Peds Exam 3

Front 1

School age

Back 1

•6-12 years; begin with shedding first tooth; ends at puberty. Growth/height steady rate. 2 in/yr 4.5-6.5 lbs/yr
•boys tend to be slightly taller and heavier.
•slimmer look longer legs; fat gradually diminishes
•more damage by muscular injury caused by overuse.

Front 2

Changes that indicate maturity in children

Back 2

Decrease in head circumference, in waist circumference and an increase in leg length in relation to height (predicts readiness for the demands of school)

Front 3

changes in RR, HR and BP

Back 3

HEART RATE AND RESPIRATORY RATE SLIGHTLY DECREASE AND BLOOD PRESSURE INCREASE

Front 4

Freud

Back 4

: Latency period, relationships with same sex peers

Front 5

Erikson

: Industry Vs Inferiority:

Back 5

Increased ability to cooperate and to cope effectively with people.

Industry: school age children are eager to develop skills and participate in meaningful and socially useful work (acquire a sense of competence and perfection and how to be useful contributing to their social communities

Front 6

Down Syndrome Clinincal manifestations

Back 6

o Rounded and small skull
o Flat occiput
o Enlarged anterior fontanel
o Inner epicanthal folds
o Small nose
o Saddle nose (depressed nasal bridge)
o Small ears and narrow canals
o Short pinna
o High narrow palate
o Protruding tongue
o Short and broad neck
o Neck skin escess
o Shorterned rib cage
o Umbilical hernia
o Small penis
o Short hands and stubby fingers
o Big space btw first and second toe
o Mottling of skin, etc

Front 7

Several physical problems are associated with Down Syndrome

Back 7

o Congenital heart malformations (septal defects)
o Respiratory tract infections are prevalent
o Cardiac + respiratory problems main cause of death during the first year
o Thyroid dysfunction
o Great incidence of leukemia
o Sleep apnea
o Frequent ear infections
o Sensory problems: hearing loss, strabismus (squint-crossed eyes), nystagmus (rapid side to side movement of the eye)
o Airway compromise due to large tongue

Front 8

Down Syndrome...Nursing Mgmt

Back 8

-encourage swaddling before picking up due to hypotonicity of muscles and hyperextensibility of joints.
-underdeveloped nasal bone causes inadequate drainage leading to URI. use bulb syringe, rinse mouth after feedings, inc fluid intake, cool mist vaporizer
-clear nose before feeding
-long tongue use small but long straight spoon to push food toward the back and side of the mouth

Front 9

Down Syndrome...Nursing Mgmt (cont)

Back 9

-constipation: increase fiber and fluid
-prevent obesity: low BMRs
-skin prone to cracking and infections; rough and dry. skin care, lip balms

Front 10

Type 1 Diabetes

Back 10

More predominant in Caucasians
-destruction of the pancreatic B cells, leading to insulin deficiency
-autoiimune or idiopathic
-SX: polyuria, polydispsia, and polyphagia
-common ketoacidosis(dehydration, electrolyte imbalance, acidosis, kussmaul’s respirations.(metabolic acidosis)

Front 11

Type 2 Diabetes

Back 11

-Native Americans, Hispanic and African American
-usually arise because insulin resistance in which the body fails to use insulin properly combined with insulin deficiency
-most common in people over 45 with asedentary life, obese and w/ family hx.
-SX: may be related to long term complications

Front 12

Diabetes Dx

Back 12

An 8 hour fasting blood glucose of >126, a random value of >200 or an oral glucose of >200
KETOACIDOSIS: >330, bicarbonate <15 PH <7.30

Front 13

Diabetes Tx

Back 13

o Regular insulin is better administered at least 30 min. before meals (allow time for absorption)

Front 14

Diabetes o Monitor for signs of hypoglycemia (usually before meals or when medication is in its peak):

Back 14

• Nervousness, pallor, palpitations, sweating, and hunger. More severe responses: HA, weakness, dizziness, drowsiness, loss of coordination seizures and coma. Urinary ketones may be present as a result of starvation. GIVE 10 TO 15G OF SIMPLE CARBOHYDRATE: 1 tbsp of table sugar or orange juice or honey, and after a complex carb like a slice of bread or a cracker or peanut butter or milk. For a sever reaction administer glucagon.
• For a mild rxn: milk or fruit juice.
• Promote always carry glucose tabs or lifesavers

Front 15

DKA (DIABETES KETOACIDOSIS)

Back 15

o IS the most complete state of insulin deficiency, LIFE THREATENING SITUATION, fruity breath, dehydration,abdominal pain,metabolic acidosis , glucose >330;
o Rapid assessment, adequate insulin to reduce elevated blood glucose, fluids for dehydration slowly to avoid cerebral edema replace over 24-48 hrs, and electrolyte replacement (potassium especially slowly to avoid cardiac arrhythmia,MAKE SURE THEY ARE VOIDING FIRST NEVER K+ BOLUS).
o Insulin tx is initiated after the initial rehydration bolus
o Report any increase in temperature
o Monitor VS and I&O

Front 16

Dietary changes in the schoolager

Back 16

• Caloric needs are diminished in relation to body size
• Importance of a balanced diet to promote growth, quality of food depends of what parents eat
• Be careful with foods that do not promote growth like sugars, starches and excess fats, increase obesity d/t sedentary life as well

Front 17

Glomerulonephritis

Back 17

• Increase water and sodium retention, increase BP
• Periorbital edema (face most common), extremities as day progresses
• Cloudy urine (tea or cola colored) decrease volume
• Pallor, headache, dysuria, increase BP, irritable, lethargic
• DX: strep infection 10 days before
• HEMATURIA & PROTEINURIA
• Azotemia: increase level of nitrogen
• Increase BUN/CR
• Can cause cardiac enlargement/ congestion
• MGMT: decrease sodium amd H2O intake
• Decrease potassium intake for oliguria
• VS tracking, BP especially often
• Daily weight
• I & O strict
• Check LOC
• Increase rest

Front 18

Nephrotic Syndrome

Back 18

• Most common in 2 – 7 years old
• Capillary permeability to protein
• Hypoalbuminuria: protein loss in urine
• Edema: can cause ascites
• Hypovolemia risk: decrease fluid vascular volume
• SX: weight gain over days and weeks
• Clothes that fit tightly
• Decrease urine output
• Pallor and fatigue
• Decreased BP, puffiness face
• MGMT: low salt diet
• Fluid restriction for severe cases
• Diuretics tx
• Steroids
• Monitor I&O
• If baby on diaper place cotton balls in diaper and squeeze in morning

Front 19

Seizure Disorders

Back 19

o MALFUNCTION OF THE BRAIN’S ELECTRICAL SYSTEM
o Are the most common treatable neurologic disorder in children. SEIZURES ARE A SYMPTOM OF AN UNDERLYING DISEASE (Infection, tumor, toxin, trauma, hypoxia or febrile seizures), SHOULDN’T BE TREATED WITH LTC ANTIEPILEPTYC DRUGS

Front 20

Types of seizures

Back 20

GENERALIZED
Involve both hemispheres of the brain and are w/o local onset

PARTIAL:
Have a local onset and involve a relatively small location in the brain

Front 21

Generalized Seizures - Grand Mal

Back 21

TONIC CLONIC SEIZURES: GRAND MAL
-Most common and more dramatic of all
-occur w/o warning
Tonic Phase:
Last 10 -20 sec, eyes roll upward, immediate lost of consciousness, if standing fall to floor, generalized stiffness, flexed arms, legs, head and neck extended; apneic, may become cyanotic, increase salivation and loss of swallowing reflex.
Clonic Phase:
Last about 30 seconds but can be last 30 min. or more
Violent jerking movements (contraction and relaxation of body muscles)
Foam of the mouth
Incontinent of urine and feces

Front 22

Generalized Seizures - Mycoclonic

Back 22

Variety of seizure episodes
Sudden, brief contractures of muscles
Singly or repetitively
Both sides jerk
No postictal state
May or not include loss of consciousness

Front 23

Absence seizures: petite mal:

Back 23

Usually last 5-10 seconds
May cause child to drop objects
Stop talking then begin again after a few seconds
Lip smacking,
May need to reorient self to previous activity
Usually cease at puberty

Front 24

Postictal State:

Back 24

Appears to relax
Semiconscious and difficult to arouse
May awaken in few mins.
Poor coordination
Remains confused for several hours
May vomit or complaining of HA

Front 25

Partial Seizures:

Back 25

SIMPLE:
No change in LOC
Include numbness, tingling, or pain in one area
Any age
Usually less than 30 secs.
Frequent clonic movements
COMPLEX:
Loc changes
AURA
Déjà vu
Uncommon before age 3

Front 26

o STATUS EPILEPTICUS

Back 26

continuos seizure that lasts more than 30 minutes from which the child doesn’t regain a premorbid LOC:
• ABC’s: administering O2, and gain IV access, immediately after IV administration of antiepileptic agents (valium or ativan( lorazepam), lorazepam (ativan) have a longer duration and causes less resp. depression
• Rectal diazepam is a safe tx for home mgmt, or midazolam (nasal)
• Monitor BP (first 30 min. BP is elevated) and T.

Front 27

o DURING SEIZURE:

Back 27

o Remain calm
o Time seizure episode
o If child is standing or seated ease child to floor, place pillow or folded blanket under child’s head
o Loose restrictive clothing
o Remove eyeglasses
o Clear area of any hazards
o Allow seizure to end w/o any interference
o If vomitus occur put child on the side
o DO NOT; attempt to restraint child; don’t put anything on the mouth; don’t give any fluid or food.

Front 28

o AFTER SEIZURE;

Back 28

o Time postictal period
o Check for breathing, check position of head and tongue
o Reposition if head is hyperextended
o If child is not breathing give cpr and call EMS
o Keep child on side
o Remain with client
o Check for unequal pupils or persistent vomit after seizure

Front 29

PEDICULOSIS CAPITUS -HEAD LICE

Back 29

EGG ND NT FOND ON THE H R HFT
– EGGS AND NITS FOUND ON THE HAIR SHAFT
CLOSE TO THE SKIN
TREATMENT WITH PEDICULOSIDES AND MANUAL
– TREATMENT WITH PEDICULOSIDES AND MANUAL
REMOVAL OF NIT CASES
LICE CAN’T FLY OR JUMP NO RESPECT FOR AGE
– LICE CANT FLY OR JUMP -NO RESPECT FOR AGE,
CLEANLINESS OR SOCIOECONOMICS
– CAUTION AGAINST SHARING COMBS CAPS
– CAUTION AGAINST SHARING COMBS, CAPS,
SCARVES, PILLOWS, ETC.

Front 30

CEREBRAL PALSY:

Back 30

o Disorder of development and posture, causing activity limitation due to nonprogressive disturbances that occurred in the developing fetal or infant brain due to intrauterine infection, birth asphyxia, or unknown prenatal factors (80%) shaken baby syndrome can be another cause, bacterial meningitis, viral encephalitis, MVA, and child abuse.

o PRIMARY DISTURBANCE: abnormal muscle tone and coordination
o DX: reflexes found after the age at which they should have disappear

Front 31

CP: Classification/Clinical
Manifestations

Back 31

• Ataxic
– Wide based gate
– Rapid, repetitive movements performed poorly
• Dyskinetic/atheoid
– Abnormal involuntary movements
– Athetosis-slow, “wormlike”, writhing movements (involves all
extremities along with tongue, facial muscles, and trunk)
• Mixed-type/dystonic
– Combination of spasticity and athetosis
• Spastic
– Involves one or both sides
Involves one or both sides
– Hypertonicity with poor control of posture, balance and
coordinated motion
• Impairment of fine and gross motor skills

Front 32

CP: Nursing Implications

Back 32

•Ensure adequate nutrition
• Maintain skin integrity
• Promote physical mobility
• Promote safety
• Promote growth and development
• Emotional support to families
• Educate parents and patients

Front 33

CP: Nursing considerations

Back 33

Common clinical findings
Infancy
•Extreme irritability
•Extreme irritability
•Very early preferential unilateral hand use
•Feeding difficulties
•Persistent primitive reflexes
•Associated disabilities/disorders
-Mental retardation in two thirds of
individuals
-Seizures
-Sensory impairment (vision and hearing)

Front 34

Candidiasis

Back 34

manifestations: Grows in moist areas, inflamed areas w/ white exudates, peeling, and easy bleeding
pruritic

Mgmt: Amphotericin B, nystatint ointments
-predisposed in pt w/ abx therapy, diabetes and immunosupression

Front 35

Candidiasis cont

Back 35

-don’t scrape areas
Common form of diaper dermatitis.
Oral form common in babies (Thrush), if not clean from neck folds is candida
Vaginal form in older females

Front 36

Sickle Cell Disease

Back 36

-caused by autosomal recessive gene. (both parents must be carriers)
-abnormal shape of hgbS causes obstruction of vessels and increased RBC destruction.
-Causes intermittent blocks in tissue ischemia and infarction.
-multiple problem upon area affected. Stroke, blindness, gallstones, hematuria, abd pain, pneumonia, chf, osteomyelitis, chronic skin ulcers

Front 37

Sickle Cell Disease Crisis

Back 37

Crisis can be caused by:
Infection, dehydration, hypoxia, stress, high altitude.
-types of sickle crisis
vaso-occlusive-causes ischemia, pain and strokes
sequestration-pooling of blood in liver/spleen causes hypovolemic shock
aplastic - failure to make new RBC

(Vaso-occlusive = painful episode
Aplastic – dimished rbc production > profound anemia. Can be due to overwhelming sepsis)

Front 38

Sickle Cell Tx

Back 38

H = hydration
O= Oxygenation
P = Pain Relief

bed rest and hydration
correct metabolic acidosis
pain relief
blood transfusions
Abx for Infx
O2 if needed
Oral penicillin prophylaxis
Vaccines for pneumococcus, meningiococcus and HepB

Front 39

pediculosis mgmt

Back 39

• Nurse need to educate parents about pediculosis, emphasize that anyone can get it.
• Louse don’t jump or fly but it can be transmitted from one person to other through personal items
• Caucasian children more likely to be infested: straight hair and girls
• Slumber parties put children at risk
• Avoid sharing combs, hair ornaments, hats, caps, scarves, coats, etc.
• Children who share lockers are more likely to be infested
• Is NOT transmitted by pets
• Nurse need to inspect head of children if noted extreme scratching with two tongue depressors or flat sticks. Wear gloves. Lice are visible to the naked eye.

Front 40

pediculosis mgmt (cont)

Back 40

• If infestation is found: teach parents to read instructions carefully, cover the eyes with a towel or washcloth (prevent medication from entering the eye and cause chemical conjunctivitis).
• Manual removal is necessary with an extra fine tooth comb
• Retreatment may be needed
• Home remedies work little and increased risk for infection with s.aureus
• Hot air for 3 mins. Can eliminate lice infestations
• Avoid sharing personal items
• Wash all linens, towels and clothes in hot water and hot dryer for 20 min
• Vacuum carpets, car seats, pillows, stuffed animals, furniture
• If unable to wash items seal them for 14 day
• Can come back to school after proper treatment.

Front 41

Leukemia: S/Sx

Back 41

A = Anemia (low Hgb)
N = Neutropenia - risk of infection (small number of neutrophils)
T = Thrombocytopenia - bleeding

Front 42

Leukemia: Nursing Care

Back 42

-education and support of the family
-pain relief
-Prevention of complications- infection, hemorrhage, anemia
-mgmt of therapy S/E
N/V, anorexia, mucosal ulceration, neuropathy, alopecia, moon face, hemorrhagic cystitis, mood changes

Front 43

Leukcytopenia

Back 43

bnormal decrease in the number of leukocytes in the blood

Front 44

thrombocytopenia

Back 44

any disorder in which there is an abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. This condition is sometimes associated with abnormal bleeding.

Front 45

Burn managment

Back 45

-1ST 12 -24 HOURS FLUID REPLACEMENT MOST IMPORTANT
-NUTRITION
-MEDICATION: ABX/PAIN MANAGEMENT
-PRIMARY EXCISION/DEBRIDEMENT/ HYDROTHERAPY
-TOPICAL ANTIMICROBIALS (SILVADENE)
-GRAFTING: BIOLOGICS/PIG/HOMOGRAFT/

Front 46

Burn mgmt cont

Back 46

H2O VOLUME LOSSES/ SODIUM LOSSES TO INTERSTITIAL SPACES
RESTORE CIRCULATING VOLUME
NUTRITION: INCREASED CATABOLIC REQUIREMENTS
MEDS: PROPHYLACTIC ABX NOT USUALLY; PREVENTION MOST IMPORTANT
PAIN MGMT: SEDATION/ANALGESIA/PCA PUMP WITH CONTINUOUS RATE

Front 47

Wilm's Tumor Nursing mgmt

Back 47

Pre-op - Do not palpate abd; high risk for spreading cells. tumor is usually encapsulated
-b/c of fast pace of surgery and therapy, the family needs lots of support and education.

Front 48

Wilm's Tumor Nursing mgmt (cont)

Back 48

post op usually rapid recovery
-there is a risk of intestinal obstruction and GI activity is carefully monitored
-Also monitor BP, urine output, and signs of infx
-family increase support
-child should avoid contact sports since left with only one kidney.`

Front 49

Wilm's Tumor Nursing mgmt (cont)

Back 49

Mets to lungs, liver or bone via the blood or via the lymphatics to the lymph nodes
Mass deep within the flank
Pain
Hematuria
Hypertension
Fever
DX
Liver enzymes – high alt, ast and ldh
Ua – hematuria
Cbc – increased rbc , polycythemia since tumor secretes more erythropoitin
DX – IVP and abdominal scan to determine extenstion to the bone marrow.