Pediatric Conditions Flashcards by erica kaczmarczyk

Neonate age range

0-28 days

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Infant age range

1 month - 12 months

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Child age range

1 year to 12 years

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Adolescent age range

13-18 years

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At what temperature should a child

temperature of 100.4 F (rectal)

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At what temperature should a child 3-6 months old be referred for urgent care

101 F (rectal)

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At what temperature should a child >6 months old be referred for urgent care

103 F (rectal)

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After how long of a cough/cold that worsens or does not improve should a child be referred for urgent care

several days

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after how long of unusual, severe, or persistent pain should a child be referred for urgent care

several hours

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Signs of bacterial meningitis in neonates

bulging fontanelles, nuchal rigidity, nonspecific symptoms

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Common bacterial pathogens in bacterial meningitis for

Streptococcus agalactiae (Group B strep), E. coli, Listeria, Klebsiella

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Empiric antibiotic treatment of bacterial meningitis in those

Ampicillin + Cefotaxime or Ampicillin + Aminoglycoside (Gentamicin)

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Why is ceftriaxone avoided in neonates

ceftriaxone displaces bilirubin from albumin and can cause bilirubin induced brain damage (kernicterus)

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Common bacterial pathogens in bacterial meningitis for 1-23 months of age

Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenza, E. coli

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Empiric antibiotic treatment of bacterial meningitis for patients 1-23 months of age

Vancomycin + 3rd generation cephalosporin (ceftriaxone or cefotaxime)

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Common bacterial pathogens in bacterial meningitis for 2+ years of age

N. meningitidis, S. pneumoniae

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Empiric treatment of bacterial meningitis for 2+ years of age

Vancomycin + 3rd generation cephalosporin (Ceftriaxone or cefotaxime)

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Symptoms of RSV

low grade fever, cough, dyspnea, and cyanosis

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Palivizumab brand name

Synagis

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Palivizumab indication

prevention of high risk lower respiratory tract disease caused by RSV in high risk children

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Palivizumab mechanism/class

humanized monoclonal antibody

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When is Synagis (palivizumab) recommended

RSV season (late fall - early spring) for infants born before 29 weeks gestation and younger than 12 months or infants with chronic illness (congential heart disease or chronic lung disease)

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Synagis dosing

15 mg/kg IM (anterolateral thigh muscle) per dose - monthly - max 5 doses per season

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CROUP symptoms

inspiratory stridor, barking cough, hoarseness

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treatment for mild, moderate, and severe croup

steroid (dexamethasone) and nebulized racemic ephinephrine via neb (use L-epinephrine if racemic not available)

dexamethasone dosing for croup

0.6 mg/kg x 1 PO/IM/IV - max 16 mg/dose

dosing of racemic epinephrine for croup

0.05-0.1 ml/kg (max 0.5 ml) diluted in 2 ml NS Q 20 minutes PRN

dosing of L-epinephrine for croup

0.5 ml/kg of 1:1000 solution (max 5 ml) diluted in NS, can repeat Q 20 minutes PRN

Warnings for epinephrine

caution with cardiovascular disease, cerebrovascular disease, thyroid disease, diabetes (increase BG), extravasation (IV)

Side effects of epinephrine

increased BP, HR, anxiety, arrhythmia

Behavioral approaches to nocturnal enuresis

positive reinforcement, normal daytime voiding pattern, normal bowel pattern, normal hydration pattern

First line treatment for nocturnal enuresis

behavioral methods

Length of an adequate trial of behavioral approaches for nocturnal enuresis

up to 3 months

Drug treatment for nocturnal enuresis

Desmopressin

Desmopressin MOA

synthetic analog of antidiuretic hormone leading to decreased nocturnal urine production

DDAVP dosing

0.2 mg PO HS up to 0.6 mg max

DDAVP contraindications

hyponatremia or history of hyponatremia, CrCl

DDAVP side effects

HA, fatigue, possible hyponatremia due to water retention

DDAVP counseling notes

limit fluid intake 1 hour before dose until the next morning

OTC treatment for intestinal gas in children

simethicone drops - mild if any benefit, safe to use. symptoms will dissipate at 6-8 months of age

OTC treatment for nasal congestion in children

car seat - sitting upright, cool mist humidifier, steamy bathroom, suctioning with saline drops or spray

At what age does FDA say not to use OTC cough and cold meds in children

At what age does the AAP say not to use OTC cough and cold meds in children

Ibuprofen should be avoided at what age and why

OTC treatment of constipation in children

pediatric glycerin suppositories or PEG (miralax)

Simethicone dosing for infants

20 mg, 1-4 times/day PRN

Simethicone counseling notes

Take after meals. shake before using. Can be mixed with water, formula or other liquids.

Dosing of acetaminophen in infants

10-15 mg/kg/dose Q4-6H (max 75 mg/kg/day)

Dosing of ibuprofen in infants

5-10 mg/kg/dose Q6-8H (max 40 mg/kg/day)

Ibuprofen counseling notes for infants

caution about nausea, drop strength 50 mg/1.25mL

Glycerin suppository dosing for infants

1 pediatric suppository. insert high into the rectum. retain for ~15 minutes

Miralax dosing for infants

> or = 6 monhts: 0.2-1 gram/kg (max 17 grams). Dissolve in a least 4 oz of water or beverage.

Why are quinolones not used in pediatrics and exceptions

possibility of adverse musculoskeletal effects - exceptions: anthrax, cystic fibrosis, or MDR organisms

Why are tetracyclines not used in pediatrics and exceptions

not used

Why is promethazine not used in children?

Contraindicated

Why is codeine not used in pediatrics?

Some children are rapid metabolizers of CYP2D6 - leading to excess conversion to morphine and respiratory depression. Boxed warning for tonsillectomy and adenoidectomy.

What are Koplick spots

small white spots in the inside of the cheeks appearing 2-5 days prior to measles rash

Symptoms of measles

koplick spots, maculopapular rash, fever, malaise, cough, rhinitis, conjunctivitis

Symptoms of mumps

swollen salivary glands, fever, headache, myalgia, fatgue, loss of appetite - 50% have mild/no symptoms

Symptoms of rubella

Fever, rash, swollen glands, cold-like symptoms, aching joints, birth defects if contracted in pregnancy, up to 50% have mild/no symptoms

Symptoms of polio

Fever, fatigue, sore throat, nausea, headache, abdominal pain, nerve damage, post-polio syndrome - progressive weakness and cognitive issues

Symptoms of pertusiss

sudden cough outbursts, whoooping cough, fever, rhinitis, bluish skin, vomiting, fatigue, respiratory failure, death

Symptoms of chicken pox

itchy rash(starting on head, trunk, then arms and legs; starts as sores, blisters, bursting to crusts) fever malaise