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Pediatric Exam 2

Cerebral loss is shown mainly by ____ posturing. decorticate
The child's arms are adducted and flexed on the chest with wrists flexed and hands fisted. decorticate
When the midbrain is not functional it causes _____ posturing. decerebrate
Rigid extension and adduction of arms and pronation of the wrists with fingers flexed, legs extended and feet are plantar flexed. decerebrate
Group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction cerebral palsy
What can lead to orthopedic/gait difficulty in a child with cerebral palsy? muscle spasticity
Cerebral palsy is associated with low birth wt., ______ birth, or birth injury premature
Cerebral palsy is caused by brain _____ leading to cell destruction of the motor tracts. anoxia
Type of cerebral palsy where there is excessive tone in the voluntary muscles that results in the loss of upper motor neurons. spastic
This cerebral palsy involves damage to the cortex and is related to cerebral asphyxia. spastic
Patient's with spastic cerebral palsy, they have ______ muscles. hypertonic
Patient's with spastic cerebral palsy, they have abnormal _______ clonus
Patient's with spastic cerebral palsy, they have an exaggeration of deep ______ _____. tendon reflexes
Patient's with spastic cerebral palsy, they will have a continuation of ________ reflexes. neonatal
In spastic cerebral palsy, the child fails to demonstrate the _____ reflex, when they are lowered to the ground suddenly, they do not hold out their arms as if to break their fall. parachute
In spastic CP, tight adductor thigh muscles cause their legs to cross when held upright, which is called _____ _____. scissor gait
Scissor gait may be so severe that it could lead to a _______ ______. subluxated hip
When both extremities are affected on one side is ______. hemiplegia
When all four extremities are affected it is ______. quadriplegia
When only the lower extremities are affected it is ______. paraplegia
Most children with hemiplegia have difficulty identifying objects placed in their involved hand when eyes are closed, which is called _____. astereognosis
A child with quadriplegia invariably has impaired speech, but may or may not be cognitively challenged is known as _____ palsy. pseudobulbar
If there is no involvement of the arms at all it is _____ ______ paraplegia, and it is a spinal chord anomaly rather than a cerebral anomaly is suggested. true spastic
Type of cerebral palsy that involves abnormal involuntary movements, "worm-like", is called ______. athetoid
With athetoid CP, early in life, the child is limp and flaccid; but later in age they make ____, writhing motions. slow
In athetoid CP, the child drools and speech is difficult because of poor _____ and ______ movements. tongue swallowing
In athetoid CP, with emotional stress, involuntary movements become ______ (irregular and jerking)with diskenetic (disordered muscle tone) choreoid
This cerebral palsy involves damage to the basal nuclei ganglion. athetoid
This cerebral palsy involves the cerebellum. ataxic
This cerebral palsy is usually a combination of spastic and athetoid. mixed
Mixed cerebral palsy results in a severe degree of _____ impairment. physical
Children with _____ CP are unable to perform the finger-to-nose test or rapid-repetitive movements or fine coordination movements ataxia
Deafness caused by kernicterus occurs in connection with _____ cerebral palsy. athetoid
______ challenge and recurrent _____ accompany cerebral palsy. cognitive seizures
An infection of the cerebral meninges, most often in children younger than 24 months. Its peak incidence appears in winter. bacterial meningitis
____ _____ or infection in cranial nerves can result in blindness, deafness, or facial paralysis with bacterial meningitis. brain abscess
In meningitis, pus accumulation in the Sylvius duct can cause obstruction, leading to ______. hydrocephalus
Brain tissue edema, from meningitis, can put pressure on the pituitary gland causing an increase in ________ hormone, which causes an increase in edema. antidiuretic
In some children, seizure or shock is the _____ noticeable sign of meningitis. first
As _____ progresses, there is a positive signs of brudinski's and kernig's. meningitis
Flex child's neck forward, bilateral hip, knee, and ankle flex is a positive sign of _____. brudinskis
Flex child's hip and knee (90 degrees), when leg is extended, there is pain, resistance, and spasms which is a positive sign of ____. kernigs
Children have had 2-3 days of upper respiratory tract infection, irritability from headache, may have seizures/shock are signs and symptoms of ________. meningitis
With meningitis, if fontanelles are open, they are _____ and tense. bulging
In meningitis, children's backs may become arched and their necks hyper-extended which is called ______. opisthotonos
In newborns, after generalized beginning, there is sudden cardiovascular shock, seizures, and nuchal rigidity or apnea may occur. meningitis
In a normal child, the glucose level is _____ percent of serum glucose. sixty
Why is a blood culture done in patient's with meningitis? septicemia
In meningitis, typically ICP is severely ________. elevated
In meningitis, these may be necessary to reduce infection because the blood brain barrier may prevent the ATB from passing freely to the CSF. intrathecal injection
What happens to the vital signs in increased intracranial pressure? Increased temperature and blood pressure, decrease in pulse and respirations
What is the normal ICP in a child? what is abnormal? 1-10 mmHg, anything above 15 is abnormal
What nursing care is provided for with children who have increased ICP? place in semi fowlers, allow rest periods, treat the underlying cause, dim lights, arterial line, central line (dec. amount of times being poked), corticosteroids and osmotic diuretics
Why do children with ICP need corticosteroids and osmotic diuretics? The corticosteroids decrease inflammation, and the osmotic diuretics pull off fluid and dehydrate the cells to reduce ICP
What is another technique to reduce ICP other than medications? hyperventilation
Which posturing is better to have or there is a better outcome? decorticate
What disorder would you suspect if a child has feeding difficulties, convulsions with no fever, developmental delays and do not understand why Cerebral palsy
What is one of the most important goals in the treatment of cerebral palsy? assist in making the most of their assets and maximizing their abilities, encourage to do as much as for self as possible.
What type of motor activities do children with cerebral palsy do best at? gross motor, not fine motor
_____ alignment is very important with children with CP, along with good skin care, maintaining posture, adequate nutrition, and prevention contractures Body
What is a common muscle relaxant given to children with CP that reduces muscle spasms? Baclofen
With meningiococcal you may see a purple rash or petechai
How do we obtain a true diagnosis for meningitis? By testing a lumbar spinal tap
What is the treatment for meningitis? Isolation until full 24 hours of antibiotic, monitor vitals signs, neuro checks, rest, dec. stimulation, watch for ICP
how do you assess for nuchal rigidity in children who cannot communicate? They become irritable and cry when held, but when you put them down they are more calm.
What common types of medications are given for the treatment of meningitis? IV antibiotics, anticonvulsants, and sedatives
What is the most common isotonic fluid given to children? D5 and 1/3
Reye's syndrome is associated between the use of aspirin and in a _______ illness viral
What are the s&s of liver dysfunction, which could be a complication of Reye's? bleeding, poor clotting, elevated ammonia, hypoglycemia
What do children look like when they are affected by botulism? ragdolls from hypotonia which can lead to flaccid paralysis, then lead to decreased respiratory function
rapid movements of trunk with sudden strong contractions of most of the body, reults from a failure of normal organized electrical activity in the brain infantile spasms
Infantile spasms seem to stop at age two
What most likely remains, even if the infantile spasms stop? developmental delays
What is the treatment for infantile spasms? ACTH and Vit. B 6
If the child does not respond to treatment of infantile spasms, what is the next medications used? Topamax or valproic acid
Children usually outgrow these types of seizures, commonly 5 mo to 5 years old, tonic clonic activity for 15-20 seconds febrile
What topics need to be taught to parents whose child experiences febrile seizures? give tepid sponge bath, give antipyretic at the first sign of fever
May have an aura, automastisms (lip smacking ,hand rubbing), can cause memory loss, last 1-2 min., regain consciousness in under 5 minutes, but have no memory of actions Complex partial
Treatment for complex partial seizures? Tegretol, Depakene, Dilantin, phenobarbital
In complex partial seizure, they may be drowsy afterwards but do not experience a true postictal phase
Jerking begins in one area to the body, cannot stop, stays awake, then jerking moves to other areas of body, difficult to tell from tonic clonic Partial (focal) seizure
Rarely lasts longer than 20 seconds, often a blank stare beginning and ending abruptly, may see blinking and twitching of mouth, child loses awareness Absence Seizure
What is the treatment for an absence seizure? can be controlled with Zarontin, sodium valproate
When does absence seizures stop? significantly decreases or stops entirely at adolescence
Prodromal (not themselves), warning sign (aura), progress to muscles contract and extremeties stiffening, jerking movements, may loos control of bowel and bladder, then postictal phase (recovery tonic clonic
What is the treatment for tonic clonic seizures? anticonvulsants
Seizure lasting longer than 30 minutes or a series of seizures from which the child does not return to baseline. MEDICAL EMERGENCY Status epilepticus
What is the treatment for status epilepticus? IV benzodiazapine (valium, ativan), followed by IV phenobarbital or phenytoin (Dilantin)
What is important to remember about Dilantin? IV is not compatible with Dextrose, and oral can cause hypertrophy of gums
What can Tegretol cause? neutropenia
What is important to remember about Phenobarbital? may cause drowsiness and to give with food to decrease GI upset
Generally continue seizure meds free for _____ then may try to meds from daily use 2-3 years
What is important to remember when teaching to adolescents that experience seizures? must seizure free for 1 year to be able to drive
What is the ketosis diet composed of? high fat, adequate protein, low carbs
What is the purpose if the ketosis diet? Instead of using medications, doctors will prescribe this because the diet causes ketosis which may decrease myclonic of tonic clonic seizures, along with mild dehydration
lazy eye is known as amblyopia
crossed eyed is known as strabismus
What is the treatment for amblyopia and strabismus? patch the "stronger" eye, exercises, glasses, surgery (if other treatments dont work)
If untreated or undertreated before approx. ________ visual damage may be permanent 6-10 years
What is used for recurrent otitis media? PE (pressure equalizing tubes)
________ are at increased risk for otitis media due to position of the eustachian tube (straighter, shorter, wider) infants
When PE tubes are placed, teach parents and child if you see drainage, thats a good thing, the PE's fall out spontaneously, and to not get liquids in the ear
Recurrent otitis media can cause _______ to the tympanic membrane scarring
Louder the murmer the _______ the defect smaller
What are pre-procedure techniques for cardiac cath? EMLA, educate parents on the procedure and reassure them
What is needed to be done in procedure for cardiac cath? conscious sedation, monitor for arrythmias, and allergic reaction to dye (especially infants)
What needs to be monitored for post-procedure of cardiac cath? bleeding, arrythmias, thrombophlebitits
When the patient goes to the PEds ICU following cardiac surgery to allow for ______ and ______ monitoring using swanz glanz catheter CVP and PA pressure
After cardiac surgery we need to prevent pooling of secretions and pulmonary complications
What complications could happen after cardiac surgery? hemorrhage, shock arrhythimias
approx 1 week after surgery, see febrile illness with pericarditis and pleurisy post cardiac surgery syndrome
What is the treatment for post cardiac surgery syndrome? anti-inflammatories and rest
3-12 weeks after, fever, spleenomegaly, malaise, maculopapular rash, this happens when child is on bi-pass post perfusion syndrome
What is the treament post perfusion syndrome? allow it to run its course, monitor and complications, hydrate, positioning, C & DB to prevent pooling
Pacemaker's may be placed in ______ if the childs thoracic abdomen
it is imperative that you know where AICD is located because you cannot shock a patient over an implanted device
What are the 4 congenital heart defects that increase pulmonary blood flow? ventricular septal defect, atrial septal defect, atrioventricular canal defect, patent ductus arteriosus
What do you see with increased pulmonary blood flow left to right shunting (oxygenated blood being re-circulated to the pulmonary bed) or (sending oxygenated blood to lungs)
most common in premies when there is a persistence of normal fetal vessel which connects aorta and pulmonary artery patent ductus arteriosus
If left untreated in PDA, it can cause pulmonary HTN, continuous murmur, widened pulse pressure, peripheral pulses may be full and bounding
Small PDA is generally asymptomatic
Large PDA can develop into congestive heart failure
What medical treatment is used for PDA's? Indomethacin and Ibuprofen which are PGE inhibitors which encourages duct closure, but is only effective in infants less than 7 days old
With coil embolization, a coil is deployed into the area to clot it off for the treatment of PDA
What is the complications of coil embolization for a PDA bleeding, infection, incomplete closure, coil migration
What are the complications from surgical ligation, division, oversewing ends or clip placement of a PDA phrenic nerve damage, diaphragmatic paralysis, laryngeal nerve damage, chylothorax, transient HTN
If we need need to keep ductus open we give PGE1 (prostaglandins) is administer IV to keep this open
What rhythm do you need to assess for after surgical treatment for a PDA? Atrial flutter (saw toothed)
defect in atrial septum allowing communication between left and right atrium atrial septal defect
What are the signs and symptoms of ASD? gerneally asymptomatic, murmur
If left untreated, what can ASD lead to? left anf right hypertrophy, atrial arrythmias, CHF, and emboli formation
What cath treatment is used to for ASD? use umbrella device and clamshell occluder
What are the complications from an umbrella device or a clamshell occluder in ASD treatment? bleeding, infection, arrythmias, device migration, incomplete disclosure
What is used for surgical repair of an ASD? stitch closure or goretex patch
What are the possible complications from stitch repair or goretex patch when fixing an ASD? heart block, and/or arrythmias, imcomplete closure, left ventricle failure
Some CHD and ASD is necessary to sustain life
defect in ventricular septum allowing communication between left and right ventricles Ventricular septal defect
What are the clinical manifestations of VSD? murmur... small: asymptomatic, normal growth and development...Mod-large: decreased exercise tolerance, repeated pulmonary infections, CHF, FTT
Surgical repair in VSD, early surgical correction when medical management fails, or between 2-4 years, stitch closure and goretex patch
What are post op complications after surgery for repair of a VSD? arrythmias, residual VSD, decreased CO, altered hemodynamics
What nursing care is need post op surgical repair of an LSD? monitor for renal perfusion, cap refill, skin turgor, distal pulses, immediately frequent dopamine and nipride
What specific arrythmia are you watching for after surgery of LSD? bundle branch block
failure of the endocardial cushion to close located mid heart around the tricuspid and mitral valves endocardial cushion (AV canal)
This allows open communication between all chambers of the heart and there is an increased incidence in children with Down's endocardial cushion (AV canal)
What are the signs and symptoms of endocardial cushion? signs of CHF and FTT
What is the medical management for endocardial cushion? digoxin and diuretics for CHF, increase calories for FTT, small frequent feeds to decrease the work of eating, position to decrease work of breathing.
What are the HR for infants and adult chilren recieving digoxin? infants greater than 100, older kids greater than 60
What is the surgical repair for endocardial cushion? to close the ASD, VSD and "complete" valves, may be multistaged.
palliative surgery might be needed first, for endocardial cushion surgical repair, called a PA band which decreases the amount of blood entering/reentering pulmonary circulation to decrease CHF (kinda like a lap band)
What is the best kind of diuretic to give to small chilren? Aldactone which is a potassium sparing diuretic
What are the 3 congenital heart disorders that obstruct blood flow? pulmonary stenosis, aortic stenosis, and coarctation of the aorta
What are the clincal manifestations of mild pulmonary stenosis? asymptomatic, mild RVH, murmur
What can be done in the cath lab for repair of pulmonary stenosis other than surgical opening, and what needs to be monitored postop? balloon angioplasty can be used to tear open the narrowed area at the pulmonary artery. Need to watch for s/s of CHF d/t inc. pulmonary blood flow
what are the clinical manifestations of moderate pulmonary stenosis? loud murmur with thrill, possible cyanosis
What are the clinical manifestations of severe pulmonary stenosis? right sided heart failure, thrill, heave
this obstructive blood flow disorder you can see either no signs and symptoms OR you could see symptoms of right sided heart failure pulmonary stenosis
this obstructive blood flow disorder you can see varying degrees of left sided heart failure aortic stenosis
What are the mild to moderate symptoms of aortic stenosis? dyspnea, exercise intolerance, angina, syncope, murmur
What are the severe symptoms of aortic stenosis? CHF (left side), narrow pulse pressure, arrythmias, sudden death, thrill
What are used to reduce cardiac hypertrophy in aortic stenosis? beta blockers and calcium channel blockers
What is the treatment of aortic stenosis and what is controversial and why? balloon angioplasty is controversial due to risk of rupture of the aorta (no time to correct), surgical opening of valve and artificial valve is tx of choice
narrowing of the aorta that obstructs blood flow coarctation of aorta
What are the clinical manifestations of coarctation of aorta? above the defect: increase BP and Pulse Belove the defect: decrease BP and pulse
Where is the most common site for coarctation of the aorta? below the left subclavian
Other than cath or surgery, what other medical treatment can be used for coarctation of the aorta? PGE1 to keep the PDA open to get blood to the lower body
What surgical intervention is done for the treatment of coarctation of the aorta? primary end to end anastamosis, using subclavian flap, where the narrowed part is removed, then distal and proximal ends attached
Why would they not do balloon angioplasty or use a goretex patch for the treatment of coarctation of the aorta? Balloon angioplasty has a risk of rupturing the aorta, and goretex patch does not grow when the child grows, which the aorta needs to grow
What are post op complications following surgery of a coarctation of the aorta? chylothorax, infection, residual HTN, bleeding, paralytic ileus, post cardectomy syndrome, paralysis
What are the special considerations post op a coarctation of the aorta repair with a subclavian flap? LEFT ARM: NO BP,phlebotomy, IV's to flapped arm due to decrease flow, collaterals with form with time
Why is it important for newborns to get pulse and blood pressure in all 4 extremeties? because they could have coarctation of aorta, or other defects (10-15mmHg difference)
What are the two congenital heart disorders that cause mixed blood flow? Transpositions of the great arteries and hypoplastic left heart syndrome
The aorta comes from right ventricle, the pulmonary artery comes from left ventricle and forms two complete and separate circulations transposition of the great arteries/vessels
What is happening with the blood in transposition of the great vessels? deoxy blood returns to lungs, oxy blood returns to body, THIS IS NOT CONDUSIVE WITH LIFE!!
What are the clinical manifestations of transposition of the great vessels? CYANOSIS and CHF at birth or shortly after PDA begins to close, dyspnea, RVH, progressive acidosis, and hypoxia
What is the medical management for transposition of the great vessels? PGE1 to maintain PDA, oxygen, correct metabolic acidosis (w/ sodium bicarb), tx HF with digoxin and diuretics (aldactone)
What emergency palliative procedure can be done in transposition of the great vessels if there is no sufficient ASD or VSD present? Rashkin Balloon atrial septostomy to create or enlarge a patent foramen ovale (flap like opening)
What are the possible complications after a rashkin balloon atrial septostomy for transposition of the great vessels? arrythmias, bleeding, infection
What SURGICAL repair can be done for transposition of the great vessels? Arterial switch
During cath lab, before an atrial switch for treatment of transposition of the great vessels, what does the doctor need to do? needs to determine where coronary arteries arise to ensure that they will be located on the lefts side following surgical correction
What do you need to watch for post op after an atrial switch for transposition of the great vessels? decreased cardiac output and CHF due to shock of the heart (the heart has to get used to it)
This is the leading cause of death from CV disease in the first 2 weeks of life, where the left ventricle fails to develop normal or sufficiently Hypoplastic left heart syndrome
What are the clinical manifestations of HLHS? Cyanosis increases as PDA closes, respiratory distress, right ventricular hypertrophy
What three options are families given if their child has HLHS? Transplant, staged surgical repair, palliative care
How does the staged surgical repair work in the tx of HLHS? 3 chambered heart: blood enters right atrium which works as the right ventricle, and exits the lungs. The blood returns from the lungs, to the left atrium, passes through the true right ventricle which now works as the left ventricle, exits RV to the body
What is the benefit of a three chambered heart in children with HLHS? This can buy time for the child to grow and possible increase chances of getting a heart transplant later in life.
What do we need to watch the child for when they have a three chambered heart in HLHS? The right ventricle was not designed for the increased work of pumping blood to the body, so need to watch them for heart failure (also tire easily)
What is the congenital heart defect that decreases pulmonary blood flow? Tetralogy of Fallot
What are the 4 anomalies seen together that make up Tetralogy of fallot? Large ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta (ventricular septum goes into aorta)
What are the clinical manifestations of tetralogy of fallot? cyanosis increased with crying, TET spells, dyspnea on exertion, murmur, polycythemia (inc. RBC)
Why is deoxygenated blood re-circulating to the body in tetralogy of fallot? right to left shunting of blood since the pressure is high in the pulmonary artery, it is "easier" for the blood to cross the ventricular septal defect into the left ventricle
REMEMBER: eating is considered exertion
Why is it bad to have polycythemia which is caused from tetralogy of fallots? the RBC's increase in attempt to increase oxygen carrying capacity which is not good because the increase in RBC increases the blood viscosity making it more difficult for blood to flow
What nursing interventions are done for children whom have tetralogy of fallot? prevent dehydration, Inderal (increase pulm. artery dilation) maintain nutrition
When is surgical correction for children that have tetralogy of fallot and what needs to be watched postop?? often 1-2 years old, watch for CHF post op
What would you see in the hands if tetralogy of fallot goes untreated? clubbing of the fingers
This is seen in tetralogy of fallot, peaks 2-4 months old, related to the increase oxygen demand in the face of limited pulmonary blood flow TET spells (hypercyanotic spells)
Are TET spells a primary oxygen problem or a circulation problem? Circulation: Right to left shunting, deoxy blood (acidosis), hyperpnea (breathe faster), blood pumps faster, the cycle starts over.
What is the treatment for TET spells? MUST BREAK THE CHAIN! place the child into the knee to chest position, if this does not work morphine may be used, blow by 02 (not first line, can scare child with 02, then they have more TET spells)
Congenital heart disorders, rheumatic fever, kawasaki disease, or infectious endocarditis can cause heart failure
What is the goal of treatment for heart failure? decrease work of the heart, improve respirations, maintain proper nutrition, prevent infection, decrease anxiety
What are the nursing interventions for a child with heart failure? small freq. feeds (dec. exertion), rest, digoxin, diuretics (lasix or aldactone), aterial vasodilators (hydralazine) or calcium channel blockers (nifedipine), oxy as little as needed (1/4L)
What are the clinical manifestations do you see with right sided heart failure and why? blood is backing up into the body: distended neck veins, tachycardia, enlarged liver (see this before dependent edema)
What are the clinical manifestations do you see with left sided heart failure? LUNGS: cyanosis, dyspnea, rales, orthopnea, tachycardia, fatique, restlessness
1 PINT of excess fluid is approx. 1 pound of weight gain
Autoimmune disease and a systemic disease involving joints, heart, CNS, skin, and subcutaneous tissue. Reaction to group A Beta-hemolytic strept Rheumatic fever
What are the important lab findings with rheumatic fever? INCREASED: ASO titer, ESR, C-reactive protein levels
What are the clinical manifestations of rheumatic fever? migratory polyarthritis (left hip today, right knee hurts tomorrow), erythema marginatum (sm. circle patches w/ red center), sydenhams chorea (aimless irr. mvmts, clumsy), low grade fever, pale, listless, poor appetite, P and RR out proportion of fever
Is migratory polyarthritis painful? yes, given salicylates for pain
What is the goal and treatment for rheumatic fever? Aimed at preventing permanent heart damage because mitral valve scarring is possible. Treat with rest, ASA (pain), antibacterials, manage HF
Why is it okay to give ASA for rheumatic fever? Since rheumatic fever is BACTERIAL, not VIRAL, you dont have to worry about Reye's syndrome. The aspirin is needed for the heart to dec. pain and used as an antiplatelet
this is also known as mucopurulent lymph node syndrome, not contagious, and usally in kids under 5 years old. it may be a reaction to toxins from a previous infection such as staph. Kawasaki disease
What is the principle finding in kawasaki disease and what can it lead to? vasculitits which leads to an aneurysm which can lead to an MI
What are the signs and symptoms of kawasaki disease? abrupt onset of temp greater than 104, pink eye with NO discharge, cracked lips, strawberry tongue, erythmatous skin rash, swollen hands, peeling of the palms and soles of feet
What is the treatment for kawasaki disease? ASA or ibuprofen, abciximab, IV gamma globulin
What does ASA, Ibuprofen, abciximab, and IV gamma globulin do in the body for the treatment of kawasaki disease? ASA/Ibuprofen (decreases inflamm, antiplatelets), Abciximab (platelet receptor inhibitor to promote vascular remodeling), IV gamma globulin (help prevent coronary artery damage
In children sinus arrythmia on inspiration is normal
If children have high blood pressure, what is done? evaluated for renal and hepatic problems
What are the first line treatments in HTN in chidren? diet and exercise before antihypertensive meds
What are important things to remember about cardiac arrest in children? CAB (not ABC), do not defib initially UNLESS the child has a known cardiac disease
water and electrolytes are lost equally, sodium is normal isotonic dehydration
What is the greatest risk of isotonic dehydration? shock
What are the signs and symptoms of isotonic dehydration? lethargic, poor skin turgor, cool, dry mucous membranes and skin, sunken and soft fontanelles and eyes, absence or dec. in tears or salivation, thirsty, dec. UO
What are the vital signs like in isotonic dehydration? increased respirations and HR, normal to low BP, temp subnormal or elevated
What do you rehydrate the child with in isotonic dehydration? Isotonic solutions
more water lost than electrolytes, sodium and other e-lytes are high hypertonic dehydration
What is the risk of hypertonic dehydration? it has a higher mortality rate than isotonic dehydration
What are the signs and symptoms of hypertonic dehydration? lethargic, irritable, good turgor, PARCHED mucous membranes, sunken eyes and fontanelles, absence/dec. tearing and salivation, MARKED THIRST, UO normal to dec.
What are the vital signs like in hypertonic dehydration? increased temp, HR, respirations...normal to low BP
What do you rehydrate with in hypertonic dehydration? hypotonic solution
more electrolytes are lost than water, sodium is decreased hypotonic dehydration
What is the risk of hypotonic dehydration? water intoxication
What are the signs and symptoms of hypotonic dehydration? lethargic to DELIRIOUS, coma, poor skin turgor, clammy skin and mucous membrane, sunken soft fontanelles and eyes, thirsty, decreased UO
What are the vital signs like with hypotonic dehydration? temp subnormal to normal, increased HR and respirations, VERY LOW B/P
What is the treatment for hypotonic dehydration? hypertonic solutions
What are nursing interventions for all types of dehydration? If caught early enough, give oral rehydration solutions (pedialyte) if otherwise, IV therapy, and watch for overhydration
What is the most common cause of overhydration in a child? too much IVF, watch for e-lyte imbalance
What three bacterial infections cause vomiting and diarrhea? Salmonella, Shigellosis, Staph food poisoning
this is the most common type of food poisoning which causes severe dehydration, diarrhea may contain blood or mucuous, abd. pain, vomiting, high temp, H/A, drowsy salmonella
These complications: meningitis, bronchitis, osteomyelitis can be caused by salmonella
What is the treatment for mild-mod, and severe salmonella infection? mild-mod: watch fluids and electrolytes let it run its course. Severe: tx with ATB
this is also known as dysentery, from contaminated food or water and causes SEVERE diarrhea with blood or mucus Shigellosis
What is the treatment for Shigellosis? cephalosporins
This infection is most often caused through creamed foods, causes SEVERE V & D, abd. cramping, excessive salivation, nausea staph food poisoning
What is staph food poisoing treated with? cefotaxime IV
Viral infection that is the most common cause of severe diarrhea in children under 5 years old. Rotavirus
What S&S do you see with Rotavirus? Acute onset of temp greater than 102, vomiting, followed by watery diarrhea, which may be seedy yellow green with pungent odor. They will have 10-20 stools/day
What is the treatment of rotavirus? watch for and manage dehydration
this happens from relaxed or noncompetent lower GI sphincter, where there is a return of gastric contents into esophagus, therefore seeing vomiting gastroesophageal reflux
What are the S&S of GERD in children? vomiting, wt. loss, FTT, fussy, hungry
What is the treatment for GERD? burp frequently, dont overfeed, position upright in infant sling (fowlers swing) for one hour post feed, thicken formula (w/ rice cereal),
With GERD, these children sit upright or side lying or prone position due to risk of aspiration
What are prescription meds given for GERD? Zantac, Pepcid, Prevacid, Prilosec
Severe cases of GERD may need fundoplicaion, may have temporary or permanent gastronomy tube placed during OR
narrowing of the lower end of the stomach pyloric stenosis
What are the signs and symptoms of pyloric stenosis? projectile vomiting immediately after feeding, constantly hungry, dehyrdation, olive shaped mass in RUQ
What is the treatment for pyloric stenosis? surgery
What are the nursing interventions for pyloric stenosis? monitor fluid and electrolytes, before surgery thicken feedings, frequent burping, place upright on right side following feeds
What post op interventions are done after surgery of pyloric stenosis? monitor VS, surgical site, resume clears after recovers from anesthesia but do not over feed
intermittent protrusion of stomach through esophageal opening in diaphram that cause vomiting with pain and SOB hiatal hernia
What is an important intervention for children who have hiatal hernias? KEEP THEM UPRIGHT
If hiatal hernias do not correct by 6 months they need surgical correction
shallow erosion in mucosal wall that cause blood in vomit and stool, abdominal pain with an empty stomach, vomiting and pain after meals peptic ulcer disease
Where is the erosion in the mucosal wall, in peptic ulcer disease, in infants and adolescents? Infants: gastric Adolescents: duodenal
What is the treatment for peptic ulcer disease? antibiotics and antacids as ordered, maintain nutrition
What is important to teach with any hepatitis? handwashing
This is infections hepatitis, fecal/oral transmission, often from contaminated water and food Hep A
This must be administered within 2 weeks of exposure to Hep A that is for prophylaxis immune globulin
What are the signs and symptoms of Hep A? flu-like, jaundice, dark urine, tender liver
This is serum hep, parenteral transmission often through of blood and body products Hep B
after exposure of hep B there is a prophylaxis available which is immune globulin
What are the signs and symptoms of Hep B? some asymptomatic, anorexia, abdominal pain, fatigue, rash, slight temp, visible jaundice, enlarged liver
Spread through blood/blood products and is the most common blood-borne infection in the US. Hep C
What are the signs and symptoms of Hep C? if chronic often asymptomatic, flu-like, jaundice, heptatospleenomegaly,
Is there a vaccination for Hep A, B, or C? A: first dose age 1 B: three dose series C: No vaccine or prophylaxis
What are 3 types of obstruction in the bile ducts of the liver? atresia, stenosis, or absence
What are the signs and symptoms of obstruction of bile ducts in the liver? jaundice (app. 2 weeks) from increased direct bilirubin, stools light in color, cirrhosis
What is the treatment for hepatic disorders? surgical correction, liver transplant may be needed if extensive involvement
you can use a lobe of an adult relative to transplant into a child because the liver will continue to grow
slipping of one part of the intestine into another part below it, can correct itself without treatment, or cause an intestinal obstruction intussuception
twisting of the intestine volvulus
what are the signs and symptoms of a volvulus? intense crying, pain, pulling up legs, abdominal distention, vomiting
What is the treatment for volvulus? surgical correction
bowels develop dead patched and results from ichemia or poor perfusion of the bowel, higher incidence in premies necrotitis entercolitis
When do symptoms begin with necrotitis entercolitis AFTER feeding a child
what are the signs and symptoms of necrotitis enterocolitis? abdominal tense and distended, occult positive in stools, apnea, signs and symptoms of blood loss
What is priority for a child if there is suspicion that they have necrotitis entercolitis? NPO immediately, stop feeds, begin IVF, surgical removal of necrotic patches
What might the child have after surgery for necrotitis enterocolitis and why? may need a temporary colostomy because they may had to take out large sections of the dead tissue
Why is short gut syndrome bad after surgery from necrotitis enterocolitis leads to nutritional defects because they cant absorb nutrients
What are the signs and symptoms of appendicitis in children? begins in periumbilical, increases with in 4 hours, rebound tenderness, pain on lifting the right thigh while in the supine position
The appendix can rupture within how many hours of onset of pain? 36
What is the sign of ruptured appendix and what are we going to do for them?? appear severely ill, position them in semi-fowlers, IVF, ATB
Located near the ileocecal valve, omphalomesentaric duct fails to atrophy, and it isnt needed after birth Meckel's diverticulum
What are the signs and symptoms of Meckel's diverticulum? most often before 2, condition appears suddenly, painless bleeding from the rectum (bright red blood) may/may not have abd. pain
this is known as sprue, it is an immune response to gluten factor of protein like wheat, rye, oats, and barley celiac disease
What are the signs and symptoms of celiac disease? (6m-2yrs) begins after introduction to gluten in diet, FTT, large bulky frothy stools, irritability, abdominal distention and wasting of extremeties
What is the treatment of celiac disease? lifelong restriction of wheat, rye, oats, and barley, may need water soluable vitamins
What happens in a celiac crisis? If patients with celiac disease develop any type of infection extreme symptoms will occur like acute vomiting and diarrhea, quickly experience fluid and electrolyte imbalance
protrusion of section of bowel into inguinal ring and appears as a lump in the right or left groin and may be only apparent when crying Inguinal hernia
Occurs where there is an absence of ganglionic innervation that results in chronic constipation Hirchsprung's disease
What are the signs and symptoms of hirschsprung's disease? ribbon-like stools, abdominal distention, anorexia, vomiting, FFT
What is the serious complication that can arise from Hirschsprung's disease? enterocolitits
protein deficiency (1-3yrs) and occurs in mostly developing countries like africa, major growth failure, wasting of muscles, edema, ASCITES, irritability Kwashiorkor
Without treatment, kwashiorkhor can be fatal!
What is the treatment for Kwashiorkhor? protein rich diet, however any delays that occur will remain
Def of vitamin B that causes tingling, numbness of extremities, heart palpatataions, D?V, crying without making a sound (aphonia) BERIBERI
deficiency of vit C that causes muscle tenderness, petechiae SCURVY
deficiency of vitamin D and see poor bone formation, poor muscle tone, delayed tooth development RICKETS
Created by: taylor_rhoades