1. N427: Test 3
1.1. Skin Integrity
1.1.1. Pediatric differences
1.1.1.1. 40-60% thinner skin
1.1.1.2. More susceptible to drug reactions
1.1.1.3. Epidermis loosely bound to dermis
1.1.1.3.1. More susceptible to bacterial infection
1.1.1.3.2. Blisters easy during inflammation
1.1.1.3.3. Preterm infants may blister easily
1.1.1.4. Low melanin production
1.1.1.4.1. Sun damage
1.1.1.4.2. UV damage
1.1.1.5. Non-functional apocrine glands
1.1.1.6. Maceration common around mouth
1.1.2. Overview of skin lesions
1.1.2.1. Etiology
1.1.2.1.1. Contact with agent
1.1.2.1.2. Physical trauma
1.1.2.1.3. Hereditary factors
1.1.2.1.4. External factors >> Reaction
1.1.2.1.5. Systemic disease
1.1.2.1.6. Age of child
1.1.2.1.7. Time of year
1.1.2.1.8. Anxiety issues
1.1.2.2. Types
1.1.2.2.1. Primary
1.1.2.2.2. Secondary
1.1.3. Skin assessment
1.1.3.1. Previous history
1.1.3.2. Changes in pigment
1.1.3.3. Moles, bruises, rashes, lesions
1.1.3.4. Excessive dryness or moisture
1.1.3.5. Medications
1.1.3.6. Changes in soaps, etc.
1.1.3.7. Hair loss
1.1.3.8. Sick contacts
1.1.3.9. Physical exam
1.1.3.9.1. Skin character
1.1.3.9.2. Inspect and palpate
1.1.4. Skin alterations
1.1.4.1. Pruritis
1.1.4.1.1. Cool compresses
1.1.4.1.2. Alkaline bath
1.1.4.1.3. Soft, lightweight clothing
1.1.4.1.4. Short, clean nails
1.1.4.1.5. Mittens
1.1.4.1.6. Antihistamines
1.1.4.1.7. Topical treatment
1.1.4.1.8. Wet dressings
1.1.4.2. Dermatitis
1.1.4.2.1. Most common skin alterations (+50%)
1.1.4.2.2. Acute (temporary) or chronic (permanent)
1.1.4.2.3. Types
1.1.4.3. Candida (Thrush)
1.1.4.3.1. White plaques on roof of mouth, buccal mucosa, tongue
1.1.4.3.2. Impedes proper eating
1.1.4.3.3. Treated with Nystatin (swish and spit OR paint)
1.1.4.4. Impetigo
1.1.4.4.1. Most common bacterial skin infection
1.1.4.4.2. Red papule >> vesicle >> rupture >> erosion >> honey-colored crust
1.1.4.4.3. Extends peripherally with sharp, irregular margins
1.1.4.4.4. Treatment
1.1.4.5. Bullous impetigo
1.1.4.5.1. Bullous eruptions on intact skin
1.1.4.5.2. Face, buttocks/perineum, trunk
1.1.4.5.3. Same treatment as regular impetigo (PO/parenteral antibiotics)
1.1.4.6. CA-MRSA
1.1.4.6.1. Found on skin, mucous membranes, nares of healthy people
1.1.4.6.2. May develop furuncle after exposure >> cultured for d
1.1.4.6.3. Treatment
1.1.4.7. Folliculitis
1.1.4.7.1. Superficial inflammation
1.1.4.7.2. Caused by staph aureus (**) and pseudonoma aeruginosa (hot tub)
1.1.4.7.3. Treated with antibacterial cleansure; benzyol peroxide (drying)
1.1.4.7.4. May require cipro for infection >1 week
1.1.4.8. Cellulitis
1.1.4.8.1. Acute bacterial infection (skin + SQ)
1.1.4.8.2. Follows infection or impaired integrity
1.1.4.8.3. Strep and staph (MRSA)
1.1.4.8.4. Treatment
1.1.4.8.5. Complications
1.1.4.9. Molluscum Contagiosum
1.1.4.9.1. Direct/sexual contact or fomite
1.1.4.9.2. Pearl-like, flesh colored papules
1.1.4.9.3. Usually 1-20 lesions
1.1.4.9.4. Can last 1-2 years
1.1.4.9.5. Tx: destroy lesions
1.1.4.10. Warts
1.1.4.10.1. Caused by HPV
1.1.4.10.2. Skin-colored, rough, scaly papule/nodule
1.1.4.10.3. Can occur on feet
1.1.4.10.4. Capillary thrombosis visible (black spots)
1.1.4.10.5. Can be treated w/duct tape
1.1.4.11. Fungal infections
1.1.4.11.1. Dermatophytoses (Tinea)
1.1.4.11.2. Tinea capitis
1.1.4.11.3. Tinea corporis
1.1.4.11.4. Tinea cruris
1.1.4.11.5. Tinea pedis
1.1.5. Other skin alterations
1.1.5.1. Atopic dermatitis
1.1.5.1.1. Eczema
1.1.5.1.2. 3 types
1.1.5.1.3. Treatment
1.1.5.2. Infestations
1.1.5.2.1. Pediculosis capitis
1.1.5.2.2. Pediculosis pubis
1.1.5.2.3. Scabies
1.1.5.3. Drug reactions
1.1.5.3.1. Erythema multiforme
1.1.5.3.2. Red man syndrome
1.1.5.3.3. Steven-Johnson syndrome
1.1.5.3.4. Toxic epidermal necrolysis
1.1.5.4. Birth marks
1.1.5.4.1. Mongolian spot
1.1.5.4.2. Cafe au lait spots
1.1.5.4.3. Vascular birthmarks
1.1.5.5. NF-1
1.1.5.5.1. Autosomal dom
1.1.5.5.2. Cafe-au-lait spots or freckles in infancy
1.1.5.5.3. Slow-growing neurofibromas on peripheral nerve later
1.1.5.5.4. May have Lisch nodules (dome-shaped, clear/yellow/brown on iris)
1.1.5.5.5. Elephantiasis may occur
1.1.5.5.6. Associated dx
1.1.6. Communicable diseases
1.1.6.1. Fever
1.1.6.1.1. >= 100.4
1.1.6.1.2. Dangerous @ 105.9F
1.1.6.1.3. In >2-3 months - emergency! (septic!)
1.1.6.1.4. Treat w/tylenol, motrin, alternate
1.1.6.2. Sepsis
1.1.6.2.1. Perinatal period most at risk
1.1.6.2.2. Group B strep, E. coli, H. flu or staph
1.1.6.2.3. Manifestations
1.1.6.2.4. Locate infection
1.1.6.3. Chickenpox (varicella)
1.1.6.3.1. Chickenbox
1.1.6.3.2. F/M/A
1.1.6.3.3. Itchy rash - MPV >> Crust
1.1.6.3.4. All 3 (PVC) at same time for DX
1.1.6.3.5. Trunk, face, proximal
1.1.6.3.6. Don't treat w/aspirin
1.1.6.3.7. Short nails
1.1.6.3.8. S/A/C precautions
1.1.6.3.9. Contagious until V dried up
1.1.6.4. Shingles
1.1.6.4.1. Varicella on nerve route
1.1.6.4.2. Itching, neuropathic pain
1.1.6.4.3. Treat symptoms, isolate, antivirals
1.1.6.4.4. Complications
1.1.6.5. Erythema infectiosum
1.1.6.5.1. Fifth Disease (Parvo B19)
1.1.6.5.2. Fever, irritability
1.1.6.5.3. 3-part rash
1.1.6.5.4. Treatment
1.1.6.6. Roseola (exanthem subitum)
1.1.6.6.1. Herpes T6
1.1.6.6.2. High fever for 3-4 days in well child
1.1.6.7. Measles (rubeola)
1.1.6.7.1. Viral infection
1.1.6.7.2. Fever, malaise >> 3 Cs
1.1.6.7.3. Koplik spots on face >> down
1.1.6.7.4. Progressive SX until 2 days after rash appears
1.1.6.7.5. Treat bedrest, skin, antipyretics
1.1.6.7.6. Isolation until day 5
1.1.6.8. Rubella (german measles)
1.1.6.8.1. Rubella virus
1.1.6.8.2. Prodrome phase possible
1.1.6.8.3. Rash on face >> neck, trunk, limbs
1.1.6.8.4. Treatment
1.1.6.9. Scarlet fever
1.1.6.9.1. Group A hemolytic strep
1.1.6.9.2. Prodrome period
1.1.6.9.3. Enathema
1.1.6.9.4. Exathema
1.1.6.9.5. Treatment
1.1.6.9.6. Complications
1.1.6.10. Stomatitis
1.1.6.10.1. Oral mucosa
1.1.6.10.2. Contagious or non-
1.1.6.10.3. Treat the symptoms
1.1.6.11. Erythema toxicum neonatorum
1.1.6.11.1. Newborn, flea-bite dermatitis
1.1.6.11.2. Benign and self-limiting
1.1.6.11.3. Within first 2 days
1.1.6.11.4. Never on palms or soles
1.1.6.11.5. May worsen with crying
1.1.6.11.6. Lasts up to a week
1.2. Quality in Nursing Care
1.2.1. Overview
1.2.1.1. 22% of Americans affected by medical error
1.2.1.2. 8th leading COD in USA
1.2.2. Blame culture
1.2.2.1. Unwillingness to take risks or accept responsibility for fear of criticism
1.2.2.2. Breeds distrust and fear
1.2.2.3. Protect yourself
1.2.2.4. Silence in both directions
1.2.3. Just culture
1.2.3.1. Open, fair and just culture
1.2.3.2. Learning culture
1.2.3.2.1. Foundation of patient safety
1.2.3.2.2. Hungry for knowledge
1.2.3.2.3. Seeks to see risks at individual, org level
1.2.3.3. Dialogue
1.2.3.4. Must move away from overly-punitive reactions
1.2.3.5. Must recognize own fallibility
1.2.3.6. Two key areas
1.2.3.6.1. Designing safe systems
1.2.3.6.2. Managing behavioral choices
1.2.4. Duties
1.2.4.1. To produce an outcome for system
1.2.4.1.1. On time
1.2.4.1.2. Badge
1.2.4.1.3. Don't steal
1.2.4.1.4. Don't snoop
1.2.4.2. To follow procedural rules
1.2.4.2.1. 2 identifiers
1.2.4.2.2. Hand hygiene
1.2.4.2.3. Med admin
1.2.4.3. To avoid causing unjustifiable risk/harm
1.2.4.3.1. Right thing for patient
1.2.4.3.2. ...coworkers
1.2.4.3.3. ...family/visitors
1.2.4.3.4. ...organization
1.2.5. Behaviors
1.2.5.1. Human error
1.2.5.1.1. Inadvertant
1.2.5.1.2. Slip, lapse, mistake
1.2.5.1.3. Console
1.2.5.2. At-risk
1.2.5.2.1. Increases risk (unrecognized)
1.2.5.2.2. Mistakenly believed to be warranted
1.2.5.2.3. Coach
1.2.5.3. Reckless
1.2.5.3.1. Choice to disregard major risk
1.2.5.3.2. Punish
1.3. Cardiovascular Alterations
1.3.1. Fetal circulation
1.3.1.1. Movement through BC squeezes out fluid from lungs
1.3.1.2. Clamp the chord >> Wharton's jelly solidifies and clamps umb vessels
1.3.1.3. Chemoreceptors (CA) respond to changes
1.3.1.4. Pressure on chest released at birth >> Recoil
1.3.1.5. Temp change and skin sensors stimulate respiratory effort
1.3.1.6. Surfactant keeps alveoli open
1.3.1.6.1. Crying >> Increased P
1.3.1.6.2. >> Keeps alveoli open
1.3.1.7. Shunts close due to increase oxygen >> Reversed heart pressures
1.3.1.7.1. Dcutosis venosis constricts when chord clamped
1.3.1.7.2. Foramen ovale closes too >> Increased SVR (LA > RA)
1.3.1.7.3. 1st breaths > DA constricts (closes in 15-hrs)
1.3.1.7.4. Pulmonary BVs dilate w/first breaths r/t oxygen
1.3.2. Acquired heart disease
1.3.2.1. Pulmonary HTN
1.3.2.1.1. CHD >> Increased PA pressure or pulm disease
1.3.2.1.2. Chronic excess pulm flow >> Pulmonary VC
1.3.2.1.3. Hypoxemia >> VC >> R-L shunt >> RHF
1.3.2.1.4. Patho
1.3.2.1.5. Manifestations
1.3.2.1.6. Treatment
1.3.2.2. Infective endocarditis
1.3.2.2.1. Uncommon
1.3.2.2.2. Manifestations
1.3.2.2.3. Treatment
1.3.2.3. Kawasaki disease
1.3.2.3.1. Acute, febrile, systemic inflammation
1.3.2.3.2. Leading cause of AHD in kids
1.3.2.3.3. Most common in Asians
1.3.2.3.4. Three stages
1.3.2.3.5. Treatment
1.3.3. Congenital heart disease
1.3.3.1. Defect or persistant fetal circulation
1.3.3.2. Four broad types
1.3.3.2.1. Increased pulm
1.3.3.2.2. Decreased pulm
1.3.3.2.3. Obstructed systemic
1.3.3.2.4. Mixed defects
1.3.3.3. Manifestations
1.3.3.3.1. Murmur
1.3.3.3.2. Struggle (after birth; within days; school)
1.3.4. Nursing care
1.3.4.1. Assessment
1.3.4.1.1. RR status
1.3.4.1.2. Perfusion
1.3.4.1.3. CV status
1.3.4.1.4. Activity/behavior
1.3.4.1.5. Growth chart
1.3.4.2. Goals
1.3.4.3. Interventions
1.3.4.4. Post-cardiac cath
1.3.4.4.1. Baseline data prior
1.3.4.4.2. Bleeding, hematoma, infection
1.3.4.4.3. VS
1.3.4.4.4. Bed rest, straight limb, supine for 6-8 hrs
1.3.4.4.5. No HOB elevation w/o orders
1.3.4.4.6. No hip flexion
1.3.4.4.7. Check dressing q15min
1.3.4.4.8. Check under buttocks for bleeding
1.3.4.4.9. I&O
1.3.4.4.10. Emergency
1.3.4.5. Home care for cath
1.3.4.5.1. S/S complications
1.3.4.5.2. Rest and quiet play
1.3.4.5.3. When to call MD
1.3.5. Discharge
1.3.5.1. Pad baby seat restraints
1.3.5.2. Don't lift under arms
1.3.5.3. Healthy diet with protein
1.3.5.4. S/S complications
1.3.5.5. Medications
1.3.5.5.1. Digoxin (contractility, slow HR)
1.3.5.5.2. Furosemide (loop, blocks salt/water, lose K)
1.3.5.5.3. Thiazide (maintain diureisis, decreased absorption)
1.3.5.5.4. Spironolactone (maintain diuresis, K-sparing)
1.3.5.5.5. ACEI (vascular relaxation, reduced PR, no fluid retention)
1.3.5.5.6. Propanolol (contractility, slow HR)
1.3.5.5.7. Carvedilol (LV fxn, VD of SC)
1.3.6. CHD in pediatrics
1.3.6.1. Inadequate CO
1.3.6.2. Overwhelming blood vol >> PHTN >> Reduced CO
1.3.6.3. Appears as above + high metabolic rate
1.3.6.4. Worsened by body's own stress response
1.3.6.5. Manifestations
1.3.6.5.1. Tachypnea
1.3.6.5.2. Wheezing, etc
1.3.6.5.3. Muscle use
1.3.6.5.4. Tiring easily
1.3.6.5.5. Hepatomegaly, acites
1.3.6.5.6. Fluid retention, edema, etc
1.3.6.5.7. Tachycardia, weak pulses, hTN
1.3.6.5.8. Delayed refill, pallor, cool
1.3.6.5.9. Failure to thrive
1.3.6.5.10. Diaphoresis
2. N427: Test 2
2.1. Chronic Illness
2.1.1. Overview
2.1.1.1. Interferes with functioning for +3 months
2.1.1.2. May also cause hospitalization for +1 month in a year
2.1.1.3. Effects the patient and their family
2.1.1.4. Limiting in three categories
2.1.1.4.1. Diagnostic
2.1.1.4.2. Functional
2.1.1.4.3. Social
2.1.1.5. Causes of chronicity
2.1.1.5.1. Genetic conditions
2.1.1.5.2. Congenital abnormalities
2.1.1.5.3. Injury in utero or at birth
2.1.1.5.4. Complications after birth
2.1.1.5.5. Serious infection
2.1.1.5.6. Major injury
2.1.1.6. Over 10 million CSHCNs in USA
2.1.1.6.1. Have or at risk for a condition
2.1.1.6.2. Also require additional health or other services
2.1.1.7. Disability = limitation
2.1.1.8. Disability >> Developmental delay
2.1.1.9. Need to have hope
2.1.2. Informing of Chronicity
2.1.2.1. Parents
2.1.2.1.1. Varied reactions
2.1.2.1.2. Grieve the loss of perfect child
2.1.2.1.3. Experiences
2.1.2.1.4. Strain on marriages
2.1.2.2. Children
2.1.2.2.1. Response effected by age, developmental level
2.1.2.2.2. Many concerns
2.1.2.3. Sibling
2.1.2.3.1. Response highly variable and influenced by age
2.1.2.3.2. May benefit from support groups if older
2.1.2.3.3. Nurse should help parent promote normal G/D
2.1.3. Normalization
2.1.3.1. Definition
2.1.3.1.1. Process of promoting +++ self-image
2.1.3.1.2. Minimizes feeling of alienation
2.1.3.1.3. Coping mechanism by sick child to redefine normal
2.1.3.2. Promotion
2.1.3.2.1. Child
2.1.3.2.2. Siblings
2.1.3.2.3. Parents
2.1.3.3. Strategies
2.1.3.3.1. Preparation
2.1.3.3.2. Participation
2.1.3.3.3. Sharing
2.1.3.3.4. Control
2.1.3.3.5. Expectations
2.1.3.3.6. Positive attitude
2.1.3.4. Threats
2.1.3.4.1. Worsening condition
2.1.3.4.2. Changes in management routines
2.1.3.4.3. Additions to the family
2.1.3.4.4. Situational changes or stressors
2.1.4. Transition
2.1.4.1. Must plan based on needs
2.1.4.1.1. Collaborate with family
2.1.4.1.2. Involve the child
2.1.4.2. Can assist planning with healthy/ready-to-work services
2.1.4.3. Chronically ill person may have to assume responsibility for own care
2.1.4.3.1. Multi-factoral process to determine readiness
2.1.4.3.2. Want a smooth, undisruptive process
2.1.5. The Role of the Nurse
2.1.5.1. Promoting G/D
2.1.5.1.1. Trust vs. mistrust
2.1.5.1.2. Autonomy vs. shame/doubt
2.1.5.1.3. Initiative vs. guilt
2.1.5.1.4. Industry vs. inferiority
2.1.5.1.5. Identity vs. role confusion
2.1.5.2. Early intervention services
2.1.5.2.1. IWDA of 1973
2.1.5.2.2. State and local education
2.1.5.2.3. Reasonable accomodations to lower cost of ed
2.1.5.2.4. Mainstreaming
2.1.5.3. Emergency preparedness
2.1.5.3.1. To prepare for needs
2.1.5.3.2. Shelter, generator, fx member, DPOA
2.1.6. Death & Dying
2.1.6.1. Stages of grief
2.1.6.1.1. Denial
2.1.6.1.2. Anger
2.1.6.1.3. Bargaining
2.1.6.1.4. Sadness/Depression
2.1.6.1.5. Acceptance
2.1.6.2. Chronic grief
2.1.6.2.1. Not the same as chronic sorrow
2.1.6.2.2. Mourning after death that is excessive & impedes functioning
2.1.6.3. Differences by age
2.1.6.3.1. Infants and toddlers
2.1.6.3.2. Preschoolers
2.1.6.3.3. School age
2.1.6.3.4. Adolescent
2.1.6.4. Compassion fatigue
2.1.6.4.1. After caring for chronically ill for long time
2.1.6.4.2. Weariness & lack of energy >> Impedes function
2.2. Child Maltreatment
2.2.1. Overview
2.2.1.1. Three areas
2.2.1.1.1. Physical abuse/neglect
2.2.1.1.2. Emotional abuse/neglect
2.2.1.1.3. Sexual abuse
2.2.1.2. Omission OR commission
2.2.1.3. Legal area: CAPTA 1996
2.2.2. Specific situations
2.2.2.1. MSBP
2.2.2.2. SBS
2.2.2.2.1. Hallmark symptoms
2.2.2.2.2. Suspect abuse with symptoms
2.2.2.3. Hazing
2.2.2.4. Domestic violence
2.2.2.5. Dating violence
2.2.2.6. International issues
2.2.2.6.1. Abuse occurs in many ways
2.2.2.6.2. Declaration of Rights of Children (UNGA)
2.2.2.6.3. Abuse and mutilation of women and children
2.2.2.6.4. Child soldiers, routine executions, honor killings
2.2.3. Nursing responsibilities
2.2.3.1. Assessment
2.2.3.1.1. Most critical element
2.2.3.1.2. High index of suspicion
2.2.3.1.3. No typical profile of victim
2.2.3.1.4. Detailed and thorough history
2.2.3.2. Protect child from abuse
2.2.3.3. Provide support to child
2.2.3.3.1. Don't try to be their parent
2.2.3.3.2. Continue to be an advocate
2.2.3.3.3. Encourage parental relationship*
2.2.3.3.4. Also support the family genuinely
2.2.3.4. Documentation
2.2.3.4.1. Accurate, factual, concise, legible
2.2.3.4.2. Describe behaviors (don't interpret)
2.2.3.4.3. Verbatim conversations if possible
2.2.3.4.4. Be prepared to testify
2.2.3.5. Prevention
2.2.3.5.1. Difficult goal
2.2.3.5.2. Identify and intervene appropriately
2.2.3.5.3. Collaborative
2.3. Genetic Abnormalities
2.3.1. Overview
2.3.1.1. Thousands of known inherited disorders
2.3.1.2. May have same manifestations but different MOI
2.3.1.3. At least one minor anomaly in 50% of all infants
2.3.1.3.1. 3+ >> 20-50% have serious defect
2.3.1.4. Genes
2.3.1.4.1. Specific sequence of bases
2.3.1.4.2. Protein blueprints >> Body structure and fxn
2.3.1.4.3. Occupy a position on a chromosome (locus)
2.3.1.4.4. Variable forms at each site (alleles)
2.3.1.4.5. Can be mutated (inherited alteration)
2.3.1.5. DNA analysis
2.3.1.5.1. Karyotypic analysis
2.3.1.6. Inheritance variability
2.3.1.6.1. Penetrance
2.3.1.6.2. Reduced or incomplete penetrance
2.3.1.6.3. Variable expressivity
2.3.2. MOIs for single-gene disorders
2.3.2.1. Autosomal dominant
2.3.2.1.1. Disorders
2.3.2.1.2. Pattern
2.3.2.2. Autosomal recessive
2.3.2.2.1. Disorders
2.3.2.2.2. Characteristics
2.3.2.3. X-linked dominant
2.3.2.3.1. Characteristics
2.3.2.3.2. Disorders
2.3.2.4. X-linked recessive
2.3.2.4.1. Characteristics
2.3.2.4.2. Disorders
2.3.3. Specific genetic disorders
2.3.3.1. Down Syndrome
2.3.3.1.1. Most common
2.3.3.1.2. 1:800 - 1:1000 births
2.3.3.1.3. Unknown etiology - many factors
2.3.3.1.4. Transmission patterns
2.3.3.1.5. Widely variable phenotypes
2.3.3.1.6. Therapeutic management
2.3.3.2. Hemophilia
2.3.3.2.1. Hereditary bleeding disorder
2.3.3.2.2. Clotting factor deficiency
2.3.3.2.3. X-linked recessive
2.3.3.2.4. Three types
2.3.4. Genetic testing
2.3.4.1. Diagnosis and screening
2.3.4.2. For diagnosis
2.3.4.2.1. Cytogenic (karyotype, enhanced res)
2.3.4.2.2. Molecular (DNA methylation analysis)
2.3.4.3. Only screen kids for medical benefit
2.3.4.4. Social issues
2.3.4.4.1. Personal
2.3.4.4.2. Private
2.3.4.4.3. Powerful
2.3.4.4.4. Potentially predictive
2.3.4.4.5. Pedigree sensitive
2.3.4.4.6. Permanent
2.3.4.4.7. Prejudicial
2.3.4.5. Must provide only the facts (not a course of action)
2.3.5. Assessment and management
2.3.5.1. Hypotonia = Neuro problem
2.3.5.1.1. In infants, there IS a problem!
2.3.5.1.2. Have to identify the mutation
2.3.5.2. Check for tone by measuring
2.3.5.3. Include a pedigree
2.3.5.4. Phenotypic modification
2.3.5.4.1. Surgical
2.3.5.4.2. Diet (PKU)
2.3.5.4.3. Metabolic (THY)
2.3.5.4.4. Avoiding carcinogens (ASA in hemolytic anemia)
2.3.5.4.5. Immunologic prevention (Rh- moms get IGB)
2.3.5.4.6. Transplants (PKD)
2.3.5.5. Genetic manipulation
2.3.5.5.1. Gene product replacement therapy
2.3.5.5.2. Recombinant DNA
2.3.5.5.3. Gene transfer
2.3.5.5.4. Enzyme repression
2.3.5.5.5. Competitive inhibition
3. N427: Test 4
3.1. N427: Immunology
3.1.1. Overview
3.1.1.1. Recognize foreign bodies
3.1.1.2. Several types
3.1.1.2.1. Natural
3.1.1.2.2. Acquired
3.1.1.2.3. Cell-mediated
3.1.1.2.4. Humoral
3.1.1.3. Components
3.1.1.3.1. B-lymphocytes
3.1.1.3.2. T-lymphocytes
3.1.1.3.3. Complement
3.1.1.3.4. Cytokines (messengers)
3.1.1.4. Pediatric variations
3.1.1.4.1. Influenced by several factors
3.1.1.4.2. Variable amount of Ig in infants
3.1.1.4.3. Undeveloped humoral immunity until age 7
3.1.1.4.4. Cell-mediated immunity fully developed earlier
3.1.2. SCID
3.1.2.1. No humoral or cell-mediated immunity
3.1.2.1.1. Susceptibility to infection
3.1.2.1.2. Failure to recover fully
3.1.2.1.3. Frequent reinfection
3.1.2.2. Genetic abnormality
3.1.2.2.1. X-linked
3.1.2.2.2. Autosomal receissive
3.1.2.3. Confirmed by lab tests
3.1.2.3.1. Very low t-cell count
3.1.2.3.2. Very low immunoglobulins
3.1.2.4. Treatment
3.1.2.4.1. Antibiotics
3.1.2.4.2. IVIG
3.1.2.4.3. HSCT
3.1.2.5. Nursing care
3.1.2.5.1. S/S infection
3.1.2.5.2. Skin, RR, G/D assessment
3.1.2.5.3. Skin integrity
3.1.2.5.4. Medications
3.1.2.5.5. Parent education
3.1.3. HIV/AIDS
3.1.3.1. Alters body's ability to fight off infection
3.1.3.2. Destroys CD4+ t-cells
3.1.3.3. Often perinatal transmission
3.1.3.4. May result from unsafe sex
3.1.3.5. Manifestations
3.1.3.5.1. Chronic, frequent or unusual infections
3.1.3.5.2. Poor growth, weight loss, FTT
3.1.3.5.3. Hepato- or splenomegaly
3.1.3.5.4. Lymphoid interstitial pneumonia
3.1.3.5.5. Burkitt lymphoma
3.1.3.5.6. Developmental delay
3.1.3.6. Diagnostics
3.1.3.6.1. Serologic testing
3.1.3.6.2. HIV DNA PCR
3.1.3.6.3. Retesting to confirm
3.1.3.7. Management
3.1.3.7.1. Preventing vertical transmission
3.1.3.7.2. Testing
3.1.3.7.3. Prophylaxis
3.1.3.7.4. Antibiotics
3.1.3.7.5. HAART
3.1.3.8. Nursing care
3.1.3.8.1. Assessing & identifying at-risk patients
3.1.3.8.2. Preventing vertical transmission
3.1.3.8.3. Pediatric assessment
3.1.3.8.4. Prevent infection
3.1.3.8.5. Support
3.1.3.8.6. Education
3.1.3.8.7. Medications
3.1.3.8.8. Nutrition
3.1.4. SLE
3.1.4.1. Systemic lupus erythematosus
3.1.4.1.1. Autoimmune disease
3.1.4.1.2. May be genetic and triggered
3.1.4.1.3. Pediatric variation
3.1.4.2. Demographics
3.1.4.2.1. Females > males
3.1.4.2.2. Ages 10-19
3.1.4.2.3. More common in non-Caucasians
3.1.4.3. Manifestations
3.1.4.3.1. Cutaneous
3.1.4.3.2. GI
3.1.4.3.3. MSKT
3.1.4.3.4. Neuro
3.1.4.3.5. CV
3.1.4.3.6. Renal
3.1.4.4. Diagnostic criteria (4+)
3.1.4.4.1. Butterfly or discoid rash
3.1.4.4.2. Photosensitivity
3.1.4.4.3. Oral ulcers
3.1.4.4.4. Arthritis
3.1.4.4.5. Serositis
3.1.4.4.6. ANA
3.1.4.4.7. Systemic disorders
3.1.4.5. Therapeutic management
3.1.4.5.1. Reverse or minimize disease
3.1.4.5.2. Medications
3.1.4.5.3. Education
3.1.4.5.4. Diet
3.1.4.5.5. Rest
3.1.4.5.6. Exercise
3.1.4.6. Nursing care
3.1.4.6.1. Minimize exacerbations
3.1.4.6.2. Compliance issues
3.1.4.6.3. Body image concerns
3.1.5. JRA
3.1.5.1. Juvenile RA
3.1.5.1.1. Idiopathic, chronic
3.1.5.1.2. Inflammatory diseases
3.1.5.1.3. Joints and tissues
3.1.5.1.4. Autoimmune cause
3.1.5.2. Prognosis
3.1.5.2.1. No cure
3.1.5.2.2. Eventually inactivates (70%)
3.1.5.2.3. Earlier onset >> better prognosis?
3.1.5.2.4. Can progress to uveitis >> permanent vision loss*
3.1.5.3. Courses
3.1.5.3.1. Oligoarthritis
3.1.5.3.2. Polyarthritis
3.1.5.3.3. Systemic
3.1.5.4. Manifestations
3.1.5.4.1. Stiffness
3.1.5.4.2. Swelling
3.1.5.4.3. LOM in affected joints
3.1.5.4.4. Warm to touch
3.1.5.4.5. NO erythema
3.1.5.4.6. Tenderness*
3.1.5.4.7. Exacerbated by stress
3.1.5.4.8. Growth retardation
3.1.5.5. Diagnosis
3.1.5.5.1. No definitive tests
3.1.5.5.2. Supportive tests
3.1.5.5.3. Criteria
3.1.5.6. Therapy
3.1.5.6.1. Goals
3.1.5.6.2. Medications
3.1.5.6.3. PT
3.1.5.6.4. Surgery
3.1.5.7. Nursing care
3.1.5.7.1. Pain management
3.1.5.7.2. Nutrition
3.1.5.7.3. Exercise
3.1.5.7.4. Rest
3.1.5.7.5. Patient, family ed
3.1.6. Allergic Reactions
3.1.6.1. Response to allergens
3.1.6.2. Four types
3.1.6.2.1. Type 1: anaphylaxis
3.1.6.2.2. Type 2: tissue-specific
3.1.6.2.3. Type 3: immune-complex
3.1.6.2.4. Type 4: delayed
3.1.6.3. Treatment
3.1.6.3.1. Avoidance
3.1.6.3.2. Desensitization
3.1.6.3.3. Antihistamines
3.1.6.3.4. Epi-pen
3.1.6.4. Nursing care
3.1.6.4.1. Assessment
3.1.6.4.2. Skin testing
3.1.6.4.3. Education
3.2. N427: Hematology
3.2.1. Review
3.2.1.1. Types of cells
3.2.1.1.1. RBC
3.2.1.1.2. WBC
3.2.1.1.3. Platelets
3.2.1.2. Lab tests
3.2.1.2.1. CBC
3.2.1.2.2. Clotting indices
3.2.1.2.3. Iron indices
3.2.1.2.4. RBC indices
3.2.1.2.5. WBC differential
3.2.2. Anemia
3.2.2.1. Alterations
3.2.2.1.1. Decreased #s of RBCs
3.2.2.1.2. Decreased quantity of HgB
3.2.2.1.3. Decreased volume of packed RBCs
3.2.2.2. Causes
3.2.2.2.1. Loss/destruction of RBCs
3.2.2.2.2. Impaired RBC production
3.2.2.3. Types
3.2.2.3.1. Iron deficiency
3.2.2.3.2. Sickle cell disease
3.2.2.3.3. Thalassemia
3.2.2.3.4. Aplastic
3.2.3. Transfusion Reactions
3.2.3.1. Types
3.2.3.1.1. Allergic reaction
3.2.3.1.2. Hemolytic reaction
3.2.3.1.3. Febrile/septic reaction
3.2.3.1.4. Circulatory overload
3.2.3.2. Prevention
3.2.3.2.1. Check blood w/another RN
3.2.3.2.2. 1st 20 mL slow infusion while monitoring
3.2.3.2.3. Frequent assessment
3.2.4. Hemosiderosis
3.2.4.1. Overload of iron in tissues
3.2.4.2. Causes
3.2.4.2.1. Frequent transfusions
3.2.4.2.2. Excessive RBC breakdown
3.2.4.3. Treat with Fe-chelating agents
3.2.4.3.1. Deferasirox
3.2.4.3.2. Deferoxamine
3.2.5. Bleeding Disorders
3.2.5.1. Hemophilia
3.2.5.1.1. Hereditary
3.2.5.1.2. Types
3.2.5.1.3. Manifestations
3.2.5.1.4. Diagnostics
3.2.5.1.5. Medical care
3.2.5.1.6. Nursing care
3.2.5.2. Von Willebrand disease
3.2.5.2.1. Most common genetic bleeding disorder
3.2.5.2.2. Autosomal dominant
3.2.5.2.3. Manifestations
3.2.5.2.4. Diagnosis
3.2.5.2.5. Treatment
3.2.5.3. DIC
3.2.5.3.1. Acquired, abnormal clotting activation
3.2.5.3.2. Commonly caused by sepsis
3.2.5.3.3. Manifestations
3.2.5.3.4. Management
3.2.5.4. ITP
3.2.5.4.1. Increased splenic destruction of platelets
3.2.5.4.2. Autoimmune disorder
3.2.5.4.3. May occur after MMR vaccine
3.2.5.4.4. Manifestations
3.2.5.4.5. Diagnostics
3.2.5.4.6. Treatment
3.2.6. HSCT
3.2.6.1. Found mainly in bone marrow
3.2.6.2. May grow into new body cells
3.2.6.3. Autologous (self) or allogenic (donor)
3.2.6.3.1. Donar needs compatible MLA
3.2.6.4. Three phase process
3.2.6.4.1. Pre-transplant
3.2.6.4.2. Transplant
3.2.6.4.3. Post-transplant
3.3. N427: Oncology
3.3.1. Overview
3.3.1.1. Leading COD (disease) for <15 yo
3.3.1.2. Cells are warped
3.3.1.2.1. Don't divide normally
3.3.1.2.2. Don't die
3.3.1.3. Etiology
3.3.1.3.1. External stimuli
3.3.1.3.2. Immune system
3.3.1.3.3. Gene abnormalities
3.3.1.3.4. Chromosomal abnormalities
3.3.1.4. Manifestations
3.3.1.4.1. Pain
3.3.1.4.2. Excessive, rapid weight loss
3.3.1.4.3. Unusual mass/swelling
3.3.1.4.4. Pallor & loss of energy
3.3.1.4.5. Sudden bruising
3.3.1.4.6. Prolonged illness or fever
3.3.1.4.7. Frequent headaches
3.3.1.4.8. Vision changes
3.3.1.5. Diagnostics
3.3.1.5.1. H&P
3.3.1.5.2. CBC with diff
3.3.1.5.3. BM aspiration
3.3.1.5.4. LP
3.3.1.5.5. Imaging
3.3.1.5.6. Biopsy
3.3.1.6. Treatment
3.3.1.6.1. Chemo
3.3.1.6.2. Surgery
3.3.1.6.3. Radiotherapy
3.3.1.6.4. BM/SC transplant
3.3.1.6.5. Biologic response modifiers
3.3.1.6.6. Complementary therapy
3.3.2. Oncologic Emergencies
3.3.2.1. Metabolic emergency
3.3.2.1.1. Tumor lysis syndrome
3.3.2.1.2. Septic shock
3.3.2.1.3. Hypercalcemia
3.3.2.2. Hematologic emergency
3.3.2.2.1. Thrombocytopenia
3.3.2.2.2. DIC
3.3.2.3. Space-occupying lesions
3.3.2.3.1. SVC syndrome
3.3.2.3.2. Spinal cord compression
3.3.3. Solid Tumors
3.3.3.1. CNS tumors
3.3.3.1.1. Incidence
3.3.3.1.2. Etiology
3.3.3.1.3. Types
3.3.3.1.4. Presentation
3.3.3.1.5. Treatment
3.3.3.1.6. Nursing care
3.3.3.2. Neuroblastoma
3.3.3.2.1. Malignant; "SILENT TUMOR"
3.3.3.2.2. Most common ECST in children
3.3.3.2.3. NOT a brain tumor
3.3.3.2.4. Presentation
3.3.3.2.5. Diagnosis
3.3.3.2.6. Staging/prognosis
3.3.3.2.7. Treatment
3.3.3.3. Nephroblastoma
3.3.3.3.1. AKA Wilms tumor
3.3.3.3.2. Large, rapidly growing
3.3.3.3.3. Vascular abdominal tumor
3.3.3.3.4. NEVER PALPATE ABDOMEN
3.3.3.3.5. Presentation
3.3.3.3.6. Diagnosed via imaging
3.3.3.3.7. Treatment
3.3.3.3.8. 90% overall cure rate
3.3.3.4. Osteosarcoma
3.3.3.4.1. Malignant bone tumor
3.3.3.4.2. Most common bone tumor (peds)
3.3.3.4.3. Often metastasizes to lungs by diagnosis (20%)
3.3.3.4.4. Presentation
3.3.3.4.5. Treatment
3.3.3.4.6. Prognosis
3.3.3.5. Ewing sarcoma
3.3.3.5.1. Tumor of bone and soft tissue
3.3.3.5.2. Presentation
3.3.3.5.3. Treated w/SCR
3.3.3.5.4. Nursing care
3.3.3.6. Rhabdomyosarcoma
3.3.3.6.1. Striated muscle (SM)
3.3.3.6.2. Common site: head/neck/orbital
3.3.3.6.3. Rapid metastasis
3.3.3.6.4. Manifestation
3.3.3.6.5. Treatment
3.3.3.6.6. Prognosis
3.3.3.7. Retinoblastoma
3.3.3.7.1. Most common intraocular peds tumor
3.3.3.7.2. Manifestations
3.3.3.7.3. Treatment
3.3.3.7.4. Prognosis
3.3.3.7.5. Nursing care
3.3.4. Leukemias
3.3.4.1. ALL
3.3.4.1.1. Most common cancer (peds)
3.3.4.1.2. Lymphoid cell lineage
3.3.4.1.3. Presentation
3.3.4.1.4. Diagnosis
3.3.4.1.5. Prognostic factors
3.3.4.1.6. Treatment
3.3.4.2. AML
3.3.4.2.1. Less common than ALL
3.3.4.2.2. Myeloid cell lineage
3.3.4.2.3. Treatment aspects
3.3.4.3. Relapse info
3.3.4.3.1. Reinduction therapy
3.3.4.3.2. BMT to replace diseased marrow
3.3.4.3.3. Unable to control prolif >> death
3.3.4.4. Nursing care
3.3.4.4.1. Patient/family education
3.3.4.4.2. Emotional support
3.3.4.4.3. ADRs for treatment (assess!!)
3.3.5. Lymphoma
3.3.5.1. Hodgkin's
3.3.5.1.1. Lymphoid system
3.3.5.1.2. Common presentation
3.3.5.1.3. Treated w/ chemo and/or radiation
3.3.5.1.4. Survival rates
3.3.5.1.5. Diagnosis
3.3.5.2. Non-hodgkin's
3.3.5.2.1. Majority of peds lymphomas
3.3.5.2.2. 10-15% of all peds cancer
3.3.5.2.3. Characteristics
3.3.5.2.4. Staging
3.3.5.2.5. Treated w/chemo & radiation
3.3.5.2.6. Good survival rate (80%) w/multiagent chemo
3.3.6. Nursing Care
3.3.6.1. CVAD
3.3.6.1.1. Broviac/hickman
3.3.6.1.2. Groshong
3.3.6.1.3. PICC
3.3.6.1.4. Ports
3.3.6.2. Supportive therapy
3.3.6.2.1. Nutrition
3.3.6.2.2. Medication
3.3.6.2.3. Side effects
3.3.6.2.4. Infection
3.3.6.2.5. Pain management
3.3.6.2.6. Psychosocial support
3.3.6.3. Overall effect
3.3.6.3.1. 80% cancer survival rate :)
3.3.6.3.2. Research effects
3.3.7. Cancer Survival
3.3.7.1. Radiation after-effects
3.3.7.1.1. Growth retardation
3.3.7.1.2. Endocrine dysfunction
3.3.7.1.3. Cardiac toxicity
3.3.7.2. Secondary malignancies
3.3.7.3. Chemo after-effects
3.3.7.3.1. Cardiomyopathy
3.3.7.3.2. Neuropsychological deficits
3.3.7.4. Social/behavioral problems
4. N427: Test 5
4.1. Gastrointestinal
4.1.1. General Concepts
4.1.1.1. Immature at birth
4.1.1.2. Common consequences
4.1.1.2.1. Malabsorption
4.1.1.2.2. Fluid/electrolyte imbalances
4.1.1.2.3. Malnutrition
4.1.1.2.4. Poor growth
4.1.1.3. Adversely affect g/d & health
4.1.1.4. Nursing care
4.1.1.4.1. I&O
4.1.1.4.2. Height and weight
4.1.1.4.3. Abdominal exam
4.1.1.4.4. Urine, stool tests
4.1.1.5. Diagnostics
4.1.1.5.1. X-ray
4.1.1.5.2. Barium swallow
4.1.1.5.3. Barium enema
4.1.1.5.4. Ultrasound/CT
4.1.1.5.5. Colonscopy
4.1.1.5.6. 24-hr pH probe
4.1.1.5.7. UGI
4.1.2. Structural Defects
4.1.2.1. Cleft lip/cleft palate
4.1.2.1.1. Failure of fusion
4.1.2.1.2. Unilateral or bilateral
4.1.2.1.3. Multifactorial etiology
4.1.2.1.4. Assessment
4.1.2.1.5. Manifestations
4.1.2.1.6. Medical care
4.1.2.1.7. Nursing care
4.1.2.2. Esophageal atresia/TEF
4.1.2.2.1. Doesn't form continuous tube
4.1.2.2.2. Symptoms
4.1.2.2.3. Assessment
4.1.2.2.4. Diagnosis
4.1.2.2.5. Management
4.1.2.3. Pyloric stenosis
4.1.2.3.1. Opening b/w lower stomach & duodenum
4.1.2.3.2. Diagnostics
4.1.2.3.3. Manifestations
4.1.2.3.4. Management
4.1.2.4. GERD
4.1.2.4.1. Usually normal
4.1.2.4.2. Disease if symptomatic
4.1.2.4.3. May be caused by P in LES
4.1.2.4.4. Manifestations
4.1.2.4.5. Diagnostics
4.1.2.4.6. Management
4.1.2.5. Omphalocele/Gastroschisis
4.1.2.5.1. Congenital herniation of stomach contents
4.1.2.5.2. Diagnostics
4.1.2.5.3. Nursing care
4.1.2.6. Intussuception
4.1.2.6.1. Invagination of two portions in intestine
4.1.2.6.2. Surgical emergency
4.1.2.6.3. Manifestations
4.1.2.6.4. Diagnostics
4.1.2.6.5. Treatment
4.1.2.6.6. Nursing care
4.1.2.7. Hirschsprung disease
4.1.2.7.1. Absence of ganglionic nerves
4.1.2.7.2. Acute or chronic
4.1.2.7.3. Manifestations
4.1.2.7.4. Diagnosis
4.1.2.7.5. Management
4.1.2.7.6. Complication: Enterocolitis
4.1.2.7.7. Nursing care
4.1.2.8. Anorectal malformations
4.1.2.8.1. Diagnostic
4.1.2.8.2. Management
4.1.2.8.3. Nursing care
4.1.2.8.4. DC planning
4.1.2.9. Hernias
4.1.2.9.1. Protrusion of organ through muscle wall
4.1.2.9.2. Congenital diaphragmatic hernia
4.1.2.9.3. Umbilical hernia
4.1.3. Ostomies
4.1.3.1. Surgical opening
4.1.3.2. Temporary or permanent
4.1.3.3. Risk for disturbed body image, G/D
4.1.3.4. Nursing care
4.1.3.4.1. Education
4.1.3.4.2. Pain
4.1.3.4.3. Stoma care
4.1.3.4.4. Functioning
4.1.3.4.5. Skin care
4.1.3.4.6. Support groups
4.1.4. Inflammatory Disorders
4.1.4.1. Appendicitis
4.1.4.1.1. Surgical emergency
4.1.4.1.2. Hard to diagnose
4.1.4.1.3. R/T obstruction
4.1.4.1.4. Manifestations
4.1.4.1.5. Diagnostics
4.1.4.1.6. Management
4.1.4.1.7. Nurse's role
4.1.4.2. Inflammatory bowel disease
4.1.4.2.1. Ulcerative colitis
4.1.4.2.2. Crohn's disease
4.1.4.2.3. Diagnostics
4.1.4.2.4. Management
4.1.4.2.5. Nursing care
4.1.4.3. Peptic ulcer
4.1.4.3.1. Erosion of mucosa
4.1.4.3.2. Primary or secondary
4.1.4.3.3. R/T h. pylori
4.1.4.3.4. Symptoms
4.1.4.3.5. Diagnosis
4.1.4.3.6. Medical care
4.1.5. Motility Disorders
4.1.5.1. Gastroenteritis
4.1.5.1.1. Acute diarrhea
4.1.5.1.2. Inflammation of stomach, intestines
4.1.5.1.3. Major cause of infant mortality in 3rd world
4.1.5.1.4. Viruses, bacteria or parasites
4.1.5.1.5. Mild form
4.1.5.1.6. Severe form
4.1.5.2. Constipation
4.1.5.2.1. Infrequent, hard stools
4.1.5.2.2. For at least 2 weeks
4.1.5.2.3. >2x/week
4.1.5.2.4. School-age children
4.1.5.2.5. Get description from parents
4.1.5.2.6. DD
4.1.5.2.7. Treatment
4.1.6. Pinworms
4.1.6.1. Pinworms
4.1.6.2. PO ingestion
4.1.6.2.1. Eggs hatch in upper intestines
4.1.6.2.2. Mature in 2-4 wks
4.1.6.2.3. Migrate to cecal area
4.1.6.2.4. Migrate to anus
4.1.6.2.5. Itch during movement
4.1.6.2.6. Scratching >> hand-to-mouth
4.1.6.3. Can last for a week+
4.1.6.4. Diagnostics
4.1.6.4.1. Tape test
4.1.6.4.2. Early in AM
4.1.6.4.3. Penlight
4.1.6.4.4. Microscopic exam
4.1.6.5. Meds
4.1.6.5.1. All family members
4.1.6.5.2. Treat once, then repeat in 1-2 wks
4.1.6.5.3. Vermox, Pinex, Antiminth
4.1.6.6. Nursing
4.1.6.6.1. Tape test directions
4.1.6.6.2. S/S
4.1.6.6.3. Cleaning practices
4.1.6.6.4. Showers instead of baths
4.1.7. Diseases of Malabsorption
4.1.7.1. Celiac disease
4.1.7.1.1. Permanent gluten intolerance
4.1.7.1.2. Lack of peptidase for digestion
4.1.7.1.3. Four characteristics
4.1.7.1.4. Usually appears 9-12 months (dx in pre-school)
4.1.7.1.5. Diagnosis
4.1.7.1.6. Therapeutic management
4.1.7.1.7. Nursing care
4.1.7.2. Short bowel syndrome
4.1.7.2.1. Decreased SA r/t SI resection
4.1.7.2.2. Causes
4.1.7.2.3. Problems
4.1.7.2.4. M/WL/D
4.1.7.2.5. Nursing care
4.2. Musculoskeletal
4.2.1. Feet & Legs
4.2.1.1. Metatarsus adductus
4.2.1.1.1. "In-toeing"
4.2.1.1.2. Most common congenital FD
4.2.1.1.3. Diagnosis
4.2.1.1.4. Treatment
4.2.1.1.5. Nursing care
4.2.1.2. Clubfoot
4.2.1.2.1. Talipes equinovarus
4.2.1.2.2. Boys > girls
4.2.1.2.3. Etiology
4.2.1.2.4. Treatment
4.2.1.3. Genu varum
4.2.1.3.1. Bow legs
4.2.1.3.2. Normal until 2-3
4.2.1.3.3. Combined info
4.2.1.4. Genu valgum
4.2.1.4.1. Knock knees
4.2.1.4.2. Normal until 4-5
4.2.2. Hips
4.2.2.1. DDH
4.2.2.1.1. Females > males
4.2.2.1.2. Unknown causes
4.2.2.1.3. Manifestations
4.2.2.1.4. Screen until 1 yo or walking
4.2.2.1.5. Diagnosis
4.2.2.1.6. Therapeutic care
4.2.2.1.7. Nursing care
4.2.2.2. LCPD
4.2.2.2.1. Self-limiting, idiopathic, ages 2-12
4.2.2.2.2. White males > other groups
4.2.2.2.3. Suspect if boy age 2-12 CC hip pain + limp
4.2.2.2.4. Stages
4.2.2.2.5. Treatment
4.2.2.3. SCFE
4.2.2.3.1. Displacement of femoral head from neck
4.2.2.3.2. Before or during growth spurts
4.2.2.3.3. Idiopathic, multifactorial
4.2.2.3.4. Manifestations
4.2.2.3.5. Therapeutic management
4.2.3. Spine
4.2.3.1. Torticollis
4.2.3.1.1. Tilt of head r/t rotated C-spine
4.2.3.1.2. Injury to SCM or C-spine abnormality
4.2.3.1.3. Treated with stretching
4.2.3.2. Kyphosis
4.2.3.2.1. Abnormal convex angle of thoracic spine
4.2.3.2.2. Usually postural
4.2.3.2.3. TB, arthritis, OD, compression fx
4.2.3.3. Lordosis
4.2.3.3.1. Accentuation of lumbar curve
4.2.3.3.2. Secondary or idiopathic
4.2.3.3.3. Obesity
4.2.3.4. Scoliosis
4.2.3.4.1. Most common
4.2.3.4.2. Lateral curve >10 degrees
4.2.3.4.3. Congenital, compensatory (leg length), idiopathic (10-13yo)
4.2.3.4.4. Medical care
4.2.3.4.5. Nursing care
4.2.4. Misc. Bone Disorders
4.2.4.1. Osteomyelitis
4.2.4.1.1. Inflammation/infection
4.2.4.1.2. Abrupt onset
4.2.4.1.3. Marked leukocytosis
4.2.4.1.4. Increased ESR/CRP*
4.2.4.1.5. Medical treatment
4.2.4.2. Marfan syndrome
4.2.4.2.1. Autosomal dominant CT
4.2.4.2.2. Various symptoms
4.2.4.2.3. Present w/murmur
4.2.4.2.4. No cure
4.2.4.3. Osteogenesis imperfecta
4.2.4.3.1. BBD
4.2.4.3.2. Autosomal dominant
4.2.4.3.3. Classifications
4.2.4.3.4. Medications
4.2.4.3.5. Nursing care
4.2.5. Injuries
4.2.5.1. Sports injuries
4.2.5.1.1. Types
4.2.5.1.2. RICE
4.2.5.1.3. Stretch before activity
4.2.5.2. Fractures
4.2.5.2.1. Nursing assessment
4.2.5.2.2. Traction
4.2.5.3. Immobility
4.2.5.3.1. Many negative effects
4.2.5.3.2. RN first to ambulate PT r/t orthostatic hTN
4.2.5.4. Braces/orthoses
4.2.5.4.1. Variety of types
4.2.5.4.2. Frequent readjustments
4.2.5.4.3. Skin checks q1-2 hrs for few days
4.2.5.4.4. Protective clothing
4.2.5.4.5. NVCs
4.2.6. Muscular Dystrophies
4.2.6.1. General
4.2.6.1.1. Largest group
4.2.6.1.2. Inherited
4.2.6.1.3. Increased disability, deformity
4.2.6.1.4. Terminal
4.2.6.2. DMD
4.2.6.2.1. Most severe, common
4.2.6.2.2. X-linked inheritence
4.2.6.2.3. Abnormal coding for dystrophin
4.2.6.2.4. Characteristics
4.2.6.2.5. Diagnoses
4.2.6.2.6. Nursing care
4.3. Respiratory
4.3.1. Distress vs. Failure
4.3.1.1. Distress
4.3.1.1.1. Any onset
4.3.1.1.2. Abnormal resp effort
4.3.1.2. Failure
4.3.1.2.1. Inability to maintain gas exchange
4.3.2. Apnea
4.3.2.1. Periodic breathing
4.3.2.1.1. Irregular
4.3.2.1.2. Up to 20 sec b/w breaths
4.3.2.2. Apnea
4.3.2.2.1. Cessation of RR for >20sec
4.3.2.2.2. Any pause associated w/
4.3.2.2.3. Prematurity
4.3.2.2.4. ALTE
4.3.2.2.5. OSAS
4.3.2.2.6. SIDS
4.3.3. Croup Syndromes
4.3.3.1. LTB
4.3.3.1.1. Parainfluenza; flu A; MP; RSV
4.3.3.1.2. Post-URI
4.3.3.1.3. Seal-like barking cough/stridor
4.3.3.1.4. Self-limiting
4.3.3.1.5. Treated with NEB and O2
4.3.3.2. Spasmodic croup
4.3.3.2.1. Similar symptoms, less serious croup
4.3.3.2.2. Sudden, at night, no viral illness
4.3.3.2.3. Resolves quickly
4.3.3.3. Acute epiglottis
4.3.3.3.1. Severe, life-threatening
4.3.3.3.2. Flu B, Strep or Staph
4.3.3.3.3. Manifestations
4.3.3.3.4. No visual inspection
4.3.3.3.5. Medications
4.3.3.4. Bacterial tracheitis
4.3.3.5. Pertussis
4.3.3.5.1. On the rise in older kids/adults
4.3.3.5.2. Direct contact
4.3.3.5.3. Persistent URI
4.3.3.5.4. Treat family
4.3.4. Lower Airway Disorders
4.3.4.1. Bronchitis
4.3.4.1.1. Usually non-isolated
4.3.4.1.2. Coarse, hacking cough
4.3.4.1.3. Woarse hS
4.3.4.1.4. Palliative treatment
4.3.4.2. Bronchiolitis
4.3.4.2.1. Usually RSV
4.3.4.2.2. Higher risk populations
4.3.4.2.3. Progression
4.3.4.3. Pneumonia
4.3.4.3.1. Acute inflammation of lung parenchyma
4.3.4.3.2. Involves small airways, alveoli
4.3.4.3.3. Many causes
4.3.4.4. TB
4.3.4.4.1. Increases US incidence
4.3.4.4.2. Mycobacterium
4.3.5. Chronic Disorders
4.3.5.1. Asthma
4.3.5.1.1. Chronic inflammation
4.3.5.1.2. Reversible hyperactivity
4.3.5.1.3. Triggered
4.3.5.1.4. Manifestations
4.3.5.1.5. Complications
4.3.5.2. BPD
4.3.5.2.1. R/T acute neonatal RD
4.3.5.2.2. Related to prematurity
4.3.5.2.3. Manifestations
4.3.5.2.4. Reduced prevalence
4.3.5.3. CF
4.3.5.3.1. Exocrine gland dysfunction
4.3.5.3.2. Chromosome 7 ARD
4.3.5.3.3. Median life span of 37 years
4.3.5.3.4. Associated infections
4.3.5.3.5. Nursing care