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Pediatrics ch 14

Disorders of the School-Age Child

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
Created by: laotracuata