PEDS exam 4 Flashcards
Ambylopia
lazy eye
poor visual development that leads to reduced visual acuity in one eye or blindness in one or both eyes if not corrected
-can be caused by strabismus, trauma, cataracts, ptosis
strabismus
misalignment of eyes where eye either turn inward (estropia) or outward (exotropia)
causes diplopia and asymmetric corneal light reflex
patch or surgery to correct
Hyperopia
Farsightedness
Sees distant clearly, not objects that are close
Myopia
Nearsightedness
-close objects clearly, distant objects not
How far away is the child from the snellen or tumbling E chart for a vision test?
10 feet
How to conduct vision test on a child
10 ft away
-start at bottom first until they pass (4/6)
-then start at top and move down until they do not pass the line
Vision test-misalignment
Cover test
Color vision test
Ishihara
The three vision test
Cover test
Peripheral vision test
Color vision test
Ambylopia- therapeutic management
-eye patch (over strong eye to encourage brain to use weaker one)
-corrective lenses(encourage)
-atropine eye drops (dilate strong eye to encourage more use of weak eye)
-surgery
-eye exams more frequent due to developing eye monitor for signs visual changes (HA, squinting, dizziness, constant removal)
Hearing loss types
conductive, sensorineural, mixed
hearing loss signs by age
infant-no startle to noises
young child- communicates needs through gestures
older child-often asks for statement to be repeated
Etiology of hearing loss types-conductive
transmission of sound through middle ear disrupted (i.e. frequent infections)
Etiology of hearing loss types-sensorineural
damage to hair cells in cochlea or along auditory pathway (i.e. ototoxic med, meningitis, CMV, rubella, excessive noise)
Etiology of hearing loss types-mixed
attributed to both conductive and sensorineural
Infantile glaucoma
autosomal recessive disorder
-vision loss result of retinal scarring and optic nerve damage
Patho infantile glaucoma
obstruction of aqueous humor flow and high intraocular pressure
Assessment findings infantile glaucoma
infant keeping eyes closed most of time, frequent eye rubbing, spasmodic winking, corneal clouding, enlargement of eyeball, excessive tearing or conjunctivitis
-red reflex may appear gray or green
Management of infantile glaucoma
surgical intervention first line management in children
-pre-op=prepare parents 3-4 surgeries
-protection of surgical site postop=critical
-maintain eye patch and bedrest, provide distraction and activities
-elbow restraints for infants and toddlers
-teach parents how to administer eye medications
-no rough housing or horseplay for two weeks
Congenital cataracts patho
opacity of optic lens preventing light from entering eye- severe ambylopia if not treated
-leading cause of blindness and visual impairment in children
-best outcomes when removed before 3 mo age can be done as early as 2 weeks of age
Congenital cataracts assessment findings
- Bilateral can be associated with genetic defects or metabolic syndromes
-cloudy cornea, absent red reflex in affected eye
Congenital cataracts management
implantable lens placed or fitted with contact lens
-postop eye patching normal eye after surgical eye healed to strengthen vision
-elbow restraints for infants
-teach fam to administer abx and steroid drops
-sunglasses needed when outside to protect against UV
Nursing care of children with visual impairment
Promote optimal development, Independence, parent-child attachment
-refer to educational services
-promote corrective lense use
-encourage compliance with eye exams and screenings
Education: safety hazards, eye injury prevention
Tips for interacting with visually impaired child
Childs name to gain attention and identify presence FIRST BEFORE touching child
-discuss upcoming activities, walk them through it
-use their body parts as reference points for location of items
-simple specific directions
-name and describe people/objects to make child more aware of what is happening
-encourage exploration of objects through touch
Educational resources referral
Younger than 3=early intervention
Older than 3= individualized care plan (IEP)
acute otitis media
infection of middle ear structures bacterial (strep pneumoniae) or viral (RSV, influenza)
Acute otitis media physical findings
rubbing/pulling on ear
Crying,irritability, fussiness, reports ear pain
Fever (low to 104)
TM dull, red, bulging, opaque
Purulent drainage may be visible behind eardrum or in canal if TM ruptured
Lymphadenopathy
Poor feeding
Difficulty sleeping, crying during night
acute otitis media S/S
fever, ear pulling, irritability, poor feeding, lymphadenopathy; TM dull, red, bulging w/ dec or no movement
acute otitis media tx
amoxicillin/augmentin or azithromycin- PO or ceftriazone IM (1 dose)
-tylenol/ibuprofen to manage ear pain (otalgia) and fever
-benzocain drops for pain if TM intact
Otitis media acute with effusion patho
collection of fluid in middle ear w/ NO infection r/t allergies or Ig adenoids
Otitis media acute with effusion assessment findings
TM=dull. orange discoloration, air bubbles, dec movement
S/S= feeling of fullness, transient hearing loss possible
Otitis media acute with effusion management
tx: resolves on own
i fpersist: >3 mo, refer to ENT and assess for hearing loss or speech delay
Tympanostomy management
Surgical procedure where ear tubes are placed in eardrum to treat middle ear issues, equalize pressure and minimize fluid collection; long-term relief
Myringotomy management
small incision on TM and placement of PE tubes can be indicated for child who has multiple episodes of OM; short-term relief
Tympanosotmy discharge teaching
teach ear drop administration
Ear plugs recommended when swimming, if water enters ear, allow it to drain out
Notify provider if drainage noted with PE tubes
Tubes remain in place for several months usually fall out spontaneously (~8-18 months
Proper ear drop administration
<3yrs=pinna down and back
>3yrs=pinna up and back
Types of skin lesions
Macule,papule, plaque/annular, vesicle, pustule
Macule
circular, flat discoloration <1cm
papule
superficial, solid, elevated <0.5cm
Plaque/annular
ring-like with central clearing
Vesicle
circular collection of free fluid <1 cm
Pustule
vesicle containing pus
Skin injury types
abrasions, lacerations, bites, bruises, burns
Abrasion
superficial rub or wearing off of skin due to friction mainly limited to epidermis
Laceration
injury that penetrates skin and soft tissue
Bites
human or animal
Burns
major cause of accidental death in children <15 yrs old
-most common types= thermal, chemical, electrical
-hot water heater temp >140 can cause a 3rd degree burn in 15 sec
-younger children=deeper injuries
Risk factors for skin injury types
Poverty, prematurity (<1 yr), chronic illness, intellectual disability, parent with abuse history,alcohol/substance abuse, extreme stressors
Suspicious cues for skin injuries
injuries uncommon locations
-bruises in infants <9 months
-multiple injuries other than LEs
-frequent ED visits, delay in seeking care
-inconsistent stories
-unusual caregiver-child interactions
Sun safety pt education and sunscreen
infants <6 months out of direct sunlight, minimal sunscreen use
-hats, sun shirts
-limit sun exposure between 10am-4pm
-broad spectrum (screens out UVA and UVB)
-fragrance and oxybenzone free
-SPF 15 or higher, zinc oxide products for nose cheeks ears shoulders
-apply 30 in prior to sun activity, reapply at least every two hours or every 60-80 min while in water (resistant or not)
Burn assessments
Primary and secondary
Primary burn assessment
airway- patent, maintainable,
Unmaintainable?
Assess for signs of airway injury or smoke inhalation
Resp effort, symmetry of breathing, breath sounds, pulse ox, ABG, carboxyhemoglobin
-skin color pulse strength, HR, perfusion status, edema, ECG if electrical burn
Secondary burn assessments
burn depth
Body surface area
Other traumatic injuries
Burn staging
severity depends on child’s age, causative agent, body area involved and temp and duration of contact
-minor
-moderate
-major
Minor burns
<10% TBSA, treated outpatient
Moderate burns
10-20% of TBSA treated in hospital with expertise in burn care
Major burns
> 20% TBSA requires medical services of burn center
Priorities of care for burns
airway, manage complications, prevent hypothermia, wound care, prevent infection, managing pain, providing nutritional and psychological support, restore mobility
Nursing actions for burns- Minor
minor: stop burning process, cover to prevent contamination, cleanse with mild soap and tepid water, apply antimicrobial ointment and apply non adherent dressing, pain management
Burn prevention education
Nursing actions for burns-Major
airway: airway edema continues for up to two days after burn
Humidified 100% O2 as Rx
Emergency airway mngmt sooner than later, anticipate intubation (100% O2 via NRB or ambulance, intubation for infants)
Complications: inhalation injury (thermal or carbon monoxide), pulmonary problems
Atopic dermatitis (eczema) physical cues
Extreme itching to allergen or environmental factors (temp change, sweating)
-dry, scaly pruritus, erythematous patches on flexural surfaces lesions (face, scalp, wrists or arms, antecubital, popliteal areas)
-indicators of secondary infection
-elevated IgE
-presence of wheezing (asthma common)
Atopic dermatitis (eczema) Diagnostic cues
elevated IgE levels
Atopic dermatitis (eczema) Management
topical corticosteroids and immune modulators-tacrolimus
Atopic dermatitis (eczema) Pt education
-avoid hot water and bathe 2X/day in warm water
-Avoid soaps containing perfumes, dyes, or fragrances
-pat skin dry and leave moist while apply moisturizers multiple times daily
-100% cotton clothing and bed linens, avoiding synthetics and wool
-keep fingernails short
-antihistamines assist with itching
Diaper dermatitis physical cues
inflammatory hypersensitive rxn by detergents, soaps, chemicals
+Non-candida- red, shiny
Diaper dermatitis therapeutic management
Keep the skin dry, barrier creams- zinc oxide
Acne
Acne-Hx and physical cues
fam Hx
Acne- med management
Acne- pt education
Hx cues of immunodeficiency
Lab cues of immunodeficiency
Immunoglobulin (IgG, IgA, IgM, IgE) characteristics
igG-only one that crosses placental barrier, virus toxins and bacteria, through breast milk lack=severe immunodeficiency (baby produces to-1yr)
IgE-allergic rxns (eczema) and parasitic
IgM-bacterial infections , primary immune response(meningitis)
IgA-first line of defense against resp GI Gu patho, production-at 3 mo
Severe combined immunodeficiency (SCID) patho
Lack IgA and IgM
Absent B and T cells, no immune function
“Bubble boy”-protection isolation
Severe combined immunodeficiency (SCID) Assessment findings
Severe combined immunodeficiency (SCID) Diagnostic findings
HIV in children- physical findings
HIV in children-Diagnostic labs
18 mo<= positive ELISA and Western Blot
>18mo= positive pCR and viral culture
HIV in children- Priority of care
Management of condition
Nutrition, weight, height
Juvenile idiopathic arthritis-patho
systemic inflammation in synovial joints
Fever
Juvenile idiopathic arthritis-assessment findings
morning stifnesss
Fussy
Not wanting to get out of bed
Juvenile idiopathic arthritis- diagnostic findings
Latex allergy
Latex allergy-cross sensitivity
Latex allergy- clinical manifestations
Latex allergy- nursing care and interventions
Allergic and anaphylaxis reactions
Allergic and anaphylaxis reactions-physical cues
Allergic and anaphylaxis reactions-management
Rubeola
Aka measles
Rubeola Patho
virus
Rubeola(measles) assessment findings
Koplik spots-oral mucosa grains of sand
Rash at top and moves down body
Cough
Maculopapular rash
Malaise
Nasal inflammation, conjunctivitis
Complications=pneumnia and encephalitis
Rubeola(measles) nursing care
vitamin A 6mo-2yr
Airborne precautions
Post-exposure vaccination after 72 hrs or immune globulin IgE within 6 days may reduce severity
Pertussis-physical findings
swelling and irritation of airways
Paroxysmal coughing(10-30 times in a row)
Cyanosis
Protruding tongue
Red face
Tearing eyes, drooling, copious secretions
Pertussis
”whooping cough”
Pertussis therapeutic management
bacterial, azithromycin if <1 mo
TMP-SMZ=alternative to macro life’s
DTaP vaccine <7
High humidity environment
Droplet/standard precautions
Treating fever in children-clinical manifestations
dehydration
Dec oral intake of fluids
Above
Treating fever in children- nursing care and interventions
-Assess temp 30-60 min after antipyretic given
-Same temp device and site for measurement
-Assess fluid intake and encourage oral intake.
-Admin IVF per order
Acetaminophen(any age) and ibuprofen(>6mo)
Lyme disease
Vector borne disease-tick bite
Lyme disease-physical findings
malaise fever chills
Neck stiffness
Joint pain
Erythema migrans at tick bite
Itchy nodule, firm, urticaria or localized edema, progresses stages 1-3 to more systemic involvement
Lyme disease- therapeutic management
Doxycycline if >8yrs, amoxicillin if <8yrs
Tx for 14-28 days
Lyme disease- nursing management
Pediculosis capitis
Head lice
Pediculosis capitis- physical cues
excessive itching
Nits
Eggs
Small red bumps on scalp, white specks attached to hair shaft
Nits or lice seen behind ears or at nape of neck
Pediculosis capitis-Management
follow head lice treatment directions exactly -Permethrin, neurotoxic
Comb every 2-3 days
Gowns, gloves-direct contact transmission-contact precautions
Soak combs and brushes in hot water, dry cleaning/sealing in plastic bags
Types of precautions and indications for infections
Contact-transmitted when in close proximity w/pts and environment(head lice)
Droplet-large droplets by coughing, sneezing, talking(pertussis)
Airborne-infectious pathogens that remain suspended in air and can travel great distance-N95 (rubeola aka measles)
Leukemia- ALL
acute lymphoblastic leukemia
Over-production of immature leukoblast cells (WBC) with infiltration of organs and tissues
Leukemia-ALL history/physical cues
low-grade fever
Signs of infection
Pallor
Bruising/petechiae/purpora
Leg pain
Joint pain
Enlarged liver/lymph nodes
HA
N/V
Abd pain
Leukemia-ALL lab cues
neutropenia
Anemia - H&H low, RBCs low
Platelets low
Blood smear shows blasts
BMA=most definitive, diagnostic
Hodgkin’s Lymphoma patho
Cancer cells in lymph fluids and nodes
Uncontrolled proliferation
Presence of reed sternburg cells
Cytokines release
Lymphoma history and physical cues
-Hx immnodificiency
Infections
-Epstein Barr virus
-Fam Hx lymphoma
-Unintentional weight loss
-Night sweats
-Fever
-Cough
-SOB
-Pruritus
Splenomegaly/hepatomegaly
-Painless , enlarged supraclavicular or cervical lymph nodes (sentinel nodes)
Lymphoma lab cues
hodgkin’s=reed sternburg cells
Brain tumors pre-op priorities of care
monitor for inc ICP
Steroids dec ICP swelling
Pre-op teaching and emotional support
Brain tumors post-op priorities of care
-monitor for inc ICP
-Frequent VS w pupil and LOC checks
-Tx for hyperthermia w antipyretics
-Pain mngmt
-Position on unaffected side at level ordered
-JP drain monitor
-Keep head midline
Wilm’s tumor (Nephroblastoma)
renal mass
Wilm’s tumor (Nephroblastoma)- assessment cues
-Abdominal assymmetry
-Vomiting
-Weight loss
-Renal mass ultrasound
-Hematuria
-Firm non tender abdominal swelling and mass
-HTN
Wilm’s tumor (Nephroblastoma) Lab cues
-Ultrasound
-CT or MRI
-CBC (anemia-kidneys produce erythropoetin)
-UA (may potive for WBCs or RBCs)
-24 hr urine neg for homovanillic acid(HVA) and vanillylmandelic acid(VMA)
Bone marrow aspirate procedure
-Prone position
-Iliac crest=bone of choice
-Tibia in infant
-BM procedure tray/needle
-Topical anesthetic and conscious sedation (fentanyl/versed)
Explain procedure, comfort, infection prevention
Bone marrow aspirate monitoring
LOC, pain
Hold pressure prevent bleeding monitor for bleeding and prevent infection and monitor
Neutropenia precautions
avoid raw fruits and veggies
No flowers
Limit visitors
Private room
Hand hygiene
Avoid rectal temps and catheters and invasive procedures
Common cancer tx-chemo and a/e
anemia
Thrombocytopenia
Infection/immunosuppressed (ANC<1,000=neutropenia)
N/V/anorexia
Common cancer tx-radiation therapy
complication- skin irritation/burns/altered integrity
Teach: wash with mild soap and water
-Avoid lotions/powders/ointments
-Avoid sun or heat exposure
-Diphenhydramine or hydro cortisone for itching
-Antimicrobial cream to desquamation
-mositurize with aloe vera
Iron deficiency anemia
Not enough RBC and Hbg and Hct
-Not enough oxygen carrying capacity
Iron deficiency anemia- assessment
Irritability
HA
Unsteady gait, weakness, fatigue
Dizziness
SOB
Pallor in skin and MM and conjunctiva
Difficulty feeding
Pica
Spooning of Nails
Iron deficiency anemia- diagnostic findings
low RBC, H&H, MCV, MCH, ferritin
Red cell distribution width high
Iron deficiency anemia- management
-iron supplement for BF infant by 4-5 mo(behind teeth to avoid staining), cause constipation, give with OJ or acidic things , causes dark green stools
-Iron fortified formula
-BF mothers inc iron in diet
-Limit cows milk in children >1yr to 24/oz day
-Encourage iron rich foods
Hemophilia
deficiency of factor VIII—> essential to activate factor X—>converts prothrombin to thrombin-without it-PLTs cannot make clots
Hemophilia physical findings
Swollen or stiff joints (Hemarthrosis)
Multiple bruises
Hematuria
Bleeding gums
Bloody sputum or emesis
Black tarry stools
Chest or abd pain (internal bleeding)
Hemophilia labs
PTT is only thing abnormal(factor 8 here)
PT and PLT are normal
H&H may be low if bleeding going
Hemophilia management of bleeding episodes
Give factor 8- slow IV push
RICE
Desmopressin-mild, trigger endothelium of blood vessels to release factor 8
Sickle cell
causes ischemia and infarction
Sickle cell vaso-occlusive crisis
exacerbation
Sickle cell vaso-occlusive crisis assessment findings
Sickle cell vaso-occlusive crisis- labs
Sickle cell vaso-occlusive crisis-management
Lead poisoning risk factors
Lead poisoning physical and lab cues
Lead poisoning chelation therapy
