-provide care to promote comfort:
-rest (cluster care), apply skin lotions, apply cool clothes to skin, perform oral hygiene
Gamma Globuliin nursing consideration
-administer via IV infusion
-ideally, given within the first 7 days of illness
-REPEAT for clients who remain febrile
-assess for allergic reaction
what is important regarding immunizations and kawasaki?
-AVOID live immunizations for 11 months
what is autism spectrum disorder?
-complex neurodevelopmental disorders with spectrum of behaviors affecting an individuals ability to communicate and interact with others in a social setting
expected findings in autism?
-delays in at least one of the following:
1. social interaction
2. Social communication
3. imaginative play prior to age 3
-distress when routines are changed
-unusual attachments to objects
-inability to start or continue a conversation
-grunting or humming
-using gestures instead of words
-withdrawn, labile mood
-avoid eye contact
-intense temper tantrums
-exhibiting repetitive movements
-typical IQ < 70
-decreased pain sensation
-delayed or absent language development
-heightened or lowered senses
what is patient centered care for autism?
-assist with screening tool such as Checklist for Autisim in Toddler (CHAT)
-assist with behavior modification program:
1. promote positive reinforcement
2. increase social awareness
3. decrease unacceptable behaviors
4. set realistic goals
5. set clear rules
6. structure opportunities for small success
-decrease environmental stimuli
-introduce child to new situations slowly
-talk at an age appropriate level (brief and concrete)
-encourage age appropriate play
why might medications be given in autism?
-what kind of medications?
-used to try and control aggression, anxiety, hyperactivity, mood swings, compulsions, and attention problems
1. SSRI'a can be used to try and control aggression
2. anti-psychotic and melatonin can help with insomnia
expected findings in down syndrome?
-small nose, depressed nasal bridge
-upward, outward slant to eyes
-epicanthal folds (skin fold of the upper eyelid)
-high arched narrow palate
-short, broad neck
-shortened rib cage
-dry skin that crack easily
-hyperflexibilitiy, hypotonia, muscle weakness
-broad, short feet and hands with stubby toes and fingers
what are feeding strategies for a child with down syndrome
(to deal with protruding tongue)
-small, but long straight handled spoon
-push food toward back and side of mouth
-refeed food if thrust out
-inattentiveness, hyperactivity, and impulsiveness usually revealed prior to age 7
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psychostimulatnt, which incrases dopamine and NE levels
- given to ADHD kids
-gradually increase dose to reach therapeutic results
-give 30 mins before a meal
-give last dose of the day prior to 1800 to prevent insomnia
-store properly, potential for abuse
developmental dysplasia of the hip (DDH)
-variety of disorders resulting in abnormal development of the hip structures that can affect infants and children
expected findings of DDH in:
-asymmetry of gluteal and thigh folds
-limited hip abduction
-shortening of femur
-positive ortolani test (hip is reduced by abduction)
-positive Barlow test (hip is dislocated by adduction)
-one leg shorter than other
-walking on toes on one foot
-walk with a limp
-positive Trendelenburg sing (while bearing weight on the affected side, the pelvis tilts downward)
what is the pavlik harness?
-it is used in DDH for newborn- 6 month old kid
-maintain harness placement for 12 weeks
-check straps every1-2 weeks for adjustment
-perform neurovascular and skin integrity checks
-removing the harness is dependent on child
-do NOT adjust the straps
-have child in an undershirt, wear knee socks, gently massage skin under straps, NO lotion or powders, place diaper under the straps
what is Bryant traction?
-hips flexed at 90 degrees with the buttock raised off the bed
what medication is used in OI?
-given to increase bone density
Pamidronate is given IV
-failure of the osseous spine to close
Spinda bifida occulta: mostly affects the lumbosacral area and is NOT visible
Spina bifida cystica: protrusion of the sac is visible
expected findings of spina bifida occulta?
-dimpling in lumbrosacral area
-port wine angioma
-dark tufts of hair
expected findings of spina bifida cystica?
-protruding sac midline of the osseous spine
-flaccid, lower extremity paralysis
-club foot, kyphosis, hip dislocation, other skeletal deformities
-urinary incontinence (dribbling)
what should you do initially for the child with spina bifida with sac showing?
1.place prone in infant warmer with hips flexed, legs abducted (without clothing)
2. place sterile, moist, nonadhering dressing with .9% sodium chloride to sac. Change Q 2 hrs
3. avoid applying pressure to sac
4. monitor neurological status (head circumference, fontanels, cry, suck, movement, sensory)
5. inspect sac for leaks, irritation, signs of infection
6. strict I & O (may need intermittent cath)
7. avoid rectal temps
8. no diapering until defect is repaired and healed
9. administer IV antibiotics if prescribed
what is child with spina bifida at increased risk for?
-avoid latex things (water toys, pacifiers, plastic storage bags)
think BACK for latex allergy. explain
latex allergy is linked to certain foods