Common Pediatric Illness Cards

Question 1

Bronchiolitis

Answer 1

Nursing Interventions: antipyretics, cool-mist humidifier, nasal saline rinses, & ensuring the patient is eating and hydrated.

Symptoms: fever, runny nose, cough, decreased appetite, tachypnea, wheezing

Pathophysiology: infection as well as inflammation, edema, and debris leading to obstruction of the bronchioles ultimately causing hyperinflation, increased airway resistance, atelectasis, & ventilation-perfusion mismatching.

Question 2

Hyperbilirubinemia

Jaundice

Answer 2

Nursing Interventions:
* monitor intake & output
* administer prescribed medications & fluids
* maintain IV access
* anticipate & prepare equipment for phototheraphy
* daily weight (at same time each day)
* If doing phototherapy: shield the baby’s eyes to protect retina, protect the baby’s genitals & perianal area, provide meticulus skin care, & expose as much of the baby’s skin to the lights as possible

Symptoms: yellowish skin (specifically in the sclerae), tachycardia, hypotension, increased sleepiness or tiredness, decreased appetite or not feeding as well as usual, dark urine

Pathophysiology:
* As RBCs break down, hemoglobin separates into globin (protein) & heme (iron) fragments.

• Heme fragments from unconjugated (indirect) bilirubin
• Since unconjugated bilirubin is fat-soluble & can’t be excreted in urine or bile, it may escape into extravascular tissue, resulting in hyperbilirubinemia, especially in fatty tissue & the brain, causing acute bilirubin encephalopathy.

Question 3

Pneumonia

Answer 3

Nursing Interventions:
* administer prescribed medications, IV fluids, & oxygen as prescribed
* maintain a patent IV
* elevate the head of the bed to ease breathing
* suction patient’s airway as needed
* monitor intake & output
* daily weights at same time
* monitor oxygen saturation, respiratory status, pain level, vitals, etc.

Symptoms: fever, crackles / wheezing / rhonchi, cyanosis (severe), decreased breath sounds, tachypnea, retractions, grunting, flaring of nares, cough with sputum production, dullness with percussion over affected area

Pathophysiology: A gel-like substance forms as microorganisms & phagocytic cells break down. The substance consolidates within the lower airway structures leading to nflammation which involves the alveoli, alveolar ducts, & interstitial spaces surrounding the alveolar walls.

Question 4

Tonsillectomy & Adenoidectomy

Answer 4

Nursing Interventions:
* ensure proper hydration
* pain management - administer meds as prescribed
* monitor intake & output

Symptoms: recurrent infections in the throat / tonsils such as strep throat, pain / difficulty swallowing, decreased appetite, snoring, tonsil stones, significant blockage of the nasal passage, uncomfortable breathing

Pathophysiology: often occurs due to
* recurrent or chronic tonsil & adenoid infection
* obstructive sleep apnea (OSA)
* peritonsillar abscess cellulitis or abscess
* tonsillar obstruction that alters voice quality
* nasal obstruction
* tonsil enlargement
* recurrent middle ear infections due to tonsil enlargement

Question 5

Dehydration

Answer 5

Nursing Interventions:
* maintain patent IV access
* administer IV fluids as prescribed
* encourage fluid intake (popsicles, pedialight, juice)
* monitor intake & output

Symptoms: increased thirst, decreased urination, dark urine, dry mouth or cracked lips, feeling tired or confused, dizziness or lightheadedness, sunken eyes or sunken fontanel (in babies), abnormal capillary refill and/or skin turgor

Pathophysiology: a loss of free water in greater proportion than the loss of sodium in the body. Since infants & children have higher body water content, they require proportionally greater volumes of water than adults to maintain their fluid equilibrium & are more susceptibel to dehydration. Can also lead to acid-base imbalance if left untreated (metabolic-acidosis, can also lead to hypokalemia, hyponatremia, or hypernatremia).

Question 6

Sepsis

Answer 6

Nursing Interventions:
* administer medications, IV therapy, & oxygen as prescribed
* administer blood products (if prescribed) & monitor transfusion reactions
* monitor vitals
* assess heart & lung sounds for any changes
* monitor intake & output
* maintain a patent IV
* daily weights
* monitor for neurological changes

Symptoms: fever (in young infants you may see hypothermia), altered mental status such as confusion / letharagy / irritability, poor oral intake, decreased urine output, signs of dehydration (decreased skin turgor, dry mucous membranes), hypotension,

Pathophysiology:
* An infection triggers pro-inflammatory & anti-inflammatory mechanisms.
* in sepsis, an imbalance in the inflammatory cascade leads to tissue damage & low systemci vascular resistance
* leads to functional hypovolemia, thrombosis of small & mid-sized vessels, decreased cardiac output, poor tissue perfusion, hypotension, as well as hypoperfusion & hypoxemia to the tissues & end-organs which can cause organ dysfunction

Question 7

Appendicitis

Answer 7

Nursing Interventions:
* obtain & maintain IV access
* administer medications & IV fluids as prescribed
* utilize non-pharmacological measures to treat pain & discomfort (positioning, splinting when coughing, etc.)
* ensure patient is NPO until it is determined if they need surgery
* monitor output, pain level, vitals, abdominal pain / symptoms

Symptoms: abdominal peri-umbilical pain or tenderness usually in RLQ (+ McBurney Point), nausea, vomiting, fever, lethargy, tachycardia, pallor, shallow breathing, guarding

Pathophysiology:
* mucosal ulceration triggers inflammation which temporarily obstructs the appendix which causes mucus outflow therefore increased pressure in the distended appendix
* bacteria multiply & inflammation & pressure increase, restricting blood flow which causes thrombosis & abdominal pain
* continued inflammation, pressure, & fluid collection can lead to perforation & spillage of the appendiceal contents into the peritoneal cavity leading to peritonitis