Week 2 - Paediatric 2 Flashcards
Anatomy & Physiology - Airway of a paediatric:
- Small mandible
- Larger occiput - results in neck flexion when lying supine
- Preferential nose breathing until 4-6 months
- Small diameter of airways results in higher resistance to air flow & increased chance of airway obstruction
- Highly compliant trachea (risks ‘kinking’)
Anatomy & Physiology - Breathing of a paediatric:
- Alveoli less numerous and less mature
- Thin chest wall
- Diaphragmatic breathing
- Fewer type 1 fibres in respiratory muscles
Anatomy & Physiology - Circulation of a paediatric:
- Higher metabolic demands
- Smaller vessels/more subcutaneous tissue
- Higher circulating blood volume/weight
- Bradycardia is often a result of hypoxia
What is a fontanelle?
An anatomical feature of the infant skull comprising any of the soft membranous gaps (sutures) between the cranial bones
What is pyloric stenosis?
A problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration
Pathophysiology of pyloric stenosis:
Pyloric Stenosis occurs when the circular muscle of the pylorus thickens as a result of hypertrophy, which narrows the pyloric canal between the stomach and the duodenum
Clinical manifestations of pyloric stenosis:
- Vomiting
- Distended upper abdomen
- Readily palpable olive-shaped tumor in the epigastrium just to the right of the umbilicus
- Visible gastric peristaltic waves that move from left to right across the epigastrium
Treatment of pyloric stenosis:
Laparoscopic pyloromyotomy is the standard treatment to relieve the pyloric obstruction
Post op nursing care of pyloric stenosis:
- Monitor IV fluids and strict monitoring of intake and output, including any vomiting and the number and character of bowel actions
- Observation of vital signs
What is intussusception?
A condition that happens when part of the intestine folds into another section of the intestines resulting in obstruction
Risk factors of intussusception:
- Having had one previously
- Having a sibling with intussusception
- Having intestinal malrotation
Clinical manifestations of intussusception:
- Sudden acute abdominal pain
- Child is clearly distressed, screaming and drawing the knees onto the chest
- Child appearing normal and comfortable between episodes of pain
- Vomiting
- Lethargy
- Red-current coloured jelly like stools (stool mixed with blood and mucous)
- Tender, distended abdomen
- Palpable sausage-shaped mass in upper right quadrant
- Eventual fever and signs of peritonitis (inflammation of the peritoneum)
How is intussusception diagnosed?
- In children it may be felt during a rectal exam
- A definite diagnosis requires imaging (ultrasound, x-ray, CT) which can show ‘Bulls-Eye’, telescoped intestine on end
Pre/post op nursing care of intussusception:
- May require NGT insertion for bowel decompression before undergoing surgery and monitoring of all bowel actions/dirty nappies for blood
- Post procedural care may include maintenance of IV fluids, administration of antibiotics, pain assessment, obtaining vital signs, wound/dressing assessment and establishing when the return of bowel sounds and normal bowel action has occurred
What is gastroenteritis?
Inflammation of the digestive system secondary to viral or bacterial infection, parasites, chemicals or some drugs
Pathogens that can cause gastroenteritis:
- Rotavirus
- Norovirus
- Enterotoxigenic E.coli
Clinical manifestations of gastroenteritis:
- Sudden onset diarrhoea in children is almost synonymous with acute viral or bacterial gastroenteritis
- The child may say they feel unwell, have a fever, abdominal pain, and have minimal intake of food or fluids
- Vomiting can be common in the 24-48 hours before diarrhoea begins
- Diarrhoea can last up to 10 days
- Severe dehydration results from vomiting and diarrhoea
What is bronchiolitis?
A very common viral infection of the lower airways that occurs mostly in children under 2 year
Pathophysiology of bronchitis:
Bronchiolitis is inflammation of the bronchioles and is a viral infection. The most common virus that causes bronchiolitis is RSV
What is croup?
A general term applied to a group of symptoms characterized by hoarseness, a resonant cough described as “barking” or “brassy” (croupy), varying degrees of inspiratory stridor, and varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx and subglottic airway
Pathophysiology of croup:
Croup, also known as laryngotracheobronchitis is the inflammation of the entire laryngotracheal tree (larynx, trachea and bronchi), but is usually the greatest in the subglottic area which is the narrowest part of the child’s airway
Clinical manifestations of croup:
- Inspiratory stridor (from increased airflow turbulence), hoarseness
- Barking cough
- Suprasternal retractions
- Increased breathing
What is asthma?
A common chronic illness in children and the pathophysiology of the disease is similar to that of adults
Characteristics of asthma:
- Airway inflammation
- Airway hyper-responsiveness
- Mucus hypersecretion
- Wheeze
- Dyspnea
- Cough
- CHest tightness
Pathophysiology of asthma:
The lining of the airways swells and goes red, the air passages make more fluid called mucous and the muscle bands around the air passages come tighter and narrower
Nursing care management of asthma:
- Food should not be encouraged during the acute phase of respiratory distress due to the risk of aspiration.
- Pulse oximetry, respiratory rate and depth of breathing, chest auscultation of air movement and adventitious sounds, and any signs of respiratory distress (e.g., nasal flaring, tachypnea, retractions)
- Children receiving supplemental oxygen require intermittent or continuous oxygenation monitoring, depending on the severity of respiratory compromise
How many puffs of salbutamol can a child under 5 and over 6 have?
Children 5 years and younger can have up to six puffs of salbutamol, children 6 years and over can have up to 12 puffs of salbutamol
What is acute otitis media?
Acute Otitis Media (AOM) is inflammation of the middle ear space and children will present with a rapid onset of fever and otalgia (ear pain)
Pathophysiology of acute otitis media:
Children with Acute Otitis Media have dysfunctioning eustachian tubes from mechanical or functional obstruction causing accumulation of secretions in the middle ear
Most common pathogens of acute otitis media:
The most common pathogens include Streptococcus pneumoniae and Haemophilus influenzae
Clinical manifestations of acute otitis media:
- Ear pain (that results from the pressure on surrounding structures)
- Fever, irritability, inflamed tympanic membrane and fluid in the middle ear
- A temperature as high as 40
Nursing management/treatment for acute otitis media:
- Analgesic-antipyretic medications
- Myringotomy, a surgical incision of the eardrum to alleviate severe pain
What is tonsillitis?
Bacterial or viral tonsillitis is a common cause of illness in young children because of their susceptibility to upper respiratory tract infections, and the abundant lymphoid tissue
Pathophysiology of tonsillitis:
Several pairs of tonsils are part of a mass of lymphoid tissue encircling the nasopharynx and oropharynx, tonsils and adenoids are part of the lymphatic system which help your immune system fight infection
Clinical manifestations of tonsillitis:
- Dry and irritated mucous membranes of the oropharynx because of continuous mouth breathing
- Offensive mouth odor and impaired senses of taste and smell
- Nasal and muffled sounding voice because air cannot be trapped for proper speech sounds
- Persistent cough
Tonsillectomy/adenoidectomy nursing management:
- Monitoring the child’s vital signs and looking for early signs of bleeding (continuous swallowing may mean the child is swallowing the trickling blood)
- The throat is very sore after surgery and children should receive pain assessment and analgesic-antipyretic medications routinely every 4 hours while symptoms persist.
- A soft diet and oral fluids
Effects of unrelieved pain in terms of cardiovascular:
↑HR, BP, CO2, O2 consumption
Effects of unrelieved pain in terms of respiratory:
↑ RR, ↓ flow/vol, ↓SaO2
Effects of unrelieved pain in terms of endocrine:
↑ cortisol, adrenaline, glucagon, BSL
Effects of unrelieved pain in terms of gastrointestinal:
↓ gastric & gut motility
Effects of unrelieved pain in terms of musculoskeletal:
tension, spasm, fatigue
Pain scale for neonates:
paeds assessment triangle
Pain scale for children under 3 or people who are non-verbal:
FLACC
Pain scale for children 3-4:
Wong-baker faces scale
Pain scale for older children/adolescents:
Ask them to colour in the area that hurts
Adverse drug reaction prevention:
- Know the medication prior to administration
- Confirm patient information
- Ensure most recent weight used in calculation
- Check allergies
- Clarify illegible orders
- Confirm accuracy of dose (particularly if different to recommended dose)
- Double check if unsure (some medications should always be double checked)
- Improve communication
