HESI Flash Cards Peds and OB (FAU) Flashcards

Sickle-cell disease
Terms Definitions
When does birth weight double?
6 months
When does birth weight triple?
12 months
When does the posterior fontanel close?
By 8 weeks
When does a baby give its 1st social smile?
2 months
When does a baby turn its head toward sounds?
3 months
When does the Moro reflex disappear?
4 months
When does a child achieve steady head control?
4 months
When does a baby turn completely over?
5-6 months
When does a baby transfer objects hand to hand?
7 months
When does a baby play peek a boo for 1st time?
After 6 months
When does stranger anxiety develop?
7-9 months
When does a child sit unsupported?
8 months
When does a child crawl?
10 months
When does a child’s fine pincer grasp appear?
10-12 months
When does a child wave bye bye?
10 months
When does a child walk with assistance?
10-12 months
When does a child say a few words in addition to mama or dada?
12 months
When does birth weight quadruple?
30 months
When do you achieve 50% of adult height?
2 years
What is the appearance of a toddler?
Bowlegged and potbellied
What are the teeth of a toddler (1-3 year old) like?
All 20 primary teeth are present
When does the anterior fontanel close?
12-18 months
When does a child throw a ball overhand for 1st time?
18 months
When can a child kick a ball?
2 yrs
When does a child feed self with cup and spoon?
2 yrs
When can daytime toilet training begin?
2 yrs
When can kids form 2-3 word sentences?
2 yrs
When can kids form 3-4 word sentences?
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3 yrs
When can child state full name?
2.5-3 years
When are temper tantrums common?
Toddler (1-3)
What is Erickson’s Theory of the toddler (1-3)?
Developing a sense of autonomy
What type of toys should you give to babies under 1 year old?
Mobiles, rattles, squeaking toys, picture books, balls, colored blocks, activity boxes
What happens to a baby under 1 whose parents are not able to stay with him?
May be inconsolable due to separation anxiety
What is Erickson’s Theory of infants under 1?
Developing a sense of trust
What are the toys appropriate for the toddler (1-3)?
Board and mallet, push/pull toys, toy phone, stuffed animals, storybooks with pictures, use of the hospital playroom bc of mobility (which is important to their development).
How much weight does a preschool child (3-5) gain each year/ inches grown each year?
5 lbs and 2-3 inches/year
When do kids learn to run, skip, jump?
Preschool
How old are you when you start riding tricycle?
3 years old
At what age is standing erect began?
Preschool
When do you establish handedness?
Preschool
At what age do you use scissors?
4 years old
What age ties shoelaces?
5 years old
At what stage do you learn colors and shapes?
Preschool
What is the visual acuity of a preschooler?
20/20
What is the thinking of a preschooler like?
Egocentric and concrete
When does a child learn sexual identity/curiosity/masturbation?
Preschool
When are imaginary friends and fears common?
Preschool
Aggressiveness at ___years old is replaced by independence at ___years old.
4, 5
What should you make sure a preschooler knows about their illness?
They did not cause it, painful procedures are not punishment
When is fear of mutilation from procedures common? How can you help restore body integrity?
Preschool, put on a Bandaid
What are appropriate toys for a preschooler?
Coloring books, puzzles, cutting/pasting, dolls, clay, toys that let you work out hospital experiences
What is Erickson’s Theory of Preschoolers?
Developing a sense of initiative
School age (6-12 year olds) have what weight/height gain per year?
4-6 lbs and 2 inches per year
What is Erickson’s Theory of school-agers?
Developing a sense of industry
When are primary teeth lost and permanent teeth established?
school age
At what age are you able to write script?
8 years
Egocentric thinking in the school age child is replaced by _________.
Social awareness of others
When are cause and effect relationships learned?
School age
When does socialization with peers become important?
School age
When do molars erupt?
School age (6 year molars)
Whose growth spurt develops 1st? As early as what age?
Girls-10 years old. Boys at 14.
Adult-like thinking begins at what age?
15
When does growth end?
Girl-15, boys-17
What is Erickson’s theory for adolescents (12 to 19)?
Developing sense of identity
After 6 months what is the baby’s concept of bodily injury?
They can remember the pain
What is the toddler’s concept of bodily injury?
Fear of intrusive procedures
What is the preschooler’s concept of bodily injury?
Fear of body mutilation
What is the school age childs concept of bodily injury?
Fear of loss of control over their body
What is the adolescent’s concept of bodily injury?
Change in body image
When can you start using the numeric pain scale?
9 and up
How can a non verbal child be assessed for pain?
Using the FLACC pain assessment tool, that looks at the face, leg movement, activity, cry, and consolability
What are the best nondrug measures to reduce pain in infants?
Pacifiers, holding, rocking
What are the best nondrug measures to reduce pain in toddlers and preschoolers?
Distraction
What are the best nondrug measures to reduce pain in school age and adolescents?
Guided imagery
At what age can you teach a child how to use PCA?
5 years old
When is MMR vaccine given?
12-15 months and then 1 other time between 4 and 12 years old
During a measles epidemic when can you give the MMR?
6 months and then again at 15 months
What are contraindications for MMR?
Allergy to neomycin or eggs
How do you administer the MMR vaccine?
SQ at 2 difft sites
After the MMR vaccine what is a normal finding?
Light rash 2 weeks later
When do you give the DTaP vaccine?
At 2 months, 4 months, and 6 months. THEN get boosters at 15-18 months and again at 4-6 years.
How do you give DTaP vaccine?
IM apart from other vaccines
When do you have to stop giving DTaP vaccine?
At age 7, bc then you switch to Td vaccine
After the injection of DTaP what should the nurse tell the parents to do?
Give acetaminophen (Tylenol)
When do you give the IPV vaccine?
At 2 months and 4 months, THEN boosters at 6-18months and again at 4-6 years old
How do you administer IPV?
SQ or IM at separate site from other vaccines
What is the contraindication for IPV vaccine?
Allergy to neomycin or streptomycin
How and when do you administer Hib vaccine?
IM at 2, 4, and 6 months
When and how do you administer the HepB vaccine?
IM at 0-2 months, 1-4 months, 6-18 months
When and how do you give the varicella vaccine?
12-18 months –should be given with the MMR vaccine OR over 30 days apart
What are normal side effects from DPT and IPV vaccinations?
Irritability, fever under 102, redness and soreness at injection site for 2-3 days
What can decrease soreness after thigh injections?
Warm washcloth on injection sites, bicycling the legs with each diaper change
How do you treat fever in a child with a communicable disease?
NON-ASPIRIN PRODUCT
What can you use for itching in communicable diseases?
Diphenhydramine (benadryl)
What is Rubeola (Measles)? How is it transmitted? When is it contagious? What are classic symptoms?
Highly contagious, viral disease that can cause neurologic problems or death, transmitted by droplets; contagious mainly during prodromal period when they have fever and upper respiratory symptoms; symptoms include photophobia, Koplik’s spots in the mouth, rash starting on face and spreading downward.
When is chicken pox no longer contagious?
Once scabs have formed on all lesions
What is German Measles?
A viral disease that can kill babies in 1st trimester; spread by droplets and contact, a red maculopapular rash spreads from face to rest of body and fades in 3 days
What is pertussis?
Whooping cough; caused by bacteria prolonged coughing for 4-6 weeks; treated with erythromycin; complications are pneumonia, hemorrhage, and seizures
How do you measure past nutrition in a child?
Height and head circumference
How do you measure current nutrition in a child?
Weight, skinfold thickness, arm circumference
How do you measure the body fat content of a child?
Skinfold thickness
What does vitamin B2 (riboflavin) deficiency look like?

How do you treat it?
Redness and itchiness of eyes, magenta tongue, delayed wound healing

Give these kids green leafy veggies, liver, cow milk, cheddar cheese
What does vitamin A deficiency (retinol) look like?

How do you treat these kids?
Rough dry skin, cornea problems, retarded growth

Give them orange foods (sweet potatoes, peaches, apricots)
What are signs of dehydration in an infant/child?
Poor turgor, depressed fontanels, no tears, dry mucous membranes, weight loss, decreasued urine output
What are lab signs of metabolic acidosis (caused by dehydration)?
pH under 7.3, low sodium and potassium, high Hct and BUN
When should you add potassium to IV fluids?
ONLY when the child has adequeate urine output
What is the expected urine output for both infants and children per hour?
1-2 mL/kg/hr
How many children die from child abuse each year?
3 to 5 thousand
How should burns in children be assessed?
Using the Lund-Browder Chart, which takes into account the changing proportions fo the child's body
How can the nurse BEST evaluate adequacy of fluid replacement in children?
Monitor urine output
What interventions should be done FIRST when caring for a child who has ingested poison?
Assess repiratory, cardiac, and neuro status
What are the cardinal signs of respiratory distress in children, and other signs of resp. distress in kids?
Cardinal signs: restless, inc respirations, inc pulse, sweating

Other signs: flaring nostrils, retractions, grunting, bad breath sounds, accessory muscle use, head bobbing, low PO2, high PCO2, cyanosis, pallor
Which usually occurs 1st: cardiac failure or respiratoy failure in children?
Respiratory failure
What is epiglottitis caused by?

What is the classic position these kids are in?

What do you NEVER do in these patients?
HIB

Upright sitting position with chin out and tongue protruding ("tripod position")

NEVER examine the throat of this child!!
What causes bronchiolitis?

What lung sounds do you hear?

What are their respirations like?
RSV

Wheezing and rales

Respirations are shallow and fast
What is given to kids under 2 yrs old born either premature or with lung/heart disease to give passive immunity to RSV?
Synagis
What is a risk of untreated otitis media?

What do you see on assessment?

What can you do to ear for comfort?
Conductive hearing loss

Pulling at ears, fever, pain, enlarged lymph nodes, discharge from ear IF drum is ruptured, V/D

Apply warm compress on ear
How can you reduce body temperature in children to avoid seizure risk?
Tepid bath or Tylenol
Tonsillitis can be either bacterial or viral. If related to strep why is treatment so important?
bc the child can develop acute glomerulonephritis or rheumatic heart disease
Prior to tonsillectomy what lab values must be drawn?
PT and PTT, assess for history of bleeding of family hx of bleeding disorders
What are signs of postoperative tonsillectomy bleeding?

when is highest risk for hemorrhage?

These kids should NEVER be given what?
Clearing throat, vomiting fresh blood, frequent swallowing

1st 24 hours and 5-10 days post surgery

NO STRAWS!
What is the drug of choice for an acute asthma attack?
Epinephrine bc it is a rapid acting bronchodilator
What are the normal PO2 and PCO2 values for kids in an arterial blood gas draw?
PO2: 83-100
PCO2: 35-45
What nutritional support should be given to a child with CF?
pancreatic enzyme replacement, fat soluble vitamins, low carb, high protein, moderate fat diet
What type of genetic disease is CF?
autosomal recessive
How do you care for a child in a mist tent?
Monitor temperature. Keep clothing dry. Keep tent edges tucked in, assess respiratory status.
An increased respiratory rate in kids puts them at risk for _____________.
dehydration and acid/base imbalance
What is a patent ductus arteriosus?
Hole between the aorta and pulmonary artery, which normally closes within 72 hours postbirth. If it stays open blood from the aorta returns to the pulmonary artery, resulting in increased blood flow to the lungs and pulmonary hypertension.
Describe acyanotic defects.

Examples
They can be 1 of three things:
1. L to R shunts
2. Increased pulmonary blood flow
3. Obstructive defects

VSD, ASD, PDA, AS, and coarctation of the aorta
Describe cyanotic heart defects.

Examples
They can be either:
1. R to L shunts
2. Decreased pulmonary blood flow
3. Mixed blood flow

The 3 T's: Tetralogy of Fallot, TA, TGV
What is a ventricular septal defect?
Acyanotic

Blood from the L ventricle is shunted to the R ventricle through a hole and recirculated to the lungs, resulting in increased pulmonary blood flow
What is an atrial septal defect?
Oxygenated blood from the L atrium is shunted into the R atrium and lungs through a hole , resulting in increased pulmonary blood flow.
What is a coarctation of the aorta?
It is a narrowing of the aorta which causes HTN in the upper extremities and decreased/absent pulses in the lower extremities.
What is aortic stenosis?
A narrowing at or around the aortic valve; Oxygenation to the systemic circulation is poor bc cardiac output is low.
What is a common finding in children with cyanotic heart defects (3 T's)?
polycythemia
What is truncus arteriosus?
When the pulmonary artery and aorta do not separate. The blood from the 2 ventricles mix and causes cyanosis
What is transposition of the great vessels?
Incompatible with life, a medical emergency where babies recieve prostaglandin E to keep ductus open.
Is CHF associated more with cyanotic or acyantoic defects?
acyanotic
MANAGING DIGOXIN:
1. Before giving digoxin what must the nurse do?

2. What are therapeutic levels?

What is an early sign of digoxin toxicity?

What electrolyte imbalance increases digoxin toxicity?
1. Take child's apical pulse. If bradycardic do not administer.

2. 0.8-2.0ng/mL

3. Throwing or spitting up

4. Hypokalemia
Rheumatic fever is an _______disease. It is the most common cause of ________ in children. It is associated with an infection of ________.
Rheumatic fever is a collagen disease that injures _________.
Inflammatory
Acquired heart disease
B-hemolytic strep bacteria
Heart, blood vessels, joints, subQ tissue
What assessment findings are associated with rheumatic fever?

Lab values?
Chest pain, SOB, tachycardia ALL the time, joint pain, chorea (involuntary movements), rash, subQ nodules over bony prominences, fever

Increased Erythrocyte sedimentation rate, increased ASO titer (anistreptolysin O).
What medications are used to treat rheumatic fever?
Penicillin, eryhtromycin, and aspirin
In ____________ (a type of congenital heart defect) the child often experiences "tet spells" (_________), which are relieved by which position?
Tetralogy of Fallot
hypoxic episodes
squatting or knee chest position
What is the nurse's goal in caring for kids with Down Syndrome?
help the child reach its OPTIMAL level of functioning
What is cerebral palsy?

Its major risk factor?
An injury to the motor centers of the brain causes neuromuscular problems of spaasticity or dyskinesia (involuntary movements)

Low birth weight
What is "scissoring" a characteristic of?
Cerebral Palsy; it occurs when legs are extended and crossed over each other with feet plantar flexed.
If a mother of a Cerebral Palsy child says she is having "difficulty with diapering," what is the mom describing?
Spasticity
What should the nurse do while feeding a cerebral palsy child?
Prevent aspiiration by sitting the child upright and supporting the lower jaw
What is the most common allergy of kids with spina bifida?
Latex
What are 2 nursing priorities for the infant with myelomeningocele?
1. Prevent infection of the sac
2. Monitor for hydrocephalus (measure head circumference, assess fontanel, and neuro functioning).
What is hydrocephalus and assessment findings?
Accumulation of CSF within the brain and is often associated with spina bifida or meningitis

Symptoms: Increased ICP (low pulse, high BP), change in LOC, vomiting, seizures, bulging fontanels, widening suture lines, sunset eyes
What is the surgery like for kids with hydrocephalus?
A shunt is inserted into the brain ventricle and tubing is then tunneled through skin to the peritoneum where excess CSF is drained out
Seizures are more common in what age group?
Under 2 yrs old
Describe tonic clonic seizures (grand mal).
You get an aura. Then you lose consciousness and the body becomes stiff (tonic). Then you stop breathing and become cyonotic before you go into spasms (clonic) and relax. Pupils will be dilated and nonreactive to light, incontinent, and then you lay there sleepy and disoriented
Describe absence seizures (petit mal).
Usually occur between 4 anbd 12 years old. You lose consciousness for 5-10 seconds and appear to be daydreaming because posture is kept and you get minor face and hand movements. These kids may be doing poorly in school.
What is the most common cause of increased seizure activity?
Medication noncompliance
What do you see in older children with bacterial meningitis (normally caused by HIB)?
ICP, fever, chills, neck stiffness, opisthotonos, photophobia, positive Kernig's Sign (inable to extend leg when knee is bent toward chest), positive Brudzinski's sign (neck flexion causes flexion movements of lower extremities)
What do you see in infants with bacterial meningitis?
BULGING FONTANELS, poor feeding, vomiting, irritable, seizures
With meningitis it is important to monitor hydration status and IV therapy. Why?
Bc with meningtitis there may be inappropriate secretions of ADH, causing fluid retention (cerebral edema) and dilutional hyponatremia
What antibiotics are usually prescribed for bacterial meningitis?
Ampicillin, penicillin, chloramphenicol
How do kids usually get Reye's syndrome?
ASA + chicken pox/influenza
What is the most common presenting symptom of brain tumors?
Headache upon awakening
How is a child usually positioned after brain tumor surgery?
flat on his or her side
What is the mechanism for inheritance of Duchenne muscular dystrophy?
it is an x-linked recessive trait affecting mostly males
What is "Gower's sign?"
An indicator of muscular dystrophy; difficulty moving to standing position-child has to walk up legs using hands to stand up.
What is the first sign of renal failure?
Decreased urine output
What are the symptoms of acute glomerulonephritis?

Dietary interventions?
blood in urine, recent strep infection, HTN, mild edema around eyes, positive ASO titer

low sodium diet
what are the symptoms of nephrosis?

dietary interventions?
severa edema, massive proteinuria, frothy urine, anorexia, negative ASO titer

high protein AND low salt
Decribe safe monitoring of prednisone administration and withdrawal?
Give prednisone every other day, signs of ededma/mood changes/GI distress should be reported; the drug should always be tapered.
How can you prevent Urinary Tract Infections in kids?
avoid bubble baths, pee a lot, drink lots of fluids (especially acidic ones), wipe from frant to back
what is the vesicoureteral reflex?
When urine backflows from the bladder up into the ureters. Recurrent UTIs are common.
What do you see in a kid with Wilms Tumor?
Mass at midline on abdomen, fever, pallor, lethargy, high BP (bc of excess renin secretion)
What is THE MOST IMPORTANT thing for a nurse to do w/ a child who has Wilms Tumor?
Prevent injury to the capsulated tumor by making sure noone palpates the abdomen.
What is hypospadias?

Why is surgical correction usually done before preschool?
When the urethra opens on the ventral side of the penis behind the glans

To schieve sexual identity, toilet training, and remove the fear of castration anxiety
When is closure of cleft lip normally performed?

After surgery how is child positioned?
When the baby weighs 10 pounds and has Hgb of 10g/dL.

on side or upright in car seat (NOT PRONE)
When is closure of cleft palate usually performed?

After surgery how is the child positioned?
1 year of age to minimize speech impairment

on side or abdomen
How can you protect the surgical site on a child with cleft lip/palate?
Apply elbow restraints, minimize crying, maintain Logan Bow to lip if applied
What is an esophageal atresia with tracheoesophageal fistula?
When the upper esophagus ends in a blind pouch with the lower esophagus connected to the trachea. It is a MEDICAL EMERGENCY!!
In tracheoesophageal fistula what do you see on assessment?
The 3 c's (coughing, choking, cyanosis), exxcess salivation, resp. distress, aspiration pneumonia
What nursing actions are initiated for a child suspected of having esophageal atresia with tracheoesophageal fistula?
NPO immediately and suction secretions
What are the feeding techniques for a child with cleft lip/palate?
Feed upright with lamb's nipple or prosthesis. Use frequent bubbling.
What assessment findings do you see in kids with pyloric stenosis?
Projectile vomiting, constant hunger, weight loss, dehydration, palpable olive shaped mass in RUQ, visible walves of peristalsis
What lab values are seen in kids with pyloric stenosis?
Low sodium, low potassium, metabolic alkalosis (low chloride, increased ph, increased CO2)
What is postoperative nursing care for a child with pyloric stenosis?
IV hydration, small frequent feedings of oral glucose or electrolyte solutions, gradually increasing to full strength formula. Position ON RIGHT SIDE in semi fowlers after feedings
What assessment findings do you see in a child with intussusception (when 1 part of intestine telescopes into another part of intestine)?
Intermittent abdominal pain, screaming when legs are pulled toward abdomen, "currant jelly stools" (blood +mucus), sausage shaped mass in RUQ with empty RLQ (Dance sign)
Why is a barium enema used to treat intussusception?
It reduces intestinal telescoping via hydrostatic pressure instead of surgery
What is Hirschsprung's Disease?
Lack of persitalsis in area of colon where ganglion cells are missing. Fecal matter accumulates above this area.
What do you see when assessing a Hirschsprung's Disease child?

How do you take their temperature?
Failure to pass meconium in 1st 24 hours, distended abdomen, ribbon like stools

Take axillary temperature.
What are signs of anorectal malformation?
Failure to pass meconium in 24 hours, meconium appearing from a fistula or in the urine, an unusual anal dimple
What are the Hgb norms for:

1. Newborn
2. Infant
3. Child
Newborn 14-24
Infant 10-15
Child 11-16
What are assessment findings in kids who have iron deficiency anemia?
Pale, fatigue, milk intake over 32oz/day, pica, low Hgb, Low serum iron values
What is the genetic transmission pattern of hemophelia?
x-linked recessive transmitted by the mother and expressed by male offspring. These children are missing factors 8 or 9.
What are assessment findings in a child with hemophelia?

Never give these kids______.
Prolonged bleeding(after circumcision or in general); loss of motion in joints, prolonged PTT

Aspirin
Describe autosomal recessive transmission and give examples.
Both parent must be heterozygous carriers of the trait. Each child has a 1 in 4 chance of having the disease.

ex.) sickle cell, CF, PKU
Describe X-linked recessive transmission. Give an example.
The trait is carried on the X chromosome, so it usually affects male offspring. With each pregnancy of a woman who is a carrier there is a 25% chance of having a child with the disease. If male there is a 50% chance of getting disease. If female there is a 50% chance of being a carrier.

ex.) hemophelia
What is the sequence of events in a vasooclusive crisis of sickle cell anemia?
RBCs clump together and block small blood vessels. Cells cannot get through the capillaries, causing pain and ischemia. Lowered O2 affects the HgbS and causes sickling.
Why is hydration a priority in treating sickle cell disease?
Hydration promotes hemodilution and circulation of RBCs through the blood vessels
What should families and clients do to prevent sickle cell episodes?
Keep hydrated, avoid high altitudes, avoid strenuous exercises, avoid unknown sources of infection
Do you give supplemental iron to kids with sickle cell anemia?
No, bc it is not caused by iron deficiency. You DO give them folic acid, however, to stimulate RBC synthesis.
Nursing interventions and medical treatment for a child with leukemia are based on which 3 physiological problems?
Anemia (decreased RBCs), Infection (neutropenia), and bleeding thrombocytopenia (decreased platelets)
What should you have nearby when administering l-asparaginase to a leukemic patient?
Epinephrine and oxygen in case of anaphylaxis
An infant with ________is often described as a "good, quiet baby" by the parents.
Hypothyroidism
What do you see in children with hypothyroidism?
sleepy, poor feeders, flat expression, constipations, hypoactive
What are the outcomes of untreated congenital hypothyroidism?
Mental retardation, growth failure
What is phenylketonuria?

What is the result of PKU?
An autosomal recessive disorder where the body cannot metabolize the aa phenylalanine

The buildup of phe leads to CNS damage (mental retardation) and decreased melanin
On assessment of a child with PKU what do you see?
Newborn screening using Guthrie test is positive when serum phenylalanine is 4mg/dL or higher. Vomiting, failure to gain weight, hyperactive, musty urine odor
What are foods high in phenylalanine (which should be avoided if you have PKU)?
high protein foods including meat, dairy, eggs, aspartame. This low protein diet should be done until brain growth is complete (6-8 years old).
What 2 formulas are prescribed for kids with PKU?
Lofenelac and PKU-1
What are the 3 classic signs of diabetes?
Polydipsia, polyuria (including bedwetting-"enuresis"), polyphagia
Diabetes is diagnosed if the fasting blood sugar is greater than_____mg/dl.
120+
What do you do if a diabetic child is in ketoacidosis?
Provide care for unconscious child, administer REGULAR insulin IV in Normal Saline, monitor blood gases, maintain strict I&O
What are the signs and symptoms of hypOglycemia?
tremors, sweating, headache, hunger, nausea, lethargy, confusion, slurred speech, anxiety, tingling around mouth, nightmares
What are the signs and symptoms of hypERglycemia?
polydipsia, polyuria, polyphagia, blurry vision, weight loss, weakness, syncope
What is the relationship between hypOglycemia and exercise?
During exercise insulin uptake is increased and the risk for hypOglycemia occurs.
What is a complete fracture?
When bone fragments completely separate
What is an incomplete fracture?
When bone fragments remain attached
Wha is a comminuted fracture?
When bone fragments of the bone shaft break free and lie in surrounding tissue. Rare in children.
What type of fractures have serious consequences in terms of growth of the affected limb?
Fractures involving the epiphyseal (growth) plate
What re the 5 "P's" that may indicate ischemia in the fractured limb?
pain, pallor, pulselessness, paresthesia (pins and needles), paralysis
What is a skin traction?
Force is applied to the skin. This should NEVER be removed unless specifically prescribed by the MD
What is Buck's Skin Traction?
For the lower extremities; keeps legs extended with no hip flexion.
What is Dunlop Skin/Skeletal Traction?
When there are 2 lines of pull on the arm
What is Russell Skin Traction?
2 lines of pull on lower extremity (1 perpendicular, 1 longitudinal)
What is Bryant's Skin Traction?
Both lower extremities are flexed 90 degrees at hips (rarely used bc extreme elevation of legs causes decreased peripheral circulation)
What is a skeletal Traction?
When a pin or wire applies pull directly to the distal bone fragment
What is a 90 degree skeletal traction?
90 degree flexion of the hip and knee. The lower leg is in a boot cast. This can also be used on upper extremities.
What is a hip spica?

How do you help with toileting a child with a hip spica?
A special type of cast used to immobilize the hip joints and/or the thigh

Use Bradford frame under the child. NEVER USE abduction bar to turn a child.
What is compartment syndrome?

Assessment findings?
Damage to nerves and vasculature of an extremity due to compression. You see coldness, severe pain, inability to move extremity, poor capillary refill
What are the signs and symptoms of congenital hip dysplasia in infants?
Unequal skin fold of buttocks, positive Ortalani Sign (clicking with abduction), limited abduction of affected hip, unequal leg lengths
What are signs of hip dysplasia in older children?
Limp on affected side, positive Trendelenburg Sign (when standing on one leg the pelvis drops on the side opposite to the stance leg. )
How does the nurse conduct scoliosis screening?
Ask child to bend forward from hips with arms hanging free. Examine child for curvature of the spine, rib hump, and hip asymmetry
What instructions should the child with scoliosis receive about the Milwaukee brace?
Wear it 23 hours each day. Wear t-shirt under brace. Check skin for irritation. Perform back and abdominal exercises. Modify clothing. Maintain normal activities as able.

A brace does not correct the curve of a child with scoliosis. It only stops or slows the progression.
What is the potential outcome for untreated scoliosis?
respiratory difficulty
What is postoperative nursing care of a child with scoliosis?
Frequent neuro assessments, log roll for 5 days, keep npo, monitor NG tube/bowel sounds
Describe log rolling.
Used postoperatively for scoliosis patients.

Requires 2+ people.

Client is moved on a draw sheet to the side of the bed away from which they are to be turned (rolled toward the L if they are to face the R).

Client is the turned in a simultaneous motion, maintaining the spine in a straight position.
Pillows arranged for support and comfort
What nursing care is indicated for a child with juvenile rheumatoid arthritis?
Prescribed exercise to maintain mobility, splinting of affected joints, teach medication management and side effects
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