Pedi test 3

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Pedi test 3
2013-04-04 05:04:06
VNSG 1307

toddler & preschooler
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  1. Types of bacterial mengitis
    • aceptic
    • septic
    • TB
  2. Aseptic meningitis
    viral or secondary to leukemia, brain ases
  3. Septic meningits
    bacteria or microorganism gets in blood crosses the BBB-trigers inflamatory respons
  4. when is septic menigits most common

    who has highest risk

    high risk   birth -6mo

    Af Am esp boys
  5. what age is 70% of menigitis found
  6. what can be done if someone's been exposed to bacterial meningitis
    have vaccine if w/im 4hr of exposure

    usually give combo therapy
  7. Viral Menengitis
    • many types
    • mumps, androvirus
  8. Tx of viral meningitis

    college students requires to get meningococcal vaccine
  9. what is 95% of all bacterial meningitis organism
    • hemopholus influenza
    • mengingioccus
    • neumococis
  10. SS of bacterial meningitis
    • sudden onset dev
    • septosemia
    • facial lesions
    • can die w/in 2hr
  11. how does one get bacterial meningitis
    • invades meningies
    • dircet contact
    • droplet
    • throat discharge
  12. 2 specific methods of spread of bacterial meneingitis
    • indirect method-travels to blood stream
    •   -ex infection in sinus andtravel
    • -dev sepsis-once get in blood it will get septic
    • direct method-area closest to brain
    •  (ear, skull, scalp infection -untreated)
  13. Dx of bacterial meningitis
    • 2 blood cultures from differant sites
    • liver puncture for meningitis
  14. what form of meningits is most severe
    • bacterial meningits
    • perulant form can lead to hydrocephalus
  15. when does incidence of bacterial meneingitis peak

    what is done when they get it
    b/w 6-12 mo

    strict isolation
  16. s/s of bacterial meneingitis in neonate

    what is a very common symptom

    what can develope
    • weak cry
    • poor muscle tone
    • hypo or hyper thermia
    • apnea


  17. what can develop in neonate bacterial meningitis


    • bulging fontanel
    • DTC
  18. syptoms of bacterial meningitis in infants and kids
    • poor feeding
    • irritable
    • vomit
    • bulging fontanel
    • lathargic
    • seizures
    • abn cry
    • high pitch cry
  19. general symptoms with meningitis
    • ncal(neck) rigidity
    • sever headach
    • + cernigs side-can't fully extend leg
    • +Brusinky sign-neck flextion
  20. s/s brusinky sign
    • when move one side the other side moves
    • photphobia esp w/
    • v/d -go w/increased intercrania pressure
  21. late symptoms on meningitis
    • seizures
    • ecamosis
    • fever
    • joint/muscle fever
    • very drowsy
    •  hard to arrouse
  22. Dx of meningitis
    lumbar puncture
  23. lumbar puncture
    • need to be on side w/ knee/ chest postition
    • watch airway carefully
    • check CSF
    • check glucose will be <45 
    •             increase intercranial pressure
    • color initially clear->cloudy-> perulant (pus)

    tramadic spinal tap not rare
  24. norm lab values
    • lymph 5cells
    • protein 14-15 mg/dL
    • glucose 3
  25. CHF values (meningitis)
    • WBC # too numberous to count
    • elevated protein
    • decreased glucose
  26. what is emergency treatment of meningits
    • Iv antibiotics for 10days (even before culture)
    • broad spectrum
    • strict droplet isolation at least 24 hr after start antibiotics
    • still strict isol w/ antibiotic-usually 3rd or 4th cep
    • sephotoxine-combo of ampicilin and getamizcin if can't afford other
  27. % dev SIDH
    • 60%
    • fluid restriction hydroceph
    • phebitis
    • nosocomial suberal effusion
    • DIC
    • pericaritus
  28. how prevent bacterial meningitis
    • Vaccine
    • Hep A & B

    start Hep B-<18mo
  29. nurse care of bacterial meningits

    strict isolation precausion

    prevent further brain insult
  30. nurse care of bacterial meningitis for infants
    put in protective cav in crib b/c higher risk of seizure

    • avoid startling them
    • place them on side
    • frequent vs monitor
    • up to date w/ immunization

    • recent Hx of URI b/c precurser view drop in blood pressure & rise in pulse
    • look for seizure activities & immos of joints-pain- many need to give O2
  31. during recovery for meningitis
  32. increase fluid
    i & O
  33. Hydrocele
    • accumulation of fluid in scrotum are
    • very common esp in  
    • usually self resolving if doesn't go down
  34. Tx for hydrocele
    hydrocephely-small insicion & drain
  35. Cryptorchadism
    undesended testicles in term newborns

    testies stay in abd can be bi or unilateral
  36. % of cryptorchadism seen in low birth weight babies
  37. what plays big role in male reproductive system
    body temp

    temp of body too hot cand destroy sperm-becomes sterile
  38. complications of cryptochadism
    • can be exposure to injury
    • high incidences for angler hernia
    • not affect 2ndary sex characteristics
  39. Tx for cryptochadism
    • can desend on own
    • can give HCS hormone -can bring down testicles and be used for Dx purposes
    • surgery
    • sometimes need to do orcodectomy-remove testical b/c problem w/ CA or injury

    • surgery usually done b/w 2-3 yr
    • can lower possibility of sterility
    • testierin  band around testicle
  40. SIDS
    • have no outward symptoms of any disease
    • seem otherwise healthy
    • happens in sleep
    • refered to as crib death

    higher in males

    leading cause of death in norm term newborn
  41. cause of SIDS

    • Theory
    •  defect in brain stem
    • possibly to hypersensetivity to cow's milk
    • over wrapping-cause more stress
    • -some recomend not wrap babies over armpit
    • abn gene-affects
    • -SCN 5 A gene isolated in some studies
  42. risk factors for SIDS
    • low social economic level-crowded living
    • mom>20yr, multipregnancy
    • multi birth w/o rest period twin triplet
    • male infants esp w/ low birthweight
  43. Groups in higher risk of SIDS
    • Native Am
    • Af Am
    • Hisp
    • Caucasions
  44. groups in lower risk of SIDS
  45. Theories of possible causes of SIDS
    • cardiac dysrhythmia
    • family history-esp neuro problems
    • abn breathing while baby sleeping/stops breathing

    all unproven
  46. Tx of SIDS
  47. Biggest problem w/ SIDS
    dealing w/ grieving parents
  48. what happens if humen don't have physical contact
    don't survive
  49. s/s of failure to thrive
    • child fails to gain weight
    • weigh falls below 5th% of age group
    • usually <2yrs
  50. what can failure to thrive be
  51. pathological
    • organic
    • nonorganic
  52. what causes failure to thrive

    what can be done if know pathological
    • emotional deprevation
    • basic needs met but w/o touch
    • often from neglect

    can go in and treat
  53. what is one of biggest factors in failure to thrive

    • interaction b/w parent & infant
    • lack of food-

    • b/c don't have touch/interaction they stop eating
    • sometimes too lathargic to eat b/c don't have that interaction
    • care very irregular/inconsistant usually absent
  54. what is worst case scenario of failure to thrive
    infant doesn't learn to trust / interlectually delayed
  55. symptoms of failure to thrive
    • not respond to affection
    • listless
    • apathetic
    • no direct eye contact
    • no fear of strangers
    • no interest in toys or playig
    • no nurturing/teaching
  56. Tx of failure to thrive
    • goal - make sure they have adequate nutrition
    • if possible try to keep baby w/ family
    • teaching very important
    • you are role model
    • teaching of nutritional needs
    • family counseling
  57. Watch for what in Failure to thrive

    nurse care
    if parent only points out neg of kids

    • support mother /father
    • observe them
    • encourage parernting classes
    • have consistant caregiver
    • -observe infant response from mom look at parent affect

    give parent info about baby
  58. when does bonding/attachment happen

    what happens when failure to thrive baby comes

    • immediatly
    • after about 1 yr
    • sometimes these baby parents don't attach

    • give them special diet
    • teaching to parent
    • CPS is called

    • uncertain-worry esp of very young
    • if malnurished-intellectually affected
  59. what is battered child syndrome
    child abuse/neglect
  60. what is most common type of child abuse
    • battering hitting
    • get phys abused
  61. baby/child bones

    whats often seen in phy abused kid
    • bend
    • only break under direct impact
    • can get splintered

    • lots of old fractures
    • have Hx of old/unhealed Fx
  62. how many kids abused in US

    what groups high risk of abuse

    highest risk of death -major cause
    2.4 mil (known)

    • 3mo-3yr
    • adolescent
    • elders

    • younger kids
    • major cause-parent temper
    • should never disciplin child angrey
  63. requirements as healthcare worker
    by law to report and follow through on child abuse
  64. differant types of child abuse

    worst type
    • physical
    • social
    • sexual
    • societal
    • emotional

    societal-whole society doing same abuse
  65.  victoms of child abuse
    • abuser & person being abused-
    • abuser was often abused
  66. Theories of cause of cerebral palsy
    anoxia of brain during delivery
  67. what is cerebral palsy
    • chronic disease
    • no cure
    • nonprogressive

    one of most crippling toddler conditions
  68. what does cerebral palsy effect
    • motor & nerve cortex
    • basal ganglia
    • cerebellum

    • some damage to brain that controls movement
    • damage can occur at differant points prenatal
  69. Prenatal causes of cerebral palsy

    perinatal causes 

    postnatal causes
    • Rh/ABO incompatability-cause severe jaundice
    • diabetes
    • genetics

    • anoxia
    • intacranial bleeding
    • no Oxygen
    • intracranial hemeraging
    • preme high risk

    • head trauma
    • infection
    • neoplasm
    • stroke
  70. how many live births w/ cerbral palsy
  71. s/s of cerbral palsy
    • primitive reflexes don't go away as should
    • ave decayed gross motor movement
    • lack mildstones-don't go through all
    • difficult to control movement
    • ataxia-toe walk4behavior prob
  72. Dx cerbral palsy
    • r/o usually not till ~2mo
    • eeg
    • ct & MRI
    • electrolyte/BMP
  73. spastic CP

    • most common
    • affects cortex of brain

    • poor purposeful movement
    • hyperactive contractions-common
    • contstant contractions
  74. athetoid CP
    • constant movement
    • dysarthria-poor speach
    • slow writhing muscle contracions
    • drooling
  75. ataxic CP


    aquard gait/lak coordination

    rigid movement, hard to move at all

    mixture onf morte than one
  76. Tx for CP
    • fam teaching lots
    • feeding-may need special eating utencils
    • phys therapy- to maintain what have
    • good skin care
    • nutritional supp
    • allow rest times-need lots naps

    main thing-make most of their assets
  77. types fractures
    • Greenstick-splinter, one side bent
    • spiral-twisting-oftenassos w/ abuse
    • oblique
  78. pedi healing of fractures
    1wk for every year of life up to age 10
  79. hip spica cast
    • covers lower part of body
    • maintains legs in froglike position
    • usually haave a bar b/w legs to help support cast
  80. Compartment syndrome
    increasing pressure w/in muscle compartment causes decreased circu

    monitor neurovadc status frequent
  81. 5 P's
    • Pain
    • Pulse
    • Paresthesia-diminished/absent sensation/numb/tingling
    • paralysis
  82. traction for fractures
    • pullin force applied
    • can realign bone
    • w/ weights--need to make sure weights hanging freely
    • reduce/elim muscle spasm
    • reduces contractures of muscles
    • used to align/aleviate problems of spine, large bones, can be applied to skin or bone
  83. Buck's traction
    • body provides countertraction to wts
    • short term immobilization use
    • to correct contractures & bone deformities
  84. Russell tration

    Dunlop's traction
    more effective than Bucks in olde kids

    • sometimes used for fractures of humerous or elbow
    • either skel or skin
  85. Bryan'ts traction
    • often used for Tx of fractured femur in kids <2
    • often transverese or spiral fractures
    • hip should not rest on bed in tration

    • some risk of compromised circulaton-may result in contractures of foot/lower leg
    • s/s extreme pain
  86. external fixation device
    • uses pins
    • need special skin care at pin site q8h
    • for severe fracture or to lengthen extremity
  87. causes of head injuries
    • toddler/young kids-fall /abuse
    • school-age &teen- bicycling,skating, mva
  88. head injury care
    • watch for @ least 6 hr for LOC& vomit
    • awakened q1-2 hr in sleep to see LOC,
    • q4h for 48h check pupils for reaction to light
  89. complications of head injuries
    • cerbral edema
    • increased intratracranial pressure
    • cranial hemorrhage
  90. toddler growth
    • gain5-10bs/yr
    • 3in/yr
  91. toddler sleep
    • 1st yr 12-14hr
    • by 3yr 10-12
  92. preschool growth

    area of greatest growth
    • 3-5lb/yr
    • 2.5in/yr

    legs & ft
  93. preschool vaccine
    • DTP booster
    • pollio
    • MMR
    • varcella (b/w 4-6yr)
  94. Enuresis
    • bed wetting
    • involuntary urination beyond the age when control of urination is commonly acquired
  95. age of complete nightime urine control
    b/w 5-7
  96. physiologic causes of bed wetting
    • sleep to soundly-don't get signal
    • UTI
    • small baldder capacity
  97. Types nephrotic syndrome

    early charactersitics
    • lipoid nephrosis
    • idiopathic nephrotic cyndrome

    edma proteinuria,
  98. high risk group for nephrotic syndrome

    age range of most occurances

  99. location of edema in nephrotic syndrome

    s/s as swelling advances
    1st around eyes & ankles

    • lbecomse geralized w/ a pendulous abdomen full of fluid
    • anorexi
    • irritability
    • loss of appetite
    • malnutiron
  100. Dx of nephrotic syndrome
    • labs
    • -marked proteinuria-esp albumil
    • larg # of hyaline & granular casts in urine
    • hfew blood cells
    • reduced blood serum protein
    • increase in cholesteral
  101. Tx of nephrotic syndrome
    • corticosteroids
    • -prednisone-most used

    • daily urine testing for protein
    • immunosuppressant therapy-reduce s/s
    • -cytoxan most often used
    • frequent small meals
  102. assess in nephrotic syndrome

    major goals
    • edema
    • wt
    • abd measurements

    • relieve edema
    • improve nutritional status
    • maintain skin integrity
    • covserving energy
    • prevent infection
  103. nurse actions for nephrotic syndrome
    • monitor fluid i/o
    • --wt pt same time every day
    • -measure abd daily
    • -test urine regularly for albumin& spec grav
    • improve nutrional intake
    • promot skin integrity
    • promot energy conservation-bed rest
    • prevent infection
    • family support/teaching
  104. Wilm's tumor (nephroblastoma)


    when found
    • anadenosarcoma in kidney region
    • one of most common abd neoplasms of early kid

    from bits of embryonic tissue remaining after birth

    rarely before big enough to palpate through abd wall
  105. what to avoid in Wilm's tumor
    abd palpation
  106. Tx of Wilm's tumor

    • surgical removal ASAP
    • radiation/chemo

    best in kids < 2yr
  107. Hydrocele

    • collection of peritoneal fluid accumulates in scrotum
    • -from nonclosure of processus vaginalis

    corrective surgery > 1 yr
  108. cryptorchidism
    • non descent of testes
    • often self correcting by 1yr
    • -if not need orchiopexy-surg bring testies
    • --usually b/w 1-2yrs
  109. most commonly fractured bones in kids
    • clavicle
    • femur
    • tibia
    • humerus
    • wrist
    • fingers
  110. epiglottitis


    at risk age
    acute inflammation of epiglottis

    Haemophilus influenza type B

  111. s/s of epiglottitis
    epiglottis inflamed /swollen w/ edema-edmadecreasesability to move->blockage of airway

    • sore throat
    • dysphagia-drooling
    • fever 102.2-104
    • breath-sitting up leaning foward w/ mouth open& tongue out-tripod position
  112. tx epiglottitis
    • endotracheal intubation/trach-if too swollen
    • moist air-reduce inflammation
    • pulse ox
    • antibiot-IV
    • antibiot-10days
  113. ASA Tx
    • gastric lavage
    • activated charcoal
    • sodium bicarbonate-combat acidosis
  114. Tylenol Tx
    • gastric lavage
    • acetylcysteine (mucomsyt)-diluted
  115. Ibuprofen Tx
    • activated charcoal
    • observe for/Tx Gi bleed
  116. Iron Tx
    deferoxamine-chelating agent
  117. Corrosive Tx
    • alkali corrosives-initially w/ lots water
    • -diluted fruit juice or vindger
    • ACID corrosives Tx w/
    • alkaline  drinks-milk, olive oil, mineral oil/ss