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-Take w/ water to decrease constipation, take btwn meals w/ a beverage other than tea, coffe, or milk, or qhs if abd discomfort is experienced. Avoid consuming bran, tea, coffee, milk, oxylates (swiss chard & spinach), and egg yolk (decreases absorption). Vit C increases absorption (take w/ OJ).
-Iron supplementation not necessary in term infants who are breastfed. Bottle-fed infants need iron-fortified formula, and supplements beginning at 6 mos or iron-rich foods.
Admin. – Do not call for product until needed. --Transfusion must be given w/ in 30 min after blood leaves bank due to r/o of bacterial contamination and cell lysis.
-Max time for infusion is 4 hrs. –complete forms, accurate identification, indicate product type, check for ordered premedication, use PPE (goggles & gloves), check product by bedside w/ 2 team members, 2 pt identifiers: matching number on blood and wrist band.
-Baseline vitals, start infusion slowly for first 15 min and stay w/ pt.
-Do not infuse any other solutions w/ blood through the same line, except normal saline.
-Never add blood to med.
-All identification attached to the blood product must remain attached until the transfusion is complete.
****KNOW more RE: admin - digoxin (Lanoxin) - Safe for breastfeeding - treats CHF in children
Depend on the tumor location, tumor type, and the age of the child.
Raised or tense fontanel
Projectile vomiting in AM with little warning
-Antiemetics for nausea/vomiting.
Odansetron (Zofran)- give 30 min prior to chemo (not as effective after vomiting has begun). -Diphenhydramine (Benadryl), Lorazepam (Ativan)- used for anticipatory nausea/vomiting.
-Nystatin swish and swallow, “magic mouthwash”
-Loperamide (Imodium), Diphenoxylate (Lomotil), for diarrhea
-Docusate sodium (Colace), Bisacodyl (Dulcolax) for constipation
-hematopoietic growth factor (filgrastim [Neupogen]) decreases need for blood transfusions in anemia.
· Denial and Isolation- numbness, disbelief, shock
· Anger- develop awareness of situation or diagnosis, feel anger, guilt, fear
· Bargaining- express guilt, bargain with higher power for cure or to take place of ill child
· Depression- When the illness can no longer be denied or bargained away; the family and child may begin to feel a profound sadness.
· Acceptance- accepts illness and death. Find strength and joy in everyday living.
Take them out of their room for a procedure
Depends on their age/cognitive level
· Use terminology the child can understand
· Allow parents to be present
· Role play with equipment, let them explore/play with equipment
· Use distractions; singing, squeezing hands, deep breathing, story telling
-Poor muscle tone, slanting eyes with folds of skin at inner corners (epicanthal folds), hyperflexibility, short, broad hands, broad feet with increased space between the first and second toes, flat bridge of the nose, short, low-set ears, short neck with extra folds of skin, small head, small oral cavity and airway, and short, high pitched cries in infancy. Wide set nipples.
-1/3 have heart defects. GI anomalies. Visual and hearing impairments, speech difficulties, sleep related issues due to sleep apnea. Prone to hypothyroidism.
Include hypotension, weak and rapid pulse, cool and clammy skin, rapid breathing, restlessness, and reduced urine output.
-Risk for Injury related to bleeding tendencies
-Pain related to bleeding episodes in joints and muscles
-Knowledge deficit related to home care
-Potential for Impaired Physical Mobility related to bleeding in the joints and muscles.
-Risk for infection related to decreased white blood cell count
Fractures, usually of the humorous or clavicle.
Guarding of limbs, do not move
-Solitary Play- the child plays alone, w/out regard for those around him.
-Onlooker Play- The child observes the other children around him as he plays alone; may alter own play activities based on what he sees the others doing or may be content to continue in his play while simply talking w/ the other children; play activities are different (e.g., one child may be bouncing a ball while another is playing with jacks).
-Parallel Play- Children play with the same materials and items, but they do not yet play together.
-Associative Play- The peer group is developed to the extent that children play together, but iin a loosely organized manner.
-Cooperative Play- children assume designated roles in the games, have goals for the games, and rely on one another for the game to continue and progress.
· R- Rest. Allows ligaments to heal/prevents further injury
· I- Ice. For the first 48 hrs. at 15 min intervals (per book)
· C-Compression- Ace wrap to apply pressure to decrease swelling
· E- Elevate- reduces swelling, allows for early movement to keep full ROM.
**Encourage effective hand hygiene – most important
-Prevent alterations in skin integrity which is a first line of defense
-Minimize/decrease stress r/t negative life events
· Characterized by a yellow (icteric) coloration of the skin, sclera, and oral mucous membranes.
· Many babies develop jaundice in the first few days of life that is typically worse at 2-4 days of age.
· delay in feeding place the infant, poor feeding
· delayed clamping of the umbilical cord
· Traumatic births that involve the use of forceps or vacuum extraction
· Although the mechanism is unclear, there is evidence to suggest that the use of oxytocin and epidural medications may lead to hemolysis of RBCs and serve as an increased
source of jaundice
· Treatment of jaundice is based on the underlying cause. Infants who are plotted on the graph in the high-risk zone on the bilirubin risk chart undergo phototherapy (bilirubin lights), or a bili-blanket
· hydration with an electrolyte solution if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine, or limited urine output and irritability
· “Nonhemolytic” jaundice describes the more commonly occurring yellowing of the skin in neonates that becomes apparent after the ﬁrst 24 hours of life and usually peaks by the third to ﬁfth day. Physiological jaundice often has a nonhemolytic cause and frequently results from a failure to adequately process bilirubin due to inadequate intake or elimination, birth trauma, or from minor blood incompatibilities.
· Breastfed infants may develop early-onset or “breastfeeding jaundice,” which is associated with insufﬁcient feeding and infrequent stooling. Since colostrum has a natural laxative effect that stimulates the passage of meconium, frequent breastfeeding during the early days of life is beneﬁcial in reducing the neonate’s serum bilirubin levels.
· Sometimes affects breastfed infants during the second week of life. This type of jaundice usually develops around the fourth day when the mother’s mature breast milk comes in and peaks around day 10. Breast milk jaundice is believed to be related to a factor in human milk that causes an increased intestinal absorption of bilirubin. Although usually no treatment is necessary, some physicians advise mothers to discontinue breastfeeding for 12 to 24 hours to allow the infant’s bilirubin levels to decrease.
- Maintain airway & provide adequate respiratory exchange
- Mild cases treated w/ cool mist to moisten airway secretions to facilitate clearance, soothe inflamed mucosa, & provide comfort and reassurance to the child thereby lessening anxiety.
-High-humidity cool air vaporizer may be used @ home
-Oxygen hoods for infants and oxygen tents for toddlers are used in hospital setting
-Observe child after nebulization to assess airway & side effects of delivered medication
-Corticosteroids are given to decrease edema in laryngeal mucosa
-Intramuscular dexamethasone (Decadron) & nebulized budesonide (Pulmicort)
-Antibiotic therapy is indicated for Acute epiglottitis or supraglottits (ampicillin & sulbactam)
**Symptoms which warrant hospitalization are: progressive stridor, severe stridor at rest, respiratory distress, hypoxia, cyanosis, and depressed mental status.
-*Croup is a heterogeneous group of illnesses affecting the larynx, tachea, and bronchi
-Commonly affects children btwn 3 mos and 5 y/of age – incidence higher in boys
-Occurs frequently in winter months
-Causes of croup – viral agents (parainfluenza viruses 1.2.& 3 – account for 75%)
-Causes of Epiglottitis – streptococcus pyogenes, S. pnemoniae, and staphylococcus aureus
-Causes of Bacterial Tracheitis – Haemophilus influenza, staphylococcus aureus, & corynebacterium diphtheria
· Distraction- provide toy to divert attention
· Time-out- move child to cooling off place to calm down
· Removal of Privileges- withhold toy until appropriate behavior returns
· Verbal Reprimands- spoken warnings/disapprovals without berating child or judging child as “bad”
· Corporal Punishment- NOT RECOMMENDED
· Allows for negotiation and flexibility (builds social skills)
· Child to experience consequences of behavior
· Speak to child as you want to be spoken to
· No name calling, yelling, or disrespect
· Be clear, firm, specific about what you mean
· Consequences delivered immediately, elate to rule broken, short duration, emphasize positives
· Consequences- fair and appropriate to child’s age
-Persistent, unexplained crying or fusing in infants younger than 3 months of age
-Episodes generally occur at same time each day (usually late afternoon or evening)
-Infant is fussing and appears to be pulling both legs and arms into a flexed position.
-Earliest symptoms is periumbilical pain (pain around the umbilicus)
-pain often awakens child peaking @ 4 hr intervals
Peiumbilical pain subsides & is followed by the classic sign of RLQ pain
-Vomiting generally follows peiumbilical pain
-Anorexia is common
-Stools may be described as low in volume and mucus-like
Recognized in childhood (65% younger than 5y/o and peak at 2y/o)
-Manifested by abdominal pain (described as periumbilical or lower abdominal)
-Pain is similar to appendicitis or volvulus and may be vague and recurrent
-Major manifestation in the older child includes painless rectal bleeding w/ stools described as bright or dark red w/ mucus or of a “current jelly” appearance
-Rectal bleeding in infants may be accompanied by pain.
-If undetected, severe anemia and shock can occur
-Causes a variety of symptoms including: abd pain, flatus, bloating, constipation, or diarrhea or a combination of both constipation and diarrhea.
-Referred to as “nervous stomach” or spastic colon
-Classified as a functional GI disorder because symptoms occur when intestines or bowels function improperly.
-When intestines are exposed to certain “triggers” – bowels respond w/ muscle spasms instead of normal peristalsis.
-Triggers include: eating large amounts of food at one time; eating spicy, high-fat or gas-causing foods; or stress.
-Childhood IBS symptoms including variable stool patterns, alternating btwn constipation & diarrhea and pain beginning with a change in stool frequency or consistency.
-Does not cause constant symptoms
-Exacerbations occur at any time and cause one or more symptoms
· Exercise-never restricted unless child has other health issues that warrant restriction
Ø Children more likely to have hypoglycemic crisis
Ø Caloric intake & insulin dosage may need adjustment w/ inc. activity
Ø Exercise god way to inc. cell’s sensitivity to insulin & helps insulin to be better used by body
Ø Spontaneity of childhood activity doesn’t leave much time to plan snacks and meals
Ø Snacking during activity helps ward off hypoglycemic crisis later
Ø Medical Nutrition Therapy (MNT) is important in preventing & managing diabetes as well as preventing dev. of diabetic complications.
Ø There are no forbidden foods in child’s diet
Ø Goal should balance various foods/caloric intake
Carbs- 50-60%, milk, fruits, veggies, grains
Fats- 20-30% mayo, butter, margarine, oils
Proteins- 10-20% meats, eggs, cheese, beans, legumes
· Children may lack capacity to recognize & respond to hypoglycemic symptoms.
Ø Home glucose monitoring occurs 3-6 times/day
Ø Glucose monitoring generally covered by insurance
Ø Urine testing for ketones preformed every 3 hrs. during child’s illness. Check whenever BGM reading >240mg/dL or when child experiences wt. loss even if well
Ø Ketones in urine indicate insulin deficiency
·Needs are affected by nutritional intake and physical energy expended, as well as emotional & stress level that accompany normal activities like growth spurts, puberty, and illness.
§ Combinations of long, intermediate, and short acting insulin given sun-q thru out day in attempt to stimulate body’s natural release of hormone
§ Some children and adolescents, use of insulin pump is increasing b/c delivery of insulin is steady throughout day, which resembles body’s natural response.
-Teaching should be holistic in nature and include relaxation and breathing techniques, the use of heat to reduce uterine contractions and increase blood ﬂow to the uterine tissues, exercise or rest, and the use of nonsteroidal anti-inﬂammatory drugs to inhibit the synthesis of prostaglandin.
-For more problematic symptoms, treatment may include the use of diuretics to reduce ﬂuid retention, oral contraceptives to inhibit ovulation, central nervous depressants to promote relaxation, antidepressants, and vitamin supplements.
• History of preterm birth
• Uterine or cervical anomalies
• Multiple gestation
• Clotting disorders
• Infection, especially urinary tract infections
• Fetal anomalies
• Premature rupture of membranes
• Vaginal bleeding, especially in the second trimester or in more than
• Late or no prenatal care
• Illicit drug use
• Diethylstilbestrol (DES) exposure
• Domestic violence
• Non-Hispanic African American race
• Age 17 years or 35 years
• Low socioeconomic status
• Long working hours with long periods of standing
• Periodontal disease
- Antenatal glucocorticoids such as betamethasone may be given (12 mg IM 24 hours apart) to promote lung maturity if the gestational age is less than 34 weeks and delivery can be delayed for 48 hours.
Administer medication as ordered and evaluate its effect. Adhere to hospital protocol for magnesium sulfate infusion. Monitor maternal vital signs, FHR, urine output, DTRs, IV ﬂow rate and serum magnesium levels to assess for magnesium sulfate toxicity (e.g., depressed respirations,
hyporeﬂexia, sudden onset of hypotension, oliguria, indicators of fetal compromise). Administer calcium gluconate (the antidote for magnesium sulfate toxicity) for respirations below 12 breaths/min and discontinue the magnesium sulfate infusion.
-If the screen is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed
***MORE specific/what does it mean if #/s are off
-Lightening “dropped” uterus moves down
-cervical changes (softens, thins, stretches)
-Bloody show, blood tinged mucus plug
-ROM – wt. loss – GI disturbances
-Energy spurt (high hormones/adrenaline)
-Contractions @ regular intervals
-Pains lower in back, radiate to abdomen
-Dilation & effacement
-walking increases labor pain
-Child abuse may include physical, sexual, emotional abuse, and neglect.
-A person is abusive if he or she fails to nurture the child, physically injures the child, or relates sexually to the child.
-Infants and children diagnosed with attachment disorders have usually endured neglect or maltreatment or have experienced severe trauma.
- The child is exposed to situations where there is excessive stress, marital conﬂict, parental substance abuse and psychopathology, intergenerational history of abuse, beliefs that children need to be “toughened up,” and in families who experience hardships.
Tetrahydrocannabinol (THC)npasses through the placenta and may remain in the fetus for up to 30 days.
-The carbon monoxide levels are ﬁve times higher than w/cigarette smoking.
-May cause intrauterine growth restriction, and research has indicated that use has bad effect on neonatal neurobe-
havior (e.g., hyperirritability, tremors, photosensitivity)
-Can affect cognitive and language development in infants up to 48 months of age
-Repeated use during pregnancy may increase the incidence of maternal anemia and
low weight gain.
-Maternal malnutrition, tachycardia, and withdrawal symptoms that include lethargy and depression.
The fetus is at an increased risk for intrauterine
growth restriction, prematurity, cardiac anomalies, cleft palate, and placental abruption.
Following birth, affected neonates may exhibit hypoglycemia, sweating, poor visual tracking, lethargy, and difﬁculty feeding.
-Spontaneous abortion, premature rupture of the membranes, preterm labor, an increased incidence of sexually transmitted infections, hepatitis, an
increased potential for HIV exposure, and malnutrition.
Methadone is frequently given to pregnant women who enter drug addiction programs. Fetal death, intrauterine growth restriction, perinatal asphyxia, prematurity, intellectual impairment, and neonatal infection are associated with maternal opiate use. Neonatal withdrawal syndrome, characterized by hyperirritability, gastrointestinal dysfunction, respiratory distress, and autonomic disturbances, has been reported in 50 to 80% of infants born to opiate-dependent mothers.
Causes vasoconstriction of the uterine vessels & adversely affects blood ﬂow to the fetus.
-Associated with spontaneous abortion, abruptio placentae, stillbirth, intrauterine growth restriction (IUGR), fetal distress, meconium staining, and preterm birth.
Problems manifested in children include altered neurological and behavior patterns, neonatal strokes and seizures, and congenital malformations (genitourinary anomalies, limb reduction deformities, intestinal atresia, and heart defects).
N&V, Hyperemesis gravidarum (1st tri)
- decreased fundal ht
- abd pain, cramping, vaginal bleeding or spotting
- Infections = chills, fever, malaise, anorexia
- burning urination
- Vision changes, HA, high BP, edema
- PROM in 2nd tri, vaginal discharge
- Presence of uterine contractions in 2nd tri
- Absent fetal HR following quickening
-Cushion/protect/maintain temp/ freedom of movement/muscoskeletal movement
-vital for fetal growth and development
-Allows for symmetrical growth
-Essential for fetal lung development
-contains antibacterial & other prot substances
-contains transferrin, beta-lysis, IgG & IgA, Albumin, uric acid, creatinine, bilirubin, vemix, WBC
Know the required assessment for the immediate postpartum period, what is considered normal & abnormal with the assessment, and the nursing interventions provided with abnormal findings (ex: a displaced, boggy uterus; postpartum hemorrhage, DVT, or pulmonary embolism)
Know about the different obstetrical emergencies of labor (ex. Cord prolapse, uterine rupture, and placental abruption)
Know the medical & nursing interventions for labor dystocia
-Lack of progress in the rate of cervical dilation; fetal descent and expulsion; or an alteration in the pattern of normal uterine contractions.
Nursing care begins with a thorough assessment. It is critical to identify factors that contribute to increased maternal anxiety. Careful monitoring of contractions may provide early information regarding poor labor progression and lead to timely interventions. While frequent checks for cervical dilation are not advisable, this assessment, when performed at proper intervals, provides a strong indicator of labor progression. Along with continued assessment of the contraction pattern, the nurse can use this information to validate the ﬁnding of hypertonic labor. Once any intervention has occurred, the nurse evaluates the plan of care and, depending on the results, initiates appropriate measures.
-A failure of the uterine myometrium to contract & retract following birth.
-At risk for hemorrhage
-Continued fundal massage w/ lower uterine support is mandatory
-One nurse massages, one puts in IV & administers oxytocic drugs (oxytocin) Pitocin, followed by methergine or ergotrate, hemabate, or cytotec.
-Hand in C position just above symphysis pubis
-DO NOT express clots if uterus does not get firm
-Assess vaginal drainage
-When tapping on the skull, a resonant sound “macewen’s sign” or “cracked pot” sound is heard when cranial suture separation occurs
-Difficulty holding head upright
-Face & cranial vault disproportionate & unusually prominent forehead present.
-Dramatic head growth & enlargement of optic chiasm (vision loss & compression of optic nerves occur if untreated).
-Bulging, tense fontanels (large head circumference) = high ICP
-Treat w/ O2
-Pain management (IV morphine)
-Complete Resp assessment
-Auscultate lung sounds
-Rapid/precipitous labor (less than 3 hrs)
-Rapid 2nd stage labor
-Vaginal (operative) deliveries, forceps, vacuum extractions
-Retained placental fragments
-Enlarged axillary lymph nodes
-Breast engorgement w/ obstruction of milk flow
-Fever, malaise, localized breast tenderness
Teaching instructions for a postpartum mother receiving a rubella vaccine prior to discharge
-Teach to be assessed for rubella immunity before discharge
-If non-immune, MMR vaccine should be administered
-Avoid pregnancy x1mo after receiving vaccine due to teratogenic effects
-May experience: lymphadenopathy, arthralgia, and low grade fever
-She can continue breast feeding
-Signed consent before admin
Know how to communicate therapeutically with a family to promote coping
-The acute, or early phase, is from the time of the initial assault until wound closure.
-2nd phase, recovery, is from time of wound closure until scar maturation, could be 16 mos.
-For some children burn recovery may last a lifetime.
-Prevention of infection is the priority outcome when providing meticulous wound care
-Wounds are initially decontaminated.
-Subsequent burn wound care includes cleansing wound with a special solution or debridement.
-Wound debridement is very painful & pediatric patients are often given Midazolam (Versed) & Fentanyl prior to beginning the process.
Know the nursing tools used for preoperative teaching with kids
Risk factors for STIs
-IV drug use
-Multiple sex partners
-Exposure to blood/blood products or sex
Brickdust is when the infant may pass urate crystal. It is common until the fluid intake is greater.
To prevent blindness caused by gonorrhea and chlamydia present in vagina.
Commitment, attachment, and preparation for an infant during pregnancy.
Acquaintance with & ↑ attachment to the infant, learning how to care for the infant and physical restoration during weeks after birth.
Achievement of a maternal identity around 4 months.
Bonding is defined as the emotional feelings that begin during pregnancy or shortly after birth between the parent and the newborn. Bonding is unidirectional from parent to newborn.
Attachment is defined as an emotional connection that forms between infant and parents. Attachment is bidirectional from parent to infant and infant to parent. Attachment has a lifelong impact on the developing individual. Quality of the attachment influences the person’s physical and emotional development and is the foundation for future relationships.
Apply petroleum jelly
allow the child to choose from a many of high calorie/protein foods
3. sunken abdomen
4. weight gain
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