Health Problems of the Toddler

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  1. What is Autism spectrum disorder?
    • Complex neuro-developmental disorders of brain function: autistic disorder, asperger syndrome, pervasive developmental disorder not otherwise specified
    • Can range from mild to severe
  2. What are the possible causes of ASD?
    • Currently recognized as a genetic disorder of prenatal and postnatal brain development
    • Immune and environmental factors may increase ASD incidence
    • High risk for reoccurance in families
    • Not apparently caused by MMR or Thimerosal containing vaccines
  3. How is ASD Diagnosed?
    • May use the CHAT (checklist of autism in toddlers)
    • Qualitative impairment in social interaction
    • Qualitative impairment in communication
    • Restricted repetitive and stereotyped patterns of behavior (such as echoalia), interests, and activities
    • Delays or abnormal functioning with onset prior to 3rd birthday
    • American Psychiatric Association DSM IV TR
  4. What nursing considerations should be taken for a child with ASD?
    • Wide variation in individual client response to treatment efforts
    • No cure for ASD, but many therapies
    • Most promising results seem to be through highly structured routines and intensive behavior modification programs
  5. What are some goals for children with ASD?
    • Promotion of normal development
    • Language development
    • Social Interaction
    • Learning
  6. How can you support a family with a child that has ASD?
    • ASD often becomes a "family disease"
    • Help alleviate parents' unwarranted feelings guilt and shame
    • Stress importance of family counseling
    • Autism Society of America (ASA) is good source of information
    • Encouraging home care for children; assisting with long-term placement later in life
  7. What are some common eye conditions of the toddler?
    • Cataracts: Dm, galactosemia, eye injury. Requires surgical removal and possible post op contacts
    • Glaucoma: congenital if developed <3yrs
    • Strabismus: lazy eye or cross eyed leading to double vision. Often corrected before school age with eye patch on good eye
    • Eye Injury: if penetrating, patch both eyes prior to intervention (ophthalmic emergency)
    • Infections: conjuctivitis
  8. How is conjunctivitis treated?
    • Ophthalmic antibiotics
    • System antibiotics in some cases
    • Caution with the use of steroids because they can worsen viral infections
    • Infection control concerns
  9. What are some eye emergencies and how are they treated?
    • Foreign body: removal
    • Hematoma: check for hyphema
    • Penetrating injuries: both eyes patched
  10. What is important to consider in the visually impaired, hospitalized client?
    • Safe Environment
    • Reassurance
    • Orient the child to surroundings
    • Encourage independence
    • Consistency of team members
  11. What is celiac disease and what are some common s/s?
    • Gluten induced enteropathy- defect of metabolism when gluten is ingested (wheat, rye, barley, oats)
    • General malnutrition (FTT), secondary vitamin deficiencies, steanorrhea (fatty, foul stools), abdominal distention
    • S/S generally not seen before 6mo
  12. What is a celiac crisis and how is celiac disease managed?
    • Explosive n/v/d leading to dehydration, electrolyte imbalance, and hypovolemic shock
    • Often precipitated by other infection
    • Needs f/e replacement
  13. How is celiac disease managed?
    • Managed by excluding gluten from diet
    • Important to consider different cultures and the meaning behind food, such as at holidays (may lead to a diet change in the entire family)
    • Educate about reading labels and choosing approp foods
  14. What are croup syndromes?
    • Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress
    • Croup syndromes affect the larynx, trachea, and bronchi: epiglottitis, laryngitis, laryngotracheobronchitis (LTB), tracheitis
  15. Describe acute epiglottitis
    • Most common in 2-7 y/os
    • Clinical manifestations include sore throat, pain, tripod positioning, retractions, inspiratory stridor, mild hypoxia, distress
    • 3 Ds: dysphagia, hyspnea, drooling (dysphonia)
    • No spontaneous cough- frog like sound
    • Fever 102-104
    • Therapeutic management: Edema of the upper airway (DO NOT USE TONGUE BLADE TO INITIATE GAG REFLEX). Prepare to intubate
  16. Describe acute laryngitis
    • More common in older children and adolescents
    • Usually caused by a virus
    • Chief complaint is horseness
    • Generally self-limiting and without long term sequalae
    • Treatment: symptomatic
  17. Describe Acute Laryngotracheobronchitis (LTB) and it's clinical manifestations
    • The most common croup syndrome
    • Generally affects children <5yrs
    • Organisms responsible include RSV, parainfluenza virus, mycoplasma pneumonia, and influenza A & B
    • Clinically manifested by inspiratory stridor, suprasternal retractions, barking or seal-like cough, increasing respiratory distress and hypoxia, can progress to respiratory acidosis, respiratory failure, and death
  18. What is the therapeutic management for LTB?
    • Airway management/O2
    • Maintain hydration (PO or IV)
    • High humidity
    • Nebulizer treatments: racemic epinephrine,
    • steroids, heliox
  19. What is acute spasmodic laryngitis?
    • Also called spasmotic croup or midnight croup
    • Praoxysmal attacks of laryngeal obstruction
    • Occurs chiefly at night
    • inflammation: mild or absent
    • Most often affects children ages 1-3yrs old
    • treatment includes humidity such as placing in shower or cool night drives
  20. What is bacterial tracheitis and how it therapeutically managed?
    • Infection of the mucosa of the upper trachea
    • Distinct entity with features of croup and epiglottitis
    • Clinical manifestations simulation to LTB
    • May be a complication of LTB
    • Thick, purulent secretions result in respiratory distress
    • Therapeutic management: humidified oxygen, antipyretics, antibiotics, may require intubation
  21. What is cystic fibrosis?
    • Hereditary autosomal recessive trait- if both parents carry, there is 1 in 4 chance
    • Basic defect related to abnormal secretions of exocrine glands (mucus producing)
    • Lead to obstruction of secretory ducts of pancreas, liver, reproductive organs
    • Thick mucus obstructs respiratory passages leading to air trapping and overinflation
  22. What are the s/s of cystic fibrosis?
    • Meconium ileus
    • Intestinal malabsorption
    • Pancreatic enzyme deficiency
    • Anemia
    • Atelectesis, lung abscess, pneumonitis
    • Clubbed fingers
    • FTT, weight loss
    • Non-productive cough
    • fatty stools
    • barrel chest
  23. How is cystic fibrosis diagnosed?
    • s/s in the newborn include meconium ileus
    • Salty taste, hard nonproductive cough,bronchial infections, barrel chest, clubbing, malnutrition (ftt and bruising)
    • Newborn screening for CF
    • Stool analysis may show increased fat and decreased albumin with an absence of trypsin
    • sweat-chloride test induces sweat and measures sodium chloride. >60 meq/L on 2 tests is diagnostically positive
  24. How is cystic fibrosis treated and managed?
    • newborn: meconium ileus treated user hyperosmolar enemas or surgery
    • Older child: aimed at correcting pancreatic ¬†deficiency, improving pulmonary function, preventing respiratory disease, maintaining physical activity
    • Diet is high in complex carbs and proteins with no fat restriction (may need 1.5-2x cal requirements to promote growth)
    • No salt restriction due to loss of salt (increase salt intake in hot weather)
    • Pancreatic enzymes (such as pancrealase) to increase digestion and absorption of fat
    • ADEK Vitamin supplements (fat soluble)
    • Prophylactic antibiotics (may be parenteral)
    • Postural drainage/qvest/flutter device
    • Inhalation therapy: pilmonzyme/albuterol, mucomyst for acute infection, humidified environment
    • Physical activity is essential!!!
  25. What are some good resources for cystic fibrosis?
    • Home care and an interdisciplinary team
    • Compliance to treatment is key!
    • Cystic Fibrosis Foundation
  26. What is the emergency treatment for ingesting a toxic substance?
    • Remove obvious remnants of the substance and maintain airway
    • Call poison control (keep number handy!)
    • Follow directions PER SUBSTANCE as to how to prevent further absorption
    • When possible, bring container to ER with you
    • Administer general supportive and symptomatic care
  27. What are some commonly ingested toxic substances?
    • Acetaminophen
    • Aspirin
    • Ibuprofen (motrin, advil)
    • Ferrous sulfate¬†
    • Barbiturates
    • Corrosives (such as lye, bleach, drain and toilet cleaners, iodine, silver nitrate)
    • Hydrocarbons (kerosene, gasoline, furniture polish, turpentine)
  28. What should be done if a child ingests a foreign object?
    • Many objects pass safely through the intestinal tract
    • Occasionally lodge in esophagus or bowel (including foods)
    • Unless choking, gagging, or pain is present, it is usually safe to wait and see if it passes
    • For choking- abdominal thrusts can be used for children older than1 y/o
  29. What should be done if a child puts a small object in their nose or ear?
    • May irrigate ears to remove (not paper)
    • Risk for infection and aspiration if object is in ears
    • May use speculum to remove
    • S/S of infection in nose due to object includes one sided purulent drainage
  30. What are two common types of heavy metal poisoning?
    • Lead poisoning
    • Mercury Poisoning
  31. What are common methods of lead poisoning?
    • Common by peeling lead based paint
    • Microparticles in the air can be inhaled or ingested
    • Lead can also be found in soil and water that has been contaminated by Microparticles
    • May also come in contact with hobbies that use lead, near by industries that use lead, and foreign made toys that contain lead
  32. Describe lead screening for children
    • Screening is done at well check up at 1 & 2 yrs of age
    • Screen any child between 3-6 who has not been screened
  33. What are the s/s of lead poisoning in children?
    • Insidious symptoms! Often misdiagnosed for ADHD
    • Early signs: irritability, hyperactivity, aggression, impulsiveness, short attention span, mild learning disabilities
    • Late Signs: encephalopathy r/t increased ICP, degeneration of brain, MR, blindness, paralysis, seizures, coma, death
    • Acute signs: n/v, constipation, anorexia, abd pain, anemia (lead prevents iron from binding to the heme molecule)
  34. What are the ABCDEFG of lead poisoning?
    • Anemia
    • Basophillic stripping
    • Collicky pain and constipation
    • Difficulty concentrating/developmental delays
    • Encephalopathy
    • Foot Drop
    • Gums (lead line)
  35. How is lead poisoning diagnosed?
    • Diagnosed with a blood test
    • 5-14mcg/dL: educate and retest
    • 20-44mcg/dL: chelation therapy, environmental investigation, lead hazard control
    • 45-69 mcg/dl: chelation within 48 hrs
    • >70 mcg/dL: needs immediate chelation therapy
  36. What medications are used with chelation therapy?
    • EDTA: Ca edetate disodium, given IV for levels >45 mcg/dL
    • BAL: dimercaprol, given deep IM for levels >70 mcg/L
    • Succimer (chemet): given PO for levels >45 mcg/dL
    • D penicillamin: given PO for levels <45 mcg/dL
  37. What are some common intestinal parasites and how are they diagnosed?
    • Common intestinal parasites are roundworm, hookworm, threadworm, and whipworm
    • Commonly transmitted by ora/fecal route, or direct contact with contaminated objects
    • Diagnosed by stool sample
    • Nurses most important role is education
  38. How can intestinal parasites be prevented and how are they treated?
    • Treated by medications such as flagyl
    • Prevented by frequent hand washing!!
    • Short finger nails
    • Wear shoes outside
    • Proper Diaper disposal
    • Safe drinking water
    • Keep pets out of play areas
    • Disinfect bathrooms, diaper areas
  39. Describe Giardiasis, how it is dx and how it is treated
    • Giardiasis is the most common intestinal parasite
    • Cysts are passed in stool for months
    • Contracted through person to person contact or contaminated water
    • S/S include abdominal cramps and diarrhea
    • May require mult stool samples to dx
    • Treated with flagyl, alinia, tindamax, or albendazole (mix with juice or sweet food)
  40. Describe enteriobiasis
    • Also called pinworms, it is the most common helminthic infection
    • Ingest (oral fecal rt) or inhale eggs (floating in the air)
    • Common in day cares
    • Diagnosed by a tape test on anus where eggs are laid
    • Main symptom is intense anal itching
    • Reinfects self from eggs on hands or under fingernails
  41. How is enterobiasis treated and prevented?
    • Treated with vermox, antimith, or albendazole in 1 dose with a repeat dose in 2 wks
    • Wash clothing and bedding in hot water
    • Promote hand washing
    • Cut nails short and possible 1 piece pjs
    • Reoccurrence is common
Card Set
Health Problems of the Toddler
For Gosselins Exam 3
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