This study material is compiled from a copy-pasted text and a lecture audio transcript, providing a comprehensive overview of core clinical concepts, patient care guidelines, and nursing interventions.

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📚 Core Clinical Concepts: Study Guide

1. General Clinical Principles & Delegation

✅ Delegation Rule: DO NOT delegate what you can EAT!

• E - Evaluate
• A - Assess
• T - Teach
  • These tasks, along with medication administration, evaluation, and care for unstable patients, cannot be delegated to Unlicensed Assistive Personnel (UAP).
  • Licensed Vocational Nurses (LVN) / Licensed Practical Nurses (LPN) cannot handle blood.

✅ Prioritization & Assessment

• ⚠️ Always assess the patient first before checking monitors or machines.
• Prioritize answers that directly address the patient's body over equipment.
• In emergencies, treat patients with the greatest chance of survival first.
• Always select a "patient-focused" answer.
• An answer that delays care or treatment is always wrong.
• Deal with actual problems or harm before potential problems.

✅ Critical Thinking & Test-Taking Tips

• When choosing between two opposite answers, one is likely correct.
• If two or three answers are similar, none are correct.
• Avoid answers with absolutes (e.g., "always," "never," "must").
• Never use "why" questions when asking patients.
• If you've never heard of an option, it's probably not the answer.
• An answer option stating "reassess in 15 minutes" is often incorrect.
• If a nurse discovers another nurse's mistake, address it with the colleague first; if it persists, escalate to management.

✅ General Medical Practices

• Cultures are obtained before starting IV antibiotics.
• Always check for allergies (especially penicillin) before administering antibiotics. Ensure culture and sensitivity tests are done before the first dose.
• IV push medications should be administered over at least 2 minutes.
• If the patient is not a child, answers involving family options can often be ruled out.

2. Endocrine System Disorders

2.1. Adrenal Gland Disorders

• 📚 Addison's Disease (Adrenal Insufficiency)
  • Mnemonic: "Down, Down, Down, Up, Down"
    • Hyponatremia (down sodium)
    • Hypotension (down blood pressure)
    • Decreased blood volume (down volume)
    • Hyperkalemia (up potassium)
    • Hypoglycemia (down glucose)
  • Key Features: Dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress.
  • Management: Administer mineralocorticoids. Stress management is paramount to prevent Addisonian crisis. Blood pressure is a critical assessment parameter due to severe hypotension.
• ⚠️ Addisonian Crisis
  • Symptoms: Nausea, vomiting, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased blood pressure.
• 📚 Cushing's Syndrome (Adrenal Hyperfunction)
  • Mnemonic: "Up, Up, Up, Down, Up"
    • Hypernatremia (up sodium)
    • Hypertension (up blood pressure)
    • Increased blood volume (up volume)
    • Hypokalemia (down potassium)
    • Hyperglycemia (up glucose)
  • Key Features: Prone to infection, muscle wasting, weakness, edema, hirsutism, moon face, buffalo hump.
  • Cause: Can be due to prednisone toxicity.

2.2. Thyroid Gland Disorders

• 📚 Hypothyroidism / Myxedema
  • Symptoms: Slowed physical and mental function, sensitivity to cold, dry skin and hair.
  • Myxedema Coma: Characterized by hypothermia (COLD).
• 📚 Hyperthyroidism / Graves' Disease
  • Symptoms: Accelerated physical and mental function, sensitivity to heat, fine/soft hair, exophthalmos (bulging eyes).
  • Mnemonic: Think of Michael Jackson in THRILLER! Skinny, nervous, bulging eyes, up all night, heart beating fast.
• ⚠️ Thyroid Storm
  • Symptoms: Increased temperature (HOT), pulse, and hypertension.
• Post-Thyroidectomy Care: Semi-Fowler's position, prevent neck flexion/hyperextension, keep tracheostomy kit at bedside.
• Medication: Synthroid (levothyroxine) for hypothyroidism. May take several weeks for full effect. Take in the morning on an empty stomach. Can cause hyperthyroidism if dose is too high. Insomnia is a side effect of thyroid hormones.

2.3. Parathyroid Gland Disorders

• 📚 Hypoparathyroidism (Decreased Calcium)
  • Mnemonic: "CATS"
    • Convulsions
    • Arrhythmias
    • Tetany
    • Spasms (and stridor)
  • Diet: High calcium, low phosphorus.
  • Signs: Trousseau's sign (carpopedal spasm) and Chvostek's sign (facial spasm).
• 📚 Hyperparathyroidism (Increased Calcium)
  • Symptoms: Fatigue, muscle weakness, renal calculi, back and joint pain.
  • Diet: Low calcium, high phosphorus.
  • Polyuria is common due to hypercalcemia.

2.4. Pancreatic Disorders

• 📚 Diabetes Insipidus (Decreased ADH)
  • Symptoms: Excessive urine output and thirst, dehydration, weakness.
  • Management: Administer Pitressin (vasopressin).
  • Water intoxication can occur with desmopressin (for DI), leading to drowsiness and altered mental status.
• 📚 SIADH (Increased ADH)
  • Symptoms: Change in LOC, decreased deep tendon reflexes, tachycardia, nausea/vomiting/anorexia, headache.
  • Management: Administer Declomycin, diuretics.
• 📚 Diabetes Mellitus
  • Symptoms: Polyuria, polydipsia, polyphagia.
• ⚠️ Diabetic Ketoacidosis (DKA)
  • Body breaks down fat for energy, producing ketones (acids), which decrease pH.
  • Symptoms: Kussmaul's respirations (deep, rapid breathing).
  • Rare in Type 2 DM due to sufficient insulin to prevent fat breakdown.
  • Serum acetone and ketones rise. Potassium drops rapidly during treatment; be ready for replacement.
  • Fluids are the most important intervention.
  • Bringing glucose down too quickly can cause increased intracranial pressure.
• 📚 Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
  • No ketosis, no acidosis. Potassium is low due to diuresis.
  • Fluids are the most important intervention.

3. Electrolyte Imbalances

• ⚠️ Potassium Rule: No Pee, No K! Do not give potassium without adequate urine output.
• Hypokalemia
  • Symptoms: Muscle weakness, dysrhythmias.
  • Increase K intake: Raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery.
• 📚 Hyperkalemia
  • Mnemonic: "MURDER"
    • Muscle weakness
    • Urine (oliguria/anuria)
    • Respiratory depression
    • Decreased cardiac contractility
    • ECG changes
    • Reflexes
  • Priority Assessment: Check pulse due to risk of dysrhythmias.
  • Note: Salt substitutes often contain potassium. Never give IV potassium push.
  • Insight: Alkalosis = Low K; Acidosis = High K.
• Hyponatremia
  • Symptoms: Nausea, muscle cramps, increased ICP, muscular twitching, convulsions.
  • Management: Osmotic diuretics, fluids.
• 📚 Hypernatremia
  • Symptoms: Increased temperature, weakness, disorientation/delusions, hypotension, tachycardia.
  • Mnemonic: "SALT"
    • Skin flushed
    • Agitation
    • Low-grade fever
    • Thirst
  • Management: Hypotonic solutions.
• Hypocalcemia
  • Mnemonic: "CATS"
    • Convulsions
    • Arrhythmias
    • Tetany
    • Spasms (and stridor)
  • Signs: Trousseau's and Chvostek's signs.
• Hypercalcemia
  • Symptoms: Muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS.
• Hypomagnesemia
  • Symptoms: Tremors, tetany, seizures, dysrhythmias, depression, confusion, dysphagia, increased risk of digoxin toxicity.
• Hypermagnesemia
  • Symptoms: Depresses CNS, hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations (emergency).

4. Infection Control Precautions

4.1. Transmission-Based Precautions

• 📚 Airborne Precautions
  • Mnemonic: "MTV"
    • Measles
    • Tuberculosis (TB)
    • Varicella (Chicken Pox) / Herpes Zoster (Shingles)
  • Requirements: Private room with negative pressure, 6-12 air exchanges/hour. N95 mask for TB.
  • Note: Disseminated Herpes Zoster requires Airborne precautions. SARS also requires Airborne + Contact.
• 📚 Droplet Precautions
  • Mnemonic: "SPIDERMAN"
    • Sepsis, Scarlet fever, Streptococcal pharyngitis
    • Parvovirus B19, Pneumonia, Pertussis
    • Influenza
    • Diphtheria (pharyngeal)
    • Epiglottitis
    • Rubella
    • Mumps, Meningitis, Mycoplasma or Meningeal pneumonia
    • An Adenovirus
  • Requirements: Private room or cohorting, mask. Maintain 3-foot distance.
• 📚 Contact Precautions
  • Mnemonic: "MRS. WEE"
    • Multidrug-resistant organism (MDRO)
    • Respiratory infection
    • Skin infections
    • Wound infection
    • Enteric infection (e.g., Clostridium difficile)
    • Eye infection (e.g., conjunctivitis)
  • Skin Infections Mnemonic: "VCHIPS"
    • Varicella zoster
    • Cutaneous diphtheria
    • Herpes simplex
    • Impetigo
    • Pediculosis
    • Scabies
  • Note: Localized Herpes Zoster requires Contact precautions. A nurse with localized herpes zoster can care for patients if they are not immunosuppressed and lesions are covered. Hepatitis A requires Contact precautions.

4.2. General Infection Control

• Tetanus, Hepatitis B, and HIV require Standard Precautions.
• No live vaccines, fresh fruits, or flowers for neutropenic patients.
• No milk (or fresh fruit/veggies) on neutropenic precautions.
• Yogurt with live cultures should not be given to immunosuppressed patients.

5. Patient Positioning Strategies

Proper positioning is crucial for patient comfort, preventing complications, and promoting healing.

• Air/Pulmonary Embolism: Turn patient to the left side and lower the head of the bed.
• Un-reassuring Fetal Heart Rate (FHR): Turn mother to the left side, give O2, stop Pitocin, increase IV fluids.
• Tube Feeding with Decreased LOC: Position patient on the right side (promotes stomach emptying) with HOB elevated (prevents aspiration).
• Epidural Puncture: Side-lying position.
• After Lumbar Puncture: Lie flat supine for 4-12 hours to prevent headache and CSF leakage.
• Heat Stroke: Lie flat with legs elevated.
• Continuous Bladder Irrigation (CBI): Catheter taped to thigh, leg kept straight. No other restrictions.
• After Myringotomy: Position on the side of the affected ear to allow drainage.
• After Cataract Surgery: Sleep on unaffected side with a night shield for 1-4 weeks.
• After Thyroidectomy: Low or semi-Fowler's, support head, neck, and shoulders.
• Infant with Spina Bifida: Position prone (on abdomen) to prevent sac rupture.
• Buck's Traction (Skin Traction): Elevate foot of bed for counter-traction.
• Total Hip Replacement: Don't sleep on operated side, don't flex hip >45-60 degrees, don't elevate HOB >45 degrees. Maintain hip abduction with pillows.
• Prolapsed Cord: Knee-chest position or Trendelenburg.
• Infant with Cleft Lip: Position on back or in infant seat to prevent trauma to suture line. Hold upright during feeding.
• To Prevent Dumping Syndrome: Eat in reclining position, lie down after meals for 20-30 minutes. Restrict fluids during meals, low CHO and fiber diet, small frequent meals. Low-Fowler's during meals.
• Above Knee Amputation: Elevate for first 24 hours on pillow, position prone daily for hip extension.
• Below Knee Amputation: Foot of bed elevated for first 24 hours, position prone daily for hip extension.
• Detached Retina: Area of detachment should be in the dependent position.
• Administration of Enema: Left side-lying (Sim's) with knee flexed.
• After Supratentorial Surgery (incision behind hairline): Elevate HOB 30-45 degrees.
• After Infratentorial Surgery (incision at nape of neck): Position patient flat and lateral on either side.
• During Internal Radiation: Bedrest while implant is in place.
• Autonomic Dysreflexia/Hyperreflexia: Place client in sitting position (elevate HOB) first.
• Shock: Bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg).
• Head Injury: Elevate HOB 30 degrees to decrease intracranial pressure.
• Peritoneal Dialysis (Inadequate Outflow): Turn patient from side to side BEFORE checking for kinks in tubing.
• Lower Amputations: Patient placed in prone position.
• William's Position: Semi-Fowler's with knees flexed (increased knee gatch) to relieve lower back pain.
• Pneumonia: Lay on the affected side to splint and reduce pain. For congestion, position with the sick lung up.
• GERD: Position prone with HOB elevated. Lay on left side with HOB elevated 30 degrees.
• Appendectomy: Position on right side with legs flexed.
• Emphysema: High-Fowler's and leaning forward.

6. Medication Management & Antidotes

6.1. General Medication Considerations

• Mannitol (Osmotic Diuretic): Crystallizes at room temp; always use a filter needle.
• Digoxin: Check pulse; hold if <60 bpm. Monitor digoxin and potassium levels. Theophylline increases digoxin toxicity risk. Low potassium potentiates digoxin toxicity.
• Amphojel (Aluminum Hydroxide): Treats GERD and kidney stones. Watch for constipation. Take with meals. Long-term use can bind phosphates, increase calcium, and weaken bones.
• Vistaril (Hydroxyzine): Treats anxiety and itching. Watch for dry mouth. Commonly given pre-op.
• Versed (Midazolam): Given for conscious sedation. Watch for respiratory depression and hypotension.
• PTU (Propylthiouracil) & Tapazole (Methimazole): Prevent thyroid storm.
• Sinemet (Carbidopa/Levodopa): Treats Parkinson's. Sweat, saliva, urine may turn reddish-brown. Causes drowsiness. Contraindicated with MAOIs. Avoid B6.
• Artane (Trihexyphenidyl) & Cogentin (Benztropine): Treat Parkinson's and extrapyramidal effects. Sedative effect.
• Tigan (Trimethobenzamide): Treats post-op N/V and gastroenteritis-associated nausea.
• Timolol (Timoptic): Treats glaucoma.
• Bactrim (Sulfamethoxazole/Trimethoprim): Antibiotic. Do not take if allergic to sulfa drugs. Diarrhea is common. Drink plenty of fluids.
• Gout Medications: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim). Push fluids with Allopurinol to flush uric acid; do not take Vitamin C with Allopurinol.
• Apresoline (Hydralazine): Treats HTN or CHF. Report flu-like symptoms. Rise slowly from sitting/lying. Take with meals.
• Bentyl (Dicyclomine): Treats irritable bowel. Assess for anticholinergic side effects.
• Calan (Verapamil): Calcium channel blocker for HTN, angina. Assess for constipation.
• Carafate (Sucralfate): Treats duodenal ulcers by coating them. Take before meals.
• Theophylline: Treats asthma or COPD. Therapeutic drug level: 10-20 mcg/mL. Causes GI upset; give with food.
• Diamox (Acetazolamide): Treats glaucoma, high altitude sickness. Do not take if allergic to sulfa drugs. Can cause hypokalemia.
• Indocin (Indomethacin): NSAID for arthritis (osteo, rheumatoid, gouty), bursitis, tendonitis.
• Librium (Chlordiazepoxide): Treats alcohol withdrawal. Do not take with alcohol (severe N/V).
• Oncovin (Vincristine): Treats leukemia. Given IV ONLY.
• Kwell (Lindane): Treats scabies and lice. For scabies, apply lotion once for 8-12 hours. For lice, use shampoo for 4 minutes, then rinse and comb.
• Premarin (Conjugated Estrogens): Estrogen replacement after menopause.
• Dilantin (Phenytoin): Treats seizures. Therapeutic drug level: 10-20 mcg/mL. Can cause gingival hyperplasia (emphasize good oral hygiene). Toxicity: poor gait/coordination, slurred speech, nausea, lethargy, diplopia. Phenobarbital can be taken during pregnancy, but Dilantin is contraindicated.
• Navane (Thiothixene): Treats schizophrenia. Assess for Extrapyramidal Symptoms (EPS).
• Ritalin (Methylphenidate): Treats ADHD. Assess for heart-related side effects (report immediately). Child may need drug holiday due to growth stunting.
• Dopamine (Intropin): Treats hypotension, shock, low cardiac output. Monitor EKG for arrhythmias, monitor BP.
• Pitocin (Oxytocin): Used for uterine stimulation.
• Magnesium Sulfate: Used to halt preterm labor. Contraindicated if deep tendon reflexes are ineffective. If seizure occurs during administration, deliver baby STAT.
• Demerol (Meperidine): Used for pancreatitis (NOT morphine sulfate). Do not give to patients with sickle cell crisis.
• Iron Injections: Give via Z-track method to prevent leakage into subcutaneous tissues.
• Aminoglycosides (e.g., Vancomycin): Nephrotoxic and ototoxic.
• NSAIDs, Corticosteroids, Bipolar Meds, Cephalosporins, Sulfonamides: Take with food.
• Bronchodilator + Glucocorticoid Inhalers: Administer bronchodilator first.
• Intal (Cromolyn): Treats allergy-induced asthma. May cause bronchospasm.
• Isoniazid (INH): Causes peripheral neuritis. Take with Vitamin B6 to prevent. Hepatotoxic. Do not give with Dilantin (can cause phenytoin toxicity). Monitor LFTs.
• Peptic Ulcers (H. pylori): Treated with Flagyl, Prilosec, and Biaxin to kill bacteria and stop acid production (does not heal ulcer).
• Weighted Naso-Intestinal (NI) Tubes: Must float from stomach to intestine. Do not tape immediately; coil next to patient on HOB. Position patient on RIGHT side to facilitate movement through pylorus.
• Diaphragm (Contraceptive): Must stay in place 6 hours after intercourse. Refitting needed with significant weight change.
• Best Time to Take Medications:
  • Growth Hormone: PM
  • Steroids: AM
  • Diuretics: AM
  • Aricept: AM
• Tagamet (Cimetidine): Take with food. Interacts with many drugs, use cautiously in elderly.
• Antacids: Take after meals.
• Rifampin: For TB. Dyes bodily fluids (tears, urine) orange. Reduces effectiveness of contraceptives.
• Ethambutol: For TB. Affects vision (eyes).
• TB Drugs: Liver toxic. Can cause peripheral neuropathy.
• Eye Drops: Apply to conjunctival sac, then apply pressure to nasolacrimal duct/inner canthus.
• Mixing Antipsychotics (e.g., Haldol, Thorazine, Prolixin): Incompatible with caffeine and apple juice.
• Haldol (Haloperidol): Preferred antipsychotic in elderly, but high risk for EPS (dystonia, tardive dyskinesia, jaw tightening, stiff neck, swollen tongue/airway). Monitor for early signs; give IM Benadryl for reactions.
• Risperdal (Risperidone): Antipsychotic. Doses >6mg can cause tardive dyskinesia. First-line antipsychotic in children.
• Hydroxyurea: For sickle cell. Report GI symptoms immediately (sign of toxicity).
• Zocor (Simvastatin): For hyperlipidemia. Take on empty stomach for enhanced absorption. Report unexplained muscle pain, especially with fever.
• Neostigmine/Atropine: Anticholinergic to reverse pancuronium effect.
• Amphotericin B (Ampho B): Causes hypokalemia. Premedicate before administration (patients often get fever).
• Asparaginase: Test for hypersensitivity before administration.
• Vermox (Mebendazole): Take with high-fat diet to increase absorption.
• Ativan (Lorazepam): Treatment of choice for status epilepticus.
• Lithium:
  • Therapeutic level: 0.5-1.5 mEq/L
  • Indicated for mania.
  • Toxic level: 2-3 mEq/L (N/V, diarrhea, tremors).
  • Hydrate with 2-3 L water/day.
  • Causes increased urine output and dry mouth.
  • Give Mannitol and Diamox for toxic symptoms.
  • Maintain Na intake of 2-3g/day.
• Psych Meds (except Lithium): Side effects often mimic SNS activation (increased BP, HR, RR, dilated pupils, decreased GI/GU motility, dry mouth), but BP is typically decreased.
• Flecainide (Tambocor): Antiarrhythmic. Limit fluids and sodium intake to prevent heart failure.
• Adenosine: Treatment of choice for paroxysmal atrial tachycardia.
• Dantrium (Dantrolene): For spasticity. May take a week or more to be effective.
• Vasopressin: "Press in" (vasoconstricts).
• Lugol Solution (Potassium Iodide): For hyperthyroidism. Report burning in mouth or brassy taste.
• Prednisone: May require extra insulin due to increased glucose.
• Oral Hypoglycemics: Common adverse reactions include rash, photosensitivity.

6.2. Antidotes

• Heparin: Protamine Sulfate
• Coumadin (Warfarin): Vitamin K
• Ammonia: Lactulose
• Acetaminophen: N-Acetylcysteine (Mucomyst)
• Iron: Deferoxamine
• Digitoxin/Digoxin: Digibind
• Alcohol Withdrawal: Librium (Chlordiazepoxide)
• Magnesium Sulfate: Calcium Gluconate
• TPA (Tissue Plasminogen Activator): Amicar (Aminocaproic Acid)

7. Pediatric Care Considerations

7.1. Assessment & Milestones

• 📚 APGAR Score: Measures Heart Rate, Respiratory Rate, Muscle Tone, Reflexes, Skin Color (0-2 points each).
  • 8-10: OK
  • 0-3: Resuscitate
• Neonatal Hemoglobin: 18-27 g/dL.
• Lead Poisoning: Test around 12 months of age.
• Newborn Warming: Skin-to-skin contact with mother, covered with a blanket.
• Birth Weight: Doubles by 6 months, triples by 1 year.
• Digoxin in Children: Do not give if HR <100 bpm.
• Infant CPR: Brachial pulse is the area for pulse check.
• Developmental Milestones:
  • 2-3 months: Turns head side to side.
  • 4-5 months: Grasps, switches objects, rolls.
  • 6-7 months: Sits at 6 months, waves bye-bye.
  • 8-9 months: Stands straight at eight.
  • 10-11 months: Belly to butt (10 letters).
  • 12-13 months: Drinks from a cup.
• Low-Set Ears: Associated with renal anomalies (kidneys and ears develop concurrently).
• 4-Year-Olds: Cannot interpret time; explain events relative to common occurrences (e.g., "Mom will be back after supper").
• Stranger Anxiety: Greatest at 7-9 months.
• Separation Anxiety: Peaks in toddlerhood.

7.2. Specific Pediatric Conditions

• 📚 Pyloric Stenosis:
  • First Sign: Mild vomiting, progressing to projectile vomiting.
  • Later Signs: Palpable mass, frequent hunger, spitting up after feedings.
  • Classic Sign: Olive-like mass.
• 📚 Kawasaki Disease:
  • Key Feature: Strawberry tongue.
  • Complication: Coronary artery aneurysms due to blood vessel inflammation. Leads to cardiac problems.
• 📚 Ventriculoperitoneal (VP) Shunt:
  • Post-op: Small upper-abdominal incision.
  • Monitor for: Abdominal distention (fluid redirection), increased ICP (irritability, bulging fontanels, high-pitched cry in infants; lack of appetite, headache in toddlers).
  • Positioning: Initially flat to prevent rapid fluid reduction. If ICP increases, elevate HOB 15-30 degrees.
• Bronchopulmonary Dysplasia: Caused by mechanical ventilation in premature newborns with immature lungs, infection, or inflammation.
• Nasal Patency (<1 year): Essential as infants are obligatory nasal breathers.
• Excessive Milk Intake (Children): >3-4 cups/day reduces intake of other nutrients, especially iron, leading to anemia. Avoid juice/milk in bottles during naps/overnight to prevent dental caries.
• Traction (Pediatric):
  • Ninety-Ninety Traction: For femur/tibial fractures with skin damage. Pin in distal bone, boot cast on lower extremity.
  • Bryant's Traction: For femurs/congenital hip in young kids. Hinder should clear the bed.
• Oral Candidiasis (Thrush): White patches in baby's mouth that cannot be easily wiped away (unlike formula residue).
• Undescended Testis (Cryptorchidism): Risk factor for testicular cancer. Teach testicular self-exam around age 12.
• Cystic Fibrosis (CF):
  • First Sign: Meconium ileus at birth (inconsolable, not eating, not passing meconium).
  • Diet: Low fat, high sodium, fat-soluble vitamins (ADEK).
  • Management: Aerosol bronchodilators, mucolytics, pancreatic enzymes with meals.
  • Classic Sign: Salty skin.
  • Respiratory problems are the chief concern.
• Cerebral Palsy: Poor muscle control due to birth injuries and/or decreased oxygen to brain tissues.
• Increased ICP in Infants: Should be <2 mmHg. Measure head circumference.
• Wilms' Tumor: Encapsulated above the kidneys, causing flank pain.
• Hemophilia: X-linked; mother passes to son.
• Phenylketonuria (PKU): Increased phenylalanine causes brain problems. No meat, dairy, or aspartame.
• Anterior Fontanelle: Closes by 18 months. Posterior: 6-8 weeks.
• Caput Succedaneum: Diffuse edema of fetal scalp that crosses suture lines. Resolves in 1-3 days.
• Jaundice: Pathological (before 24 hrs, lasts >7 days); Physiological (after 24 hrs).
• Bethamethasone (Celestone): Surfactant for lung expansion.
• Dystocia: Baby cannot make it down the birth canal.
• Fetal Alcohol Syndrome: Upturned nose, flat nasal bridge, thin upper lip, Small for Gestational Age (SGA).
• Intraosseous (IO) Infusion: For life-threatening emergencies when IV access is difficult. Needle into bone (e.g., tibia) for fluids/meds. Temporary. Isoproterenol cannot be given IO.
• Sickle Cell Crisis: Prioritize fluids and pain relief.
• Aspirin in Children: Contraindicated due to association with Reye's Syndrome. Give Tylenol instead.
• Child Abuse: Always report suspected cases.
• Nasotracheal Suctioning: Contraindicated with head injury or skull fracture.
• Feeding Position: Feed upright to avoid otitis media.
• Eardrops (<3 years): Pull pinna down and back.
• Respiratory Syncytial Virus (RSV): No contact lenses or pregnant nurses in rooms where ribavirin is administered.
• Tet Spells: Treated with morphine.
• Rheumatic Fever: Preceded by Group A Strep. Symptoms include chorea (grimacing, sudden body movements) and joint pain. Elevated antistreptolysin O. Treat with penicillin. Can lead to cardiac valve malfunction.
• Congestive Heart Failure (CHF) in Infants: Tachycardia is a key sign (not cough).
• G-Tube Placement (Pediatric): Stomach contents drained by gravity for 24 hours before feedings begin.
• Omphalocele & Gastroschisis: Dress herniated abdominal contents with loose saline dressing covered with plastic wrap. Monitor temperature (risk of heat loss).
• Hydrocele Repair: Provide ice bags and scrotal support.
• HIV in Children:
  • Positive Western blot (<18 months) indicates maternal infection.
  • Two or more positive p24 antigen tests confirm HIV (<18 months). p24 can be used at any age.
  • Avoid OPV (oral polio vaccine) and Varicella (live vaccines). Give Pneumococcal and Influenza. MMR avoided only if severely immunocompromised.
  • Parents should wear gloves for care, avoid kissing on mouth, and not share eating utensils.
• Cold Stress (Newborn): Biggest concern is respiratory distress.

7.3. Immunizations

• MMR vaccine is given SQ, not IM.
• MMR and Varicella immunizations are given later (around 15 months).
• If a child has a cold, immunizations can still be given.
• Anaphylactic reaction to baker's yeast is a contraindication for Hep B vaccine.
• Ask about egg allergy before Flu shot.
• Ask about anaphylactic reaction to eggs or neomycin before MMR.

8. Diagnostic Tests & Procedures

• Prior to Liver Biopsy: Check prothrombin time (PT).
• CT Scan: Assess for allergies (especially to contrast dye).
• MRI: Assess for claustrophobia, remove all metal, check for pacemakers.
• Cardiac Catheterization: NPO 8-12 hrs, empty bladder, mark pulses. Patient may feel heat, palpitations, or cough with dye injection. Post-procedure: vital signs, keep leg straight, bedrest 6-8 hrs.
• Cerebral Angiography: Well hydrated, lie flat, shave site, mark pulses. Post-procedure: keep flat 12-14 hrs, check site, pulses, force fluids.
• Lumbar Puncture: Fetal position. Post-procedure: neuro assessment q15-30 min until stable, flat 2-3 hrs, encourage fluids, oral analgesics for headache, observe dressing.
• EEG (Electroencephalogram): No sleep the night before, meals not withheld, no stimulants for 24 hrs prior, tranquilizer/stimulant meds held 24-48 hrs prior. May be asked to hyperventilate and watch flashing light. Post-EEG: assess for seizures (increased risk).
• Myelogram: NPO 4-6 hrs, allergy history. Phenothiazines, CNS depressants, stimulants withheld 48 hrs prior. Table moves during test. Post-procedure: neuro assessment q2-4 hrs. Water-soluble dye: HOB up. Oil-soluble dye: HOB down. Oral analgesics for headache, encourage PO fluids, assess for distended bladder, inspect site.
• **Paracen…