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Pediatrics ch 14
Disorders of the School-Age Child
| Question | Answer |
|---|---|
| Three types of Pediculosis | capitis (head lice); corporis (body lice); and pubis (crab or pubic lice) |
| Main symptom of pediculosis | severe itching in the affected area |
| Pediculosis treatment is aimed at | ridding the patient of the parasite, treating the excoriated skin, and preventing the infestation of others |
| Nits and location | the adult attaches nuemerous eggs, known as nits, to the hair shafts approximately 1/8 inch from the scalp |
| Diabetes Mellitus Type 1: morbidity and Mortality | associated with chronic complications that affect small and large blood vessels, resulting in retinopathy, nephropathy, neuropathy, ischemic heart disease, and obstruction of large vessels |
| Type 1 DM formerly known as | juvenile-onset diabetes or brittle diabetes |
| Type 1 DM characterized by | partial or complete insulin deficiency; patients eventually become completely insulin deficient |
| Type 1 DM cause | autoimmune process in which the body destroys the insulin-producing islet cells in the pancreas of those who are genetically vulnerable |
| What children are at risk for developing type 2 DM | BMI greater than 95% |
| Classic triad of symptoms in children with type 1 DM | polyuria, polydipsia, polyphagia; despite the hunger and increased food intake, the child loses weight |
| Symptoms and onset of DM | can appear insidiously, with fatigue, anorexia, nausea, lethargy, and weakness; dry skin, vaginal yeast infections in adolescent girl |
| Symptoms of concern in young children with DM type 1 | bedwetting or urine accidents during play periods in a previously trained child |
| Most frequently used insulin and why | human insulin, developed with recombinant DNA technique, because it is associated with a lesser incidence of allergies |
| Insulin’s effects on the body | when injected into the patient with diabetes, it enables the body to burn and store sugar |
| Glargine | is a clear formula unlike other long-acting insulins and cannot be mixed with any other type of insulin |
| Age to teach a child self-injections | after the age of 7 years |
| Hypoglycemia | low blood glucose, also known as insulin shock, occurs when the blood glucose level becomes abnormally low (below 70 mg/dL) |
| Immediate treatment for hypoglycemia | administer sugar in some form, such as orange juice, cola beverages, ginger ale, hard candy, or a commercial product such as Glutose |
| After successful immediate treatment for hypoglycemia, what can you give child | child may eat a small amount of protein or starch (sandwhich, milk, cheese) to prevent another reaction |
| Glucagon | a hormone that raises the blood glucose level by causing a rapid breakdown of glycogen into glucose in the liver; it is recommended for the treatment of severe hypoglycemia |
| Reaction in child with Glucagon | it acts quickly to restore the child to consciousness in emergency situation; child can then be able to consume some form of sugar |
| Glucagon produced where? | hormone produced by the pancreatic islets that also produce insulin |
| What should be taught to all young patients and their caretakers concerning DM | home glucose monitoring |
| What has simplified the obtaining of blood specimens | use of blood-letting devices such as the Autolet |
| Best fingers to use for blood glucose testing | middle, ring, or little fingers on either hand |
| What helps the finger bleed more easily for blood glucose testing? | washing of the hands in warm water for about 30 seconds |
| Nutrient needs of children with diabetes | essentially no different from those of children without diabetes, with the exception of the elimination of concentrated carbohydrates (simple sugars), and refined sugars |
| Two major approaches to nutritional management include | use of exchange lists and the constant carbohydrate diet |
| Constant carbohydrate diet goal | maintain a consistent amount of carbohydrate at each meal and snack; regularity of meals is stressed |
| Importance of fiber in diet | fiber has been shown to reduce blood glucose and serum cholesterol levels |
| Why is exercise important to the child with diabetes? | it causes the body to use sugar and promotes good circulation |
| Diabetes and skin care | patient should be instructed to bathe daily and dry well; inspect skin for cuts, rashes, abrasions, bruises, cysts, or boils and treat promptly |
| Diabetes and foot care | Instruct the patient to wash and dry the feet well each day; trim the nails straight across |
| Diabetes and infections | obtain immunizations against communicable diseases; cystitits, subcutaneous nodules, and monilial vulvititis occur with greater frequency in patients with diabetes |
| Diabetes and urine checks | routine urine checks for sugar are being replaced by the more accurate glucose blood monitoring; quantitative urine collection is sometimes ordered |
| Diabetes and glucose-insulin imbalances | the patient is taught to recognize the signs of insulin shock and ketacidosis |
| Diabetes and psychosocial aspects | adolescents often resent this condition, which deviates from their concept of the body ideal; emotional upsets can be as disturbing to the patient as an infection and may require food or insulin adjustments |
| Diabetes and traveling | beforehand, the child should be seen by the physician for a checkup and prescriptions for supplies; written statement and card should be carried stating child has diabetes; keep insulin, sugar, and food available |
| Diabetes and dentist visit | the patient should be taught to visit the dentist regularly for cleaning of teeth and gums; appointments should be scheduled for right after meals |
| Diabetes and vision checks | eyes should be examined regularly; blurry vision must not be disregarded |
| Diabetes and role of the nurse | blood glucose checks before meals and at bedtime; when child is finished eating, observe the types and amounts of foods that were refused and chart them |
| General statement of what the nurse does with the diabetic patient? | The nurse reinforces the interaction between nutrition, insulin requirements, and exercise and answers questions from the child or family |
| Advances in research concerning diabetes | vaccine for viruses involved; transplantation of B cells in animals has been successful; artificial pancreas; insulin via inhalation; laser beam has aided in treatment of complicated eye conditions |
| Asthma | a reversible obstruction of the large and small airways caused by mucosal edema, smooth muscle constriction, and thick tenacious mucus |
| Precipitators of asthma | allergens such as pollens, foods, dust mites, animal dander; temperature changes, cold air, viral infections, exercise, and exposure to cigarette smoke |
| Asthma precipitators cause what? | irritate the airways and initiate bronchoconstriction and the inflammatory process |
| Asthma signs and symptoms | tight nonproductive cough initially and expiratory wheezing; signs of increasing respiratory distress develop (tachycardia, dyspnea, tachypnea, retractions, pallor) |
| Asthma rescuer medications:Short-Acting B2-Agonist | Albuterol, Terbutaline; Levalbuterol |
| Asthma rescuer medications:Corticosteroids-systemic | Methylprenisolone; Prednisolone; Prednisone |
| Asthma rescuer medications:Anticholinergics | Ipratropium bromide |
| Side effects of asthma rescuer medications:Anti-IgE Antibodies | Omalizumab |
| Side effects of asthma rescuer medications:Short-Acting B2-Agonist | tremors, anxiety, insomnia, tachycardia, heartburn, vomiting; (Levalbuterol has tremors, insomnia, nausea, and headache) |
| Side effects of asthma rescuer medications:Corticosteroids-systemic | (M)mask infection, growth retardation, cushingoid signs;(Pl) insomnia, nervousness, mood swings, facial flushing; (P)insomnia, heartburn, nervousness, increased appetite |
| Side effects of asthma rescuer medications:Anticholinergics | tachycardia, eye pain, cough, nervousness |
| Side effects of asthma rescuer medications:Anti-IgE Antibodies | headache |
| How to facilitate optimal gas exchange in child with asthma | place child in high fowler’s or some prefer to have a pillow placed on the over-the bed table and to extend their arms over it; this allows max use of accessory muscles; humidified oxygen |
| What should be monitored every 2 to 4 hours in child with asthma | vital signs, breath sounds, and a respiratory assessment, which includes oxygen saturation measurement |
| What can the nurse do to a child in respiratory distress who is apprehensive | display a calm manner and remain with child during distress; encourage child to breathe slowly, or breathe along with you, (this decreases the child’s anxiety and allows for maximum air exchange) |
| Maintaining hydration in asthmatic patient | need for fluid is increased because of fluid loss through dyspnea and diaphoresis; fluids should not be cold-can cause bronchospasm; intake and output are measured |
| Acute rheumatic fever | a systemic disease that involves the joints, heart, central nervous system, skin, and subcutaneous tissues; it follows an infection with certain strains of group A B-hemolytic streptococci |
| Jones Major criteria | chorea, carditis, erythema marginatum, subcutaneous nodules, polyarthritis |
| Jones Minor criteria | fever, elevated ESR or CRP, prolonged P-R interval with ECG; abdominal pain; arthralgia |
| Carditis | involves the myocardium,pericardium, and endocardium, and mitral valve; inflammation causes dysfunction of the valve;later, scarring leads to mitral stenosis; murmurs heard, and ECG alterations are present; the taxed heart may become enlarged and fail |
| Polyarthritis | painful, tender, warm, red, and swollen joints, especially the knees, elbows, ankles, wrists, and shoulders; migratory arthritis; this pattern may continue without treatment; no permanent joint damage |
| Erythema marginatum | small red circles and wavy lines on the trunk and extremities that appear and disappear rapidly; the rash may come and go for several months |
| Sydenham chorea | characterized by involuntary, purposeless movements of the muscles; begins as clumsiness and facial grimaces; child may laugh and cry inappropriately; severe:incapacitated and deterioration of speech may be noticed; symptoms decrease when at rest |
| Sydenham chorea treatment | it is self-limiting and full recovery is expected, it can last as little as 2 weeks or more than a year |
| Subcutaneous nodules | hard, painless swellings that occur most frequently over bony prominences (scalp, spine, joints) |
| What can indicate a high probability of rheumatic fever? | the presence of two major criteria (Jones criteria)or of one major and two minor criteria, along with evidence of recent streptococcal infection |
| Acute rheumatic fever treatment | elimination of the initial infection is followed by long-term chemoprophylaxis; Intramuscular penicillin G benzathine (Bicillin) is drug of choice and given as an intramuscular injection every 28 days |
| What is used to decrease pain and inflammation with acute rheumatic fever? | antiinflammatory drugs: salicylates or NSAIDs |
| Acute rheumatic fever and activity limitations | bed rest during the initial attack is not necessary but is recommended if carditis is present |
| How is the nurse involved in prevention of rheumatic fever in the community? | recognizing signs and symptoms of streptococcal infections, doing screening, and referring for treatment |
| Appendicitis | occurs when the opening of the appendix into the cecum becomes obstructed caused by: fecaliths, infection, allergy, diet |
| Appendicitis signs and symptoms | nausea, with or without vomiting; abdominal tenderness; fever; constipation or diarrhea; elevated WBC count; pain, which is initially about the umbilicus, localizes at (McBurney’s point) |
| McBurney’s point | right lower quadrant midway between the umbilicus and the iliac crest |
| What maneuver can help localize pain in cooperative younger children(r/t appendicitis)? | having the child stand on the toes and then drop onto the heels |
| With appendicitis, what does pain followed by a sudden absence of pain indicate? | appendix rupture, peritonitis results |
| Treatment for appendicitis | appendectomy; antibiotic therapy is instituted before surgery in the patient with a perforated appendix, never apply heat |
| What happens to the abdomen after the appendix ruptures? | the abdomen rapidly becomes rigid |
| What is instigated before surgery with appendicitis? | IV administration of fluids, electrolytes, systemic antibiotics, NG suctioning, and positioning in low Fowler’s or on the right side to facilitate drainage into the pelvic area; NPO; intermittent suction is maintained with irrigations to maintain patency |
| Nursing care with appencicitis | penrose drains placed in incision; wet-to-dry dressing change several times a day; medication applied; analgesics for pain relief; monitor intake, output and bowel sounds; supply nutritious foods as diet increases; semi-Fowler’s |
| Legg-Calve-Perthes Disease (Coxa Plana) | this disease is one of a group of disorders called the osteochondroses, in which the blood supply to the epiphysis is disrupted. The tissue death that results from the inadequate blood supply is termed avascular necrosis |
| Legg-Calve-Perthes Disease signs and symptoms | classic symptom is “painless” limping; intermittent thigh pain that might be referred to the knee and limitation of motion |
| Legg-Calve-Perthes Disease treatment | ambulation-abduction casts or braces that prevent dislocation of the femoral head and enable the acetabulum to mold to the healing head in such a way that it does not become deformed |
| What is the most common arthritic condition of childhood? | Juvenile rheumatoid arthritis (JRS); is classified as several different syndromes that involve the joints, connective tissues, and viscera |
| Juvenile rheumatoid arthritis signs and symptoms | affected joints are swollen, warm, and stiff; joint stiffness occurs mainly in the morning or after a period of inactivity |
| Juvenile rheumatoid arthritis treatment | NSAIDs, (ibuprofen, naproxen, and tolmetin); corticosteroids used intraarticularly; methotrexate, sulfasalazine, and etanercept (monitor bone marrow and liver function with methotrexate); physical and occupational therapy |
| Juvenile rheumatoid arthritis hospitalized with JRA | treatment consists of medications, warm tub baths, joint exercises, and rest |
| Reye’s Syndrome | a pediatric disease characterized by a nonspecific encephalopathy with fatty degeneration of the viscera and altered ammonia metabolism; is triggered by a virus, particularly influenza or varicella |
| Reye’s syndrome signs and symptoms | recuperation of typical upper respiratory infection or chickenpox is interrupted by general malaise; then there is a sudden onset of persistent vomiting, which may continue for 24 hours, and lethargy; Metabolic acidosis and respiratory alkalosis can occur |
| Reye’s syndrome treatment | Fluid management in conjunction with treatment of increased ICP is crucial; EEG is performed until stabilization is seen; osmotic diuretics (mannitol), sedatives, and barbiturates; hypothermia pad |
| Brain tumors and children | these are the second most common type of neoplasm in children (leukemia is first); usually occurs in area below the cerebellum |
| Brain tumor signs and symptoms | ICP, headache, vomiting, drowsiness, seizures; nystagmus; double vision, strabismus, and decreased vision; papilledema; ataxia, clumsiness, head tilt, behavioral changes, cerebral enlargement, particularly in infants |
| Nystagmus | constant jerky movements of the eyeball |
| Papilledema | edema of the optic nerve |
| Brain tumor treatment | is multidisciplinary and includes surgery, radiation therapy, and in some cases, chemotherapy |
| Radiation therapy nurse teaching | hair loss; reassure the family that the hair grows back but that it may be a different color or texture |
| Attention deficit/hyperactivity disorder | refers to specific patterns of behavior that include inattention and impulsivity and might or might not involve hyperactivity |
| ADHD signs and symptoms | inattentive to details; careless; trouble organizing; easily distracted; does not listen, follow instructions, or complete tasks; interrupts a lot; avoids tasks that need concentration; fidgety; forgetful; excessive energy |
| Controversial therapies for ADHD | dietary modification (particularly eliminating food additives, such as preservatives and artificial flavors and colors) and the use of megavitamins |
| What does the American Academy of Pediatrics also recommend for use with treating ADHD? | behavior therapy |
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