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We're all getting our asses kicked in nursing school right now. So here is a damn good poem to a damn good beat to remind you to keep fu##ing going to til the very end. because again

DO NOT GO GENTLE INTO THAT GOOD NIGHT!

***This song was downloaded from epidemic sound a royalty free music and sound effect service and I DO NOT have the rights to this song.

Music:

Song: Crash Out [Instrumental]

Artist: Bhris Drip & Cushy

Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light. Though wise men at their end know dark is right,

Because their words had forked no lightning they

Do not go gentle into that good night. Good men, the last wave by, crying how bright Their frail deeds might have danced in a green bay,

Rage, rage against the dying of the light. Wild men who caught and sang the sun in flight,

And learn, too late, they grieved it on its way,

Do not go gentle into that good night. Grave men, near death, who see with blinding sight Blind eyes could blaze like meteors and be gay,

Rage, rage against the dying of the light. And you, my father, there on the sad height,

Curse, bless, me now with your fierce tears, I pray.

Do not go gentle into that good night.

Rage, rage against the dying of the light.

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General Nursing Framework

• Assessment: Critical reliance on growth charts (height/weight velocity) and developmental milestones. Physical exams focus on dysmorphic features, skin changes, and sexual maturity ratings.

• Interventions: Priorities include medication adherence (often lifelong), managing fluid/nutrition, and supporting psychosocial needs like body image and self-esteem.

Key Pituitary Disorders

• Growth Hormone (GH) Deficiency: Manifests as short stature and delayed bone age. Treated with daily subcutaneous somatropin injections. Success is measured by improved growth rates before epiphyseal plates fuse.

• Precocious Puberty: Sexual development before age 8 (girls) or 9 (boys). If untreated, it leads to rapid bone aging and short adult stature. Treated with GnRH agonists to halt puberty.

• Diabetes Insipidus (AVP-D): Deficiency of ADH (Vasopressin) leading to massive water loss. Symptoms: Polyuria, polydipsia, hypernatremia ("High and Dry"). Treated with Desmopressin (DDAVP).

• SIADH: Excess ADH causing fluid retention and dilutional hyponatremia ("Low and Wet"). Management involves strict fluid restriction and seizure precautions.

Thyroid Disorders

• Congenital Hypothyroidism: A medical emergency for brain development. Untreated infants risk severe intellectual disability. Symptoms include lethargy, large tongue, and hypotonia. Treated immediately with Levothyroxine.

• Hyperthyroidism (Graves Disease): Autoimmune excess of thyroid hormone. Signs include weight loss, tachycardia, goiter, and exophthalmos. Risk of thyroid storm (fever, severe tachycardia). Treated with antithyroid meds (methimazole), radiation, or surgery.

Adrenal Disorders

• Congenital Adrenal Hyperplasia (CAH): Genetic cortisol deficiency and androgen excess. Females may present with ambiguous genitalia. Treatment requires lifelong steroids (hydrocortisone/fludrocortisone).

◦ Critical Alert: Patients are at risk for Adrenal Crisis (shock, dehydration, hyperkalemia) during illness/stress and require "stress dosing" of steroids.

Pancreatic Disorders (Diabetes Mellitus)

• Type 1 DM: Autoimmune destruction of beta cells leading to absolute insulin deficiency. Management requires insulin therapy, glucose monitoring, and balancing diet/exercise.

• Diabetic Ketoacidosis (DKA): A life-threatening complication (hyperglycemia, ketones, acidosis). Signs include Kussmaul respirations and fruity breath. Requires ICU care for fluid and insulin management.

• Type 2 DM: Insulin resistance often linked to obesity. Managed with lifestyle changes and metformin.

Parathyroid Disorders

• Hypoparathyroidism: leads to hypocalcemia. Monitor for tetany (Chvostek sign) and seizures. Treat with Calcium and Vitamin D

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Pediatric Physiological Immaturity

The pediatric GU system differs significantly from adults. Children have a slower Glomerular Filtration Rate (GFR) and less efficient urinary concentration, making them highly susceptible to dehydration and fluid overload.

• Anatomy: The female urethra is shorter, increasing Urinary Tract Infection (UTI) risk. The kidneys are less protected by fat/ribs, increasing injury risk.

• Assessment Priority: Weight is the best indicator of fluid status. Assessment focuses on hydration (I&O, specific gravity), blood pressure (critical in renal disease), and edema.

Major Structural Disorders

• Hypospadias/Epispadias: Displacement of the urethral opening. Key Intervention: Do not circumcise the infant; the foreskin is reserved for surgical reconstruction. Post-op care involves maintaining stents and a double-diapering technique to keep the site clean.

• Bladder Exstrophy: The bladder is exposed externally. Care focuses on preventing infection and skin breakdown. Note: These children are at high risk for latex allergies.

• Vesicoureteral Reflux (VUR): Urine backflows from the bladder to ureters, causing renal scarring. The goal is preventing pyelonephritis via prophylactic antibiotics or surgical reimplantation.

Renal Disorders: The "Big Three" Differentiators

Distinguishing these acquired disorders is critical for nursing management:

1. Nephrotic Syndrome (The "Leaky" Filter)

• Pathology: Increased glomerular permeability leads to massive loss of protein.

• Key Symptoms: Severe edema (anasarca), massive proteinuria, hypoalbuminemia, and hyperlipidemia.

• Management: Corticosteroids (prednisone) are the gold standard. Monitor for infection (due to steroid immunosuppression) and skin breakdown.

2. Acute Poststreptococcal Glomerulonephritis (APSGN)

• Pathology: Immune complex injury following a Group A Strep infection.

• Key Symptoms: Gross hematuria (tea/cola-colored urine), Hypertension, and mild edema.

• Management: No specific cure; supportive care focuses on managing hypertension and fluid balance.

3. Hemolytic Uremic Syndrome (HUS)

• Pathology: Often follows E. coli diarrheal illness.

• The Triad: Hemolytic anemia, Thrombocytopenia (low platelets), and Acute Kidney Injury (AKI).

• Management: Dialysis for renal failure; monitor for bleeding and fluid overload.

Renal Failure & Emergencies

• Acute Kidney Injury (AKI): Primary danger is Hyperkalemia (muscle weakness, irregular pulse). Treatment restores fluid balance and reduces potassium.

• Chronic/ESKD: Requires dialysis (Peritoneal allows for more independence) or transplant. Rejection is the major transplant risk.

• Reproductive Emergency: Testicular Torsion (twisted spermatic cord) causes sudden severe pain and is a surgical emergency requiring immediate intervention to prevent necrosis

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This material focuses on the endocrine system's role in regulating metabolism, growth, and development through hormones. Disorders generally stem from hypofunction (deficiency) or hyperfunction (excess) of specific glands.

General Nursing Framework

• Assessment: Critical reliance on growth charts (height/weight velocity) and developmental milestones. Physical exams focus on dysmorphic features, skin changes, and sexual maturity ratings.

• Interventions: Priorities include medication adherence (often lifelong), managing fluid/nutrition, and supporting psychosocial needs like body image and self-esteem.

Key Pituitary Disorders

• Growth Hormone (GH) Deficiency: Manifests as short stature and delayed bone age. Treated with daily subcutaneous somatropin injections. Success is measured by improved growth rates before epiphyseal plates fuse.

• Precocious Puberty: Sexual development before age 8 (girls) or 9 (boys). If untreated, it leads to rapid bone aging and short adult stature. Treated with GnRH agonists to halt puberty.

• Diabetes Insipidus (AVP-D): Deficiency of ADH (Vasopressin) leading to massive water loss. Symptoms: Polyuria, polydipsia, hypernatremia ("High and Dry"). Treated with Desmopressin (DDAVP).

• SIADH: Excess ADH causing fluid retention and dilutional hyponatremia ("Low and Wet"). Management involves strict fluid restriction and seizure precautions.

Thyroid Disorders

• Congenital Hypothyroidism: A medical emergency for brain development. Untreated infants risk severe intellectual disability. Symptoms include lethargy, large tongue, and hypotonia. Treated immediately with Levothyroxine.

• Hyperthyroidism (Graves Disease): Autoimmune excess of thyroid hormone. Signs include weight loss, tachycardia, goiter, and exophthalmos. Risk of thyroid storm (fever, severe tachycardia). Treated with antithyroid meds (methimazole), radiation, or surgery.

Adrenal Disorders

• Congenital Adrenal Hyperplasia (CAH): Genetic cortisol deficiency and androgen excess. Females may present with ambiguous genitalia. Treatment requires lifelong steroids (hydrocortisone/fludrocortisone).

◦ Critical Alert: Patients are at risk for Adrenal Crisis (shock, dehydration, hyperkalemia) during illness/stress and require "stress dosing" of steroids.

Pancreatic Disorders (Diabetes Mellitus)

• Type 1 DM: Autoimmune destruction of beta cells leading to absolute insulin deficiency. Management requires insulin therapy, glucose monitoring, and balancing diet/exercise.

• Diabetic Ketoacidosis (DKA): A life-threatening complication (hyperglycemia, ketones, acidosis). Signs include Kussmaul respirations and fruity breath. Requires ICU care for fluid and insulin management.

• Type 2 DM: Insulin resistance often linked to obesity. Managed with lifestyle changes and metformin.

Parathyroid Disorders

• Hypoparathyroidism: leads to hypocalcemia. Monitor for tetany (Chvostek sign) and seizures. Treat with Calcium and Vitamin D

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1. Pediatric GI Physiology & Fluid Balance

• Assessment: Evaluate hydration status via fontanels (sunken = dehydration), skin turgor, mucous membranes, and urine output.

• Management:

◦ Mild/Moderate Dehydration: First-line treatment is Oral Rehydration Solution (ORS) (e.g., Pedialyte) in small, frequent amounts.

◦ Severe Dehydration: Requires isotonic IV fluids (e.g., normal saline).

2. Structural Anomalies

These congenital defects require immediate protection of the airway or defect and surgical intervention.

• Cleft Lip/Palate: Major concerns are feeding difficulties and aspiration. Use specialty bottles (e.g., Haberman) and keep the infant upright. Post-op: Protect the suture line (no pacifiers, use elbow restraints).

• Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF): Watch for the "Three C’s": Coughing, Choking, and Cyanosis during feeding. Management includes immediate NPO status, elevating the head, and surgical repair.

• Abdominal Wall Defects:

◦ Omphalocele: Organs in a sac.

◦ Gastroschisis: Herniated bowel without a sac.

◦ Care: Prevent hypothermia and cover the defect with a sterile, non-adherent, moist dressing immediately after birth.

• Anorectal Malformations: Assess for failure to pass meconium in the first 24 hours (imperforate anus).

3. Acute & Obstructive Disorders

These conditions often present as emergencies requiring rapid recognition of specific symptoms.

• Hypertrophic Pyloric Stenosis: Characterized by projectile, non-bilious vomiting and a palpable "olive-shaped" mass in the RUQ. Treated via pyloromyotomy.

• Intussusception: The telescoping of the bowel causing edema and obstruction. Classic signs are "currant jelly" stools (blood/mucus) and a sausage-shaped abdominal mass. Treatment is often a pneumatic (air) enema.

• Appendicitis: Inflammation causing RLQ pain (McBurney’s point). Warning: A sudden relief of pain may indicate rupture and peritonitis.

4. Chronic & Inflammatory Disorders

Management focuses on diet, medication, and preventing growth failure.

• Hirschsprung Disease (Megacolon): Absence of ganglion cells in the colon leads to obstruction. Signs include failure to pass meconium and ribbon-like stools. Surgical removal of the aganglionic section is required.

• Gastroesophageal Reflux (GERD): Common in infants. Management includes thickening feeds with rice cereal, keeping the infant upright for 30 minutes post-feed, and medications (PPIs). Severe cases may need a Nissen fundoplication.

• Celiac Disease: Immunological reaction to gluten damaging small intestine villi. Symptoms include steatorrhea (fatty stools) and failure to thrive. Strict lifelong avoidance of wheat, barley, rye, and oats is the only cure.

• Biliary Atresia: Bile duct obstruction leading to liver failure. Presents with jaundice and pale stools. The Kasai procedure is the primary treatment, though liver transplant is often eventually needed

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The pediatric GU system differs significantly from adults. Children have a slower Glomerular Filtration Rate (GFR) and less efficient urinary concentration, making them highly susceptible to dehydration and fluid overload.

• Anatomy: The female urethra is shorter, increasing Urinary Tract Infection (UTI) risk. The kidneys are less protected by fat/ribs, increasing injury risk.

• Assessment Priority: Weight is the best indicator of fluid status. Assessment focuses on hydration (I&O, specific gravity), blood pressure (critical in renal disease), and edema.

Major Structural Disorders

• Hypospadias/Epispadias: Displacement of the urethral opening. Key Intervention: Do not circumcise the infant; the foreskin is reserved for surgical reconstruction. Post-op care involves maintaining stents and a double-diapering technique to keep the site clean.

• Bladder Exstrophy: The bladder is exposed externally. Care focuses on preventing infection and skin breakdown. Note: These children are at high risk for latex allergies.

• Vesicoureteral Reflux (VUR): Urine backflows from the bladder to ureters, causing renal scarring. The goal is preventing pyelonephritis via prophylactic antibiotics or surgical reimplantation.

Renal Disorders: The "Big Three" Differentiators

Distinguishing these acquired disorders is critical for nursing management:

1. Nephrotic Syndrome (The "Leaky" Filter)

• Pathology: Increased glomerular permeability leads to massive loss of protein.

• Key Symptoms: Severe edema (anasarca), massive proteinuria, hypoalbuminemia, and hyperlipidemia.

• Management: Corticosteroids (prednisone) are the gold standard. Monitor for infection (due to steroid immunosuppression) and skin breakdown.

2. Acute Poststreptococcal Glomerulonephritis (APSGN)

• Pathology: Immune complex injury following a Group A Strep infection.

• Key Symptoms: Gross hematuria (tea/cola-colored urine), Hypertension, and mild edema.

• Management: No specific cure; supportive care focuses on managing hypertension and fluid balance.

3. Hemolytic Uremic Syndrome (HUS)

• Pathology: Often follows E. coli diarrheal illness.

• The Triad: Hemolytic anemia, Thrombocytopenia (low platelets), and Acute Kidney Injury (AKI).

• Management: Dialysis for renal failure; monitor for bleeding and fluid overload.

Renal Failure & Emergencies

• Acute Kidney Injury (AKI): Primary danger is Hyperkalemia (muscle weakness, irregular pulse). Treatment restores fluid balance and reduces potassium.

• Chronic/ESKD: Requires dialysis (Peritoneal allows for more independence) or transplant. Rejection is the major transplant risk.

• Reproductive Emergency: Testicular Torsion (twisted spermatic cord) causes sudden severe pain and is a surgical emergency requiring immediate intervention to prevent necrosis

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will fill out later running late for work

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Will do this later running late for work

I got this music from epidemic sound. It is a royalty free music service. The song is by

Artist: Cushy

Song: Canines

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The Core Philosophy: Physiology Drives Care

The central theme across all sources is that children are not just "small adults." Their anatomy dictates specific risks and interventions:

• The Growth Plate (Physis): This is the weakest point of long bones. Injury here can stunt growth, making Salter-Harris fracture classifications critical knowledge.

• Healing Speed: A child’s thick periosteum and rich blood supply mean bones heal much faster than in adults, necessitating rapid alignment (often non-surgical) to prevent malunion.

• Myelinization: The nervous system is incomplete at birth. Voluntary control proceeds cephalocaudal (head-to-toe) and proximodistal (center-to-out). Deviations from this sequence or the persistence of primitive reflexes often signal disorders like Cerebral Palsy.

The "Vital Sign" of Orthopedics: Neurovascular Assessment

For any child in a cast, traction, or with a fracture, the nurse's priority is preventing Compartment Syndrome.

• The 5 P's: Pain (out of proportion/unrelieved by meds), Pulselessness, Pallor, Paresthesia, and Paralysis.

• Intervention: Elevate the limb and report "positive" findings immediately—this is a medical emergency.

Major Clinical Profiles (The "Big Few")

1. Neural Tube Defects (Spina Bifida/Myelomeningocele)

• Prevention: Maternal folic acid is the only known prevention.

• Acute Care: Keep the sac moist and sterile; position the infant prone (on stomach) to prevent rupture before surgery.

• Long-term: Assume Latex Allergy (high risk due to multiple exposures) and manage neurogenic bladder (catheterization).

2. Cerebral Palsy (CP)

• Nature: A non-progressive brain injury causing permanent motor impairment.

• Management: Focus on maximizing mobility and preventing contractures. Spasticity is managed with Baclofen (oral/pump) or Botulinum toxin injections.

• Key Sign: Persistent primitive reflexes or scissoring legs.

3. Muscular Dystrophy (Duchenne)

• Nature: X-linked recessive (boys), progressive muscle wasting starting in legs.

• Key Sign: Gower Sign (using hands to "walk" up legs to stand).

• Priority: Cardiopulmonary function is the life-limiting factor; prevent respiratory infection.

4. Hip & Foot Disorders

• DDH (Dysplasia of the Hip): Screen infants using Ortolani and Barlow maneuvers (listen for the "clunk"). Treatment is the Pavlik Harness (worn continuously) for infants <6 months.

• Clubfoot: Requires serial casting beginning immediately after birth (Ponseti method).

• SCFE (Slipped Capital Femoral Epiphysis): Occurs in adolescents (often obese) presenting with a limp or groin pain. Immediate non-weight bearing is required to prevent femoral head necrosis.

Trauma & Red Flags

• Scoliosis: Bracing is the primary intervention for moderate curves (25–45 degrees). Compliance (wearing it 18–23 hours/day) is the biggest hurdle due to body image issues.

• Osteogenesis Imperfecta: "Brittle bone disease." Never pull legs by ankles or lift under armpits; requires extremely gentle handling to prevent fracture