Peds Common Illness Flashcards. Revised
Flat, nonpalpable, and may vary in color (e.g. brown, red, purple, white, tan)
Macule
Examples of Macule include:
freckles, flat moles, rubella, rubiola (measles)
Elevated, palpable, firm, vary in color (brown, red, pink or bluish), not filled with anything
Papule
Examples of papules include:
warts, pigmented nevi, first stage of varicella
Elevated, circumscribed, superficial, filled with serous fluid
Vesicles
Example of vesicles include:
blister, 2nd stage of varicella
What skin condition is elevated, circumscribed, superficial, filled with PURULENT fluid?
Pustule
Impetigo, acne, and congenital candidiasis are examples of which skin condition?
Pustule
What is worse a mouth ulcer or an excoriation?
Mouth ulcer because it is deeper in the skin. Keep in mind that excoriation can lead to infection caused by thrush
What is an ulcer?
a crater-like lesion of the skin. A deeper discontinuity of body membrane.
A raw irritated lesion, which is more superficial is described as:
Excoriation
True or False, Another word for seborrheic dermatitis is called Cradle Crap?
False, Cradle CAP
Seborrheic Dermatitis
common and self-limiting condition of infancy. Seen in 1st 3 months.
The presentation of Seborrheic Dermatitis includes: mildly ________, greasy, white to ____, flaky to thick _____ on scalp
mild erythematous, greasy, white to yellow, flaky to thick scaling on scalp
You are discharging a patient with seborrheic dermatitis, what are key points you will make?
Wash hair daily with non-medicated shampoo, emollient and infant hair brush, use warmed mineral oil
Baby George is diagnosed with seborrheic dermatitis, his parents are very scared their child will not fit in with other kids because his head will always have this dry skin appearance. What is your best response?
It will be gone in a few weeks, not permanent.
What is the most common form of pediatric rashes?
diaper dermatitis
You are the intake nurse in the ED. You admit Michael, a baby with a reddened area on his bottom, you suspect diaper rash. What do you question the parents about?
Assess for recent diarrhea or use of antibiotics
You are educating new moms about management of diaper rash, what are key points you need to cover?
diaper changes q2h, superabsorbent diapers, sitz bath 10-15 min QID, try to stay away from wipes, powders, and hair dryers. A & D (smells medicated) and Zinc oxide ( no smell).
True or False, open air to a diaper rash helps with healing
True. Even bag & mask the area will promote healing
True or False, Atopic Dermatitis (AD) is a hypersensitivity response with a family history origin
True, patients with AD have a family history of allergic reactions.50% will develop asthma and/or hay fever
Dry, itchy skin, erythema, vesicles, exudation and crusts are associated with what disease?
Atopic Dermatitis
You are caring for Karla, a 2 you diagnosed with acute exacerbation of AD. To help prevent future complications, what can you educate Karla and her parents about?
Give warm water baths with no soap, use hydrating creams and low-dose steroids, avoid precipitants (e.g. hot weather), use cotton for clothing, reevaluate diet (e.g. daily), avoid stuffed animals
Would you give a child with a severe exacerbation of Atopic dermatitis an immunization?
No
Baby Nick is 1 month old and keeps scratching at his skin. As the nurse, what could you do to help prevent the scratching?
socks on hands, nails shorts
What disease is characterized by highly contagious superficial skin infection by staph aureus or strep?
impetigo
True or False, in impetigo, lesions will not rise and will only occur with trauma
False, lesions can rise and occur w/o trauma
Describe the lesions associated with Impetigo
lesions will rise w/o trauma, straw colored fluid filled lesions that rupture
What would you expect as common orders for Impetigo?
Wash off crust and apply topical antibiotic for 5-7 d, possible PO antibiotic, and school exclusion for 24 h post first application of antibiotic tx
Tine (ringworm) is associated with a _____ infection
Fungal
Describe the clinical presentation of Tinea (ringworm)
circular shape with central clearing, pruitis, painful, possibly symptom free
True or False, Tinea (ringworm) is transmitted via Airborne & droplets
False, contact
True or False, you can catch ringworm form animals
TRUE (e.g. cats)
Would you keep a child home with tinea (ringworm)?
no exclusion needed, just keep that bad boy covered
How is Tinea (ringworm) treated?
OTC antifungal (e.g. lotrimin, Monistat)
What age group mostly gets conjunctivitis?
Preschoolers
___% of conjunctivitis cases are _____. Can be allergic, ____, or ____ as well.
50% of cases are bacterial. Can be allergic, fungal, or viral as well
Clinical presentation and treatment of conjunctivitis includes:
purulent drainage, red conjunctiva. Topical antibiotics or ointment
How long should a child with conjunctivitis be excluded from home?
until 24 hours of treatment is complete
In what disease do mites burrow into skin and deposit eggs?
Scabies
How is scabies passed?
direct, prolonged, skin-to-skin contact with an infected person
Pruritis (especially at night) and a papular eruption between fingers is common in what disease?
scabies
How is scabies treated?
scabicide lotion from head to toe of infected person and household contacts. Leave on for recommended time before washing it off.
What home education would you give to a family that has a child infected with scabies?
bedding, clothing, towels should be decontaminated by washing in hot water and drying in a hot dryer. Items (e.g. stuffed animals) sealed in plastic bag for 72 hours
How is Lice transmitted?
interaction with playmates, cross transfer from articles of clothing on adjacent hooks, shared combs, headphones, towels and beds
True or False, children with lice are asymptomatic
TRUE
How is lice diagnosed?
demonstration of the louse or nits
What is the treatment process for Lice?
OTC meds and retreat in 10 days
In children that do not have any other issues, what is apnea?
pauses of < 20 seconds but accompanied by pallor, cyanosis, bradycardia or hypotension in full term infant
Periods of respiratory pause that last > 20 seconds is called
Apnea
What is apnea of prematurity?
impaired resp effort due to immaturity of resp. center in the brain
ALTE (apparent life threatening event) is identified by:
apnea, changing in color, change in muscle tone, choking/gagging/or coughing, and requires intervention
Is ALTE a diagnosis or chief complaint
Chief Complaint
What can cause ALTE?
GERD, infection, seizures, cardiac, head injury
Causes of SIDS
maternal smoking, co-sleeping, rebreathing of CO2 when sleeping prone, side-lying sleep position, soft bedding
What’s the relationship with ALTE and SIDS?
ALTE replaced old title near-SIDS, but no confirmed relationship with SIDS
What kind of isolation would you put a kid with impetigo under?
contact because when lesion is filled fluid and it pops, that can be spread
What is a common area for Tinea (ringworm)
elbow
If patient has viral conjunctivitis, what would be the treatment course?
no antibiotics, saline flush may be helpful
What is the appearance of scabies?
cluster of 4 or more in a linear straight line
Promithine is the most common OTC treatment for what?
Scabies
How long is a child school excluded?
Once treated they can go back to school
A temperature of greater than 100.4 in peds patients would indicate?
Fever
Whenever a child a has a 1 degree of temperature elevation, their respiration rate raises by ____ breaths, their oxygen demand raises by ____, and their metabolic rate increases by ____?
RR- 4 breaths; O2- 7%; Metabolic rate- 10%
Why is early intervention for a temperature of greater than 100.4 (Fever) so important?
Early intervention is necessary because a fever increases hydration, caloric requirements, and heart rate
In regards to a fever, what do parents and caretakers need to know?
When to call their provider. Caretakers of a child with a fever should call their providers IMMEDIATELTLY if the child with a fever is less than 2 months of age; has a fever of greater than 105 (could be Roseola), or if the child acts very sick, has a stiff neck, petechia, confusion, breathing problems, or excessive vomiting.
According to the CDC School Exclusion Guidelines, students with a temperature of greater than ____ should be dismissed from school.
> 101
T or F. Children excluded from school because of fever may be readmitted if they’re fever FREE for 24 hours with no help from Antipyretics?
TRUE
Examples of common Antipyretics used to treat fever include?
Acetaminophen and Ibuprofen
T or F. Acetaminophen is used more for comfort.
True. It only lowers temperature by 1 degree. It should be used in addition to Ibuprophen.
What would indicate a fever in a child that is less than 2 months?
A temperature of 100.4 or greater
What would indicate a fever in a child that is greater than 6 months?
A temperature of 103 or greater
Two reasons why a family should call about a fever include?
When the temperature persists for 24 hours or more and when the child acts or behaves differently
As part of the discharge process for a patient with a fever, your job is to give examples to parents about WHEN their child should be SEEN as soon as possible. These examples include?
The parents notice the child does NOT respond to them, has trouble waking, or is limp; The child has trouble breathing; Has blue lips, tongue, or nails; Their child starts to lean forward and drool; Bulging or caving fontanel’s; They have a stiff neck, severe HA, and severe belly pain; Their child has a rash or purple spots; They’re refusing to eat or drink anything; They won’t stop crying or seem very cranky/ irritable.
In regards to fever and treatment, name 4 other reasons parents should CALL or VISIT their pediatrician?
Their child has diarrhea that lasts more than 2 or 3 days or seems to be getting worse; Has vomiting that goes on for more than 1 day; Has a specific symptom, such as a sore throat or ear pain; Has pain when they urinate.
What is FUO?
Fever Unknown Origin. It is associated with a fever of greater than 101 for more than 8 days.
What are 3 important things to remember about FUO?
- It’s very concerning 2. You should always have/keep an algorithm when the child first comes in 3. Antibiotics should started after diagnostic testing
According to UP to Date 2012, suggested diagnostic testing needed for FUO include?
CBC and peripheral smear; ESR; CRP; Blood cultures; U/A and urine culture; CXR; TB skin testing; Serum electrolytes, BUN, Creatinine, and Hepatic enzymes; HIV serology.
T or F. The influenza vaccine prevents influenza?
False. The vaccine decreases the risk of getting it; doesn’t prevent it.
T or F. 10,000 children are hospitalized each year for influenza?
False. 20,000/ year.
T or F. In regards to Influenza, children 6 months and older should be vaccinated annually?
TRUE
T or F. The first time vaccination process for Influenza includes 2 injections (28 days later)?
True, the 1st dose “primes” the immune system and the 2nd dose provides immune protection.
T or F. It takes 1 week after vaccination for Influenza for antibodies to develop in the body?
False, it takes 2 weeks.
This condition is very common between the months of October and March (Fall & Winter)
Croup
A term applied to a symptom complex characterized by hoarseness, a resonant cough described as “barking” or “brassy,” varying degrees of inspiratory stridor, and varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx.
Croup
T or F. CXR are common in Croup diagnosis?
False. Although this condition is confirmed by the Steeple Sign (appearance of sharp pencil) which is visible with CXRs, it contributes to UN-nececessary exposure to radiation.
The cause of most cases of Croup in the US is attributed to viruses, such as _______?
Parainfluenza
In regards to the Westley Croup Score (0-17), what score do we want to see when assessing our patients for Croup?
Less than 5 (We want <5 to manage it).
LOC; Cyanosis; Stridor; Air Entry; and Retractions are all assessed and SCORED in what measurement tool?
The Westley Croup Score
T or F. In regards to the Westley Croup Score, a score of 8 or more would indicate SEVERE croup?
TRUE
Baby McKenzie comes into the ED with a low-grade fever and stridor. Although you can HEAR it without needing to ausculatate the patient, her parents confirm your suspicion of a turbulent airway when they tell you that Baby McKenzie has been hoarse and has had a barking cough for the past 2 days that seems to worsen at night. What is causing McKenzie’s barking cough?
Baby McKenzie is exhibiting the most common S/S of Croup, an obstruction of the upper airway. Her barking is caused by a turbulent airway that is very swollen, as indicated by hoarseness and her cough.
T or F. In regards to the Westley Croup Score, a score of 10 or more would indicate Respiratory Failure?
False, a score of 12 or more would indicate respiratory failure.
According to Evidenced- Based Clinical Guidelines and Up to Date, what past interventions are no longer practiced and which interventions have been shown to be effective?
X-rays are not needed, humidified air has not been proven effective, corticosteriods should not be given right away (treat symptoms 1st) because they should be used to only treat more moderate to severe cases of Croup, 10 mins in steamy bathroom is not effective; Give oxygen to keep O2 sats >92, encourage fluids.
What is another term used to describe Pharyngitis (GABHS)?
Strep throat (Streptococcus Pharyngitis)
A patient is just admitted to your floor what a confirmed diagnosis of Streptococcus Pharyngitis (GABHS). As her nurse, what precautions will you inititate for this patient?
Airborne droplet and direct contact precautions
Children who experience GABHS infection of the upper airway (strep throat) are at risk for 2 potential complications. What are they?
Rheumatic Fever (RF) and Acute GLOMERULONEPHRITIS (AGN). Permanent damage can result from these sequelae, especially (RF).
T or F. GABHS infection is generally a relatively brief illness that varies in severity from subclinical (no symptoms) to severe toxicity.
True. The onset is often abrupt and characterized by sore throat, HA, fever, chills, abdominal pain, and N/V. Other symptoms include an inflammed/ beefy red pharynx that is covered with exudate, palatal patechiae, and a scarlatinform rash.
What medication order would you expect to see for your patient with GABHS/ Strep Throat?
Oral penicillins, such as Amoxicillin (50mg/kg/day) is the preferred treatment.
This condition is caused by the spirochete Borrelia burgdorferi, which enters the skin and bloodstream through the saliva and feces of ticks, especially the deer tick.
Lyme Disease
T or F. Testing of tick is not indicated for the diagnosing of Lyme disease because a positive test does not ,ean the infection has occurred?
TRUE
During the early stages of Lyme disease, diagnosis is best made clinically by _______________________?
Recognizing the characteristic rash, Erythema Migrans.
Erythema migrans
A painless, circular rash with a central clearing, necleic center (BULL’s EYES).
Malaise, Fever, Aches, Joint pain/ swelling, and HA are all common S/S associated with ____________?
Lyme Disease
What is the coomon Tx for Lyme Disease?
Doxycycline and Amoxicillin. Children that are older than 8 are treated with Doxycycline and Amoxicillin is recommended for children that are younger than 8
What is the most common bacterial infection diagnosed in children in the US?
Otis Media (OM). Its incidence is highest in the winter months and many cases are preceded by a VIRAL infection.
Risk factors that contribute to the development of Otis Media (OM) include?
Bottle propping, Day care, Cleft palate, and Cigarette smoke increases the risk of acute or chronic infection of the middle ear.
T or F. A side effect if recurrent OM is hearing loss?
TRUE
Fever, Ear pain, Fussiness, Congestion, Discharge, and Crying are all S/S associated with ________?
Otis Media (OM). Its incidence is highest in the winter months and many cases are preceded by a VIRAL infection.
During your assessment of a patient complaining of ear pain, you prepare an otoscope for the MD so that he can carefully examine this patient’s tympanic membrane (TM). After assessing the inside of the ear, the MD confirms that the patient has OM. What must the MD have seen?
A tympanic membrane that is red, opaque, bulging, and absent light reflexes.
What is the Tx of choice for children under 2 years of age with Otis Media?
High dose Amoxicillin PO bid. (80-90 mg/kg/day, divided twice daily).
How does cigarette smoking cause OM?
Smoking leads to hypersensitive upper airways and sensitivity.
If you were to examine the eustachian tube of an individual that is PRONE to OM, what would you see?
A shorter and horizontal tube, instead a longer and pointy tube which is normal.
What are 3 general rules for Exclusion from School?
- The child’s symptoms or illness prevents them from participating on a program’s activities 2. The child’s symptoms or illness results in a need for greater care than the staff can provide with compromising the care, health, and safety of other children in care 3. The symptoms and illness falls into one of the recognized excludable conditions, according to the National Resource Center for Health and Safety in Child Care and Early Education
A 3 year old with Croup had a RR of 28. Based on this finding, the RN will:
Document the finding because that is a normal RR finding and you don’t need to notify the MD because the patient is not retracting.
