ATI Nursing Care of Children

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1.

2.5 years
milestones

Jump across floor using both feet and off

a chair
Stand on one foot
Draw circles
Hand-finger coordination

2.

2 years milestones

Walk up and down stairs by placing both

feet on each step
Build a tower of 6-7 blocks

3.

15 months
milestones

Walk without help

Creep up steps
Use a cup well
Build a tower with 2 blocks

4.

18 months
milestones

Assume a standing position

Throw a ball overhead
Jump up and down
Manage a spoon without rotation
Turn pages in a book

5.

ADHD

Symptoms must be present between age

4-18
Manifestations must be present in more
than one setting
Social or academic impairment
6 or more findings from INATTENTIVE or
HYPERACTIVE-IMPULSIVE
Possible familial tendency

6.

ANC

Total WBC x %neutrophils

7.

Anterior fontanel
closes at...
Posterior fontanel
closes at...

...12-18 MONTHS
...6-8 WEEKS

8.

Artial septal
defect

Loud, harsh murmur

Mild heart failure
Possible enlarged RA
Increased oxygen saturations in RA
Possibly asymptomatic

9.

At 1 month...
At 2 months...
At 3 months...
At 4 months...
At 5 months...
At 6 months...
At 7 months...
At 9 months...
At 10 months...
At 11 months...
At 12 months...

1...head lag; grasp reflex

2...lift head off mattress when prone;
hold hands open
3...raise head and shoulder off mattress
when prone; slight head lag; no grasp
reflex; hold hands slightly open
4...roll back to side; place objects in mouth
5...roll front to back; use palmar grasp
6...roll back to front; hold bottle
7...bear full weight on feet; move object
hand to hand
8...sit unsupported; begin using pincer
grasp
9...pull to stand; creep on hands and
needs; crude pincer grasp
10...change from prone to sitting; grasp a
rattle by handle
11...walk while holding something; place
objects in a container; neat pincer grasp
12...sit down from standing without
assistance; build 2 block tower

10.

Autonomy vs.
shame and doubt

Independence
Negativism
Ritualism

11.

Bronchiolitis/RSV

Common 2-12 months

Cough
Wheezing
Nasal congestion
Fever
Difficulty feeding
Increased RR

12.

Candidiasis

Candida albicans
Moist areas on skin surface
Pruritic
White exudate, peeling inflammed areas
that bleed easily
Treatment: Nystatin, Amphotericin B

13.

Carbuncle

Staph
More extensive, swollen, red lesions
involving multiple hair follicles
Multiple boils
Treatment: warm compresses, clean skin,
antibacterial ointments, antibiotics,
incision, draining, irrigation

14.

Cellulitis

Strep/Staph/H. influenzae
Firm, swollen, red area of skin and
subcutaneous tissue
Possible systemic effects
Treatment: antibiotics, warm and moist
compresses, immobilize affected area

15.

Cerebral edema

Develops 24-72 hours post trauma

16.

Cheyne-stokes

Rapid breathing followed by apnea

17.

Clubfoot

May occur with spina bifida or cerebral

palsy
Identified by US
Treatment: casting;
osteotomy/fusion/tendon
lengthening/shortening if
congenital/syndromic

18.

Coarctation of
the aorta

Increased BP and O2 saturation in upper

extremities compared to lower extremities.
Nosebleeds
Headaches
Vertigo
Leg pain
Weak or absent lower extremity pulses
(decreased CO)

25.

Erikson

Trust vs. mistrust

Autonomy vs. shame and doubt
Initiative vs. guilt
Industry vs. inferiority
Identity vs. role confusion
Intimacy vs. isolation
Generativity vs. stagnation
Integrity vs. despair

26.

FLACC scale

2 months - 7 years

27.

Folliculitis

Staph
Infection of hair follicle
Pimple
Treatment: warm compresses, clean skin,
antibacterial ointments, antibiotics,
incision, draining, irrigation

28.

Furuncle

Staph
Larger, swollen red lesion of a single hair
follicle
Boil
Treatment: warm compresses, clean skin,
antibacterial ointments, antibiotics,
incision, draining, irrigation

19.

Cranial
meninges

skull-->dura-->arachnoid-->pia

20.

Decorticate
Decerebrate

Dysfunction of cerebral cortex

Dysfunction of midbrain

21.

Depression

Must be present 1 year in children to

diagnose
Tx: TCAs, SSRIs

22.

Developmental
dysplasia of hip

Acetabular
dysplasia/subluxation/dislocation
Asymmetry of gluteal thigh folds, limited hip
abduction, shortened femur, positive
Ortolani (hip is reduced by abduction),
positive Barlow test (hip is dislocated by
adduction), one leg short, positive
trendelenburg sign (pelvis tilts downward
while bearing weight on affected side),
walking on toes on one foot, walk with a limp
Newborn-6 months: Pavlik harness for 12
weeks, Bryant traction, hip spica cast
6 months-2 years: surgical closed reduction
with spica cast

29.

Haemophilus
influenza type b4
(Hib) vaccine

2 months
4 months
12-15 months

30.

Hepatitis B
vaccine

Birth
1-2 months
6-18 months
*Contraindicated if hypersensitivty to
yeast

31.

Hep A vaccine

12 months-2 years
6-18 months following

32.

HPV vaccine

11-12 years (3 doses)

*Contraindicated if allergy to yeast or
pregnant

23.

Diptheria,
tetanus,
pertussin
(DTap) vaccine

2 months
4 months
6 months
15-18 months
4-6 years
11-12 years
Booster every 10 years
*Contraindicated if h/o
encephalopathy/seizures to vaccines

33.

HSV

Near a mucocutaneous area

Group of vesicles that itch and burn
After drying, form a crusty area followed
by exfoliation
Healing in 8-10 days
Possible lymphadenopathy
Treatment: Burrow's solution if weeping,
peniciclovir (Denavir) to oral lesions,
acyclovir to reduce duration

24.

Epidural
hemorrhage

Between dura and skull

Short period of unconsciousness followed
by a normal period leading to herniation,
coma, death

34.

IM child
injection sites

vastus lateralis
ventrogluteal

35.

Immunizations 12
months - 3 years

12-15 months: inactivated poliovirus

(third dose at 12-18 months), Hib,
PCV, MMR, varicella
12-23 months: Hep A (2 doses 6
months apart)
15-18 months: DTap
12-36 months: inactivated influenza
vaccine (TIV), nasal LAIV (at 2 years)

36.

Immunizations birth,
2 months, 4 months, 6
months, 6-12 months

Birth...Hep B
2...DTap, Hep B, Hib, IPV, RV, PCV
4...DTap, Hib, IPV, RV, PCV
6...DTap, Hep B, Hib, IPV, RV, PCV
6-12...trivalent inactivated influenza

37.

Impetigo contagiosa

Staph
Reddish macule becomes vesicular
Spreads peripherally and by direct
contact
Pruritus
Erupts easily leaving moist erosion
on skin, dries leaving crusty
secretions
Treatment: compresses of
aluminum acetate in water
(Burrow's solution), topical
antibacterials, antibiotics

38.

Inactivated polio (IPV)

vaccine

2 months
4 months
6-18 months
4-6 years
*Contraindicated if allergy to
neomycin and/streptomycin and
polymyxin B, pregnancy

39.

Infant growth

Gain 150-210g (5-7oz) per week in

first 6 months
6 months = birth weight x2
12 months = birth weight x3
Grow 2.5 cm (1 in) per month in first
6 months
Grow 0.5 cm (0.2 in) per month in
month 6-12
6-8 teeth eruptions by age 1

40.

Infant nutrition

Vitamin D within first few days of life

Iron after 4 months if exclusively
breastfeeding
4-6 oz fruit juice only after 6 months
Solids at 4-6 months
Begin with new food every 4-7 days
Veg/fruit at 6-8 months --> meat,
eggs, citrus fruit at 6 months
Weaning at 6 months

41.

Infant sleeping

Nocturnal sleep pattern by 3-4

months
Sleep 14-15 hours/day and 911hours/night by 4 months

42.

Influenza
vaccine

Yearly
*Contraindicated if egg allergy
Must be at least 2 to receive live vaccine

43.

Intussusception

Most common at 5-9 months; up to age 5

Sudden and acute pain
Sausage-shaped mass in URQ
Red currant jelly-like stools

44.

Language as a
toddler

300 words by age 2

1 year - one word sentences (holophrases)
2 year - multiword sentences
3 years - simple sentences with
grammatical skills

45.

Legg-calveperthes disease

Aseptic necrosis of femoral head

(unilateral/bilateral)
Trauma, inflammation, coagulation defects,
intermittent painless limp, hip stiffness,
limited ROM, thigh pain, shortening of
affected leg, muscle wasting
Treatment: NSAIDs, abduction brace, casts,
leather harness sling, traction, total hip
resurfacing
Unknown cause

46.

Leukemia

Immature WBCs -->

Deficient RBCs --> anemia
Neutropena
Thrombocytopenia
Increased ICP
Tissue fibrosis
More boys and caucasians
Peak age 2-5
Family history
Greater risk if Down Syndrome
Low-grade fever, pallor bruising,
petechiae, listlessness, enlarged
liver/lymph nodes/joints,
abdominal/leg/joint pain, constipation, HA,
vomiting, anorexia, unsteady gait,
hematuria, ulcerations in mouth, enlarged
kidney and testicles
Bone biopsy (iliac crest/tibia)
CSF analysis (remain in bed 4-8 hours)
Tx: induction therapy (remisssion OR <5%
leukemic cells), CNS prophylactic therapy,
intensification/consolidation therapy,
maintenance therapy
Hematopoietic stem cell transplant

47.

48.

49.

Lyme disease

Measles,
mumps,
rubella vaccine

Meds for head

injury

Borrelia burgdorferi
Stage 1: 3-31 days following bite (erythema
migrans at site), chills, fever, itching, HA,
fainting, stiff neck, muscle weakness
Stage 2: neurologic, cardiac, muscuoskeletal
involvement (knees and weakness in face)
several weeks following bite
Stage 3: advanced systemic involvement
(arthritis, deafness, encephalopathy)
Observe bite for 30 days
Doxycycline if >8
Amoxicillin if <8
Cefuroxime or erythromycin if allergy to
penicilin
12-15 months
4-6 years
*Contraindicated if pregnant, allergy to
gelatin/neomycin, h/o thrombocytopenia,
immunosuppression, recent tranfusion with
blood/immunoglobulins
Corticosteroids
Mannitol (osmotic diuretic to treat cerebral
edema)
Antiepileptics
Antibiotics
Analgesics (Tylenol)

50.

Meningococcal
vaccine

11-12 years
*Contraindicated if h/o Gullian-Barre

51.

Minor head
injury

Possible LOC
Confusion
Vomiting
Pallor
Irritability
Drowsiness

52.

Molluscum
contagiosum

Pox virus
Asymptomatic flesh-colored papules on
stalks
Treatment: resolves spontaneously in 18
months

53.

Normal ICP

10-15 mmHg

54.

Osteogenesis
imperfecta (OI)

Heterogenous, autosomal dominant

disorder resulting in fractures and
deformity
Multiple bone fractures, blue sclera, early
hearing loss, bowed legs and arms,
kyphosis, scoliosis
Need bone biopsy
Treatment: supportive, Pamidronate
(Aredia) to increase bone density Sc

55.

Patent ductus
arteriosus

Murmur (machine-like)
Wide pulse pressure
Bounding pulses
Possible asymptomatic

56.

Pediculosis
capitus

Head lice
Adult lifespan of 1 month
Live 48 hours without a human host
Nits hatch in 7-10 days
Small, red bumps on scalp and white nits
Treatment: Permethrin shampoo (repeat in
7 days)
Bag items that cannot be washed for 14
days
Boil combs and hair accessories for 1 hour

57.

Pediculosis
corporis

Feeds on human blood

Red bumps on skin
Worse itching around waist and under arms
Treatment: Permethrin

58.

Piaget

Sensorimotor (0-2)
Preoperational (2-7)
Concrete operations (7-11)
Formal operations (12+)

59.

Pneumococcal
vaccine

2 months
4 months
6 months
12-15 months

60.

Preoperational
stage

Begins at 19-24 months

Object permanence
Demonstrate memories of events that relate
to them
Domestic mimicry
Symbolize objects and people

61.

PTSD

Tx: SNRIs

62.

Pulmonary
stenosis

Systolic ejection murmur

Right ventricular enlargement
Exercise intolerance
Cyanosis with severe narrowing

63.

Pyoderma

Staph/Strep
Deeper infections into dermis
Possible systemic effects
Treatment: soap and water, wet
compresses, antibacterial soap, mupirocin
(Bactroban), antibiotics

64.

Rheumatic
fever

Nontender, subcutaneous nodules over

bony prominences
Pink, nonpruritic macupapular rash on
trunk and inner surfaces of extremities
CNS involvement (chorea) including
involuntary, purposeless muscle
movements
Muffled heart sounds, pericardial friction
rub, chest pain

65.

Rotavirus
vaccine

2 months
4 months
*Contraindicated if intussusception or
immunocompromised

66.

67.

Scabies

Scoliosis

Sarcoptes scabiei
Spread by direct contact
Eggs mature in 21 days
Risk factors: nursing homes, nursing
facilities, day care
Rash between fingers
Itchy at night
Widespread, pimples on trunk, blisters on
palms and soles, pencil-like marks
Hands, wrist, genitals, abdomen
Treatment: Permethrin 1x (may repeat in 1
week)
Treat all people in contact and for next 60
days
Must have at least a 10 degree deformity for
diagnosis
25 degree deformity = mild
Cobb technique to determine degree
Risser scle to determine skeletal deformity
Spinal fusion if curves greater than 45
degrees (may need blood transfusion)

68.

Sensorimotor
stage

Birth to 24 months
Progress from reflexive to simple, imitative
activities
Separation, object permanence (object still
exists even if out of view ~9 months), mental
representations (symbols)

69.

Separation
anxiety

At 4-8 months

70.

Staphylococcal
scalded skin
syndrome

Staph
Rough textured with macular erythema
Erythema becomes wrinkled within 2 days
with large bullae
Treatment: antibiotics, saline/Burrow's
solution, 0.25% silver nitrate

71.

Stranger fear

At 6-8 months

72.

Subdural
hemorrhage

Between dura and arachnoid

Due to birth injury, falls, or violent shaking
Irritability, vomiting, seizures

Tetralogy of
Fallot

Murmur
Cyanosis
Severe dyspnea
Clubbing of fingers
Hypercyanotic spells
Acidosis
Polycythemia
Clot formation
Frequently sits in a squatting position
(decreases venous return)
Failure to thrive
Growth retardation

73.

74.

Tinnea capitis

Trichophyton tonsurans
Microsporum audouinii
Microsporum canis
Scaly, circumscribed lesions with alopecia on
scalp
Treatment: selenium sulfide shampoo, topical
antifungals, oral griseofulvin, oral
ketaconazole if severe

75.

Tinnea
corporis

Trichophyton rubrum
Trichophyton mentagrophytes
Microsporum canis
Round erythematous scaling patch
Spreads peripherally and clears centrally
Treatment: oral griseofulvin, topical
antifungals, wet compresses, sitz bath, light
colored socks and well-ventilated shoes

76.

Tinnea cruris

Epidermophyton floccosum
Trichophyton rubrum
Trichophyton mentagrophytes
Medial and proximal areas of thigh and
crural folds
May include scrotum
Pruritic
Round erythematous scaling patch
Spreads peripherally and clears centrally
Treatment: oral griseofulvin, topical
antifungals, wet compresses, sitz bath, light
colored socks and well-ventilated shoes

77.

Tinnea pedis

Trichophyton rubrum
Trichophyton interdigitale
Epidermophyton floccosum
Between toes or on plamar surface of feet
Maceration and fissuring lesions between
toes and patches with tiny vesicles on plantar
surface
Treatment: oral griseofulvin, topical
antifungals, wet compresses, sitz bath, light
colored socks and well-ventilated shoes

78.

Toddler
growth

4x birth weight at 2.5 years old

Grow 3in/year
Head and chest circumference are equal at 12 years old

79.

Toddler milk
and juice
consumption

24-30 oz milk/day --> whole milk to low-fat milk

after age 2
4-6 oz juice/day max.

80.

Toddler sleep
cycle

11-12 hours/night
1 nap/day

81.

Trust vs.
mistrust

Learn delayed gratification

Trust is developed by meeting comfort,
feeding, stimulation, caring needs

82.

Vaccines to protect against bacterial

meningitis

Hib
PCV

83.

Varicella vaccine

12-15 months
4-6 years
*Contraindicated if taking corticosteroids, immunosuppressed, allergy to gelatin neomycin,
cancer, pregnant
Risk for seizures

84.

Varicella zoster

Neurologic pain
Hyperesthesias
Itching
Treatment: analgesics, moist compresses, acyclovir

85.

Varruca

Warts
HPV
Elevated, rough, gray-brown firm papule
Can occur anywhere
Can be single or in groups
Treatment: surgical removal, electrocautery, cyrotherapy, laser

86.

Varruca plantaris

Plantar warts
Flat warts on plantar surface of feet
Possibly surrounded by hyperkeratosis
Treatment: apply caustic solution, soak area 20 min

87.

Ventricular septal defect

Loud, harsh murmur not usually heard until pulmonary pressures drop at 4-8 weeks old
Heart failure
Failure to thrive
Small, possible asymptomatic defects