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Week 1 Notes

by: Nicole Notetaker
Nicole Notetaker
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Exam 1 Material
Diane Griever
Class Notes
development, Respiratory




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Popular in Nursing (bachelor's

This 13 page Class Notes was uploaded by Nicole Notetaker on Monday August 29, 2016. The Class Notes belongs to at The University of Cincinnati taught by Diane Griever in Fall 2016. Since its upload, it has received 5 views. For similar materials see Pediatrics in Nursing (bachelor's at The University of Cincinnati.

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Date Created: 08/29/16
Peds 8/22 Growth and Development  2.2 kilos in a pound  The first year o Head most important (measurement- will they grow normally?) o Always going to be larger than chest circumference in the first year of life.  Chest nipple region vs. head circumference will be equal by 1 year of age. o Average head circumference is 33-36cm (normal)  Larger (macrocephaly)  Smaller (microcephaly) o Why do we worry about head growth?  Controls everything baby needs good head control (grab baby by arms and head flips back- this is normal until 2 months, no head control no neck muscle-lagging behind plane of shoulders.  By 4 months/16 weeks, their head circumference should be in the plane of the shoulders (be able to control head when picked up by arms)  If you still see head lag by 16 weeksred flag o Red flag for:  They will never roll over  They will not sit up  They will not walk. o Cerebral pulsy with mental retardation:  About 3 month age group as far as development.  Anterior fontanel  Opened until 9 months (earlier), can stay open until 18 months.  Allows brain to grow  Cephaloncomes from the word head and coddle stands for tail (feet)  Spinal cord- begins to develop from top to bottom. o reflexes: higher up on the vertebrae, higher up on the body you’re checking the reflex. o Tummy time- grow neck and head muscles  Belly to backeasier/first. 4-5 months.  Back to belly 5-6 months. o Sitting up  6-7 months to be sitting up curled over  9 months sitting up straight o rolling over/stances  outstretched arms when on belly = can roll over  abdominal muscles used o Walking  Cruising: holding onto someone’s hands while leaning forward walking9/10 months.  Standing up straighter/wobbly 11/12 months  Nutrition expect to be tested on maintence fluids and caloric intake o Newborn in the first 6 months of life child needs 108cal/kilo/day (roughly 100)  Gaining weight at a rapid pace  First year of life- triple weight o Next 6 months of life 90 calories/kilo/day o Adult Maintain weight: moderate exercise 25 cal/kilo/day o Biggest reason why babies need more: oxygen requirement and demand is huge. Metabolic rate is much higher. o Absolutely never prop bottle on a baby. 2 o Hotdog is #1 choking hazard in US (cut it up super tiny)  Palmar grasp6-8 months  Pincher grasp9-10 months  Most amount of milk/formula baby needs in 1 day32 ounces.  If theyre taking more: they can drink water/supplements/etc.  4 oz of juice  32 oz of formula  How many calories are in an oz of formula  20 calories in regular formula.  Never introduce baby foods until they can handle it- have to be able to be sitting up- 4-6 months.  Safety o Water temperature safety:  Highest degree temperature to use with a baby: 120  Toes at 140- not burn. But babies with thin skin will burn.  150 degrees babies can get 3 degree burns o Car Seat  Middle of the back seat facing backwards  Not removed until 1 year and greater than 20lbs  Eriksonst o 1 year trust versus mistrust.  Identify age with situation  Doesn’t matter caretaker, as long as needs are met it doesn’t matter.  Infancy growing: o 1 year of life 3  1 6 months of life = gain 5-7 oz a week. (about half a pound) in one months time = 1.5- 2 lbs gained.  Quarter of an inch a week in length growth.  Head circumference: 1/16-1/8 of an inch (1/4- 1/2 inch in a month)  WHY DO WE CARE: growth charts. One time plot tells us nothing. Does the pattern condinue?  2 6 months (6-12)  take all of the numbers and divide in half  ¾-1 lbs a month, etc.  Teeth: o First two on the bottom, then laterals next. o Teeth fall out in a very methodical way as well. Come out at the same time they came in. o 32 teeth + wisdom teeth out= 28 teeth. o 18 year molars = wisdom teeth  Toddlers (1-3 years) o Waddling gate—lordosis.  Stance of pregnancy. Belly heavy and bow legged. o 1 year- pigeon toed, bow legged, belly is center of gravity o 2 years of age- 90% is of adult size- not 90% of knowledge.  Psychosocial  Parallel play- 2 kids playing next to each other but not interacting.  Communication lacking.  temper tantrums come from this  Erikson: autonomy independence toddlers 1-3  Give them choices.  Pool Safety o Never let them swim alone 4  Toys o Cause and effect toys o Music and noises o Indestructible type toys  Nutrition for Toddlers o 100cal/kilo/day o asking too much to sit down to eat meals too antsy. Won’t sit still. o When do they come off formula?- 1 year of age.- stay on it until then. Helps brain development. o When should they have sippy cups?- whole milk in a cup at 1 year of age.  No more than 4-8oz cups of milk.  Finger foods  PRESCHOOL 3-6 years o People pleasers o Grow roughly 2 inches a year o Gain 5lbs a year o Safety  Fire safety  Electric safety o Nutrition  90cal/kilo/day  able to sit down for meals  variety of foods  vocabulary continues to grow. o Social development  More engaged with friends  Converse appropriately  Organized sports o Piaget/Erikson  Initiative versus guilt  School Aged (6-12) o Promoting growth and development o 70cal/kilo/day  major structural shift of jaw line 5  ear infections most common infection to come in with primary care.-->drastically decline because Eustachian tube line up to drain efficiently. o Adolescent (11-14) caloric intake: girls 47cal/kilo/day..boys 56cal/kilo/day. o Maturation of systems  GI: feed a baby?- moves through immediately. Instant change diaper.  School Aged: much more mature able to digest food, absorb food, absorb more nutrients, able to tolerate a variety of foods. o Newborn: truly hungry every 1-2 hours. Goes right through them.  Bladder Capacity  Much better in school aged  Heart  Newborn 140-160 heart rate / respiratory 40-60  School aged 6-20 respirations  Blood pressure is low in newborns (70/50)  School aged BP 110/70  Temperature: hypothalamus is immature in newborns so temperature is variable. As you grow it matures and temperature is more stable. o School aged  Erikson: industry versus inferiority  Industry: productive/successful key  School aged years--? Kids need to know they’ve done a really good job they need positive reinforcement.  Team sports/part of a team/accepted by peers- most important o Cognition- Piaget- school aged—read in book 6  Conservation—tervis versus red bull can.  Mass vs. volume concept (10-11)  Reversibility  7x5 is the same as 5x7  Classification 10-11 you get these concepts (prior to that you don’t have the mental capacity to get it.  You can put fruit in a category  Analogies  Language Development o 8,000-14,000 words in school aged kids (6-12) o depends on what we’ve been exposed to  how to increase: crosswords, read to them, reading outloud and building on each other, cooking (measuring), gardening, playing musical instrument  Social development for school aged kids o Organized sports o Rules/regulations/practice/teamwork o Bullying  Look at the dental chart o When would you expect your secondary set of teeth to be in o When would you expect all primary set of teeth to fall out o All in Review Sheet  Immunizations o Read Respiratory Issues  Airway starts in nares/mouthpharynxvoicebox (larynx)trachea o When people get aspiration pneumonia (usually right sided)  In lungs main bronchus o Kids usually get bronchiolitis..not bronchitis? 7 o Inflammation of the bronchials o Kids die of respiratory arrest  Metabolically 4x higher than adults oxygen demands are much greater  Babies are abdominal breathersbabies have very large tongues through their mouthsobligate nose breathers. Only nose.  Get dehydrated very rapidly  Diane: if you get a good history, you can decide what is wrong  Auscultation is the last thing we should do. – be methodical about pattern. o Inspect first  History: o ask about premature birth? Ask about gestational age? History of family of CF/asthma. Heat/AC? Smokers? Animals? o When did it begin, where were they, anything make sit worse/better, meds given for it? How high is the fever, etc.  Inspection o Cough, stridor, nasal flaring, grunting, head bobbing, snoring (adenoids), wheezing, sputum, retractions  Croup (LTP) o Viral- comes on slow. o Common in kids 6-12 months of age o Laryngeal narrowing—the lungs are clear. Nothing to do with lower respiratory system. o Low grade fever, inspiratory stridor o Steroids IMrecemic epinephrine breathing treatment, helps open up the airways. Decadron or Cortef- IV o Self limited. Treating signs and symptoms since its viral. 8 o Low sats should not happen on a crouper- does not change oxygenation. Theyre just causing severe distress in getting the air in.  Epiglottitis o Bacterial o H. Flu Type B o Comes on out of nowhere o Epiglottis gets inflammation/swelling- obstructs entire airway o Medical Emergency – admitted to ICU o Number 1 Intervention: intubation equipment ready. For up to a week. IV antibiotics,  Bronchiolitis o Very common in kids less than 6 months o Viral o Common in Cincinnati o RSV- other name- respiratory syncytial virus o Lives on contaminated surfaces (skin up to an hour after contact, nonporous (babies cribs) up to 60 hours) o 18 hours since the last wet diaper extremely dehydrated because decreased PO intake because congestion.  AMOUNT OF WET DIAPERS A DAY: 5-7 a day. o Starts with upper respiratory, sneezing, fever, can lead into respiratory distress type of problem. o Treat: symptomatically. Fever-tylenol always dosed 10-15mg/kilo/dose Q4 5 doses in 24 hours. Maintnence fluids. Rest. May need oxygen supplement- O2 sat monitoring.  Pnemonia o Read. o Pleural effusion- fluid  Why do we care if there is a pleural effusion/hematoma/etc: shifts structures. 9  If you have hematoma/fluid in neck area, putting pressure on your trachea  Apnea o Stop breathing for more than 20 seconds or longer o Usually cardiac and neuro issues (rule out) o Order ECG and an EEG o Labs, electrolytes, chest xray o Patient education/parent comfort o Go home on heart and respiratory monitor 24 hours a day. o Recessitative equipment at home, bag, oxygen, suction o Always make a plan- initiative plan if the episode occurs again. o Post that in the most common rooms that the baby is going to be.  SIDS o Sudden infant death syndrome o “sudden or unexplained death of an infant less than 1 year of age” – when they’re sleeping usually. o Any premature infant is at risk- respiratory system is compromised o Chidren with brain stem defects are at risk- alters respiratory status o If you’ve had another child with SIDS you have an increased chance o Any lack of prenatal care are at risk. Especially the first three months of pregnancy. o 1-3 months/2-4 months- BIGGEST RISK age group. Can’t control head, can’t roll over. o 95% of all SIDS cases happen before 6 months of age o more common in boys o more common in low birth wait o mor eocmmon in native American Indians and African americans 10 o diagnosis made upon autopsy o Parents need grief counseling o Rough parents- find a strength (spirituality, counseling, etc ) o Treatment: supine position, smoke free environment, no covers/blankets in the bed  Cystic Fibrosis- study hard. Do the case study. o Autosomal recessive disease o Exocrine gland disease (endocrine: a vascular issue, within the vessels. Exocrine: through a duct or a tube/glandular) o Digestive system- get backed up/cleaned up with golytely- does not secrete juices amylase/tripsin/lipase that help with the break down of food (the ductal system gets backed up) o Skin- smell salty. 2-5x of sodium chloride that normal people do. Blood level of sodium chloride is low. Don’t have a lot in the vessels. They secrete it and it comes off of them. o Reproductive system- very heavy cervical secretions. Have a hard time with fertility because of secretions. 98% of all males are sterile. o Respiratory system- gummy looking sputum.yellow/green foul smelling. Sticky secretitions block the airways and over time it scars at the airway. o Digestive issues: 85% have pancreatic problems (do not secrete amylase, trypsin and lipase into the small intenstine like normal people). Proper absorption of proteins carbohydrates and fats do not get absorbed- very emaciated wasting away appearance. Wasting away of buttocks, thin extremities, protruding abdomen. o Usually die of respiratory distress o Expected ilfe span: 31 years 8 months.  Assessment: 11  Respiratory: chronic infections, using accessory muscles, hypoxic, baselines be down in the 80s, consistent coughing spells, dyspneic (difficulty breathing), rapid respirations or tachypnea, chronic lung disease, clubbing. (normal is 160 degrees, their fingers will be greater than 180), very sluggish cap refill  Digestive: protruberant abdomen, wasted buttocks, don’t have trouble eating, they lack the absorption capacity for nutrients  Reproductively: secondary sex characteristics (anything you don’t need for procreation) axillary hair, breasts, etc. delayed by 2 years.  Diagnosis: Sweat Test- take a measurement over 60? Or something like that. Anything greater than 40 they’ll redo the test.  Nursing Treatment: GI obstruction- cleaned out with Golytely by NG. Respiratory infections- repeated high dose antibiotics. These kids usually have a Mediport. Be on oxygen. o Not just in the hospital: these kids will be getting breathing treatments and chest physiotherapy. All three sides of their lungs CPT. CPT with every breathing treatment to help loose secretions- ALWAYS have feet above their head. o Bronchodilators: side effect- increase heart rate. o Mucous lysing agents: trying to thin secretions 12  Drinking lots of water helps too o Any exercise they can-airate the lungs  Acute: IV steroids (decardron, solu-cortef), then taper down on a med draw. 6 the first day, 5 the next, etc. o Side effects of steroids: mood swings, increased appetite, GI symptoms, hyperglycemia o Vitamin ADEK- fat soluble vitamins  Diet: very high calorie- eat eat eat. o Need to gain weight- let them eat at all times  Pancreatic Enzymes o They get them any time they eat. 2-3 with snacks, 5-6 with meals etc. always take them before they eat to help with absorption.  Spend a long time away from school, hot weather is bad for them, cannot participate in sports. o 13


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