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Resp, Circ, Nut

Peds Exam 1

What are Acute Infectious Pharyngitis symptoms? Pharyngitis, Headache, Fever, and Abdominal Pain. Tonsils and Pharynx may be inflamed and covered with exudate
When should you suspect a streptococcal infection in children older than 2 years of age? Streptococcal infection should be suspected in children older than 2 years of age who have pharyngitis without exudate or nasal symptoms
What are complications of Acute Infectious Pharyngitis caused by Group A Beta-Hemolytic Streptococci? Children with GABHA infection of the upper airway - strep throat, are at risk for Rheumatic Fever (RF) and Acute Glomerulonephritis (AGN)
What are early signs of respiratory complications with URI's? Refusal to eat, evidence of earache, resps.> than 50-60 breaths / min, fever over 38.3C or 101F, Listlessness, confusion, increased irritability with or without fever, persistent cough for 2 days or more, wheezing, restlessness and poor sleep pattern
What is nursing care for Acute Infectious Pharyngitis? Throat swab for culture, analgesics as prescribed, cold or warm compresses, warm saline gargles if cooperative, Ibuprofen >6mths and Tylenol, cool liquids, ice chips and popsicles. ATB as ordered
What drug should never be administered IV? Penicillin G Procaine or Penicillin G Benzathine Suspensions can cause embolism or toxic reaction. Must be given IM
What are Tonsillitis symptoms? Enlarged tonsils by edema, difficulty swallowing and breathing, if Adenoids are involved, child will mouth breath
What is the treatment for Tonsillitis? Treat symptoms as long as culture comes back negative. Analgesics, ice, popsicles, cold or warm compresses
When is a Tonsillectomy and or Adenoidectomy warranted? Recurrent throat infections (7 or > in last year) and sleep disorder breathing for tonsillectomy. Adenoidectomy is 4 or > recurrent purulent rhinorrhea in 12 months, nasal obstruction >3 months
What is an obvious sign of bleeding after tonsillectomy or adenoidectomy? Continuous swallowing, even while sleeping
What is Otitis Media (OM)? An inflammation of the middle ear without reference to etiology or pathogenesis
What is Acute Otitis Media (AOM)? An inflammation of the middle ear space with a rapid onset of the signs and symptoms of acute infection - fever and otalgia (ear pain)
What is Otitis Media with Effusion (OME)? Fluid in the middle ear space without symptoms of acute infection
What is the nursing care for Tonsillectomy and Adenoidectomy? Providing comfort and minimizing activities or interventions that can cause bleeding. Soft diet, warm salt water gargles, warm fluids, throat lozenges, pain meds, ice chips, popcicles
What are the most common bacteria that causes Acute Otitis Media (AOM)? Streptococcus pneumonia, H. influenzae and Moraxella catarrhalis
What is the primary reason for Otitis Media (OM)? Malfunctioning Eustachian Tubes
What are some symptoms of Chronic Otitis Media? Hearing loss, difficulty communicating, feeling of fullness, tinnitus or vertigo may be present
What are the Croup Syndromes? Acute Epiglottitis, Acute Laryngotracheobronchitis (ALTB), Acute Spasmodic Laryngitis, Acute Tracheitis
What is Acute Epiglottitis? It is a medical emergency. It is an obstructive inflammatory process that occurs mostly in children 2-5 years old, usually caused by H.influenzae
What are symptoms of Acute Epiglottitis? Rapid progression, dysphagia, Stridor aggravated when supine, drooling, high fever, toxic appearance, rapid pulse and respirations
What are the treatments for Acute Epiglottitis? Airway protection, Corticosteroids, Fluids, ATB, Reassurance
What is Acute Laryngotracheobronchitis (ALTB)? It is the most common Croup Syndrome effecting infants and children younger than 5 years old. It is usually caused by a virus, particularly parainfluenza 1, 2, and 3, adenovirus, enterovirus, RSV, rhinovirus and influenza A and B
What are the symptoms of Acute Laryngotracheobronchitis? Usually have a URI 1st, Low grade fever, barky, brassy cough and hoarseness. Dyspnea, Restlessness, Irritability. Inflammation of mucosal lining of larynx/trachea, airway narrows, struggles to breath, then will see stridor, suprasternal retractions
What are the treatments of Acute Laryngotracheobronchitis? Humidified oxygen, if needed. Corticosteroids, Fluids, Reassurance
What is Acute Spasmodic Laryngitis? Recurrent paroxysmal attacks of laryngeal obstruction that occur chiefly at night in 1-3 year olds. It is viral with an allergic component
What are the symptoms of Acute Spasmodic Laryngitis? Usually have a URI 1st, Occurs at night, croupy cough, stridor, hoarseness, dyspnea, restlessness, awakens child at night but disappears during the day. Tendency to recur
What are the treatments of Acute Spasmodic Laryngitis? Cool Mist and Reassurance
What is Acute Tracheitis? An inflammation of the mucosa and soft tissues of the upper trachea caused by viral or bacterial infection. It is more than likely a complication of LTB. Staphylococcus aureus is most common cause
What are the symptoms of Acute Tracheitis? Symptoms are similar to LTB, croupy cough, stridor unaffected by position, toxicity, absence of drooling, and high fever, Thick purulent tracheal secretions are common and respiratory difficulties are secondary to these copious secretions. WBC up
What are the treatments of Acute Tracheitis? Even though symptoms are similar to LTB, LTB therapy does not work. Oxygen, Antibiotics, antipyretics and fluids are needed
What are some Secondary Observations for Celiac Disease? (screening) Stool for Fat, CBC for Anemia, PT-Prolonged d/t Vit K, Low Protein & Iron, Altered Immunoglobulins, GI Series, Barium Enema, Sweat Test, Peroral Jejunal Biopsy, Glucose TT
What are some complications of Celiac Disease? Shock, Metabolic Acidosis from dehydration, Death (secondary to Celiac Crises)
What are treatments for Celiac Disease that needs removed from diet? Low Gluten Diet to remove gluten products from diet and hydrolyzed vegetable protein. Avoid rye, oats, wheat & barley
What treatments for Celiac Disease that needs added to the diet? Use Corn & Rice instead of grains, Water soluble Vit. A,E,D,K. Replace Ca, Iron, Folate, TPN when severe, Corticosteroids for Crisis
What are some Plan of Care Implementation that should be made? Obtain accurate history - Signs & Symptoms, What activities and foods may cause crises. Teach Low Gluten Diet, Protect from Infection, Monitor for Acidosis, NPO, IV Fluids, NG - low suction to rest bowel, Steroids as ordered
What is the Health Promotion for Celiac Disease Prevention? Primary - Careful Introduction of Solid Foods at appropriate time in life. Secondary - Early recognition of S/Sx. Tertiary - Support for life long problem, Refer to support groups
What diagnosis should you think of with Pyloric Stenosis Projectile Vomiting, because muscles / tissue around sphincter are hypertrophied which narrows the opeing
What is the assessment finding or pyloric sphincter? Obstruction of pyloric sphincter secondary to combination of hypertrophy and hyperplasia of muscles around the pylorus
What is the etiology of Pyloric Stenosis? Classified as congenital, but doesn't show up immediately at birth, Exact cause unknown, 1 in 500 live birth have
What is the incidence of Pyloric Stenosis? 1 in 500 live births have it, 4-5 :1 Males vs Females have, Higher incidence in whites. 90-95% of cases appear between 2wks - 2mths. More prevalent in 1st born and monozygotic twins
What are some Primary Observations of Pyloric Stenosis (Prevention)? Projectile Vomiting - no bile (could be some blood d/t irritation), infants begin w/spit up then progress to projectile, Fever, Dehydration, Metabolic Alkalosis, FTT, decreased void & BM, hunger, Palpable tumor r-umbilicus, visible perstalis
What are some Secondary Observations of Pyloric Stenosis (Screening)? UGI - Shows delayed emptying Electrolytes - Decreased r/t Dehydration Ultrasound - Best d/t less traumatic and more accurate
What are some Nursing Diagnosis's for Pyloric Stenosis? Fluid Volume Deficit d/t Vomiting Altered Nutrition (<body requirements) r/t vomiting Altered Comfort r/t Hunger Potential Aspiration r/t Projectile Vomiting
What are treatments for Pyloric Stenosis? Fredet-Ramstedt Surgery (Pyloromyotomy) Laparoscopes - Effective, Loess time in OR, Less Post Op Recovery
What are Pre-Op Nursing Interventions for Pyloric Stenosis? Obtain H&P, Feed Upright, Small Frequent Feedings, Burp Frequently, After feeding - Place on R-Side in High Fowler's, Handle Minimally after feeding, Monitor Electrolytes, I&O, Daily Weights
What are Post-Op Nursing Interventions for Pyloric Stenosis? Monitor Electrolytes, Daily Wgts, I&O, Assess for Dehydration, May need NG Tube, Feed 2-8hrs after OR - small amounts of clear liquids, then lower strength formula then up to full strength, Teach Feeding Regiment
What are the complications does the nurse need to teach parents about Post-Op Pyloric Stenosis? S/Sx of Infection Watch for Sudden ABD Distention Watch for Wound Dehiscence
What is GER (Chalasia)? Gastro Esophageal Reflux has similar symptoms as Pyloric Stenosis, but different treatment The Cardiac Sphincter is incompetent which causes frequent reflux of gastric contents into esophagus
What are the treatments for GER (Chalasia)? Thickened feedings which rice cereal, Keep elevated after feeding, Give Medications to promote gastric emptying Usually improves by age 1 Severe cases - Fundoplication Surgery to Prevent Reflux
What is Cleft Lip and Palate? Facial Malformation including Lip and/or palate Occurs during Embryonic Development May Occur Separately or More Often, Together Varies in Severity
What is the Etiology of Cleft Lip and Palate? It is considered Multifactorial Inherited Defect Increased within Families and in Monozygotic Twins Some Chromosomal Abnormalities are associated with it Environmental Teratogens are linked: Smoking 1st Trimester
What is the Etiology / Incidence of Cleft Lip? Results from Failure of Maxillary & Medial Nasal Processes to Fuse, Occurs the 7th-8th week of fetal development, More Common in Males, More Frequently in Asians & Native Americans, Less Frequently in Whites & Blacks
What is the Etiology / Incidence of Cleft Palate? A midline fissure of the palate that results in failure of the 2 side to fuse Occurs during 7th-12th weeks of fetal development More Common in Females
What are Nursing Diagnosis's r/t Cleft Lip and Palate? Potential for Aspiration Potential for Altered Self Esteem Potential for Altered Family Processes Potential for Infection (Otitis Media)
What are the Planning or Implementation for Cleft Lip and Palate? Cleft Lip Repair (Cheiloplasty) age 6-12 wks Rule of 10's - 10 pounds, 10 wks., 10gm Hgb Palate Repair (Palatoplasty) age 12-18mths, May require 2 surgeries 3-6mths in between
What is the Pre-Op Care for Cleft Lip and Palate? Education for Parents Get child use to supine or side-lying position Use are restraints periodically so child can get use to Feed pre-operatively with alternate devices often before surgery
What do you use to feed Pre-Op for Cleft Lip and Palate? Bottle Feeding - Nipple may have to cross cut hole, Nipple should be soft & easily squeezed, Nipple should not be placed in the cleft, Mead Johnson Cleft Palate Nurse may be used or a Haberman Feeder
What are some Post-Op Nursing Interventions for Cleft Lip? Protect Suture Line, Apply Logan Bow over suture line, position on back or side, use elbow or jacket restraints, Clean suture line after feeding & PRN w/NS & apply ATB, Monitor for Mucus Production, Give Pain medications, Anticipate Needs
What are additional Post-Op Nursing Interventions for Cleft Lip? Encourage parents to hold, Feed w/Adept Rubber tipped Syringe - Brecht Feeder place on opposite side of mouth away from suture line, Start clear liquids, then advance to normal diet, Teach suture line care, address parent's needs
What are some Post-Op Nursing Interventions for Cleft Palate? Position on ABD, immediately after surgery - monitor airway, Elbow restraints as needed, No objects in mouth - straws, spoons, suction, May resume breast, bottle & cup feeding - clear liquids advance gradually, pain control, may have oral packing
What is some Long Term Care for Cleft Lip and Palate? Lots of F/U care - especially for Cleft Palate, Dental/Orthodontic Care, Speech Therapy, Plastic Surgery, Emotional Support
What is Celiac Disease? A malabsorption disorder - Intolerance to Gluten
What is the pathophysiology of Celiac Disease?
What foods are Gluten found in? Rye, Oats, Wheat and Barley
What is the cause of Celiac Disease? Exact cause is unknown. It may be inherited through dominant gene. It is rare in blacks, seen more in Europe, Not diagnosed until 9-18 months. Could be after 5yrs. old
What are the predisposing factors of Celiac Disease? Time of solid food introduction - like to early for age. Breast fed child develops later d/t time of foods introduced usually later. Immunological Alteration, Inborn Erro of Metabolism
What can cause a Celiac Crisis? Infection, Prolonged Fasting, Ingestion of Gluten, Anti-Cholinergic Agents
What can an episode of Celiac Crisis lead to? Electrolyte Imbalance - Rapid Dehydration, Severe Acidosis
What are Primary Observations of Celiac Disease? (prevention)
Created by: DSwords01
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