Pediactrics Flashcards
Pain scales
- The name of the pain scale is CRIES, it’s an acronym for:
Crying (0-2)
Requires increased oxygen (0-2)
Increased vital signs (0-2)
Expression (0-2)
Sleepless (0-2)
• The higher the score the worse pain in all the scales. - FLACC
2months to 7 years
Face, Legs, Activity, crying, Consolability. 0-10 scale: 0 no pain, 10 worst pain - Wong-Baker rating scale is used on children at what age? Any age but usually 3 years and older.
• Make sure child has cognitive development and is not developmentally delayed.
• Scale is 0-5. Shows smiling faces.
d. Numerical scale is used at age 5 and older.
Pedi vitals
Order of obtaining vital signs:
1) Respirations
2) Heart Rate
3) Blood Pressure
4) Temperature
b. Always count RR and HR for one full minute because of irregularities.
c. If vital signs cannot be taken with out disturbing the child, then record the
behavior with the measurements.
d. Temperature:
1) Rectal: Do not use in children over 3 months.
• Most reliable measurement of core temperature.
2) Axillary: All ages may be done when an oral route is not possible.
3) Oral: Start at age 5-6.
4) Tympanic: All ages.
Hint: Always document where temperature was taken, do not add a degree.
e. Oxygen saturation: Used to obtain a picture of blood oxygen level through the skin.
1) Check perfusion, skin temp, and edema to determine the best location for sensor probe.
2) Common sites are fingers and toes.
3) Record what is going on at the time the pulse ox is measured.
• Will activity level affect the oxygen level? Yes
4) The pulse wave form/intensity display on the oximeter machine should
correlate with the child’s radial pulse.
Laryngotracheobronchitits/croup
• Most common type of Croup experienced by children admitted to the hospital and primarily affects children under 5.
1) Causes:
• Parainfluenza, adenovirus, and RSV
2) S/S:
• Slight to severe diarrhea
• barking or brassy cough.
• Increased temperature.
3) Tx:
• Mild croup can be treated at home with steam (hot showers), cool mist humidifiers, car rides with windows down.
• If symptoms worsen or do not improve, hospitalization is required with corticosteroid therapy.
Epiglottitis
1) Causes: H. influenza
2) S/S:
• Absence of cough
• Drooling
• Agitation with the rapid progression to severe respiratory distress.
3) Tx:
• This is an emergency
• May require intubation or trach
• IV antibiotics and corticosteroids
Hint: Children with Epiglottitis usually look worse than they sound, and the kid with LTB sounds worse then they look.
Tonsillitis
1) S/S:
• Difficulty swallowing and breathing so child is a mouth breather and they have bad breath.
• Impaired taste and smell, voice has nasal/muffled quality.
• Persistent couch
• Swollen tonsils can block drainage of the ear canal and cause otitis media.
2) Tx: Tonsillectomy
• How should a client be positioned after a tonsillectomy? Place on side with elevated head of bed or prone.
• Why are brown and red fluids not given post op? We do not want anything to be confused with blood.
• What would indicate that hemorrhaging is occurring? frequent swallowing
• How many days post op is the client at risk for hemorrhage?up to 10
• Complaint post op? Sore throat and slight ear pain
• Low grade temp
• Bad breath
Otitis media
1) Patho:
• What part of the ear is affected? Middle ear
• The Eustachian tubes are blocked.
• It usually follows an upper respiratory infection.
2) S/S:
• What does the tympanic membrane look like with otitis? Bulging and bright red
3) Tx:
• heating pads help with the pain
• Avoid chewing . And provide soft foods.
• Lie on the affected side.
• May not hear you.
• Avoid smoke.
• May require PE tubes to keep the middle ear drain. Wear ear plugs in water
• The ear tube (grommet) stays in about 6 months and then falls out.
4) Prevention:
• While tubes are in wear ear plugs when bathing or swimming.
• Have baby sitting up for feedings.
• No bottle propping.
• gentle nose blowing.
• Avoid smoke.
RSV
1) Causes: • An acute viral infection that affects the bronchioles and includes RSV bronchiolitis or RSV pneumonia. • Leading cause of Lower Respiratory Tract Illness in children less than 2 years. 2) Risk Factors: • Prematurity • Congenital disorders • Smoke • Focus is on prevention (high risk will get RSV vaccine) 3) S/S: • URI • Nasal congestion • Mild fever • Dyspnea • Nonproductive cough • Tachypnea with flaring nares • Retraction and wheezing • It is important to know the onset of s/s because the disease will become worse on days 2-3 Hint: Sign and symptoms can range from mild to severe; can go from cough, runny nose with copious amounts of mucus, to severe respiratory distress! 4) Dx: • Nasal swab. 5) Tx: Transmission • contact precautions. • Teach good hand washing Mild • Treat symptoms (supportive care: antipyretics) Severe • Oxygen: may need mechanical ventilation • IV fluids • Suction • Antipyretics • Antiviral (Ribavirin) thru tent.
Pneumonia
1) Causes:
• Viral (RSV, adenovirus or parainfluenza)
• Bacterial (Culprit is strep pneumonia) children <4 yrs
• Mycotic (walking pneumonia) primarily in adolescents.
• Aspiration pneumonia (something other than air gets in the lung)
2) S/S:
• Fine crackles or rhonchi with a cough that is productive or nonproductive.
• Abdominal distention
• Back pain
• Fever that is usually high.
• Chest pain from coughing
3) Tx:
• Oxygen
• Fluids
• Antibiotics for bacterial
• Antipyretics
• Nebulizer
• Cough suppressant only at night
Down syndrome
1) What type of infection are Down syndrome children prone to developing? respiratory Why? Because they have a poor immune system
2) The most common type of defect associated with Down Syndrome is heart defect.
3) The primary aim in genetic counseling is to inform the parents of their risk.
Cystic fibrosis
1) Causes: inherited trait, and must get trait from both parents.
2) S/S:
• thick sticky secretions.
• Characterized by exocrine gland dysfunction. (These secrete mucus)
• Thick, sticky secretions are found in the lungs and GI tract.
3) Dx:
• Diagnostic test for cystic fibrosis? Positive sweat chloride test. Baby tastes salty
• At risk for hyponatremia.
• The earliest sign in the newborn is the meconium ileus.
• They will have steatorrhea stools, which means fatty and frothy.
4) Tx:
• Enzymes that help improve digestion are the pancreatic enzymes. Take 30 minutes prior to eating, do not crush or chew.
• Need a well balanced, low fat, high calorie, high protein diet. Require 150% of the recommended daily allowance.
• They need to take water soluble vitamins including A, D, E, and K.
Heart failure
a. Causes: Usually due to congenital defects.
b. S/S:
1) Lips turn blue when taking a bottle.
2) Increase pulse at rest, or with slight exertion. 3) Increased respiratory rate
4) Scalp sweating
5) Fatigue
6) Sudden weight gain
c. Tx:
1) Ongoing assessment
2) Control room temperature
3) Sit them up
4) Rest
5) decrease stimuli
6) Cool, humidified oxygen
7) Uninterrupted sleep
Cardiac meds for infants
a. Digoxin:
1) Infants rarely get more than 1 mL.
2) Give 1 hour before and 2 hours after feedings.
3) DO NOT mix with medicine, food, or fluid.
4) Always check the dose with another nurse.
5) Check the apical pulse for 1 minute.
b. Ace Inhibitors: enalapril (Vasotec®), captopril (Capoten®)
1) Side effects:
• low blood pressure
• Kidney problems
• dry cough
2) Action: They block aldosterone.
c. Lasix: To decrease the volume.
Nutrition for heart failure
a. Well rested prior to eating.
1) Feed them when they wake up or show signs of hunger.
2) decrease crying.
b. Small frequent feedings every 3 hrs, no longer than 30 min.
c. High calories.
d. We want to use a soft nipple with a large opening so the baby won’t have to work so hard to get the formula out.
e. May require gavage feedings.
f. Usually don’t require sodium and water restrictions because of decreased intake.
Rheumatic heart disease
a. Rheumatic Fever is an inflammatory disease that occurs after an infection with group A beta hemolytic streptococcus.
1) Major cardiac clinical manifestation is carditis.
2) Therapeutic management is PCN G, if they are allergic then erythromycin is the drug of choice.
Kawasaki disease
b. Kawasaki Disease is characterized by wide spread inflammation of the small and medium sized blood vessels. Coronary arteries are most susceptible. • Treatment: High dose IV immune-globulin aspirin therapy quiet environment.
