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1307 Unit 4 BP

Legge-Calve-Perthes Disease asceptic necrosis of head of femur; s/s pain in hip and groin and a limp with muscle spasms and limitation of motion; mimic synovitis (innovation of a joint); difficult to diagnose; diagnosis done by radiographic examiniation that may need to be repeated
stages of Legge-Calve-Perthes Disease each lasts 9 months to 1 year; first stage - x-ray studies show opacity of the epiphysis of femur; 2nd stage - epiphysis becomes mottled and fragmented; 3rd stage - reossification occurs
treatment of Legge-Calve-Perthes Disease in the past immobilization for 2 years or more; currently - containing femoral head within the acetabulum during the revascularization process so the new femoral head will form to make a smoothly functioning joint; use of brace during healing; surgery
Bryant's traction used for treatment of fractured femur in child under 2; legs wrapped with elastic bandages (removed daily to observe skin); check skin temp, color of legs and feet frequently; hips should not rest on the bed; severe pain may be from circulatory difficulty
Buck's traction body provides countertraction to weights; used for short-term immobilization to correct contractures and bone deformities such as Legg-Calve-Perthes disease; don't let child slide down in bed; weights hang freely; ropes aligned with pulleys
Russell traction more effective for older children; same as Buck's but leg is elevated and hoist is placed under knee (see pg. 885)
Duchenne's muscular distrophy most common muscular dystrophy; x-linked; mostly in males, females are carriers; first signs within 3-4 yrs; difficulty standing and walking and later trunk muscle weakness; mild mental retardation; Gower's sign when getting up from floor; lordosis
Duchenne's muscular distrophy highly increased serum creatinine phosphokinase levels; decrease in muscle fibers seen in biopsy (confirms diagnosis); no treatment; kyphosis can develop and cause decrease in respiratory function, increasing infections; breathing exercises necessary
treatment for soft tissue injury RICE (rest, ice, compression, elevation)
x-ray definition used for suspected pathological condition; affected areas compared with unaffected
bone scan pathological conditions not seen on x-rays
CT cross sectional picture of bone and relationship to other structures
MRI detailed pics of soft tissue
ultrasound rule out foreign body in soft tissues, joint effusions, developmental dysplasia of the hip
osteomyelitis bone infection from Staph. aureus; more common in boys; results from a primary infection burns, or furuncle, penetrating wound or fracture; infection carried through blood to metaphysis (growing portion) of bone where abcess forms, ruptures and spreads
neurovascular checks and musculoskeletal assessment CMS - circulation, movement, sensation; assesses for impaired neurovascular function; observe, document, report the five P's (pain, pulse, paresthesia, paralysis, pallor); check for heat, non-fitting cast, temperature (danger signals)
scoliosis - functional - define lateral curvature of spine, two forms (functional or postural) - more common type; causes: poor posture, muscle spasm from trauma, unequal length of legs; when primary problem is corrected, elmination of functional scoliosis begins
Milwaukee brace first type of scoliosis brace, more commonly used for kyphosis; exerts pressure on chine, pelvis, convex side of spine; worn 23 hrs over t-shirt to protect skin
tracheoesophageal fistula upper (proximal) end of the esophagus ends in a blind pouch and the lower (distal) segment from the stomach is connected to the trachea by a fustulous tract
s/s tracheoesophageal fistula and nursing care chokes, coughs, regurgitates when fed as it enters the blind pouch; continuous gentle suction to avoid mucous aspiration; IV fluids; observe for signs
dehydration - how do you know? sunken eyes, dark circles under eyes, poor skin turgor, anuria, lab shows high specific gravity, dark urine, decreased activity, no tears when crying, mouth sticky and dry
pyloric stenosis characterized by hypertrophy of the circular muscle fibers of the pylorus, severe narrowing of its lumen; distal end of stomach becomes dilated
s/s pyloric stenosis eats well, gains weight first weeks of light; later starts vomiting after meals; within a few days the vomiting increases in frequency and force, becoming projectile
nursing care for pyloric stenosis determine when vomiting started and it's characteristics; physical exam may show dehydration; help determine need for fluid and electrolyte replacement
treatment for pyloric stenosis impaired colon removed and anastomosis of intestine performed; temporary colostomy with closure in a few months; no tap water enemas - can lead to WATER INTOXICATION and death; use only normal saline enemas
pinworms child unknowingly swallows pinworm eggs; hatch in intestinal tract and grow in cecum; femal work lays eggs on the perineum; s/s - anal itching; treatment - antihelmintics (Mebendazole (Vermox); repeat meds in 2-3 weeks; teach handwashing; change bedding
roundworms large intestinal worm found only in humans; from contact of feces of people with infestation; found where sanitary facilities are lacking
hookworms live in human intestinal tract, attaches itself to the wall of small intestine; eggs come out in feces of host; prevalent in areas where infected human feces are on the ground and where soil, moisture, temp are favorable for development (SE US, W Africa)
constipation ribbonlike stools; abdominal distention; anorexia; vomiting; failure to thrive; laxatives without success; untreated leads to intestinal obstruction and shock, interocolitis; barium enema and rectal biopsy
diarrhea common in a variety of conditions; may be mild, accompanied by slight dehydration, or extremely severe; simple diarrhea can quickly turn into life-threatening diarrhea; treatment BRAT diet, liquids in small amounts, nonsalty soups or broths
gastroenteritis infectious diarrhea; inflammation of stomach and intestines; identify and erradicate cause; oral rehydration
vomiting can cause alkalosis
diarrhea can cause acidosis
Tylenol antidote acetylcystine (Mucomyst)
lead poisoning caused by ingestion of lead from paint from old houses, toys from other countries, etc; treatment - chelating agents bind to lead
Celiac disease malabsorptive disorders; malabsorption with steatorrhea(fatty stools); common causes cystic fibrosis and gluten-induced enteropathy; malabsorption prob.; 6 mos - 2 yrs; large bulky frothy stools, triggered by URI; restrict wheat, barley, oats, rye
oral rehydration therapy Pedialyte
thrush - treatment and prevention fungal infection in the oral cavity; causes white patches on the tongue; treatment - Nystatin
UTI common in "diaper age" and 2-6 years; fever, n/v, foul-smelling urine, weight loss, increased urination; little or no fever; short urethra in females; abnormal urinary system; urinary stasis; short-term indwelling catheter; antimicrobrial agents
more causes of UTI tight clothing, poor hygiene, local inflammation, oils in bubble bath/shampoos
hypospadias opening of urethra is on ventral (under) surface of glans
epispadias opening of urethra located abnormally on dorsal (upper) surface of glans penis
nephrotic syndrome severe proteinuri leading to edema and hypoalbuminemia; s/s ascites, abdominal pain, periorbital, dependent to generalized (shifts with sleep); oliguria, dark frothy UOP; BP is normal
glomerulophritis accute inflammation of glomeruli; most common form of necrosis; 1-3 weeks after strep infection; s/s coke, tea colored urine, increased BUN, creatinine, ESR; decreased albumin; severe oliguria; mild-mod edema; peri-orbital edema; HTN; abdominal pain
assessment of burns assess airways especially if around face or mouth; severity depends on area, extent, depth, burn is calculated according to body surface area
pain with burns 2nd degree burns will hurt around edges; 3rd degree - nerve damage - won't hurt as bad at first; give pain meds 30 minutes before wound care; clean with mild soap and water; debridement - to remove necrotic skin
nephrostomy tube temporary; to drain urine from kidneys when there is an issue or blockage
Willm's tumor abdominal neoplasm of kidney most common in intra-abdominal tumor; peaks at 3 y.o.; treatment - surgery, chemo with radiation, support, prepare for diagnostic tests/treatments; no abdominal palpitation (may rupture/spread); careful handling and bathing
Undescended testes when one or both testes do not descend, called cryptochordism; usually normal in size, cause for failure to descend not clearly understood; orchiopexy is procedure to bring testes down into scrotum and anchor it there; injections of hcg
VCUG diagnostic test for vesicoureteral reflux; inject with dye and pee on table
acidic urine prevents UTI
scabies female mite burrows in areas between the fingers and toes and in warm folds of body, like axilla and groing; seen as black dot at the end of burrow; severe itching, causing scratching with secondary infection
treatment of scabies Elimite or lindane lotion - scrub with soap and water the apply lotion as directed. Permiethrin is preffered due to decreased risk of neurologic problems; left on skin 8-14 hrs; treat people in close contact; wash clothing, soft toys, bedding
pediculosis capitis - treatment Pronto, RID, Nix (Permethrin), prescription is Malathion (Ovide); use again 7-10 days later
pediculosis capitis - prevention wash bedding and clothing in hot water and dry in hot dryer; vacuum carpets, car seats, mattresses, upholstery, pillows, stuffed animals, dry clean non-washables, seal in plastic bag 2 weeks; wash hair items; report to school or daycare; clean headphones
acne prevention well-balanced nutritious diet; caused by increased hormones, especially androgens; heredity; irritation and irritating substances (vigorous scrubbing; growth of anaerobic bacteria
cradle cap seborrheic dermatitis - thickened, yellow, oily, adherent, crustlike scales and forehead; resembles eczema; doesn't itch; treatment - shampooing on regular basis
eczema - cause characterized by 3 factors: hereditary predisposition, hypersensitivity of deeper layers of skin to protein or proteinlike allergens; allgergens to which child is sensitive that may be inhaled, ingested, or absorbed through direct contact
eczema - s/s usually starts on cheeks and spreads to extensor surfaces of arms and legs; entire trunk may become affected; reddening of skin is quickly followed by papule and vesicle formation; itching is intense, scratching makes skin weep and crust
common eczema allergens: foods (egg white, cow's milk, wheat products, orange juice, tomato juice); inhalants (house dust, pollens, animal dander); materials (wool, nylon, plastic)
treatment for eczema elimination diet; hypoallergenic diet; relieve itching (emollients, special baths, alternate soaps), hydrating skin (bathing, special soaps); relieve inflammation (medications); prevent infection (meds, special baths)
spongiosis breatkdown of dermal cells (in eczema)
eczema asthma is also often seen along with eczema; rarely seen in breastefed babies until solids are introduced; symptom rather than disease; oversensitive to allergens; some children devleop triad of symptoms (atopic dermatitis, asthma, hay fever)
topical therapy best applied right after warm bath; in direction of hair growth; pea-size amount of ointment; use elbow restraints; no topical steroids if viral infection present; avoid cortisone creams
prickly heat - cause miliaria - caused by excessive heat and moisture; retention of sweat and glad becomes blocked and inflammation response begins; tiny, pin-head reddened papules develop; may itch; harmless; seen in hot weather; reversed by removing clothes
strawberry nevus common hemangioma; harmless; disturbing to parents; on head or face; starts flat, may become raised; gradually blanches; removed with laser or excision
diaper rash treatment change frequently without waiting for obvious leaking; wash and cleanse each change; no baby powder; A&D ointment
frostbite - areas affected fingers, toes, ears
diabetes mellitus
hypoglycemia treatment sugar, orange juice, etc
hypothyroidism, s/s, treatment s/s - sluggishness, dry skin, cold hands and feet, dry brittle hair, enlarged tongue; treatment - Levothyroxine
diabetes insipidus thirst never satisfied; watch for water intoxication; commonly seen with head injury; decreased pituitary function and decreased vasopressin (ADH); polydipsia, polyuria, weight loss, dehydration, dry skin
precautions for varicella contact precautions (after sores appear); droplet/airborn precautions (before sores)
incubation period for varicella 14-21
Hep B immunizations series; 1st is at birth or 2 months after (will be combination vaccine @ 2 months)
Hep A mandatory vaccine; fecal contaminated with food or water; well water can cause (in the past)
if allergic to eggs cannot get flu, varicella, MMR vaccines (pros/cons would be weighed for MMR)
Fifth's disease hand-foot-mouth - rash on palms and trunk; looks like they've been slapped - sores in mouth; droplet/airborn precautions
opportunistic infection immune system is down; takes advantage of low immune system (when taking corticosteroids or chemo)
what type of immunity is a vaccination? active, or artificially acquired
neutropenic patient no fresh flowers or fruits; protecting them from us - put on mask when entering; they mask when leaving their room
Mantoux Test TB test
Emula Cream deadening cream before shots, IVs, etc
antibiotic directions take it all; use birth control
whooping cough vaccine pertussis; live, attenuated vaccine
why would the nurse delay immunizing? fever or viral infection
Lyme Disease cover yourself; light clothing; check for ticks
Rubeola - tell-tell sign Koplik spots - small red spots with blue-white centers
MMR schedule 12 months, 15 or 18 months, 4 years old
who will not get live virus? immunocompromised or family member who is immunocompromised
what meds contradict vaccines? chemo, corticosteroids
VCUG check kidney function; uses dye to check that urine stays in the bladder, doesn't go back up into kidneys
Scabies is a parasitic infection caused by itch mite. Female mite burrows under the skin and lays eggs. Itching is intense. Seen in body folds
Tx of Scabies Elimite - ecveryone is treated.
Important to remember with lice and scabies do not forget to clean the sheets, stuffed animals, couch, and anything child may have come in contact with.
Prevention of lice do not share combs, headgear or bed linens!
Treatment of Lice Nonprescription meds are available to treat cases of head lice. Products such as Pronto, RID, NIX. These are safe and usually effective in killing the lice.
Superficial or First degree burns epidermis is inuured but there is no destruction of tissue or nerve endings - prompt regen. dry, no blisters or edema, painful.
Partial-Thickness or Second Degree burns Moist blebs or blisters, Mottled white to pink cherry red in color. Very painful. May include fat domes of subq layer.
Full-thickness or Third Degree Burns Dry with leathery eschar until debridement; charred blood vessels visible under eschar. Mixed white, dark , charred in color. Little or no pain; hair pulls out easily. Down to and including subq. tissue may include fascia, muscle and bone!
Emergency Treatment of burns Cool water (small areas). Clothing should be romed but wrapped with a sheet to prevent shivering.
acne prevention foods are not a trigger, general hygiene: cleanliness, rest, and avoidance of emotional stress. Do not squeeze.
tay-sachs deficiency of enzyme needed for fat metabolism. Evident at 5-6 months of age when their growth starts to slow. Causes mental and physical deterioration. Blindness. Mental retardation. There is no treatment. Emotional support.
Ultimate goal for child with diabetes is self-management.
Staphylococcal infection compromises bacteria that are found in dust and skin. Under normal conditions it doesn't cause problems. Spreads readily.
Treatment and nursing care for a staph infection ointments. MRSA-strict standard precautions
Scalded skin syndrome- staph aureus looks like a burn. child abuse suspected. Strict isolation, iv antibiotics, prevention of secondary infections, maintainw armth and fluid electrolyte balance.
Tinea Pedis Athletes foot. Between toes, on instep and on soles. OTC topical therapy. Aggravated by heat and moisture. Keep feet DRY.
Nutrition for healing with burns high protein high calories
Six C's of burn care Clothing, cooling, cleaning, chemoprophylaxis (medications), covering, comfort
RSV precautions Contact transmission precautions to prevent the spread of infection.
Lyme disease caused by a deer tick bite. Incubation: 3-30days. Not communicable bw people. Avoid ticks. Inspect skin after being in wooded area. Starts as a red papule that spreads and becomes a large round red ring. Antibiotics to treat.
Created by: akgalyean