Peds Exam 1
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| Morbidity | Death rate per 100,000 population
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| Mortality | Number of ill people per 1,000 - acute, chronic illness & disability
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| Injuries et Peds | leading cause of death in children over 1yr; more deaths et disabilities than all diseases
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| Temperament | the way a child interacts with the environment; behavioral tendencies
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| 9 attributes of temperament | activity, rhythmicity, approach-withdrawal, adaptability, intensity of response, threshold of response, mood, distractibility, attention span/persistence
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| Examples of personality types & temperament | easy (average), difficult (active), slow-to-warm up (quiet)
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| Easy temperament | adapts readily, overall positive mood, sleeps et eats well, regular et predictable behaviors
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| Difficult temperament | adapts slowly, overall negative mood, requires structures environment, can do well alone, constant motion, irregular behavior patterns
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| slow-to-warm up temperament | adapts slowly but watchful, withdrawn/moody, loner, shy, oversensitive, slow to mature, inactive, reacts passively to changes in routine
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| Communicating c parents/siblings with child in hospital | answer questions, involve whole family, familiarize to rules, be aware of health of other family members, teach, prepare for visits, encourage contact with sibling, help understand rxn to hospitalization of child
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| Preparing a child for hospitalization, surgery, et procedures | orient to surroundings, informed consent/assent, estab trust/support, parental presence et support, explanations, analgesia/sedation PRN
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| Goals for care of the hospitalized child (5 questions, look at more?) | to eliminate disparities in health care, improve QOL et years of life
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| Fluid alterations - assessment MILD DEHYDRATION | plae, dec turgor, dry mucous membranes, thick saliva, norm BP, norm/inc P, cap refill <2sec, ant fontanel flat
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| Fluid alterations - assessment MODERATE DEHYDRATION | eyes sunken, gray skin, tears absent, dry mucous membranes, sunken fontanel, weak/rapid P, tenting turgor, 2-3sec cap refill, listless/irritable
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| Fluid alterations - assessment SEVERE DEHYDRATION | sunken fontanel, limp, cold, lethargy/coma, acrocyanosis, mottling, thready/raid P, grunting, deep/rapid RR, cap refill >4sec, >2sec skin retraction
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| Fluid alterations - assessment FVE | sudden wt gain, bounding P, JVD, hepatomegaly, crackles, dyspnea, dependent edema, irritability, seizures --> death
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| Fluid alterations - assessment HYPOKALEMIA | muscle weakness, leg cramps, weak/irregular/rapid P, hypoTN, ileus/dec bowel sounds, HA, irritability, fatigue, slow thought processes
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| Fluid alterations - assessment HYPERKALEMIA | irritability, anxiety, hyperreflexia, weakness, brady, cardiac arrest, apnea, resp arrest, ABD muscle cramps
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| Fluid alterations - assessment HYPOCALCEMIA | paresthesias (fingers, toes, nose, ears, circumoral), hyperreflexia, seizures, muslce cramps/tetany, laryngospasm, lethargy, poor feeding, hypoTN, cardiac arrest
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| Fluid alterations - assessment HYPERCALCEMIA | lethargy, weakness, hypotonicity, anorexia, thirst, itching, confusion, personality/behavioral changes, stupor, N/V, constipation, brady, cardiac arrest
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| Fluid alterations - assessment METABOLIC ACIDOSIS | inc HR, dysrhythmias, hyperventilation, kussmaul respirations, cold et clammy (mild), warm skin (severe)
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| Fluid alterations - assessment METABOLIC ALKALOSIS | dysrhythmias, inc HR, dec RR/depth, change LOC, apathy/confusion --> stupor, muscular weakness
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| Fluid alterations - assessment RESPIRATORY ACIDOSIS | inc HR, inc rate/depth RR (accessory muscles to breathe, retractions, cyanosis), inc ICP
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| Fluid alterations - assessment RESPIRATORY ALKALOSIS | dizziness, paresthesias, diaphoresis, dysrhythmias
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| Fluid alterations - assessment GENERAL HYDRATION | intake; output; level of activity (active vs lethargic); temperature; previous wt; P (tachy?); skin; mucous membranes; fontanel; eyes (tears, sunken); LOC; cap refill; mottling; BP
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| Calculating fluid maintenance | 1-10kg = 100ml/kg; 11-20kg = 1000ml + 50ml/kg for kg >10kg; >20kg = 1500ml + 20ml/kg for kg >20kg
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| PO et IV hydration needs | ORS solution (contains NA, K, HCO3; pedialyte, lytren, infalyte, resol; glucose helps intestines absorb NaCl); Inc fluids; IV (K only when urine output adequate; prevent or tx shock; LR or 0.9% NaCl -- hyponatremic 24hrs, hypernatremic 48hrs)
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| Diarrhea | excess fluid in small intestine; infections, parasites, over feeding/new foods, excess sugar, meds, metals et organic phosphates
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| Vomiting | undigested food/sour milk curds; greenish emesis (bile, intestinal obstruction); V c D (gastroenteritis); fecal odor (lower GI obstruction); blood (tinged emesis - red upper GI, coffee grounds/dark - lower GI)
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| Chalasia | spit up in infancy
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| Regurgitation | backflow of undigested food; could indicate overfeeding, poor absorption, reflux
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| Projectile vomit | indicates some types of obstruction, tumor, or inc ICP
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| Managing Vomiting | dx et tx cause; maintain hydration; prevent aspiration; oral care
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| Primary Electrolytes | Sodium, potassium, chloride, calcium, magnesium
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| Early sx respiratory distress | mood changes (euphoria, depression), HA, HTN, change depth/pattern RR, SOE, anorexia, pallor, inc CO/renal output, retractions, nasal flaring, grunting, markedly prolonged expiration
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| Late sx respiratory distress | hypoTN (LAST), somnolence, stupor, coma, depressed respirations, brady, cyanosis, hypoxemia, hypercapnia, serial blood gases
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| Cardinal signs of respiratory failure | restlessness, tachypnea, tachy, diaphoresis
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| Respiratory failure interventions | important to assess et tx before it occurs; ABG analysis; O2 therapy; POSITIONING; stimulation; suctioning; intubation; inc humidity; dec O2 needs; meds; dec fever; infection control; support parents; maintain safety
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| Asthma | Most common chronic disease of childhood; major cause of peds ER/hospital admissions; chronic inflammation of airways; episodes of wheezing, breathlessness, chest tightness, cough, reversible either spontaneously or c tx
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| Asthma manifestations | dyspnea, wheeze, cough, variable
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| Asthma tx | Corticosteroids (edema); bronchodilators (bronchospasm); salmeterol; methylxanthines; leukotriene modifiers; chest physiotherapy (loosen et remove mucous secretions)
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| Corticosteroids et Asthma | long-term control; dec inflammation --> dec airway hyperreactivity; ORAL CARE TO PREVENT THRUSH
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| Beta-adrenergic bronchodilators et Asthma | rescue meds; allow smooth muscle to relax
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| Salmeterol et Asthma | Long-acting bronchodilator; not in children under 12y.o.; never for acute exacerbations; never more than 2x/day
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| Methylxanthines et Asthma | rarely used unless nocturnal asthma; narrow TI; drug levels monitored
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| Leukotriene modifiers et Asthma | block leukotrienes (potent inflammatory mediators released); suitable alternative to corticosteroids in mild to moderate persistent asthma
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| CF | genetic; usually dx by 1y.o.; exocrine glands throughout the body secrete thick, sticky secretions; obstruction of large et small airways et pancreatic ducts; fibrous changes in lung tisues et CHF; poor absorption of foods, bowel obstructions, diabetes
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| CF manifestations | wheezing, dry/non-productive cough; pulmonary infections; emphysema, cor pulmonale, CHF, digital clubbing, barrel chest, steatorrhea, malnutrition et growth failure, meconium ileus
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| CF dx evaluation | sweat test, chlorine level, fecal fat, liver function tests, FBS, pulmonary function, sputum cultures
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| CF goals of management | min pulmonary complications, ensure adequate nutrition for growth, encourage appropriate physical activity, PROMOTE QOL, mobilize secretions, dec # of infections, high-calorie/high-protein diet, TEACHING
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| Long-term management of CF | vigorous antibiotic therapy, regular chest physiotherapy et inhalation tx, high-calorie/high-protein diet, pancreatic enzyme replacement therapy, fat-soluble vitamin supplements, nighttime gastrostomy feedings if nutritional problems are severe
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| Croup | group of conditions characterized by inspiratory stridor, harsh/barky cough, hoarseness, resp distress
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| Types of Croup | epiglottitis, laryngotracheobronchitis, acute spasmodic croup, bacterial tracheitis
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| Epiglottitis | bacterial; sudden onset; EMERGENCY; complete airway obstruction --> death
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| Cardinal signs of epiglottitis | drooling; dysphagia; dysphonia; distressed
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| Epiglottitis tx | intubation, steroids, antibiotics, humidified O2, antipyretics, IV fluids
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| Laryngotracheobronchitis sx | usually begins at night; preceded several days on non-specific URI sx; fever; barky cough; stridor; sore throat; accessory muscles; agitated/frightened; cyanosis
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| Bronchitis | Viral; winter months; non-productive cough; norm chest x-ray; rhonchi, wheezing, rales
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| Lower airway respiratory alterations | bronciolitis; pneumonia; asthma; foreign body aspiration; resp distres syndrome; bronchopulmonary dysplasia, CF
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| Bronchiolitis | RSV; by 2y.o. 100% will have had RSV et be immune; highly communicable; droplets
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| Bronchiolitis sx | tachypnea, wheezes, crackles, rhonchi, retractions, pale, mottles, cyanotic, rattly cough, difficulty feeding, mild to moderate temp elevation
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| Complications of bronchiolitis | dehydration; airway obstruction from mucous secretions; resp failure from exhaustion; secondary infections
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| Pneumonia manifestations | acute onset; fever; HA; chills; absent or diminished breath sounds; ABD/chest pain; resp distress may or may not present; cough often dry, non-productive @ 1st
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| Complications of pneumonia | dehydration; sepsis; pneumothorax; pleural effusion
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| Cleft lip/palate repair | may cause difficulty feeding (point nipple towards intact area); lip repair @ 6-8 weeks; palate repair @ 7-12 weeks; severity depends on timing of abnormal fusing during this time; aspiration; head upright; protect incision site; speech therapy; restraint
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| Poisonings | 1-4yrs most common age for poisoning related deaths; 60% in adolescents are deliberate; most r/t oral ingestion
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| Tx poisonings | ABCs; remove poisoning/neutralize effects; limit complications; tx varies depending on poison
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| Types of poisonings | corrosives, hydrocarbons, meds (acetaminophen, ASA), iron, plants, leab, carbon monoxide
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| corrosives poisonings manifestations | severe burning pain mouth, throat, stomach; oral ulcerations; violent vomiting; anxiety/agitations; signs of shock
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| corrosives poisonings tx | vomiting, neutralizing are contraindicated; dilute corrosive c h2o/milk (4oz); patent airway; analgesia, NPO; esophageal stricture
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| hydrocarbons poisonings manifestations | gagging, coughing, choking, N/V, lethargy, resp (tachypnea, cyanosis, grunting, retractions)
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| hydrocarbons poisonings tx | VOMITING CONTRAINDICATED, high humidity, O2, hydration, antibiotics for chemical pneumonia, lavage if using cuffed ET tube
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| acetaminophen poisonings | most common drug poisoning in children; toxic dose is 150mg/kg or greater
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| tx for acetaminophen toxicity | induce vomiting/lavage within 1 hour; mucomyst (1 loading dose/17 maintenance doses); dilute in juice/soda - has offensive odor
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| Stages of acetaminophen toxicity | 2-4hrs (N/V, sweating, pallor); 24-36hrs (latenet period, liver enzymes inc, RUQ pain); up to 7days (hepatic involvement, may be permanent, jaundice, liver necrosis)
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| stages of ASA toxicity | 1st (resp alkalosis); 2nd (metabolic acidosis, hypokalemia, dehydration); 3rd (inhibition of prothrombin formation, dec platelet levels)
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| TE fistula (1 analysis, where in notes?) |
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| Hirschsprung | aganglionic or megacolon; embryonic failure of migration of ganglionic cells; delayed passage or absence of meconium; chronic constipation 1st month, pellet-like/ribon stool; ABD pain/distention; stool infrequency
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| Management of hirschsprung disease | majority require surgery; frequent enemas; bowel retraining p surg repair; temporary colostomy
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| Pyloric stenosis | common surg disorder of early infancy; cause unknown (1st-born males, full-term); obstruction of gastric emptying; not present @ birth
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| Progressive pyloric stenosis | progressive, projectile vomit; moveable, palpable olive shaped mass in RUQ et deep L->R peristaltic waves; irritability et hunger shortly p being fed; dehydration et metabolic alkalosis
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| Tx of pyloric stenosis | pyloromyotomy
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| Peptic ulcer | well-defined area c loss of mucosa, submucosa, or muscular tissue in GI tract where exposed to acid/pepsin; primary (no underlying systemic disease); secondary (c other disease); gastric (stomach, rare children); duodenal (most common children)
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| etiology of ulcers | excessive acid secretion; bile salts; genetic factors; bacteria (heliobacter pylori); psychologic; stress
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| Manifestations of peptic ulcers | burning, cramping pain when stomach empty, vomiting under 6yrs, endoscopy definitive, fecal occult blood
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| tx peptic ulcers | meds; reg diet, low caffeine; surg if hemorrhage, perforation, obstructions; tx of acute bleeding episodes; prepare for lifetime chronic condition
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| celiac disease | inability to digest protein in wheat, rye, barley, oats; maldigestion et malabsorption if dietary changes not made; D et growth failure most common manifestations
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| management of celiac disease | removal of all wheat, rye, barley, oats; vitamin supplements; assist c long-term management; support groups; education
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| gastroesophagesal reflux (GER) | most common GI disorder in infants; normal; all people experience periodically; physiologic, functional, pathologic
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| GER tx | dietary changes (small, frequent feedings; frequent burping); positioning (30degress elevation); meds
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| constipation | infants (rare); toddlers (toilet training woes); r/t dietary, hirshsprung's; diabetes; cerebral palsy; meds; fear; lack or time/modesty issues
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| IBS (crohn's disease) | inc intestinal motility --> spasm et pain; triggered by stress et emotional factors
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| IBS (crohn's disease) manifestations | ABD pain un-r/t meals; alternating D et constipation; inc mucous production -> maldigestion; dx by ruling out other pathology
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| IBS (crohn's disease) tx | support, education, high fiber diet, antispasmodics, antidiarrheal drugs, simethicone, self-limiting, psychological implications, healthy habits, exercise
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| appendicitis | most common cause of emergency surgery in Peds; inflammation et infectin of vermiform appendix; uncommon under 4yrs.
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| Appendicitis manifestations | pain (inc intensity, RLQ); N/V/D or constipation; fever; chills; initial relief from pain if perforates
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| Appendicitis assessment | peritoneal irritation; ABD pain (RLQ c rebound tenderness); guarding; appetite; activity; sequence of sx (pain-N/V)
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| Post-op care appendicitis | pain management; restoring norm bowel function; fluids et nutrition; minimize risk of infection
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| 1st degree burns | erythema, painful, no epidermal loss; 7 days to heal
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| 2nd degree burns | superficial (blistering, debriding cause erythema et fluid secretion, no debriding = blister-> dry, callused); deep (less painful d/t nerve damage; erythema; dry et fixed); 14 days to heal
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| 3rd degree burns | not painful, dry c brown or white leathery appearance, generally require skin grafting; 21+ days to heal
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| burns tx | stop burning process, cool soaks (NO ICE), clean covering prevent contamination et hypothermia, cleanse c soap et h2o
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| moderate to severe burns tx | maintain airway, O2, VS, maintain CO by starting IV access, monitor septic shock, pain management, prevent infection, nutritional support, restoration of mobility, psychological support
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| burns wound care | premedicate c analgesic, remove old dressings, assess, cleanse, deridement, topical enzyme to break down et remove dead tissue, thin layer antibiotic ointment, cover c new dressing
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