Pedi test 5

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Author:
mowgli
ID:
217174
Filename:
Pedi test 5
Updated:
2013-05-02 08:56:13
Tags:
school age adolecent
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Description:
DM, eatind d/o hodgkins, mono, legg-calf, JRA, teen preg
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  1. what causes appendicitis
    • materiall fill up appendix
    • ferments
    • bact
    • infection
    • -once cecum opening obstructed -> issues
  2. kid s/s of appendicitis
    • flu like s/s
    • abd tender
    • lowgrade fever (99-100)
    • draw legs toward abd
    • alt diarrhea & constipation
    • unbulicus rebound
    • Berny sign
  3. Tx of appedicitis
    surgery
  4. nurse care of appendicitis
    • basics /surg care
    • GI Hx
    • maintain fluid balance
    • ccomfort through positioning
    • teach
    • I/O/ check dressing
  5. Labs for appedicitis
    • H& H ,
    • cbc
    •   spec WBC up
  6. Pre-op appendicits
    • lowfowlers
    • NPO
    • no pain med w/ uexplained abd pain-mask s/s
    • -NG tube if ape ruptur or lots N/V
    • triple abx- gentimycin,almemcyi
  7. appendicitis post op
    • airway
    • change possitioin frequently
    • report 1st void
    • accurate I/O
    • assess bowel sounds/incision for inf/bleed
    • meds as ordered
    • splint if can't cough

    Surg= perose drain
  8. what to do if appendix ruptures and pain stops
    • wait few wks
    • 1st put i IV abx
    • may wait few wks for surgery
    •   meds-to get infection under control 1st
    •   abd filed w/ infection
    • elevate HOB slighly for comfort & drawing
  9. Post op tx of appendicitis
    • antibiotix
    • aalgesic
    • clear liquid progress as tolerated
  10. What is insulin
    • storage hormone
    • key to unlock cells
    • boost inermitence  glucose
    • get energy from food-->
    • need enough insuli to pick up glucose & put ito cell
    • produces fatty acid& stores as adipose tissue
    • prevents protein conversion to glucose
  11. DM I dx age
    • usually prior to age 30
    • may be before puberty
    • ~5-15
  12. DM I cause

    onset
    • inlets of lngerhas -virtually o beta cells
    •    or are dead

    rapid
  13. Dx of type I DM
    • HA1C--confirms
    • fast blood glucose >100mg/dL
    • random glucose > 160 mg/dL

    • c peptide blood test
    • honeymoon phase ca last 1-3mo or up to 1 yr after or till stop producing insulin
  14. s/s DM I
    • polyuria
    • polydipsea
    • polyphagia
    • will loose wt even when eating
    • lack energy
    • only type prone to DKA

    not show till at least 90% beta cells gone
  15. DKA s/s
    • drowsiness
    • dry skin
    • flushed cheeks
    • cherry red lips
    • acetone breath-fruity smell
    • kusmaul breathing
  16. DKA Tx
    • replace lost fluid w/ dextrose free IV
    • moniter blood sugar Q 1-2 hr
    • regular insulin
  17. DM II onset
    usually  over 45 and overweight
  18. s/s DM II
    gradual onset

    • same as DMI
    • no polyphagia
  19. DM teach
    care for feet- nuropathy numbness
  20. nutritional Tx of DM I

    insulin Tx
    • perfer complex carbs to simple sugars
    • more fiber lower blood sugar

    best use 31g needle
  21. why don't want to freeze insulin
    change make up
  22. insulin Tx
    • best use 31g needle
    • now type etc given
    • have food i system prior
    • kids >7yr can give own shots

    lipoatrophy/distraphy-won't absorb, too much fatty tissue
  23. when mixing insulin which put air in 1st
    • the cloudy
    •   air 1st / draw last
  24. DM sick day mgmt
    • if can't keep anything down- can't take oral meds or isulin b/c hypoglyc
    • sick day chck blood sugr at least Q8 hr
  25. when shouldn't DM exercise
    when >240 & <70 cap blood
  26. DM exercise
    up carb intake based on amount & type exercise
  27. DM complications
    • insulin shock
    • hypoglyc
    • hyperglycem
  28. kid Hypoglyc s/s
    • antisocial behavior
    • irritabl
    • wk
    • hungrea
    • sweat
    • blurred vis
    • tachycard

    worry of AM hypoglyc in kid and teen

    once Tx should feel better w/i 5-10min reck 15
  29. Somogi phenomeno
    • rebound hyperglycemia
    • hypoglyc evently get hyperglyce
  30. Dawn phenomeno
    • early AM hyperglycemia--not result of hypoglycemia
    • main cause--> growth hormone
    • Tx up to Dr
    •    change pm insulin   chck early AM blood sugar
    • usually see s/s 4-7am
    • split pm dose of insulin
  31. surg & DM
    • befor & after surg may need special Tm
    • if NPO-- ring lactate
    • during recovery period may need higher doses of insulin till heal
  32. Legg-Calf Perthes (ostochondritis)
    • iscemic aseptic necrosis at head of femur
    • epfacial

    may heal on own
  33. Legg-calf perthes occurance
    • highest incidence white boys
    • 3-11yr
  34. Legg-Calf Perthes Dx
    confirmed w/ xray & bone scan
  35. Legg-Calf Perthes s/s
    • ab walk-one leg shorter
    • Hx pain
    • limp
    • limited hip movement

    may be mistaken for inflimatio of synovian synovitis
  36. Legg-Calf Perthes Tx
    • focus on contaiig femoral head w/i the acetabulum during revasculation
    • weight baring
    • med
    • to mobalize pt-need distracion

    • cast/brace care-chk
    • may last up to 2 yr
  37. complication of Legg-Calf Perthes
    • have prob keep head femur i socket
    • adductin last
  38. Legg-Calf Perthes nurse care
    focus on helping kid & cargiver manage corrective device & importance of compliance

    parental /emotional support big part
  39. Reye syndrome
    • on spec ensepholopathy
    • distruction of vicisul of brain
    • affects liver & brain
    •    liver is 2ndary affecte area
  40. cause of Reye syndrome
    exact cause unknown

    one main viral trigger---flue
  41. Reye syndrome lab
    up ammonia / liver ezyems / hypoglyce
  42. s/s Reye syndrome
    • cerebral edema--effects CNS
    • fluid/electrolyte imbalance
    • acid based imbalance
    • progressin of neuro disunction
    • alt coagulation
    • metab acidosis w/ resp alkidosis
  43. Dx Reye syndrome
    • lab values,
    • ct scan
    • r/o brain tumor
    • eeg
    • liver Bx
    • lliver function test
    • serum bili
    • amoia
    • pt/PTT
    • glucose

    monitor neuro status
  44. onset of Reye syndrome
    • averagte 4-12yr
    • peak    6-7
  45. nurse care for Reye syndrome
    • HOB at least 30o
    • kids padded side rails    don't compress neck
    • parents--lots teaching
    • **prevet further brain insult
    • give O2 prn
  46. Reye syndrom stage gradient
    • 1-lethargy-lifver diffuc
    • 2 deep liver defunc
    • 3  abtunded  /hig coma-cloudy cognition
    •      difficult to arouse
    • 4 deep coma
    • 5 coma-loose deep reflexes 
    •      can't feel or acknoledge pai

    • check deep tenden reflex
    • progress depends on severity

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