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Peds Ch 13

Test 1

sleep disturbances preschool years are prime time for sleep disturbances. Have trouble going to sleep, waking during night, nightmares or terrors, or prolong bedtime through elaborate rituals.
for children who delay going to bed use consistent bedtime ritual, ignore attention seeking behavior, do not let into parents bed or allow to stay up past a reasonable hour.
contact dermatitis sharp demarcation between inflamed and normal skin that ranges from faint, transient erythema to massive bullae on an erythematous swollen base. Itching is a constant symptom.
poison ivy treatment calemine lotion, burow solution compresses, aveeno baths, corticosteriod gel or oral. Earlier the skin is cleansed, the greater the chance is of removing urushiol before it attaches. flush with cold water.
animal bites rinse wound with copious amounts of saline or lactated ringers under pressure with a large syringe. wash surrounding area with mild soap. prophylactic antibiotic for punctures and vascularized areas. all human bites should get medical attention.
criteria for admission for electrical burns *loss of consciousness *ECG changes *10% TBSA affected * need for monitoring an affected extremity. Cardiac monitoring is standard burn care when ECG changes are identified on admission.
superficial burns (1st degree) of minor significance, involves epidermal layer only. tissue damage is minimal and no blistering. pain is predominant symptom. heals in 5-10 days w/o scarring. Ex: mild sunburn.
partial-thickness burn (2nd degree) involves epidermis and varying degrees of dermal layer. painful, moist, red, and blistered. heals in 14-21 days with varying scarring. extremely sensitive to temp, air, touch. sweat glands & hair follicles intact. pink, red or waxy white. edema.
full-thickness (3rd degree) extends into subcu tissue. nerve endings, sweat glands & hair follicles destroyed. color is red to tan, waxy white, brown or black. dry leathery. lack sensation. not capable of re-epithelialization and require grafting to close.
forth-degree burns full-thickness burns that involve muscle, fascia or bone. wound is dull and dry. ligaments and bone may be exposed.
inhalation injury clinical manifestations can be delayed 24-48 hours. Inhalation of carbon monoxide is suspected when injury has occurred in an enclosed space. Mucopurulent membrane replaces the mucosal lining and seriously compromises respiration and ventilation.
burn shock immediate post burn period. dramatic alterations in circulation. fluid loss thru denuded skin, capillary permeability increases and vessels become dilated. circulating blood volume decreases and cardiac output reduced.
treatment for carbon monoxide inhalation 100% O2
early signs of sepsis decreased level of consciousness and lethargy. early placement of autograph reduces incidence of sepsis.
emergency burn care (minor) MINOR 1. stop burning process 2. remove burned clothing and jewelry 3. apply cool water not ice * do not disturb blisters unless from chemical burn *do not apply anything to burn *cover with clean cloth
emergency burn care (major) MAJOR 1. smother fire 2. place in horizontal position 3. roll in blanket 4. remove burnt clothing and jewelry *assess for airway clearance *mouth-to-mouth if not breathing *cover burn with clean cloth *keep warm *begin IV & O2 *transport
fluid replacement therapy 1. compensate for water and sodium lost to traumatized areas 2. re-establish sodium balance 3. restore circulating volume 4. provide perfusion 5. correct acidosis 6. improve renal function
burn nutrition *hypoglycemia can result from stress *high protein and calorie diet *most children with burns over 25% require tube feeding *enteral feeding is preferred route *supplement with A, C, and Zinc
acute phase treatment of burn shock and mgmt of pulm stat *monitor VS, I&O, respiratory *maintain urine output of 1-2ml/kg if less than 30lb and 30-50ml/hr in more than 30lb. *check burned extremity pulse every hr
management phase *concentrate on preventing infection, closing burn and preventing complications *keep environment temp 82.4-91.4 F *warm solutions
rehabilitative phase when majority of burns have healed and rehabilitation becomes predominant focus
symptoms of sepsis decreased LOC * rising or falling WBC *hyperthermia progrssing to hypothermia *increasing fluid requirements *hypoactive or absent bowel sounds *rising or falling glucose *tachycardia *tachypnea *thrombocytopenia
sunburn treatment *cool tap water soaks for 20 min or until skin is cool *apply bland oil-in-water lotion *protecting from sunburn is the major goal of mgmt, skin should be covered, and use of sun screens and sun blockers *sunscreens PABA is most effective
when to use activated charcoal *child ingested large amounts of carbamazepine, dapsone, phenobarbital, quinine, or theophylline *w/i 1 hour of poison ingestion *has intact or protected airway
when to use gastric lavage *1 hour of ingesting toxin *decreased gastric motility *toxic amount of sustained-release medication or a large or life-threatening amount of poison
aceteminophen antidote N-acetylcysteine
benzodiazepine antidote flumazenil (Romazicon)
digoxin antidote digoxin immune fab (Digibind)
cyanide antidote amyl nitrate
acrodynia painful extremities. classic form of mercury poisoning
chelation chemical compound that combines with metal for rapid and safe excretion *adequate hydration is essential, chelates are excreted thru kidneys
affects of lead *competes with calcium, interferes with regulation *cognitive and behavioral problems like aggression & hyperactivity *developmental delays *low in iron is more susceptible to mercury absorption
acceptable BLL (blood lead level) 10mcg/dl
lead screening done at 1 and 2 years old. any children between 3 and 6 who have not been screened should be
lead nursing mgmt *prevent initial or further exposure *admin chelating agents deeply into large muscle, with procaine *rotate admin sites *records I&Os
abusive head trauma (AHT) symptoms retinal hemorrhages *flu-like symptoms to unresponsiveness *vomiting *irritability *poor feeding *listlessness *severe forms include seizures, posturing, change in LOC, apnea, bradycardia, or death
munchausen symptoms seizures, N&V, diarrhea, altered mental status. symptoms resolve after separation from the perpetrator.
Created by: tkulwicki