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71 Cards in this Set
- Front
- Back
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Otitis Media (OM) 1
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More frequently seen in pediatric patients due to the small eustacian tubes often associated with a URI or allergies that cause increased secretions
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Otitis Media (OM) 2
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Diagnosed by visualizing the Tympanic membrane which either appear red and bulging or will be sunken in key is decreased motility
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Otitis Media (OM) 3
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Theraputic management is typicaly antibiotics (ampicillin is most commonly used)
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Otitis Media (OM) 4
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In children with recurrent infections surgical tubes may be placed to help ear drainage. The tube will expell itself as the ear heals usually over 6-18 months
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Otitis Media (OM) 5
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Considerations are for children with cronic infections may need surgery if speech development is delayed. Counsel parents second hand smoke and increases chanced of otitis media (including wood burning fire places)
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Rhinitis 1
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Often allergic
Affects children and adults Can be associated with Asthma OME and chronic sinusitis Generally see more of it in the spring and fall Can be chronic recurrent or acute Often is seen with itching of the nose, eyes pharynx, palate and conjunctiva OME is otitis media with effusion ( fluid in middle ear without symptoms of infection) |
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Rhinitis exam
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May see dark circles under eyes- due to obstruction of outflow from lymphatics and veins
May become an obligatory mouth breather Horizontal nasal crease Pale blue and boggy nasal turbinated |
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Rhinitis Treatment
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Avoid offending allergens
Remove allergens from home Hardwood floors better than carpet Avoid pet dander Can treat with immunotherapy Treat with meds Antihistamines Nasal corticosteroids Avoid benedryl |
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Rhinitis Nursing management
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Focus on identification of problem and referral for treatment
Education on avoiding allergens Education on medication administration |
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Sinusitis 1
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Occurs when the exit from the sinuses are narrowed or blocked
By hypertrophy or inflammation of the mucosa Fluids get infected with bacteria, viruses, and fungi Affect children and adults children often ethmoid sinuses, adults ethmoid and maxillary |
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Sinusitis causes
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Upper respiratory infection
Allergic rhinitis Swimming Dental work |
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Sinusitis manifestations
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Pain over affected sinus
Purulent nasal drainage Nasal obstruction Congestion Fever Malaise |
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Sinusitis treatment
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Reduce Inflammation
Treat causes Medications First Line Corticosteroid (Nasal Spray) Mast cell stabilizers (Nasal Spray) Leukotriene Receptor Antagonists and inhibitors Anticholinergic Nasal Spray Antihistamines 2nd Line Antibiotics Control alergens |
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Epiglottitis, What is it?
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Swelling of the epiglottitis
The condition is life threatening! Edema in the airway can cause an obstruction in minutes! Affects children between 2 and 8 months |
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Acute Epiglottitis
CM TM NC Prevention |
Clinical manifestations
Sore throat, pain, tripod positioning, retractions Inspiratiory stridor, mild hypoxia, distress Therapeutic management Potential for respiratory obstruction Nursing considerations Prevention: Hib vaccine |
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Epiglottitis Assessment
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High fever (102 F)
Sore Throat Restless anxous child Muffled Voice (Dysphonia), difficulty Swllowing, DROOLING Respiratory Distress |
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Epiglottitis Plan
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Do not try to examine epoglottis!
Cool mist + O2 as needed Keep Pt calm! Set up for intubation! |
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Epiglottitis ND
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Ineffective breathing pattern
Fear Ineffective airway clearance |
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Acute Laryngitis
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More common in older children and adolescents
Usually caused by virus Chief complaint is hoarseness Generally self-limiting and without long-term sequelae Treatment: symptomatic |
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Tonsils
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Masses of lymphoid tissue encircling the nasopharynix and oropharynx
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Tonsillitis
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Often occurs with pharyngitis
Includes the Waldyer tonsil ring (see –pg 1321 fig 32-2) Is common in young children Can be bacterial or viral Tonslilitis more commonly needs surgery in kids because it takes less inflamation to block airways |
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Tonsillitis Manifestations
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Inflammation
May meet midline May have difficulty swallowing and breathing If adnoids are involved then it may not be possible to pass air from the nose into the mouth May have bad breath Voice may have a nasal quality Persistent cough |
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Tonsillitis Treatment 1
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If viral often self limiting
Throat cultures may be taken If positive for GABHS than may need antibiotics Surgical treatment of chronic tonsillitis is controversial |
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Tonsillitis Treatment 2
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Group A beta hemolytic strepococcus
rheumatic fever glomerulo nephritis inflammation of joints and feet MOVES FROM TOP TO BOTTOM |
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Tonsillectomy
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NOT indicated for recurrent pharyingitis!
May be indicated with: Frequent strep infections Preitonsilar abcess Massive hypertrophy (with difficulty breathing) Adenectomy may be indicated if adenoids obstruct breathing Watch for postop bleeding |
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Diaper Dermatitis 1
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35% of young children have some degree of diaper dermatitis (diaper rash)
Caused by prolonged repetitive contact with irritant (Urine, feces) Is found primarily in the convex surfaces Can have a variety of configurations Eruptions generally occur in areas with the most contact with the diaper |
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Diaper Dermatitis 2
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Peaks at 9 to 12 months
Greater incidence in bottle fed babies than breast fed |
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Diaper rash-Yeast
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Candida albicans is a common cause of diaper rash
This rash will be bright red with raised boarders This rash will include skin folds and will be painful |
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Diaper rash
Tx Prevention |
Change infants frequently!
May leave infant diaperless Barrier creams Hydrocortazone can be used for contact dermatitis type rashes (will make yeast worse) Nystatin cream or powder is used for yeast |
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Seborrheic Dermatitis
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AKA cradle cap
Chronic recurrent inflammatory reaction of the skin Most commonly occurs on the scalp Most common in early infancy with increased sebum production and thought to be linked with overgrowth of Malassezia yeast |
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Seborrheic Dermatitis Treatment
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Wash scalp and hair frequently
May use a special seborrheic dermatitis shampoo (contains sulfur and salicylic acid) Apply shampoo to scalp and allow to set until crusts have softened then rinse hair thoroughly A soft baby brush or face brush may be gently used to help loosen crusts and remove them from the hair |
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Atopic Dermatitis (AKA Eczema)
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A descriptive category of dermatologic diseases
Is usually associated with hereditary tendency and allergy 3 forms: Infantile eczema Childhood Adolescent |
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Infantile Eczema
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Begins between 2 and 6 months of age
Generally undergoes spontaneous remission by 3 yrs Generalized rash often involving cheeks, scalp, trunk, and exterior surfaces of extremities Lesions appear Erythema, vesicles, papules, weeping, oozing, crusting, scaling Lesions are often symmetric |
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Childhood eczema
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Commonly on the flexural areas, wrists, ankles and feet
There’s commonly symmetrical involvement Often see clusters of small erythemetous or flesh-colored papules or minimally scaling patches May be dry or hyper pigmented May see Lichinification or keratosis pilaris |
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Adolescent Eczema
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Occurs on the face, side of neck, hands feet, and anticubital and poplateal fossa (to a lesser extent)
Same as childhood manifestations Dry thick lesions (lichenified plaques) are common May have confluent papules |
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Atopic Dermatitis
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They may also have one or more of the following
Lymphadenopathy, espc. Near affected sites Increased palmar creases Atopic pleats Tendency towards cold hands Pityriasis alba Facial pallor Bluish discoloration beneath eyes Increased susceptibility to unusual cutanious infections |
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Atopic Dermatitis management
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Avoid exposure to skin irritants or allergens, avoid overheating.
Hydrate the skin avoid skin moisture loss Tepid bath followed by emollient application Relive itching Reduce inflammation or flare-ups Prevent and control and infections |
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Impetigo 1
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Infection with Staphylococcus
Exudates dries to form a thick honey colored crust Tends to spread peripherally in sharply marginated irregular outlines Itching is common |
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Impetigo 2
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Treat by carefully removing crust and treat with antibacterial ointments
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Scabies
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An infection caused by the scabies mite
Lesions occur when the female mite burrows into the stratum corneum to deposit eggs and feces |
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Scabies Manifestations
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Macular papular lesions seen:
In between fingers Under arms Behind knees In the inguinal area Close inspection will show burrows Itching |
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Scabies treatment
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Scabicide:
Permethrin 5% crème All people in close contact with the person will need treatment Cream must be applied to all skin and left on for approximately 8-12hours |
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Pediculosis Capitis
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Head Lice
Infection of the scalp by parasites Often in school age children Also frequently seen in homeless populations May create embarrassment + concern in family and community |
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The Louse
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A blood sucking organism
Eats 5 times a day Lives 48 hours away from human contact On a host live about 1 month Typically lays eggs close to the scalp Eggs hatch in 7-10 days |
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Pediculosis Capitis
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Manifestations
Itching Diagnosis may by observation of nits Nits are commonly found at the base of the neck and behind the ears Nits are attached to the hair shaft |
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Pediculosis Capitis Treatment 1
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Pediculicides
Over the counter Permethrin 1% crème rinse Nix Pyrethrin + piperonyl butoxide RID Prescriptions 0.5% MALATHION |
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Pediculosis Capitis Treatment 2
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Nit removal
With metal nit or flea comb daily Pyrethrin products are contraindicated in patients allergic to ragweed or turpintine Malathion contains flamable alcohol must remain in contact with skin for 8-12 hrs- not reccomended for children under 2 Not reccomended to cut childs hair due to ridacule etc by other children |
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Pediculosis Capitis Treatment 3
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Environmental management
Machine-wash all washable clothing, towels, linen etc + dry in dryer for at least 20 min Thoroughly vacuum carpets, car seats, pillows, stuffed animals, rugs, mattresses, and upholstered furniture Seal nonwashables in a plastic bag for 14 days |
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Pediculosis Capitis Management
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Education on how to prevent and treat these conditions!
Proper identification of conditions Treatment |
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Varicella
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Chickenpox
Caused by Varicella Virus Zoster Causes Shingles in adults Is primarily in the respiratory tract Is also found to a lesser degree in skin lesions Is spread by direct contact, droplets, and contaminated objects Is communicable for 1 day before lesions erupt to 6 days after first crop crusts |
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Varicella Manifestations 1
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Fever
Malasie Anorexia Itchy Rash Rash begins as a macule and progresses to a papule and then a vesicle Rash is central and spreads to face and proximal extremities spares distal limbs and areas exposed to heat |
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Varicella Manifestations 2
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Only treatment is antiviral agents
Varicella zoster immunoglobulin Supportive Benadryl for itching Skin care to prevent secondary infections Tylenol for fever |
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Varicella Complications
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Secondary bacterial infections
Encephalitis Variclla pneumonia (rare in children) Hemorrhagic Varicella Chronic or transient thrombocytopenia |
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Rubeola
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Measles
Caused by a virus Is found in respiratory tract, blood and urine of an infected person Is spread by droplets Contagious from 4 days before rash to 5 days after rash Incubation period is 10-20 days |
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Rubeola manifestations
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Initially
Fever and malaise After 24 hours they typically have head cold symptoms with cough + conjunctivitis Koplik spots Symptoms increase in severity until about 2 days after rash appears |
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Rubeola Rash
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Starts 2-3 days after onset of symptoms
Begins as erythematous maculopapular Starts on face and spreads downward After 3-4 days assumes a brownish appearance and pealing occurs over the extensively involved areas |
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Rubeola Management
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Rubeola decreases the availability of Vit A and it can lead to dry eye syndrome and blindness
Supportive measures include bed rest, and anti pyretics (no Asprin) Antibiotics for secondary infection only in high risk children |
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Rubeola Complications
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Otitis media
PNA Bronchiolitis Laryngitis Encephalitis |
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Rubeola Nursing considerations
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Isolate until 5th day of rash
Maintain bed rest in febrile stage Antipyretics for fever Clean eyelids with warm saline, keep child from rubbing eyes Use cool mist for cough Encourage fluids Keep skin clean use tepid baths for discomfort from rash Avoid chilling for fever d/t seizures |
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Rubella
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German Measles
Caused by a virus (Rubella virus) Found in nasopharyngeal secretions, blood stool and urine Is communicable from 7 days before rash to 5 days after rash appears |
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Rubella Manifestations
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Onset
Can have no symptoms prior to rash in children Adolescents and adults may have: Low grade fever HA Malaise Anorexia Head cold symptoms Sore throat Cough lymphadenopathy |
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Rubella Rash
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First appears on face and rapidly spreads downward to neck arms trunk and legs
By the end of day 1 the body is covered Rash is pinkish red maculopapular exanthema It disappears in the same order it begins Usually gone by 3rd day |
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Rubella
Tx |
No treatment needed
May treat symptoms Complications are rare Isolate child from pregnant women Complecations may include: arthrits and encephalitis. It is the most benign of childhood illnesses, but has teratogenic effect on fetus |
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Mononucleosis
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Kissing disease
Caused by the Epstein-Barr virus Transmitted by direct contact with oral secretions Period of communicability is unknown |
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Mononucleosis Manifestations
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Symptoms appear 10days to 6 weeks after exposure
Presenting symptoms vary greatly Main symptoms are: Malaise Sore throat Lymphadenopaty splenomegaly |
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Mononucleosis
Nursing care |
Symptomatic treatment
Nursing care Provide comfort Encourage fluids Soft foods for sore throat Prevent secondary infection No contact sports due to splenomegaly, should not return to contact sports until spleen is no longer enlarged |
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TORCH
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group of infections that can lead to fetal anomalies or fetal loss if contracted by pregnant women
Include several childhood diseases we immunize against |
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Torch
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TORCH stands for:
Toxoplasmosis Other (such as syphilis, varicella, mumps, parvovirus, and HIV) Rubella Cytomegalovirus Herpes simplex |
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Torch symptoms
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Symptoms of a TORCH infection may include fever and poor feeding. The newborn is often small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is the yellowish discoloration of the skin and eyes called jaundice. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by TORCH infections
OUR MAIN GOAL IS TO PREVENT THESE FROM HAPPENING!!! |
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Poisoning
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The developmental characteristics of children put them at risk for poisoning by ingestion
Poisoning may or may not require emergency intervention Medical evaluation is needed in all cases Poison Control Center (PCC)Phone Numbers are in the front of every phone book With any suspected poisoning the PCC should be contacted |
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Poisoning Treatments
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Activated Charcoal
Absorbs many compounds Cathartics Stimulate evacuation of bowel to decrease absorption time Ipecac Cause emesis to evacuate poison No longer recommended to keep at home Antidotes |
