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NUR2204C > Common Childhood Problems > Flashcards

Common Childhood Problems Flashcards

1
Q

Risk factor of hyperbilirubinemia

A
  1. Gestational diabetes
  2. ABO blood
  3. RH incompatibility
  4. Preterm births <37 weeks
  5. Birth weight <1.5kg
  6. East Asian
  7. Genetic disorders (ie. G6PD)
  8. Birth injuries
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2
Q

Kernicterus & signs/symptoms

A

Develop cerebral palsy due to damage to basal ganglia

  1. Lethargic
  2. Poor feeding
  3. Abnormal tone & posturing
  4. High pitch cry
  5. Irritability
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3
Q

Temperature routes & fever levels

A
  1. Oral 37.8
  2. Tympanic 38
  3. Axillary 37.2
  4. Rectal 38
  5. Temporal 38
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4
Q

Tools for diagnosis of fever

A
  1. CBC (leukocytosis)
  2. Urinalysis (pyuria- WBCs in urine)
  3. Specific antibody tests (autoimmune suspected - antinuclear antibodies for lupus)
  4. Imaging (depending on underlying cause suspected)
    - chest x ray
    - abdominal ultrasound
    - echocardiogram
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5
Q

Treatment for fever

A

Depends on underlying cause
1. antibiotics to treat bacterial infections along with extra fluids and rest
2. Antipyretics (acetaminophen or ibuprofen) to decrease body temperature, restore thermoregulatory set point and decrease symptoms

DO NOT GIVE ASPIRIN (unless they have Kawasaki disease) as it leads to risk of reye syndrome which is rare but fatal and can cause liver and brain damage.

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6
Q

Physiology of thermoregulation (heat dissipation)

A
  • vasodilation of blood vessels near the skin
  • increase sweat production by sweat glands
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7
Q

Physiology of thermoregulation (heat production)

A
  • metabolic processes that generate heat as a byproduct
  • hypothalamus initiate cold stress response by shivering
  • increase release of thyroid hormone thyroxine
  • neonates rely on nonshivering thermogenesis -> brown adipose tissue which disappears after infancy
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8
Q

Order of fever pathophysiology

A
  1. Exogenous pyrogens are released into the bloodstream
  2. Pro inflammatory molecules reach the hypothalamus
  3. Body temperature rises
  4. Neutrophil & T cell counts increases
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9
Q

Sympathetic stimulation that helps avoid heat dissipation

A
  • vasoconstriction of blood vessels on skin
  • piloerection (erection of hairs due to contraction of affect or pili muscles)
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10
Q

Failure to thrive

A

Inadequate growth (typically in infancy & childhood)

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11
Q

Causes of FTT

A

Organic
- underlying disorder interfering with bodily functions necessary for growth and development (nutrient intake, absorption and metabolism)
- e.g. gastroesophageal reflux, celiac disease, nephrotic syndrome, cystic fibrosis, Down syndrome or congenital malformation (hypertrophic pyloric stenosis/cleft lip/palate

Non-organic
- inappropriate feeding methods
- low socio economic status or parental education level
- structural racism & practices
- domestic abuse & violence
- substance use disorder
- family stress

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12
Q

Pathology of FTT

A
  1. Not eating enough (under nutrition)
  2. Body unable to use those nutrients due to celiac disease or nephrotic syndrome
  3. Increase caloric demand that is not met e.g. heart failure
  4. Metabolic disease e.g. DM interfere with body’s ability to utilise the nutrients and calories from food eaten
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13
Q

Clinical manifestations of FTT

A
  1. Most fail to gain weight & height
  2. Delays in developmental milestones or loss acquired milestones
  3. Poor muscle tone
  4. Decrease activity
  5. Easily irritable
  6. Refuse food & uninterested in feeding
  7. Hypertrophic pyloric stenosis - postprandial vomiting
  8. Diabetes mellitus - polydipsia, polyphagia, polyuria & weight loss
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14
Q

Causes & risk factors for fever (inflammation in absence of infection)

A
  1. Hypersensitivity reactions in response to medications like penicillin
  2. Malignant conditions like lymphoma
  3. Chronic inflammatory conditions like inflammatory bowel disease & Kawasaki disease
  4. Autoimmune diseases like lupus
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15
Q

Clinical manifestations for fever

A
  1. Lethargy or malaise
  2. Dehydration
  3. Increase temperature
  4. Tachycardia
  5. Vomiting
  6. Sore throat
  7. Chills
  8. Decreased appetite
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16
Q

Treatment for FTT

A
  1. Provide prescribed diet based on severity malnutrition (estimated energy needs, desired weight gain)
  2. Start refeeding process slowly (smaller amounts & frequent, NG tube)
  3. Monitor nutritional and fluid I/O, weigh daily
  4. Interdisciplinary team (identify & address underlying cause)
  5. Signs of refeeding syndrome (vital signs, laboratory test results) & signs of electrolyte imbalance (hypophosphatemia, hypokalemia, hypomagnesemia)
  6. Provide emotional support for child & caregivers (involve them in providing care, praise positive interactions)
17
Q

First stage of poisoning

A

<24 hours
No or mild symptoms
- Vomiting & nausea

18
Q

Second stage of poisoning

A

18-72 hours
Upper right quadrant pain due to liver involvement
Hypotension

19
Q

Third stage of poisoning (72-96 hours)

A
  1. Liver dysfunction
  2. Jaundice
  3. Coagulopathy
  4. Hepatic encelopathy
  5. Renal failure
  6. Metabolic acidosis
20
Q

Fourth stage of poisoning

A

> 5 days
* possible to Recover
multiple organ failure
Death
For acetaminophen heavy use, can lead to acute chronic liver failure

21
Q

Complications of FTT

A

Infectious diarrhoea
Sepsis
Respiratory tract infections
Permanent effects:
- short stature
- poor cognitive development
- poor academic performance (late childhood & adulthood)

22
Q

(NAI) Physical abuse

A
  1. Shaken baby syndrome
  2. Ritual abuse
  3. Physical neglect
  4. Failure to thrive
23
Q

(NAI) Psychological Abuse

A
  1. Verbal abuse
  2. Bullying
24
Q

(NAI) Sexual abuse

A
  1. Rape
  2. Molestation
  3. Incest
  4. Pornography
  5. Prostitution

NUR2204C (4 decks)

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