Pediatrics Flashcards
What are antipyretics?
Includes acetaminophen, aspirin and NSAIDS. Tylenol is the preferred medication and aspirin should not be given to children because of its association with chickenpox and Reyes syndrome. Ibuprofen is approved for fever reduction in children as young as six months old.
What is the dosage for Acetaminophen?
Acetaminophen: should be given every four hours but no more than five times in 24 hours. Body temperature normally decreases at night. 3 to 4 doses at 10 to 15 mg/kg in 24 hours will control most fevers.
What is the dosage for ibuprofen?
Ibuprofen: Dose is based on initial temperature. 5 mg/kg for temp <39.2 and 10 mg/kg for a temp >39.2. The max daily dose for pain and fever is 40 mg/kg in 24 hours.
What is the disease process of chickenpox or varicella?
Varicella zoster virus comes from primary secretions of the respiratory tract and creates skin lesions. Transmission is by direct contact or droplet spread. Incubation period is 2 to 3 weeks.
The period of communicability is 1 to 2 days before the eruption of lesions and until all lesions have crusted over.
What are the clinical manifestations of the chickenpox?
During the prodromal stage fever, malaise, and anorexia for the first 24 hours. A highly pruritic rash begins and rapidly progresses. The rash distributes to the face and proximal extremities but spares the distal limbs. Constitutional signs and symptoms include elevated temperature and irritability from pruritus.
What is the therapeutic management of the chickenpox?
Antiviral agents such acyclovir, varicella zoster immune globulin or IGIV after exposure I. High-risk children, diphenhydramine or anti-histamine to relieve itchiness, skin care to prevent secondary bacterial infection.
What are the complications of chickenpox?
Secondary bacterial infection, encephalitis, varicella pneumonia, hemorrhagic varicella, chronic or transient thrombocytopenia.
What are the nursing interventions for the chickenpox?
Maintain airborne and contact precautions, isolate until no new lesions are seen, keep child in home away from susceptible individuals, isolate high risk children from effective children, skin care including bath and change of clothes and linen daily, topical Calamine lotion, mittens for children that are scratching, prevent secondary infections, administer antipyretics and antihistamines, keep child cool, minimization itchiness, keep child distracted, oatmeal or baking soda baths to minimize itchiness, teach child to apply pressure to itchy areas rather than scratching.
What are the manifestations of the herpes simplex virus?
Grouped, burning, and itchy vesicles usually on or near mucocutaneous junctions (lips, nose, genitalia, buttock), vesicles dry, forming a crust with spontaneous healing in 8 to 10 days.
What is the management for herpes Symplex virus?
Avoidance of secondary infection, burow solution compresses during weeping stages, topical therapy to shorten duration of cold sores, oral antiviral for an initial infection, should heal without scarring, use of sunscreen, can be aggravated by corticosteroids, may be fatal in children with depressed immunity.
Medications: Penciclovir, acyclovir, valacyclovir.
What is cat scratch disease or batonella henslae ?
Most common cause of regional lymphadenitis in children. Follows the scratch or bite of an animal ( cat in 99% of cases), usually benign and resolve spontaneously in 2 to 4 months. In some children, especially immunocompromise, adenitis may progress to suppurations or serious complications. Treatment is supportive but antibiotic therapy can be offered.
What are the six links of infection? (in order)
The infectious agent, Reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.
What is poliomyelitis?
It is a highly infectious viral illness and it spread person to person through faecal oral route and can cause irreversible paralysis in less than 1% of infected. Non-paralytic polio causes mild flu like illness with signs and symptoms similar to other viral illnesses lasting up to 10 days. Paralytic polio is rare in the initial signs mimic non-paralytic, within a week loss of reflexes and severe muscle aches. Post polio syndrome is a cluster of disabling signs and symptoms which include progressive muscle or joint weakness, muscle atrophy, breathing and swallowing problems, apnea, and decreased tolerance of cold temperatures.
What are the complications of polio in children?
Temporary or permanent muscle paralysis, disability, bone deformities, death.
How has polio become eradicated?
Although there is no treatment for polio, the inactivated polio virus(IPV) is a routine childhood vaccination given over four doses, two months, four months, 18 months, and at 4-6 years of age. One infected child can put all countries at risk and can result in as many as 200,000 new cases every year.
What are airborne precautions?
Airborne transmission refers to dissemination of micro organisms by aerosolization, organisms are contained in small airborne particles, or in dust particles that remain suspended in the air for long periods of time. These are widely dispersed in air currents and inhaled by others who may be some distances away. Patients require a single room with negative pressure airflow. Examples of airborne diseases include pulmonary tuberculosis, chickenpox, shingles, and measles.
What is Scarlett fever?
Caused by group A Beta haemolytic streptococcus. Usually from nasal pharyngeal secretions of the infected person. Transmission is by direct contact or droplet spread. Indirectly by contaminated articles or ingestion of contaminated milk or food. Incubation period is 2 to 5 days. Period of communicability is approximately 10 days during the first two weeks of carrier phase and may persist for months. During the prodromal stage, abrupt high fever, increased pulse, vomiting, headache, chills, abdominal pain, enlarged tonsils, pharynx Adema. During the first one to two days the tongue is coated and papillae become red and swollen, by the fourth or fifth day the white coat sloughs off. Exanthema Is a rash that appears within 12 hours after the prodromal signs, read pinhead sized lesions generalized but absent on the face. Rash is more intense in the folds of joints. By the end of the first week desquamination begins which may be complete by three weeks.
What is the treatment for scarlet fever?
A full course of penicillin or a erythromycin, rest, analgesic for sore throat, antipruritics
What are the complications of scarlet fever
Perry tonsilar and retropharyngeal abscess, sinusitis, otitis media, acute glomerulonephritis, acute rheumatic fever, poly arthritis, toxic shock syndrome, osteomyelitis,
What are the nursing interventions for scarlet fever?
Maintain routine and droplet precautions until 24 hours after initiation of treatment, ensure compliance with oral antibiotic therapy, intramuscular penicillin may be given if difficulty giving oral medications, encourage rest and provide quiet activities, relieve discomfort with analgesics, gargles, Losenges, antiseptic throat sprays. Encourage oral fluids and avoid irritating liquids, and rough foods.
What is pediculosis or head lice?
It is an infestation of the scalp caused by a common parasite in school-age children. Head lice is not a primary health hazard or a sign of poor hygiene. Head lice is a wing with six legged bloodsucking insect, approximately 2 to 4 mm bong that live on the human scalp. Infestation involves less than 10 live lice, patient will experience itching. Nits are empty egg cases attached to hair that the head lice have hatched from. The lice crawl rapidly and are spread through direct head-to-head contact. Diagnosis involves the living lice, the presence of nits indicates passed infestation. Detection requires a fine tooth lice comb and visual examination of the scalp.
What is the treatment for head lice?
Topical insecticides: pyrethrins and perethrin 1% available in Canada. With two applications seven days apart. If that does not eradicate lice consider another treatment option.
Topical non-insecticidal‘s: isopropyl myristate 50%, ST-cyclomethicone 50%, dimethicone silicone oil, benzyl alcohol lotion 5% are approved for use in Canada.
Oral therapies: trimethoprim sulfamethizole is not approved for use in Canada.
Wet coming: there is little evidence to support this as a primary treatment
Other products: mayonnaise, petroleum jelly, olive oil, margarine, and hair gel have been suggested as treatments but are not as effective as medicinal solutions.
What is hydrocephalus?
Caused by an imbalance in the production and absorption of CSF, CSF accumulates within ventricular system, producing passive dilation of the ventricles. Causes are varied, but result is impaired absorption of CSF or obstruction of flow to CSF, ventricles become dilated and compress the brain causing enlargement of skull and dilation of ventricles. Most cases are from developmental malformations, neoplasm, infections, and trauma.
What are the clinical manifestations of hydrocephalus?
Early infancy: rapid head growth, bulging fontanelles, dilated scalp veins, separated sutures, thinning of skull bones.
Later infancy: frontal enlargement, depressed eyes, setting sun sign, sluggish pupils, unequal response to light.
General infancy: irritability, lethargy, crying with movement, exaggerated responses, change in LOC, lower extremity spasticity, vomiting, high-pitched cry.
Childhood: irritability, headache on wakening, strabismus, lethargy, apathy, confusion, incoherence, vomiting.
How is hydrocephalus diagnosed?
Detected based on head circumference, CT, MRI.
What is the treatment of hydrocephalus?
Treatment is directed towards the relief of the hydrocephalus, and treatment of complications. Treatment is usually surgical and requires the removal of the obstruction and placement of a shunt to drain CSF. Survival rate is 80%.
What are the nursing interventions for hydrocephalus?
Measurement of the head, pressure sensitive mattress, frequent position changes, ensuring adequate nutrition, monitoring ICP, alterations in LOC, preparation for tests, perioperative care, pain management, neurological assessment, vitals, monitoring for infection, family support, discharge instructions, community support, possible long term health care needs.
What are the nursing instructions for administration of diazepam?
Diazepam is an anti-anxiety, anti-convulsant, it is considered a benzodiazepines and is long lasting. Do not use more than five times per month or for an episode every five days. Negative side effects include drowsiness, confusion, slow reflexes, and rash. Give rectally. For children 6 to 11 years of age, 0.3 mg/kg, may repeat in 4 to 12 hours. For children 2 to 5 years of age, give 0.5 mg/kg, may repeat in 4 to 12 hours.
What causes a seizure?
Seizures are the most common paediatric neurological disorder and can be caused by infections, neurological disorders, metabolic disorders, trauma, and can be related to the ingestion of toxins.
What are the main causes of nonrecurrent or acute seizures?
Febrile episodes, intracranial infection or hemorrhage, cysts or tumors, cerebral edema, toxins, medication, tetanus, lead and cephalopathy, hypoglycemia, hypomagnesium, or hyperbilirubinaemia
What are the causes of recurrent or chronic seizures?
Idiopathic epilepsy, secondary causes including trauma or hemorrhage, congenital defects, parasitic brain disease, syncopal episodes, or migraines.
What are the manifestations of a simple partial seizure with motor signs?
Localized motor symptoms, somatosensory and autonomic symptoms,
Aversive seizure: eyes or eye and head turn away from the side of the focus, awareness of movement or loss of consciousness.
Rolandic Seizure: tonic clonic movements involving the face, salvation, arrested speech, most common during sleep.
What are the characteristics of simple partial seizures with sensory signs?
Characterized by various sensations, include numbness, tingling, prickling, paresthesia, pain in one area, motor phenomena such as posturing or hypertonia.
What are the characteristics of complex partial seizures?
Periods of altered behavior, amnesia, inability to respond, impaired consciousness, drowsiness following the seizure, confusion, strange feeling called an aura, auditory or visual hallucinations and feelings of fear and anxiety.
Motor behaviour includes sudden cease of activity, may appear dazed, stare into space, become confused, or become limp or stiff.
What are tonic clonic seizures?
Most common and most dramatic, occur without warning. The tonic phase lasts 10 to 20 seconds. Manifestations include eyes roll up words, immediate LOC, falls to the floor, stiffens and generalized symmetrical tonic contractions, arms flexed, legs head and neck extended, apnea and potentially cyanotic, increased salvation and loss of swallowing. The clonic phase lasts about 30 seconds but can vary from a few seconds to half an hour or longer. Manifestations include violent jerking movements, rhythmic contractions, may foam at the mouth, may become incontinent of urine and feces.
