Paediatric - Conditions Flashcards
1
Q
Asthma
A
- narrowing of small airways (bronchospasm + inflammation + mucous production)
- symptoms in children more severe as they have smaller airways
- caused by triggers - URTI, dust, exercise, seasonal changes, pet hair, pollens
2
Q
Asthma - Symptoms
A
- shortness of breath
- increased WOB
- tachycardia
- tachypnoea
- cough
- ? wheeze (airways can be occluded, no air passing through, no wheeze)
3
Q
Asthma - Management
A
- continual assessment of respiratory status
- bronchodilators, corticosteroids (reduce inflammation), supplemental oxygen therapy, aminophylline
- hydration
- can become acute quickly, need to be in area where visual assessments can be done frequently
4
Q
Bronchiolitis - Definition
A
- acute viral infection of the lower airway (antibiotics are useless), inflammatory obstruction of the bronchioles
- even minor swelling of bronchioles in an infant can produce profound changes in airflow
- common in the cooler months
- source is usually family member with minor respiratory illness
- peak incidence 1-6 months up to 2 years old
- diagnosed on nasal pharyngeal aspirate (NPA)
5
Q
Bronchiolitis - Symptoms
A
- can inhale, can’t exhale
- presentation
- increasing respiratory distress
- tachypnoea
- increasing cough
- irritability
- decreased feeding
- wheeze / apnoea
- develops into respiratory distress, wheezy cough, dyspnoea, irritability
- air becomes trapped in the lungs & interferes with gas exchange
- hypoxaemia
- hypercapnia in severe cases
- collapse of alveoli
- wheezing & rales
6
Q
Bronchiolitis - Management
A
- most critical phase - first 48-72hrs
- cyanosis, pallor, listlessness, sudden diminution or absence of breath sounds indicate impending respiratory failure
- nurse upright
- monitor respiratory status frequently
- antibiotics are ineffective (viral infection)
- treat dehydration if present - ensure adequate hydration
- minimal handling - conservation of energy - comfort
- educate parents
- incubation 2-8 days, nurse in isolation
- strict hand washing, course of illness is 7-10 days
7
Q
Croup - Acute Laryngotracheobronchitis - Definition
A
- acute viral illness, causes inflammation oedema & obstruction of the larynx, trachea & bronchi (inflammation & swelling in upper & lower airway)
- swelling causes narrowing = high pitched stridor and barking cough
- most common in cooler months
- infants & children 6-36 months, up to 7 years
- usually due to parainfluenza (75%)
8
Q
Croup - Acute Laryngotracheobronchitis - Presentation
A
- diagnosis made on presentation & symptoms rather than testing for the virus
- 2-3 days of URTI symptoms
- increasing respiratory distress
- inspiratory stridor
- barking cough
- fever
- all worsening at night
- substernal & intercostal retractions
- child prefers to sit up or be cuddled
9
Q
Croup - Acute Laryngotrachobronchitis - Management
A
- ongoing assessment of respiratory status
- good history
- minimal interventions - if child becomes stressed, increases work of breathing & can lead to respiratory distress
- steroids - get inflammation down
- hydration
- adrenaline (nebulised)
10
Q
Pertussis - Definition
A
- bacterial infection of the respiratory tract
- highly contagious, 70% of unimmunised children will get it, is preventable by vaccination, confirmed cases need to be reported to the health department
- can be fatal
- causes - bordatella pertussis - gram negative bacillus
- diagnosis - with NPA or bloods
- transmission - via respiratory droplets or handling contaminated items
11
Q
Pertussis - Symptoms
A
- incubation of 7-10 days
- URTI symptoms 1-2 weeks
- irritating cough, sneezing, fever, collection of thick secretions
- cough becomes paroxysmal (develops an odd pattern) or spasmodic with little or no effective respiration inbetween
- deep breath after prolonged coughing = characteristic “whoop” or apnoea in babies
12
Q
Pertussis - Management
A
- isolation
- assistance with adequate oxygenation
- support during coughing episodes - positioning, suctioning, oxygen if required
- hydration
- antibiotics - 10-14 days to recude communicability - doesn’t reduce severity or length of illness
13
Q
Chicken Pox - Definition
A
- contagious viral infection
- cause - varicella zoster
- incubation period 12-21 days, infectious 2 days prior to spots appearing until all dried and crusted
- complications - pneumonia, bacterial infection, meningitis, representation as shingles later in life
- doesn’t require hospitalisation unless child is under 12 months old, develops infection of spots or if involves oral mucosa or eyes
14
Q
Chicken Pox - Symptoms
A
- 2-3 days of viral symptoms
- fever
- runny nose
- lethargy
- decreased appetite
- conjunctivitis
- appearance of prodromal rash (pustules) which gradually spread
- spots begin on the trunk
15
Q
Chicken Pox - Management
A
- isolation
- treatment of fever
- adequate diet & fluids
- pinetarsol baths & calamine lotion for itching
16
Q
Measles - Definition
A
- viral illness caused by morbillivirus
- preventable disease, vaccination available, contagious, cases are reportable to health department
- complications - otitis media, pneumonia, encephalitis
17
Q
Measles - Symptoms
A
- all must be present for diagnosis
- generalised macropapular rash for 3 days or more
- consistent fever of 38 degrees or more
- cough
- cold symptoms
- Koplik’s spots
18
Q
Measles - Management
A
- isolation
- self limiting
- early gammaglobulin may reduce severity
- fluids & diet
- comfort
19
Q
Gastroenteritis - Definition
A
- infective diarrhoea and vomiting resulting from acute infection of the bowel
- predominantly viral in developed countries, bacterial does exist but is rare
- highly contagious, faecal - oral contact
- poor management leads to dehydration which can be fatal
20
Q
Gastroenteritis - Pathophysiology
A
- ingestion of pathogen (most commonly viral - rotavirus)
- colonisation in and destruction of mucosal cells and villi of small intestine
- smaller intestinal surface area, much reduced capacity for fluid and electrolyte absorption = diarrhoea
- aggravation of the stomach and intestines = vomiting to rid the body of the toxic pathogens
21
Q
Gastroenteritis - Symptoms
A
- vomiting
- diarrhoea
- fever
- lethargy - floppy child = dangerous
- weight loss - acute
- clinical signs & symptoms of dehydration
- possible fluid & electrolyte imbalance
- abdominal pain & cramping
22
Q
Gastroenteritis - Dehydration Symptoms
A
- poor skin turgor
- sunken eyes
- dry mucous membranes
- irritable child
- reduction in number of wet nappies
- flat appearance
- tachycardia
- tachypnoea
- oliguria
- prolonged capillary refill time
- decreased level of conciousness
- peripherial vasoconstriction
- hypotension (late indicator)
23
Q
Gastroenteritis - Diagnosis
A
- clinical assessment
- determination of hydration state
- bloods
- urine - specific gravity, anything in the urine, quantity of urine
- faecal spec - if bacterial
- detailed history
- vomiting - projectile is pyloric stenosis, pattern, type of vomiting
- diarrhoea - frequency, descriptive
- hydration status
- vital signs
- pain
- intake / output
24
Q
Gastroenteritis - Management
A
- accurate assessment - half hourly
- replace water losses
- correct acid base / fluid & electrolyte imbalances
- medication
- maintenance of fluid balance
- infection control
- fluid management
- oral rehydration solution based on weight
- severe dehydration - treat for shock first (20mls/kg normal saline bolus)
25
Q
Urinary Tract Infection - Definition
A
- pathological microorganisms in renal tract, risk of renal scarring (can impact on adult renal function)
- causes - bowel flora, anatomical factors, blood borne (systemic infection that settles in kidneys)
- girls more than boys, but equal in infants (when wearing nappies)
26
Q
UTI - Symptoms
A
- infants
- FTT
- vomiting
- diarrhoea
- sepsis
- apnoea
- children
- enuresis
- odour
- fever
- frequency / urgency
- dysuria / pain
- haematuria
27
Q
UTI - Management
A
- uncomplicated
- urine culture
- oral / IV antibiotics
- complicated
- urine culture
- treat for pyelonephritis
- IV antibiotics
- oral antibiotics
- follow-up
28
Q
Fever - Definition
A
- fever is a symptom, not a disease
- high temperature does not indicate serious illness, fever itself isn’t harmful until it reaches 42 degrees
- normal body temp varies during the day, from 36.2-38, can increase up to 38.5 by the end of the day in a normal active toddler
- fever is a normal response to infection, bodies natural defense against invasion of microorganisms
29
Q
Febrile Convulsions
A
- generalised transient convulsion in a febrile child
- usually occurs when sudden temperature change
- leads to minor discomfort, frequent occurrence, 1 in 30, can occur from 6 months - 6 years old
- not harmful, doesn’t lead to brain damage, no increased risk of epilepsy in a single episode, repeated febrile convulsions do increase risk of epilepsy
- the younger the child the greater the risk of re-occurrence, can have repeated convulsions with the same illness
- parents need to be comforted & calmed as is frightening to watch, support & educate parents
30
Q
Febrile Convulsions - Symptoms
A
- loss of consciousness
- muscle jerking or stiffness
- colour change
- frothing
- lasting under 5 minutes
- regains consciousness but “drowsy”, associated period of being unwell
31
Q
Surgical Admissions
A
- for
- elective surgery (ENT, hernias, plastics, ortho, day cases)
- fractures (GAMP - general anesthesic manipulation & plaster, LAMP - local anesthetic manipulation & plaster, ORIF - open reduction, internal fixation)
- emergency surgery (trauma, plastics, microsurgery, acute abdomen)
- management
- fasting
- theater checklists
- pain assessment & relief
- parental education & support
- family centred care
- post operative management
