Chp.

50 A childs musculoskeletal system is different than adults because soft tissues are resilient in children, dislocations and sprains are less common than in adults. Fractures in infants warrant further investigation to rule out child abuse. Fractures in children younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large amount of force is necessary to fracture their bones. An inability to bear weight on the affected extremity is indicative of a more serious injury. With a fracture, general manifestations include pain or tenderness at the site, immobility or decreased range of motion, deformity of the extremity, edema, and inability to bear weight. The major cause of childrens fractures is falls. Because of the protection reflexes, the outstretched arm often receives the full force of the fall. Pediatric fractures seldom are complete breaks. Rather, children's bones tend to bend or buckle The child with mild scoliosis requires long-term follow-up to determine whether the curve will progress or remain stable. The Pavlik harness is used to maintain the infants hips in flexion and external rotation to allow the hips (femoral head and acetabulum) to mold and grow normally. The child in a Pavlik harness needs special attention to skin care because the infants skin is sensitive and the harness may cause irritation. Chp. 53 Poor self-concept and depression contribute significantly to suicidal behaviors. You need to acknowledge the adolescents suicide gesture and further assesses the adolescents condition. The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors. Chp. 41 When taking prednisone the dosage must be tapered before the drug is discontinued to allow the gradual return of function in the pituitary-adrenal axis. Children receiving long-term systemic corticosteroid therapy are most at risk for growth delays. The child on high doses of steroids should not receive live virus vaccines because of immunosuppression.

Laryngospasms resulting in ineffective breathing patterns is a life-threatening manifestation of anaphylaxis. The primary action is to assess airway patency, respiratory rate and effort, level of consciousness, oxygen saturation, and urine output. Epinephrine is the first drug of choice in immediate treatment of anaphylaxis. Treatment must be initiated immediately because it may only be a matter of minutes before shock occurs. Chp.54 The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup. Intense stress and isolation as a result of caring for a child with developmental disabilities often lead parents to grieving. Chp. 6 Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior. Chp. 7 Use a consequence that is consistent with the inappropriate behavior Chp. 8 Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Chp. 40 A child taking oral corticosteroids for asthma is exposed to varicella. The child has not had the varicella vaccine and has never had the disease; acyclovir is often utilized in the treatment plan. The first lines of defense in the innate immune system are the skin and intact mucous membranes. Rubella is associated with fetus anomalies, rubella virus can cross the placenta and infect the fetus, causing fetal anomalies. Erthema infectiosum is fifth disease. Fifth disease manifests with an intense, fiery red, edematous rash on the cheeks, which gives a slapped cheek appearance. It causes fetal death in first half of pregnancy, so children with this disease should not be around pregnant women.

The childs skin lesions are characteristic of varicella. Varicella is transmitted through direct contact, droplets, and airborne particles. In the hospital setting, children with varicella should be placed in strict isolation, and on contact and airborne precautions. The purpose is to prevent transmission of microorganisms by inhalation of small-particle droplet nuclei and to protect other patients and health care providers from acquiring this disease. Primary prevention of pertussis can be accomplished through administration of the pertussis vaccine. Erythromycin, azithromycin, or clarithromycin is given to all close contacts for the child diagnosed with pertussis It is necessary to give the entire course of antibiotic for 10 to 14 days. Penicillin is the preferred treatment for any streptococcal infection. Chp.43 Cleft lip and palate result from embryonic failure resulting from multiple genetic and environmental factors. A genetic pattern or familial risk seems to exist. Showing the parents pictures of successful lip repair promotes bonding and enhances coping ability An infant with hypertropic pyloric stenosis is most at risk for metabolic alkalosis .Frequent projectile vomiting, characteristic of pyloric stenosis, results in a loss of nonvolatile acids that decreases hydrogen ion concentration. This results in an excess of bicarbonate that increases arterial pH above 7.45 (metabolic alkalosis). Simple dietary modifications are effective in management of lactose intolerance. Symptoms of lactose intolerance are usually relieved after a lactose-free diet is instituted. The child between 1 and 10 years requires a minimum of 800 mg of calcium daily. Because high-calcium dairy products containing lactose are restricted from the child's diet, alternative sources such as egg yolk, green leafy vegetables, dried beans, and cauliflower must be provided to prevent hypocalcemia. The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Oatmeal contains gluten and is not an appropriate food selection. In intussusception pressure on the bowel from obstruction leads to passage of currant jelly stools. Abdominal pain is relieved when appendix rupture occurs. Classic signs of celiac disease are underweight, with abdominal distention, thin legs and arms, and foulsmelling stools. A K-pad (moist heat device) is contraindicated for suspected appendicitis because it may contribute to the rupture of the appendix. Diarrhea associated with malabsorption syndrome often associated with lactose intolerance.

Chp. 42 Infants have an increased extracellular fluid volume. The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration. Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement. The primary focus of managing vomiting is detection of the cause and then treatment of the cause. Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery. CRAM= complex carbohydrates, rice, and milk BRAT = Bananas, rice, applesauce, and toast Chp. 44 Acute poststreptococcal glomerulonephritis is characterized by hematuria, proteinuria, edema, and renal insufficiency. Tea-colored urine is an indication of hematuria. The presence of red blood cell casts in the urine indicates glomerular injury. Clinical findings of poststreptococcal glomerulonephritis are excess fluid volume may have pulmonary edema. Inspiratory crackles indicate fluid in the lungs. Pulmonary edema can be a life-threatening complication. In nephrotic syndrome large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Protein intake is restricted for kidney disorders because of the kidney's inability to remove waste products. Hypospadias is a congenital anomaly in which the actual opening of the urethral meatus is below normal placement of the glans of the penis, ventral placement of urethral opening. Epispadias is dorsal placement of urethral opening. The correction of hypospadias should ideally be accomplished by the time the child is 6 to 12 months of age and before toilet training. The child is not circumcised because the foreskin may be used for reconstruction. Chp. 45 Chronic otitis media with effusion is the most common cause of hearing loss in children

For select children 6 months of age or older with acute otitis media, as an alternative to initiating antibiotic therapy, once diagnosed, acute otitis media is treated by initiating symptomatic treatment and observation for 48 to 72 hours. Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. Spasmodic croup is viral in origin, is usually preceded by several days of symptoms of upper respiratory tract infection, often begins at night, and has a harsh, metallic, barky cough, sore throat, inspiratory stridor, and hoarseness. Sitting in the bathroom with the shower on provides humidity for the child, which usually improves symptoms in croup. Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. Epiglottitis can rapidly progress to complete airway obstruction and death. The goal of treatment is to maintain a patent airway. Meticulous handwashing can decrease the spread of organisms of RSV. Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea with bronchiolitis Wheezing is a classic manifestation of asthma Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. The peak flowmeter is a device used to monitor breathing capacity in the child with asthma. - The green zone indicates all clear. There are no asthma symptoms present. The childs exhalation is 80% to 100% of his personal best - The yellow zone indicates caution. The childs peak flow is 50% to 80% of his personal best. A temporary increase in medication may be indicated - The red zone is interpreted as a medical alert. The childs exhalation is below 50% of his personal best. The child should use a bronchodilator immediately Short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short burst courses of 5 to 7 days Inhaled corticosteroids are used for long-term, routine control of asthma The appropriate time to use an inhaled beta2-agonist is before an event that could trigger an attack, usually 30 min beforehand.

The airway in infants and young children is narrower; respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child The diagnosis of cystic fibrosis requires a positive sweat test Chp. 48 Wilms tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms, such as hematuria, hypertension, and anemia. A whitish reflex in the eye, leukocoria, is a common finding of retinoblastoma. It is an overt sign of cancer in children. With Wilms tumor Do not palpate the abdomen. Chp. 49 To prevent the spread of impetigo to others, the child should be kept home from school for 24 hours after treatment is initiated. Good handwashing is imperative in preventing the spread of impetigo. Ringworm is a fungal infection. It is transmitted by humans, cats, and dogs. Treatment is with topical clotrimazole. Chp. 46 Desquamation of the fingers and toes is a manifestation of Kawasaki syndrome Kawasaki disease causes inflammation in the walls of arteries. Heart complications include: Vasculitis, myocarditis, arrhythmia, and pericarditis. This disease occurs in children under 5 who show signs of beet red lips and tongue. It is not preventable.