Pediatric-ATI review packet PDF

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Pediatric ATI Chapter 1 Parenting styles  Dictatorial or authoritarian  not really good parents  Democratic or authoritative  very good parents  Passive Chapter 2 Physical assessment findings  Everything is going to be higher except for BP  Infant HR: 80-180 RR: 30-35 BP: 65-80/40-50  Fontanels – flat and soft o Posterior closes between 6 & 8 weeks o Anterior closes between 12 & 18 months  Teeth – 6 to 8 teeth by 1 year o 20 baby teeth and 32 permanent teeth  Reflexes ** chart on pg. 10 o Moro o Tonic neck reflex o Babinski  Cranial nerves ** chart on pg. 11 o Olfactory o Optic o Oculomotor o Trochlear o Trigeminal o Abducens o Facial o Acoustic o Glossopharyngeal o Vagus o Spinal accessory o Hypoglossal Chapter 3 Infants  Baby’s birth weight will double by 6m and triple by 12m  Infants will grow 1 inch per month (2.5 cm) for the first 6m of life and at 12m their birth length has increased by 50%  First teeth erupt between 6 and 10m  Gross and fine motor skills o By 3m a baby should only have slight head lag o 4m should be able to roll from back to side o 5m roll from front to back o 6m roll from back to front and hold a bottle o 7m move object from hand to hand o 8m sit unsupported o 9m crude pincer grasp o 10m prone to sitting position and grasp a rattle by handle o 11m put objects into a container and have a neater pincer grasp o 12m try to build a 2-block tower and won’t succeed  Piaget cognitive developmental stages o Sensorimotor (birth to 24m)  Separation  Object permanence – around 9m  Mental representation  3-5 words by 1yr  Concept of no

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Erikson’s: Trust vs. mistrust birth – 1yr. o Caretaker meeting the needs of the infant Separation anxiety begins to occur around 4-8m of age Stranger fear 6-8m of age Rattles, Blocks, Brightly colored toys , Mirrors, Patty cake Immunizations o Birth –hep B o 2m – hep B, IPV, RV, PCV + dtap & HIB o 4m – all of the 2m – the hep B o 6m – hep B + all the previous o Flu shots 6m-1 yr. Nutrition o Breast milk first 6m o Solids 4-6m & first solid is usually iron fortified rice cereal o No juice or water is not needed for first year o Foods introduced one at a time over a 4-7 day period to monitor for allergies Choking/aspirating – grapes, coins, candy Burns – sunscreen, handles turned away on stove, electrical outlets are covered Drowning Rear facing car seat until 2yrs. Crib slats are no more than 6cm apart, no pillows, and sleep on back

Chapter 4 Toddlers  4x their birth weight by 30m  3 inches per year (7.5 cm)  Head and chest circumference are about equal – compared to when they are born, and their head is wider than their chest  Gross and fine motor skills o 15m expect walking without help + should be able to build 2 block tower o 18m can throw a ball over hand o 2 yr. can walk up and down stairs by placing feet on each step + 6/7 block tower o 2.5 yrs. Can jump with both feet + draw circles  Language o 1 yr. = 1 word sentences  “hollow phrases” o 2 yr. = 2-3-word sentences  Erikson’s stages – autonomy vs shame and doubt o Independence o Begin to express selves by saying no a lot o Thrive on rituals – maintain routines  Age appropriate activities – blocks, push pull, thick crayons, puzzle  Toilet training begin when they have recognized the sensation that they need to go potty  Immunizations o 12-15m – IPV, PCV + MMR & varicella + HIB o 12-23m – Hep A 2 doses/6m apart o 15-18m – dtap + annual flu vaccine  Nutrition o Breast milk or formula through 1 year o 1-2 year whole milk o After 2 can transition to low fat o Limit juice consumption – 4-6oz per day o Prevent choking  nuts, grapes, hot dogs, peanut butter, raw carrots, tough meat and popcorn  Burns, drowning, falls, aspiration prevention Chapter 5 Preschoolers  4.5-6.5 pounds per year  2.5-3.5 inches per year (6-9 cm)  Gross motor skills

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o 3yr. can ride tricycle + jump off bottom step on stairs o 4yr. can skip and hop on q foot + throw ball over head o 5 can jump rope Cognitive development o Piaget: preoperational phase 4-7 yrs.  Moving from the preconceptual phase to the phase of intuitive thought  Magical thinking  Animism  Centration  Time Psychosocial development – Erikson’s o Initiative vs guilt Another baby in the family can cause the preschooler to regress to bed wetting or thumb sucking – to be expected Playing ball. Puzzles, tricycles, dress up, role playing Immunizations o 4-6 years – dtap, MMR, IPV + annual flu 12 hours of sleep, bedtime routine Eruption of primary teeth is finalized by the beginning of the preschool years Protective gear with tricycles

Chapter 6 School-age children  4-6-pound weight gain per year & grow 2 inches (5 cm) per year  Permanent teeth start to come in  Piagets cog development – concrete operations o Perceptual to conceptual thinking o Learns to tell time, see other perspectives, solve problems  Erikson’s: industry vs inferiority o Trying to make meaning contributions to society & cooperative and compete with othe rs  Peer groups important – competitive and cooperative play  Board games, hop scotch, bikes, jump rope & organized sports  Immunizations o 11-12yr – dtap + HPV vaccine (series of 3 shots)  9 hours of sleep recommended @ 12 yrs.  Safety – helmets Chapter 7 Adolescents (12-20)  Girls stop growing 2-2.5 years after their period starts  Boys stop growing around 18-20  Sexual maturation in girls: o Breast development o Pubic hair growth o Underarm hair o Period  Sexual maturation in boys: o Testicular enlargement o Pubic hair o Penile enlargement o Underarm hair growth o Facial hair o Vocal changes  Piagets cog development – formal operations  Erikson’s: identity vs role confusion  Video games, music, sports, pets, reading  Immunizations o Flu o 16-18 – meningitis (before college)  Injury prevention – helmet use, seat belts, driving, substance abuse

Chapter 8 Safe med admin  Oral is preferred, smallest measuring device possible, don’t mix oral meds in formula  Put in side of mouth, hold cheeks, and stroke chin to swallow  Ear drops 2+ protein, hypoalbuminemia, hyperlipidemia, hemoconcentrion, hyponatremia maybe  Daily weights – same scale, same time, same amount of clothing on everyday  Monitor edema – measure abd girth @ the level of the umbilicus  Restrict fluids and salt  Skin breakdown  Meds – steroids  monitor for GI bleeding, hyperglycemia, etc o Albumin and diuretics  help increase the plasma volume and decrease edema in the pt. Chapter 27 – musculoskeletal Fractures  Open or compound – bone is sticking out of the skin  Closed or simple – bone not sticking out  Complicated – organ or tissue is also damaged  ABC’s + elevated the extremity, apply ice, stabilize the injured area & a complete neurovascular check o Sensation o Skin temp. o Skin color o Cap refill o Pulses o Movement  Casting – elevate the cast above the level of the heart for the first 24-48 hours, apply ice for 24 hours to dec swelling & turn and position the pt. every 2 hours to help dry the cast, assess for inc warmth or hot spots on the cast – hot spot indicated infection  Plaster casts  use the palms of your hands to avoid denting  Expose all surfaces to promote drying  Don’t put anything in the cast to itch Traction care  Align, mobilize, and reduce muscle spasms in patients who have fractures  Maintain body alignment, give meds to help prevent muscle spasms and pain, neurovascular checks, pin sites for s/s of infection, make sure the weights hang freely & not on the bed or floor, do not lift or remove weights unless ordered  Halo tractions – wrench attached to the vest if needed for CPR Complications of fractures: Compartment syndrome  compression of the nerves, blood vessels, and muscle within a confined space  Tissue necrosis can occur  Very intense pain unrelieved with meds, numbness, pulselessness, inability to move digits, pallor, cool extremities  Fasciotomy  muscle compartment is cut open to allow tissue to swell, decrease pressure, and restore blood flow  5 P’s – pain, paresthesia, pulselessness, paralysis, and paleness

Osteomyelitis – open/compound fractures – infection of the bone  Fever, pain, tachycardia, edema  Bone biopsy  Abx therapy to treat Chapter 28 – congenital musculoskeletal disorders Clubfoot  Treatment is serial casting Legg-calve-perthes disease – aseptic necrosis of the femoral head (uni or bi)  Intermittent painless limp, hip stiffness, shortening of the effected leg, limited ROM  Bracing, casting, or traction or replacement of the hip joint Developmental dysplasia of the hip [DDH] *  Infants – asymmetry of the gluteal and thigh folds, limited hip abduction o + ortolani test  hip is reduced by abduction o + barlow test  hip is dislocated by adduction  Children – one leg is shorted than the other, walk with a limp, + tendelenberg sign [while bearing weight on the effected side, the pelvis tilts down], walks on tippy toes on one foot  Newborn to 6 months = Pavlik harness o 12 weeks o Check straps every 1-2 weeks for adjustments by HCP o Preform neurovascular and skin checks o Use an undershirt and wear knee socks o Gently massage under the straps o No lotion or powders o Put diaper on under the straps  Over 6 months o Bryant harness  Hips flexed at a 90-degree angle with the butt raised off the bed  Maintain traction & assure alignment  Skin care o Hip spica cast  Neurovascular checks  Position casts on the pillow & keep elevated until dry  Frequent position changes to promote even drying  Handle casts with palm of hands to prevents dents until dry  Give sponge baths to avoid wetting the cast  Use waterproof barrier around the genital opening so nothing gets in there  Complications from casts and harnesses – bowel and bladder eliminations  Fiber to help pooping and fluids Osteogenesis imperfecta – an inherited condition that results in bone fractures and deformity along with restricted growth  Heterogeneous autosom dominant  Brittle bone disease  Multiple bone fracture, blue sclera, early hearing loss, small discolored teeth  No cure – treatment is supportive  Medication  pamidronate: can be used to increase bone density o s/e: hypocalcemia, hypomagnesia, low phosphate, low K, thrombocytopenia, dysrhythmias, kidney failure  encourage the child to do low impact exercises – braces and splints for support scoliosis – lateral curvature of the spine and spinal rotation that causes rib asymmetry  diagnosis – bend at the waist with arms hanging while assessing for asymmetry of the rubs and flank  treatment – bracing or spinal fusion with rod placement Chapter 29: chronic neuromuscular disorders Cerebral palsy – impairment of motor function, coordination, and posture

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Abnormal perception and sensation, visual, hearing, and speech impairments; seizures, and cognitive disabilities Cause is unknown – correlated with prenatal risk factors Assessment findings: o Spastic hypertonicity o Dyskinetic (non-spastic, extrapyramidal) – jerking movements that appear slow and wormlike of the trunk neck face and tongue o Ataxic s/s – wide based gait and difficulty with coordination, difficulty with precise movements, and low muscle tone Treatments – skeletal muscle relaxants [Baclofen] + valium [diazepam] Complications – aspiration *, elevated HOB, handle secretions, risk for injury

Spina bifida – failure of the osseous spine to close  Neural tube defects are present at birth and effect the CNS and osseous spine  Occulta – not visible  Cystica – protrusion of the sac is visible  Meningocele – contains spinal fluid and the meninges  Myelomeningocele – contains spinal fluid, meninges, and nerves  Associated with a lack of folate acid during pregnancy 

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cystica – protruding sac midline of the spine occulta – dimpling of the lumbosacral area + port wine angioma + dark hair tufts, subcutaneous lipoma

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interventions – close asap o sterile moist non-adherent dressing and change Q2 hours o prone position with hips flexed and legs abducted o no pressure on the sac

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complications – skin ulceration, latex allergies *, increased ICP, bladder issues, and orthopedic issues

down syndrome  chromosomal abnormality  small round head, flattened forehead, small nose with depressed nasal bridge, small ears with short pinna, protruding abd, hypotonia and hyper flexibility  manage secretions and help prevent respiratory infections  cardiac defects and strabismus  rinse mouth after feeding and throughout the day  cool mist humidification and use bulb syringe prn juvenile idiopathic arthritis – chronic autoimmune inflammatory disease affecting the joints and other tissues  joint swelling, stiffness, redness and warmth  worse in morning or after naps  apply a splint for sleeping  encourage use of a firm mattress and discourage use of pillows  apply heat or warm moist packs to the affected joints  encourage warm baths  NSAIDS, methotrexate, steroids      

Muscular dystrophy – group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups causing progressive muscle weakness and wasting Most common  Duchenne’s MD – onset within 3-7years s/s: muscle weakness, unsteady gait, waddling, lordosis, and delayed motor skills development o frequent falling, learning difficulties, progressive muscle atrophy resp. and cardiac difficulties around age 20 corticosteroids complications: resp. compromise  progressive weakening of the resp. muscles

Chapter 30: skin infections + infestations

Impetigo  Caused by staph  Reddish macule that becomes vascular and can erupt forming dry crusty’s + itchy  Direct contact  Abx ointment, burow’s solution Cellulitis   

Firm swollen red area of the skin and subcutaneous tissue Fever Abx and warm moist compresses

Tinea – fungal  Round red scaley patches, itchy in warm and moist areas  Head – selenium sulfide shampoo  Topical antifungal  Treat infected pets as well Lyme disease  Bit by a tick carrying borrelia burgdorferi  Stage 1 - 3-31 days: flu like s/s * bullseye rash at the bite area  Stage 2 – after 31 days  more systemic issues – paralysis, swelling in joints, weakness  Stage 3 – deaf, encephalopathy, arthritis, weakness, numbness and tingling, and speech issues Scabies  

Itchiness, rash, thin pencil mark lines, pimples on trunk, blisters on palms and soles Apply 5% permethrin cream everywhere + family + wash everything in hot water

Pediculosis capitits (lice)  Small red bumps on the scalp, nits (white specks) on the hair shaft  Shampoo containing 1% permethrin + remove nits with special comb + wash everything in hot water  

Can’t wash? Bag for 14 days Boil hair products for 1 hour in lice killing solution

Chapter 31: dermatitis and acne Dermatitis – diaper rash  Washing with warm water and mild soap  Expose to air  Encourage parents to use good diapers + frequent changes  No bubble baths  Skin barrier – zinc oxide containing  Corn starch to reduce friction NOT TALCUM POWDER Poison ivy  Plant exposure – treat area with alcohol followed by water then mild soap and water  Then apply a calamine lotion  Or a burrow solution  Steroid gel Seborrheic dermatitis – cradle cap  Scaly and greasy thick flakes  Not contagious  Gently scrub the scalp with mild shampoo or special treatment  Fine tooth comb   

Keep nails trimmed short for skin issue kids + gloves or socks over hands for sleeping Cotton clothing Avoid excessive heat

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Avoid irritants

Atopic dermatitis – eczema  Intense itchy  Damage from so much itching  Antihistamines + topical steroids Acne  

Good diet, exercise, mild cleanser, don’t pick Meds

Chapter 32: Burns Thermal Chemical Electrical First degree Superficial

Damage to the epidermis

Pink to red No blisters Blanches with pressure

Painful Heals in 3-7 days No scarring

Seconds degree Superficial Deep partial partial thickness thickness Damage to Epidermis + the entire some of the epidermis dermis

Painful, moist, red, blisters, mild to moderate swelling, no eschar Blanches with pressure Painful Heals in 21 days Scaring is likely

Third degree Full thickness

Fourth degree Deep full thickness

Epidermis + dermis + possible subcutaneous damage

Damage to all layers and extends to the muscle, fascia, and bones

Nerve endings, hair follicles, and sweat glands are destroyed Red to tan, black, or brown, or waxy white in color Dry, leathery appearance No blanching

As it heals – painful sensation returns, and severity increases Heals in weeks-months Scarring Grafting is required

Rule of nines: Nursing interventions for burns: ABC’s IV access with lg bore catheters Immunization status – tetanus in last 5 years = they are going to get one Advise family nothing greasy on burn Fluids based on urine output Kids 30 kg  30ml/hour LR and NS sometimes Manage pain – IV opioid’s

Color variable Dull and dry Charring Possible visible ligaments, bone or tendons

No pain is present Heals in weeks to months Scarring Grafting required Possible amputation

Nutrition – increase protein and calories + vitamin A, C, and Zinc Restoring mobility – active and passive ROM Silver sulfadiazine – 2nd and 3rd degree  transient neutropenia Allograft – cavader Xenograft – animals Autograft – own skin

Chapter 33: diabetes mellitus Type 1: beta cells in the pancreas are destroyed and the pt. then becomes dependent on insulin Type 2: body fails to use insulin properly Hypoglycemia s/s: cold and clammy need some candy...