pediatrics test 3

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pediatrics test 3
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  1. Bacterial meningitis-
    • brain tissue affected,
    • oAseptic- caused by virus or secondary disorder-lymphoma, brain diseases
    • oSeptic- bacterial, neisseria,
    • oTubercular- covers meninges (brain and spinal cord membrane coverings)
    • o Bacterial- most deadly, seen more in boys, give haemophilus influenza type B (HIB) vaccine within 4 hours – 7 days, direct spread-otitis media, bacteria caused are HIB, pneumococcus, meningococcus microorganism. Passes through the blood, direct contact or droplet are ways to catch it, happens around meninges, subdural ; hydrocephalus or subdural effusion, affects 6 months to 12 months, very contagious, S/S infant-poor sucking, poor eating, hypo and hyperthermia, stiff neck, S/S infant and child- seizure activity,
    • fontantel bulging, fever, poor feeding, restlessness, N/V, high pitch cry, lethargic; nuchal rigidity- early sign in child and adolscent, HA, kernig sign(+)- laying down knees at chest, brudzinski sign (+)- neck stiffness, “passive flexion on one side of neck copies other side” , photo sensitivity, seizure activity, increase cranial pressure, diarrhea, decreased level of consciousness(late sign), rashes, petechiae hemorrhaging under skin to large ecchymoses, vomiting, joint pain, fever,
    • decrease appetite, irritability, seizure is late sign; severe cases- neck retraction(arching of neck), and the back, deadly sign- “ostistmytonis”; DX: lumbar puncture C&S, glucose level in CSF is decreased below 45mg/dl,
    • increased CSF- color is cloudy and purulent;
    • o Normal levels of CSF- luek. 0-5 cells, protein 14-50mg/dl, glucose 45-100mg/dl, color is clear; abnormal: WBC: TNTC, increased protein, decreased glucose
    • o TX: emergency IV antibiotic- 3rd and 4th generation-broad spectrum for over 2 months of age (ex: ceftazidime,
    • ampicillin+ gentamicin(cheaper together)), isolation- must have written orders, for CSF: dilatin- give it by itself, monitor dilatin levels, syndrome of inappropriate antidiuretic hormone hypersecretion(SIADH) develop- check serum osmolarity, urinalysis, fluid restriction; can develop hydrocephalus, pheumbitis, nosocomial infection, “deremote reaction”, subdural effusion, septic arthritis, DIC, pericarditis, can be prevented by HIB vaccine but does not protect kids under 18 months
    • o Nursing care main goals: prevent futher brain insult, protect brain, strict isolation for 24 hours, indirect lighting, increase
    • B/P, decrease pulse, monitor pain, seizure, O2 when needed, monitor I&O
  2. Cerebral palsy-
    • lack of O2 at birth, it’s a nonprogressive disorder, in basal ganglia, cerebellum, motor area of brain, nerve pathways, cortex- most crippling condition. damage can happen from dm pregnancy, parents how are Rh and O incompatible blood, or O2 cut off at birth, 2 out of every 1,000 births have it, can have one or more symptoms: persistent primitive reflexes(newborn reflexes) don’t go away, delayed gross motor development, don’t progress through mental milestones, abnormal posture, ADD, drool, feeding problems, seizure activity, physical challenges, apoxia. DX test: EEG, MRI, BMP, monitor electrolytes, glasgow coma
    • scale, rule out brain tumor, they tire easily- use up a lot of energy
    • o Spastic- jerky movements, hyperactive stretch reflex, most common type, contractures form – toes down and inward , involuntary, hip flexion with adjunction, they want to relax
    • oAthetoid- moving around, uncoordinated, constantly
    • moving around, whole body in motion, face permanence, disorphia- poor speech, above or average intelligence
    • oAtaxia coordination- dx when able to walk, abnormal gait,
    • o Rigid- rare- stuck in position, lack of active movement,
    • oMixed- more than one type, severally disabled, mostly post-natal
  3. Fracture and traction-
    • growth plate is most crucial, bruising with simple closed Fx., compound Fx has hemorrhaging- chance for infection, cover
    • and immobilize, release turnakit every 15 mins,
    • o green stick is most common, healing is quick- 1 week for every year of life,
    • o most swelling happens with in 28 hours for compound Fx, femur Fx- use xray, immobilize it, traction – used to realign, for young kids their body is used as the weight, traction is not 100% immobilized, can be applied to skin or bone, halo traction does not use weight, continuous or intermittent,
    • obryants traction – with weights and pulleys , under 2(25-36lbs), works for hip dysplysia, issues with circulation(legs upright), it relaxes hamstring, legs wrapped with ace bandage, free floating weights,, remove once a day check
    • circulation
    • oBuck’s traction- for hip or muscle spasms, continuous or intermittent, applied to boot or wrap, can elevate foot of bed for more traction,
    • oRussell’s traction- look in book
    • oCervical traction- rub/ irritation on shoulder, elevate bed 20-30*
    • oSkeletal traction- special bed,
    • oCervical Fx- needs to heal, balance suspension hip, ???
    • o90-90 fremoral traction, over age 6- 2-3 weeks, wire dorsal femur and then cast lower leg
    • oDunlop’s traction- pin through dorsal … worry about circulation,
    • otoddlers- head injury- penetrates goes through skull, non- penetrating, impailment-, skull Fx (depressed?), linear or hairline Fx, depressed, contusion, petechiae, concusion, epidural- worry about bleeding, subdural – accident leading cause of death, 2000 head injuries, car, bike, fall down, sports, beating, and gunshot
    • o Classify with Glasgow coma scale- mild 13-15:HA,
    • memory affected, cognitive affected, ; moderate 9-12: ha, memory deficit, no adl , sometimes death; severe 3-8: post trauma, sensor- long term care, irreversible
    • oS/S- increased cranial pressure, ABC’s, head injury- immobilize neck, altered LOC, loss consciousness, abnormal posture can occur, if injury above heart- “decordikit”, a serious brain injury, “descrabit”- depression on brain stem, comatos, all limbs “pronated”, destinded, S/S- increase cranial pressure, HA, blurred vision, mood swings, edema, papilla edema- doesn’t show for up to 48 hours, altered
    • LOC, slurred speech, N/V- very commonto head injury,
    • o Nurse intervention: raise head of bed, neuro exams, Glasgow scale, monitor N/V, electrolytes, rotate every 2 hours, do not give pain meds- mask symptom, clear liquids until vomiting stops, report any drainage form nose or ear
    • o Basailar fx- suction?
  4. Sudden infant death syndrome(SIDS)-
    mucous blood tinged in airway, high risk in males, 1-12 months, no known causes, leading cause of death, SCNA5- abnormal DNA, low birth weight babies, cardiac dysrrythmias, common in native Americans, 7-8000 a year
  5. Epiglottitis-
    life threatening, avoid swabbing throat, DX: lateral neck x-ray, caused by HIB type A, TX: maintain airway, nasotrach intubation, give HIB vacc, to prevent, ages 3-7 males and females affected, S/S- temp. 102-104*, sits straight up in bed, its bright red and swollen, WBC over 20,000
  6. Poisoning, corrosive substances-
    • TX: meds.- “medic”- may gastric lavage, give lots of water to vomit, 15mls twice of 10 hours since took then oral charcoal, lavage, then “ukomis”, monitor liver enzymes, Asa- 150 mg needed to OD a kid, “methal solisata- cause death- 1 tsp. kills kid, peeks in 2 hours, S/S: ringing inears, dizziness, N/V/D, hyperpnea(early sign)- rapid breathing, get dehydrated, metabolic acidosis, to much acid, seizures,
    • fever, bleed out, loss pot., hypoglycemic, TX: forced fluids, transfusion of blood, lavage, can have acute renal failure, DX: urine test “barick fluoride, check ph, I &O, O2 meds, v/s
  7. Iron deficiency-
  8. Pinworms-
    out at night, toddlers play in dirt, check at 3 am, kid scratches at bottom, meds- “antiphelmitic-vermocs”, OTC- coven, turns the stool red, don’t share towel or soap, can develop hives if on skin,
  9. Impetigo-
    vesical fluid?, antibiotic, topical and PO, spread by contact, wash lesion with soap and water TID, strep A or STAPH
  10. Nephritic syndrome
    • chronic syndrome “neucrosis”- abnormal issue of kidney, primary mineral change…, some develop renal stage disease, secondary – DM,lupus, sickle cell, congential- rare, TX: steroid therapy,S/S- protein uria, edema, hypoalbuminia, primary edema, over 7 weeks, seen in eyes first, ankles, spreads to entire body, monitor weight, abd. Distention, N/V/D, B/P normal, DX: 3-4+ protein uria, blood %, massive loss of protein, urine cloudy and foamy,
    • dark in color, biopsy to conform, look at H&H, increased chol., increased triglycerides, increased platelets, serum albumin decrease below to 2.5 mg/dl, 4.5mg/dl is normal range for kids, ASO titer(-) result is normal, 5-7 days
    • diuretic steroids- IM, 1st drug of choice is “priminsone” , takes one month to get over it, oral penicillin, recommend flu shot, liver effected by meds, diet- no extra sodium, normal amount of water, remove fluid from abd. If needed, turn freq., elevate head of bed
  11. Wilm’s tumor-
    grows in remaining embryonic cells , DX: by age 3, fastest growing cancer, don’t touch abd., DX: abd. Ultrasounds, x-ray, kidneys, born with bilateral tumors, better if found before age 2, meds- acetomyacin, IV, under 6 months, “ thicristine sulfate, IV, andromycin, treat metatisis, N/V, increase B/P, blood in urine
  12. Asthma-
    • allergies, runs in family, smaller airways, males more prone, S/S- dry cough, dark circle around eyes, asthma shiners, increase pulse, increase respiration, cackles, wheezing, chest tight, meds- broncodilators, epienpherine fast- increase b/p,
    • and pulse for 5-10 min, neb. Tx, puberty can cause it to start or stop
  13. Pneumonia-
    • RSV chief cause, staph pneu.- is resistant , toddlers most common for aspiration, microplasma pneu. Or walking pneu., high risk for classic pneu., S/S: viral- sudden, 103*, last 5-7 days, antibiotic does not work for viral
    • oBacterial – Hx of respiratory infection, 16-40,000 WBC, antibiotics, TB testing, X-Ray, 4-5 days develop pleurisy
  14. Leukemia-
  15. T&A-
    watch for signs of bleeding- swallowing a lot, surgery happens after age 3, pain meds- codeine, phenergan, keep bed elevated, oral suction only/ not back of throat
  16. Hemophilia-
    • bleeding disorder, heredity, no cure, get it from the mother, errors of metabolism, delay in blood clotting, 3 factors: A most common, transmitted to males, girls if both parents have it, shot of vit k given at birth, bleed in joints, factor
    • 8 and 9 : mild might see some clotting, use “cryopersipate” for fluid overload, “combiant”- not from humans, synthetic, nasal spray “DEAPE”, hem. A- classic , factor 8, most severe, 1-10,000, hem. B- decrease factor 9, 15 % of all hemo disease, hemo C- missing factor 11, vascular hemo- dominant recessive, pseudo hemo- both parents had cell- use nose spray for this, oral bleeding use amicar, epinephirine constricts blood vessels, oral bleeding- amicar
  17. CROUP-
    • RSV, brociolitis, coarse cough, viral infection, inflammation of mucousa, keep airway open, strider, respiratory distress, cyanotic, unknown cause, may develop larygnospasms- clears after few hours on its own, DX: by S/S: drop in
    • O2, TX: humidify room eases respiration, use cool humidifier, vomit helps relieve strider, larygntrachal bronchitis- most severe- few hours, ages 1-4, virus to bacterial infection, temp. 104-105, larynx edema, RDS, TX: airway, super Sat.- mix O2 or Croup tent, meds- broncodilator, steroids, neb. Tx, worry about rebound efects, restless kid do something right away
  18. Failure to thrive-
    · fails to gain weight, under age 2, disease causing it, caused by organic, environmental, or non-organic, decrease interaction, emotional deprieved, lack of food, neglect, poor parenting, irregular care or absent, worst type of abuse is social or societal
  19. Pgs. 759-761 Meningitis
    Pgs.468-469 Sudden Infant Death Syndrome
    Chap. 33 Child Abuse
    Pgs. 923-926 HIV in Children
    Pgs.945-948 Failure to Thrive
    Chapter 24: Toddler: Growth & Development- Early Childhood
    Pgs.761-768 Cerebral Palsy/Mentally Challenged (Retardation)
    Pgs.882-887 Fractured Femur/Fractures
    Pgs.768-769 Head injuries
    Pgs.906-908 Atopic Dermatitis
    Pg. 848 Pinworms
    Pgs.902 Impetigo
    Pgs.779-792 Croup
    Epiglotitis Acute Laryngotracheobronchitis (Supraglottitis)
    Pneumonia Asthma
    Pgs.872-875 Nephrotic Syndrome
    Pgs.875 Wilm’s Tumor
    Pgs. 870-940 Enuresis (Student Cover for test)
    Pgs. 749-752 Deafness (Hearing loss)
    Pgs.849-854 Poisoning/Ingestion of Toxic Substances
    Acetaminophen poisoning, Salicylate poisoning, Corrosive stricture, Lead poisoning
    Chapter 25: Preschool Child: Growth&Development
    Pgs.820-823 Leukemia
    Pgs.816-819 Hemophilia
    Pgs.777-778 Tonsillectomy & Adenoidectomy/Pharyngitis

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