Unit V & VI PEDS

Deficient immune system, anemia, chilling of the body, malnutrition, fatigue

Allergies, bronchopulmonary dysplasia, history of RSV, cardiac anomalies, pre term birth, asthma and CF

Daycare attendance, second hand smoke

Smaller airway size, orientation and pliability of ribs, cartilaginous airway, fewer alveoli, increase O2 consumption, higher respiratory rate

Smaller airway size and cartilagious airway

Croup, upper airway, crowing, collapse of far airway lobes, it is usually heard when taking in a breath

High pitched, whistle like most obvious when breathing out (exhaling) but may be heard when taking a breath (inhaling)

Deep guttural can be heard each time person exhales. This grunting is the bodes way of trying to keep air in the lungs so they will stay open

Using accessory muscles to breathe, The chest appears to sink in just below the neck and or under the breastbone with each breath-one way of trying to bring more air into the lungs

Crackling or rattle sound

Hydrate, pedialyte, no caffeine

Promote rest, decrease anxiety, small frequent feedings, temperature regulation, decrease infection exposure

Cool mist for safety, add moisture to the air which helps ease coughing and congestion

Loosen mucous, open the bronchi's and moisten the mucus

Cool mist, steam shower, rest, saline nasal drops, decrease body temp, promote hydration, nutrition, prevent spread of infection

Spacer

Improvement in oxygen saturation

Acute strep throat-if untreated--scarlet fever, rheumatic fever, acute glomerular nephritis

yes, if comes back negative will be sent off for a culture that comes back in 24 hr to 48 hrs.

Until they have been on an antibiotic for 24 hrs, can not return till on medication for 24 hrs also.

Palatine and Pharyngeal (adenoids)

Bright red, swallowing continuously, metallic taste, vomiting bright blood

10-14 days

Side or stomach until awake for drainage

No citrus, no milk, no ASA, straw drinking, coughing, yelling, gargling, nose blowing, plenty of fluids, soft bland food.

Pacifiers (gone by 10 months), bottle feeding, second hand smoke, day care, anatomical (Eustachian tube is shorter)

• AOM: acute otitis media it has a rapid onset, effusion and infection, red or pale yellow, decreased motility of TM, TM full/bulging, dull, may be pus or perforation. Tubes for treatment, antibiotics
• OME: Otitis media with effusion (Fluid) is fluid with no signs of infection, fluid middle ear, orange discolored membrane, immobile TM, bubbles, TX with antihistamines.

Pain is minimal and can be controlled with Tylenol, children may run a low-grade fever-100 degrees for one or two days following tube surgery, return to activity when feels up to it, will see an increase in drainage.

Possible spleen rupture

Barking cough, inspiratory stridor

Yes because of rapid onset

Inspiratory stridor

Sore throat, pain, tripod position, retractions, mild hypoxia, distress.

Maintain open airway, do not use tongue blade could cause airway to close.

Maintain airway management, hydration

Yes to help lessen the childs anxiety

Humidity, if struggling to breathe, retractions, stridor

Very contagious, Cough up to 3 ft, skin 20 mins, Kleenex 30 mins, surface 24 hrs. Contact Isolation required.

Hand washing and synagis (RXV antibodies) which is an injection for children under 2

Peak expiratory flow rate= detecting changes or trends in asthma control

Progression- Eczema, cough, and congestion, asthma

Allergen exposure-histamine response-bronchoconstriction-inflammation-respiratory acidosis-dehydration

Autosomal recessive "Recessive" means that two copies of the gene are necessary to have the trait, one inherited from the mother and one from the father. 25% chance with each subsequent pregnant to passing it on.

Both parents are carries of the defective genes. There is a 25% chance a child will be affected, a 25% change a child will not be affected and a 50% chance of the child being a carrier. Prenatal and carrier testing are available

72 hr stool for fat and trypsin, Immunoreactive Trypsinogen Assay, sweat rest, prenatal and carrier testing

• Low or missing CF transmembrane regulator, disturbance in Cl ion, transfer in sweat and mucus, increased viscious mucus, respiratory changes, gastrointestinal changes, reproductive changes, pancreatic changes (enzymes can't reach duodenum, growth problems, sperm can't get through cervix)
• A sweat producing chemial is applied to a small area of skin, The collected sweat is then tested to see if it's saltier than normal. Genetic testing: DNA samples from blood or saliva can be checked for specific defects on the gene responsible for CF.

Chloride get trapped in epithelial cell membrane in mucus and sweat glands, increased viscious mucus, respiratory changes, gastrointestinal changes, reproductive changes, decreased fertility, pancreatic changes.

ACT's (airway clearnace therapies) Percussion,, and postural drainage, positive expiratory pressure (PEPS), active cycling of breathing technique, atogenic drainage, oscillatory PEP, high frequency chest compressions, and exercise, twice daily (on rising and evening)

In the morning, with meals and snacks

To decrease the amount of bacteria in the lungs

High calories, diet including protein, carbs, and fats, free use of salt

Before each meal or snack within 30 min of eating

N/V, loss of appetite, low grade fever, constipation, inability to pass gas, diarrhea, Abdominal swelling, pain in the peri-umbilical that radiates down to rt abdomen

Followed by extremely watery and forceful stools

before diarrhea and 20 days after onset

Universal precautions, good hand washing

Weight loss, change in consciousness, decreased skin elasticity, increased HR and respirations, sunken eyes and fontanels, thirst, dry mucous membranes, no tears, oliguria, anuria

At home with fluid or IV in hospital

• 3-5% mild
• 6-9% moderate
• >10% severe

Oral replacement therapy used to treat mild or moderate dehydration, electrolyte solution with glucose

To rehydrate in 4 hours 40-50 cc/kg

Observation, capillary refill, fontanel, thirst, skin turgor, vital signs, accurate I&0, skin, body weight

Banana, rice, applesauce, toast or tea

Soft bland food when rehydrated. No roughage, spicy, or fried foods or milk.

First 10 kg x 100 + 2nd 10 kg X 50 + rest of Kg X 20= # for 24 hours intake

Constipation, intestinal obstruction, stool softners, mineral oil enema, auscultate bowel sounds

Congenital, 90% males, a disorder of the abdomen which occurs when all or part of the large intestine has no nerves and therfore cannot function, part of the colon lacks the nerve bodies that regulate the activity of the colon. The affected segment of the colon cannot contract and therfore pass stool through the colon, creating an obstruction

Asucultate bowel sounds, check for bowel functions

50% of newborns have GER, it becomes a disease when complications develp, dysphagia, bleeding, failure to thrive

24 hour intraesophageal pH monitor study.

head up or prone 1 hr after feeding, thick formula, hypoallergenic formula, small frequent feedings, burp well, medication to decrease acid or increase GI motility

Enlarge nipple, stimulate suck, swallow, rest

those with cleft or lip palate or more prone because of the opening and bacteria going straight in.

Take off periodically

Speech, hearing, orthodontia (braces) and body image (scars)

Projectile vomitting, hunger, wt loss, dehydration, distended upper abdomen, olive shape mass right of umbilicus

upper Gi shows severely decreased or No fluid going into intestines

Small progressive feedings 4-6 hours after surgery, glucose H20 first, right side and head up after feeding, minimal handling

Acute intestinal obstruction, bowel slides inside itself, SX: vomitting, pain, redu currant jelly looking bloody stool.

3rd to 4th intercostal space near the sternum

5th left intercostal space in the midclavicular line

Below 100 for infant below 60 for child

Poor feeding, fast breathing, heart, Failure to thrive, poor weight gain associated with heart disease

small meals

Describe or visit the cath lab, explain the procedure chronologically, emphasize what they will see, hear and feel. Bring earphones because the equipment is loud. May make up picture books, videos and tours.

Pulses especially below cath site, for equality adn symmetry (pulse distal from cath site may be weaker for the first few hours but should gradually increase) Temp and color of affected extremity-because coolness or blanching may indicate arterial obstruction. Vital signs-taken frequently 15 mins with special emphasis on heart rate, which is counted for 1 full min for evidence for dysarrhythmia or bradycardia. BP espcially for HTN (may indicate hemorrhage for cardiac performance or bleeding at the site of initial cath) Dressing: for evidence or hematoma formation in the femoral or anticubital area. Fluid intake: both IV and oral, to ensure adequate hydration (blood loss in the cath lab, child NPO's status, diuretic actions of dyes can put child at risk for hypovolemia or dehydration) Blood glucose levels-for hypoglycemia, especially in infans, who should receive dextrose-containing IV fluids.

Remove dressing 24 H post op, keep clean and dry, no baths, watch for infection, may atend school, but no heavy activity, Regular diet, Tylenol

Ventricular Septal Defect?

Ductus Arteriosus closes 10-15 hrs after birth, Foramen Ovale closes at birth due to increase pressure in cardiac chamber

Failure of ductus arteriosus to close within first weeks of birth

Abnormal opening between right and left ventricles

Ventricular septal defect and pulmonic stenosis and overriding aorta and right ventricular hypertrophy

Narrowing of the aorta near the insertion of the ductus arteriosis

asymptomatic signs of CHF, machine like murmur, widened pulse pressure, bounding pulses

CHF common, loud holosystolic (hollow) murmur

, may be acutely cyanotic @ birth or mild cyanosis that progresses, characteristic moderate systolic murmur “blue spells or tet spells”

high blood pressure and bounding pulses in the arms, weak or absentpulses with cool lower extremities and lower blood pressure, infants maydeteriorate quickly with severe acidosis and hypotension, older children dizzy,headache, fainting, epistaxis (nose bleeds)

Heart or Brain

Tetrology of Fallot, acutely cyanotic at birth or mild cyanosis thatprogresses, characteristic moderate systolic murmur

Decrease cardiac demand, remove excess sodium and fluid, improve cardiacfunction, family support.

Assess heart rate don’t give if under 100 in infant and under 70 forchild, adolescent under 60, watch for signs of toxicity N&V, Dizzy, HA,weakness, don’t give with food, give water after

Safe dosage calculations, rarely get more than 1 mL, assess heart rate

Identify high risk invasive procedures, prophylactic penicillinadministration, educate parents of children at risk.

Slow, muscle aches, fever

Hypovolemic: blood volume/fluid volume lossCardiogenic: heart damage (MI)Distributive: anaphylactic/septic shockNeurogenic: arterial dilatation (BP drops)Sequesteration crisis: sickle cell anemia (blood pools in liver/spleen)

Mild: 9.5-11 g/dl Moderate: 8-9.5 Severe: less than 8....2 year old: Hct less than 33, Hgb less than 11

ALL TYPES: Pallor, tachycardia, HA, fatigue Increased blood loss: cool skin, decreased peripheral pulses, decreased BP Increased RBC destruction: dark urine, icteric sclera, enlarged spleen/liver Decreased RBC production: SOB, muscle weakness, heart murmur, pica

Caused by inadequate supply of dietary iron, impaired absorption, increase in the bodies need for iron, affected synthesis of Hgb, excessive milk. How can we prevent it? Maternal: poor maternal iron and cross over during pregnancy so encourage iron supplements for pregnant moms. Decrease amount of milk (24 ounces/per day)

Dietary counseling and administration of oral supplements Prophylaxis: 1-2 mg/kg/d (up to 15 mg/ d)Mild to moderate: 3-6 mg/kg/d (in 1-2 doses)Severe: 6+ mg/kg (3 doses) *may need transfusion of packed RBC’s

Encourage Fe in diet: Infants: Give iron-fortified cereals/formula, Toddlers: decrease milk intake by bottle (no more than 24 ounces of milk/day), Adolescents: better eating habits (red meat, beans, raisins, green veggies, tuna, dried fruit. Limit caffeine, it interferes with iron absorption).Give oral iron with orange juice or Vitamin C (NOT MILK) on empty stomach. Vitamin C increases absorption of iron.

Give with citrus juice, empty stomach, with a dropper or straw, rinse teeth (will stain), causes tarry green stools, constipation. Comes in drops, elixir, tabs. IM iron given Z track, don’t massage site (causes discoloration to skin).

Autosomal recessive disorder (hereditary hemoglobinopathy)

25% chance of getting it.

Partial or complete replacement of normal Hgb with abnormal hemoglobin S (Hgb S).Hemoglobin in RBCs are elongated “sickle” shape, rigid and obstruct capillary blood flow, lead to engorgement and tissue ischemia (clump prevents O2 from getting through), hypoxia occurs and causes sickling.

increased O2 demand, altered transport of O2, trauma, infection, fever, increased need O2/fluid, physical/emotional stress, increased blood viscosity r/t dehydration, hypoxia r/t high altitude, poorly pressurized airplanes, hypoventilation, vasoconstriction due to hypothermia, alcohol, smoking, acidosis

Hydration (oral or IV), rest (minimize energy expenditure/O2 use), electrolyte replacement, analgesics (Morphine) for severe pain from vasococlusion, blood replacement, antibiotics to treat infection

Oral or IV Hydration, electrolyte replacement

painful, clumping of cells, ischemia, infarction, common in joints.signs: fever, pain, tissue engorgement.

hemosiderosis (iron overload)

cardiac failure

treat with iron chelating drugs such as deferoxamine (Desferal): sub Q by pump for 10 hours, deferasirox (Exjade): tablet 1 daily, dissolve in orange juice without food. Binds excess iron for excretion by kidney

No rectal temps, soft foam brushing, no picking nose

Anemia, infection, bleeding, severe joint pain, enlargement of spleen, liver, lymph glands, increased intracranial pressure (HA), pallor, fatigue, fever, petechiae, irritability, Wt loss, anorexia, weakening of bone and fractures.

Aplastic anemia, Infection, N&V, anorexia, mucosal ulcers, cystitis, FTT, Neuropathy, constipation, ototoxicity, dec. cognition, delayed development, Alopecia, photosensitivity, renal failure, hepatotoxity, infertility

Hair may come back in thicker, darker and curlier

Establish healthy cells in both malignant and nonmalignant disease

Tumor in lymph system

Enlarged lymph nodes, fever, wt loss, night sweats, cough, abdominal discomfort, anorexia, nausea, pruritis

Early stage Survival rate > 90%, Advanced stage survival rate b/w65-75%

Sex linked recessive, mom carries, pass on to son 50/50 change of getting disease

A: deficiency in Factor VIII, B: deficiency in Factor IX and IIX, VonWillebrand: Deficiency in vWB factor and mild factor VIII

Bleeding into joint spaces, Factor VIII given

PTT reveals deficiency factors 7-12

Pressure

Administer immediately after constituted (IV Push), let dilutent  run down sides of vial, don’t shake or heat. Monitor BP, pulse, and respirations. If tachycardia occurs, slow or stop infusion rate and notify physician.

antiretroviral prophylaxis

Infection

Antivirals  for 6 weeks (Zidovudine & Nevirapine)

Yes as long as their immunity is not low and are not running a high fever or ill

Pneumonia like symptoms coughing, wheezing, hypoxia, dyspnea, call Dr. right away...will need order for blood transfusion and antibiotics