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Peds Exam 1

QuestionAnswer
Morbidity Death rate per 100,000 population
Mortality Number of ill people per 1,000 - acute, chronic illness & disability
Injuries et Peds leading cause of death in children over 1yr; more deaths et disabilities than all diseases
Temperament the way a child interacts with the environment; behavioral tendencies
9 attributes of temperament activity, rhythmicity, approach-withdrawal, adaptability, intensity of response, threshold of response, mood, distractibility, attention span/persistence
Examples of personality types & temperament easy (average), difficult (active), slow-to-warm up (quiet)
Easy temperament adapts readily, overall positive mood, sleeps et eats well, regular et predictable behaviors
Difficult temperament adapts slowly, overall negative mood, requires structures environment, can do well alone, constant motion, irregular behavior patterns
slow-to-warm up temperament adapts slowly but watchful, withdrawn/moody, loner, shy, oversensitive, slow to mature, inactive, reacts passively to changes in routine
Communicating c parents/siblings with child in hospital answer questions, involve whole family, familiarize to rules, be aware of health of other family members, teach, prepare for visits, encourage contact with sibling, help understand rxn to hospitalization of child
Preparing a child for hospitalization, surgery, et procedures orient to surroundings, informed consent/assent, estab trust/support, parental presence et support, explanations, analgesia/sedation PRN
Goals for care of the hospitalized child (5 questions, look at more?) to eliminate disparities in health care, improve QOL et years of life
Fluid alterations - assessment MILD DEHYDRATION plae, dec turgor, dry mucous membranes, thick saliva, norm BP, norm/inc P, cap refill <2sec, ant fontanel flat
Fluid alterations - assessment MODERATE DEHYDRATION eyes sunken, gray skin, tears absent, dry mucous membranes, sunken fontanel, weak/rapid P, tenting turgor, 2-3sec cap refill, listless/irritable
Fluid alterations - assessment SEVERE DEHYDRATION sunken fontanel, limp, cold, lethargy/coma, acrocyanosis, mottling, thready/raid P, grunting, deep/rapid RR, cap refill >4sec, >2sec skin retraction
Fluid alterations - assessment FVE sudden wt gain, bounding P, JVD, hepatomegaly, crackles, dyspnea, dependent edema, irritability, seizures --> death
Fluid alterations - assessment HYPOKALEMIA muscle weakness, leg cramps, weak/irregular/rapid P, hypoTN, ileus/dec bowel sounds, HA, irritability, fatigue, slow thought processes
Fluid alterations - assessment HYPERKALEMIA irritability, anxiety, hyperreflexia, weakness, brady, cardiac arrest, apnea, resp arrest, ABD muscle cramps
Fluid alterations - assessment HYPOCALCEMIA paresthesias (fingers, toes, nose, ears, circumoral), hyperreflexia, seizures, muslce cramps/tetany, laryngospasm, lethargy, poor feeding, hypoTN, cardiac arrest
Fluid alterations - assessment HYPERCALCEMIA lethargy, weakness, hypotonicity, anorexia, thirst, itching, confusion, personality/behavioral changes, stupor, N/V, constipation, brady, cardiac arrest
Fluid alterations - assessment METABOLIC ACIDOSIS inc HR, dysrhythmias, hyperventilation, kussmaul respirations, cold et clammy (mild), warm skin (severe)
Fluid alterations - assessment METABOLIC ALKALOSIS dysrhythmias, inc HR, dec RR/depth, change LOC, apathy/confusion --> stupor, muscular weakness
Fluid alterations - assessment RESPIRATORY ACIDOSIS inc HR, inc rate/depth RR (accessory muscles to breathe, retractions, cyanosis), inc ICP
Fluid alterations - assessment RESPIRATORY ALKALOSIS dizziness, paresthesias, diaphoresis, dysrhythmias
Fluid alterations - assessment GENERAL HYDRATION intake; output; level of activity (active vs lethargic); temperature; previous wt; P (tachy?); skin; mucous membranes; fontanel; eyes (tears, sunken); LOC; cap refill; mottling; BP
Calculating fluid maintenance 1-10kg = 100ml/kg; 11-20kg = 1000ml + 50ml/kg for kg >10kg; >20kg = 1500ml + 20ml/kg for kg >20kg
PO et IV hydration needs ORS solution (contains NA, K, HCO3; pedialyte, lytren, infalyte, resol; glucose helps intestines absorb NaCl); Inc fluids; IV (K only when urine output adequate; prevent or tx shock; LR or 0.9% NaCl -- hyponatremic 24hrs, hypernatremic 48hrs)
Diarrhea excess fluid in small intestine; infections, parasites, over feeding/new foods, excess sugar, meds, metals et organic phosphates
Vomiting undigested food/sour milk curds; greenish emesis (bile, intestinal obstruction); V c D (gastroenteritis); fecal odor (lower GI obstruction); blood (tinged emesis - red upper GI, coffee grounds/dark - lower GI)
Chalasia spit up in infancy
Regurgitation backflow of undigested food; could indicate overfeeding, poor absorption, reflux
Projectile vomit indicates some types of obstruction, tumor, or inc ICP
Managing Vomiting dx et tx cause; maintain hydration; prevent aspiration; oral care
Primary Electrolytes Sodium, potassium, chloride, calcium, magnesium
Early sx respiratory distress mood changes (euphoria, depression), HA, HTN, change depth/pattern RR, SOE, anorexia, pallor, inc CO/renal output, retractions, nasal flaring, grunting, markedly prolonged expiration
Late sx respiratory distress hypoTN (LAST), somnolence, stupor, coma, depressed respirations, brady, cyanosis, hypoxemia, hypercapnia, serial blood gases
Cardinal signs of respiratory failure restlessness, tachypnea, tachy, diaphoresis
Respiratory failure interventions important to assess et tx before it occurs; ABG analysis; O2 therapy; POSITIONING; stimulation; suctioning; intubation; inc humidity; dec O2 needs; meds; dec fever; infection control; support parents; maintain safety
Asthma Most common chronic disease of childhood; major cause of peds ER/hospital admissions; chronic inflammation of airways; episodes of wheezing, breathlessness, chest tightness, cough, reversible either spontaneously or c tx
Asthma manifestations dyspnea, wheeze, cough, variable
Asthma tx Corticosteroids (edema); bronchodilators (bronchospasm); salmeterol; methylxanthines; leukotriene modifiers; chest physiotherapy (loosen et remove mucous secretions)
Corticosteroids et Asthma long-term control; dec inflammation --> dec airway hyperreactivity; ORAL CARE TO PREVENT THRUSH
Beta-adrenergic bronchodilators et Asthma rescue meds; allow smooth muscle to relax
Salmeterol et Asthma Long-acting bronchodilator; not in children under 12y.o.; never for acute exacerbations; never more than 2x/day
Methylxanthines et Asthma rarely used unless nocturnal asthma; narrow TI; drug levels monitored
Leukotriene modifiers et Asthma block leukotrienes (potent inflammatory mediators released); suitable alternative to corticosteroids in mild to moderate persistent asthma
CF genetic; usually dx by 1y.o.; exocrine glands throughout the body secrete thick, sticky secretions; obstruction of large et small airways et pancreatic ducts; fibrous changes in lung tisues et CHF; poor absorption of foods, bowel obstructions, diabetes
CF manifestations wheezing, dry/non-productive cough; pulmonary infections; emphysema, cor pulmonale, CHF, digital clubbing, barrel chest, steatorrhea, malnutrition et growth failure, meconium ileus
CF dx evaluation sweat test, chlorine level, fecal fat, liver function tests, FBS, pulmonary function, sputum cultures
CF goals of management min pulmonary complications, ensure adequate nutrition for growth, encourage appropriate physical activity, PROMOTE QOL, mobilize secretions, dec # of infections, high-calorie/high-protein diet, TEACHING
Long-term management of CF vigorous antibiotic therapy, regular chest physiotherapy et inhalation tx, high-calorie/high-protein diet, pancreatic enzyme replacement therapy, fat-soluble vitamin supplements, nighttime gastrostomy feedings if nutritional problems are severe
Croup group of conditions characterized by inspiratory stridor, harsh/barky cough, hoarseness, resp distress
Types of Croup epiglottitis, laryngotracheobronchitis, acute spasmodic croup, bacterial tracheitis
Epiglottitis bacterial; sudden onset; EMERGENCY; complete airway obstruction --> death
Cardinal signs of epiglottitis drooling; dysphagia; dysphonia; distressed
Epiglottitis tx intubation, steroids, antibiotics, humidified O2, antipyretics, IV fluids
Laryngotracheobronchitis sx usually begins at night; preceded several days on non-specific URI sx; fever; barky cough; stridor; sore throat; accessory muscles; agitated/frightened; cyanosis
Bronchitis Viral; winter months; non-productive cough; norm chest x-ray; rhonchi, wheezing, rales
Lower airway respiratory alterations bronciolitis; pneumonia; asthma; foreign body aspiration; resp distres syndrome; bronchopulmonary dysplasia, CF
Bronchiolitis RSV; by 2y.o. 100% will have had RSV et be immune; highly communicable; droplets
Bronchiolitis sx tachypnea, wheezes, crackles, rhonchi, retractions, pale, mottles, cyanotic, rattly cough, difficulty feeding, mild to moderate temp elevation
Complications of bronchiolitis dehydration; airway obstruction from mucous secretions; resp failure from exhaustion; secondary infections
Pneumonia manifestations acute onset; fever; HA; chills; absent or diminished breath sounds; ABD/chest pain; resp distress may or may not present; cough often dry, non-productive @ 1st
Complications of pneumonia dehydration; sepsis; pneumothorax; pleural effusion
Cleft lip/palate repair may cause difficulty feeding (point nipple towards intact area); lip repair @ 6-8 weeks; palate repair @ 7-12 weeks; severity depends on timing of abnormal fusing during this time; aspiration; head upright; protect incision site; speech therapy; restraint
Poisonings 1-4yrs most common age for poisoning related deaths; 60% in adolescents are deliberate; most r/t oral ingestion
Tx poisonings ABCs; remove poisoning/neutralize effects; limit complications; tx varies depending on poison
Types of poisonings corrosives, hydrocarbons, meds (acetaminophen, ASA), iron, plants, leab, carbon monoxide
corrosives poisonings manifestations severe burning pain mouth, throat, stomach; oral ulcerations; violent vomiting; anxiety/agitations; signs of shock
corrosives poisonings tx vomiting, neutralizing are contraindicated; dilute corrosive c h2o/milk (4oz); patent airway; analgesia, NPO; esophageal stricture
hydrocarbons poisonings manifestations gagging, coughing, choking, N/V, lethargy, resp (tachypnea, cyanosis, grunting, retractions)
hydrocarbons poisonings tx VOMITING CONTRAINDICATED, high humidity, O2, hydration, antibiotics for chemical pneumonia, lavage if using cuffed ET tube
acetaminophen poisonings most common drug poisoning in children; toxic dose is 150mg/kg or greater
tx for acetaminophen toxicity induce vomiting/lavage within 1 hour; mucomyst (1 loading dose/17 maintenance doses); dilute in juice/soda - has offensive odor
Stages of acetaminophen toxicity 2-4hrs (N/V, sweating, pallor); 24-36hrs (latenet period, liver enzymes inc, RUQ pain); up to 7days (hepatic involvement, may be permanent, jaundice, liver necrosis)
stages of ASA toxicity 1st (resp alkalosis); 2nd (metabolic acidosis, hypokalemia, dehydration); 3rd (inhibition of prothrombin formation, dec platelet levels)
TE fistula (1 analysis, where in notes?)
Hirschsprung aganglionic or megacolon; embryonic failure of migration of ganglionic cells; delayed passage or absence of meconium; chronic constipation 1st month, pellet-like/ribon stool; ABD pain/distention; stool infrequency
Management of hirschsprung disease majority require surgery; frequent enemas; bowel retraining p surg repair; temporary colostomy
Pyloric stenosis common surg disorder of early infancy; cause unknown (1st-born males, full-term); obstruction of gastric emptying; not present @ birth
Progressive pyloric stenosis progressive, projectile vomit; moveable, palpable olive shaped mass in RUQ et deep L->R peristaltic waves; irritability et hunger shortly p being fed; dehydration et metabolic alkalosis
Tx of pyloric stenosis pyloromyotomy
Peptic ulcer well-defined area c loss of mucosa, submucosa, or muscular tissue in GI tract where exposed to acid/pepsin; primary (no underlying systemic disease); secondary (c other disease); gastric (stomach, rare children); duodenal (most common children)
etiology of ulcers excessive acid secretion; bile salts; genetic factors; bacteria (heliobacter pylori); psychologic; stress
Manifestations of peptic ulcers burning, cramping pain when stomach empty, vomiting under 6yrs, endoscopy definitive, fecal occult blood
tx peptic ulcers meds; reg diet, low caffeine; surg if hemorrhage, perforation, obstructions; tx of acute bleeding episodes; prepare for lifetime chronic condition
celiac disease inability to digest protein in wheat, rye, barley, oats; maldigestion et malabsorption if dietary changes not made; D et growth failure most common manifestations
management of celiac disease removal of all wheat, rye, barley, oats; vitamin supplements; assist c long-term management; support groups; education
gastroesophagesal reflux (GER) most common GI disorder in infants; normal; all people experience periodically; physiologic, functional, pathologic
GER tx dietary changes (small, frequent feedings; frequent burping); positioning (30degress elevation); meds
constipation infants (rare); toddlers (toilet training woes); r/t dietary, hirshsprung's; diabetes; cerebral palsy; meds; fear; lack or time/modesty issues
IBS (crohn's disease) inc intestinal motility --> spasm et pain; triggered by stress et emotional factors
IBS (crohn's disease) manifestations ABD pain un-r/t meals; alternating D et constipation; inc mucous production -> maldigestion; dx by ruling out other pathology
IBS (crohn's disease) tx support, education, high fiber diet, antispasmodics, antidiarrheal drugs, simethicone, self-limiting, psychological implications, healthy habits, exercise
appendicitis most common cause of emergency surgery in Peds; inflammation et infectin of vermiform appendix; uncommon under 4yrs.
Appendicitis manifestations pain (inc intensity, RLQ); N/V/D or constipation; fever; chills; initial relief from pain if perforates
Appendicitis assessment peritoneal irritation; ABD pain (RLQ c rebound tenderness); guarding; appetite; activity; sequence of sx (pain-N/V)
Post-op care appendicitis pain management; restoring norm bowel function; fluids et nutrition; minimize risk of infection
1st degree burns erythema, painful, no epidermal loss; 7 days to heal
2nd degree burns superficial (blistering, debriding cause erythema et fluid secretion, no debriding = blister-> dry, callused); deep (less painful d/t nerve damage; erythema; dry et fixed); 14 days to heal
3rd degree burns not painful, dry c brown or white leathery appearance, generally require skin grafting; 21+ days to heal
burns tx stop burning process, cool soaks (NO ICE), clean covering prevent contamination et hypothermia, cleanse c soap et h2o
moderate to severe burns tx maintain airway, O2, VS, maintain CO by starting IV access, monitor septic shock, pain management, prevent infection, nutritional support, restoration of mobility, psychological support
burns wound care premedicate c analgesic, remove old dressings, assess, cleanse, deridement, topical enzyme to break down et remove dead tissue, thin layer antibiotic ointment, cover c new dressing
Created by: kdrummond08