Chapter 6 Childhood diseases:
Chapter 19 Family-centered care of the child with chronic illness:
Chronic longer than 3 months
Goal for the child?
Obtain the highest level of health and function as possible
Goal for family?
Remain intact, achieve normalization, and maximize function
Stages of grief:
Kubler-Ross
o Denial
o Anger
o Bargaining
o Depression
o Acceptance
Childs concept of death:
0 – 2 years death as loss of the caretaker
2 – 7 years death as a reversible and temporary seperation
7 – 12 years Death as sad and irreversible but not inevitable
12 years death as inevitable and irreversible
Chapter 21 Cognitive, sensory, or communication impairment:
Down Syndrome: #1 chromosomal abnormality (TRISOMY 21)
Risk factor maternal age over 35
Signs/Symptoms:
Degrees of mental retardation and appearance
Transverse palmar crease (simian)
Flat nasal bridge/face
Protruding tongue
Inner eye folds (eyes look upwards often)
Wide space between Big toe and second toe.
Goal: reach optimal level of functioning
Treatment:
Teach parents to detect resp problems
Speech therapy
Eyes:
Diagnosis:
< 3yrs visual acuity assessed indirectly
uncover/cover test (look for movement as eye is uncovered)
, Red reflex test (direct light at child’s eyes individually and together. Check for equal
bright red reflex)
Signs/Symptoms:
Myopia (nearsighted)
o Eyeball long cant see far
Hyperopia (far sighted)
o Eyeball short cant see near
o Accommodates over years
Astigmatism (blurred vision)
o Uneven curvature of corneal/lens prevents focus of light rays
Strabismus cross-eyed
o Can cause double vision as well
o Hirschberg Corneal Light reflex shine light in fron of childs face, light should
reflect off the cornea symmetrically (medial to center of pupil)
o Cover test uncover eye and it shouldn’t move/adjust
o Condition is normal until 4 months
If Surgery is needed happens @ 2 years old
Treatment: eye patch over the good eye to that bad one grows stronger
Amblyopia: lazy eye
CANNOT be corrected past age 7
S/S loss of visioning 1 eye AND over reaching for items
Treatment: eye patch
Blindness: less than 20/200 with correction or peripheral fields narrowed to less than or
equal to 20 degrees
Treatment: Braille, tape recorder, or computer
ocular trauma:
Penetrating don’t remove, let doctor remove
Do NOT bend over
Treatment:
Secure object with tape
Cover uninjured eye to thus decrease movement of both eyes
After item is removed eye patch worn and HOB @30 degrees
Conjuctivitis: pink eye
Usually caused by allergy, infection, trauma
Signs/Symptoms:
Itching, burning, scratchy eyelids
Redness, edema, discharge
Treatment:
Good hand washing
, Antibiotic or antiviral eye drops
Keep child home until antibiotics have been administered for 24hours
Avoid rubbing eyes
Discard and obtain new lenses & eye makeup
Autism:
Signs/Symptoms:
Extreme difficulty communicating
o Self absorbed
o Poor social relations
o Little eye contact
Obsessive behaviors with eating, dressing, moving, & physical environment
Bizarre body movements such as stiff gestures, rocking, awkward gait, waving hands
back and forth
Echolalia repetition of another persons words
Diagnosis:
ALL screened 18-24 months
CARS (childhood autism rating scale) 2+ year olds
Symptoms noticeable by 3 years old but as early as 1
Treatment:
One to one
Highly structured environment
Don’t place demands
Hearing impaired
Chapter 24 Fluid & electrolyte dysfunction:
Vomiting Metabolic alkalosis (losing hydrochloric acid from stomach)
Diarrhea Metabolic Acidosis (losing bicarbonate via stool)
Renal assessment
Bun 8 – 25
Creatinine 0.6 – 1.3
Uric acid 2.5 – 8
Potassium 3.5 - 5
GFR 125/min (>60 is good for kidney pt)
Specific gravity – 1.003 – 1.02
AST: 0 – 35
ALT: 10 – 35
, Albumin: 3.5 – 5.5 (same as potassium)
Bilirubin: 0.1 – 1.2 mg/dl
Chapter 25 Renal Dysfunction:
Kidney filter blood and create urine
Kidneys ureters bladder
Responsibilities:
Filter blood
Remove waste
Control and regulate F&E balance
High specific Gravity dehydration or have extra substances in urine
Low Specific Gravity
Acute glomerulonephritis Acute or sudden inflammation of the glomeruli within the
kidney which can lead to acute renal failure
antibodies lodge in the glomerulus = scarring/decreased filtering occurs
Risk Factors:
Group A Beta-hemolytic streptococcus-Streptococcal of pharynx or skin or history of
pharyngitis/tonsillitis) [2-3 weeks before symptoms]
as a result of impetigo (streptococcal infection)
Signs and Symptoms:
Fever/previous infection
↓ filter = Na+ ↑in serum = edematous tissue from build up of fluid
↓ filter = H2O retained = hypervolemia, HTN, & ↓GFR as passage narrows from
inflammation
Protein/blood urine (RBC/WBC) What will this look like?
o Hematuria Cloudy, smoky and brown in color
o Proteniuria Foam in the urine
Facial/pre-orbital edema in the A.M. How come??
o think they have been sleeping all night so most fluid will go to their head, but
throughout the day as they move the fluid will shift.
↓ UO b/c fluid is staying in and not going out.
Elevated BP kidney function is decreased (sodium retention)
What is the 1st sign of renal failure??? Decreased urinary output!
Labs:
↑ Na, BUN & creatinine
↓ GFR
↑ or ↓K+ (excreting or retaining)
Protein/Bloody urine
Azotemia Retention of nitrogenous waste in blood.
Dx:
Urinalysis & O-titer elevated strep = infection
Chapter 19 Family-centered care of the child with chronic illness:
Chronic longer than 3 months
Goal for the child?
Obtain the highest level of health and function as possible
Goal for family?
Remain intact, achieve normalization, and maximize function
Stages of grief:
Kubler-Ross
o Denial
o Anger
o Bargaining
o Depression
o Acceptance
Childs concept of death:
0 – 2 years death as loss of the caretaker
2 – 7 years death as a reversible and temporary seperation
7 – 12 years Death as sad and irreversible but not inevitable
12 years death as inevitable and irreversible
Chapter 21 Cognitive, sensory, or communication impairment:
Down Syndrome: #1 chromosomal abnormality (TRISOMY 21)
Risk factor maternal age over 35
Signs/Symptoms:
Degrees of mental retardation and appearance
Transverse palmar crease (simian)
Flat nasal bridge/face
Protruding tongue
Inner eye folds (eyes look upwards often)
Wide space between Big toe and second toe.
Goal: reach optimal level of functioning
Treatment:
Teach parents to detect resp problems
Speech therapy
Eyes:
Diagnosis:
< 3yrs visual acuity assessed indirectly
uncover/cover test (look for movement as eye is uncovered)
, Red reflex test (direct light at child’s eyes individually and together. Check for equal
bright red reflex)
Signs/Symptoms:
Myopia (nearsighted)
o Eyeball long cant see far
Hyperopia (far sighted)
o Eyeball short cant see near
o Accommodates over years
Astigmatism (blurred vision)
o Uneven curvature of corneal/lens prevents focus of light rays
Strabismus cross-eyed
o Can cause double vision as well
o Hirschberg Corneal Light reflex shine light in fron of childs face, light should
reflect off the cornea symmetrically (medial to center of pupil)
o Cover test uncover eye and it shouldn’t move/adjust
o Condition is normal until 4 months
If Surgery is needed happens @ 2 years old
Treatment: eye patch over the good eye to that bad one grows stronger
Amblyopia: lazy eye
CANNOT be corrected past age 7
S/S loss of visioning 1 eye AND over reaching for items
Treatment: eye patch
Blindness: less than 20/200 with correction or peripheral fields narrowed to less than or
equal to 20 degrees
Treatment: Braille, tape recorder, or computer
ocular trauma:
Penetrating don’t remove, let doctor remove
Do NOT bend over
Treatment:
Secure object with tape
Cover uninjured eye to thus decrease movement of both eyes
After item is removed eye patch worn and HOB @30 degrees
Conjuctivitis: pink eye
Usually caused by allergy, infection, trauma
Signs/Symptoms:
Itching, burning, scratchy eyelids
Redness, edema, discharge
Treatment:
Good hand washing
, Antibiotic or antiviral eye drops
Keep child home until antibiotics have been administered for 24hours
Avoid rubbing eyes
Discard and obtain new lenses & eye makeup
Autism:
Signs/Symptoms:
Extreme difficulty communicating
o Self absorbed
o Poor social relations
o Little eye contact
Obsessive behaviors with eating, dressing, moving, & physical environment
Bizarre body movements such as stiff gestures, rocking, awkward gait, waving hands
back and forth
Echolalia repetition of another persons words
Diagnosis:
ALL screened 18-24 months
CARS (childhood autism rating scale) 2+ year olds
Symptoms noticeable by 3 years old but as early as 1
Treatment:
One to one
Highly structured environment
Don’t place demands
Hearing impaired
Chapter 24 Fluid & electrolyte dysfunction:
Vomiting Metabolic alkalosis (losing hydrochloric acid from stomach)
Diarrhea Metabolic Acidosis (losing bicarbonate via stool)
Renal assessment
Bun 8 – 25
Creatinine 0.6 – 1.3
Uric acid 2.5 – 8
Potassium 3.5 - 5
GFR 125/min (>60 is good for kidney pt)
Specific gravity – 1.003 – 1.02
AST: 0 – 35
ALT: 10 – 35
, Albumin: 3.5 – 5.5 (same as potassium)
Bilirubin: 0.1 – 1.2 mg/dl
Chapter 25 Renal Dysfunction:
Kidney filter blood and create urine
Kidneys ureters bladder
Responsibilities:
Filter blood
Remove waste
Control and regulate F&E balance
High specific Gravity dehydration or have extra substances in urine
Low Specific Gravity
Acute glomerulonephritis Acute or sudden inflammation of the glomeruli within the
kidney which can lead to acute renal failure
antibodies lodge in the glomerulus = scarring/decreased filtering occurs
Risk Factors:
Group A Beta-hemolytic streptococcus-Streptococcal of pharynx or skin or history of
pharyngitis/tonsillitis) [2-3 weeks before symptoms]
as a result of impetigo (streptococcal infection)
Signs and Symptoms:
Fever/previous infection
↓ filter = Na+ ↑in serum = edematous tissue from build up of fluid
↓ filter = H2O retained = hypervolemia, HTN, & ↓GFR as passage narrows from
inflammation
Protein/blood urine (RBC/WBC) What will this look like?
o Hematuria Cloudy, smoky and brown in color
o Proteniuria Foam in the urine
Facial/pre-orbital edema in the A.M. How come??
o think they have been sleeping all night so most fluid will go to their head, but
throughout the day as they move the fluid will shift.
↓ UO b/c fluid is staying in and not going out.
Elevated BP kidney function is decreased (sodium retention)
What is the 1st sign of renal failure??? Decreased urinary output!
Labs:
↑ Na, BUN & creatinine
↓ GFR
↑ or ↓K+ (excreting or retaining)
Protein/Bloody urine
Azotemia Retention of nitrogenous waste in blood.
Dx:
Urinalysis & O-titer elevated strep = infection
