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323 Cards in this Set
- Front
- Back
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Exanthem def.
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communicable dz that causes skin problems
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how many cases of diaper dermatitis are severe, w/ intense erythema, scaling, papules, ulcerations?
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5%
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peak age for diaper dermatitis?
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9-12 months
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which type of feeding has higher incidence of diaper dermatitis?
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bottle fed
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prolonged contact with _____ causes diaper dermatitis?
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urine/feces
soaps/detergents ointments friction |
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what is the primary organism for diaper dermatitis?
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candida albicans
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sign of candidal albicans diaper dermatitis? (fungus)
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red dots
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how long to use anti-fungal tx after diaper rash goes away?
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2 weeks after bumps go away
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prevent diaper dermatitis?
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zinc oxide, frequent diaper changes
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cradle cap aka?
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sebohhreic dermatitis
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blepharitis def?
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seborrheic derm on eyelids
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otitis exterma def?
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seborrheic derm in external ear canal
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organism causes seborrheic derm?
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malassezia yeast
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places for seborrheic derm?
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most common on scalp. (cradle cap)
also, eyelids, external ear canal, nasolabial folds, inguinal region |
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most common times for seborrheic derm?
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early infancy, then after puberty (sebum production is increased in early infancy)
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how is seborrheic derm dx?
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appearance and location of crusts or scales
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tx of seborrheic derm?
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educate parent to bathe child every 1-2 days. shampoo daily w/ mild soap
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eczema aka?
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atopic dermatitis (it's a category)
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when does infantile eczema begin? where?
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begins 2-6 months
generalized, esp cheeks, scalp, trunk, and extensor surfaces of extremities |
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which type of ezema may resolve w/ age?
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infantile
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when does childhood eczema occur?
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2-3 years. 90% manifest by age 5.
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Where does childhood eczema show up?
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flexural areas (antecubital & poplitela fossa, neck), wrists, ankles, feet (JOINTS)
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defenoxin
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motofen
greater CNS effects than loperamide, Rx only opioid antidiarrheal use w/ atropine (prevent abuse) |
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When does preadolescent/adolescent ezzema occur?
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begins at 12 years and may continue indefinitely
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Where does (pre)adolexcet exema occur?
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face, sides of neck, hands, feet, and to a lesser extent the antecubital and popliteal fossae
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ezema cause??
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unknown. May be assoc w/ dust mites, foods, molds, animal hair/dander. Possible blunted immune response. IgE
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therapeutic mngmt of eczema?
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hydrate skin, tepid baths, mild soap, eucerin. Relive pruitis - aderax or benadryl. reduce flareups - topical coricosteroids, systemic abx, coal tar, wet wraps or pats. Prevent infection - reduced exposure to allergens, topical immunomodulators (ex tacrolimus) to suppress immune response
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S/S of ROSEOLA
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fever, possibly high for 3-5 days. After fever, macropapular rash appears on trunk then neck for 1-2 days
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transmission of ROSEOLA
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direct droplet transmission
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How to treat ROSEOLA??
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treat fever NO ASPIRIN. risk of seizures.
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Is there a vaccine for ROSEOLA?
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no
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Associations w/ ROSEOLA?
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lymphadenopathy, cough, coryza
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Measles AKA?
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Rubeola
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Cause Rubeola/Measles?
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RNA virus
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S/S of Rubeola/Measles?
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3 Cs: coryza, cough, conjuntivitis
Koplick spots in mouth (Blue) |
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Incubation and infectious period of Rubeola/measles?
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8-12 days incubation; infectious 3-5 days before and 4 days after rash
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rubeola/measles transmission method?
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infectious droplets (droplet precautions = mask)
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tx rubeola/measles?
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symptomatic, vit A therapy
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complications of rubeola/measles?
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pneumonia, encephalitis, diarrhea, croup, obstructive laryngitis
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isolation measures for rubeola measles ?
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isolation-urine, resp, blood
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rubella AKA
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German or 3-day measles
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S/S rubella?
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rash, nasal drainage, fever, h/a, eye pain, polyarthrits, nausea, anorexia
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transmission method of rubella?
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droplet precautions (mask)
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incubation period of rubella?
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14-21 days
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complications of rubella?
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arthritis, arthralgia
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what does congential rubella cause?
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growth retardation, blindness, deafness, cardiac probs
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what kind of droplets carry rubella?
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nasopharyngeal secretions and body fluids
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5th disease AKA?
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erytherema infectiosum/ slapped cheek
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incubation period of 5th dz?
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4-14-21 days
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cause of 5th dz?
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parvovirus
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S/S of 5th dz?
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slapped cheek, low fever, runny nose
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which exanthem is deadly to unborn fetus?
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5th dz (erytherma infectiousm)
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association b/t sickle cell and 5th dz?
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parvovirus in sickle cell can cause aplastic crisis
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Chicken Pox caused by?
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varicella zoster
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chicken pox transmission method?
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direct! droplet and airborne!
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chicken pox infectioius period?
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airborn and droplet 1-2 days before onset until lesions are crusted (5-7 days)
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incubation period of chicken px?
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14-21 days
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S/S of chicken px?
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LESIONS: MACULAR, PAPULAR, VESICLES, PUSTULES, CRUST
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Medical tx for chicken pox?
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immunocompromised or severe cases use Acyclovir or immune globulin (VZIG) w/in first 96 hours
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Complications of chick px?
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pneumonia, meningitis, conjunctivits encephalitis.
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how can a baby or fetus catch chick px?
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from the infected mom
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tx of chick px?
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colloidal oatmeal bath, aveeno
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what causes scarlet fever?
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Group A Beta Hemolytic strep
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S/S scarlet fever?
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strawberry tongue. Rash - red, fine, located in groin, neck and axilary
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complications of scarlet fever?
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spread of infection -> sinusitis, menintigis, osteomylitis, rheumatic fever, and glomerulonephritis
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Pertussis aka?
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whooping cough. Cough so much they vomit
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Pertussis description?
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upper resp and persistent cough, usually in infants
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best tx for pertussis?
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Erythromycin
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complications of pertussis?
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pneumonia, hemorrhage, seizure,. infants: resp distress, reflux, apnea
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prevention of pertussis?
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immunization
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incubation period of mumps?
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16-18 days
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transmission method of mumps?
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direct or droplet spread
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infectious period of mumps?
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7-9 days after swelling
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S/S of mumps?
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fever, difficulty swallowing, joint pain, swollen testicles
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complication of mumps?
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epididymyoorchitis (swelling testicles)
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what is the most common tick-borne disorder in the USA?
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Lyme Dz
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Is there a vaccine for lyme dz?
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approved for 15-70 year old
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Stage 1 of lyme dz?
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early skin lesions: red,raised,round (donut or bullseye)
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Stage 2 of lyme dz?
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cardiac and neuro findings. (cerebral ataxia, h/a, N/V
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Stage 3 of lyme dz?
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Arthritis and worsend neuro probs
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Treat lyme dz?
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Early detection and ABX: doxycycline/amoxicillin/cephalosporins. If not treat, 3 weeks later they get stage 2. If still not treat, they keep those symtoms and also get stage 3. Need very heavy ABX at this point. Neuro symptoms may never go away now.
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prevent Lyme dz?
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Off, Deet, light colored clothing in woods
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Rocky Mt Spotted fever transmission and incubation period?
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tick bite. incubation 2-14 days
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Rocky mt spotted fever S/S?
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fever h/a, anorexia, rash
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What happens if rocky mt spotted fever is left untreated?
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untreated rash progresses, hemorrhagic lesion, risk for thrombus, necrosis, edema, and death
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drug tx for rocky mt spotted fever?
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Doxycycline is drug of choice. of tetracycline
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cat scratch fever?
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bartonella henselae
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conjunctivits causes
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bacteria, virus, allergens, trauma
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bacterial conjunctivitis?
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very contagious, don't touch! bright red and prurulent
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how to cleanse eye?
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from inner canthus outward
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cellutitis: cause? S/S? Tx?
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bacteria,
erythrema, edema, heat antibx |
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candidiasis cause? S/S? Tx?
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candida albicans
white patches in mouth, red discrete diaper rash nystatin liquid or oral |
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scabies cause? S/S? Tx?
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female burrows eggs into skin
itching Elimite (premetherine cream) or lindane (Kwell) oral antihistamines and corticosteroid cream |
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Impetigo is caused by?
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it's a 2dary infection caused by staph or strep
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impetigo appearance?
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honey-colored, crusty drainage
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impetigo tx?
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oral and topical antibx. Severe cases will be hospitalized
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how long is impetigo contagious?
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until 48 hours after treatment begins. cover draining lesions
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impetigo facts:
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10 of all childhood skin disorders
spread by direct or indirect contact take the whole course of abx |
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fungal lesions aka?
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dermatophytoses
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tinea corporis?
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fungal infection on body
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tinea capitus?
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on the head
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tinea crusis?
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jock itch
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tinea pedis
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athlete's foot
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tx for tinea (dermatophytoses)
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griseofulvin - oral med
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contact isolation for tinea fungal lesions- how long?
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24-48 hrs
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meds for tinea?
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topical: monistat, lotrimin
oral: grieofulvin newer: itraconazole (sporanox) - works faster but watch liver functions |
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how long does it take to treat tinea?
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months
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what is pediculosis?
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lice
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pediculosis m/c in?
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white girls. lice love blond, clean hair.
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S/S lice?
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scratching may be only symptom! may also see whitish/gray eggs near scalp.
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where will you see nits?
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¼- ½ inch from scalp. and red lesions on scalp
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tx lice
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wash hair w/ Nix or RID, leave shampoo wrapped in towel for 10 min. dangerous for eyes. KILL LICE, REMOVE NITS, RID THE ENVIRONMENT OF LICE AND NITS. REPEAT IN 2 WEEKS.
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acne vulgaris cause? How many adolescents affected?
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alteration in sebaceous hair follicle
affects 85% of adolescents |
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acne drugs side effects?
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suicide, teratogenic birth defects, and depression
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how to treat 1st degree sunburns?
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cool tap water
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how often to reapply sunscreen?
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Q 2-3 hr
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maintenance fluid requirements for 1-10 kg?
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100 mL/kg/day
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maintenance fluid requirements for 11-20 kg?
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1000 mL plus 50 mL/kg for each kg >10
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maintenance fluid requirements for >20 kg?
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1500 mL plus 20 mL/kg for each kg > 20
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Name 11 conditions that increase fluid needs?
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Fever (add 12% for each 1 d C)
Vomitting/diarhhea high output kidney failure diabetes insipidus diabetic ketoacidios burns shock tachypnea radiant warmer phototherapy post-op bowel surgery (gastroschisis, omphalocele) |
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Name 6 conditions that decrease fluid needs?
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CHF
SIADH (syndrome of inappropriate antidiuretic horm) mechanical ventilation after surgery oliguric renal failure increase ICP |
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dehydration definition?
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occurs when total output exceeds total intake, regardless of underlying cause
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most common causes of dehydration?
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vomit, diarrhea, DKA, burns…also, lack of oral intake, esp combined with elevated environmental temp.
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Isotonic dehydration def.
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electrolyte and water deficits are present in equal proportsion. This is the most common one we'll see.
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2 facts about isotonic dehydration?
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major loss of extracellular fluid
can result in shock |
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hypotonic dehydration def.
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electrolyte deficit exceeds water deficit
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usual cause of hypotonic dehydration?
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overuse of diuretics
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describe what happens in hypotonic dehydration:
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water transfers from ECF to ICF, resulting in low ECF
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Na levels in hypotonic dehydration? Symptoms?
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Na < 130
Seizures, LOC change, neuro damage |
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Hypertonic dehydration def?
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water deficit exceeds electrolyte deficit' Losing water, but not electrolytes. Not real common. Maybe the baby gets too much formula.
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Hypertonic dehydration cause?
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water loss, or larger intake of electrolytes
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Hypertonic dehydration sodium levels?
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Na > 150
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Explain the fluid shift in hypertonic dehydration?
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from ICF to ECF
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mild dehydration, %
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(3-5% infant, 3-4% child)
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mild dehydration: S/S
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Normal pulse, RR, BP, behaviour, mucus membranes, fontanel. Slight thirst, cap refil 2 sec, urine SG > 1.020
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moderate dehydration, %
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6-9 % infant, 6-8 % child
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moderate dehydration, S/S
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Slight increase in HR, RR; normal to orthostatic BP. Irritable, dry mucus membranes, moderate thirst, decreased tears, normal/sunken fontanelle, cap refil 2-4 sec, decreased turgor, oliguria
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severe dehydration %
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> or = 10%
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severe dehydration S/S
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very high RR and PR, decreased BP (shock). Lethargy. Parched mucus membranes. Absent tears. Sunken fontanelle. Cap reful > 4 seconds, skin cool and mottled, acrocyanotic (peripheral cyanosis). Oliguria or anuria.
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high specific gravity means?
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dehydration d/t not enough fluids
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what is the leading cause of illness in children < 5 years?
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diarrhea
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acute diarrhea lasts how long?
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self-limiting, under 14 days
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chronic diarrhea lasts how long?
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over 14 days
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causes of chronic diarrhea?
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malabsorption syndromes, inflammatory bowel dz, immunodeficiency, food allergy, lactose intolerance
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what is chronic non-specific diarrhea?
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the child grows normally, no blood or infection, r/t poor diet.
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Reason for ORT (oral rehydration therapy)?
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To enhance the reabsorption of Na and water. Cheaper, safer, more effective and less painful than IV therapy.
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How much ORT is needed?
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Mild dehydration: 50 mL/kg within 4 hours
Moderate dehydration: 100 mL/kg within 4 hours Severe dehydration/Shock: IV fluids 40 mL/kg/hr until HR and LOC are normal, then IV or oral rehyd. Take to hospital! |
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What to feed child recovering from vom/diarr?
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Not the BRAT diet. Give regular food for protein and nutrients.
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Barriers to ORT?
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emesis or stomatitis. Give small amts (2-5 mL) until child can tolerate more. Zofran daily. Can add unsweetend koolaid. goal is to prevent IV.
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what is the first priority for shock? How to do it?
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Rapid expansion of ECF volume. Use isotonic solutions (NS or LR), no dextrose or sugar! 20 mL/kg over 10-20 min. Boluses.
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causes of water intoxication?
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intake of too much water
diluting formula or feeding infants water swimming lessons hypotonic solutions |
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clinical manifestations of water intoxication?
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decreased Na ->seizures, irritability, vomiting, diarrahea
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examples of fluid volume excess
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generalized edema
ascites pulmonary edema cerebral edema respiratory distress |
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how many mL in fluid bags for small children?
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250-500 mL
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how often do infusion IV pumps need to be cleared?
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at least Q 2h
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what size catheter gauge for peds IV?
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22 or 24 g
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what fluids do we often give peds?
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D5 ½ NS
D5 ¼ NS with 20 mEq KCl/L |
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what are 7 important nursing care facts for peds IV infusions?
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I&O q 2h
monitor site q2h ensure child is voiding monitor VS, breath sounds, and perfusion monitor lytes when ordered secure w/ "house" or soft splint prevent infection |
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TPN: how to administer dextrose?
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in central venous catheter!!!! NOT PERIPHERALLY!!! use filtered tubing and titrate the dosing.
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where does an intra-osseous IV go?
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bone marrow of tibia (or manubrium of sternum)
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name the 4 types of shock
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hypovolemic-not enough fluid in the body
cardiogenic-heart isn't pumping hard enough distributive-maldistribution of blood supply obstructive-something pushing against heart |
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Hypovolemic shock- causes?
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volume loss:
trauma (bleeding), burns, diarrhea, vomiting, dehydration |
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Cardiogenic shock- causes?
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impaired cardiac muscle function:
dysrhythmias, CHF, cardiomyopathy |
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Distributive Shock - 3 types?
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1. neurogenic - spinal cord injury
2. anaphylactic-hypersensitivity reaction. airways constrict or vasodilate. not enough fluid pumping back. not actually losing fluid. 3. septic-caused by overwhelming infection. Blood vessels become permeable and start leaking fluid. child may look puffy. |
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Obstructive Shock - causes?
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cardiac tamponade, tension pneumothorax, pulmonary embolism, ductal dependent heart lesion
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Shock definition:
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the inability of the body to meet its metabolic demands
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clinical manifestations of shock (3)
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1. compensated (catch it early!!)
2. decompensated (getting sicker) 3. irreversible (impending cardiac arrest |
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Compensated Shock - symptoms?
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mild tachycardia, apprehension, irritability, normal BP, narrowing pulse pressure, thirst, pallor, decreased urine output
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Decompensated Shock - symptoms?
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Pronounced tachycardia, tachypnea, oliguria, cool pale extremities, poor cap refill, confusion, decreased responsiveness
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Irreversible Shock - symptoms?
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thready weak pulse, hypotension, acidosis, lethargy or coma, anuria
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Management of Shock - 3 things?
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1. ventilation
2. fluid administration 3. vasopressor support |
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Explain fluid administration for shock:
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Isotonic fluids (NS or LR). IV boluses of 10-20 mL/kg over 10-15 min. Reassess the child and repeat as needed. Assess colloids (albumin) and blood if blood loss
If it's trauma and they're bleeding, give them blood. If it's septic shock, don't give blood. |
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Nursing Care in Shock (9 things)
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1. position flat w/ legs elevated
2. monitor VS 3. assess LOC, perfusion, IV site 4. I&O hourly 5. blood gasses, lytes, Hct 6. continous cardiac and pulse ox monitor 7. family support 8. septic: cultures and stat abx 9. anaphylactic: antihist or epi |
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4 types of burns, and examples:
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1. thermal: flames, steam, liquids
2. chemical: caustic agents, cleaning supplies 3. electrical burns: cords 4. radiation: sun, radiation |
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Care of major, moderate, and minor burns?
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Major: >20% of TBSA - burn ctr.
Mod: 10-20% TBSA - hospital Minor: <10% TBSA - outpatient |
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3 phases of burn tx?
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1. emergent: first 24-48 hrs
2. acute: begins when resuscitation finished. ends when wound is covered by tissue. 3. rehabilitative: begins when most of burn area healed. ends when reconstructive & corrective procedures complete. may last for years. |
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management of minor burns?
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stop the burning process. remove clothes jewels. cool water (no ice). Flush chemical burns w/ lots of water. cover burn w/ clean cloth. provide warmth, analgesia. clean w/ mind soap/tepid water. no greasy lotions or butter. use antimicrobial ointment. monitor for infection. immunize for tetanus PRN.
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Priority management of major burns?
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airway give 100% O2
fluid replacement nutrition meds prevent infection |
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Airway Management of major burns?
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AIRWAY - 100% O2
blood gas levels check CO2 leves intubate before severe edema occurs albuterol for bronchoconstriction percussion, postural drainage suctioning PRN |
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GOAL OF Fluid Management of major burns?
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Compensation of water and Na losses. restoring circulating blood volume, correct acidosis, provide perfusion, improve renal function
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Fluid managemnt of major burns?
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Isotonic sol (NS or LR) during early stages
Colloid solutions (albumin or Hespan) after first 24 hrs maintain UOP of 1-2 mL/hr for < 30 kg. maintain UOP of 30-50 mL/hr for > 30 kg. |
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Nutrition management of major burns?
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increase calories
increase protein enteral therapy (PO or feeding tube) supplement TPN less frequently used |
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Medical management of major burns?
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NO prophylactic ABX.
Pain: morphine, fentanyl, dilaudid Sedation: Versed, anesthetics Topical: to minimize wound colonization |
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Infection prevention for major burns?
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standard precautions
reverse isolation client-designated equipment tetanus shot prn monitor for infection restrict plants, flowers, fresh fruit and veg |
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Wound care for major burns?
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hydrotherapy and debridement 1-2 times daily. premedicate. Topical antimicrobials. skin grafts.
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Types of skin grafts? (3)
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temporary (allograft - human cadaver) (xenograft-pigskin)
Permanent (autograft - self)(isograft - another person) Sheet or mesh graft |
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Nursing Dx for burns:
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risk for ineffective thermoregul.
def. fluid volume impaired skin int. risk for impaired tissue perf. impaired phys. mobil. pain risk for infect. altered body image altered family process fear/anxiety |
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Common age for iron deficiency anemia?
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6 months - 2 yrs, and adolescence
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How to dx iron deficiency anemia?
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CBC= low RBC, H/H
reticulocyte count may be low avg size,weight of RBC (MCV & MCH) |
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S/S of iron def. anemia?
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edema
irritable fatigue, muscle weakness pallor tachycardia or murmur glossitis angular stomatitis koilonychia (concave nails) impaired alertness, attn. span |
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Limit of milk for toddlers to prevent anemia?
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maximum 32 oz/day
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good food sources of iron?
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green leafy veg
chicken red meat dried legumes or fruit nuts |
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KNOW THIS: oral supplements for iron def. anemia?
|
give in 2 doses b/w meals w/ vit C
stools tarry or black liquid may stain teeth (Straw, brush teeth) overdose may be fatal |
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3 types of sickle cell dz?
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1. SCA (HgbSS)-most common form in USA in blacks. 90,000 americans.
2. SCC (HgbSC) 3. Sickle thalassemia dz. |
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How is SSD transmitted?
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autosomal recessive. 2 carriers = 25% chance of child w/ dz, 50% chance of child carrier, and 25% of unaffected child. 1 in 12 african americans carries trait. risk of child w/ diz is 0.7%
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Probs created by sickle cell anemia?
|
clogs up the vessels -> dehydration, adidosis, hypoxia, fever. obstruction from adhesion and inflammationS
increased RBC destruction |
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Sickle Cell Anemia (SCA) Dx:
|
manifestations not common before 4-6 months old.
Sickledex - screen that detects but can't differentiate trait from dz. Hgb electrophoresis - definitive Dx. |
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clinical manifestations of SCA?
|
growth retardation, delayed sexual maturity. chronic anemia (Hbg 6-9) Marked susceptibility to sepsis.
Vasoocclusive crisis (ischemia and pain) in joints, hands, feet (dactilitys), abd pain, stroke or visual changes, acute chest syndrome, hematuria, priapism |
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Treat priapism?
|
Painful. if it lasts more than 2 hours, they need to hydrate. if it lasts longer, get tx. it may need surgery.
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Sequestration crisis?
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A manifestation of SCA.
hepatomegaly splenomegaly circulatory collapse |
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chronic vasoocclusive phenomena?
|
Clinical manifestation of SCA.
cardiomegaly, systolic murmur decreased pulmonary fx and increased infecion progressive renal failure splenomegaly blindness Avascular necrosis of hip/shoulder, lordosis, kyphosis, leg ulcers stroke and hemiparesis seizures |
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How to treat SCA?
|
Prevent sickling. Give Hydroxyurea daily. Penicilin prophy. Hydrate. Admin PRBC or exchange transfusion.
The only chance for a cure is HSCT. bur very risky. |
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Acute pain r/t tissue anoxia?
|
CHRONIC PAIN: GIVE MEDS when they ask!!! Mild-torado, tylenol, advil, codeine. Severe: immed, sustained release morphine, oxycodone, hydromorphone, methadone. PCA. avoid demerol. Heat, not cold compresses.
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Pt/family education about anemia/hgb level?
|
avoid high altitudes
frequent rest periods avoid contact sports (splenomegaly) no strenous exercise in the heat |
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Acute Chest Syndrome?
|
An SCA emergency. Lungs get clogged. Report chest pain, fever of 38.9 or higher, congested cough, tachycardia, dyspnea, retractions, decreased O2 sat.
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CVA?
|
an SCA emergency. Report seizures, abnormal behaviour, weakness or inability ot move an extremity, slurred speech, vision changes, vomiting, h/a.
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4 types of Beta-Thalassemia ?
|
1. thalassemia minor (asymptomatic carrier)
2. thalassemia trait (mild microcytic anemia) 3. thalassemia intermedia (splenomegaly & moderate anemia) 4. thalassemia major (Cooley's anemia) |
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What is B-thalassemia? where geographically?
|
an autosomal recessive inheritance. mediterranean, asian, african descent
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How is B-thal dx?
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inadequate production of Hgb A
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clinical effects of B-thal?
|
defective synthesis of HgbA
structurally impaired RBCs shortened lifespan of erythrocyte |
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clinical manifestations of Beta Thal?
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anemia symptoms, small stature, delayed sexual maturation, bronzed speckled complexion, enlarged head, frontal & parietal bossing, prominent malar (cheekbones), flat/depressed bridge of nose, osteoporisis
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Management of Beta Thal?
|
chronic blood transfusions Q 3-4 weeks, to maintain Hgb > 9.5.
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Problems occuring from management of Beta Thal?
|
hemosiderosis = iron overload
hemochromatosis = too much iron being absorbed from GI tract. |
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Antidote to Iron overdose?
|
deferoxamine SUBQ or IV pump almost every night. Also, deferiprone and deferasirox. Give Vit. C along w/ these drugs.
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How to dx aplastic anemia?
|
bone marrow aspirate
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tx of aplastic anemia?
|
*immunosuppressive: cyclosporin, antithymocyte (may cause serum sickness), steroids, Granulocyte colony. stimulating factor, or chemo cyclophosphamide. Last resort is bone marrow transplant. up to 90% survival.
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nursing care for aplastic anemia?
|
no contact sports, avoid sick people, lots of rest, checking bone marrow. pain control, emla before G-CSF injections, emotional support, prevent anemia thrombocytopenia & netropenia.
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what is hemophilia?
|
bleeding disorder from a congenital deficiency of specific coagulation proteins. No clotting factor.
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2 most common forms of hemophilia?
|
1. Factor VIII Deficiency (Hemophilia A). 1 in 5,000 ppl. 80% of all cases
2. Factor IX deficiency (Hem B or Christmas dz). 1 in 50,000 ppl. |
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Transmission of hemophilila?
|
1. 60% of cases are x-linked recessive.
2. gene mutation (no family hx) |
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how is hemophilia dx?
|
Factor VIII and Factor IX assays
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Severity of Factor VIII Hemophilia?
|
1. severe (<1%) spontaneous bleeding w/out trauma
2. moderate (1-5%) bleed w/ trauma 3. mild (5-40%) bleed w/ severe trauma or surgery 60-70% of children are severe |
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How to manage Hemophilia?
|
replace missing clotting factor - vasopressin
corticosteroids |
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|
clinical manifestations of hemophilia?
|
1. brusing/bleeding
2. hemarthrosis (bleeding into joints) can ->bony changes and deformity. early signs:stiff, ache, tingling.obvious signs: warm, red, swell, pain, loss ROM 3. hematuria 4. epistaxis 5. subQ and IM hemorrhages |
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Nursing care of hemophilia?
|
prevent injury, regu exercie and PT, no contact sports, soft toothbrush, electric shaver, subq instead of IM, avoid aspirin or advil. Give them Factor 8 to stop bleeding. Cold packs. Only active ROM. RICE.
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Primary prophylaxis for hemophilia?
|
injection 3x/week or every other day of factor 8. starts age 2-3 yers. child learns to do it himslef age 8-12 yrs.
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Idiopathic Thrombocytopenic Purpura ITP
|
acquired excessive destruction of platelets. maybe autoimmune. 70-80% are children under 10 yrs.
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when does acute ITP start?
|
after URI, parvovirus, Measles, mumps, rubella, varicella
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what is chronic ITP?
|
lasts over 6 months
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clinical manifestations of ITP?
|
petechia, bruising, bleeding from mucus membranes, prolonged bleeding. symptomatic bleeding occurs when platelet <20,000.
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management of ITP?
|
prednisone, IVIG, Anti-D antibody
splenectomy if chronic |
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Anti-D antibody administration to treat ITP
|
cheaper than IVIG. 5-10 min infusion. premedicate w/ tylenol. baseline vitals, then 5, 20, 60 min. fever chills h/a. if reaction, GIVE TYLENOL, BENADRYL, OR HYDROCORTIZONE. observe for an hour after infusion
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nursing care for ITP
|
*restrict activity if platelet<100,000
*helmets *immediate medical tx for trauma *no aspirin or NSAIDS *prevention of infection r/t immunosuppressants |
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What is HSP? Henoch-Schonlein Purpura
|
inflamed small blood vessels->extravasation of RBCs->petechial skin lesions
etiology unknown, often follows URI, springtime |
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|
Who is more likely to have HSP?
|
ages 6 months - 16 years
caucasian twice as high in boys |
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Is HSP a platelet problem?
|
No. The blood vessels swell and burst, then leaking out.C
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Clinical manifestations of HSP? Henoch-Schonlein Purpura
sudden onset |
*purpura of buttocks, legs (may be on trunk and arms too)
*macropapular lesions *urticaria *erythema *edema scalp, eyelids, lips, ears, hands, feet *arthritis knees and ankles *abd pain, N/V *blood in stools *renal involvement (50%) |
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nursing care for HCP
|
don't need hospital
most recover w/in a month NSAIDS Steroids Monitor urine, stool for blooed I&O, low salt, monitor BP body image d/t rash reassurance-rash is temporary long term follow up -nephritis rarely, death r/t GI, renal, CNS |
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How long is the latency period in children?
|
shorter than in adults (can be 10 yrs in adults)
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What does HIV do?
|
takes over T cells, CD4 cells, and B cells to suppress the humoral immunity.
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How do peds contract HIV?
|
1. perinatal transmission (90% of cases)(100-200 infants born in US annually) Decreased d/t testing, antiretroviral, C-section, and avoid breastfed)
2. sexually acquired - 5% of all HIV in USA. teens 3. Drug use 4. Blood products. risk 1 in 250,000 |
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clinical manifestations of HIV in peds?
|
lympadenopathy, HSM, thrush, diarrhea, FTT, devel delays, parotitis
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more clinical manifestations of HIV in peds?
|
Pneumocystis carinii pneumonia (take septra for prophy)
lymphoid bacterial infections wasting syndrome recurrent bacterial infections candidal esophagitis encephalopathy cytomegalovirus dz mycobacterium avium pulmonary candidiasis herpes simplex dz |
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Goals for management of HIV?
|
*slow progression
*promote/restore normal growth and devel *prevent infection (PCP pneumonia) with septra, atovaquone, dapsone, pentamidine *improve quality of life *prolong survival |
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HIV Meds?
|
1. HAART (highly active antiretroviral therapy) 3-4 med combo
2. antiretrovirals: decrease the amt of virus in the body. nucleoside reverst transcriptase inhibitors. non-nucleoside reverse transciptase inhibitors; protease inhibitors |
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nursing care for HIV?
|
parents have the right to tell the schools or not. adolescent education for prevention. recommend all children exposed/infected to get immunizations, but not live virus (MMR and Varcella) if severely infected. nutritional support, comfort, custody, stigma, tell the child or not?
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What is SCID? Severe Combined Immunodeficiency Dz.
|
poor or absent function of T cells and B cells.
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S/S of SCID?
|
Susceptible to infection. Poor growth, URIs, diarrhea, chronic candida of mouth and nails.
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Sx of SCID?
|
family hx, lymphopenia, absence of plasma cells in bone marrow, and lack of lymphocyte response to antigens.
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SCID management?
|
HSCT (stem cell transplant) sibling or parent.
IVIG isolation/sterile environment treat infections gene therapy |
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nursing care in SCID?
|
prevent infection, genetic counseling, family support, fatal if no donor found. PREVENT INFECTION!
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What happens to heart rate and BP during dehydration?
|
HR goes up, BP goes down
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|
most common parasitic pathogen? where spread?
|
Giardiasis, frequently spread in day care centers
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What happens with pinworms? how long can the live out in the environment?
|
Anal itching, tape test reveals pinworms on their bottom while they're sleeping. Can live out in env. for 2-3 weeks.
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How to treat pinworms?
|
Vermox. 2nd dose in 2 weeks. Family may also need tx. contagious, oral-fecal.
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What happens with hookworms? How to treat?
|
Anemia, malnutrition. Treat with Pyrantel Pamoate drug.
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What happens with tapeworms? Where do they come from?
|
Nausea, pain, weight loss. From infected beef or pork.
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What is the #1 cause of GI probs in children? What is the manifestation?
|
Rotavirus. Green, sweet stinky diarrhea.
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What med to kill GI pathogens?
|
Flagyl. alcohol not sufficient, so wash hands thoroughly.
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possible complications of gastroenteritis?
|
sepsis
possible cardiac arrest d/t dehydration |
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|
What type of isolation precautions should be used for C diff?
|
contact precautions
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|
What age for repair of cleft lip?
|
surgical repair by 3-6 months. Cosmetic procedures later 4-5 yrs.
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What are for repair of cleft palate?
|
Age 6-8 months, done in stages
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How do we treat the family of a cleft lip/palate pt?
|
Be supportive. We can show them photos of before/after surgeries of other ppl.
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Nursing Dx for clefts?
|
1. altered family process
2. altered nutrition (less than BR) (preoperative) |
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|
What do we do to improve nutrition for pre-op cleft pt?
|
monitor respt status while feeding
feed in upright position feed slowly, burp q 1-2 oz. rest after each swallow remove oral secretions carefully special nipples and devices bottle feeding encourage bonding, cuddling milk may come out of nose, normal NUTRITION AND AIRWAY |
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Post op care for cleft repair?
|
*monitor for resp distress
*keep objects out of mouth for 7-10 days *CP: liquids from cup, soft foods from side of spoon. feed the child. *cleans lip and suture line post feed and prn *antimicrobial ointment to suture line *no brushing for 1-2 weeks *assess for infection *control pain *speech therapy referral *soft elbow restraint to prevent bending elbow and touching suture site |
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|
What is it called when the esophagus stops before reaching the stomach?
|
Esophageal Atresia
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|
|
What is it called when the trachea connects to the stomach?
|
Tracheoesophageal Fistula (it's most common to have this and EA. at birth. Very dangerous, may aspirate stomach secretions).
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|
What's the most common form of EA and or TEF?
|
EA and TEF combo. Upper esophagus ends in a blind pouch w/ lower part of esophagus connected to the trachea. Clinical and surgical emergency!!
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|
Manifestations of EA/TEF?
|
The 3 Cs: coughing, choking, cyanosis!!
Excessive salivation frothy cough resp distress aspiration pneumonia |
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|
What to do for EA/TEF?
|
Place on NPO immediately to prevent aspiration. Surgery ASAP. Give pacis and stuff to stimulate them orally
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|
Interventions for EA/TEF?
|
pre-op care
Post-op care: *NPO *IV, I&O *teach about G-tube care and feedings *provide for developmental needs *O2 *suction continous to blind pouch *suck reflex should be maintained *pain management, VS |
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|
What is Hirschprung's Dz?
|
AKA: Congenital?Aganglionic Megacolon=congenital absence of autonomic parasympathetic ganglion cells in a distal portion of the colon and rectum.
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|
|
What happens with Hirschprung's Dz?
|
Lack of peristalsis in area of absent ganglions.
Fecal contents accumulate above affected area of the bowel. |
|
|
Correction of Hirchprung's dz?
|
1. Temporary colostomy-cut out the bad part. consult w/ wound care nurse pre-op, and measure bowel distention
2. Reversal of colostomy |
|
|
Nursing considerations for Hirschprungs dz?
|
No rectal temps
NPO assess for pain |
|
|
How to assess for Hirschprungs Dz?
|
1. failure to pass meconium w/in 24 hours
2. Distended abdomen (monitor girth): vomiting, abd tenderness, irritable, dyspnea, cyanosis are signs of bowel perferation 3. chronic constipation alternating w/ diarrhea 4. nutritional deficiency 5. ribbon-like stools in older child 6. entercolitis may occur as an emergent event 7. biopsy |
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Nursing Dx and Interventions for Hirschprungs Dz?
|
1. alteration in bowel elimination
2. alteration in nutrtition Interventions: 1. pre-op 2. bowel cleansing 3. rectal tube 4. Vs - no rectal temps 5. NG tube 6. Colostomy care instructions 7. parent education: wait until after age 2 to toilet train. |
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|
What is Celiac dz?
|
unable to tolerate foods w/ gluten (wheat, barley, rye, oats)
|
|
|
signs/symptoms of Celiac dz?
|
bulky, stinky, frothy stools
abd distention, Vom/Diarrhea/anorexia growth retardation |
|
|
How to dx Celiac?
|
72 hour fecal fat study, small intestine biopsy
|
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|
How to manage Celiac?
|
gluten-free diet for life. Eat rice, corn, quinoa, potato. Can be expensive and difficult for the whole family.
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|
Symptoms of pyloric stenosis?
|
projective vomit
palpate a hard, olive-shaped mass at the bottom of the stomach. get dehydrated. get progressively worse. |
|
|
Pre-op? Post-op? for pyloric stenosis
|
pre-op: don't feed them!
surgery: pyelorectomy post-op: pedialyte w/in a few hrs. Pain management, advance diet as tolerated. go home. |
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|
What is biliary atresia? symptoms?
|
A closed biliary duct., cause unknown, at birth.
S/S: persistent jaundice, stool color. |
|
|
Complications of biliary atresia?
|
liver failure. Bilialry atresia is life-threatening. need to dx by 2 mon.
|
|
|
Treatment of biliary atresia?
|
KASAI procedure. Liver transplant may be needed by age 2.
|
|
|
What is intussusception?
|
telescoping of one part of intestine into another part of the intestine. Ileocolic = ileum into colon. Partial to complete bowel obstruction. blood vessels become trapped and necrotic.
|
|
|
S/S of intussusception?
|
sudden, sharp, bad pain. may or may not have bowel function, liquid stool, bowel distention. Curved elongated mass is palpable, and jelly-like stool.
|
|
|
Tx of intussusception?
|
NPO and tell mom what to expect: air enema attached to a pressure gauge. if that doesn't work, surgery.
|
|
|
Our main concern about appendicitis?
|
Prevent a rupture!
|
|
|
What is the main cause of emergency surgery of children and adolescents?
|
appendicitis
|
|
|
Appendicitis causes?
|
viral infections
fecal obstruction parasites |
|
|
clinical manifestations of appendicitis?
|
1. early-periumbilical pain
2. cardinal symptom=pain, RLQ, progressing intensity in McBurney's point. trouble walking, right hip pain, fever chills, GI. PERFORATION BRINGS RAPID RELIEF, FOLLOWED BY INTENSE PAIN. |
|
|
Dx appendicitis?
|
elevated WBC, increased bands and immature neutrophils
physical exam (N/V/D/C) ultrasound exploratory lap |
|
|
true or false?
the older the child, the more vulnerable they are to fluid and electrolyte imbalances and the greater need for caloric intake required for growth |
false
|
|
|
organic causes of FTT?
|
cerebral palsy, chronic renal failure, congenital heart dz, GER, diabetes, cystic fibrosis, many more
|
|
|
non-organic causes of FTT?
|
lack of parental knowledge/neglect/disturbed bonding, poverty, health/child rearing beliefs, family stress, feeding resistance, insufficient breast milk.
|
|
|
risk factors for maltreatment:
|
1. under age 3
2. physically disabled 3. result of unwanted pregnancy 4. has a vulnerable trait/seems different |
|
|
how many calories/oz should formula have when we're trying to augment the feeding for FTT?
|
24-30 cal/oz. maybe add a little veggie oil, too.
|
|
|
good ways to provide adequate nutrition for FTT?
|
1. formula 24-30 cal/oz
2. offer food/drink q 2-3 h 3. maintain consistent mealtimes 4. milk/formula, not water/juice 5. limit to 35 min. 6. feed in quiet envirmont 7. eye contact, role model |
|
|
4 types of GI reflux?
|
1. regurgitation/ spit up
2. emesis/vomit 3. GER 4. GERD GER and GERD are if the symptoms persist. |
|
|
Dx reflux?
|
upper GI
barium swallow endoscopy |
|
|
manage reflux?
|
thickener
position upright for 30 min, and on right side meds H2 antagonists |
|
|
spitting up/regurgitation?
|
small amount, little force. common in newborn. spincter not effective until 6-12 mon. more common in bottle fed babies. not assoc w/ allergies or food intolerance.
|
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|
GER
|
transfer of gastric contents into esophagus. normal in healthy peds and adults. brief, asymptomatic. doesnt extend above distal esophagus.
|
|
|
GERD
|
occurs when the gastric contents reflux INTO the esophagus or oropharynx and produces symptoms.
|
|
|
GERD causes?
|
relaxation of lower esophageal sphincter d/t:
gastric distention CNS or coughing produces high abd pressure slowed gastric emptying hiatal hernia (adults) G tube or intubation |
|
|
surgery for GERD?
|
Nisan Fundoplication - take top of stomach and wrap it around bottom of esophagus.
|
|
|
predisposing factors for GERD?
|
preemie
bronchopulmonary dysplasia TEF/EA repairs neuro disorders scoliosis asthma CF CP |
|
|
complications of GERD?
|
FTT
resp difficulties, asthma barret's mucosa (cancer) |
|
|
Dx GERD?
|
H&P
modified barium swallow study upper GI series esophageal pH monitoring endoscopy w/ biopsy |
|
|
treat GERD?
|
1. meds: Proton pump inhibitors: prilosec, prevacid. Histmaine receptor blockers: pepcid, zantac.
2. thickened formula 3. positioning 4. small, frequent feedings, may thicken w/ rice 5. G tube placement |
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|
what does the hypothalamus secrete?
|
"releasing hormones", which act on the anterior pituitary gland
|
|
|
what does the anterior pituitary gland secrete?
|
1. tyroid stim hormone TSH
2. Adrenocorticotropic hormone ACTH 3. Growth hormone GH 4. prolactin 5. follicle-stim horm FSH 6. Leutinizing horm. LH |
|
|
what does the posterior hormone secrete?
|
1. antidiuretic hormone ADH
2. oxytocin (in response to nerve stimuli) |
|
|
most common cause of hypo- or hyper- pituitarism?
|
tumor or pituitary or hypothalmic region
|
|
|
S/S of GH deficiency?
|
1. growth slows after 1 yr old (delayed linear growth)
2. height <= 2 standard deviations for age 3. delayed teeth development |
|
|
dx GH deficiency?
|
r/o other causes
x-ray for bone age assess for deficiencies in IFG-1 (1st) and GH |
|
|
tx Idiopathic Hypopituitarism and/or GH deficiency?
|
STOP EPIPHYSEAL CLOSURE.
somatropin SQ somatrem SQ/IM given daily hs for 4-6 years to achieve bone maturation of 16 years for males and 14 years for females |
|
|
what causes precocious puberty?
|
50% have central origin - hypothalamic activation
|
|
|
S/S precocious puberty?
|
1. premature thelarche (Breasts) or testicular enlargement
2. accelerated growth 3. premature pubarche (hair) 4. premature menarche or spontaneous erections 5. deepening voice, acne |
