peds Flashcards
anterior fontanel closes
12 - 18 months
posterior fontanel closes
2 - 3 months
earlobe positioned to view auditory canal in child
down and back
cups of milk 15 mo toddler should consume daily
2 - 3
best friend stage occurs at what stage
9 - 10
major causes of accidents in children up to 1 year x3
falls
poisoning
burn
major cause of accidents 6 - 12 years
motor vehicle accident (more active)
school age child requires how many calories per day on average
2400
how much earlier do girls experience onset of adolescence
1 - 2 years
obtaining vitals (peds)
least invasive first, observe before touching/talking
RR *
HR *
BP
T
- count for 1 full minute (irregularities)
temperature routes (peds) x4
rectal ( under 2 )
axillary ( alt to oral )
oral ( start 5 - 6 )
tympanic ( all )
observable signs of respiratory dysfunction (peds)
- accessory muscle use
- nasal flaring
- circumoral pallor (around mouth)
- sternal retraction
- cap refill greater than 3 seconds
if child is grunting do what?
assist into position of comfort (tripoding)
laryngotracheobronchitis
most common type of croup experienced by peds admitted to hospital
primary affects kids under 5; viral
causative viruses of laryngotracheobronchitis
parainfluenza
adenovirus
RSV
laryngotracheobronchitis s/s
slight to severe dyspnea
barking / brassy cough
increased temperature
amount of distress depends on degree of airway obstruction
laryngotracheobronchitis treatment (mild)
at home
- steam (hot showers)
- night car rides, windows down
- cool-temp therapy (constricts edematous blood vessels)
laryngotracheobronchitis treatment (severe)
hospitalization
nebulized epinephrine (racemic epi) = vasoconstrict edematous blood vessels
corticosteroids (decrease airway inflammation)
epiglottitis
serious obstructive inflammatory process in 2 - 5 yo
epiglottitis key s/s
absence of cough
dysphagia
rapid progression to severe resp distress
epiglottitis vs laryngotracheobronchitis kids
epiglottitis kids look worse than they sound
laryngotracheobronchitis kids sounds worse than they look
nebulized epinephrine
aka racemic epinephrine; vasoconstriction of edematous blood vessels in kids with severe laryngotracheobronchitis
rapid onset
improvement in 10 - 15 minutes
(observe for relapse; ~2 hours)
respiratory syncytial virus
acute viral infection affecting bronchioles
RSV bronchiolitis or RSV pneumonia
more serious in very young (leading cause lower resp tract illness in under 2)
RSV is more serious in who?
very young
leading cause of lower respiratory tract illness in children less than 2 years
RSV
RSV s/s
important to know onset bc will become worse on days 2 - 3
progressively worse: URI snot mild fever dyspnea non-prod cough tachypnea (flaring nares) retraction, possible wheezing
RSV will become worse…
on days 2 - 3
pneumonia
disease marked by inflammation of lungs
viral pneumonia (peds)
RSV, adenovirus, parainfluenza
bacterial pneumonia (peds)
usually strep pneumo
children under 4 = greatest % attacks
mycotic pneumonia (peds)
“walking pneumo” - mostly adolescents
mycoplasma pneumonia
aspiration pneumonia
something other than air has gotten into lungs
pneumonia s/s (peds)
fine crackles/rhonchi + cough that is prod or not
decreased or absent breath sounds
abd distension
back pain
fever (usually very high)
chest pain
pneumonia tx (peds)
depends on type
- ABCs always priority
- oxygen
- fluids - hydrate to move secretions
- abx for bacterial
- supportive care: hydration, antipyretics, nebulizers (appropriate for viral)
asthma
inflammation and constriction of airways resulting in obstruction
asthma s/s
cough sob audible wheeze prolonged expiratory wheeze restless and cyanosis
what is prolonged in asthma
expiratory wheeze
most important thing in proactive care for asthma patient
education, especially id-ing triggers
cystic fibrosis
respiratory and gi impacted
give pancreatic enzymes to improve digestion
diet: well-balanced, low fat, high calorie, high protein
pancreatic enzymes for + how
cystic fibrosis
take within 30 minutes of eating, do not crush or chew
vitamins for CF patient
ADEK are fat soluble but need to make them water soluble since CF kids can’t process fat
diagnostic test for CF
sweat chloride
electrolyte imbalance child with CF at risk for
hyponatremia
earliest sign of CF (newborn)
meconium ileus (can’t pass; thick and sticky)
CF inheritance
autosomal recessive
CF stools
steatorrhea
down syndrome kids prone to infection where?
respiratory - poor immune system
most common type of defect associated with down syndrome
heart
in peds, HF usually due to
congenital heart defects
s/s early heart failure (peds)
increased HR at rest + with slight exertion
increased RR
scalp sweating (infants @ feeding)
fatigue
sudden weight gain (greater than 1lb/day)
FLUID RETENTION THINK HEART PROBLEMS FIRST
main signs of digoxin toxicity
bradycardia, vomiting (earliest sign)
digoxin: hold for ? in infants, children
infants: HR less than 110
kids: HR less than 70
normal digoxin level
0.8 - 2.0
infants rarely get more than ? of digoxin
1.0 mL per dose
give digoxin to infants when?
1 hour before or 2 hours after feeding
nursing considerations for digoxin admin to peds x2
ALWAYS check with another nurse
if 2 doses in a row missed, call provider
good feeding schedule for a heart baby
q 3 hours, do not prolong feedings past 30 minutes
blue spells aka tet spells
hypercyanotic spells often seen in infants with Tetralogy of Fallot
ace-i in kids, watch for
decreased BP
kidney problems
cough (dry) – d/c ASAP
treatment for tet spell
infant: knee-chest position 100% O2 morphine (sedate) loose clothes, diapers quiet play no stress respond to crying quickly treat infections promptly (can't handle fever)
why knee-chest position for infants with tet spell?
decrease venous return from LE
increase systemic resistance to divert blood to pulmonary artery (increases O2 in blood)
polycythemia
increased red blood cells in response to chronic hypoxia; body senses hypoxia, increases RBC production, no more O2 to carry, blood gets thick
so many RBCs no room for platelets
polycythemia treatment
hydration - keep blood thinned out
s/s chronic hypoxia
clubbing (late sign)
poor growth, development
squatting
congenital heart defects (peds)
structural or functional defect of heart or great vessels present at birth
classified by blood flow patterns
- increased or decreased pulmonary blood flow
- obstructive defects
tetralogy of fallot
Ventricular Septal Defect Stenosis of Pulmonary Artery Overriding Aorta -- directly over VSD instead of LV Right Ventricular Hypertrophy
post cleft lip repair (peds)
on back or side-lying
- protect suture line (NOT PRONE)
clean suture with saline
elbow no nos
best time for cleft palate repair to be done
before speech develops, between 1 - 2
GER vs GERD
GER = passage of gastric contents into esophagus
GERD = tissue damage to respiratory structures, which can lead to pneumonia and bronchospasms
pyloric stenosis s/s x3
projectile vomiting, usually after feeding
- pressure behind vomitus
olive shaped mass in epigastric region near umbilicus (enlarged pylorus)
pressure build up in stomach = pyloric ultrasound
intussusception key s/s (peds)
sudden onset
cramping, intermittent abd pain, inconsolable
drawing up of knees
currant jelly stools!
intussusception poo
currant jelly stools
celiac disease
celiac sprue is a genetic malabsorption disorder where there is permanent intestinal intolerance to gluten
celiac patients can’t have (mnemonic)
b arley
r ye
o ats
w heat
hirschsprung’s disease
congenital anomaly known as aganglionic megacolon - results in mechanical obstruction; usually affects sigmoid colon
no nerves, no peristalsis = constipation + abdominal distention
remove disease bowel - give intestines time to heal (maybe 2 sx)
hirschprung’s poo
foul smelling and ribbon-like
sickle cell disease
hereditary disorder in which hemoglobin is partly or complete replaced with sick-shaped hgb
- reduced O2 carrying cap as result of shape
1 tx to stop sickling process
HYDRATION!!
FLACC
face legs activity crying consolability
numerical pain scale starting at age
5
hydrocephalus
disturbance of ventricular circulation of cerebral spinal fluid in brain; increased icp
often associated with myelomeningocele
myelomeningocele
type of spina bifida, sac on the back
- prone
- moist sterile normal saline dressing
- surgery ASAP
spina bifida
any birth defect involving incomplete closure of the spine
pinworms: transmission, test, treatment
hand to mouth
tape test (rectal itching)
whole family treatment; mebendazole
infectious mononucleosis: causative agent
epstein barr virus
positioning post tonsillectomy
side + elevated hob
or
prone
tonsillectomy post-op risk for hemorrhage up to
10 days (scabs slough 7 - 10)
otitis media
eustachian tubes (middle ear) blocked
usually follows upper respiratory infection
bulging and bright red tympanic membrane
lie on affected side to promote drainage
cleft lip/palate epi
American Indians, Asians
boys
