Rh ABO Hyperbili; NEC; Sepsis
Hyperbilirubinemia risk factors
Hemolytic disease of the newborn; ineffective/inadequate chestfeeding; bruising/cephalohematoma; polycythemia; prematurity
Blood pressure status for APSGN and Nephrotic syndrome
APSGN commonly high BP;
Minimal change nephrotic syndrome - normal or low BP due to loss of protein >> hypovolemia
Assessment findings for suspicion of developmental dysplasia of hip
unequal knee height, asymmetry of thigh folds, positive Ortolani, limited abduction, Allis/Galeazzi sign (limb length discrepancy)
Nursing interventions that promote optimal health outcomes for peds patients
Screen for abuse with patient/caregiver or safety of environment; support spiritual/cultural practices; anticipatory guidance teaching; aware of developmental norms for deviations; safe sleep practices for infants
Screening tool for NOWS
Incompatible ABO blood types for the birthing parent and fetus/newborn
Maternal blood type O and fetus/newborn blood type A, B, or AB
Clinical findings for shaking baby syndrome
Vomiting, poor feeding, listlessness, Respiratory distress, bulging fontanels, retinal hemorrhages, seizures, posturing, Apnea, and bradycardia
Diagnostics - subdural hematoma
Clinical manifestations for Bulimia Nervosa
no change in weight, dental erosion, knuckle sores, use of diet/laxative OTC meds
s/s of child near dying
Skin mottling, noisy breathing, increase secretions, respiratory and cardio vital instability
Clinical s/s for NOWS
-Central Nervous System (CNS): hyperirritability, high-pitched cry, jitteriness, tremors (disturbed & undisturbed), increased muscle tone, exaggerated Moro reflex, myoclonic jerks, seizures, disturbed sleep pattern
-Gastrointestinal: poor feeding, diarrhea or loose stool, emesis, weight loss, failure to thrive-Respiratory, Metabolic & Vasomotor: nasal congestion, nasal flaring, frequent yawning, sneezing, mottling, sweating, retractions, apnea, tachypnea, increased WOB, sweating, temp > 37.5C
s/s for Necrotizing Enterocolitis
Signs and symptoms: abdominal distention and tenderness, bloody stools, feeding intolerance (bilious vomiting), sepsis, lethargy, apnea, shock
Onset of NEC: feeding intolerance (emesis), abdominal distention and tenderness, and bloody stools (or stool hemoccult positive) or diarrhea from enteral feedings.Progression may be rapid (decrease or absent bowel sounds), delay gastric emptying or residual with feeds, resulting in bowel perforation with evidence of free air on the x-ray (Pneumatosis).
As the disease worsens, signs and symptoms of septic shock (respiratory distress, temperature instability, lethargy, hypotension, and oliguria)Lab findings for acute post strep glomerulonephritis
Urine tea color, +RBCs, high specific gravity
Clinical manifestations of Anorexia Nervosa
severe underweight; nutritional/electrolyte imbalance; Control issues; cold intolerance
Developmental considerations for pediatric patients at EOL
Infant - trust, encourage parent presence and their engagement, hold infant
Preschooler/school age - magical thinking; ensure they did not cause this, did not do wrong, encourage child's decision if cognitively able
Adolescents - privacy; include in decision making; include in plan of care; encourage socialization with peers or like-diagnosis support groups
Teach parent of developmental considerations
Nursing interventions for NAS/NOWS
What is: low stimulation environment; Cluster care; barrier cream for diaper rash; Engage parent; skin-to-skin contact; feed when desire; encourage chestfeeding;
Daily weight, I & Os; fluid and electrolyte balance, hydration
Indications to administer RhoGAM
28week gest, within 72 hrs of birth, any opportunities of blood mixing - amniocentesis, miscarriage, abortion, abdominal trauma, fall, placental abruption/previa, fetal death in utero, ectopic pregnancy, placental accidents
When to report for ChildLine
Any suspicion of abuse are required as mandatory reporter role. Evidence not required.
Treatment measures for mild and moderate scoliosis
Mild scoliosis - strengthening exercise;
Moderate scoliosis - Boston brace
Difference for palliative and hospice
Peds patient can be on both palliative and hospice simultaneously. Palliative for those in chronic terminal disease, focus on comfort and quality of life. Hospice care is for those near dying within 6 months of life.
Common pharmacologic treatment for NOWS while inpatient
Morphine
s/s of neonatal sepsis
Neonatal sepsis – infection involving the bloodstream in newborns - Hypotension; Temperature instability (often low); Irregular breathing; Elevated WBCs; Bleeding from perforated bowel (see neo sepsis slide 7 for others)
Diet considerations for APSGN and neprhotic syndrome
Observe feeding; Educate feeding technique and feeding volume (water does not replace formula); attend well check for weights; feed as prescribed; support parent with social work needs
Elements/Considerations for End-of-Life care
facilitating EOL decision making with the care team; focus family as a unit; encourage fam to be with child; focus of care change but child not abandoned
Safe dose range for an 8-month-old infant who weighs 7 kg for prescribed acetaminophen 100 mg every 4-6 hours PO for a fever. The recommended dosage range is 10-15 mg/kg/dose.
minimum mg/dose = 10mg/kg/dose x 7kg/1 = 70mg/dose
maximum mg/dose = 15mg/kg/dose x 7kg/1 = 105mg/dose
Yes, 100mg/dose is safe for this patient.