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peds diseases

nursing first year

SIDS sudden infant death syndrome.3000 per year mortality rate decreasing (Back to sleep) children under two in which autopsy faild to id the cause of death.
SIDS risk factors low birth wt, premature, boys, winter months, crowded living conditions. co sleeping
SIDS family care parents may blame them selfs or eachother, or be blamed by other family members. sensitive suport needs to offered, recomend suport groups.(compassionate friends, national sids foundation)
Otitis Media Inflammation of middle ear._ Purulent (AOM) S pneumonia , H influenzae _ Serous (OME) unknown (most common cause of hearing loss)
Otitis risk factors early child hood=eustation tubes are shorter wider and straighter,babys that are feed supine, recient upper resp inf,S pneumonia vaccine decreases incidence of ds. cigarettes pacifiers and daycares
otitis symptoms • Pain in ear exacerbated by sucking chewing!!!!!!!!! • Rubbing/pulling ear infant S/S Fever up to 104F,pulling on ear • Rolling of head infant S/S
Treatment - Otitis Media Examine ear hygeen, lymph nodes too (and first)Antibiotics amoxicillin is choicePain control acetametophin ibuprofen, antihistamines are NOT effective. Ear drops (Auralgan) warm 115F or cold,compress, child upright helps.• Myringotomy • Tympanostomy
Bronchiolitis Inflammation of small airways, autumn-spring, edema and mucus. most caused by RSV (Respiratory syncytial virus). aveoli usualy not effected gas exchange is
Symptoms - Bronchiolitis Early _ Rhinorrhea _ Sneezing _ Cough _ Low grade fever _ Poor appetite _ Increased RR
Symptoms - Bronchiolitis late RR of 50-60, less than 6mo, inability to feed.these are causes to hospitalize.
Symptoms - Bronchiolitis late _ Tachypnea (60-80) _ Wheezing _ Nasal flaring _ Retractions _ Cyanosis _ breath sounds
Treatment - Bronchiolitis • Treat symptoms _ Fluids IV to hydrate and thin secreations _ Humidify air _ Antipyretics
Treatment - Bronchiolitis (hospital) _ IV fluid (thin secreations) _ Humidified Oxygenkeep o2 92%+ _ Bronchodilators _ Corticosteroids _ Antibiotics for infants use to prevent secondary infections _ Contact isolation!!! Nasal washing to determine if RSV
RSV immune globulin respigam, palivizumab Synagis children at high risk for Bronchiolitis
Cystic Fibrosis Multisystem disease involving cell membrane and fluid/electrolyte system lungs pancrease GI,Congenital disorder: Mendelian recessive
Cystic Fibrosis Mendelian recessive from both parents carriers do not show symptoms chromosome 7,
Respiratory Symptoms – CF Cough. Wheezing. Dyspnea. Excessive mucus. Obstructed bronchioles. Fatigue. Irritability. Cyanosis. Barrel shaped chest. Clubbing. RV hypertrophy. Obstructed emphysema. Atelectasis. Fibrosis .staph and Pseudomonas (suitable environment)
maconium illius impaction in distal sm bowel) seen in 10 -20% of CFers, clubbing may be seen in chronic O2 decrease.
GI Symptoms - Cystic Fibrosis • Meconium ileus • Rectal prolapse • decrease inPancreatic enzymes trypsin lipase and amylase all decreased • Steatorrhea • Increased appetite • Wt. Loss • Distended abdomen and lack of shitting may be indicative of obstruction
Special Considerations - CF Sweat test: pilocarpine iontophoresis (Increased Na & Cl)
Complications CF _ Liver enlargement _ Edema of extremities _ Retinal hemorrhage _ Cor pulmonaleheart strain from improper lung fxn is a freq cause of death _ Osteoporosis bones are porous because of poor utilization of fat sol Vit D
Medications for CF Pancreatic enzymes • Antibiotics: TOBI via inhalation tobramycin for Pseudomonis aeruginosa • Bronchodilators albuterol • Expectorants • DNase an enzyme decreases viscosity of sputum
Treatment – Cystic Fibrosis • High cal, PRO, Na diet • ADEK supplements • C&DB • Postural drainage • Exercise • Prevent infections
Croup common in toddler not communicable. • Respiratory conditions characterized by brassy cough and stridor _ Spasmodic laryngitis _ Laryngotracheobronchitis() • Progresses over days • Viral cause most common!!! • Risk: children & familial tendency
Laryngotracheobronchitis glotic or subglotic croup
respiratory distress!!!!! substernal retratctions, agitiation,more severe hypoxia=pallor cyanosis increased HR extream restlessness and listlessness, feel free to press that code button at any time now!
Symptoms - Croup Harsh barking cough • Hoarseness • Stridor usually worse at night • Laryngeal edema • Fever • Respiratory distress
Treatment - Croup Vapor mist • Oxygen(heliox) mix of helium and oxygen used for upper airwayobstruction • Corticosteroids • Inhaled racemic epinephrine Fluids • Rest
Inhaled racemic epinephrine 10 -30 min peek close monitoring when med wears off sudden decline may occur(hospital use only)!!!!!!!!!!!!!!restlessness and anxiety
Common Cold rhinoviruses.Spread _ Cough – Sneeze - Contact
Treatment - Common Cold OTC not to be used under 2years of age. Rest Tylenol Fluids Decongestants Diet Humidified air
Tonsillitis & Adenoiditis Inflammation of lymph tissue Dysphagia _ Sore throat _ Enlarged cervical lymph nodes
how to blow your nose both nostrils at the same time prevents pressure from spreading infection to eustations tubes
Treatment - Tonsillitis & Adenoiditis • Surgery _ T & A • Prevent post-op infection • Monitor for hemorrhage _ Up to 10 days post-op
Asthma (reactive airway disease) Reversible obstruction of airways. _ Bronchial spasm _ Mucosal edema _ Thick mucus production • Most common chronic illness • Status asthmaticus(not responding to meds must hospitalize)genetic predispose most influential.
Triggers of Asthma (abrupt exposures= faster onset) • Allergens • Temperature change • Cold air • Viral infection • Exercise • Smoke • Stress severe asthma usualy continues in adulthood
Symptoms - Asthma, intermittent, mild, moderate, severe Tight unproductive cough • Wheezing - expiratory • Tachypnea • Dyspnea • Tachycardia • Fatigue • Eosinophils as well as IgE • Abnormal ABGs • Abnormal PFTs
PFTs 5years old+, done every two days for two weeks comparisons made against child's best is used
Treatment - Asthma • Eliminate allergen • Bronchodilators • Steroids prednisone, corticos • Mast cell stabilizer montelukast aka singular • Oxygen • High Fowler’s • Hydration
Goals of Treatment - Asthma reduce episodes, minimizing the inflammatory phase, decrease hospital stays,facilitate normal growth and development. untreated persistent asthma can cause irreversible damage.
asthma drugs: long term control :inhaled corticos, systemic corticos, leukotrienes, long acting b2 agonists,
asthma drugs:quick relief(rescue) short acting b2 agonist, systemic corticos, anticholinergics
Epiglottitis (Haemophilus Influenzae type B )2-6years old Swelling of tissues above the vocal cords • Rapid and progressive • Life threatening emergency
Symptoms – Epiglottitis • Sudden sore throat • Tripod position • Drooling • Fever • Muffled voice • Dyspnea • Stridor late ominous sign( airway obstruction is almost complete) • Bacteremia
Treatment - Epiglottitis vaccinate your fucking child • Nursing: Do NOT examine throat!!!!!!!!!!!!!!!! • Artificial airway • Corticosteroids • Fluids/ IV • Antibiotics • Prevention: H. Influenzae vaccine beginning at 2months
Bronchitis (2-3 weeks) • Bronchial inflammation • Usually viral more common in winter • Symptoms: crackles and wheezes _ Low grade temperature _ Adventitious lung sounds • Self-limiting antimicrobials cough suppressants and antihistamines are not indicated
Pneumonia Inflammation of lungs where alveoli become filled with exudate • Types: _ Bacterial 20% treated with antimicrobials _ Viral 80% treatment is suportive _ Primary _ Secondary more serous because child is already immune compromised
Symptoms – Pneumonia • Dry productive cough • RR • Shallow respirations • Sternal retractions • Nasal flaring • Fever tepid sponge baths, antipyretics steal covers • Listless • Poor appetite • On affected side
DX pneumonia • + CXR!!!!!!!!!!!! •elevatedWBC!!!!!!
Treatment - Pneumonia • Antibiotics (bacterial) • Supportive _ Antipyretics _ Analgesic _ Oxygen _ Fluids/ IV _ Rest _ Reposition
Tuberculosis most volunerable to TB in first 3years of life (hispanics1st, asians2nd) • Mycobacterium tuberculosis • Spread – airborne droplets associated with poverty and crowded living conditions and poor hygeen • Active process and remissions
Symptoms – TB • Asymptomatic • Malaise • Anorexia •Weight loss • Fever • Night sweats • Productive cough Test for HIV, and vise versa if HIV test for TB
Diagnostics – TB (report to public health) • PPD or Mantoux • CXR to confirm • Sputum smears • Gastric washings • CSF • Culture
Treatment - TB • Prevention • Isolation • HEPA mask • Follow up care • Vaccine
Treatment - TB Medications _ INH _ Rifampin _ Pyrazinamide _ Streptomycin _ Myambutol
Treatment - TB Medications rifampin, pyrazinamide and ethambutol, are given for 8 weeks 56, doses. continuation phase if nessary are rifampin and isoniazid given 4-7months ALL DRUG ADMIN BE DIRECTLY OBSERVED by health care.
Congestive Heart Failure • Cardiac pump failure _ Underlying cardiac disease _ May worsen with anemia & infection • Unable to meet metabolic needs - _ CO
Right CHF Fatigue Peripheral edema Hepatomegaly Splenomegaly JVD Weight gain Nausea Cor pulmonale
Left CHF Dyspnea Cough Fatigue S3 Tachycardia LOC changes Pulmonary edema Moist lung sounds
Diagnostics for CHF • Physical exam • CXR • EKG • Echocardiogram • BNP • ABGs • Stress test • Cardiac catheterization
Treatment - CHF • Fluid restriction • Weight management • Diet _ Sodium - Potassium • Activity • Medications _ Digoxin heart rate must be counted before and after adminastration – Diuretics _ ACE Inhibitors - Beta blockers
Acute Rheumatic Fever • Systemic inflammatory disease • Affects joints, heart, CNS, skin & SQ tissue • Follows Group A beta hemolytic streptococci • Antibodies attack connective tissue
Symptoms - Rheumatic Fever MAJOR CRITERIA • Carditis (Aschoff bodies) • Polyarthritis • Erythema margination • Syndenham Chorea • SQ nodules
Symptoms - Rheumatic Fever MINOR CRITERIA • Fever • ESR or CRP • Arthralgia • 1° HB
Jones Criteria 2 major or 1 major + 2 minor
Treatment - Rheumatic Fever • PCN penicillin G (bicillin) IM Q4 weeksto prevent reoccurrence • Anti-inflammatories NSAIDS aspririn may mask migratory arthritis. • Steroids • Valium/Haldol prevents chorea (abnormal involuntary movement disorder) • Seizure precautions
Treatment - Rheumatic Fever • BR bed rest • Nutrition food high in protiens • Prevent cardiac damage antimicrobial prophylaxis for dental procedures and the like. RADT rapid antigen detection test
Symptoms - Head Injuries • Headache • Irritability • Blurred vision • Vomiting • Change in LOC • Dyspnea • Unconsciousness • Seizures • Abnormal posturing • ICP
• ICP compromised perfusion, brain death. Changes in behavior are early signs, pupils become sluggish then dilated and finaly fixed, advanced ICP causes an increase in systolic pressure, decrease in diastolic, decrease in pulse known as Cushings Triad
• Abnormal posturing decorticate arms flexed legs extended, decerebrate extention and pronation of arms and legs
Treatment - Head Injuries • Prevent/treat ICP • Prevent neurological complications • Quiet environment • Wound care • Monitor fluids overhydration causes an increase in ICP • Prevent injury
Bacterial Meningitis • Inflammation of the meninges • Cause: H. Influenzae • Invade via blood _ Other infection _ Neurological procedure _ Skull fracture • Purulent
Symptoms - Bacterial Meningitis • Headache • Drowsiness • Bulging fontanel • Irritability • Photophobia • Fever
Symptoms - Bacterial Meningitis • + Kernig’s sign prone pt flexed at hip, cannot extend lower leg out • Vomiting • Stiff neck • Seizures • Coma • Opisthotonos • High pitched cry • + Brudzinski’s sign flex the pts head to chest if the hips involuntarily flex sign is positive
Seizures aspiration precaution,observer for precipitating factors(may lead to location of brain inj)protect from injury, don't restrain.
Opisthotonos condition in which the body is held in an abnormal position. The person is usually rigid and arches the back, with the head thrown backward.on his or her back, only the back of the head and the heels touch the supporting surface.
Considerations - Bacterial Meningitis Lumbar puncture High WBC High protein Low glucose Complication SIADH
SIADH syndrome of inappropriate antidiuretic hormone, to determine ht wt I&O serum electrolytes and serum urine osmolarities should be measured at admission.if + fluid restriction is in order
Treatment - Bacterial Meningitis • Isolation • Antimicrobial cephalosporins and vanco • Anticonvulsant diazepam, adavan, • Antipyretic • Sedative • Prevention: _ Immunization: H. Influenzae
Encephalitis • Inflammation of the brain • Causes _ Virus arboviruses, enteroviruses (RNA virus) herpes virus _ URI _ Measles _ Lead Poisoning _ Bacteria _ Fungus
Symptoms – Encephalitis inquire about travel • Headache • Drowsiness • Coma • Seizures!!!!!!!!!!!!!!!!!!!!!!!!! • Stiff neck • Delirium • Fever • Cramps • Vomiting • Abdominal pain
Complications - Encephalitis • Slow speech • Slow mental process • Slow motor process • Brain damage • Mental retardation
Treatment - Encephalitis • Steroids cortico • Immunoglobulin • Acyclovir for da herps _ Herpesvirus • Antibiotics _ Bacteria • Sedatives • Antipyretics • Fluids/IV • Oxygen • Seizure precautions • ICP management
Epilepsy • Chronic, recurrent attacks • Abnormal discharge of neurons • Impaired consciousness followed by contraction/relaxation of muscles and/or disturbed feelings/behavior • Status epilepticus
Status epilepticus multiple seizures one after another( most commonly caused by sudden discontinuation of meds)may result in death from resp failure and exhaustion
Causes/Triggers - Epilepsy Causes • PKU • Hydrocephalus • Brain Injury • Acute infections • Med. withdrawal Triggers changes in Na or K+, _ Stress _ Over- tired/excited _ Flashing lights _ F/E Imbalances _ Hormone changes
Symptoms – Epilepsy aura, tonic, clonic, postectal,
tonic phase in which the body stiffens and the child losses consciousness (phase one of convulsive) arrest of resp during!!! May leave the child looking cyanotic, eyes roll up or out to one side
Clonic jerking of the trunk and extremities, incontinence muscle contraction and relaxation subside and postictal begins
Postictal dazed and confused sleep is common head ach and performs more aor less automatic acts Nonconvulsive • No aura • Lapse in conscious • Loss of muscle tone • Distorted sensations Automatisms repetitive movments
Treatment - Epilepsy • Prevent injury head and neck • Maintain airway lay on side • Anticonvulsants • Ketogenic diet high in fats • Surgery • Vagal nerve stimulator procedure that attaches a device that induces current to stop a seizure when pt feels it coming on
Reye Syndrome (nonspecific encephalopathy) malase and vomiting(up to 24Hr) directly after a viral inf like vericella or upper resp infection • Nonspecific encephalopathy with fatty degeneration of the viscera and altered ammonia metabolism • Rapid onset • Triggered by viral disease or use of
Symptoms - Reye Syndrome • Sudden vomiting • Lethargy • Confusion • Seizures • Coma • Cerebral edema • Liver enlargement • increasedSGOT, SGPT, LDH • increasedAmmonia level
Treatment - Reye Syndrome • ICU • ICP management • Osmotic diuretics (manitol) • Sedatives • Barbituates • Prevention • Early identification
Deafness • Hearing loss • Congenital or Acquired • Sensorineural or conductive _ Mixed • Complete or Partial
Symptoms - Deafness • Response to auditory stimuli • Poor communication • Speech • Behavior problems • Social isolation • Aggressiveness
Testing - Deafness • Universal screening _ Auditory brainstem response _ Otoacoustic emissions • Audiometer • Tympanography
additional symptoms does not startle to loud sounds, wont turn head to sound by 3-4months, wont bable at 6months, wont atempt syllables by one year
Treatment - Deafness Prevention PREGNANT mothers with German measles Rubella or streptomycin, neomyocin ( OTOTOXIC) _ Immunizations for communicable diseases • Early detection & treatment • Hearing & speech center • Hearing aid • Assist with communication
Communication with Deaf • Communication by deaf person _ Lip reading _ Sign Language _ Writing • Communication by caregiver _ Face child @ eye level _ Short, clear sentences _ Use gestures
Amblyopia (problem in brain not eye) • Lazy eye • Loss or of vision • Brain “turns off” confusing visual images • Treatment _ Glasses _ Patch unaffected eye, forces development of affected eye, drops to blur vision of unaffected eye
Amblyopia prognosis depends on on length untreated, critical visual development occurs from birth to 6 years, vision screening is 3-4years of age
Strabismus (cross eyed) muscle problem.(can cause amblyopia) • Crossed eyes • Muscle imbalance • Treatment _ Patch unaffected eye _ Glasses _ Eye exercises _ Surgery detected with corneal light reflex, symmetry of reflection misaligned
Strabismus in infants is normal up to 4 months of age
Pyloric Stenosis • Risk: • Overgrowth of circular muscles of the pylorus • Obstruction _ Boys > Girls and inherited thanks mom and dad.
Symptoms – Pyloric Stenosis • Projectile vomiting shouldn’t have bile or pancreatic juices. • Hunger • Dehydration • Olive shaped mass • Enlarged stomach • Decreased BM • Peristaltic wave
Treatment – Pyloric Stenosis Pyloromyotomy - enlarges opening
Hernias • Protrusion of abdominal contents _ Inguinal _ Umbilical • Congenital vs Acquired • Reducible vs Incarcerated • Strangulated loop of bowel is trapped and ischemic
Celiac Disease • Celiac sprue • Inherited, autoimmune disease • Inability to digest gluten (gliadin) _ Wheat, barley, rye, & oats • Damages intestinal mucosal cells
Symptoms – Celiac Disease • Failure to thrive • Chronic diarrhea • Steatorrhea • Abdominal distension • Abdominal pain • Muscle wasting • Anorexia • Nausea • Vomiting • Irritability
Diagnosis & Treatment – Celiac • Diagnosis _ Small bowel biopsy jejunal _ Serum antigliadin antibody • Treatment _ Gluten free diet _ Vitamin supplements
Intussusception typically under 2years, 4-9mo highest rate • EMERGENCY • Slipping of one part of the intestine into another part common site is ileocecal valve • Unknown cause • Complications obstruction and peritonitis if burst
Symptoms - Intussusception • Severe abd. pain • Straining • Vomiting bile at first and then if unchecked fecal vomiting • BM, flatus • Currant jelly stool just blood and mucus • Sausage mass - RUQ • Rigid abdomen • Elevated temp up to 106F • Shock
Treatment – Intussusception good prog if treated with in 24hrs • Hydrostatic reduction like a filling a balloon with water • Surgery _ Reduction _ Resection
Hirschsprung’s Disease • Aganglionic Megacolon • Absence of ganglionic nerve in colon prevents relaxation = ribbin shits • Affected area – constant contraction • Obstructs stool; chronic constipation life threatening • Proximal end - distended
Signs and Symptoms – Hirschsprung’s • Meconium ileus • Abdominal distension • Ribbon-like stool • Vomiting • Constipation
Diagnosis & Treatment – Hirschsprung’s • Diagnosis _ Rectal mucosal biopsy _ Rectal manometry • Treatment _ Surgical removal with reanastomosis _ Temporary colostomy
Pinworms • Parasitic worm • Hand to mouth _ Ingest eggs _ Mature in cecum _ Migrate to anus _ Lay eggs at night • Confirmed by tape test
Symptoms - Pinworms • Anal itching • Irritated rectal area • Eggs on tape test • Worms in stool • Irritability • Restlessness • Wt. Loss • Poor appetite
Treatment - Pinworms • Anthelmintics _ Vermox _ Povan • Prevent reinfection _ Linen/ clothing _ Hygiene _ Family
Appendicitis • Inflammation of appendix • Related to: _ Blockage by fecal matter - Infection _ Allergy - Foods • Boys > girls • Rare before age 2
Symptoms - Appendicitis • Restless • Nausea/vomiting • Constipation/diarrhea • Fever • increaseWBC • Rigid abdomen • Abdominal pain • Abdominal guarding • Rebound tenderness • decreasesdBowel sounds
Treatment - Appendicitis • No palpation of abdomen • No enemas • Never apply heat • Rehydration • Appendectomy • Antibiotics
Obesity (BMI > 95 percentile) feelings of inadequacy, male: developed breast, striae,small penis, teens feel unloved rejected and unattractive
Treatment - Obesity • Diet modification, for whole family, don’t invent your own diet, • Exercise • Stabilize weight • Behavior modification, eat only at the table, use a small plate, record your feelings and all food consumed • Support groups
Created by: medicalminded