PEDS Flashcards
In teenage girls: if they have pendulous breasts (really large breasts; hangs down loosely) → we will see darkening of skin right in the middle of the chest
◦ In really young children: looking for stretch marks → in front of the armpit, under the armpit
◦ Inspect abdomen: large bellies, stretch marks on their belly
◦ stretch marks on the sacrum
Metabolic Resistance
= tells average blood sugar over the past 90 days
Hemoglobin A1C (HgbA1c)
= a BMI (Body Mass Index) that is greater than the 95th percentile for children of the same age & the same gender
Childhood Obesity
• Congenital anomalies
• Baby with low birth weight = 5.5 lbs or
• SIDS = Sudden Infant Death Syndrome
African-American race
Male gender
Mother who have had a Short or long gestation time
Maternal age – really young or old mothers
Maternal education – lower levels of education of mother
Risk Factors of infant mortality
1 - ENABLING:
• When nurse teaches something to a child or parent → we always want a return demonstration
• Ex: a child is just diagnosed with asthma, we teach the child & parent how to use an inhaler → we want them to show us a return demonstration of using an inhaler after the teaching
2 - EMPOWERMENT:
• We give the child & parent a sense of control
• Ex: we encourage the parents to hold, feed, dress their newborn baby
Family-Centered Care
Is based on the premise of doing no harm, by:
1 - Goal: to minimize the child’s separation from the family
• Ex: in pediatrics setting there are no visiting hours, parents come come 24-7 anytime
2 - Minimize bodily injury or pain
• Goal: to keep the stress level down
Atraumatic Care
the child is not sick, we want to prevent the child from getting sick
Interventions that protect from disease or injury –
• Immunization injections
• Well-child check-ups
◦ Newborn baby leaves the hospital with a Hepatitis B vaccine injection
◦ Baby comes back at 6 weeks and at 2, 4, 6 [and 9, 12] months = Well-child visits
◦ We are doing: head-to-toe assessments, measuring head & chest circumference, their length
• Community safety programs – teaching parents about:
◦ helmet safety
◦ car seat safety
◦ as child gets older: using seat belts, kids cannot sit in the front seat
◦ poision safety – 3 key poisons that we teach about:
1. Lead poisoning
2. Medication poisoning
3. Cleaning products poisoning
Primary Prevention
Screening tests
Promotes early detection and treatment of illness
Efforts are made to prevent the spread of contagious diseases
Screening for diseases (secondary screening):
• Screening for Scoliosis (sideways curvature of the spine – occurs most often during the growth spurt before puberty)
• Tuberculosis test = is not a definitive test, is only a suggestive test, is a screening test
◦ we screen someone for Tuberculosis:
◦ when they have had exposure
◦ if they just came from a third-world country
◦ if they are living in a shelter; if the child is moving from one shelter to another, where it is very crowded
• Hearing screening
• Vision screening
• WIC Program (Women, Infant & Children):
Secondary Prevention
the child already has a disease (chronic disease); is already sick
• already has a chronic disability
• the child already has a diagnosis
Goal is to help manage the disease
Interventions that optimize function for children with a disability or chronic disease
Ex: child has a diagnosis for Asthma • we will teach how to use a nebulizer Ex: camps for obese children • they teach children: ◦ how to read labels ◦ making healthy food choices ◦ drinking lots of water ◦ increasing physical activity
Tertiary Prevention
Hyperactivity • very short attention span • difficulty concentrating Developmental delays • speech, language delays Reading deficits Learning disabilities • very low IQ test scores • doing poorly in school Visual problems Motor problems Headaches – lots of headaches Metallic taste in mouth – tastes like they have a penny in their mouth
Clinical manifestations of lead poisoning
• GI symptoms:
◦ severe abdominal pain
◦ nausea
◦ vomiting
S/S of Acute Lead Poisoning:
• 45-69
◦ Treatment: Chelation Therapy
Acute Lead Poisoning
• Calcium rich diet
◦ child will need almost double the amount
◦ b/c lead exposure interferes with Calcium absorption
• Foods high in Iron
◦ b/c lead exposure, high lead blood levels can cause anemia
• Increased Vitamin C
◦ b/c Vit C increases iron absorption
◦ increase juices with Vitamin C
Lead exposure diet
Start screening at ages 1-2 years old
Lead exposure
·old pipes
·paint
·toys
·old homes
Sources of lead: ·old pipes ·paint ·toys ·old homes
- no money, no material resouces
- not enough food, not enough clothes
- no home
- lacking in tangible things; ie lacking in visible things – we can see it
Visible Poverty:
An infant develops a sense of trust or mistrust on the reliability of caregivers providing for his basic needs such as food, physical contact, and attention. The child’s experiences in these months form the earliest sense of self
Birth-18 months
Trust vs mistrust
A young child learns self control, like toilet training without loss of self esteem and so develops a lasting sense of good will and pride, or the child experiences a sense of loss of control or is over controlled from outside
Autonomy vs. shame, doubt
18 months- 3 yrs
The child takes initiative and begins to develop a moral sense of sense of guilt over her goals. St this stage a youngster begins learning his to cooperate and hide to cope with jealousy
Initiative vs. guilt
3-6 yrs
School life prepares the child for productivity in her culture. She may adapt to the world of skills and tools handled by big people or become discouraged and feel inadequate
Industry vs inferiority
6-11 yrs
Adolescents try to discover who they are, how they fit in their peer groups and in society and how to relate to the opposite sex. Intense confusion may result
Identity vs role confusion
12-17 yrs
Inappropriate degrees of inattention, impulsiveness and hyperactivity
ADHD
Inattentive:
• child has trouble focusing in the classroom
• they have scattered thoughts
- Impulsive:
• ex: while teacher is teaching:
◦ the child interrupts the teacher & they dont see anything wrong with it
◦ they start having conservations with kids next to them - Hyperactive:
• child can’t sit still for too long
• theyre constantly running around, getting up
ADHD
Child does not pay attention in class
• They dont pay attention to detail
• They will go home → and they will lose their homework – they have no idea where it went
• NI’s:
◦ Give child written instructions for homework & you have to say it to them
Inattentive type
- they’re squirming in their seat, they cant sit still for too long
- they like to interrupt people
- if teacher asks a question in class → the kid will just blurt out the answer
Hyperactive-Impulsive Type:
assess IQ level • assess hand & eye coordination • visual & auditory perception ◦ vision screening ◦ hearing screening • comprehension skills • memory recall
Screening for ADHD
◦ when kid comes home from school → turn off the tv, decreased the stimulation for the child
◦ make sure all of their homework supplies are near – so theyre not running back-and-forth
• Appropriate classroom placement
• child may have a one-on-one
• may have someone to give them extra help, to go with them from class to class
• oral toothbrush/ care
Pt teaching ADHD
Palate surgery:
• child will not eat for several days
• they will be on TPN (total parenteral nutrition)
• once we start re-introducing foods into the diet – milk, give using needle-less syringe
• • No suctioning in mouth post op
Do not put in their mouth post-operative surgery:
Post-operative Cleft Lip, Cleft
chronic diarrhea
• malabsorption of nutrients
• May result in failure to thri
Celiac disease
- steatorrhea = very fatty, frothy, foul-smelling, bulky feces, stool
- child looks malnourished – over time
- big belly, abdominal distention
- seconary vitamin deficiency
• Young children:
• abdominal distention, big belly
• eating foods with wheat causes Pain
◦ once they eat → will have abdominal pain, will be irritable, moody
- Older children and adults:
- eating foods with wheat causes Pain
- alternating Diarrhea & Constipation
- Malabsorption
Celiac disease
Antigliadin antibody of both IgA and IgG – will test Positive for both
Blood tests: celiac disease
- wheat, wheat products
- rye
- barley
- oats
• Foods that we remove from diet: celiac disease
• Grains: ◦ rice ◦ corn ◦ millet • Vegetables: ◦ all vegetables; all vegetables are gluten-free • Fruits: ◦ all fruits; all fruits are gluten-free • Meat: ◦ any type of meat ◦ Except meats with wheat-based fillers: ▪ hot dogs ▪ sausages ▪ luncheon meats
Celiac disease foods can eat
striae – on armpit area, front & back of arms, breasts, abdomen, sacrum, buttocks, thighs
Stretch marks
- obstruction of lumen of appendix by hardened fecal matter – fecal matter made its way to the appendix & is stuck in there = bacteria grows = causes inflammation = swelling of appendix, pressure
- viral infection; child has a viral infection to the abdomen
Appendicitis
• belly pain
• dull pain
◦ pain starts in the periumbilical area (around the umbilicus on abdomen, stomach)
◦ pain will radiate → to the Right Lower Quadrant → pain then becomes severe, acute pain
▪ when driving to hospital & if car hits potholes → child will scream in pain = is a clue that it is appendicitis; is a Positive sign for appendicitis
• if pain goes away = rupture; perforation of appendix
• One examination – assess child for rebound tenderness at McBurney’s Point = is a Positive sign for appendicitis
◦ rebound tenderness = no pain when you press/push down on the abdomen, pain when you release pressure
S/S Appendicitis:
◦ give IV Fluids
◦ start on broad-spectrum Antibiotics
Before Appendicitis surgery
• IV Fluids
• Antibiotics
• insert Nasogastric Tube – for continuous low Suctioning
◦ to decompress the bowel; we need the bowel to rest
◦ the NG tube is removed when peristalsis has returned
After perforation: appendicitis
- 3 hours per day
- more than 3 days per week
- for more than 3 weeks
Usually occurs by 3 weeks old
Usually goes away by itself (by 4-5 months old)
Colic
If mother is breastfeeding – we do a trial supplementation phase
• tell her to stop dairy for 1 week = to see if the child will improve
For bottle-fed baby:
• switch the formula to a lactose free formula for 1 week = to see if the child will improve
Colic management
- smoking = can trigger Colic
- teach mother – avoid spicy foods, highly seasoned foods = baby will taste in breastmilk & can trigger Colic, abdominal/stomach pain
- feed baby little bits at at time; burp baby in between feedings = gas can trigger Colic
Pt teaching Colic
• series of 2 shots:
◦ first injection = 12-18 months old
◦ second injection = 4-6 years old
MMR/Varicella
is a virus - Agent is paramyxovirus
is spread via:
1. droplet transmission – cough, sneeze – is inhaled
2. direct contact – kids drinking from same straw, sharing foods back and forth
Mumps
Incubation period is 14-21 days
• once virus enter your body → it will incubate for 2-3 weeks
Mumps
• Fever – starts with a high fever; 100.3 – 100.4 degree fever
• headache
• malaise – fatigue, tired, not active, just wants to lie down
• followed by Parotitis = inflammation of parotid gland (on the jaw line; under the ear)
◦ looks like they have swollen cheeks
◦ unilateral or bilateral
• self-induced anorexia
◦ they dont eat b/c it hurts to chew; pain when chewing food
◦ NI: Drink from a straw
• Pain:
◦ ear pain; ears hurt
◦ jaw pain; jaws hurt
◦ the side of their face hurts
S/S – Mumps
- start IV line right away
- IV fluids – b/c theyre not eating
- Contact precautions – contact isolation
- PO fluids, soft, bland foods – foods that they dont have to chew much
- Hot or cold compress
for Adolescent males only → can develop Orchitis = inflammation of testacle, caused by mumps virus
• testacle will be swollen, tender to touch
• Treatment = warm compress to area
• reassure kid that it will go away in 7-10 days
Mumps
first injection: 11-12 years old
◦ second injection: 16-18 years old
Meningococcal Vaccine
Acute inflammation of the Central Nervous System
• Can be caused by various bacterial agents
– Streptococcus pneumoniae
– Neisseria meningitidis
– β-Hemolytic streptococci
– Listeria monocytogenes
– Escherichia coli
Meningitis
- Droplet infection from nasopharyngeal secretions
- Appears as an extension of other bacterial infections through vascular dissemination
- Organisms then spread through the cerebrospina
Transmission of Bacterial Meningitis
Head and neck symptoms: • headache • neck pain; severe neck pain • nuchal rigidity = stiff neck • they cannot flex their neck • back pain • confusion • photophobia = cant stand bright lights ◦ keep lights dim • high Fever = risk of seizure in children • symptoms of increased intracranial pressure •Opisthotonos = arching their head behind the body; arching their head backwards • occurs b/c of meningial irritation
Signs/Symptoms - Bacterial Meningitis:
• put child in supine position
• lift the leg & try to bend knee forward → cant do it
◦ when hip is flexed 90 degrees → cannot straighten the leg
Positive Kernig’s Sign:
• put child in supine position
• lift head & bring chin to the chest → their knees automatically flex
◦ when the head is flexed → hips & knees automatically flex
Positive Brudzinski’s Sign:
there will be low, decreased amounts of glucose in CSF
▪ there will be high, elevated protein levels in CSF
▪ there will be high, elevated protein levels in CSF
elevated white blood cell levels in CSF
Bacterial Meningitis
• ISOLATION precautions ◦ room by themselves • start IV lines • Medications: ◦ Antibiotics – b/c bacterial infection ◦ antipyretics – for high fever ◦ Seizure precautions: ▪ anti-seizure meds – b/c high fever can cause seizure ▪ pad side rails ◦ steroids – for brain swelling ▪ mannitol = decreases intracranial pressure, decreases brain swelling • Maintain hydration • Quiet environment ◦ dim lights – b/c of photophobia
Bacterial Meningitis
Onset is abrupt or gradual • Great prognosis Same S/S as Bacterial Meningitis • Except = theyre not as acutely ill Definitive Diagnosis = Lumbar Puncture: • will have clear CSF • will have normal glucose levels in CSF • will have normal protein levels in CSF • will have mildly elevated white blood cell count in CSF
Viral meningitis
• IV Fluids, IV Hydration • bedrest • Medications: ◦ Antipyretics ◦ Analgesics
Viral meningitis treatment
superficial burns • intact skin – skin is not open • only involves 1 layer of the skin: ◦ epidermal layer • skin can get red – goes away • pain – but it goes away • goes away in a few days • No scarring
1st Degree Burn
– partial thickness burns • involves 2 layers of skin: ◦ epidermal layer ◦ dermal layer • skin is open • skin is moist, red, blisters • heals in 2-3 weeks • There is scarring
2nd Degree Burn
– full thickness burns • involves more layers: ◦ epidermis ◦ dermis ◦ nerve endings ◦ sweat glands ◦ hair follicles
3rd Degree Burn
– full thickness burns
• same as 3rd degree burn, but also involves:
◦ muscles
◦ bone
• when you look at the burn area – you can see ligaments, tendons
4th Degree Burn
- keep child at a horizontal position
- roll the child
- remove clothing
- remove jewelry
- dont cover their face
Patient Teaching for Burns
- Airway compromise and shock
- Local and systemic infection
- Respiratory problems
Complications - Burns
less than 10% of body surface area burned
• treated at home – dont need to go to hospital/ER
◦ wash the area
◦ antibiotic cream, neosporin
• is like a first degree burn
◦ no open wound
◦ there will be no scarring
Minor Burn
= 10-20% of body surface area burned
• bring child to hospital/ER – need to be treated in hospital
Moderate Burn
more than 20% of body surface area burned
• child will be transferred to a burn trauma center, burn trauma unit
The more extensive the burn → the more rapid fluid loss
• fluid shift
• increase in heat loss = will get Hypothermia
◦ we have to keep them warm
Major Burn
bacterial infections
• prone to Pneumonia
Prone to Pulmonary Embolism
Prone to Atelectasis
Cause of death in Burns
give Tetanus Vaccine
• Mild analgesics
• Antipyretics
• Airway maintenance
• Fluid replacement
• High protein, high calorie diet
• Vitamin A and C, Zinc
• promotes healing – increases healing time
• Morphine Sulfate – for major burn pain, we have to sedate them
• Debridement – medicate before b/c painful procedure
• Hydrotherapy – medicate before b/c painful procedure
Treatment of Burns
• ex: Intergra – good b/c cannot be allergic to it
◦ it lacks antigenicity – body cannot reject it
◦ also has a long shelf life
◦ is soft so can mold it to body
◦ it has collagen so body absorbs it once its applied to skin, your own skin will grow into it
Artificial skin
- stress
- premenstrual, girls starting to have their periods; hormone-related
- cosmetics
- improper hygiene – not washing their face
Acne Triggers
- Cystic Acne:
• very pus-likle
• very painful - White Head = closed comedone
- Black Head = open comedone
Types of Acne
• Adequate sleep
Balanced diet = cut back (not stop eating a type of food) on high-fat, greasy foods, fatty foods
Girls with bangs or long hair = pony their hair, specially when they goto bed at night
• Cleansing = wash face BID, twice a day with mild cleanser – in morning & at night
• we encourage them to buy a neutrogena mild face wash
Acne management
Wash face BID
Mild cleanser such as neutrogena
• no manual extraction, no squeezing – leads to ice pick scars & spreads the acne, bacteria
Acne teaching Acne
–African Americans
–Mediterranean descent
–South American, Arabian, and East Indian descent
Ethnicity affected by Sickle Cell
• Cerebrum symptoms – S/S of TIA, stroke
◦ child will be staring; will have a black stare; will be unresponsive
◦ facial drooping
◦ slurred speech
◦ muscle weakness – arm weakness, leg weakness
◦ but they recover from these symptoms right away
Head symptoms of sickle cell
