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UTA NURS 4431 Exam 2

UTA NURS 4431 Children & Adolescents Exam 2

Premature infant differences in respiratory system higher risk for respiratory distress syndrome (RDS) d/t lacking surfactant; more compliant chest wall and weaker respiratory muscles
Neonatal differences in respiratory system increased risk for obstruction by mucus, edema, and foreign bodies d/t smaller airways and undeveloped cartilage; obligate nose breathers until 4wks; use diaphragm to breath; irregular rhythm with periods of apnea;
Infant differences in respiratory system primarily nasal until 5-6 mos; retractions (abnormal movements of chest wall) common
Children differences in respiratory system breathe abdominally; increased normal RR; increased O2 demand d/t increased metabolism; ear infections common d/t horizontal eustachian tubes; larynx more susceptible to spasm; enlarged tonsils
Crackle sound Discontinuous, high-pitched, short, crackling, popping sounds heard during inspiration and not cleared by coughing.
Crackle indicates Fluid in airways (e.g., Late inspiratory crackles occur with restrictive disease: pneumonia, congestive heart failure, and interstitial fibrosis. Early inspiratory crackles occur with obstructive disease: chronic bronchitis and asthma.)
High-pitched wheeze sound High-pitched, musical squeaking sounds
High-pitched wheeze indicates narrowing of the air passages from fluid, swelling, spasm, and tumors (e.g., Obstructive lung disease, such as asthma)
Low-pitched wheeze sound Low-pitched, musical snoring, moaning sounds.
Low-pitched wheeze indicates Airflow obstruction (e.g., Bronchitis)
Pleural friction rub A very superficial sound that is coarse and low-pitched; it has a grating quality, as if two pieces of leather were being rubbed together.
Pleural friction rub indicates pleurae inflamed and lose their normal lubricating fluid (e.g., Pleuritis, accompanied by pain with breathing)
nasal cannula indication, amount of oxygen, and flow rate low-flow delivery system indicated for infants and children who need modest amounts of supplemental oxygen (up to 40%, or a flow rate of 1 to 6 L/min)
Simple facemask and Venturi mask indication, amount of oxygen, and flow rate indicated for infants and children who need modest amounts of supplemental oxygen (35% to 60%, or a flow rate of 6 to 10 L/min)
Partial nonrebreather masks amount of oxygen and flow rate 50% to 60% at a rate of 10 to 12 L/min.
full nonrebreather system amount of oxygen and flow rate close to 100% oxygen at a flow rate of 10 to 15 L/min
Cystic fibrosis (CF) an inherited autosomal recessive disorder affecting the exocrine glands, leading to abnormal accumulation of viscous, dehydrated mucus, causing obstruction in the respiratory, gastrointestinal, integumentary, genitourinary, and reproductive systems.
CF manifestations short stature, sinusitis, failure to thrive, nonproductive cough, increased aneroposterior chest diameter, protuberant abdomen, digital clubbing, steatorrhea (fatty stool)
CF early manifestation wheezing, dry/nonproductive cough, frequent respiratory infections (pneumonia, bronchitis), meconium ileus
CF diagnosis a positive sweat test result (chloride level greater than 60 mEq/L is considered to be diagnostic for CF; a level of 40 to 60 mEq/L is suggestive of CF and requires repeating the test) or DNA testing
CF management CPT, exercise, antibiotics, steroid therapy, nutritional management with administration of pancreatic enzymes
Asthma manifestations dry cough, wheezing, retractions, nasal flaring, stridor, restlessness, apprehension, diaphoresis, abdominal pain, fatigue, chest tightness, dyspnea, worsening of symptoms at night.
Mild intermittent asthma symptoms ≤2/wk or only with exercise, normal peak expiratory flow rate between episodes (80% during exacerbation), brief episodes, Infrequent use of bronchodilator (<2/wk), Few missed school days, Rare activity limitation, rarely disturb sleep (< 2/mos)
Mild persistent asthma symptoms >2/wk but <1/day, may begin to affect activity, require a burst of oral corticosteroids more frequently (≥2/yr; more often in children <4 yrs), Nighttime symptoms 1-4/mos depending on age, PEFR >80% predicted
Moderate persistent asthma daily symptoms and bronchodilator use, require a corticosteroid burst ≥2/yr, > 9 school days missed/yr, Some activity limitation, Sleep disturbed >1/wk, PEFR 60% to 80% of predicted
Severe persistent asthma Throughout the day on a daily basis, Use of bronchodilator several times per day, Severely limited physical activity, Frequent sleep disturbance, Exacerbations requiring corticosteroid bursts occur frequently (≥2/yr), PEFR ≤60% of predicted
Apnea the cessation of breathing for a period of 20 seconds or longer, or for a shorter period but accompanied by bradycardia or cyanosis.
Apnea manifestations apparent life-threatening episode (ALTE) characterized by apnea, color change, change in muscle tone, choking, or gagging in an infant who otherwise appears healthy.
Apnea management apnea monitor, neutral thermal environment, monitor while feeding
SIDS the sudden and unexplained death of an infant younger than 1 year.
SIDS Risk Factors prematurity, use of soft bedding, sleeping prone, maternal smoking during pregnancy, sibling having died of SIDS, LBW, low socioeconomic status
Croup a group of conditions characterized by inspiratory stridor, a harsh (brassy or croupy) cough, hoarseness, and varying degrees of respiratory distress
Croup manifestations Fever, The sudden onset of a harsh, metallic barky cough; sore throat; inspiratory stridor; and hoarseness, The use of accessory muscles (substernal, intercostal, suprasternal retractions) to breathe, Frightened appearance, Agitation, Cyanosis
Epiglottitis bacterial form of croup; inflammation of the epiglottis.
Epiglottis manifestations 4 Ds (dyspnea, Dysphagia, drooling, distress); edematious and cherry red epiglottis, drooling, muffled voice, sore throat, inspiratory stridor, cough, and irritability; can result in airway obstruction and hypoxia, acidosis, and death.
Croup management humidified O2, increased fluids, antipyretics, IVF, corticosteroids, racemic epinephrine, possible intubation
Epiglottis management hospitalization (medical emergency), intubation, IV antibiotics and IVF
Bronchiolitis inflammation of the bronchioles caused by an acute viral infection (usually RSV) which is transmitted predominantly through inadequate handwashing
Bronchiolitis manifestations upper respiratory infection symptoms followed by tachypnea, wheezing/crackles/rhonchi, intercostal and subcostal retractions with or without nasal flaring, and cyanosis
Bronchiolitis management most treated at home with fluids, humidification, and rest; hospitalized treated with cool, humidified oxygen, IVF, elevation of head and chest, and Ribavirin; prevent with RespiGam (in high-risk children)
Bronchiolitis teaching lasts 2-3 wks, hand hygiene, bulb suctioning, when to come back
Pneumonia an inflammation of the lung parenchyma caused by infection (viral or bacterial, ingestion of chemical substances, or foreign body aspiration
Pneumonia manifestations fever, cough, tachypnea, ronchi, crackles, or wheezes, retractions, nasal flaring, chest pain, pallor to cyanosis, irritability, restlessness, lethargy, anorexia, vomiting, diarrhea
otitis media effusion (fluid) and infection or blockage of the middle ear.
Acute otitis media (AOM) effusion and inflammation in the middle ear that occurs suddenly and is associated with other signs of illness.
Otitis media with effusion (OME) the presence of fluid behind the tympanic membrane without signs of infection.
Otitis media ear infection symptoms of upper respiratory infection; infants: irritable, hold or pull at ears, roll head from side to side, or cry while feeding; preschoolers and up report pain; all children have fever, lymphadenopathy, vomiting, diarrhea, mild balance disturbances
Otitis media management no antibiotic or prophylactic antibiotics (when have 3+ episodes in 6 mos or 4+ in 1 year), tube placement (when persistent or >3mos associated with hearing loss)
Foreign Body Aspiration manifestation sudden coughing and gagging; partial obstruction may cause symptoms of respiratory infection for days or weeks; hoarseness, croupy cough, wheezing on one side, dyspnea
Chest physiotherapy (CPT) includes postural drainage, chest percussion and vibration, and coughing and deep-breathing exercises. Requires an order and usually performed 3-4 times/day.
tracheostomy a surgically created opening (stoma) in the trachea.
Neonatal sepsis bacteria or their poisonous products, known as endotoxins, gain access to the bloodstream, causing systemic signs and symptoms.
Neonatal sepsis manifestation temp instability, lethargy, mood/eating pattern changes, abnormal Moro reflex, muscle tone/activity change, pulmonary HTN, fluid/electrolyte & acid-base imbalances, neurologic irritation, jaundice or hepatosplenomegaly, and hyper- or hypoglycemia.
Nonatal sepsis management supportive treatment, IV antibiotics, environmental temperature control, respiratory support with O2, possible intubation and mechanical ventilation.
Bronchopulmonary Dysplasia (BPD) chronic obstructive pulmonary disease that occurs as a result of acute lung injury in some infants who have received supplemental oxygen and mechanical ventilation.
BPD manifestations tachycardia, tachypnea, wheezing, nasal flaring, retractions, grunting (from prolonged expiratory effort), pallor, cyanosis in response to feeding/handling, restlessness and irritability, failure to thrive
Retractions Abnormal movements of the chest wall during inspiration; may be subcostal, intercostal, substernal, suprasternal, or supraclavicular.
Acute respiratory distress manifestations tachypnea (60-80), tachycardia (>140), wheezing/crackles/rhonchi, Intercostal and subcostal retractions with or without nasal flaring, cyanosis
BPD management adequate oxygenation (oxygen therapy), prevention of further lung disease (medication), promotion of lung healing (medication), and nutrition
Cleft Lip and Palate abnormal openings in the lip or palate. The defects may occur unilaterally (on either side) or bilaterally and are the most common congenital craniofacial deformity.
Cleft Lip and Palate management A number of professionals are involved in this process, including surgeons; nurses; geneticists; psychologists or psychiatrists; ear, nose, and throat specialists; audiologists; and occupational and speech therapists.
Esophageal Atresia with Tracheoesophageal Fistula congenital malformations in which the esophagus terminates before it reaches the stomach and/or a fistula is present that forms an unnatural connection between the esophagus and the trachea.
Esophageal Atresia with Tracheoesophageal Fistula manifestations Three Cs: coughing, choking, cyanosis; feeding causes regurgication and coughing, constant flow of saliva, gastric distention
Esophageal Atresia with Tracheoesophageal Fistula management surgical repair to ligate fistula and anastomose esophagus
Immunization cautions for children with immunodeficiency can’t have any live vaccines (chickenpox [varicella], MMR [measles-mumps-rubella], intranasal influenza)
Incubation period time between exposure and disease outbreak
Infectious period period when organism can move from the host to another individual
Prodromal period time between initial symptoms and presence of the full-blown disease
Viral exanthema an eruption or rash on the skin caused by a virus
Aspirin concern risk of developing Reye syndrome
Rubeola Measles
Rubeola distinguishing manifestations rash duration: 6-7 days (vs. 1-3 days for Rubella); Koplik spots (small, blue-white spots with a red base that cluster near the molars on the buccal mucosa) appear before rash
Rubeola rash deep-red, macular rash that usually begins on the face and neck and spreads down the trunk and extremities to the feet.
Rubeola complications secondary bacterial infections such as otitis media, croup, or bronchopneumonia
Rubella German measles, 3-day measles
Rubella distinguishing manifestations rash duration: 1-3 days (vs. 6-7 for Rubeola); Forschheimer’s sign (Petechiae (spots), which are red or purple color and pinpoint in size, may occur on the soft palate); As the rash spreads to the trunk, the rash on the face begins to fade.
Rubella rash Pinkish rose maculopapular rash that begins on the face, scalp, and neck which spreads downward to include the entire body within 1 to 3 days. As the rash spreads to the trunk, the rash on the face begins to fade.
Rubella complication thrombocytopenia
Varicella Chickenpox
Varicella (Chickenpox) rash lesions begin as macular; appear in crops, progress to papules, then vesicles to pustules
Zoster Shingles
Zoster (shingles) rash lesions are unilateral macular/popular and follow a dermatome root
Varicella-Zoster infectious period 1 to 2 days before the onset of rash until all lesions are dried (crusted over), usually 5 to 7 days
Erythema Infectiosum Fifth Disease, Parvovirus B19
Erythema Infectiosum (Fifth Disease) rash maculopapular, lacy rash on trunk and extremities; fiery red, edematous rash on cheeks (“slapped cheek” sign)
Roseola Infantum Sixth Disease, Exanthem Subitum
Roseola Infantum (Sixth Disease) rash rose-pink maculopapules or macules that blanch with pressure that occurs predominantly on the neck and trunk and may be surrounded by a whitish ring.
Mumps manifestations classic clinical sign of parotid glandular swelling (parotitis) often follows fever, myalgia, headache, and malaise, although a substantial number of individuals have no such swelling.
Mumps complication aseptic meningitis; orchitis (inflammation of a testis)
Epstein-Barr Mononucleosis
Epstein-Barr (Mononucleosis) manifestations fever, exudative pharyngitis, lymphadenopathy, and hepatosplenomegaly. Some children develop a maculopapular rash (with admin of penicillin).
Epstein-Barr (Mononucleosis) complications splenic rupture; swelling of pharynx and tonsils severe enough to compromise respiration
Epstein-Barr (Mononucleosis) education avoid contact sports or anything that can cause contact to abdomen, don’t share food/drink/utensils, keep hydrated, hand hygiene, importance of rest and lengthy convalescence
Rabies management prevention (vaccinate animals, avoid wild animals); treat with HRIG (human rabies immune globulin) administered locally around wound and IM; HDCV (human diploid cell vaccine) administered 48 hrs after bite, then on days 3, 7, 14, and 28.
Pertussis Whooping Cough
Pertussis catarrhal manifestations Symptoms of upper respiratory tract infection (rhinorrhea, lacrimation, mild cough, low-grade fever)
Pertussis paroxysmal manifestations Repetitive series of coughs, followed by massive inspiration with a whoop. Cyanosis, protrusion of tongue, salivation, distention of neck veins. Coughing spells may be triggered by yawning, sneezing, eating, or drinking and may induce vomiting.
Pertussis convalescent manifestations Episodes of coughing, whooping, and vomiting that decrease in frequency and severity. Cough may persist for several months.
Pertussis complication pneumonia, respiratory failure, and death
Pertussis management erythromycin to infected child and all nonimmune close contacts
Rocky Mountain Spotted Fever transmission wood tick or dog tick bite
Rocky Mountain Spotted Fever manifestations maculopapular or petechial rash that begins on extremities and spreads to body. Rash progresses to hemorrhagic and necrotic lesions.
Rocky Mountain Spotted Fever complications gangrene of the distal parts of the body can result in thrombosis
Rocky Mountain Spotted Fever management doxycycline within 5 days of onset
Lyme Disease rash erythematous macule or papule forms at the site of the tick bite with a clearing in the center (erythema migrans, or “bull's eye” rash)
Scarlet Fever manifestations fine red papular rash appears in the axillae, groin, and neck, which feels like sandpaper to the touch.
Scarlet Fever causative agent Group A beta-hemolytic streptococci
Smallpox causative agent variola virus
Smallpox manifestations Lesions appear as red spots in the mouth and on the tongue, develop into sores and break, progress into pustules, then form scabs; After a few days a generalized vesicular rash appears
Poliomyelitis causative agent poliovirus
Poliomyelitis manifestations Flaccid paralysis, especially of lower extremities. Fever, malaise, anorexia, nausea, headache, sore throat, and generalized abdominal pain, which begin as mild symptoms, then grow more intense.
Poliomyelitis complications Cervical involvement, called bulbar polio, affects the respiratory and vasomotor centers, resulting in potential damage to respiratory centers and inability to breathe
Diptheria manifestations Hallmark sign: thin, gray membrane on the tonsils and pharynx, causing “bull neck,” or neck edema; Respiratory compromise due to a narrowing of the upper airway
Normal blood flow superior & inferior vena cava to R atrium > tricuspid valve to R ventricle > pulmonic valve & pulmonary arteries to lungs > pulmonary veins to L atrium > mitral valve to L ventricle > aortic valve & aorta to systemic circulation
Indicator of decompensated shock in Neonates and Infants Hypotension (late indicator)
HF manifestations mild tachypnea (70 to 100 breaths per minute) at rest and sometimes difficulty feeding and failure to thrive.
HF management positive inotropes (e.g., digoxin), diuretics (e.g., Lasix), and angiotensin-converting enzyme (ACE) inhibitors (e.g., Catopril)
When to withhold Digoxin (Lanoxin) HR < 100 beats/min in infants; HR is prgessively decreasing or markedly lower than previous rates.
Digoxin toxicity manifestations Level > 2ng/mL; slow pulse, vomiting, and arrhythmias.
When to withhold Furosemide (Lasix) Patient is hypokalemic or having postural hypotension
Left-to-right shunting lesions lesions that increase pulmonary blood flow (e.g., Atrial septal defect (ASD), Ventral septal defect (VSD), Patent ductus arteriosus (PDA), Endocardial cushion defect)
Left-to-right shunting lesion effects and consequences Effects: volume overload in R side of heart and in pulmonary artery causes cardiac workload increase; Consequences: HF, pulmonary vascular disease, pulmonary HTN, Eisenmenger syndrome, & frequent resp infections (can progress to respiratory failure)
Obstructive or stenotic lesions lesions that decrease cardiac outflow (e.g., Pulmonary stenosis, Aortic stenosis, Coarctation of the aorta)
Stenosis the narrowing or constriction of an opening
Atresia Absence or abnormal closure of a normal body orifice or passage.
Obstructive or stenotic lesion effects and consequences effects: increased cardiac workload and ventricular strain; consequences: HF, decreased cardiac output, and pump failure.
Cyanotic lesions with decreased pulmonary blood flow hypoplasia (incomplete development), malalignment, or obstruction on R side of the heart, and decreased amount of blood volume to the lungs (e.g., tetralogy of fallot, tricuspid valve abnormalities, pulmonary atresia with intact ventricular septum)
Cyanotic lesions with decreased pulmonary blood flow effects and consequences effects: hypoxema, increased cardiac workload, and ventricular strain; consequences: upper respiratory infection, severely limited pulmonary blood flow, and marked exercise intolerance.
Cyanotic lesions with increased pulmonary blood flow heart fails to develop into separate pulmonary and systemic circulations or there is a reversal of circulation so that desaturated blood goes to the systemic circulation and saturated blood to the pulmonary circulation
Cyanotic lesions with increased pulmonary blood flow effects and consequences effects: increased cardiac workload, ventricular strain, and decreased cardiac output; consequences: appear ruddy or cyanotic, with increased respiratory effort, or, if systemic circulation is compromised, may be dusky or gray and in cardiogenic shock
Patent ductus arteriosus (PDA) lesion that increases pulmonary blood flow; failure of fetal ductus arteriosus to close completely, causing saturated blood from aorta to move back into pulmonary arteries, increasing left-sided workload and pulmonary blood flow.
PDA manifestations HF, continuous murmur (machinery-like sound), widened pulse pressure, bounding pulses, tachypnea, poor feeding/weight gain, frequent respiratory tract infections, fatigue, diaphoresis, cardiac enlargement
PDA management HF interventions, idomethacin (Indocin) to constrict ductus, cardiac catheterization, surgical management (ligation of ductus via left thoractomy)
Atrial-Septal Defect lesion that increases pulmonary blood flow; abnormal opening between the atria
ASD manifestations may be asymptomatic, systolic murmur in the pulmonic area, splitting S2, dyspnea, fatigue and poor growth
ASD management if asymptomatic, f/u with cardiologist; if symptomatic, administer diuretics and digoxin for HF signs, antiarrhythmics for arrhythmias, interventional cardiac catheterization, surgical placement of sutures or patch
Ventricular Septal Defect (VSD) lesion that increases pulmonary blood flow; Abnormal opening between the ventricles
VSD manifestations may be asymptomatic, tachypnea, dyspnea, poor growth, palpable thrill, systolic murmur at the left lower sternal border
VSD management if asymptomatic, f/u with cardiologist; Diuretics, digoxin, and medications for afterload reduction (e.g., angiotensin-converting enzyme [ACE] inhibitors), Interventional Cardiac Catheterization, Suture or patch closure
Atrioventricular Septal Defect (AVSD; Endocardial Cushion Defect) lesion that increases pulmonary blood flow often associated with genetic syndromes (e.g., Down syndrome); Abnormal endocardial tissue development affecting the atrial and ventricular septum and mitral and tricuspid valves (AV valves).
AVSD manifestations murmur, CHF, mild cyanosis that increases with crying
AVSD management Symptomatic treatment of HF with diuretics, digoxin and ACE inhibitors; surgical repair
Pulmonary Stenosis Stenotic Lesion; Narrowing at entrance to the pulmonary artery at the valve, below the valve, or above the valve
Pulmonary Stenosis manifestations may be asymptomatic, exercise intolerance, right-sided HF, murmur, palpable thrill, cardiomegaly, cyanosis
Pulmonary Stenosis management observation and antibiotic prophylaxis for asymptomatic, Interventional catheterization or surgical management (valvulotomy or shunt) for severe stenosis, PGE1 (prostaglandin) infusion to keep ductus arteriosus open
Coarctation of the Aorta Obstructive lesion; Aorta is constricted near the ductus arteriosus insertion location
Coarctation of the Aorta manifestations asymptomatic, BP difference of 20 mm Hg between upper and lower extremities, brachial and radial pulses full, femoral pulses weak, HS, vertigo, epistaxis, exercise intolerance, dyspnea
Coarctation of the Aorta management Diuretics & digoxin; PGE1; Interventional Cardiac Catheterization (balloon dilation with placement of stent) or Surgical management (end-to-end anastomosis, prosthetic patch); prophylaxis for endocarditis with antibiotics for surgical or dental procedures
Aortic Stenosis Stenotic Lesion; Narrowing of the entrance to the aorta
Aortic Stenosis manifestations murmur, chest pain, exercise intolerance, dizziness when standing for long period, faint pulses, hypotension, tachycardia, poor feeding
Aortic Stenosis management regular follow-up (especially for athletes), Interventional catheterization or surgical management
Tetralogy of Fallot Cyanotic Lesions with Decreased Pulmonary Blood Flow; Combines four defects: VSD, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
Tetralogy of Fallot manifestations systolic murmur in the pulmonic area, polycythemia, metabolic acidosis, poor growth/poor feeders, exercise intolerance, clubbing of digits, TET spells (hypoxia, pallor, tachypnea)
Tetralogy of Fallot management PGE1; management of hypercyanotic episodes; treatment of iron deficiency anemia; surgical management (patching VSD and relieving pulmonary stenosis)
Pulmonary Atresia Cyanotic Lesions with Decreased Pulmonary Blood Flow; Failure of the pulmonary valve to develop
Pulmonary Atresia manifestations Profound cyanosis; survival depends on a PDA, Single second heart sound, PDA murmur
Pulmonary Atresia management Continuous PGE1 infusion; Interventional catheterization or surgical management
Transposition of the Great Arteries Cyanotic Lesions with Increased Pulmonary Blood Flow; Abnormal separation and rotation of the fetal common truncal vessel causes the aorta to arise from the right ventricle and the pulmonary artery to arise from the left ventricle
Transposition of the Great Arteries manifestations Cyanosis at birth; Hypoxemia, despite oxygen administration; Progressive desaturation and acidosis; developing HF
Transposition of the Great Arteries management PGE1; Interventional Cardiac Catheterization (Balloon atrial septostomy) or surgical management (Arterial switch procedure)
Hypoplastic Left Heart Syndrome Cyanotic Lesions with Increased Pulmonary Blood Flow; Inadequate development of the left side of the heart results in one effective ventricle
Hypoplastic Left Heart Syndrome manifestations HF from increased pulmonary blood flow; tachypnea; Systemic hypoperfusion and shock as ductus arteriosus begins to close; Infant is grayish blue, has dyspnea and hypotension
Hypoplastic Left Heart Syndrome management correct acid-base and electrolyte imbalances; PGE1 until surgery; surgical management (cardiac transplantation or three-stage palliative repair that will result in a single right ventricle)
Heart surgery teaching regarding activity resume regular schedules; omit contact play or activities that could cause fall; avoid ill contacts; avoid large crowds
Heart surgery teaching regarding diet resume regular formula/baby foods; no new foods; adequate liquid intake; expect improvement in appetite
Heart surgery teaching regarding incision do not bathe until instructed to do so (then normal way, patting incision dry); cover incision to avoid drool; Do not use creams, lotions, or powders on incision; Report any redness, drainage, or signs of infection at the incision or suture sites.
Heart surgery teaching regarding school return to school second to third week after discharge; half days for first few days; should not participate in PE until 2 mos postoperatively
Heart surgery teaching regarding notifying physician Faster, harder breathing than normal when child is at rest; Temp above 100° F; New, frequent coughing; Turning blue or bluer than normal; Any swelling, redness, or drainage of the incision; Frequent vomiting/diarrhea; Pain worse; Appetite worse.
Heart surgery teaching regarding checkup 1-2 week follow-up after discharge; no immunization for 4-6 weeks postoperatively
Endocarditis an inflammation resulting from infection of the cardiac valves and endocardium (inner lining of heart) by a bacterial or occasionally a fungal or viral agent.
Endocarditis manifestations fever; nonspecific complaints of anorexia, nausea, fatigue, and malaise; arthralgias; chest pain; heart failure; petechiae; neurologic impairment as a result of embolic events; and presence of, or change in, a heart murmur
Endocardits management high-dose antibiotics, removal of vegetations, valve replacement; prophylaxis with antibiotics for dental work and tonsillectomy and adenoidectomy
Rheumatic Fever diffuse inflammatory condition of connective tissue, primarily of the heart, joints, subcutaneous tissues, brain, and blood vessels, most probably of autoimmune origin
Rheumatic Fever manifestations Chorea (involuntary movements of extremities and face), fever, carditis, erythema marginatum (red skin lesions starting on trunk and spreading peripherally), abdominal pain, subcutaneous nodules (small, nontender swellings often over joints), polyarthrits
Rheumatic Fever complication rheumatic heart disease, which can result in permanent damage to the cardiac valves, most commonly the mitral and aortic valves
Rheumatic Fever management Penicillin; aspirin or corticosteroids
Kawasaki Disease also called mucocutaneous lymph node syndrome; an acute, febrile, exanthematous illness of children with a generalized vasculitis of unknown etiology.
Kawasaki Disease manifestations (acute phase) days 1-10; fever, red eyes, swollen hands and feet, red palms and soles, rash, enlarged cervical lymph nodes
Kawasaki Disease manifestations (subacute phase) days 10-25; cracking lips, desquamation of the skin on tips of fingers and toes, cardiac disease, and thrombocytosis
Kawasaki Disease manifestations (convalescent phase) days 26-40; lingering signs of inflammation
Kawasaki Disease management high-dose aspirin while elevated temperature; IVIG (IV gamma globulin); teach to avoid persons with viral illness while taking aspirin
Kawasaki Disease diagnostic evaluation Fever of 5 days duration in conjunction with at least four of the five primary clinical findings for the acute phase and no other known disease process to explain s/s
Arrhythmia a cardiac rhythm disturbance
Arrhythmia manifestations diminished cardiac output causing poor feeding, irritability, lethargy, pale/mottled color, poor peripheral perfusion, decreased urine output, HF, palpitations, dizziness, syncope, and exercise intolerance
Arrhythmia management drug therapy, radiofrequency ablation, cardioversion, and pacemakers; the choice of treatment is guided by the origin of the arrhythmia and the clinical consequences
Supraventricular Tachycardia (SVT) a narrow QRS tachycardia (Rates can be in the range of 220 to 300 beats/min)
SVT management vagal maneuvers, antiarrhythmics (e.g., Adenosine), radiofrequency ablation, or synchronized cardioversion (treatment of choice for the child with profound cardiovascular compromise)
Developmental Dysplasia of the Hip variety of conditions in which the femoral head and acetabulum are improperly aligned
Developmental Dysplasia of the Hip predisposing factors twins, breech delivery, maternal hormones, large infant
Developmental Dysplasia of the Hip manifestations positive Barlow and Ortolani tests, asymmetry of gluteal skin folds, limited ROM, asymmetric abduction, femur appears short, minimal to pronounced variations in gait with lurching towards one side
Ortolani test abduct the thighs and apply gentle pressure forward over the greater trochanter. A “clunking” sensation indicates a dislocated femoral head moving into the acetabulum. A hip click may be felt or heard, but is usually normal.
Barlow test adduct the hips and apply gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum.
Developmental Dysplasia of the Hip management newborn: splinting hips with pavlik harness to maintain flexion, abduction, and external rotation; older children: surgery
Clubfoot congenital malformation of the lower extremity that affects the lower leg, ankle, and foot
Clubfoot manifestations plantar flexion, dorsiflexion, varus deviation (foot turns in), valgus deviation (foot turns out)
Clubfoot management serial manipulation and casting; surgery (if sufficient correction not achieved within 3-6 mos); longterm follow-up
Slipped capital femoral epiphysis (SCFE) condition that occurs during a period of rapid growth in adolescence. Shearing stress causes the femoral capital (upper) epiphysis (growth plate) to displace from its normal position relative to the femoral neck.
SCFE manifestations limp and pain in the hip aggravated by activity, groin, thigh, or knee area
SCFE management bed rest, Buck’s traction, surgical internal fixation
Osteosarcoma also called osteogenic sarcoma; the most common primary bone malignancy in children; usually occurs in long bones (arms, legs, pelvis)
Osteosarcoma manifestations progressive, insidious, or intermittent pain at the tumor site; a palpable mass; limping, if a weight-bearing limb is affected; progressive, limited range of motion; and eventually pathologic fractures at the tumor site.
Osteosarcoma management surgery (biopsy, resections, bone/skin grafts, limb salvage procedures, reconstructions), amputation, chemotherapy, radiation
Ewing sarcoma second most common bone tumor seen in children occurring most commonly in the diaphysis of the femur, the tibia and humerus
Ewing sarcoma manifestations pain, soft tissue swelling around the affected bone, fever, anorexia, malaise, fatigue, and weight loss; neurologic symptoms (if vertebral) or respiratory symptoms (if rib tumor)
Ewing sarcoma management surgery, chemo, radiation, amputation, resections
Buck’s traction used for knee immobilization or for short-term immobilization of a fracture
Bryant’s traction Used to treat very young children (less than 2 years) with femur fractures or developmental dysplasia of the hip.
Dunlop’s traction used for supracondylar (around elbow) fractures of the humerus
Russell’s traction used for fractures of the femur and lower leg
Fracture reduction complications infection, nerve compression syndrome, kidney stones, pulmonary emboli, circulatory impairment, fat embolism
five Ps used as a guide for assessing neurovascular status: Pain unrelieved by analgesia, Pallor, Pulselessness or lack of capillary refill, Paresthesia, Paralysis or progressive loss of motion
Fracture A break or disruption in a bone's continuity.
Greenstick fracture break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side; most frequently in forearm
Spiral fracture tristed or circular break that affects the length rather than the width; seen frequently in child abuse
Complete (Oblique) fracture diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone
Transverse fracture break or fracture line occurs at right angles to the long axis of the bone
Fracture management reduction and fixation (closed or open), retention (cast or traction)
Contusion damage to soft tissue, subcutaneous structures, and muscle
Dislocation Displacement of a bone from its normal articulation within a joint
Sprain trauma to a joint in which ligaments are stretched or are partially or completely torn
Strain (aka pulls, tears, or ruptures) excessive stretch of muscle.
RICE Rest, Ice, Compression, Elevation
Scoliosis lateral curvature of the spine
Scoliosis manifestations visible curve, rib hump when bending forward, asymmetric rib cage, uneven should or pelvic heights, prominence of the scapula or hip, difference in space between arms and trunk when standing, apparent leg-length discrepancy
Scoliosis management regular and periodic observation, bracing, or spinal fusion surgery depending on extent of the curve, child’s age, projected growth and associated complications
Osteomyelitis a bacterial infection of the bone that involves the cortex or marrow cavity.
Osteomyelitis manifestations infant: fever, irritability, feeding difficulties, signs of sepsis; older child: pain, warmth, tenderness over site, favoring of extremity, erythema, limited ROM, fever, lethargy
Osteomyelitis management high-dose IV antibiotics, bed rest, immobilization, or surgical intervention (if abscess present or antibiotic fails)
Osteogenesis imperfecta “brittle bone disease” that results from defect in the synthesis of collagen
Osteogenesis imperfecta manifestations osteoporosis; excessive bone fragility; increased joint flexibility; blue sclera; discolored teeth; conductive hearing loss by age 20-30 yrs; translucent skin; easily bruised; short stature; multiple fractures tend to cause limb and spinal deformities
Osteogenesis imperfecta management fracture prevention; medication (calcitonin, biphosphonates); orthopedic stabilization (traction, casting, fixation)
Cerebral palsy a chronic, nonprogressive disorder of posture and movement characterized by difficulty in controlling the muscles because of an abnormality in the extrapyramidal or pyramidal motor system (motor cortex, basal ganglia, cerebellum)
Cerebral palsy manifestations poor head control after 3 mos, stiff/rigid arms/legs, pushing away/arching back, floppy/limp posture, cannot sit up without support by 8 mos, uses only one side, clenched fists after 3 mos
Cerebral palsy management early recognition and intervention to maximize abilities
Muscular Dystrophies progressively degenerative, inherited diseases that affect the muscle cells of specific muscle groups, causing weakness and atrophy.
Duchenne muscular dystrophy most common muscular dystrophy; progressive, symmetrical muscle wasting and weakness without loss of sensation first appear after walking is achieved (usually 3 to 7 years); loss of walking by 9-12 yr; death in late teens
Muscular Dystrophy manifestations waddling, wide-based gait; Lordosis; difficulty climbing, running, or pedaling; Gower’s sign; pseudohypertrophy; scolios and long bone fractures
Muscular Dystrophy management maintenance of ambulation and independence as long as possible; high protein, low calorie, high fiber diet; palliative care
Respiratory alteration after burn Upper airway tissue injury with respiratory distress, possible obstruction; Lower airway tissue injury; Carbon monoxide inhalation, hypoxia; Limited chest expansion
Cardiovascular alteration after burn Fluid volume deficit with decreased cardiac output; tachycardia; vasodilation then vasoconstriction; Edema, compartment syndrome; Elevated hemoglobin, hematocrit levels; Increase followed by decrease in serum potassium levels; Decreased sodium levels
Gastrointestinal alteration after burn Gastric dilation, paralytic ileus; Thirst
Renal alteration after burn Oliguria, elevated blood urea nitrogen and creatinine values; Risk for acute tubular necrosis
Metabolic alterations after burn Increased metabolic rate with elevated body temperature and massive evaporative heat loss; Catecholamine release; Hyperglycemia
Hematologic alterations after burn Decreased hematocrit level follows initial hematocrit increase (from hemoconcentration); Coagulation disorders; Increased immature neutrophils to digest products of injury; High risk for infection, wound sepsis, septic shock
Vesicles fluid filled lesions
Papules flesh colored lesions
Pustules pus filled lesions
Cysts may be solid-ish lesion
Impetigo Staphylococcus aureus infection that begins in an area of broken skin, such as an insect bite, scabies, or atopic dermatitis
Impetigo manifestations honey crusted lesions (crusted impetigo); shiny, lacquered-appearing lesions surrounded by scaly rim (bullous impetigo)
Impetigo management topical and/or oral antibiotics
Cellulitis bacterial infection of the subcutaneous tissue and the dermis that is usually associated with a break in the skin, although cellulitis of the head and neck can follow an upper respiratory tract infection, sinusitis, otitis media, or tooth abscess.
Cellulitis manifestations red, hot, tender, and indurated; purplish tinge (if H. influenzae); lymphangitis; fever, malaise, and headache
Cellulitis management IM or IV antibiotics, then 10 days of oral antibiotics
Pediculosis Capitis infestation of lice on the scalp
Pediculosis Capitis (Head Lice) manifestations Nits are visible and are attached firmly to the hair shafts near the scalp; commonly behind ears and nape of neck
Pediculosis Capitis (Head Lice) management kill lice with a pendiculicide; remove nits; prevent spread and recurrence
Scabies a contagious condition that results from infestation with Sarcoptes scabiei, the “itch mite.”
Scabies manifestation intense pruitus, especially at night and nap times; irritability, restless, fitful sleep
Scabies management scabicidal medications (permethrin, lidane, crotamiton); oral antihistamines; antibiotics (if secondary infection); soothing creams/lotions
Eczema (Atopic Dermatitis) common chronic inflammatory disease of the skin characterized by severe pruritus.
Eczema (Atopic Dermatitis) manifestations erythematious areas of oozing and crusting; papulovesicular rash and scaly red plaques; dry, scaly popular patches
Eczema (Atopic Dermatitis) management anti-inflammatory corticosteroid creams and ointments; antihistamines; oral antibiotics (if skin breakdown/infection)
Seborrheic Dermatitis a chronic inflammatory skin condition seen frequently in infants. It is referred to as “cradle cap” when located on the scalp.
Seborrheic Dermatitis manifestations nonpruritic, oily, yellow scales that block sweat and sebaceous glands, causing retained secretions and inflammation in affected areas
Seborrheic Dermatitis management over-the-counter antiseborrheic shampoo containing sulfur and salicylic acid (Fostex Medicated Cleansing, P&S, Sebulex), selenium, or tar (Neutrogena T/Gel, Polytar)
Tinea a superficial skin infection caused by a group of fungi known as dermatophytes.
Tinea corporis ringworm; a fungal infection of the face, trunk, or extremities.
tinea capitis fungus invades the hair shafts, causing the hairs to become brittle and to break off at the level of the scalp, leaving an area of stubby, black-dotted alopecia.
Tinea cruris jock itch; characterized by an intense inflammatory reaction with severe pruritus.
Tinea pedis athlete's foot; may become chronic, particularly in adolescents who wear unventilated athletic shoes.
Tinea management topical antifungal
Poison Ivy, Oak, and Sumac management oral antihistamines, steroids
Acne a disorder of the sebaceous hair follicles which begins when sebaceous glands, stimulated by androgens at the onset of puberty, enlarge and secrete increased amounts of sebum. The sebaceous glands become plugged and dilated with sebum.
Contact dermatitis an inflammatory reaction of the skin either caused by direct exposure to an irritant (irritant contact dermatitis) or a delayed hypersensitivity response to an allergen (allergic contact dermatitis).
Contact dermatitis manifestations irritant: dry, inflamed, and pruritic skin which correlates with skin surface in contact with offending agent; allergic: blistering, weeping lesions over an area of inflamed skin, intense pruritus, and crusted, scaly lesions
Contact dermatitis management discontinuing exposure by washing skin; cool compresses, Burow’s solution or steroid cream; possibly oral steroids
Stevens-Johnson Syndrome Acute, sometimes recurrent autoimmune disease that may be triggered by infections or medications, such as sulfonamides or anticonvulsants.
Stevens-Johnson Syndrome manifestations After a prodromal respiratory illness, bullae appear on the lips, mouth, eyes, and genitalia. Fever, chills, malaise, neutropenia, anemia, weakness. Purulent conjunctivitis is common. Skin lesions rupture and may lead to significant fluid loss.
Stevens-Johnson Syndrome management withdraw triggering medication; Treatment of skin lesions similar to treatment of extensive burns
Molluscum Contagiosum Viral infection of the skin and mucous membranes transmitted by skin-to-skin and fomite-to-skin contact or sexual contact.
Molluscum Contagiosum manifestations Firm, solid, pink papules changing into soft, waxy, umbilicated papules. Curdlike core of the lesion can be expressed. Most common sites: face, trunk, extremities, oral mucous membranes, conjunctiva, genitalia.
Molluscum Contagiosum management Lesions may be treated with cantharidin, cryotherapy, tretinoin, or imiquimod. Spontaneous disappearance is common.
Daily fluid requirements for 0-10kg 100mL/kg
Daily fluid requirements for 10-20kg 1000mL + 50mL/kg for each additional kg over 10 kg
Daily fluid requirements for 20+ kg 1500mL + 20mL/kg for each additional kg over 20 kg
Erikson’s Stage for Preschoolers Initiative vs. Guilt: Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role; characterized by purpose.
Piaget’s Period for Preschoolers Preoperational Stage: Preconceptual (3-4 yrs) and Intuitive thought (4-5 yrs): Thinking remains egocentric, becomes magical, and is dominated by perception. Transductive reasoning; field dependency thinking; centration; irreversibility in thought.
Transductive reasoning Seen in preschoolers in the preconceptual phase of Piaget’s preoperational stage; Reasoning from the particular to the particular rather than from the general to the particular.
Field dependency thinking Seen in preschoolers in the preconceptual phase of Piaget’s preoperational stage; difficulty focusing on the important aspects of a situation (everything is important and interdependent).
Centration Seen in preschoolers in the intuitive phase of Piaget’s preoperational stage; the tendency to center or focus on one part of a situation and ignore the other parts.
Irreversibility Seen in preschoolers in the intuitive phase of Piaget’s preoperational stage; the inability to understand a process in reverse or mentally undo an action that has been performed.
Erikson’s Stage for School Aged Industry vs. Inferiority: Mastering of useful skills and tools of the culture; learning how to play and work with peers; characterized by competence.
Piaget’s Period for School Aged Concrete Operations: Thinking becomes more systematic and logical, but concrete objects and activities are needed. Characterized by reversibility, conservation, classification, logic, humor
Reversibility Seen in school aged in Piaget’s concrete operations stage; can understand a process in reverse or mentally undo an action that has been performed.
Conservation Seen in school aged in Piaget’s concrete operations stage; Ability to understand that certain properties of objects do not change simply because their order, form, or appearance has changed.
3 year milestones brush teeth; put on clothes; build tower of 4-6 cubes; names familiar pictures; throws a ball overhand; jumps; kicks a ball forward
5 year milestones puts t-shirt on; washes hands; stand on one foot; jump rope; adjectives (tired, hot)
6-8 year milestones self-esteem, tie shoes, expansive vocabulary, love sports and games
9-11 year milestones peer opinions more important than parents, clubs, hero worship, boy crazy, away from home experiences, full developed hand-eye coordination and fine motor control, read a lot
Created by: CocoDiva