2022 PEDS FINAL STUDY GUIDE

Immunization schedule: ATI pg.227 Vaccine teaching and nursing interventions: ATI pg.231 Growth and Development for all age groups: ATI pg. 15, 21, 25, 29, 33 • Infants (2 days-1 year) o Head circumference averages from 33-35cm (13-14 in) ▪ Increases 2cm (0.75 in) per month during first 3 months. ▪ 1 cm per month from 4-6 months ▪ 0.5cm per month during the second 6 months o Crown to rump length is 31-35 cm (12.5-14 in), approximately equal to head circumference. o Length: head to heel average 48-53 cm (19-21 in) o Height: infant grows approximately 2.5 cm (1 in) per month for first 6 months. ▪ Growth occurs in spurts after 6 months of age. ▪ Birth length increases by 50% by age of 12 months. o Weight: ▪ Newborn average 2,700-4,000 g (6-9 lb.) ▪ Newborns lose up to 10% of birth weight by 3-4 days of age but regained in 10th-14th day of life. ▪ Infants gain approximately 680g (1.5 lb.) per month during first 5 months of life. ▪ Average weight of a 6-month-old is 7.26 kg (16 lb.) ▪ Birth weight is doubled by age of 5 months and tripled by age of 12 months to average of 9.75 kg (21.5lb.) o Posterior fontanel closes by 2-3 months. o Anterior fontanel closes by 12-18 months. o Dentition: ▪ 6-8 teeth should erupt in infant’s mouth by the end of the first year. ▪ First teeth typically erupt between 6-10 months (average 8 months) ▪ Some have difficulty sleeping, mild fever, rub their eyes, decreased appetite. o o • Toddlers (1-3 years) o Anterior fontanels close by 18 months of age. o At 30 months of age, toddlers should weigh 4 times their birth weights. o Grow approximately 1.8-2.7 kg (4-6 lb.) per year. o Toddlers grow about 7.5 cm (3 in) per year. o Head and chest circumference usually equal by 1-2 years old. o • Preschoolers (3-6 years) o Should gain about 2-3 kg (4.5-6.5 lb.) per year. o Should grow about 6.2-9 cm (2.5-3.5 in) per year. o Evolve from unsteady wide stances and protruding abdomens into more graceful postural erect, and sturdy physically. o o • School-age children (6-12 years) o Will gain about 2-3 kg (4.4-6.6 lb.) per year. o Will grow about 5 cm (2 in.) per year. o Onset of physiologic changes begin around the age of 9 years old, particularly in girls. o Rapid growth in height and weight o Difference in growth and maturation between girls and boys. o Permanent teeth erupt. o Bladder capacities differ, but greater in girls. o Immune system improves. o Bones continue to ossify. o Visible sexual maturation is minimal in boys during preadolescence. • Adolescents (12-20 years) o Final 20-25% of height is achieved during puberty. o Acne can appear. o Girls stop growing about 2-2.5 years after onset of menarche. They grow 5-20 cm (2-8 in) and gain 7-25 kg (15.5-55 lb.). o Boys stop growing at around 18-20 years of age. They grow 10-30 cm (4-12 in) and gain 7-30 kg (15.5-66 lb.) o Females’ sexual maturation occurs in following order: ▪ Breast development ▪ Pubic hair growth (some girls experience hair growth before breast development) ▪ Axillary hair growth ▪ Menstruation o Males’ sexual maturation occurs in following order: ▪ Testicular enlargement ▪ Pubic hair growth ▪ Penile enlargement ▪ Growth of axillary hair ▪ Facial hair growth ▪ Vocal changes Erickson psychosocial theory of development for all age groups: ATI pg.21, 25, 29, 33 • Toddlers (1-3 years) o Autonomy vs. shame and doubt. o Independence o Use negativism as they true to express their independence. o Ritualism/maintaining routines provides comfort. • Preschoolers (3-6 years) o Initiative vs. guilt o Become energetic learners. o Guilt occurs when they believe they misbehaved or unable to accomplish a task. o Guide preschoolers to attempt activities within their capabilities while setting limits is appropriate. • School-age children (6-12 years) o Industry vs. Inferiority o Sense of industry through development of skills and knowledge, allows child to provide meaningful contributions to society. o Sense of accomplishment gained through the ability to cooperate and compete with others. o Should be challenged with tasks that need to be accomplished and be allowed to work through individual differences in order to complete the tasks. o Create system that rewards successful mastery of skills and tasks can create a sense of inferiority in children unable to complete the tasks or acquire the skills. o Should be taught that not everyone will master every skill. • Adolescents (12-20 years) o Identity vs. role confusion o Often try different roles and experience to develop a sense of personal identity and come to view themselves as unique individuals. o Group identity: adolescents become part of a peer group that greatly influences behavior. Eye medication administration: Sheet Dr. Roberts gave in class 4/21/21 & textbook pg.1108. • Administration of eye drops: o 1.Expose lower conjunctival sac. o 2.Hold dropper/while stabilizing hand on patient’s forehead. o 3.Have patient look up while instilling drops. o 4.Have patient close eye and move eye around to circulate fluid. o 5.Hold pressure on the lacrimal duct for 1 minute. Ear irrigation administration: Sheet Dr. Roberts gave in class 4/21/21. • Irrigation to ear for wax removal: o s ear with otoscope o 2. Fill syringe with H2O o 3.Place tip in ear o ze fluid into ear to irrigate o 5. Allow fluid into ear to irrigate o 6. Repeat in 10 minutes if no cerumen removed o 7. After procedure turn head to side to drain. Cardiac defects: Week 3 PPT (3/25/21 & 2/1/21 lecture) & ATI pg.111-123 Defects that increase Pulmonary Blood Flow Atrial septal defect (ASD) • Opening in the septum between the left and the right atrium. • Left to right shunting of blood in the opening. • Size can vary. Septum could be completely absent. • Oxygenated blood from the left atrium flow through the hole into the septum, into the right atrium. mixture of oxygen, poor blood. • Increases total amount of blood towards the lungs. • Larger volume handled by the right side of the heart, causing right ventricular hypotrophy. • Can develop heart failure Assessment: • Asymptomatic • Depending on the size, will depend on the symptoms. • Systolic Murmur • Systolic Murmur: between S1 and S2 • Diastolic murmur: betweenS2 and S1 S & S: • Increased fatigue • Less physical activity • Slow growth • Risk of congestive Heart Failure Dx Test: • Echocardiogram • chest x-ray • MRI 3D images • CT scan Therapeutic Management: • Spontaneous Closure • May just close on its own, if its small enough • Diuretics • Decrease fluid and circulation in the lungs. • to reduce blood flow • Closure during cardiac catherization or surgical closure • Sent to cath lab: o in addition to be diagnosed, they can put a "septal occluder known as a patch". o They must be on aspirin 81mg for 6 months after to prevent blood clots and to help the lining of the heart grow over the heart. If septum is too large, then open heart surgery may be necessary, in the meantime they may need Cardiopulmonary Bypass to be done. Ventricular Septal Defect (VSD) • Opening between left and right ventricles • Left to right shunting. • Same as previous one. Nursing diagnosis: impaired gas exchange (b/c of the increased pulmonary congestion) Assessment: • Asymptomatic • Systolic Murmur • Heart Failure Therapeutic Management • Spontaneous closure • May close on its own, depending on the size. • Closure during cardiac catherization or surgical closure • Diuretics Atrioventricular canal defect (AVCD) • Septum between both the L & R atrium and L & R ventricles are missing, 1 valve in stent of heart instead of 2 separate valves. • This valve may not close correctly/completely • Left to right shunting. • One big opening between atriums and ventricles Assessment • Loud systolic murmur • Mild cyanosis with crying or activity • Bluish discoloration around mouth, skin, fingernails • CHF must be treated before any surgical repair. • Dx test: chest Xray (will show enlarged heart & pulmonary resistant marking), ECG Therapeutic Management • Complete surgical repair: patch closure of septal defect and reconstruction or replacement of mitral valve • Surgical repair includes a complete repair of the different septum's as well as AV valve as well. • Surgical repair must be done before the first year, can be first few months of life. • To prevent any irreversible pulmonary vascular disease • Depending on the infant: May have to perform a pulmonary banding before surgical repair, to help decrease blood flow. Patent ductus arteriosus (PDA) • Should close after birth but didn't. • Hole between the aorta and the pulmonary artery. • Left to right shunting. Shunt from aorta to pulmonary artery. • Additional fluid returning to the lungs, may inflate the lungs, causes use of more calories than normal. Assessment • Wide pulse pressure: subtract diastolic from systolic: anything greater than 40 in PEDS is considered a wide pulse pressure. • Continuous systolic murmur • Small PDA- Asymptomatic • depend on the size of the hole. • Large PDA- CHF • Failure to thrive, small for their age. • Need more calories, problem feeding. Therapeutic Management • Oral or IV indomethacin (prostaglandin inhibitor) • Can give ibuprofen or indomethacin (NSAID which is prostaglandin inhibitor), given first to see if it closes by itself. • Must be given between the first 10-14 days of life for it to be successful. • Interventional cardiac cath • they will place "coils" to close the hole, if meds were not given within the first 14 days • Diuretic • To get rid of excess fluids from the lungs • Ductal ligation for large defects Truncus Arteriosus • All of these have a left to right shunting, increase amount of blood to the lungs Obstruction to blood flow Coarctation of the aorta ? • Narrowing in descending aorta, b/c of narrowing it is an obstructive defect. • Blocks blood flow to the body, causing backflow of blood into the left ventricle • Muscles in the left ventricle work harder Dx: shortly after birth S/S: • Elevated BP in the arms • Decreased BP in lower extremities • Bounding pulses in upper extremities • Weak/ absent femoral pulses • Heart failure in infants • b/c of artery branches that supply blood to upper part of the body and descending to aorta. • Everything above is increased and not going down.