nursing first year

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SIDS

sudden infant death syndrome.3000 per year mortality rate decreasing (Back to sleep) children under two in which autopsy faild to id the cause of death.

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SIDS risk factors

low birth wt, premature, boys, winter months, crowded living conditions. co sleeping

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SIDS family care

parents may blame them selfs or eachother, or be blamed by other family members. sensitive suport needs to offered, recomend suport groups.(compassionate friends, national sids foundation)

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Otitis Media

Inflammation of middle ear._ Purulent (AOM) S pneumonia , H influenzae _ Serous (OME) unknown (most common cause of hearing loss)

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Otitis risk factors

early child hood=eustation tubes are shorter wider and straighter,babys that are feed supine, recient upper resp inf,S pneumonia vaccine decreases incidence of ds. cigarettes pacifiers and daycares

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otitis symptoms

• Pain in ear exacerbated by sucking chewing!!!!!!!!! • Rubbing/pulling ear infant S/S Fever up to 104F,pulling on ear • Rolling of head infant S/S

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Treatment - Otitis Media

Examine ear hygeen, lymph nodes too (and first)Antibiotics amoxicillin is choicePain control acetametophin ibuprofen, antihistamines are NOT effective. Ear drops (Auralgan) warm 115F or cold,compress, child upright helps.• Myringotomy • Tympanostomy

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Bronchiolitis

Inflammation of small airways, autumn-spring, edema and mucus. most caused by RSV (Respiratory syncytial virus). aveoli usualy not effected gas exchange is

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Symptoms - Bronchiolitis Early

_ Rhinorrhea _ Sneezing _ Cough _ Low grade fever _ Poor appetite _ Increased RR

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Symptoms - Bronchiolitis late

RR of 50-60, less than 6mo, inability to feed.these are causes to hospitalize.

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Symptoms - Bronchiolitis late

_ Tachypnea (60-80) _ Wheezing _ Nasal flaring _ Retractions _ Cyanosis _ breath sounds

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Treatment - Bronchiolitis

• Treat symptoms _ Fluids IV to hydrate and thin secreations _ Humidify air _ Antipyretics

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Treatment - Bronchiolitis (hospital)

_ IV fluid (thin secreations) _ Humidified Oxygenkeep o2 92%+ _ Bronchodilators _ Corticosteroids _ Antibiotics for infants use to prevent secondary infections _ Contact isolation!!! Nasal washing to determine if RSV

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RSV immune globulin respigam, palivizumab Synagis

children at high risk for Bronchiolitis

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Cystic Fibrosis

Multisystem disease involving cell membrane and fluid/electrolyte system lungs pancrease GI,Congenital disorder: Mendelian recessive

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Cystic Fibrosis Mendelian recessive

from both parents carriers do not show symptoms chromosome 7,

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Respiratory Symptoms – CF

Cough. Wheezing. Dyspnea. Excessive mucus. Obstructed bronchioles. Fatigue. Irritability. Cyanosis. Barrel shaped chest. Clubbing. RV hypertrophy. Obstructed emphysema. Atelectasis. Fibrosis .staph and Pseudomonas (suitable environment)

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maconium illius

impaction in distal sm bowel) seen in 10 -20% of CFers, clubbing may be seen in chronic O2 decrease.

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GI Symptoms - Cystic Fibrosis

• Meconium ileus • Rectal prolapse • decrease inPancreatic enzymes trypsin lipase and amylase all decreased • Steatorrhea • Increased appetite • Wt. Loss • Distended abdomen and lack of shitting may be indicative of obstruction

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Special Considerations - CF

Sweat test: pilocarpine iontophoresis (Increased Na & Cl)

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Complications CF

_ Liver enlargement _ Edema of extremities _ Retinal hemorrhage _ Cor pulmonaleheart strain from improper lung fxn is a freq cause of death _ Osteoporosis bones are porous because of poor utilization of fat sol Vit D

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Medications for CF

Pancreatic enzymes • Antibiotics: TOBI via inhalation tobramycin for Pseudomonis aeruginosa • Bronchodilators albuterol • Expectorants • DNase an enzyme decreases viscosity of sputum

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Treatment – Cystic Fibrosis

• High cal, PRO, Na diet • ADEK supplements • C&DB • Postural drainage • Exercise • Prevent infections

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Croup common in toddler

not communicable. • Respiratory conditions characterized by brassy cough and stridor _ Spasmodic laryngitis _ Laryngotracheobronchitis() • Progresses over days • Viral cause most common!!! • Risk: children & familial tendency

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Laryngotracheobronchitis

glotic or subglotic croup

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respiratory distress!!!!!

substernal retratctions, agitiation,more severe hypoxia=pallor cyanosis increased HR extream restlessness and listlessness, feel free to press that code button at any time now!

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Symptoms - Croup

Harsh barking cough • Hoarseness • Stridor usually worse at night • Laryngeal edema • Fever • Respiratory distress

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Treatment - Croup

Vapor mist • Oxygen(heliox) mix of helium and oxygen used for upper airwayobstruction • Corticosteroids • Inhaled racemic epinephrine Fluids • Rest

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Inhaled racemic epinephrine

10 -30 min peek close monitoring when med wears off sudden decline may occur(hospital use only)!!!!!!!!!!!!!!restlessness and anxiety

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Common Cold

rhinoviruses.Spread _ Cough – Sneeze - Contact

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Treatment - Common Cold

OTC not to be used under 2years of age. Rest Tylenol Fluids Decongestants Diet Humidified air

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Tonsillitis & Adenoiditis

Inflammation of lymph tissue Dysphagia _ Sore throat _ Enlarged cervical lymph nodes

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how to blow your nose

both nostrils at the same time prevents pressure from spreading infection to eustations tubes

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Treatment - Tonsillitis & Adenoiditis

• Surgery _ T & A • Prevent post-op infection • Monitor for hemorrhage _ Up to 10 days post-op

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Asthma (reactive airway disease)

Reversible obstruction of airways. _ Bronchial spasm _ Mucosal edema _ Thick mucus production • Most common chronic illness • Status asthmaticus(not responding to meds must hospitalize)genetic predispose most influential.

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Triggers of Asthma (abrupt exposures= faster onset)

• Allergens • Temperature change • Cold air • Viral infection • Exercise • Smoke • Stress severe asthma usualy continues in adulthood

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Symptoms - Asthma, intermittent, mild, moderate, severe

Tight unproductive cough • Wheezing - expiratory • Tachypnea • Dyspnea • Tachycardia • Fatigue • Eosinophils as well as IgE • Abnormal ABGs • Abnormal PFTs

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PFTs

5years old+, done every two days for two weeks comparisons made against child's best is used

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Treatment - Asthma

• Eliminate allergen • Bronchodilators • Steroids prednisone, corticos • Mast cell stabilizer montelukast aka singular • Oxygen • High Fowler’s • Hydration

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Goals of Treatment - Asthma

reduce episodes, minimizing the inflammatory phase, decrease hospital stays,facilitate normal growth and development. untreated persistent asthma can cause irreversible damage.

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asthma drugs: long term control

:inhaled corticos, systemic corticos, leukotrienes, long acting b2 agonists,

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asthma drugs:quick relief(rescue)

short acting b2 agonist, systemic corticos, anticholinergics

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Epiglottitis (Haemophilus Influenzae type B )2-6years old

Swelling of tissues above the vocal cords • Rapid and progressive • Life threatening emergency

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Symptoms – Epiglottitis

• Sudden sore throat • Tripod position • Drooling • Fever • Muffled voice • Dyspnea • Stridor late ominous sign( airway obstruction is almost complete) • Bacteremia

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Treatment - Epiglottitis vaccinate your fucking child

• Nursing: Do NOT examine throat!!!!!!!!!!!!!!!! • Artificial airway • Corticosteroids • Fluids/ IV • Antibiotics • Prevention: H. Influenzae vaccine beginning at 2months

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Bronchitis (2-3 weeks)

• Bronchial inflammation • Usually viral more common in winter • Symptoms: crackles and wheezes _ Low grade temperature _ Adventitious lung sounds • Self-limiting antimicrobials cough suppressants and antihistamines are not indicated

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Pneumonia

Inflammation of lungs where alveoli become filled with exudate • Types: _ Bacterial 20% treated with antimicrobials _ Viral 80% treatment is suportive _ Primary _ Secondary more serous because child is already immune compromised

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Symptoms – Pneumonia

• Dry productive cough • RR • Shallow respirations • Sternal retractions • Nasal flaring • Fever tepid sponge baths, antipyretics steal covers • Listless • Poor appetite • On affected side

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DX pneumonia

• + CXR!!!!!!!!!!!! •elevatedWBC!!!!!!

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Treatment - Pneumonia

• Antibiotics (bacterial) • Supportive _ Antipyretics _ Analgesic _ Oxygen _ Fluids/ IV _ Rest _ Reposition

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Tuberculosis

most volunerable to TB in first 3years of life (hispanics1st, asians2nd) • Mycobacterium tuberculosis • Spread – airborne droplets associated with poverty and crowded living conditions and poor hygeen • Active process and remissions

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Symptoms – TB

• Asymptomatic • Malaise • Anorexia •Weight loss • Fever • Night sweats • Productive cough Test for HIV, and vise versa if HIV test for TB

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Diagnostics – TB (report to public health)

• PPD or Mantoux • CXR to confirm • Sputum smears • Gastric washings • CSF • Culture

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Treatment - TB

• Prevention • Isolation • HEPA mask • Follow up care • Vaccine

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Treatment - TB Medications

_ INH _ Rifampin _ Pyrazinamide _ Streptomycin _ Myambutol

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Treatment - TB Medications

rifampin, pyrazinamide and ethambutol, are given for 8 weeks 56, doses. continuation phase if nessary are rifampin and isoniazid given 4-7months ALL DRUG ADMIN BE DIRECTLY OBSERVED by health care.

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Congestive Heart Failure

• Cardiac pump failure _ Underlying cardiac disease _ May worsen with anemia & infection • Unable to meet metabolic needs - _ CO

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Right CHF

Fatigue Peripheral edema Hepatomegaly Splenomegaly JVD Weight gain Nausea Cor pulmonale

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Left CHF

Dyspnea Cough Fatigue S3 Tachycardia LOC changes Pulmonary edema Moist lung sounds

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Diagnostics for CHF

• Physical exam • CXR • EKG • Echocardiogram • BNP • ABGs • Stress test • Cardiac catheterization

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Treatment - CHF

• Fluid restriction • Weight management • Diet _ Sodium - Potassium • Activity • Medications _ Digoxin heart rate must be counted before and after adminastration – Diuretics _ ACE Inhibitors - Beta blockers

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Acute Rheumatic Fever

• Systemic inflammatory disease • Affects joints, heart, CNS, skin & SQ tissue • Follows Group A beta hemolytic streptococci • Antibodies attack connective tissue

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Symptoms - Rheumatic Fever MAJOR CRITERIA

• Carditis (Aschoff bodies) • Polyarthritis • Erythema margination • Syndenham Chorea • SQ nodules

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Symptoms - Rheumatic Fever MINOR CRITERIA

• Fever • ESR or CRP • Arthralgia • 1° HB

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Jones Criteria

2 major or 1 major + 2 minor

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Treatment - Rheumatic Fever

• PCN penicillin G (bicillin) IM Q4 weeksto prevent reoccurrence • Anti-inflammatories NSAIDS aspririn may mask migratory arthritis. • Steroids • Valium/Haldol prevents chorea (abnormal involuntary movement disorder) • Seizure precautions

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Treatment - Rheumatic Fever

• BR bed rest • Nutrition food high in protiens • Prevent cardiac damage antimicrobial prophylaxis for dental procedures and the like. RADT rapid antigen detection test

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Symptoms - Head Injuries

• Headache • Irritability • Blurred vision • Vomiting • Change in LOC • Dyspnea • Unconsciousness • Seizures • Abnormal posturing • ICP

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• ICP

compromised perfusion, brain death. Changes in behavior are early signs, pupils become sluggish then dilated and finaly fixed, advanced ICP causes an increase in systolic pressure, decrease in diastolic, decrease in pulse known as Cushings Triad

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• Abnormal posturing

decorticate arms flexed legs extended, decerebrate extention and pronation of arms and legs

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Treatment - Head Injuries

• Prevent/treat ICP • Prevent neurological complications • Quiet environment • Wound care • Monitor fluids overhydration causes an increase in ICP • Prevent injury

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Bacterial Meningitis

• Inflammation of the meninges • Cause: H. Influenzae • Invade via blood _ Other infection _ Neurological procedure _ Skull fracture • Purulent

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Symptoms - Bacterial Meningitis

• Headache • Drowsiness • Bulging fontanel • Irritability • Photophobia • Fever

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Symptoms - Bacterial Meningitis

• + Kernig’s sign prone pt flexed at hip, cannot extend lower leg out • Vomiting • Stiff neck • Seizures • Coma • Opisthotonos • High pitched cry • + Brudzinski’s sign flex the pts head to chest if the hips involuntarily flex sign is positive

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Seizures

aspiration precaution,observer for precipitating factors(may lead to location of brain inj)protect from injury, don't restrain.

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Opisthotonos

condition in which the body is held in an abnormal position. The person is usually rigid and arches the back, with the head thrown backward.on his or her back, only the back of the head and the heels touch the supporting surface.

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Considerations - Bacterial Meningitis

Lumbar puncture High WBC High protein Low glucose Complication SIADH

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SIADH

syndrome of inappropriate antidiuretic hormone, to determine ht wt I&O serum electrolytes and serum urine osmolarities should be measured at admission.if + fluid restriction is in order

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Treatment - Bacterial Meningitis

• Isolation • Antimicrobial cephalosporins and vanco • Anticonvulsant diazepam, adavan, • Antipyretic • Sedative • Prevention: _ Immunization: H. Influenzae

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Encephalitis

• Inflammation of the brain • Causes _ Virus arboviruses, enteroviruses (RNA virus) herpes virus _ URI _ Measles _ Lead Poisoning _ Bacteria _ Fungus

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Symptoms – Encephalitis inquire about travel

• Headache • Drowsiness • Coma • Seizures!!!!!!!!!!!!!!!!!!!!!!!!! • Stiff neck • Delirium • Fever • Cramps • Vomiting • Abdominal pain

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Complications - Encephalitis

• Slow speech • Slow mental process • Slow motor process • Brain damage • Mental retardation

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Treatment - Encephalitis

• Steroids cortico • Immunoglobulin • Acyclovir for da herps _ Herpesvirus • Antibiotics _ Bacteria • Sedatives • Antipyretics • Fluids/IV • Oxygen • Seizure precautions • ICP management

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Epilepsy

• Chronic, recurrent attacks • Abnormal discharge of neurons • Impaired consciousness followed by contraction/relaxation of muscles and/or disturbed feelings/behavior • Status epilepticus

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Status epilepticus

multiple seizures one after another( most commonly caused by sudden discontinuation of meds)may result in death from resp failure and exhaustion

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Causes/Triggers - Epilepsy

Causes • PKU • Hydrocephalus • Brain Injury • Acute infections • Med. withdrawal Triggers changes in Na or K+, _ Stress _ Over- tired/excited _ Flashing lights _ F/E Imbalances _ Hormone changes

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Symptoms – Epilepsy

aura, tonic, clonic, postectal,

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tonic

phase in which the body stiffens and the child losses consciousness (phase one of convulsive) arrest of resp during!!! May leave the child looking cyanotic, eyes roll up or out to one side

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Clonic

jerking of the trunk and extremities, incontinence muscle contraction and relaxation subside and postictal begins

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Postictal

dazed and confused sleep is common head ach and performs more aor less automatic acts Nonconvulsive • No aura • Lapse in conscious • Loss of muscle tone • Distorted sensations Automatisms repetitive movments

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Treatment - Epilepsy

• Prevent injury head and neck • Maintain airway lay on side • Anticonvulsants • Ketogenic diet high in fats • Surgery • Vagal nerve stimulator procedure that attaches a device that induces current to stop a seizure when pt feels it coming on

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Reye Syndrome (nonspecific encephalopathy)

malase and vomiting(up to 24Hr) directly after a viral inf like vericella or upper resp infection • Nonspecific encephalopathy with fatty degeneration of the viscera and altered ammonia metabolism • Rapid onset • Triggered by viral disease or use of

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Symptoms - Reye Syndrome

• Sudden vomiting • Lethargy • Confusion • Seizures • Coma • Cerebral edema • Liver enlargement • increasedSGOT, SGPT, LDH • increasedAmmonia level

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Treatment - Reye Syndrome

• ICU • ICP management • Osmotic diuretics (manitol) • Sedatives • Barbituates • Prevention • Early identification

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Deafness

• Hearing loss • Congenital or Acquired • Sensorineural or conductive _ Mixed • Complete or Partial

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Symptoms - Deafness

• Response to auditory stimuli • Poor communication • Speech • Behavior problems • Social isolation • Aggressiveness

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Testing - Deafness

• Universal screening _ Auditory brainstem response _ Otoacoustic emissions • Audiometer • Tympanography

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additional symptoms

does not startle to loud sounds, wont turn head to sound by 3-4months, wont bable at 6months, wont atempt syllables by one year

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Treatment - Deafness

Prevention PREGNANT mothers with German measles Rubella or streptomycin, neomyocin ( OTOTOXIC) _ Immunizations for communicable diseases • Early detection & treatment • Hearing & speech center • Hearing aid • Assist with communication

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Communication with Deaf

• Communication by deaf person _ Lip reading _ Sign Language _ Writing • Communication by caregiver _ Face child @ eye level _ Short, clear sentences _ Use gestures

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Amblyopia (problem in brain not eye)

• Lazy eye • Loss or of vision • Brain “turns off” confusing visual images • Treatment _ Glasses _ Patch unaffected eye, forces development of affected eye, drops to blur vision of unaffected eye

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Amblyopia prognosis

depends on on length untreated, critical visual development occurs from birth to 6 years, vision screening is 3-4years of age

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Strabismus (cross eyed) muscle problem.(can cause amblyopia)

• Crossed eyes • Muscle imbalance • Treatment _ Patch unaffected eye _ Glasses _ Eye exercises _ Surgery detected with corneal light reflex, symmetry of reflection misaligned

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Strabismus in infants

is normal up to 4 months of age

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Pyloric Stenosis

• Risk: • Overgrowth of circular muscles of the pylorus • Obstruction _ Boys > Girls and inherited thanks mom and dad.

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Symptoms – Pyloric Stenosis

• Projectile vomiting shouldn’t have bile or pancreatic juices. • Hunger • Dehydration • Olive shaped mass • Enlarged stomach • Decreased BM • Peristaltic wave

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Treatment – Pyloric Stenosis

Pyloromyotomy - enlarges opening

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Hernias

• Protrusion of abdominal contents _ Inguinal _ Umbilical • Congenital vs Acquired • Reducible vs Incarcerated • Strangulated loop of bowel is trapped and ischemic

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Celiac Disease

• Celiac sprue • Inherited, autoimmune disease • Inability to digest gluten (gliadin) _ Wheat, barley, rye, & oats • Damages intestinal mucosal cells

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Symptoms – Celiac Disease

• Failure to thrive • Chronic diarrhea • Steatorrhea • Abdominal distension • Abdominal pain • Muscle wasting • Anorexia • Nausea • Vomiting • Irritability

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Diagnosis & Treatment – Celiac

• Diagnosis _ Small bowel biopsy jejunal _ Serum antigliadin antibody • Treatment _ Gluten free diet _ Vitamin supplements

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Intussusception

typically under 2years, 4-9mo highest rate • EMERGENCY • Slipping of one part of the intestine into another part common site is ileocecal valve • Unknown cause • Complications obstruction and peritonitis if burst

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Symptoms - Intussusception

• Severe abd. pain • Straining • Vomiting bile at first and then if unchecked fecal vomiting • BM, flatus • Currant jelly stool just blood and mucus • Sausage mass - RUQ • Rigid abdomen • Elevated temp up to 106F • Shock

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Treatment – Intussusception

good prog if treated with in 24hrs • Hydrostatic reduction like a filling a balloon with water • Surgery _ Reduction _ Resection

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Hirschsprung’s Disease

• Aganglionic Megacolon • Absence of ganglionic nerve in colon prevents relaxation = ribbin shits • Affected area – constant contraction • Obstructs stool; chronic constipation life threatening • Proximal end - distended

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Signs and Symptoms – Hirschsprung’s

• Meconium ileus • Abdominal distension • Ribbon-like stool • Vomiting • Constipation

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Diagnosis & Treatment – Hirschsprung’s

• Diagnosis _ Rectal mucosal biopsy _ Rectal manometry • Treatment _ Surgical removal with reanastomosis _ Temporary colostomy

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Pinworms

• Parasitic worm • Hand to mouth _ Ingest eggs _ Mature in cecum _ Migrate to anus _ Lay eggs at night • Confirmed by tape test

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Symptoms - Pinworms

• Anal itching • Irritated rectal area • Eggs on tape test • Worms in stool • Irritability • Restlessness • Wt. Loss • Poor appetite

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Treatment - Pinworms

• Anthelmintics _ Vermox _ Povan • Prevent reinfection _ Linen/ clothing _ Hygiene _ Family

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Appendicitis

• Inflammation of appendix • Related to: _ Blockage by fecal matter - Infection _ Allergy - Foods • Boys > girls • Rare before age 2

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Symptoms - Appendicitis

• Restless • Nausea/vomiting • Constipation/diarrhea • Fever • increaseWBC • Rigid abdomen • Abdominal pain • Abdominal guarding • Rebound tenderness • decreasesdBowel sounds

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Treatment - Appendicitis

• No palpation of abdomen • No enemas • Never apply heat • Rehydration • Appendectomy • Antibiotics

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Obesity (BMI > 95 percentile)

feelings of inadequacy, male: developed breast, striae,small penis, teens feel unloved rejected and unattractive

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Treatment - Obesity

• Diet modification, for whole family, don’t invent your own diet, • Exercise • Stabilize weight • Behavior modification, eat only at the table, use a small plate, record your feelings and all food consumed • Support groups

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