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What vaccine can be used to prevent epiglottitis in children?
What does "Silent Chest" indicate?
Worsening of Acute Asthma (decreased wheezes)
How is bronchiolitis diagnosed?
RSV antigen detection by nasal secretions
What are some contraindications for ribavirin (antiviral) when treating bronchiolitis?
- teratogenic- no pregnant providers
- No contact lenses
What are some signs and symptoms of bronchitis?
- dry, hacking cough
- cough may become productive after 2-3 days
- cough is worse at night
What is used prophylactically in high risk infants to prevent RSV?
RSV-IGIV (IV immunoglobulin)
what immunization prevents Pertussis?
dTap or Tdap
what are major culprits of foreign body aspiration?
grapes, hot dogs, and peanut butter
What illness would you not just treat the child with it, but the whole family as well?
What children are at increased risk for aspiration pneumonia?
- Children with feeding difficulties such as:
- cleft palate
what illness is characterized by recurrent episodes of wheezing, coughing, tightness of the chest, and SOB?
what are some diagnostic tests performed with Asthma?
- Pulmonary function tests (PFTs) upon initial assessment every 1-2 years
- Personal best Peak Flow Test
what are the "rescue" meds for Asthma?
Bronchodilators: Albuterol, Zopenex
What are the "prevention" meds given for Asthma?
- inhaled corticosteroids
- leukotriene inhibitors
What are diagnostic tests performed with suspected Allergic Rhinitis?
- RAST test: determines the IgE antibodies to specific allergen
- Blood sample for eosinophils and total IgE
- Skin testing
What are the signs and symptoms associated with Allergic Rhinitis?
- clear runny nose; sneezing
- Itchy nose, itchy watery eyes
- Allergic shiners; allergic salute
- congestion; chronic nasal obstruction
- Pallor of nose; cobblestoning
chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system
What should be at the bed side when a patient is in the hospital with Spina Bifida?
a bottle of normal saline to keep sac covered with a moist, sterile dressing to prevent breakdown of skin and infection
what is the earliest sign of Cystic Fibrosis?
meconium ileus in a newborn
What are some signs and symptoms of GER?
emesis and heart burn
What are some treatment goals associated with GER?
- small, frequent feedings every 3 hours
- thickened formula with rice cereal (1 oz of formula to 1 TBS of cereal)
- Prone positioning after feeding but NOT when sleeping
- Older child: left side position with head of bed elevated
What medications help treat GER?
- PPIs: lansoprazole (suppress acid)
- H2 receptor agonists (cimetidine)- for esophagitis
- Cholinergics (bethanechol/metoclopramide)- increase gastric emptying
What illness is the surgical procedure Nissen Fundoplication suggested for ?
constipation with soiling
How is the diagnosis of Hirschsprung Disease confirmed?
What are some surgical procedures that help manage Hirschsprung Disease?
- Temporary colostomy (relieves dilation)
- Soave endorectal pull-through (infant must be 9 kg!)
What are the nursing considerations associated with managing Hirschsprung disease?
- monitor for progressive abdominal distention (girth at umbilicus, leave tap in place)
- Preop Bowel emptying
- Teach colostomy care
- goal: return of normal bowel
acute obstruction of lumen with hard feces
What is the most important sign of Acute Appendicitis?
Focal Abdominal tenderness at McBurney's point in RLQ
RLQ pain with palpitation or precussion of other quadrants
Ruptured apendix results in?
what are the signs of a ruptured appendix?
sudden, brief relief of pain & high fever
what are the treatment methods for a ruptured appendix?
- 5-7 days of antibiotics and IV fluids
- NG suction for decompression
- drain or surgery for abscess formation
What illness causes Gastric outlet obstruction?
Hypertrophic Pyloric Stenosis
Which acid base imbalance would have to be corrected before surgery of Hypertrophic Pyloric Stenosis?
- used for HPS
- Incise circular muscle & open pylorus (RUQ incision)
What should the postoperative care be following a pyloromyotomy?
gradually progress oral feedings
What is the most frequent cause of bowel obstruction in children 1 months-3 years old?
Intussusception (more common in cystic fibrosis)
What is intussusception?
Telescoping or invagination of one portion of intestine into another (ileocecal valve)
currant jelly stools; sudden, crampy pain; and a sausage shaped mass on palpation is indicative of what?
What is the non-surgical treatment modality of intussusception?
Hydrostatic reduction with air or contrast enema
What teaching is most important regarding intussusception?
Educating parents and child on the risk of recurrence
What is it called when the bowel is not fixed in position in-utero?
What does volvulus result in?
volvulus (intestines become twisted) -- decreased blood supply -- necrosis, peritonitis, perforation & death
Abnormal rotation of the intestines around the superior mesenteric artery?
Malrotation which leads to bowel obstruction
Celiac disease (genetic intolerance of gluten-protein in wheat)
What are the four characteristics of Celiac disease?
- abdominal distention
- general malnutrition
- vitamin deficiencies
What dietary management is associated with Celiac Disease?
- life-long dietary management
- Substitutes for wheat products
What are the treatment goals of Short Bowel Syndrome?
- preserve bowel strength
- stimulate bowel adaptation
- optimal nutritional and growth as bowel adapts
What are the phases of nutritional therapy associated with Short Bowel Syndrome?
- 1st phase- TPN
- 2nd phase- introduce enteral feeding
- final phase- enteral feedings alone sustain growth
in SBS, what is taught to children in regards to developing oral muscles (speech)?
what is the main symptom of Pinworm ingestion?
Intense anal itching
what is the diagnostic tool for Pinworms?
Tape Test-collect eggs in morning after child awakens using clear tape over the anus
What medication is given to all family members (>2) when one member has pinworms?
One dose of Oral Mebendazole
How can Pinworms be prevented?
- Handwashing after toileting and before meals
- Careful diapering
- Short nails
- Stop scratching
the failure of the esophagus to develop a continuous passage is called?
the VACTERL mnemonic associated with Esophageal Atresia stands for?
- V- vertebral anomalies
- A- imperforate anus or anal atresia
- C- cardiac anomalies
- TE- tracheoesophageal fistula
- R- renal anomalies
- L- limb anomalies
What is the diagnosis based on in Esophageal Atresia?
if an infant has at least three or more of the VACTERL anomalies
an infant presenting with frothy saliva, drooling, choking, coughing, along with cyanosis and apnea r/t aspiration is indicative of
What are the nursing considerations of an infant with Esophageal Atresia?
- Maintain Patent Airway
- Prevent Aspiration
- Monitor surgical repiar/anastomosis postoperatively
an anorectal malformation in females where the rectum, vagina, and urethra drain into perineum via one channel
an anorectal malformation in males and females where there is no obvious opening (with or without a fistual)
What are the surgeries associated with anorectal malformations and their indications?
- Short-term : temporary colostomy for fecal elimination
- Long-Term: anorectoplasty and colostomy take down
- wait for 24 hours after birth to perform surgery if the anorectal malformation is not life-threatening
what nursing action can be done to identify anomalies in a newborn?
Watch for the first stool
use in Biliary atresia to drain bile
What is the definitive life-saving treatment of Biliary Atresia?
Biliary Atresia can lead to?
- Cirrhosis and death by age 2 if not treated
- Jaundice that persists after age 2 weeks
- Elevated conjugated bilirubin
What is the most serious complication associated with Kawasaki Disease ?
Cardiac involvement; aneurysms can develop
chorea, carditis, erythema marginatum, polyarthritis, fever with history of sore throat, abdominal pain, and subcutaneous nodules are associated with what illness?
the child showing signs of exercise intolerance, chest pain, and dizziness when standing for long periods of time is associated with what specific cardiovascular disorder?
- Major: Carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
- Minor: Fever, arthralgia elevated ESR or positive CRP level, prolonged P-R interval
What are the two objective of treating CHF?
- reducing workload
- increasing cardiac output
What is the prophylaxis for recurrence of Rheumatic Fever?
Penicillin G (Bicillin)
What is a major risk factor for the cause of Cerebral Palsy?
Low birth weight
A dimple with or without hair tuft at base of spine?
Spina Bifida Occulta
Spina bifida is associated with what major problem?
the signs of increased ICP are? (opposite of shock)
- Increased ICP- decreased pulse and increased BP
- Shock- increased pulse and decreased BP