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Seperation Anxiety
- - 3 stages
- - child will revert to protest stage when parents visit
- - prolonged detachment phase can dmg parent-child bonding
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3 Stages of Seperation Anxiety
- -Protest (cry for parents, cry until exhaustion)
- -Despair (depression, withdrawn)
- -Detachment (deny need for parents, uninterested in visits)
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Infant Hospital Prep
- - involve parents
- - use familiar objects
- - use distraction/soothing methods
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Toddler Hospital Prep
- - involve parents
- - simple explainations
- - allow choices
- - 1 direction at a time
- - give permission to express saddness
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School Age Hospital Prep
- - Same as infant & toddler
- - let child examine equip
- - encourage to verbilize fear
- - offer small reward (sticker)
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Teenager Hospital Prep
- - allow privacy
- - involve in tx
- - explain tx and equipment
- -suggest coping mech.
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Ear Drop Admin
- - keep in supine position with unaffected ear down
- - Children under 3 = pull pinnea down and back
- - Children over 3 = pull pinnea up and back
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Application of oint/cream
- - After bath (when skin is clean & dry)
- - Skin area is larger and skin is thinner with kids (faster absorption(
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Admin of oral meds
- - Do not mix with favorite drink/food
- - Do not call it "candy"
- - offer rewards or fluids after
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Acne
- inflam of sebaceous glands/hair follicles
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Comedo
- - plug of bacteria, sebum, keratin
- - open comedo = black head
- - closed comedo = white head
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Sebum
- fatty substance that is secreted when seb. glands enlarge due to increase in hormones
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Acne Rx/Tx
- - antibiotics (tetracycline, erythromyacin, doxycycline)
- - topical (retin-A, benzoyl peroxide)
- - Accutane
- - balanced diet, skin cleasing
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4 Types of Burns
- Thermal, radiation, chemical, electrical
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Steps in burn emergency care
- 1) stop burning process
- 2) evaluate injury
- 3) cover burn
- 4) transport to hospital
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Nursing considerations with burns
- - skin is thinner and larger surface area
- - immature immune sys = shock/heart failure
- - increase basal metabolic rate = more calories needed to heal
- - skins is more elastic = scars easily
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When is burn pt hypovolemic?
- - first 24 hours
- - nurse care = fluids to replace lost fluid and maintain blood pressure
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When is burn pt hypervolemic?
- - 2-3 days after initial burn
- - First sign of fluid overload = increase urine output
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What worsens acne?
- steroids and seizure medications
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Is aspirin and tylenol okay to take with acne?
yupyup
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Burn tx
- - moisturizers (Nivea, coco butter)
- - anti-histamines (helps with itch)
- - bicarb of soda baths (soothing)
- - sunblock (prevents hyperpigmentation)
- - no ointments with lanolin
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Burn rx
- - silver sulfa (no stinging)
- - metenide ace (painful, care for met. acidosis)
- - silver nit (needs to be kept wet, stains)
- - bacitracin (painless)
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1st s/sx of sepsis (burn)
- - disorientation
- - fever
- - diminished BS
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Intertrigo
- rash under skin folds
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Scabies
- - parasitic infection caused by itch mite
- - burough in webs of fingers/toes
- - cause intense itching at night (possible lesions)
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Nursing care for scabies
- - Elimite (used in kids older than 2 months)
- - Mites die in 2-3 days
- - all ppl in contact need tx
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Lice (pediculosis)
- - spreads via person to person
- - causes intense itching and excoriation
- - lay eggs in hair (hatch in 3-4 days)
- - lice required to bite
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3 types of pediculosis
- - pubis (pubic lice)
- - corporis (body lice)
- - captis (head lice)
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Nurse care for Lice
- - Nix shampoo (can re-tx in 7-10 days)
- - vasoline in eye lashes/brow
- - Hair combed with 1:1 water vineger solution
- - any person in contact needs tx
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Frostbite
- - freezing of a body part
- - torso warmed first for survival
- - skin will appear pale, hard, without sensation
- - Skin dmg will be similiar to burns
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Sign that sensation has returned (Frostbite)
- - skin has deep purple flush
- - extremely painful
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Tx for frost bite
- - dry clothing, warm blankets, sleeping bags
- - warm, moist O2
- - Whirlpool soaks for ulcers and blisters
- - Warming baths (100-108F)
- - VS & pain mgt crucial
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Chillblain
cold injury with erythema & formation of vesicles/ulcerative lesions due to vasoconstriction
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Strawberry Nevus
- - common hematoma (not apparent til after few weeks)
- - harmless, does not require tx (fade)
- - lesions are bright red and gradually blanch
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Port Wine Stain
- - present at birth; darken as child ages
- - appears flat and demercated
- - caused by dilated dermal capillaries
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Cradle Cap
- - inflam of skin that involves sebaceous glands
- - itchless, appears as ezcema
- - seen in newborns, infants, and puberty
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Characteristics of Cradle cap
- - thick, yellow, oily, adherent, crustlike scales on scalp and forehead
- - skin under scales will appear red
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Tx for Cradle cap
- - Dandruff shampoo on teens ONLY
- - mineral/baby oil will soften scales
- - soft brush used to remove
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Injection sites
- IM Infant - vastis lateralis
- IM child - ventrogluteal (walking age)
- IM adol - Deltoid
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Common skin lesions
- macules, papules, vesicles, pustules, crust, ecchymosis, wheal
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Macules
- - flat, circular
- - freckle
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Papule
- - raised, circular
- - pimple
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Vesicle
- - raised, fluid filled
- - cold sore, chicken pox
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Pustule
- - raised, puss filled
- - acne, impetigo
-
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Wheal
- - raised, red, irregular
- - bug bite, allergic reaction
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Eczema
- - atopic dermititis
- - inflam of genetically hypersensitive skin
- - thought to be caused by allergies/stress
- - worse in winter; remissive
- - rarely seen in breastfed infants, most common in first 2 years
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Nursing care for eczema
- - tx done at home rather hospital (easily inf.)
- - goal is to prevent inf, reduce inflam, relieve itch, and hydrate the skin
- - oils applied to skin after bathing (moisture gets sealed rather than excluded)
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Tx for eczema
- - emollient bath (oatmeal, baking soda + corn starch)
- - hair washed with soap sub. (dove, neutr.)
- - elbow restraints, oil+gloves
- - cottom fabric
- - nails kept short
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Rx fo eczema
- - corticosteroids
- - antibiotics
- - Aquaphor
- - Alpha ker theraputic bath oil
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Incubation period
Time between invasion of pathogen and onset of symptoms
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Prodromal period
- - initial stage of disease
- - time between onset of symptoms and appearance of fever/rash
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2 Types of Isolation precautions
- - Standard
- - Transmission based (airborne, contact, droplet)
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Airborne precautions
- - used for airborne transmission (TB)
- - negative air pressure room, N95 mask
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Contact precautions
- - skin to skin transmission
- - gloves and gown
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Droplet precautions
- - Flu
- - mask, gown, gloves within a 3 foot radius
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Wilm's Tumor (nephroblastoma)
- - kidney tumor
- - no s/s during early stages of growth
- - seldomly affects both kidneys
- - IV pyelogram will reveal normal tissue left and tumor growth
- - discovered by MD or parent
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Tx for nephroblastoma
- - avoid unnecessary handling of abd
- - combo of surg/chemo/radiation
- - avoid contact sports postop
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UTI
- - most common in girls
- - repeated inf = sexual abuse
- - s/s based on age (usually fever, chills, vomiting)
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Testing for UTI
- - do not collect urine from diaper
- - midstream sample for children potty trained
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Tx for infant UTI
- - infant <1 yo is hospitalized
- - low-dose antimicrobial rx
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Nephrotic Syndrome (nephrosis)
- - most common in boys 2-7 yo
- - presence of protein in urine, hypoalbuminemia, edema
- - idiopathic
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S/Sx of Nephrosis
- - characterized by slow progessive edema (around eyes and ankles)
- - weight gain and abd distention
- - normal b/p
- - child will be pale and irritable
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Tx for nephrosis
- - steroid therapy
- - aimed to reduce edema, prevent inf, reduce protein loss, and prevent rx toxicity
- - monitor I & O's and VS
- - pt turned frequently to avoid resp inf
- - NO vaccinations
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Glomerulonephritis
- - allergic reaction to strep.
- - affects both kidneys
- - usually affects boys 3-7 yo
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S/sx of glomerulonephritis
- - hyperkalemia
- - decreased output
- - periorbital edema
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Tx for glomerulonephritis
- - Limit activity and stress
- - urine cultures
- - K, Na, and H20 restrictions
- - children with HTN monitored for ICP
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Hypospadias
- - congenital defect
- - urinary meatus not at tip
- - chardee
- - surgery before 18 months
- - NO circumcision
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Chardee
downward curvature
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Nephrostomy
- - Tube passes through flank and into pelvis of kidney
- - collects urine via ostomy
- - bypasses urter, bladder, urethra
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Care for dying child
- encourage parents to use honesty
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Hemopytsis
Blood tinged sputem
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