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Pediatrics 10
disorders of the toddler
| Question | Answer |
|---|---|
| Congenital deafness | when child is born with a hearing loss |
| Acquired deafness can result from | infectious diseases such as measles, mumps, chickenpox, or meningitis, ototoxic meds or ear infections |
| Sensorineural hearing loss | results from damage to the structures of the inner ear or auditory nerve |
| What can senorineural hearing loss result from? | congenital defects of the inner ear , effects of certain conditions such as kernicterus or infection; ototoxic drugs, noise pollution |
| Conductive hearing loss | an interruption in the transmission of sound waves (from structural problems) from the external or middle ear |
| Conductive hearing loss treatment | treatment for infection, surgery, or other measures to remove a blockage |
| What is important in the treatment of the deaf child to prevent adverse physical and mental complications? | early diagnosis and early intervention |
| Points to remember in communicating with a deaf child | smile, face when speaking, at eye level, short sentences, speak clearly in a natural tone, use appropriate gestures, free from background noise |
| Children vs adult air passages | smaller air passages than adults and experience more narrowing with inflammation |
| Chief symptom of croup | brassy (croupy) “barking” cough and varying degrees of inspiratory stridor |
| Signs of increased respiratory distress in a child with croup | pallor, increased respiratory effort and restlessness, tell PHCP |
| Epiglottitis | a swelling of the tissues above the vocal cords |
| Epiglottitis most often caused by | H. influenzae type b infection |
| Epiglottitis most often occurs in children ages | 2-6 years |
| Epiglottitis symptoms | sudden sore throat, high fever, drooling, muffled voice, rapid respirations with difficulty breathing; stridor is late sign |
| How does a child with epiglottitits prefer to sit? | upright, leaning forward with the chin up and mouth open while leaning on the arms (tripod position) |
| What should not be done if epiglottitis is suspected? | do not examine the pharynx because laryngospasm may occur, followed by respiratory arrest |
| Treatment of children with pneumonia | children who are in respiratory distress, dehydrated, vomiting, or are immunocompromised are treated in the hospital |
| Nursing intervention when child is flushed with fever | remove heavy clothing and blankets and administer antipyretics, tepid sponge bath |
| Treatment for dyspnea or cyanosis | oxygen aministered and monitored with pulse oximetry |
| What is an important part of treatment of pneumonia? | rest and conservation of energy |
| Other important factors of treating pneumonia | fluid intake, or IV, reposition child frequently, administer prescribed analgesics for comfort, encourage walking or blowing bubbles |
| Most common form of worm affecting humans | pinworms, affect all ages but more common in young children |
| How does child infect self with pinworms? | contaminated toys or soiled linen, through the mouth |
| What does the pinworm look like? | a white thread about a third of an inch long |
| Where does the pinworm live? | the lower intestine, but comes out of the anus to lay its eggs, generally during the night |
| Treatment of pinworms | anthelmintics |
| Vernox | single dose chewable tablet, appropriate for children older than 2 years |
| Antiminth (pyrantel pamoate) | single dose, not recommended for children less than 2 years, medication is repeated 2 weeks later |
| Precautions for children with pinworms | linen and stool precautions, handwashing teaching, short fingernails, soothing ointment on anus, clean underwear, family is treated, daily scrub of toilet |
| Fracture | a break in a bone |
| Simple fracture | the bone is broken but the skin over the area is not |
| Compound fracture | a wound in the skin leads to the broken bone and there is the added danger of infection |
| Healing and fractures | fractures heal faster in children than in adults |
| Reason for faster healing of bones in children | the child’s periosteum is stronger and thicker, and there is less stiffness on mobilization |
| What kind of injury is serious in children? | injury to the cartilaginous epiphyseal plate |
| Compartment syndrome | can occur as a result of pressure on tissues resulting from edema or swelling. Circulation is compromised. Paralysis and necrosis can occur |
| Warning sign in compartment syndrome | pain out of proportion to injury |
| Greenstick fracture | break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side. Most frequent in forearm |
| Spiral fracture | twisted or circular break that affects the length rather than the width. Seen frequently in child abuse |
| 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 |
| Comminuted fracture | bone is splintered into pieces. This is a rare occurrence in children. |
| Fat embolism | particles of fat escape from the fracture sites and are carried through the circulatory system; they can lodge in the lung capillaries, causing respiratory distress. |
| Signs of fat embolism | altered respiratory status and possible altered level of consciousness; report immediately |
| Care of traction | traction ropes intact and in the wheel grooves of the pulleys, elastic bandages neither too loose nor too tight, avoid turning from side to side, do not remove weights once applied, hang free, and not obstructed |
| What does initial care of a child with a head injury include? | assessment of ABCs, assessment for spinal cord injury, and documentation of baseline vital signs |
| What is of particular importance immediately after head injury? | patient’s state of consciousness |
| Early sign of increasing ICP | changes in behavior |
| Cure rate for children in stage I to III (tumor is confined to kidney or abdomen) | 88% to 98%; the prognosis also depends on the histological character of the tumor and evidence of recurrence |
| Why should the abdomen not be palpated with tumors? | trauma to the mass could release cancer cells into the systems |
| Side effects from the chemotherapy and irradiation | nausea, vomiting, anorexia, general malaise, ulceration of the mouth, hair loss, and peeling of the skin |
| Routine postoperative observations includes | specific monitoring for signs of intestinal obstruction from chemotherapy |
| Chemotherapy depresses immune system, nurse must monitor what? | for sign of infection, hematuria and hypertension |
| Autistic children may exhibit | bizarre characteristics, like things to stay the same, do not interact well with others, prefer isolation, do not maintain eye contact, repetitive language and motor movements |
| Acetaminophen poisoning | occurs from acute ingestion, hepatic damage is the major concern, signs and symptoms may be vague and diagnosis delayed |
| Acetaminophen poisoning treatment | N-acetylcysteine (Mucomyst) is the antidote and is given as soon as possible after ingestion but may be started 24 to 36 hours after the ingestion in severe cases |
| Ibuprofen poisioning-what needs monitoring | renal function studies and acid-base balance need to be monitored with ingestion of large doses |
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laotracuata
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