Test 1: Health and safety Flashcards
What 2 things do you do when you observe that a child has been found near poison?
- your safety
- assess child first
What are some physical signs of poisoning?
- nausea, abdominal pain, vomiting, diarrhea
- respiratory distress, cyanosis
- burns of mouth and pharynx
- seizures, change in LOC
- shock
What should be done if child is poisoned?
- Assess ABC’s
- Instruct family to bring emesis, stool, etc to ER
- ID poisonous agent
- Determine child’s age and weight
- Ipecac syrup
When should vomiting NOT be induced?
- poisonings by corrosive substance
- neurological system compromised
What are 4 methods of removing the poison?
1) Ipecac syrup
2) Activated charcoal
3) Gastric lavage
4) Catharsis
When is gastric lavage recommended?
- Neuro compromised
- small children
- cyanide
Name the antidotes for the following:
- benzos
- acetaminophen
- digoxin
- opioid (MSO4 and heroin)
Benzos = flumazenil (Romazicon) Acetaminophen = acetylcysteine (Mucomyst) Digoxin = digoxin immune fab (Digibind) Opioid = naloxone
What are some steps to prevent poisonings?
- Teach!
- Get on child’s level
- Child resistant closures
- Symbols on bottles
- Locked box is the best!
What are some common sources of lead poisoning (plumbism)?
lead paint (1959 - 1980)
gasoline
unglazed pottery
folk remedies
What are the levels of lead requiring treatment? What percentage do children absorb?
10 mcg/dl or greater
50%
What are the effects of lead?
- Failure to gain weight
- developmental lags
- headache
- constipation
- anemia (lead takes iron’s place on RBC’s)
- renal: tubule damage
- neuro: impulsivity, distractibility, hyperactivity, blindness, coma
What is the most common heavy metal poisoning?
Lead
What is a source of mercury exposure?
mercury thermometers
What is acrondynia and what is it a classic sign of?
painful extremities
mercury poisoning
What are common signs of child abuse?
- unexplained fractures
- bruises in various stages of healing
- welts
- cigarette burns
- glove or sock burns
- bite marks
- retinal hemorrhages
- inappropriate dress
- unmet medical needs
- FTT
What are some risk factors for child abuse?
- parental history of abuse
- teen parents
- high need child
- family violence
- environment (stress, poverty, divorce, alcoholism)
Define Munchausen by Proxy
illness deception or "disease forgery" feign illness falsify results exaggerate medical problem active/passive worsen problem
Define “enuresis”.
Involuntary passage of urine past the age when a child should be expected to have attained bladder control.
What age does enuresis generally occur?
5 to 7 years
Does enuresis generally occur more often in boys or girls?
boys
Define “encopresis”.
Severe constipation that leads to an involuntary release of stool, sometimes diarrhea, b/c cause the body can no longer contain it.
What is the patho behind encopresis?
- as the stool remains in the rectum, the RECTUM RELAXES and the defecation reflex wanes
- water reabsorption continues, fissures with pain develop, causes a cycle of PAIN AND RETENTION
- STOOL BECOMES HARD, but mushy stool may be behind hard stool
- RECTUM ENLARGES resulting in failure to control external sphincter
What age does encopresis generally occur?
After age 4
What are the guidelines in diagnosing encopresis?
- child is 4 or older
- defecation 1 x month for 3 months
What are some causes of encopresis?
- constipation
- digestive tract abnormalities
- emotional
What are some ways to mangage encopresis?
- physical workup
- support parents & child
- bowel retraining
What is usually the patho behind enuresis?
alteration in neuromuscular bladder functioning
What are some ways to manage enuresis?
- urine alarms
- age (child’s bladder matures on own, just a little later than normal)
- retention control training
- motivational therapies
- eliminate bladder irritating foods
- drug therapy
- support parent and child
Common medications for enuresis:
ditropan (oxybutynin hcl)
dofranil (imipramine hcl)
DDAVP (desmopressin acetate)
What are 4 methods used to overcome the withholding associated with encopresis?
1) enema
2) stool softener or laxative
3) mineral oil 30-75 mL BID to decrease pain
4) change retention habit (sit on toilet 5-10 min, 20-30 min after meals)
What dietary changes can be made to manage encopresis?
- limit milk intake
- increase residue (citrucel)
- increase water intake
Brown Recluse Bite: What are some necessary treatments?
- antibiotics
- corticosteroids
- pain control
- skin grafting
What characteristics are seen with ADHD?
- inattention
- impulsiveness
- hyperactivity
- social and academic consequences
What are common co-morbidities seen with ADHD?
depression and learning disabilities
What are 2 areas to address in the child with ADHD?
Behavioral and pharmacologic
What meds are generally prescribed for ADHD?
- Ritalin (methylphenidate)
- Strattera (atomoxetine)
- Concerta (extended release methylphenidate)
