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323 Cards in this Set

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Exanthem def.
communicable dz that causes skin problems
how many cases of diaper dermatitis are severe, w/ intense erythema, scaling, papules, ulcerations?
5%
peak age for diaper dermatitis?
9-12 months
which type of feeding has higher incidence of diaper dermatitis?
bottle fed
prolonged contact with _____ causes diaper dermatitis?
urine/feces
soaps/detergents
ointments
friction
what is the primary organism for diaper dermatitis?
candida albicans
sign of candidal albicans diaper dermatitis? (fungus)
red dots
how long to use anti-fungal tx after diaper rash goes away?
2 weeks after bumps go away
prevent diaper dermatitis?
zinc oxide, frequent diaper changes
cradle cap aka?
sebohhreic dermatitis
blepharitis def?
seborrheic derm on eyelids
otitis exterma def?
seborrheic derm in external ear canal
organism causes seborrheic derm?
malassezia yeast
places for seborrheic derm?
most common on scalp. (cradle cap)
also, eyelids, external ear canal, nasolabial folds, inguinal region
most common times for seborrheic derm?
early infancy, then after puberty (sebum production is increased in early infancy)
how is seborrheic derm dx?
appearance and location of crusts or scales
tx of seborrheic derm?
educate parent to bathe child every 1-2 days. shampoo daily w/ mild soap
eczema aka?
atopic dermatitis (it's a category)
when does infantile eczema begin? where?
begins 2-6 months
generalized, esp cheeks, scalp, trunk, and extensor surfaces of extremities
which type of ezema may resolve w/ age?
infantile
when does childhood eczema occur?
2-3 years. 90% manifest by age 5.
Where does childhood eczema show up?
flexural areas (antecubital & poplitela fossa, neck), wrists, ankles, feet (JOINTS)
defenoxin
motofen
greater CNS effects than loperamide, Rx only
opioid antidiarrheal

use w/ atropine (prevent abuse)
When does preadolescent/adolescent ezzema occur?
begins at 12 years and may continue indefinitely
Where does (pre)adolexcet exema occur?
face, sides of neck, hands, feet, and to a lesser extent the antecubital and popliteal fossae
ezema cause??
unknown. May be assoc w/ dust mites, foods, molds, animal hair/dander. Possible blunted immune response. IgE
therapeutic mngmt of eczema?
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
S/S of ROSEOLA
fever, possibly high for 3-5 days. After fever, macropapular rash appears on trunk then neck for 1-2 days
transmission of ROSEOLA
direct droplet transmission
How to treat ROSEOLA??
treat fever NO ASPIRIN. risk of seizures.
Is there a vaccine for ROSEOLA?
no
Associations w/ ROSEOLA?
lymphadenopathy, cough, coryza
Measles AKA?
Rubeola
Cause Rubeola/Measles?
RNA virus
S/S of Rubeola/Measles?
3 Cs: coryza, cough, conjuntivitis
Koplick spots in mouth (Blue)
Incubation and infectious period of Rubeola/measles?
8-12 days incubation; infectious 3-5 days before and 4 days after rash
rubeola/measles transmission method?
infectious droplets (droplet precautions = mask)
tx rubeola/measles?
symptomatic, vit A therapy
complications of rubeola/measles?
pneumonia, encephalitis, diarrhea, croup, obstructive laryngitis
isolation measures for rubeola measles ?
isolation-urine, resp, blood
rubella AKA
German or 3-day measles
S/S rubella?
rash, nasal drainage, fever, h/a, eye pain, polyarthrits, nausea, anorexia
transmission method of rubella?
droplet precautions (mask)
incubation period of rubella?
14-21 days
complications of rubella?
arthritis, arthralgia
what does congential rubella cause?
growth retardation, blindness, deafness, cardiac probs
what kind of droplets carry rubella?
nasopharyngeal secretions and body fluids
5th disease AKA?
erytherema infectiosum/ slapped cheek
incubation period of 5th dz?
4-14-21 days
cause of 5th dz?
parvovirus
S/S of 5th dz?
slapped cheek, low fever, runny nose
which exanthem is deadly to unborn fetus?
5th dz (erytherma infectiousm)
association b/t sickle cell and 5th dz?
parvovirus in sickle cell can cause aplastic crisis
Chicken Pox caused by?
varicella zoster
chicken pox transmission method?
direct! droplet and airborne!
chicken pox infectioius period?
airborn and droplet 1-2 days before onset until lesions are crusted (5-7 days)
incubation period of chicken px?
14-21 days
S/S of chicken px?
LESIONS: MACULAR, PAPULAR, VESICLES, PUSTULES, CRUST
Medical tx for chicken pox?
immunocompromised or severe cases use Acyclovir or immune globulin (VZIG) w/in first 96 hours
Complications of chick px?
pneumonia, meningitis, conjunctivits encephalitis.
how can a baby or fetus catch chick px?
from the infected mom
tx of chick px?
colloidal oatmeal bath, aveeno
what causes scarlet fever?
Group A Beta Hemolytic strep
S/S scarlet fever?
strawberry tongue. Rash - red, fine, located in groin, neck and axilary
complications of scarlet fever?
spread of infection -> sinusitis, menintigis, osteomylitis, rheumatic fever, and glomerulonephritis
Pertussis aka?
whooping cough. Cough so much they vomit
Pertussis description?
upper resp and persistent cough, usually in infants
best tx for pertussis?
Erythromycin
complications of pertussis?
pneumonia, hemorrhage, seizure,. infants: resp distress, reflux, apnea
prevention of pertussis?
immunization
incubation period of mumps?
16-18 days
transmission method of mumps?
direct or droplet spread
infectious period of mumps?
7-9 days after swelling
S/S of mumps?
fever, difficulty swallowing, joint pain, swollen testicles
complication of mumps?
epididymyoorchitis (swelling testicles)
what is the most common tick-borne disorder in the USA?
Lyme Dz
Is there a vaccine for lyme dz?
approved for 15-70 year old
Stage 1 of lyme dz?
early skin lesions: red,raised,round (donut or bullseye)
Stage 2 of lyme dz?
cardiac and neuro findings. (cerebral ataxia, h/a, N/V
Stage 3 of lyme dz?
Arthritis and worsend neuro probs
Treat lyme dz?
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.
prevent Lyme dz?
Off, Deet, light colored clothing in woods
Rocky Mt Spotted fever transmission and incubation period?
tick bite. incubation 2-14 days
Rocky mt spotted fever S/S?
fever h/a, anorexia, rash
What happens if rocky mt spotted fever is left untreated?
untreated rash progresses, hemorrhagic lesion, risk for thrombus, necrosis, edema, and death
drug tx for rocky mt spotted fever?
Doxycycline is drug of choice. of tetracycline
cat scratch fever?
bartonella henselae
conjunctivits causes
bacteria, virus, allergens, trauma
bacterial conjunctivitis?
very contagious, don't touch! bright red and prurulent
how to cleanse eye?
from inner canthus outward
cellutitis: cause? S/S? Tx?
bacteria,
erythrema, edema, heat
antibx
candidiasis cause? S/S? Tx?
candida albicans
white patches in mouth, red discrete diaper rash
nystatin liquid or oral
scabies cause? S/S? Tx?
female burrows eggs into skin
itching
Elimite (premetherine cream) or lindane (Kwell)
oral antihistamines and corticosteroid cream
Impetigo is caused by?
it's a 2dary infection caused by staph or strep
impetigo appearance?
honey-colored, crusty drainage
impetigo tx?
oral and topical antibx. Severe cases will be hospitalized
how long is impetigo contagious?
until 48 hours after treatment begins. cover draining lesions
impetigo facts:
10 of all childhood skin disorders
spread by direct or indirect contact
take the whole course of abx
fungal lesions aka?
dermatophytoses
tinea corporis?
fungal infection on body
tinea capitus?
on the head
tinea crusis?
jock itch
tinea pedis
athlete's foot
tx for tinea (dermatophytoses)
griseofulvin - oral med
contact isolation for tinea fungal lesions- how long?
24-48 hrs
meds for tinea?
topical: monistat, lotrimin
oral: grieofulvin
newer: itraconazole (sporanox) - works faster but watch liver functions
how long does it take to treat tinea?
months
what is pediculosis?
lice
pediculosis m/c in?
white girls. lice love blond, clean hair.
S/S lice?
scratching may be only symptom! may also see whitish/gray eggs near scalp.
where will you see nits?
¼- ½ inch from scalp. and red lesions on scalp
tx lice
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.
acne vulgaris cause? How many adolescents affected?
alteration in sebaceous hair follicle
affects 85% of adolescents
acne drugs side effects?
suicide, teratogenic birth defects, and depression
how to treat 1st degree sunburns?
cool tap water
how often to reapply sunscreen?
Q 2-3 hr
maintenance fluid requirements for 1-10 kg?
100 mL/kg/day
maintenance fluid requirements for 11-20 kg?
1000 mL plus 50 mL/kg for each kg >10
maintenance fluid requirements for >20 kg?
1500 mL plus 20 mL/kg for each kg > 20
Name 11 conditions that increase fluid needs?
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)
Name 6 conditions that decrease fluid needs?
CHF
SIADH (syndrome of inappropriate antidiuretic horm)
mechanical ventilation
after surgery
oliguric renal failure
increase ICP
dehydration definition?
occurs when total output exceeds total intake, regardless of underlying cause
most common causes of dehydration?
vomit, diarrhea, DKA, burns…also, lack of oral intake, esp combined with elevated environmental temp.
Isotonic dehydration def.
electrolyte and water deficits are present in equal proportsion. This is the most common one we'll see.
2 facts about isotonic dehydration?
major loss of extracellular fluid
can result in shock
hypotonic dehydration def.
electrolyte deficit exceeds water deficit
usual cause of hypotonic dehydration?
overuse of diuretics
describe what happens in hypotonic dehydration:
water transfers from ECF to ICF, resulting in low ECF
Na levels in hypotonic dehydration? Symptoms?
Na < 130
Seizures, LOC change, neuro damage
Hypertonic dehydration def?
water deficit exceeds electrolyte deficit' Losing water, but not electrolytes. Not real common. Maybe the baby gets too much formula.
Hypertonic dehydration cause?
water loss, or larger intake of electrolytes
Hypertonic dehydration sodium levels?
Na > 150
Explain the fluid shift in hypertonic dehydration?
from ICF to ECF
mild dehydration, %
(3-5% infant, 3-4% child)
mild dehydration: S/S
Normal pulse, RR, BP, behaviour, mucus membranes, fontanel. Slight thirst, cap refil 2 sec, urine SG > 1.020
moderate dehydration, %
6-9 % infant, 6-8 % child
moderate dehydration, S/S
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
severe dehydration %
> or = 10%
severe dehydration S/S
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.
high specific gravity means?
dehydration d/t not enough fluids
what is the leading cause of illness in children < 5 years?
diarrhea
acute diarrhea lasts how long?
self-limiting, under 14 days
chronic diarrhea lasts how long?
over 14 days
causes of chronic diarrhea?
malabsorption syndromes, inflammatory bowel dz, immunodeficiency, food allergy, lactose intolerance
what is chronic non-specific diarrhea?
the child grows normally, no blood or infection, r/t poor diet.
Reason for ORT (oral rehydration therapy)?
To enhance the reabsorption of Na and water. Cheaper, safer, more effective and less painful than IV therapy.
How much ORT is needed?
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!
What to feed child recovering from vom/diarr?
Not the BRAT diet. Give regular food for protein and nutrients.
Barriers to ORT?
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.
what is the first priority for shock? How to do it?
Rapid expansion of ECF volume. Use isotonic solutions (NS or LR), no dextrose or sugar! 20 mL/kg over 10-20 min. Boluses.
causes of water intoxication?
intake of too much water
diluting formula or feeding infants water
swimming lessons
hypotonic solutions
clinical manifestations of water intoxication?
decreased Na ->seizures, irritability, vomiting, diarrahea
examples of fluid volume excess
generalized edema
ascites
pulmonary edema
cerebral edema
respiratory distress
how many mL in fluid bags for small children?
250-500 mL
how often do infusion IV pumps need to be cleared?
at least Q 2h
what size catheter gauge for peds IV?
22 or 24 g
what fluids do we often give peds?
D5 ½ NS
D5 ¼ NS with 20 mEq KCl/L
what are 7 important nursing care facts for peds IV infusions?
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
TPN: how to administer dextrose?
in central venous catheter!!!! NOT PERIPHERALLY!!! use filtered tubing and titrate the dosing.
where does an intra-osseous IV go?
bone marrow of tibia (or manubrium of sternum)
name the 4 types of shock
hypovolemic-not enough fluid in the body

cardiogenic-heart isn't pumping hard enough

distributive-maldistribution of blood supply

obstructive-something pushing against heart
Hypovolemic shock- causes?
volume loss:
trauma (bleeding), burns, diarrhea, vomiting, dehydration
Cardiogenic shock- causes?
impaired cardiac muscle function:
dysrhythmias, CHF, cardiomyopathy
Distributive Shock - 3 types?
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.
Obstructive Shock - causes?
cardiac tamponade, tension pneumothorax, pulmonary embolism, ductal dependent heart lesion
Shock definition:
the inability of the body to meet its metabolic demands
clinical manifestations of shock (3)
1. compensated (catch it early!!)
2. decompensated (getting sicker)
3. irreversible (impending cardiac arrest
Compensated Shock - symptoms?
mild tachycardia, apprehension, irritability, normal BP, narrowing pulse pressure, thirst, pallor, decreased urine output
Decompensated Shock - symptoms?
Pronounced tachycardia, tachypnea, oliguria, cool pale extremities, poor cap refill, confusion, decreased responsiveness
Irreversible Shock - symptoms?
thready weak pulse, hypotension, acidosis, lethargy or coma, anuria
Management of Shock - 3 things?
1. ventilation
2. fluid administration
3. vasopressor support
Explain fluid administration for shock:
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.
Nursing Care in Shock (9 things)
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
4 types of burns, and examples:
1. thermal: flames, steam, liquids
2. chemical: caustic agents, cleaning supplies
3. electrical burns: cords
4. radiation: sun, radiation
Care of major, moderate, and minor burns?
Major: >20% of TBSA - burn ctr.
Mod: 10-20% TBSA - hospital
Minor: <10% TBSA - outpatient
3 phases of burn tx?
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.
management of minor burns?
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.
Priority management of major burns?
airway give 100% O2
fluid replacement
nutrition
meds
prevent infection
Airway Management of major burns?
AIRWAY - 100% O2
blood gas levels
check CO2 leves
intubate before severe edema occurs
albuterol for bronchoconstriction
percussion, postural drainage
suctioning PRN
GOAL OF Fluid Management of major burns?
Compensation of water and Na losses. restoring circulating blood volume, correct acidosis, provide perfusion, improve renal function
Fluid managemnt of major burns?
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.
Nutrition management of major burns?
increase calories
increase protein
enteral therapy (PO or feeding tube) supplement
TPN less frequently used
Medical management of major burns?
NO prophylactic ABX.
Pain: morphine, fentanyl, dilaudid
Sedation: Versed, anesthetics
Topical: to minimize wound colonization
Infection prevention for major burns?
standard precautions
reverse isolation
client-designated equipment
tetanus shot prn
monitor for infection
restrict plants, flowers, fresh fruit and veg
Wound care for major burns?
hydrotherapy and debridement 1-2 times daily. premedicate. Topical antimicrobials. skin grafts.
Types of skin grafts? (3)
temporary (allograft - human cadaver) (xenograft-pigskin)

Permanent (autograft - self)(isograft - another person)

Sheet or mesh graft
Nursing Dx for burns:
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
Common age for iron deficiency anemia?
6 months - 2 yrs, and adolescence
How to dx iron deficiency anemia?
CBC= low RBC, H/H
reticulocyte count may be low
avg size,weight of RBC (MCV & MCH)
S/S of iron def. anemia?
edema
irritable
fatigue, muscle weakness
pallor
tachycardia or murmur
glossitis
angular stomatitis
koilonychia (concave nails)
impaired alertness, attn. span
Limit of milk for toddlers to prevent anemia?
maximum 32 oz/day
good food sources of iron?
green leafy veg
chicken
red meat
dried legumes or fruit
nuts
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
3 types of sickle cell dz?
1. SCA (HgbSS)-most common form in USA in blacks. 90,000 americans.
2. SCC (HgbSC)
3. Sickle thalassemia dz.
How is SSD transmitted?
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%
Probs created by sickle cell anemia?
clogs up the vessels -> dehydration, adidosis, hypoxia, fever. obstruction from adhesion and inflammationS

increased RBC destruction
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.
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
Treat priapism?
Painful. if it lasts more than 2 hours, they need to hydrate. if it lasts longer, get tx. it may need surgery.
Sequestration crisis?
A manifestation of SCA.
hepatomegaly
splenomegaly
circulatory collapse
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
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.
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.
Pt/family education about anemia/hgb level?
avoid high altitudes
frequent rest periods
avoid contact sports (splenomegaly)
no strenous exercise in the heat
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.
CVA?
an SCA emergency. Report seizures, abnormal behaviour, weakness or inability ot move an extremity, slurred speech, vision changes, vomiting, h/a.
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)
What is B-thalassemia? where geographically?
an autosomal recessive inheritance. mediterranean, asian, african descent
How is B-thal dx?
inadequate production of Hgb A
clinical effects of B-thal?
defective synthesis of HgbA
structurally impaired RBCs
shortened lifespan of erythrocyte
clinical manifestations of Beta Thal?
anemia symptoms, small stature, delayed sexual maturation, bronzed speckled complexion, enlarged head, frontal & parietal bossing, prominent malar (cheekbones), flat/depressed bridge of nose, osteoporisis
Management of Beta Thal?
chronic blood transfusions Q 3-4 weeks, to maintain Hgb > 9.5.
Problems occuring from management of Beta Thal?
hemosiderosis = iron overload
hemochromatosis = too much iron being absorbed from GI tract.
Antidote to Iron overdose?
deferoxamine SUBQ or IV pump almost every night. Also, deferiprone and deferasirox. Give Vit. C along w/ these drugs.
How to dx aplastic anemia?
bone marrow aspirate
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.
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.
what is hemophilia?
bleeding disorder from a congenital deficiency of specific coagulation proteins. No clotting factor.
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.
Transmission of hemophilila?
1. 60% of cases are x-linked recessive.
2. gene mutation (no family hx)
how is hemophilia dx?
Factor VIII and Factor IX assays
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
How to manage Hemophilia?
replace missing clotting factor - vasopressin
corticosteroids
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
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.
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.
Idiopathic Thrombocytopenic Purpura ITP
acquired excessive destruction of platelets. maybe autoimmune. 70-80% are children under 10 yrs.
when does acute ITP start?
after URI, parvovirus, Measles, mumps, rubella, varicella
what is chronic ITP?
lasts over 6 months
clinical manifestations of ITP?
petechia, bruising, bleeding from mucus membranes, prolonged bleeding. symptomatic bleeding occurs when platelet <20,000.
management of ITP?
prednisone, IVIG, Anti-D antibody

splenectomy if chronic
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
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
What is HSP? Henoch-Schonlein Purpura
inflamed small blood vessels->extravasation of RBCs->petechial skin lesions

etiology unknown, often follows URI, springtime
Who is more likely to have HSP?
ages 6 months - 16 years
caucasian
twice as high in boys
Is HSP a platelet problem?
No. The blood vessels swell and burst, then leaking out.C
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%)
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
How long is the latency period in children?
shorter than in adults (can be 10 yrs in adults)
What does HIV do?
takes over T cells, CD4 cells, and B cells to suppress the humoral immunity.
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
clinical manifestations of HIV in peds?
lympadenopathy, HSM, thrush, diarrhea, FTT, devel delays, parotitis
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
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
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
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?
What is SCID? Severe Combined Immunodeficiency Dz.
poor or absent function of T cells and B cells.
S/S of SCID?
Susceptible to infection. Poor growth, URIs, diarrhea, chronic candida of mouth and nails.
Sx of SCID?
family hx, lymphopenia, absence of plasma cells in bone marrow, and lack of lymphocyte response to antigens.
SCID management?
HSCT (stem cell transplant) sibling or parent.
IVIG
isolation/sterile environment
treat infections
gene therapy
nursing care in SCID?
prevent infection, genetic counseling, family support, fatal if no donor found. PREVENT INFECTION!
What happens to heart rate and BP during dehydration?
HR goes up, BP goes down
most common parasitic pathogen? where spread?
Giardiasis, frequently spread in day care centers
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.
How to treat pinworms?
Vermox. 2nd dose in 2 weeks. Family may also need tx. contagious, oral-fecal.
What happens with hookworms? How to treat?
Anemia, malnutrition. Treat with Pyrantel Pamoate drug.
What happens with tapeworms? Where do they come from?
Nausea, pain, weight loss. From infected beef or pork.
What is the #1 cause of GI probs in children? What is the manifestation?
Rotavirus. Green, sweet stinky diarrhea.
What med to kill GI pathogens?
Flagyl. alcohol not sufficient, so wash hands thoroughly.
possible complications of gastroenteritis?
sepsis
possible cardiac arrest d/t dehydration
What type of isolation precautions should be used for C diff?
contact precautions
What age for repair of cleft lip?
surgical repair by 3-6 months. Cosmetic procedures later 4-5 yrs.
What are for repair of cleft palate?
Age 6-8 months, done in stages
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.
Nursing Dx for clefts?
1. altered family process
2. altered nutrition (less than BR) (preoperative)
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
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
What is it called when the esophagus stops before reaching the stomach?
Esophageal Atresia
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).
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!!
Manifestations of EA/TEF?
The 3 Cs: coughing, choking, cyanosis!!

Excessive salivation
frothy cough
resp distress
aspiration pneumonia
What to do for EA/TEF?
Place on NPO immediately to prevent aspiration. Surgery ASAP. Give pacis and stuff to stimulate them orally
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
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.
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
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.
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
How to manage Celiac?
gluten-free diet for life. Eat rice, corn, quinoa, potato. Can be expensive and difficult for the whole family.
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.
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.
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
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