2. During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is
encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. 3. Hirschsprung disease (HD) occurs when a child is born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not passed. These newborns exhibit symptoms of distal intestinal obstruction. They have a distended abdomen and will not pass meconium within the expected 24-48 hours.
They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. 2,3,4,6 Bacterial meningitis is an inflammation of the meninges in the brain and spinal cord that is caused by specific types of bacteria, including group B streptococcal, meningococcal, or pneumococcal pathogens. 1. Preventing the spread of pediculosis capitis (head lice) may be accomplished by using hot water to launder clothing, sheets, and towels in the washing machine; these items should then be placed in a hot dryer for 20 minutes. Treatment of head lice consists of the use of pediculicides and the removal of nits (eggs). 1. Separation or stranger anxiety occurs when the primary caregivers leave the child in the care of others who are not
familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years. 4. Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury. Hemolysis results in anemia, and low platelets manifest as petechiae or purpura. Therefore, the presence of petechiae in this client could indicate underlying HUS and needs further
assessment. 4. When choosing foods for a toddler (age 1-3 years), parents should consider the following factors: 3. Hypoglycemia (blood glucose <70 mg/dL [3.9 mmol/L]) presents an immediate danger to the client as life-threatening neurologic impairment (eg, lethargy, seizures, coma) can occur when the brain becomes glucose depleted. If a client with diabetes has symptoms of hypoglycemia (eg, sweating, irritability, tremor, tachycardia, hunger), the nurse should immediately assess the client, check capillary blood glucose, and provide a simple carbohydrate snack that can be digested rapidly (eg, juice, soft drink, candy) (Option 3). 3. Supraventricular tachycardia (SVT) is the most common tachyarrhythmia of childhood and refers to a rapid heart rate of 200-300/min with no variation in rate during activity. It can lead to life-threatening congestive heart failure if left untreated. Symptoms in children may include
palpitations, dizziness, or chest pain. 3. Parallel play is typical behavior of a toddler and involves activities focused on improving motor skills, imitative efforts, and the use of multiple senses. Toddlers play alongside, rather than with,
other children. Having a variety of different balls for a group of children allows each child to be present with others and participate as they desire. Other examples of parallel play activities include pushing and pulling large toys; smearing paint; playing with dolls or toy cars; and digging in a sandbox. 1,4 During infancy, gross motor development begins with head and neck control and progresses to skills such as turning over, bearing weight on the arms in a prone position, sitting with the head erect, standing, crawling (ie, abdomen touching floor), creeping (ie, abdomen lifted off floor), and walking. By age 7 months, infants should be able to bear their full weight while standing with caregiver support and sit with minimal support from their hands (ie, tripod sitting) (Options 1 and
4). 1,3,4 Atopic dermatitis (AD), also known as eczema, is a chronic skin disorder characterized by pruritus, erythema, and dry skin. The exact cause of AD is unknown, although it may be associated with an impaired skin barrier and resulting immune response to invading
allergens. 1,2,4 Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie,
levothyroxine). 2. A ventriculoperitoneal shunt is an intervention for the treatment of hydrocephalus; the shunt drains excess cerebrospinal fluid (CSF) from the brain to the peritoneum, decreasing pressure on the brain. Following shunt placement or revision in a client, the nurse should avoid elevating the head of the bed to prevent rapid decreases in CSF and ventricular size, which can result in a subdural hematoma (Option 2).
Appropriate postoperative interventions include assessing neurological status (eg, pupillary dilation), measuring for abdominal distension to detect postoperative complications (eg, ileus, peritonitis), and positioning the client onto the nonsurgical side to avoid pressure on the shunt (Options 1, 3, and 4). 2. Developmental milestones (eg, motor, sensory, verbal, cognitive) are
known patterns of growth and development noted in most children by a specific age. These milestones are used as a general assessment guide, although each child has a unique pattern of development. By age 3 months, the infant recognizes familiar items and faces (Option 2). Any 3-month-old who does not respond to familiar faces may have visual impairment or an underlying neurological disorder (eg, autism). 1. Tinea capitis (ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding,
towels, hats). 1,2,3,4 Tetralogy of Fallot is a complex heart defect that results in decreased pulmonary blood flow, mixing of oxygenated and unoxygenated blood, and inadequate blood flow into the left side of the heart. Hypercyanotic episodes (ie, "tet" spell) occur when unoxygenated blood enters the systemic circulation, resulting in cyanosis and hypoxemia. Tet spells usually occur during stressful or painful procedures; on waking;
and with hunger, crying, and feeding. 3. 2,4,5 Pediatric clients are at increased risk for impaired psychosocial integrity during stressful experiences (eg, hospitalization, surgical procedures, medical treatment) and require developmentally appropriate care based on their age to assist with managing stress. Unaddressed or ineffectively managed developmental needs
may lead to or worsen the client's anxiety, disobedient behavior, and/or social withdrawal. 4. Bacterial conjunctivitis (pink eye) is highly contagious. The hands must be washed properly before and after instilling eye drops and after cleaning away eye drainage or crusting; this is the single best method to prevent the spread of infection to the other eye, the parents, other
family members, or anyone else. Therefore, parents should ensure that affected children wash their hands frequently and discourage them from rubbing their eyes. Tissues used to clean the eye should be discarded. The child's washcloths and towels should be kept separate. Many schools and day care centers require that children be kept at home during the time when they are most contagious. 1,2,3,5 Acute otitis media is caused by a blocked eustachian tube, which leads to a buildup of purulent fluid and inflammation in the middle ear. Manifestations include
a red and bulging tympanic membrane, inner ear pressure (which can rupture the tympanic membrane if not treated), pain, and fever (Option 3). Clients also may have rhinorrhea, nausea, or vomiting.
2,3,4 2,3,4 Myopia, or nearsightedness, is reduced visual acuity when viewing objects at a distance. Myopia occurs when the eye structure causes images to focus before they arrive at the retina. Near vision is usually intact, and many clients with myopia report needing to hold objects near their face or sit near objects to see clearly (Options 2 and 4). 1,2,4,5 Dental caries (ie, cavities) form when bacteria (eg, Streptococcus mutans) digest carbohydrates in the mouth, producing acids that break down tooth enamel and cause mineral loss. Oral hygiene
and dietary intake are significant factors contributing to the development of caries. 2 Aspiration of a foreign body occurs most often in the toddler age group. Swallowing of objects such as buttons, small parts of toys, or food particles can be life-threatening and result in airway obstruction due to the small diameter of the airway. Manifestations include choking, gagging, cyanosis, and inability to speak when the object is lodged in the larynx. "I will always travel with two tracheostomy tubes, one of the same size and one a size smaller." n the event of an accidental decannulation or another urgent need to change a tracheostomy tube, the most important action is to
quickly replace the tube as it is the client's only means to ventilate. Clients should always carry two spare tracheostomy tubes, one the same size and one a size smaller. If the tube is not easily replaced or is meeting resistance, the smaller tube should be used. 1,4,5 In pyloric stenosis, there is gradual hypertrophy of the pylorus until symptom onset at age 3-5 weeks. It is common in first-born boys and the etiology is unclear. Pyloric stenosis presents with
postprandial projectile vomiting (ejected up to 3 feet) followed by hunger (eg, "hungry vomiter"). This is clearly distinguished from the "wet burps" infants have due to a weak lower esophageal sphincter. The emesis is nonbilious as the obstruction is proximal to the bile duct. Infants have poor weight gain and are often dehydrated (eg, sunken fontanelle, decreased skin turgor, delayed capillary refill). 2,4,5 The first step in effective communication is to establish trust between the nurse, the child, and the parent. By actively including a school-age child in the health history interview, the nurse shows respect to
that child and obtains valuable insight into their health status. Allowing the child to describe how they feel or where they hurt gives the nurse a better understanding of the issue. Using clear, age-appropriate explanations will enhance communication with the child while maintaining the participation of the caregiver. Open-ended questions allow the child or caregiver to elaborate on the question, giving the nurse detailed information to guide further assessment. Non-verbal cues also play an
important role in communication (eg, staying at eye level with the child to ease any potential nervousness). Ask the child to count to 10 during injection Children are often fearful of injections, exhibiting unpredictable and/or uncooperative behavior. The nurse should explain the procedure to the child using simple, age-appropriate language (eg, "medicine under the skin") to reduce anxiety.
According to Piaget's cognitive developmental stages, school-age children develop concrete thought and may fear a loss of control. To improve the child's sense of control, the nurse should offer a specific, task-based coping technique (eg, counting aloud, deep breathing) (Option 1). 1,3,5 Cystic fibrosis (CF) is an
inherited disorder (autosomal recessive) characterized by thickened secretions due to impaired chloride and sodium channel regulation that causes exocrine gland dysfunction. Management of a client with CF should primarily address potential complications related to the following body systems: position child in tripod poisiton on parents lap This is a classic description of epiglottitis (supraglottitis). It
is an inflammation by bacteria of the tissues surrounding the epiglottis, a long, narrow structure that closes off the glottis during swallowing. Edema can develop rapidly (as quickly as a few minutes) and obstruct the airway by occluding the trachea. There has been a 10-fold decrease in its incidence due to the widespread use of the Hib (Haemophilus influenzae type B) vaccine. 1,3,4 Hospitalization for toddlers (ie, 12-36 months) is particularly difficult due to separation anxiety and a limited ability to cope with stress. Toddlers thrive on home rituals and routines, which bring stability and
reassurance. Hospitalization can severely disrupt these routines, triggering frustration and temper tantrums. Caregivers should maintain as many home routines as possible (eg, sleeping, eating) to help the child cope with unfamiliar hospital surroundings and procedures (Option 1). Parents should also stay with the child as much as possible, including overnight (ie, rooming-in), to provide consistency and alleviate separation anxiety (Option 3). 1,3,5 Lead poisoning occurs from repeated lead exposure, either via ingestion of lead-based paints (eg, walls, toys), glazes (eg, pottery) or water from lead pipes, or by inhalation of contaminated dust or soil found around older homes. Elevated blood
lead levels (BLLs) impair neural, blood, and renal development. A BLL screening is recommended between ages 1 and 2, or up to age 6 if the child was not previously screened. Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease (Option 5). Chelation therapy may be required if levels remain elevated. 2,3,5 Celiac disease (celiac sprue) is an autoimmune disorder in which the body is unable to process gluten, a protein found in most grains. Gluten consumption will damage the villi of the small intestine; this results in malabsorption of fats (steatorrhea, foul-smelling stools) and other nutrients, which can lead to malnutrition and failure to thrive. The
child will need to adhere to a gluten-free diet for life. Rice, corn, and potatoes are gluten free and are allowed in the diet (Options 2, 3, and 5). |