Pediatric Alterations Flashcards
What is cause of croup?
Parainfluenza virus
What is treatment of croup?
Oral dexamethasone
Inhaled Budesonide (updraft)
Humidified O2
Keep them calm and quiet
Monitor for signs of respiratory distress
What is epiglottitis and why an emergency?
Caused by flu virus
–Acute inflammation of epiglottis, can lead to complete blockage of airway–
Signs and symptoms of epiglottitis?
Tripod position
Drooling
Dysphagia (difficult swallowing)
Dysphonia (difficult talking)
Respiratory distress
High fever
Number one rule in treatment of epiglottitis?
Don’t stick anything in mouth
What vaccine can prevent epiglottitis?
HIB (Haemophilus Influenza Type B)
CDC recommends for all kids under 5
—also protects against bacterial meningitis–
Series of shots usually given at 2, 4, 6, 12 months (but depends on brand)
Treatment for epiglottitis?
Intubation
Rocephin
RSV causes inflammation of the …
Bronchioles—called bronchiolitis
What is treatment for RSV?
Supportive:
Fluids
Humidification
Rest
Not antibiotics
Two causes of pneumonia…
Viral and bacterial
–They will try to determine which type to alter treatment–
Which is more common-viral or bacterial pneumonia?
Viral
What viruses are the usual culprits of pneumonia?
RSV (in kids)
Flu
Distinguishing between viral and bacterial pneumonia is challenging (even for doctors). What are some subtle differences?
Viral is usually a slower onset. They will be sick for a while and then it will progress to pneumonia. They may also have other systemic signs of illness like GI and flu like.
Fevers will be lower grade in viral.
Not as much purulent sputum in viral.
Adventitious breath sounds will be in both lungs equally in viral. Bacterial usually settles in one location in lungs.
What is difference in treatment from viral to bacterial pneumonia?
Viral: Supportive-Fluid, O2
Bacterial: Supportive plus antibiotics
(usually amoxicillin, augmentin)
What is the most frequent age range for children with foreign body aspiration? (FBA)
6 months—–5 years
What are signs of FBA?
Sudden violent coughing
Gagging, wheezing
Apnea, cyanosis
Where does a foreign body usually lodge?
Right bronchi
What are some risk factors for SIDS?
2-4 months old
Boy
Low birth weight
Native American, black
Winter
Stomach sleepers
Smoker in pregnancy
Alcohol in pregnancy
Warm room
Bottle fed
What are some SABA (short acting beta agonists) used in treatment of asthma flare ups?
–Sometimes called rescue or reliever inhalers–
Albuterol
Terbutaline
Metaproteronol
What are some LABA (long acting beta agonists) used in asthma control?
Salmeterol
Formoterol
Indacaterol
What is cystic fibrosis?
Inherited
Characterized by thick secretions that obstruct many organs
What is early sign of possible CF (cystic fibrosis)?
Meconium ileus at birth
How do they diagnose CF?
Immunoreactive Trypsinogen assay
DNA
Pilocarpine lontophoresis (sweat test)
How do they treat CF?
Chest physiotherapy
Antibiotics
Steroids
What is patent ductus arteriosis?
Normal hole between aorta and pulmonary artery but
Normal closure doesn’t happen (usually happens within 3 days of birth)
Common in premature babies and especially girls
Leads to increased workload on heart and lungs
Presents as HF-edema, lung congestion, increased RR, failure to thrive, bounding pulses, increased pulse pressure
–Treatment is surgery–
What is atrial septal defect?
Hole in between two atrias
Usual closure doesn’t happen (normally takes weeks or months)
Often have no symptoms
If hole is large enough may hear a murmur
–Treatment is surgery–
What is ventricular septal defect?
Hole in between two ventricles
May hear a murmur
May see respiratory distress
May see failure to thrive
—Treatment is surgery–
What is tetralogy of Fallot?
Defect that blocks blood from circulating to lungs and to system.
These babies are usually cyanotic.
Increased risk of endocardiditis.
—Treatment is surgery early in life–
What is transposition of great vessels?
Blood flow cycle is reversed.
Will present with weak pulse, hypoxia, cyanosis.
—Will not survive if not repaired quickly–
What is treatment of GERD in babies?
Keep upright during and after feeding
Small, frequent feeding
Burping often
Rinitidine (if more conservative things don’t work)
What is encopresis?
Holding poop
What is the point of pain called in appendicitis?
McBurneys point
–Right lower quadrant–
What is a positive Rovsing sign?
Palpation on left lower quadrant makes pain in right side
–appendicitis sign–
What is a positive Psoas sign?
Lift leg and pain in RLQ
What is enuresis?
Can’t hold urine
Nocturnal (bed wetting)
Diurnal (day time)
What are some things that may cause enuresis?
Diabetes
Sexual abuse
UTI
Pinworms
What will urinalysis show in UTI?
Positive for leukocytes and nitrites
What antibiotic is usually given for UTIs?
Bactrim
What is epispadias?
Hypospadias?
Urethral opening on top of glans
Urethral opening on bottom of glans
What is nephrotic syndrome?
Inherited
Damaged blood vessels in kidneys lead to decreased function.
What are signs of nephrotic syndrome?
Edema
Fatigue
Abdominal pain
Anorexia
Proteinuria
Hypoalbuminemia
Weight gain
Swollen faces
What are some signs of iron deficiency anemia?
Dark circles under eyes
Pale
Fatigue
SOB
What is MCV in labs?
Mean corpuscular volume
–Testing size of RBCs, small in anemia–
What is MCHC in labs?
Mean corpuscular hemoglobin concentration
–Testing concentration of hemoglobin, light color in anemia–
–Normal range is 32-36–
What are 3 factors that precipitate a sickle cell crisis?
Infection
Dehydration
Hypoxia
What is thalassemia?
An group of inherited disorder that causes reduction in hemoglobin.
Black, Mediterranean, SE Asian descent
Difference in thalassemia minor and major?
Minor-inherit gene from one parent
Major-inherit gene from two parents
What is beta thalassemia (Cooley anemia)?
Severe type.
Life expectance is early adulthood
Frontal bossing
Maxillary prominence
Wide set eyes with flat nose
Bronze skin
Hepatosplenomegaly
What is most common clotting disorder in the US?
Von Willebrand disease
Don’t produce enough of a certain protein for clotting
Will present as frequent nose bleeds, easy bruising, slow to clot
What are common side effects of chemo?
Bruising/Bleeding
Alopecia
N/V
Anorexia
Stomatitis
Malaise (sick)
Fatigue
What are common side effects of radiation?
Skin reactions
Bruising
Fatigue
Anorexia
N/V
What is a Wilm’s tumor?
Renal tumor
What will TSH levels be in hypothyroidism? Hyperthyroidism?
Hypo:
TSH high
T3, T4 low
Hyper:
TSH low
T3, T4 high
What is diabetes insipidus?
Not diabetes!
A problem with fluid regulation in body. Usually caused by ADH problems.
Causes person to excrete large amounts of clear urine.
Characterized by polydipsia, dehyration, hypernatremia, increased urination
What is SIADH?
Syndrome of inappropriate antidiuretic hormone.
Characterized by hyponatremia
Edema
High urine specific gravity
What are some signs of hyponatremia?
N/V
Headache
Anorexia
Confusion, irritability, lethargy
Altered LOC
Seizures»Coma
Glasgow coma scale components
Eye opening
Verbal Response
Motor Response
What is the difference between disoriented and delirious?
Disoriented=doesnt recognized person or place
Delirious=Out of touch with reality with possible hallucinations
What are the 4 parts and grades of eye opening in GCS (Glasgow coma)?
4=Spontaneous
3=To sound
2=To pressure
1=None
What are the 5 parts and grades of verbal response in GCS?
5=Oriented
4=Confused
3=Words
2=Sounds
1=None
What are the 6 parts and grades of motor responses in GCS?
6=Obeys commands
5=Localizing
4=Normal flexion
3=Abnormal flexion
2=Extension
1=None
A corpse has a GCS of what?
3
A person AAOx4 has a GCS of what?
15
What does it mean to be obtunded?
Sleeps and once aroused has limited interactions with environment
What does it mean to be stuporous?
Requires stimulation to arouse
What does it mean to be in coma?
Vigorous stimulation but no response
What does it mean to be lethargic?
Awakens easily but limited responses
What is Guillain-Barré syndrome?
Autoimmune
Attacks peripheral nervous system
Demyelinization of nerves
Produces rapid limb weakness
Loss of DTR (deep tendon reflexes)
Happens to males around 5 yo
May originate as a viral infection or reaction to flu shot
