Exam 2 Flashcards
Osteogenesis Imperfecta
A group of inherited disorders characterized by fragile bones that break easily (aka brittle bone disease)
Scoliosis is a varying degree of OI
Scoliosis
a term referring to any abnormal curve in the body. Scoliosis can be defined as congenital, neuromuscular, or idiopathic.
Management of scoliosis
Curves are measured using the Cobb angle, the larger the degree of curvature, the more severe the deformity
The goals of treatment are to prevent progression of the spinal deformity, allow the child to reach the end of growth with a reasonably straight, well-balanced spine, and to allow the spine to grow as much as possible.
Children with cerebral palsy are at risk
Observe (45o)
Developmental Dysplasia of the Hip
Abnormal growth of the hip- Abnormal relationship between the acetablulum and femoral head
#1 cause of pediatric lawsuits
Will lead to poorly formed hips, abnormal gait, pain, hip damage and osteoarthritis
Uneven gluteal folds
Asymmetric hip abduction
Uneven knee heights
Waddling gait
Developmental Dysplasia of the Hip: Treatment
Early diagnosis is the most crucial aspect of the treatment
18 months or failed closed reduction = Open reduction with adductor tenotomy and arthrogram, Spica cast for 6 weeks then cast change in OR with repeat arthrogram –> Total time in spica ~ 12 week
Developmental Dysplasia of the Hip: Diagnosis
Positive physical exam = referral to pediatric orthopaedics
4 months of age: AP and Frog xray
Cerebral Palsy
Non-progressive, non-contagious CNS disorder caused by hypoxic brain injury
Symptoms range from minor to severe and include abnormal muscle movement, tone, balance, gait disturbances
Complications: mental impairments, seizures, growth problems, impaired vision or hearing, and hydrocephalus
Cerebral Palsy: Medications
Oral meds to treat spasticity = Baclofen, dantrolene sodium and diazepam
Parenteral meds to treat spasticity = Baclofen, botulin toxins
Cerebral Palsy: Treatment
Promote mobility (ex. horseback riding)
Promote nutrition
Provide support and education
Skin care
Amputation
Amputation of the upper extremities is never indicated as almost any portion of a limb is better than no limb.
Lower limb amputations are common and often indicated if the joints of the extremity are non-functional and unstable.
It is important to help parents consider the child’s function long term and remind them that their child and their friends will know this as “normal.”
Club feet: Treatment
Ponseti casting technique–> Serial casting supinates and abducts the foot until the forefoot is in normal alignment with the hindfoot.
After the serial casting, p/t wears the Denis-Browne bar. Wear the shoes 23 hours, time given for skin checks and baths. Wear until 8-9 months when they begin to express an interest in standing/walking.
Infants will hit milestones despite shoe and bar wear. They will sit, crawl, and stand in bar.
Cast care
Don’t put anything in cast
Can’t get wet (Unless waterproof, short arm casts only)
Benadryl or hairdryer on cool setting for itching
4-6 weeks typically
longer than 6 wks will cause joint contracture
Patient should be able to wiggle digits and always have normal color
Compartment Syndrome
Medical Emergency
Muscle groups are compartmentalized in the body by fascia
Fascia does not expand
Excessive swelling will lead to increased pressure in the compartment
Most common in lower leg and forearm, can occur anywhere
Compartment Syndrome: Causes
surgery, complex fractures, soft tissue injuries, crushing trauma, tight cast, IV infiltration, hyponatremia, snake bites, burns
Compartment Syndrome: S/S
Severe pain that gets worse (not relieved with medication), decreased function, loss of sensation, weakness, pale of skin
Pain when the compartment is squeezed, severe pain when you move the affected area, swollen/shiny skin
Often missed in unconscious p/t’s
Mumps: S/S
History of exposure or lack of immunization; malaise; low grade fever; anorexia; ear pain; pain with chewing; unilateral or bilateral parotid swelling, fever; orchitis in boys
Mumps: Management
Acetaminophen for fever
Oral fluids
Ice packs to testicles with support if orchitis present
Droplet precautions for 9 days after swelling starts
Pinworms: S/S
itching at night, teeth grinding at night, wt. loss, enuresis
Pinworms: Management
mebendazole x1, then repeated in 2 weeks; treat all in household
Rubeola (Measles): S/S
Koplik’s spots (grayish bumps on buccal mucosa), fever, acute rhinitis, cough, conjunctivitis, erythematous macropapular rash
Rubeola (Measles): Mangement
self-limiting requiring supportive therapy
Highly contagious; spread by droplets and contact
Contagious 3-5 days before rash until 4 days after rash
Can be fatal
Rubeola (Measles): Prevention
Measles vaccine
Scarlet Fever: S/S
Fever, nausea, sunburn rash, swollen pharynx, lymph nodes, red coated tongue
Rash 2-5 days after pharyngitis
Scarlet Fever: Management
Pennicillin V, fluids, cool mist
No longer contagious after 24 hours of antibiotics
Varicella: S/S
Fever, malaise, anorexia, headache, abdominal pain, puritis
Varicella: Management
supportive, airborne and contact precautions until MOST have crusted over.
Longer (8-21 days) before contact with immunosuppressed people.
Varicella: Prevention
Contagious 1-2 days before rash/Crust over 5-7 days,
2 doses of chickenpox vaccine- 1st at 12-15 months old, 2nd at 4-6 years old
Antivirals if high risk
Lyme Disease: S/S
Stage 1: (3-31 days) chills, fever, headache, stiff neck
Stage 2: Systemic involvement (neuro, cardiac, musculoskelatal)
Stage 3: Advanced systemic involvement, arthritis, deafness, encephalophathy
Nursing assessment: Hx, rash: “bulls eye”, fever, malaise, arthralgia, migraines
Lyme Disease: Management
Tick removal
Antibiotic treatment: (Doxycycline > 8y, Amoxicillin
Lice: S/S
intense itching; may visually see adult nit
Lice: Management
shampoo hair with pediculicide, comb out nits, wash clothing in hot water
Fifth Disease: S/S
Erythea Infectiosum
Low grade fever, upper respiratory 2 days before rash, “slapped cheek” facial appearance
Fifth Disease: Management
Erythea Infectiosum
comfort measures, droplet precautions, can cause aplastic crisis with sickle cell patients
Resolves 1-3 weeks
Otitis Media: Types
Acute otitis media
Otitis media with effusion
Otitis Externa
Asthma: Medications
Combo steroid/long acting beta agonist: Fluticasone/salmeterol (Advair)
Leukotriene modifiers: Montelukast (Singulair)
Short-acting b-agonist bronchodilators: albuterol (Proventil) levalbuterol (Xopenex), terbutaline (Brethine)
Anticholinergics: Atrovent
Sympathetic: Racemic Epinephrine
Steroids: Methylprednisolone (IV/PO), PO Prednisone (Deltasone)
Cystic Fibrosis: Meds
Short-acting b-agonists (albuterol) Anticholinergics (Atrovent) Advair Nebs/MDI/DPI Dornase alpha (Pulmozyme) Antibiotics: Tobramycin, Gentamycin, Ticardillin Pancreatic Enzymes (Pancrease) Fat-Soluble Vitamins (A,E,D,K)
Cystic Fibrosis: Treatment
maintain patent airway, preventing infection, maintaining growth, promoting family coping, high protein and caloric diet, fluids!, med compliance, preparing for adulthood
Cystic Fibrosis: S/S
wheezing, cough, dyspnea, mucus plugs, cyanosis, barrel-shaped chest, clubbing, multiple respiratory infections
**Meconium ileus- earliest recognizable sign
Cystic Fibrosis: Diagnosis
sweat chloride test, chest x-ray, stool sample, PFT’s
Croup: Treatments
Exposure to humidified air (cool mist humidifier or steamy bathroom), Fluids, analgesics or antipyretics
O2 if sats less than 92, steroids (ral, neb, injection), racemic epinephrine
Epiglottitis: Treatment
Culture directed antibiotic therapy: Ceftriaxone, cefotaxime, cefuroxime. Rifampin if H-flu B
Rifampin for all exposed to epiglottitis for 4-day prophylaxis
DO NOT ATTEMPT TO VISUALIZE THROAT, MEDICAL EMERGENCY
Epiglottitis: S/S
SICK!; sudden onset of symptoms an high fever, toxic appearing, severe sore throat, muffled voice, may refuse to speak, assume classic position of sitting forward with the neck extended, may drool, anxious an frightened, stridor late sign
Nasopharyngitis
Viral upper respiratory infection (URI) or common cold
S/S: nasal inflammation, rhinorrhea, cough, sneezing, nasal voice.
RSV/Bronchiolitis: Management
maintain patent airway, humidified O2, promote adequate gas exchange- continuous pulse ox, Fluids, nebulized bronchodilators, CPT
RSV/Bronchiolitis: Prevention
Hand washing, disinfecting surfaces, Palivizumab (Synagis) given IM every month of the season
RSV/Bronchiolitis: Diagnosis
Nursing assessment: rhinorrhea, fever, cough and Wheezing that progresses to respiratory distress, post-tussive vomiting.
Pulse ox decreased
Chest radiograph- hyperinflation and atelectasis or infiltration
Blood gases- co2 retention and hypoxemia
Nasal-pharyngeal washings- positive ID made via enzyme-linked ELISA or IFA testing
Pneumonia: S/S
High fever, cough, respiratory distress, chest pain, rhonchi, crackles, irritable, abdominal pain, N&V, pale color-cyanosis.
Pneumonia: Management
less severe- antipyretics, adequate hydration, close observation
severe -supplemental O2, IV hydration, and antibiotics
Tonsillectomy post-op care
Side-lying position Elevate head Assess for bleeding Assess airway Analgesics Ice collar, ice chips, soft diet Avoid coughing, nose blowing Rest
Strep Throat: Management
Promoting comfort and providing family education; discard toothbrush after 24 hrs of abx
RX: Group A Strep- penicillin, IV fluids if dehydrated
