Pediatric personality Disorders PDF

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Authors: Fiskvik Antwi RN, MN. Simon Osei RN, MN. Copyright© 2020 by NurseBoss Store All rights reserved. This book or any portion thereof may not be reproduced, shared or used in any manner whatsoever. Website: nursebossstore.com

Website: nursebossstore.com Instagram: nursebossessentials Authors: Fiskvik Antwi RN, MN. Simon Osei, RN, MN Copyright© 2020 by NurseBossStore

INTEGUMENTARY DISORDERS 1. ECZEMA 2. SCABIES

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INTEGUMENTARY DISORDERS ECZEMA description

Skin inflammation involving the epidermis. Forms: 1. Infantile: Onset (2-6 months) 2. Childhood: Onset (2-3 years) 3. Preadolescent and Adolescent: Onset (12 years) Interventions

Signs & Symptoms

1. Avoid skin exposure to irritants 2. Lubricate skin 3. Soothe skin with cold compressions 4. Medications: Antihistamines, topical corticosteroids 5. Avoid wet diapers

1. Redness 2. Inflammation 3. Itching 4. Papules 5. Oozing or crusting. 6. Scaly patches of skin.

SCABIES description 1. Highly contagious parasitic skin disorder caused by the human itch mite (Sarcoptes scabiei). 2. Transmission: skin-to-skin contact

Interventions 1. Monitor skin around wound 2. Medications: topical scabicide- educate the parents on application, Anti-itch topical treatment, antibiotics 3. Change bedding daily 4. Treat the family

Signs & Symptoms 1. Itching 2. Rash 3. Pruritus 4. Burrows in skin: Fine grayish red lines 5. Thick crusts on the skin (crust scabies)

HEMATOLOGY DISORDERS 1. SICKLE CELL ANEMIA 2. IRON DEFICIENCY ANEMIA

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Hematology disorders Sickle Cell Anemia description In sickle cell anemia, hemoglobin A is replaced by abnormal sickle hemoglobin S. Other characteristics: Sticky sickle cells, sickle cells block blood flow Sickle cell crisis: Vaso-occlusive crisis, sequestration, aplastic, hyperhemolytic

Interventions

Normal red blood cells

SickleD RED BLOOD CELLS

Signs & Symptoms 1. Pain 2. Anemia 3. Jaundice 4. Heart failure/dysrhythmias 5. Enlargement of the bones

1. O2 therapy 2. Blood transfusion 3.Electrolyte replacement 4.Pain management 5.Infection prevention: antibiotics 6. Non-pharmacologic pain management: positioning 7.Diet: high calorie, high protein diet, folic acid supplement

iRON DEFICIENCY aNEMIA description Iron deficiency anemia is characterized by insufficient iron which leads to depletion of red blood cells. This results in decreased hemoglobin and decreased oxygen-carrying capacity of the blood.

Interventions Administer Iron supplements Educate on the side effects of iron supplements: Constipation and black stools Educate parents on iron-rich diet/foods Educate parents to increase vitamin C consumption in their child's diet Educate parents to give the child liquid iron supplements with a straw to prevent teeth staining.

Signs & Symptoms

1. Fatigue 2. Pallor 3. Brittle nails 4. Low hemoglobin and hematocrit levels 5. Shortness of breath

ENDOCRINE DISORDERS 1. FEVER 2. DEHYDRATION 3. TYPE 1 DIABETES 4. DIABETES KETOACIDOSIS

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endocrine disorders ! fever ! ! ! ! description R Fever is the elevation in body E V temperature. E F Temperature: 1. Normal: 36.4-37.0 (degrees celsius) 2. Fever: >38.0 (degrees celsius)

Interventions

Signs & Symptoms

1. Monitor temperature 2. Assess underlying cause 3.Non-pharmacologic management: remove excess clothing, cooling measures, sponge bath. 4.Medications: Antipyretics Remember: do not administer Aspirin due to the risk of reye's syndrome

1. Temperature: >38.0 (degrees celsius) 2. Skin: warm 3. Lethargy 4. Chills

Dehydration description

Dehydration is a fluid and electrolyte imbalance that results from decreased fluid intake, increased fluid output (vomiting, diarrhea) or fluid shift (burns and sepsis). Interventions 1. Monitor vital signs 2. Monitor weight 3.Monitor intake and output 4. Treat cause of dehydration 5.Mild dehydration: oral rehydration therapy 6. Severe dehydration: maintain NPO, IV therapy 7.Remember: signs and symptoms depends on the severity of dehydration

Signs & Symptoms 1. Weight loss 2. Increased pulse 3. Tachypnea 4. Increased thirst 5. Oliguria 6. Sunken anterior fontanel 7. Sunken eyes 8. Irritability

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endocrine disorders Insulin is an essential hormone produced by the description An autoimmune dysfunction in which the beta pancreas. Its main role is to cells are being destroyed. The pancreas (beta control glucose levels in the body cells) is unable to produce insulin.

TYPE 1 DIABETES

Risk factor/causes

Autoimmune response Genetics Onset: childhood Interventions

Signs & Symptoms 1. Polyuria: increased urination 2. Polydipsia: Increased thirst 3. Polyphagia: Increased appetite 4. Weight loss 5. Hyperglycemia

1. Glucose monitoring 2. Insulin: diluted insulin for infants 3. Balanced diet 4. Exercise l mp co n io at ic

DIABETIC KETOACIDOSIS description

DKA is a sudden, life-threatening complication of Type 1 Diabetes. Characteristics: Hyperglycemia, Dehydration, Ketosis, Acidosis

Interventions

IV fluid replacement IV insulin: treat hyperglycemia Correct electrolyte imbalance: Monitor potassium levels O2 therapy

Signs & Symptoms 1. Fruity breath 2. Kussmaul's respiration 3. Ketosis 4. Acidosis 5. Electrolyte loss 6. Lethargy 7. Confusion/Coma

RESPIRATORY DISORDERS 1. EPIGLOTTITIS 2. BRONCHITIS 3. ASTHMA 4. CYSTIC FIBROSIS 5. PNEUMONIA 6. BRONCHIOLITIS 7. INFLUENZA 8. TONSILLITIS

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Respiratory disorders epiglottitis description

Inflammation and swelling of the epiglottis. Cause: Haemophilus influenza treated as an emergency Interventions 1. Maintain patent airway (priority) 2.O2 therapy as ordered 3. Monitor respiratory status 4.Maintain NPO 5. Do not place the child in a supine position 6. Avoid throat culture 7. Medications: antibiotics, antipyretics 8. Prepare resuscitation equipment

Signs & Symptoms 1. Fever 2. Severe sore throat 3. Difficulty speaking 4. Drooling 5. Tachycardia 6. Difficulty breathing 7. Stridor

bronchitis description

Inflammation of the lining of the bronchial tubes. Causes: viral infection Bronchitis may be either acute or chronic Interventions

1. Monitor temperature 2. Monitor respiratory status 3. Increase fluid intake 4. Medications: antipyretics, cough suppressants

Signs & Symptoms

1. Fever 2. Nonproductive cough 3. Productive cough (after 2 days) 4. Chest pain 5. Chills

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Respiratory disorders asthma description

Chronic inflammatory disease of the airway. Inflammation and hypersensitivity to a trigger (stimuli). Smooth muscle constriction of the bronchi. Intermittent airflow obstruction. Interventions

1. Maintain patent airway 2. Assess respiratory status 3. Administer humidified O2 4. Administer medications (anticholinergics, corticosteroids, bronchodilators) 5. Chest physiotherapy

Signs & Symptoms 1. Dyspnea, wheezing, chest tightness, non productive cough 2. Restlessness 3. Hyperresonance on percussions

Cystic Fibrosis description

Diagnostic tests: 1. Sweat test: More than 60 mmol/L: diagnosis of cystic fibrosis 2.Stool analysis and Pulmonary function test

CF is an exocrine gland dysfunction that results to chronic respiratory infections, pancreatic enzyme insufficiency, sweat gland dysfunction (results to increased Na + Cl sweat concentration). Thick mucus produced by the exocrine gland obstruct organs. CF is progressive and incurable.

Interventions Resp- Monitor resp status, chest physiotherapy, antibiotics, bronchodilators, O2 therapy, mucolytics, anticholinergics GI- Diet (Vitamins, high-protein, high calorie diet), Monitor weight and stool pattern, administer pancreatic enzymes. Others- Monitor vital signs, monitor electrolyte levels, provide emotional support

Signs & Symptoms Resp- barrel chest, clubbing of fingers, dyspnea, wheezing & cough GI: Meconium ileus, Steatorrhea, Rectal prolapse, Bile-stained emesis Skin: High Na + Cl in sweat, dehydration, electrolyte imbalance Reproductive system: Sterility

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Respiratory disorders pneumonia description Inflammation of the pulmonary tissue caused by bacteria, fungi and viruses. Viral pneumonia: occurs more frequently than bacterial pneumonia. Bacterial pneumonia: serious infection Aspiration pneumonia: Substance enters the airway due to vomiting or impaired swallowing Interventions Viral pneumonia: 1.02 therapy, 2. antipyretics, 3. chest physiotherapy 4.Increase fluid intake, Iv fluids Bacterial pneumonia: 1.O2 therapy, IV fluids, antibiotics, suction mucus, promote rest, increase fluid intake

Signs & Symptoms

1. Cough 2. Wheezing 3. Fever 4. Chills 5. Tachypnea

Bronchiolitis description

Inflammation of the lining of the bronchioles due to RSV (Respiratory Syncytial Virus).

Interventions

1. Maintain patent airway 2. Humidified oxygen 3. Increase fluid intake 4. Place the child at a semi-fowlers position. 5.Periodic suctioning

Signs & Symptoms

1. Rhinorrhea 2. Cough 3. Fever 4. Wheezing 5. Tachypnea

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Respiratory disorders Influenza description

Influenza is a viral infection that attacks the respiratory system. Highly contagious airborne disease.

Interventions

Signs & Symptoms

1. Promote bed rest 2. Administer antiviral medication 3. Increase fluid intake

1. Cough 2. Fever 3. Myalgia 4. Fatigue/body weakness

Tonsillitis description

Tonsillitis is the inflammation of the tonsils. The tonsils are two oval-shaped pads of tissue at the back of the throat.

Interventions 1. Medications: Antipyretics, Antibiotics 2. Surgical intervention: tonsillectomy-the removal of the tonsils a. Monitor for postoperative bleeding (a sign of bleeding is frequent swallowing) b. Begin with clear fluids then proceed to soft diet. c. Remember: do not administer any red liquids

Signs & Symptoms

1. Swollen tonsils 2.Sore throat 3. Snoring 4. Painful swallowing 5. Fever 6. Muffled voice

NEUROLOGICAL DISORDERS 1. MENINGITIS 2. SEIZURES 3. REYE'S SYNDROME 4. CEREBRAL PALSY 5. HEAD INJURY 6. HYDROCEPHALUS

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NEUROLOGIC disorders The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system

MENINGITIS description

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. Causes

BACTERIA

Other causes

virus

1. Trauma 2. Cancer 3. Neurosurgery

DIAGNOSTIC TEST CSF is obtained through lumbar puncture BACTERIAL Meningitis Results: Positive gram stain, Appearance (cloudy), WBC (elevated), Glucose (decreased) Protein (elevated) VIRAL Meningitis Results: Negative gram stain, Appearance (clear), WBC (elevated), Protein (within normal range), Glucose (within normal range) Interventions

1. Droplet precautions 2. Assess LOC, increased ICP 3. Medications: IV antibiotics (bacterial meningitis), antipyretics, corticosteroids 4. Monitor for hearing loss DROPLET PRECAUTIONS

Signs & Symptoms

1. Positive Brudzinski's sign 2. Positive Kernig's sign 3. Fever, headache 4. Irritability 5. Bulging anterior fontanels 6. Nuchal rigidity 7. Photophobia 8. Nausea/vomiting

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NEUROLOGIC disorders SEIZURES description Seizures: a sudden, uncontrolled electrical disturbance in the brain. Epilepsy: Chronic seizures

seizure types: Generalized Seizures 1. Tonic-Clonic 2. Absence 3. Myoclonic 4. Atonic Partial Seizures 1. Simple partial 2. Complex partial Nursing Interventions: 1. Initiate seizure precautions 2. Assess time and duration of seizure activity 3.Provide patient safety 4.Turn patient to the side 5.Maintain airway 6. Avoid restraining patient 7.Loosen clothing 8.Administer O2 9. Monitor behavior before and after seizure activity, vital signs 10. Maintain NPO status after seizure

MEDICATION: Anti-seizure medication: e.g.Phenytoin

RISK FACTORS

1. Fever 2.Meningitis 3. Head trauma 4. Stroke 5. Brain tumor 6. Electrolyte imbalances

DIAGNOSTIC TESTS: 1. An electroencephalogram 2. Computerized tomography 3. Magnetic resonance imaging (MRI) 4. Neurological exam

Signs and symptoms The signs and symptoms depends on seizure history and type. Before seizure Aura During seizure Loss of consciousness during seizures Uncontrollable involuntary muscle movements Loss of bladder and bowel control

febrile seizures A febrile seizure is a convulsion in a child that's caused by a fever. The fever is often from an infection. Types: 1. Simple febrile seizures 2. Complex febrile seizures

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neurological disorders REYE'S SYNDROME description

Reye's syndrome is characterized by encephalopathy and fatty changes in liver Risk factors: Viral infection, Aspirin

Diagnostic test

Interventions

Signs & Symptoms

1. Assessment: Hx of viral illness (4-7 days prior), liver enzymes and blood ammonia level (elevated). 2. Monitor s/s of increased ICP, LOC 3. Positioning: HOB @ 30 degrees 4. Monitor intake and output

1. Fever 2. Vomiting 3. Irritability 4. Lethargy 5. Hepatic dysfunction

CEREBRAL PALSY description

Cerebral Palsy is a disorder that affects movement, posture and muscle tone. Spastic cerebral palsy is the most common type. Interventions

1. Assessment: developmental and growth status 2. Physical therapy, speech therapy 3. Braces 4.Medication: anti-seizure

Signs & Symptoms

1. Developmental delays 2. Delayed growth 3. Abnormal posture and motor function 4. Opisthotonos

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NEUROLOGIC disorders EARLY SIGNS OF INCREASED ICP

HEAD INJURY description Trauma to the skull that causes brain damage.

1. Infants: High-pitched cry, poor feeding, irritability, bulging fontanel, setting sun sign, Macewen's sign (percussion: you will hear a cracked-pot sound) 2. Children: Blurred vision, seizures, headaches

types:

Late signs of increased icp

Open Head Injury: Object penetrates skull Closed Head Injury: Blunt trauma

1.Decorticate: flexion 2.Decerebrate: extension 3. Cheyne-Stokes respirations 4.Decreased LOC 5. Abnormal pupil reaction 6. Bradycardia 7. Poor sensory and motor function

Decorticate & decerebrate Nursing Interventions: 1. Immobilize the neck and spine 2. Elevate head @ 30 degrees (if it is not a spinal cord injury) 3. Head position: midline position 4. Monitor airway (O2 therapy) 5. Assess vital signs and level of consciousness 6. Do not suction patient 7. Seizure precautions 8. Educate child to avoid straining 9. Insert urinary catheter

MEDICATION: 1. Antibiotics: laceration 2. Osmotic diuretic (mannitol): decrease cerebral edema 3. Anticonvulsants: seizures 4. Acetaminophen: headaches

Decorticate: 1. The arms are bent in toward the body 2. wrists and fingers are bent and held on the chest 3. Legs extended Decerebrate: 1. The head and neck being arched backward 2. Arms and legs are extended

COMPLICATIONS: 1. Epidural hemorrhage 2. Subdural hemorrhage 3. Brainstem involvement 4. Leakage of CSF: drainage from nose/ears is positive for glucose

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NEUROLOGIC disorders Signs and symptoms: infant

HYDROCEPHALUS description Abnormal CSF accumulation due to the imbalance of CSF production and absorption

types: Communicating: non-obstructive hydrocephalus Non-communicating: Obstructive hydrocephalus

surgical intervention The goal of the surgical intervention is to bypass the blockage and prevent CSF accumulation. Shunt 1. Surgical insertion of a drainage system, called a shunt. Endoscopic third ventriculostomy 1. Treatment of choice for obstructive hydrocephalus

MEDICATION: 1. Antibiotics 2. Analgesics

1. Increase head size (circumference)abnormal rate of head growth 2. Bulging fontanelle 3. Setting sun sign 4. Dilated scalp veins 5. Macewen’s sign (“cracked pot sound”)

Signs and symptoms: Children

1. Headache on awakening 2. Nystagmus 3. Irritability 4. Vomiting 5. Apathy and confusion 6. Papilledema

Preoperative care 1. Assess LOC, head circumference and increase ICP 2. Support head and neck 3. Provide small and frequent feeding

Postoperative care: 1. Assess for signs of increased ICP 2. Assess head circumference 3. Assess for signs of infection 4. Provide shunt care 5. Position: unoperated side to avoid pressure on shunt valve. 6. Remember: a high, shrill cry in an infant is a sign of increased ICP.

CARDIOVASCULAR DISORDERS 1. Defects that increase pulmonary blood flow 2. Defects that decrease pulmonary blood flow 3. Obstructive defects 4. Mixed Blood Flow 5. Rheumatic Fever

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CARDIOVASCULAR disorders defects that increase pulmonary blood flow Atrial Septal Defect:

Pathophysiology: a hole in the septum between the left and right atria. Signs and symptoms: Heart murmur, palpitations, tachycardia, decreased peripheral pulse (other signs of decreased cardiac output) Management: Atrial septal defect may be closed using cardiac catheterization. VENTRICULAR SEPTAL Defect:

Pathophysiology: a hole in septum that separates the heart's lower left and right ventricles Signs and symptoms: Murmur (harsh and loud heard at the left lower sternal border), other signs of decreased cardiac output. Management: Ventricular septal defect may be closed using cardiac catheterization. PATENT DUCTUS ARTERIOSUS:

Pathophysiology: This occurs when the ductus arteriosus fails to close after birth. Signs and symptoms: Bounding pulse, wide pulse pressure, machine-like murmur Medication: Indomethacin

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CARDIOVASCULAR disorders defects that DECREASE pulmonary blood flow TETRALOGY OF FALLOT PATHOPHYSIOLOGY:

Tetralogy of Fallot includes 4 defects: 1. Ventricular septal defect (VSD): a hole in septum that separates the heart's lower left and right ventricles 2.Pulmonary stenosis: the pulmonary valve is narrow. 3. Overriding aorta:defect in the aorta. The aorta is shifted to the right and lies directly above the VSD. 4.Right ventricular hypertrophy: right ventricle thickens SIGNS AND SYMPTOMS:

1. Cyanosis 2.Hypoxia 3. Clubbing of fingers and toes 4.Poor growth Diagnostic tests:

1. Echocardiography 2. Chest X-ray sURGICAL MANAGEMENT:

1. Surgical intervention is an effective treatment option for Tetralogy of Fallot. 2. Surgical intervention: temporary procedure that uses a shunt 3. Surgical intervention: complete repair

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CARDIOVASCULAR disorders obstructive defects Aortic STENOSIS:

Pulmonary Stenosis:

Pathophysiology: the aortic valve is narrow Signs and symptoms: Exercise intolerance, murmur, chest pain, hypotension. Manage...