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Child disease Flashcards

1
Q

Spina Bifida - what is it?

A

Neural tube defect

Birth defect that occurs when the spine and spinal cord do not form correctly. This can leave the meninges and spinal cord exposed

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2
Q

What are the 3 types of Spina bifida ?

A

Spinal bifida occulta
Meningocele
Myelomeningocele

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3
Q

What is spinal bifida occulta

A

Defect is NOT visible (externally)
-lumbosacral region
-most common
-may have port wine angioma (red birth mark)
-dimple or tuft of hair over defect region

Do not take rectal temps as bowel sphincter can cause rectal prolapse

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4
Q

What is meningocele spina bifida

A

Hernial protusion of a sac like syst filled with meninges and spinal fluid that is visible on the outside of the spinal cord

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5
Q

What is myelomeningocele spina bifida

A

Hernial protrusion of sac like cyst filled with meninges, spinal fluid, and spinal cord nerves that lays outside of the spinal cord

S/S:
visible sac
incontinence of urine and feces
limb movement dysfunction below cyst

Severe:
walking complications
weakness
abnormal growth
scoliosis
hydrocephalus
meningitis

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6
Q

Treatment for Spina Bifida

A

SBO - no treatment

Mening/myelo - surgery to close the sac (has to happen within 24-72 hours)

-prevent infection
-risk for trauma
-management of GU Sx
-PT/OT

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7
Q

What are risk factors for Spina Bifida?

A

During Pregnancy:

-Low folic acid intake
-low exposure to proper nutrients
-drugs / alcohol
-exposure to radiation

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8
Q

What is viral meningitis?

A

Aseptic Meningitis

Inflammation of the meninges (membrane covering the brain and spinal cord) WITHOUT bacterial growth on SCF cultures

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9
Q

What is the onset of viral meningitis?

A

Abrupt/rapid OR develop ofver a few days

Similar features to bacterial meningitis

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10
Q

Manifestations of viral meningitis

A

-stiff neck (nuchal rigidity)
-fever
-vomiting
-headache
-irritability
-photophobia

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11
Q

Causes of viral meningitis

A

herpes simplex virus
cytomegalovirus
HIV
adenovirus
enterovirus

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12
Q

How to diagnosis viral meningitis

A

-clinical manifestations
-CSF findings (NO bacteria)

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13
Q

What labs look like for meningitis?

A

WBC:
B= elevated w/ increased neutrophils
V = slightly elevated w/ increased lymph

Protein:
B = elevated
V = Normal

Glucose:
B = decreased
V = normal

Bacteria culture:
B = positive
V = negative

Color:
B = Cloudy
V = clear

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14
Q

What is the treatment for viral meningitis ?

A

-Supportive care
-acetaminophen (pain)
-Hydration
-Positioning (comfort)

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15
Q

What is bacterial meningitis?

A

Acute inflammation of the meninges and CSF via direct invasion or thought bloodstream

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16
Q

What are clinical manifestations of bacterial meningitis

A

nuchal rigidity (stiff neck)
FEVER
headache
photosensitivity
(+) kernings sign
(+) brudinski’s sign

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17
Q

What is kernigs sign

A

thigh is flexed 90 degress at the hip and knee and extension of knee is painful

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18
Q

what is brudinski sign

A

passive forward flexion of the neck cause involuntary raise in knees and flex in hip

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19
Q

What are complications of bacterial meningitis?

A

seizures
confusion
drowsy
hallucinations

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20
Q

How to diagnose bacterial meningitis?

A

lumbar puncture with culture

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21
Q

What are preventatives for bacterial meningitis?

A

vaccine: 11-12 years old
Booster at 16 years old

Hib at 2, 4, 6 months

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22
Q

Treatment for bacterial meningitis

A

broad spectrum abx
hydration
reduce ICP
seizure precautions
isolation (droplet) precautions
low stimuli
thermoregulation
neuro checks
auditory eval every 6 months

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23
Q

What is Cerebral palsy

A

A disorder that affects motor function, muscle control, coordination and posture

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24
Q

What causes Cerebral palsy

A

damage to developing brain

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25
Q

What are risk factors for cerebral palsy

A

During pregnancy:
-CMV
-Rubella
-Herpes
-Syphilis
-Toxoplasmosis

Illness as infant:
-Bacterial meningitis
-viral encephalitis
-untreated jaundice
-stroke in womb causing brain bleed

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26
Q

S/S of cerebral palsy

A

floppy / stiff muscle tone
persistent moro/tonic reflexes
poor head control
rigid muscles / abnormal posture
favoring a particular side of the body
poor feeding / speaking
drooling
trouble meeting developmental milestones
seizures

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27
Q

What types of movements are common with cerebral palsy?

A

Spastic *most common
Dyskinetic
Ataxic

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28
Q

What is spastic movement?

A

Persistent primitive reflexes
positive Babinski reflex
ankle clonus
muscle stiff and tight

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29
Q

What is dyskinetic movement?

A

involuntary movements
dystonia (slow twisting of trunk or extremities)
involuntary jerky movements (slow, worm like movements)
drooling

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30
Q

What are ataxic movements?

A

wide based gait
rapid repetitive movements
shakey

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31
Q

Treatment for cerebral palsy

A

-correct defects as early as possible

-ankle-foot orthoses (ankle braces)

-medication:
*benzo to decrease muscle rigidity
*antiepileptics
*botulinum toxin A - to reduce spasms

-speech therapy, PO, OT
-Frequent rest periods
Safety-risk falls

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32
Q

What is Neonatal sepsis?

A

A blood infection that occurs in newborns (<28 days).

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33
Q

Why do newborns have increased susceptibility to infection?

A

Due to their diminished inflammatory and humoral immunity. This causes decreased or no inflammatory response to signal that there is an infection.

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34
Q

What is early onset neonatal sepsis?

A

Occurs within the first 3 days, and is typically acquired during labor from mom.

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35
Q

What is the most common bacteria that causes early onsite neonatal sepsis?

A

GBS

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36
Q

What are other bacteria causes of early onset neonatal sepsis

A

E.Coli, listeria

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37
Q

What are some complications that can be caused if neonatal sepsis is left untreated?

A

Neuro and respiratory problems

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38
Q

What is late onset neonatal sepsis?

A

Sepsis that occurs 4 days or later after birth.

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39
Q

What are some different bacteria that cause late onset neonatal sepsis?

A

Staphyicocci, e. coli or candida

From: skin, mucous membranes, or umbilical stump

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40
Q

How does pregnancy cause neonatal sepsis?

A

from maternal bloodstream to placenta (CMV, toxo lasmosis)

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41
Q

How does labor cause neonatal sepsis?

A

passes infection from mom to baby in the birth canal

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42
Q

What are causes postnatally of neonatal sepsis?

A

invasive devises, cross contamination with other babies or people, prolonged ROM, preterm, traumatic / difficult labor

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43
Q

What are s/s of neonatal sepsis ?

A

-Body temp changes
-irregular respirations
-Reduced sucking, grunting, retractions
-lethargy, irritability
-Abdominal distention, vomiting
-jaundice, pallor, cyanosis

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44
Q

How do you diagnose neonatal sepsis?

A

-Early recognition of s/s
-definitive DX: Blood culture, urine culture, CSF

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45
Q

How can we prevent neonatal sepsis ?

A

-GBS testing at 36 weeks
-If (+), Abx and potential C-section

-HepB + HIV screening (passed through breastmilk)

-Early recognition

-Abx therapy BEFORE lab results are confirmed and organism is identified

-Respiratory support

-VS monitoring, fluid regulation

-thermoregulation

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46
Q

What are treatment options for neonatal sepsis?

A

-Antibiotics
-potential blood transfusion for anemia

(+) organism screening needs Abx for 7-10 days
(-) organism screening, discontinue abx 48 - 72 days

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47
Q

What is PKU (Phenylketonuria) ?

A

A rare genetic disorder where babies lack the enzyme needed to breakdown phenylalanine into tyrosine

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48
Q

What does a build up of phenylketonuria lead to?

A

neuro and cognitive impairment as the body will excrete an abnormal amount of phenylaetic acid.

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49
Q

what are the S/S of PKU?

A

-Failure to thrive
-Vomiting, irritability, convulsions
-Hyperactivity, erratic behavior problems
-Older children can experience bizarre, schizoid behavior (due to decrease in dopamine and serotonin)
-musty odor (due to increase uric acid)
-lighter skin (due to decreased tyrosine (makes melanin)
-heart defects
-seizures

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50
Q

How do you diagnose PKU

A

newborn blood tests on baby (PKU test)

screen mom before pregnancy

Key: test after 24 hours old and after baby has ingested protein

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51
Q

That is the treatment for PKU?

A

Diet: limited intake of protein

PKU Formula: gived you protein that does not have phenylalanine

Watch amount of protein eaten (milk, eggs, cheese, meat, poultry, fish)

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52
Q

What should moms with PKU while they are pregnant, but what are the risks?

A

PKU moms should follow a PKU diet

Risk: microcephaly, cognitive impairment, heart defects, mother could suffer miscarriage.

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53
Q

What is neonatal jaundice?

A

yellow discoloration of a newborns eyes and skin due to excess bilirubin in the blood

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54
Q

What is bilirubin?

A

a substance that is produced and released with the breakdown of RBCs in the liver. It travels from the liver and is stored in the bile duct and expelled in the stool

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55
Q

What causes jaundice?

A

newborns produce more bilirubin than adults and their liver cannot break it down fast enough.

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56
Q

what are other causes of jaundice?

A

internal bleeding
infection / sepsis
Rh incompatibility
Biliary Atresia
Liver disfunction

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57
Q

What are the different types of neonatal jaundice?

A

Pathologic
Physiologic
Prolonged

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58
Q

What is Pathologic jaundice

A

Not normal

Onset: first 24 hours
Cause: Sepsis or decrease in blood (ABO, Rh incompatibility)

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59
Q

What is physiologic jaundice

A

Very common

Onset: 2-14 days
Cause: Immature liver has a tough time breaking down RBC and handling lots of bili

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60
Q

What is prolonged jaundice?

A

Further testing is needed

onset: >14 days *may last 4-5 weeks
Cause: may indicate an underlying condition such as hypothyroidism, biliary atresia, cystic fibrosis

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61
Q

What are the S/S of neonatal jaundice?

A

-#1; jaundice skin and sclara
-poor feeding
-not gaining weight
-high pitch cry
-lethargic
-pale stools

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62
Q

How to diagnose neonatal jaundice

A

-presenting symptoms
-bilirubin level in blood
-LFT’s torch screen -> look for underlying issue

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63
Q

What is a normal Bilirubin level?

A

<5 mg/ dl

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64
Q

What are treatment options for neonatal sepsis?

A

-phototherapy
-nutrition (more frequent feedings, breastfeeding)
-transfusion (if there was a blood incompatibility with mom)
*1st IVIg Transfusion
*2nd blood transfusion

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65
Q

What is a Febrile Seizure?

A

Seizure that is triggered by increased temperature

6mo to 5 year

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66
Q

What do febrile seizures happen?

A

Cause is unsure:

-fever increases core temp -> neurons become excited
-fever causes hyperventilation, which lowers CO2in blood (leading to resp alkalosis increase blood ph), neurons get excited
-Fever is caused by cytokines that get released by WBCs during antibodies immune response.

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67
Q

What are risk factors for febrile seizures?

A

-6 mo - 5 years (majority 12-18 mo)
-rapidly developed fever
-high fever number
-certain vaccines that stimulate the immune system (MMR)
-Family HX of febrile seizures
-the younger the age at onset, the increase risk of reoccurring episodes

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68
Q

What are S/s of febrile seizures

A

-Fever >38 C / 100.4 F
-Simple febrile seizure
*has one seizure in 24 hour span
*affects the entire body
*lasts less than 15 minutes

-complex febrile seizure
*more than one in 24 hours
*affects only one part of the body or one side
*lasts longer than 15 minutes

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69
Q

What are manifestations of febrile seizure

A

-flutter eyelids or roll eyes
-stiffen, jerk or twitch muscles
-clench jaw, lose bladder function
-lose consciousness (post ictal state)

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70
Q

Treatment for febrile seizures

A

ground and side laying position
antipyretics
antiseizure
distinguish fever from other causes (meningitis, encephalitis)

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71
Q

What is Otitis Media?

A

Any inflammation in the middle ear

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72
Q

What are the different types of otitis media?

A

(AOM) Acute otitis media: infection of rapid onset and accompanied by fever and ear pain

(OME) Otitis media with effusion: Fluid in middle ear space without acute infection symptoms (ear feels full)

73
Q

What are the causes of otitis media?

A

blockage of eustachian tubes which cause fluid to build up and sit in the middle ear (which grows bacteria)

74
Q

What is an intrinsic blockage?

A

infection or allergy

75
Q

What is an extrinsic blockage?

A

enlarged adenoids, nasopharyngeal tumors

76
Q

What are the risk factors for otitis media?

A

< 7 years old
large family
2nd hand smoke
bottle fed / incline of feeding
family history
pacifiers
daycare
chronic allergies

77
Q

What is common between 3 months and 3 years that increases the risk of otitis media?

A

the eustachian tube is more horizontal

78
Q

What are S/S of otitis media?

A

ear pain (tugging at ears)
irritability
trouble sleeping
fever
N/V/D
problems hearing / conductive hearing loss
purulent discharge
OME: Rhinitis, cough + other S.

79
Q

How to diagnose Otitis media?

A

-assessment of tympanic membrane
-AOM: red, opaque, bulging or purulent
-OME: orange, fluid build up
-clinical Sx

80
Q

How to treat OM

A

-Wait 72 hours for spontaneous resolution for pts >6 months
In pts <6 months old; with severe s/s (give Abx)

Frist line: amoxicillin
Second line cephalosporin

Note: eardrops will not do anything (unless perforated)

Supportive care: acetaminophen, clean ear from drainage, avoid water

Surgery: Tubes (tympanostomy or myringotomy

81
Q

What are gastrointestinal disorders examples

A

-Cleft lip and palate
-Esophageal Atresia
-GERD
-Appendicitis

82
Q

What is Cleft lip and palate?

A

Openings or splits in the upper lip, the roof of the mouth, or both.

It happens because the facial structures does not form properly in utero.

83
Q

What treatment options / nursing interventions for cleft lip and palate ?

A

-assess suck, swallow, and breathing abilities
-risk for otitis media and hearing loss
-hold infant upright when feeding
-feed small amounts and burn often
-surgery
*Cleft lip (3-6 months)
*Cleft palate (<12 months)

84
Q

What is Esophageal Atresia?

A

Esophagus ENDS before reaching the esophageal sphincter that connects to the stomach.

This causes food to NOT pass through to the stomach & can cause difficulty breathing

85
Q

S/S of esophageal atresia

A

-frothy saliva and drooling
-3c’s (coughing *during feeds, choking, cyanosis
-abdominal distention, respiratory distress

86
Q

What is GERD

A

Backflow of gastric contents into the esophagus

87
Q

What are S/S of GERD

A

regurgitation, heartburn, anemia, hematemesis, poor weight gain

88
Q

What are treatment options in GERD

A

-baby positioning (sitting up)
-Increase the head of bed
-antacids
-PPI
-Solids given first

89
Q

What are complications of GERD

A

-Esophagitis
-Esophageal strictures
-Aspiration PNA

90
Q

What is appendicitis ?

A

inflammation of the appendix; the appendix fills with pus

91
Q

What is the pt at risk for regarding appendicitis?

A

Perforation! -> peritonitis -> sepsis -> death

92
Q

What are S/S of appendicitis

A

McBurney’s Point! -> pain that descends to the RLQ “Buring pain”

Referred pain
rebound tenderness
fever
Increased WBC

93
Q

What is Pyloric Stenosis?

A

condition that makes the valve between the stomach and small intestine (pyloric sphincter) thicken and narrow which can block food passage

94
Q

When does pyloric stenosis present itself?

A

Typically 2weeks - 2 months of life

*does not present at birth, infants usually feed well for the first few weeks.

The cause is unknown

95
Q

What are risk factors for pyloric stenosis?

A

-male gender
-premature babies
-family Hx
-mom smoking during pregnancy
-early antibiotic use

96
Q

What are S/S of pyloric stenosis?

A

-vomiting after feeding (not bile) **projectile!!
-persistent hunger
-decreased weight
-visible peristalsis (stomach muscles are trying to push food)
-dehydration + constipation
-Epigastric mass (aka olive mass)

97
Q

What are complications from pyloric stenosis?

A

failure to grow
dehydration (electrolyte imbalance)
stomach irritation -> bleeding
jaundice

98
Q

How do you diagnose pyloric stenosis?

A

-physical exam -> olive mass or visible peristaltic waves

-blood tests -> check for dehydration and electrolyte imbalance (ABG)

-ultrasound / xray

99
Q

What are treatment options for pyloric stenosis?

A

-Rehydrate
-Surgery pyloromyotomy
-assess elimination patterns (before and after surgery)
-Assess hydration status (irritability, pulse rate, mucous membranes, fontanelles)

100
Q

What is Intussusception?

A

When a proximal segment of the bowel “telescopes” into a more distal segment

101
Q

What does intussusception do?

A

-pulls all lymphatic and venous vessels which causes an obstruction and decreased blood flow.

-Obstruction causes edema which increased pressure in the affected area

-Decreased circulation and blood flow (ischemia ) and secretion of mucous in the intestine

-blood and mucous mix together = red, currant jelly like stool

102
Q

What is the cause of intussusception

A

unknown, but may be due to abnorma growth in the intestine (tumor or polyp) that acts as a lead point to pull on when contractions happen

103
Q

How do we diagnose intussusception?

A

-Subjective findings
-confirmed by Xray / CT or ultrasound

104
Q

What are S/s of intussusception

A

-sudden, acute abdominal pain (pulling knees to chest)
-HALLMARK: HELLY like stool
-Episodes of pain come Q15-20 minutes
-abdominal mass (sausage shaped_
-Vomiting, lethargy

105
Q

What are risk factors for intussusception

A

-Age (6 months to 3 years)
-Male gender
-abnormal intestinal formation at birth
-FHx or prior hx of one

106
Q

What are the treatment options for intussusception

A

medical emergency
-avoid severe dehydration, shock and infection
-give fluids
-NG tube to decompress intestines
-Potential antibiotics (infection)
-Barium Enema or Air Enema
*pressure will unfold the intestine
*monitor bowel sounds after

*if this does not work, surgery is used to manually reduce or resect the area.

107
Q

Memory trick for intussusception

A

“Inception- a dream within a dream, a bowel within a bowel”

108
Q

What is biliary atresia ?

A

A blockage or deformity of the bile duct that occurs in infants soon after birth

109
Q

How to diagnose biliary atresia?

A

-History
-physical findings and labs (CBC, electrolytes, bili, and LFT’s)
-Exploratory surgery

110
Q

What is the cause of biliary atresia?

A

Unknown
-possibly acquired in late gestation and manifested a few weeks after birth.
-possible inflammation after birth that leads to destruction of bile ducts

111
Q

What are S/S of biliary atresia?

A

-Jaundice
-dark yellow urine
-white/tan stool
-hepatomegaly, abdominal distention
-poor fat metabolism -> poor weight gain
-irritability
-splenomegaly (occurs later)

112
Q

What are treatment options for biliary atresia?

A

Critical to get early diagnosis (before 2 mo old) *outcome is better

1) surgery - Kasai procedure
*removes damaged bile duct and joins the liver and intestine directly. This allows bile to drain
*liver transplant is often needed by 2 years ld

2) supportive care
*vitamins A, D, E, K, Iron, Zinc
*TPN or gastrostomy if severe failure to thrive

113
Q

What are complications of biliary atresia?

A

Cirrhosis -> liver failure -> death

114
Q

What is Hirschsprung disease?

A

Absence of nerve cell ganglia in the distal colon that keeps the intestines from working properly and passing stool

115
Q

What is the pathophysiology for Hirschsprung disease

A

Typically, ganglion cells trigger contractions and expansions (peristalsis) to help move food through intestines

with Hirschsprung disease: ganglion cells are absent at the end of colon (aganglionic segment)

The aganglionic segment and anal canal are unable to relax.

This increases pressure and peristalsis can’t overcome the pressure

Sttol starts to build up

116
Q

S/S of Hirschsprung disease in NEWBORNS

A

-failure to pass meconium within 48 hours of birth
-bilious vomiting
-trouble feeding
-abdominal distention / pain

117
Q

S/S of Hirschsprung disease in INFANTS

A

-failure to thrive
-constipation
-abdominal distention / pain
-diarrhea
-enterocolitis (fever, explosive watery diarrhea)

118
Q

S/S of Hirschsprung disease in CHILDHOOD

A

-Ribbon-like, foul smelling stool
-constipation
-abdominal distention / pain
-palpable fecal mass
-Undernourished

119
Q

What are treatment options for Hirschsprung disease ?

A

-Stabilize fluid / electrolytes
-DECREASE FIBER
-INCREASE protein
-HIGH calorie diet
-measure abdominal girth
-frequent enemas / irrigation to lessen irritation on colon
-Surgery: remove aganglionic portion

120
Q

What are complications of Hirschsprung disease ?

A

Risk for bowel perforation ***keep eyes open for fever, increased abd tenderness, irritability and dyspnea

Risk for infection ***keep eyes open for s/s of shock

121
Q

What is celiac disease?

A

Intestinal intolerance to dietary gluten that causes damage to villi in the small intestine

122
Q

What is gluten?

A

wheat, barley, rye, oats

123
Q

What is the pathophysiology of celiac disease

A

-Gliadin is a component in gluten that is toxic and damaging to mucosal cells

-body cannot break up the gliadin correctly.

-the gliadin crosses the gut cells and triggers an immune response

-This damages the villi of the small intestine, causing diarrhea and builds antibodies for the next meal

-malabsorption ; decreased electrolytes, protein, carbs and fat absorption

124
Q

What do intestinal villi do?

A

They line the small intestine and help absorb nutrients

125
Q

How to diagnose celiac disease

A

Diagnoses between 1-5 years old. When solids and new foods are introduced.

-blood tests can be done at 18 months

-confirmation biopsy of small intestine showing changes in villi

126
Q

What are s/s of celiac disease ?

A

M: mouth ulcers
A: anemia
L: lactose intolerance
N: N/V/D
O: osteo changes
U: Uncooperative behavior
R: Rash
I: irritability
S: steatorrhea
H: hair loss

127
Q

What is nursing care for celiac disease

A

-help child adhere to diet
-assess s/s
-vitamins
-NO Barley, wheat, rye, oat, lactose
-YES, corn and rice
-increase calories and protein
-decrease fat and fiber (bowl is inflamed)

128
Q

What is bacterial pneumonia

A

bacterial lung infection caused by streptococcus or mycoplasma bacteria

*typically follows viral infection and disturbs the natural defense mechanisms of the upper respiratory tract

129
Q

what are s/s of bacterial pneumonia

A

-high fever, chills
-tachypnea
-chest pain
-cough (may be productive)
-fatigue
-decreased appetite
-lethargy
-may cause respiratory distress (retractions, shallow breathing)

130
Q

What are nursing interventions for bacterial pneumonia

A

-culture
-antibiotic
-antipyretic
-O2
-increase fluids
-nebulizer or cool mist humidifier for thick secretions

131
Q

When should a baby be hospitalized for bacterial pneumonia?

A

<6 months old
moderate resp distress
hd of chronic illness
-pleural effusion occurs

132
Q

What is viral pneumonia?

A

Viral lung infection that is typically caused by RSV or influenza, enterovirus, adenovirus.

**more frequent than bacterial

133
Q

What are s/s of viral pneumonia?

A

-high fever
-dry cough
-tachypnea
-chest pain
-fatigue
-decreased appetite
-restlessness
-resp distress
-crackles, nasal flaring, decreased breath sounds
-irritable

134
Q

Nursing interventions for viral pneumonia

A

Supportive care: O2, fluid, cool mist humidifier, postural drainage, antipyretic

135
Q

What is bronchiolitis?

A

viral infection of the bronchioles caused by RSV

*by 3 mo, most children have been infected at least once

*WInter season

136
Q

What are s/s of bronchiolitis

A

fever
tachypnea
dry cough
wheezing
rhinorrhea
poor feeding
labored respirations

137
Q

Nursing interventions for bronchiolitis

A

O2 (humidified)
mist
suction of nasopharynx
increase fluids

138
Q

What is influenza?

A

viral infection that attacks the nose, throat, and lungs

*most severe in infants (<6 mo) and less severe in children <5 years.

139
Q

How is influenza spread

A

direct contact / droplet precautions

*Most infectious 24 hours BEFORE and AFTER onset of symptoms

140
Q

Nursing interventions for influenza

A

-Rest
-Increase fluid
-antiviral meds (only within 48 hrs of s/s)
-vaccine (after 6 mo)

141
Q

What is Pertussis?

A

Highly contagious bacterial infection that is caused by Bordetella pertussis bacteria

*primarily affects children <4 yo who are not immunized (can be life threatening in infants)

142
Q

What are s/s of perussis ?

A

s/s can take up to a week to show

-may first manifest as the common cold (rhinorrhea, nasal congestion, cough)
-1-2 weeks later, mucous becomes thick and accumulates
-uncontrolled cough -> vomiting
-extreme fatigue
-classic “whoop” breath sounds

*** <6 mo, may not cough, more so apnea

***adolescents may only have cough and no whoop

143
Q

What are treatment options for pertussis?

A

droplet precautions
supportive care
educate on whoop sound
monitor for apnea
antibiotics

*child is infectious until 5 days after abs, or 3 weeks without

144
Q

What are complications for pertussis

A

Young child: seizures, PN intracranial bleeding

Older child: rib fracture, PNA syncope

145
Q

What is croup?

A

An upper airway infection that produces a “barking” or “seal-like” cough

146
Q

Patho of croup

A

1) viral infection of nasopharynx
2) infection spreads to larynx and trachea
3) inflammatory response causing tracheal walls to swell and vocal cords to become impaired
4) edema will restrict airflow
5) croup develops (hoarse voice, barking cough, inspiratory stridor, increase work of breath

147
Q

What causes croup?

A

parainfluenza virus

148
Q

What are complications from croup?

A

excessive swelling that interferes with breathing

-bacterial infection of the trachea

149
Q

What are S/S of croup

A

Mild:
-barking cough (crying makes it worse)
-fever

Moderate:
-mild sx
-inspiration stridor
-increased resp effort
-tracheal tug

Severe:
-mild / moderate sx
-severe retractions
-restless, agitation
-hypoxia
-increased HR
-Decreased LOC

150
Q

What are treatment options for croup

A

-typical recovery is at home
-steroids to reduce swelling
-fluids via IV
-reassurance

Severe:
-immediate resuscitation
-O2
-Nebulizer
-Steroids

151
Q

What is Epiglottitis?

A

Inflammation of the epiglottis that can lead to life-threatening airway obstruction

152
Q

What is the mechanism of action for the epiglottis?

A

Closes when swallowing
Opens when breathing

153
Q

What are causes of Epiglottitis?

A

Most common in children 2-5 years

-haemophiles influenza type B (HIB)
-streptococcus pneumoniae

154
Q

What are S/S of epiglottitis?

A

A: abnormal position (tripod)
D: dysphagia
D: Difficulty speaking (frog like)

A: Apprehensive / anxious
I: Irritable, increase temp (fever)
R: Rapid onset (may wake up with sx)

N: Nasal flaring
U: Use of accessory muscles
R: Retractions
S: Stridor
E: Enlarged, red epiglottis

155
Q

Whare are nursing care interventions for epiglottitis?

A

-never insert anything into pt mouth, spasms will cut off airway

-keep pt calm, crying can increase obstruction

-assess VS

-Do NOT put in supine

-NPO

-Administer meds (abx, antipyretics, corticosteroids)

156
Q

What vaccine is giving to help prevent epiglottitis?

A

HIB Vaccine
(2, 4, 6, 12 months old)

157
Q

What is Asthma?

A

Chronic lung disease that causes inflammation and narrowing of the bronchi and bronchioles.

158
Q

What happens during an asthma attack

A

1) smooth muscle constricts
2) mucosal lining creates excess mucus production and inflammation
-> this decreased airflow, which leads to coughing, wheezing, and air trapping
3) Goblet cells collect bacteria to prevent it from going into the airway

159
Q

What are possible triggers for asthma

A

Inhaled: smoking, pollen, pollution, perfume, dander, dust, pests, mold

Cool/dry air

respiratory infection

exercise

GERD, Hormonal shift

Beta blockers, NSAIDS, Aspirin, Sulfets

160
Q

What are EARLY s/s of Asthma

A

SOB
Wheezing
easily fatigues
cough at night, trouble sleeping
sneezing, scratch throat
decreased peak flow

161
Q

What are ACTIVE s/s of asthma

A

Chest tightness
tachycardia
increased respiratory rate
cough
wheezing
dyspnea
<90% O2

162
Q

What are SEVERE s/s of asthma

A

Rescue inhaler does not work
can’t speak
chest retractions
cyanosis of lips/skin, sweating

163
Q

What are nursing interventions of asthma

A

Continuous VS
keep pt calm
high fowlers position
Oxygen
Bronchodiators
assess lung sounds

164
Q

What is peak flow?

A

person best; highest # over a 2-3 week period when asthma is controlled.

Good = 80-100%
Caution = 60-80%
Danger 60% -> go to doc

165
Q

What are actions for Acute Asthma attack

A

FAST RELIEF!

Frist: Albuterol
Second: Ipratropium

166
Q

What are actions for long term control of chronic asthma

A
  1. Salmeterol
  2. corticosteroids
  3. montelukast
167
Q

What is Cystic Fibrosis?

A

Inherited disorder that affects the exocrine glands in the lungs and digestive system

168
Q

What is happening with CF

A

affects the cells of the exocrine glands which produce mucus, sweat and digestive juices.

-NORMALLY; these are fluids are thing and slipper.
-In CFl the secretions are sticky and thick, which plugs tubes, ducts and passage ways

169
Q

What is the life expectancy for someone with CF

A

37 years old

170
Q

When is CF detected?

A

Typically 1st year of life

Earliest postnatal sign is meconium ileus; blockage of small intestine with this meconium

171
Q

What are complications and symptoms of CF - earliest signs

A

Meconium Ileus:
-failure to pass stools
-abdominal distention
-vomiting
-rapid dehydration

172
Q

What are complications and symptoms of CF - Respiratory

A

Thick, sticky mucus builds up and causes obstruction on bronchioles

-wheezing, emphysema
-air trapping, atelectasis
-Recurrent lung infections and upper sinus issues
-Nasal polyps, stuffy nose / sinuses
-increased risk of infection (mucous is just sitting there)

173
Q

What are complications and symptoms of CF - Skin

A

-sweat glands increase sodium in saliva
-risk electrolyte imbalance
-baby’ skin will taste salty

174
Q

What are complications and symptoms of CF - GI

A

Thick mucus plugs channels that carry enzymes from pancreas to small intestine -> this will decrease digestion and absorption

Enzymes = protease, amalase, lipase = digestive vitamins, fats, proteins

-Greasy foul smalling stools (bulky)
-constipation
-malabsorption of Vit A, D, E, K and protein
-poor weight gain, not digesting fats
-can lead to diabetes -> pancreatic fibrosis

175
Q

How do we diagnose cystic fibrosis?

A

1) Genetic Testing (CFTR gene)
2) Sweat Chloride test (measure Na)
*<39 = Neg, 40-59 = need to further testing, >60 = positive
3) Sputum test, pulmonary function test, Chest X-ray / CT scan

176
Q

What is the CFTR gene?

A

-Controls the Na/Chloride channels

-when mutated, chloride gets trapped in the cells

-without proper chloride mvmt, water can’t hydrate the cells surface

-thick mucus forms

177
Q

What are treatment options for CF?

A

No Cure!! Supportive treatment only

Respiratory care
-chest physiotherapy (drains airway of mucus by vibrating the chest to cough it up)
> 2-4x per day for 20 minutes;
>huff coughing
>nebulizer -> bronchodilators, mucolytics, anti-inflammatories
>Aerobic exercise -> helps to clear mucus, but increase risk of Na loss. *make sure to add Na and calories

GI
-Drink plenty of fluid
-stool softeners
-monitor Bg - may need insulin

Nutrition
-High protein, calories and fat!
-D,E,K,A Vitamins
-Pancreatic enzymes -> will help replace lost enzymes to absorption in the GI system **do not give with milk

178
Q
A

PEDS (6 decks)

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