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Peds - Growth and Development > Week 6 - Chronic illness, Disability, and Home Care > Flashcards

Week 6 - Chronic illness, Disability, and Home Care Flashcards

1
Q

Define chronic illness

A

A condition that has the potentital to:
- interfere w/ daily FN for > 3 months/yr
- causes hospitalization of > 1 month/yr

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2
Q

What is the most common endocrine disorder in childhood? When is this disorder most prevalent?

A

Diabetes Mellitus
- peak incidence in early adolescence

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3
Q

What are the major groups of DM? Explain.

A

Type 1 - pancreas does NOT make insulin d/t destruction of Beta cells
Type 2 - body cells cannot USE insulin properly
Maturity-onset diabetes of the young (MODY) - rare autosomal dominant disorder w/ abnormally formed insulin and decreased biologic activity

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4
Q

Which type of diabetes affects children?

A

Type 1

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5
Q

How do you diagnose diabetes?

A
  • 8 hr fasting blood glucose level of 126 mg/dl (7 mmol/L)
  • random blood glucose value of 200 mg/dl (11.1 mmol/L)
  • oral glucose tolerance test finding of > 200 mg/dl in the 2 hour sample, or
  • hemoglobin A1C of 6.55 or more = type 2 DM
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6
Q

Can cystic fibrosis cause diabetes?

A

Yes, CF affects the pancreas
- loses ability to make insulin over time

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7
Q

What type of medications can increase the risk of developing diabetes?

A

Steroid medications
Dexamethasone and prednisone - long term use

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8
Q

At what age is MODY diagnosed?

A

Usually before the age of 25, onset occurs before 25 generally

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9
Q

What is the therapeutic management of type 1 DM?

A

nutrition
exercise
patient teaching
illness management
management of DKA

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10
Q

What do you include in your teaching about blood sugar checks?

A
  • monitor BG levels before meals, before bed, and at specific additional times as indicated
  • monitor before and after exercise
  • monitor for symptoms of hypoglycemia
  • monitor more frequently when sick
  • optimal BG target: 4-8 mmol/L
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11
Q

What is the plasma BG goal for a toddler with Type 1 DM?
- before meals?
- before bed?
- hemoglobin A1C

A

before meals: 100-180 mg/dl
before bed: 110-200 mg/dl
hemoglobic A1C: < 8.5% (but > 7.5%)

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12
Q

What is the plasma BG goal for a preschooler with Type 1 DM?
- before meals?
- before bed?
- hemoglobin A1C

A

before meals: 100-180 mg/dl
before bed: 110-200 mg/dl
hemoglobic A1C: < 8.5% (but > 7.5%)

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13
Q

What is the plasma BG goal for a school-aged child with Type 1 DM?
- before meals?
- before bed?
- hemoglobin A1C

A

before meals: 90-180 mg/dl
before bed: 100-180 mg/dl
hemoglobic A1C: < 8 %

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14
Q

What is the plasma BG goal for an adolescent with Type 1 DM?
- before meals?
- before bed?
- hemoglobin A1C

A

before meals: 90-130 mg/dl
before bed: 90-150 mg/dl
hemoglobic A1C: < 7.5%

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15
Q

What are the signs of hyperglycemia?

A
  • feeling tired
  • irritability
  • polyuria
  • polydipsia
  • blurry vision
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16
Q

What are signs of hypoglycemia

A
  • feeling tired
  • irritability
  • blurry vision
  • dizziness
  • shakiness
  • paleness
  • increased hunger
  • sweatiness
  • headache
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17
Q

What are the signs and symptoms of DKA?

A
  • high blood sugar levels and ketones in urine
  • excessive thirst
  • polyuria - in large amounts
  • sudden weight loss
  • stomach pain or nausea
  • vomiting
  • dehydration - dry mucus membranes, mouth
  • deep heavy breathing
  • fruity smelling breath
  • drowsiness leading in time to unconsciousness
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18
Q

Explain ketoacidosis

A
  • when the body breaks down fat for energy, in the absence of glucose
  • ketones released
  • excess ketones eliminated in urine (ketonuria) or by the lungs (acetone breath)
  • ketones make the blood more acidic (lowers pH ==> ketoacidosis)
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19
Q

What lab values indicate metabolic acidosis?

A

glucose > 11 mmol/L
pH < 7.3
HCO3 < 15 mmol/L
Ketones in blood and/or urine

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20
Q

Which type of DM is DKA more common in?

A

Type 1
10-20% of kids w/ new-onset type 1 DM present w/ DKA

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21
Q

How do we manage DKA?

A

1) Fluid rehydration w/ 0.9% NaCl (deficits replaced at a rate of 50% over the first 8-12 hrs, and the remaining 50% over the next 16-24 hrs)
2) IV insulin infusion starting with 0.1 unit/kg/hr
3) IV fluids w/ K+ replacement –> but check electrolytes and renal FN first
4) blood glucose levels should decrease by 50 to 100 mg/dl/hr (2.8-5.6 mmol/L)

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22
Q

What are some tips to minimize pain during glucose monitoring?

A
  • use a warm compress to enhance blood flow to the finger before pricking
  • use the ring finger or thumb, and puncture the finger just to the side of the finger pads
  • use lancet device w/ adjustable dept tips; use a shallow one
  • use glucose monitors that require small blood samples
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23
Q

What is asthma?

A

Chronic inflammatory disorder of the airways
- bronchial hyperresponsiveness
- episodic
- limited airflow or obstruction that reverses spontaneously or w/ tx

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24
Q

What are common clinical manifestations of asthma?

A

Dyspnea, wheezing, and cough

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25
List therapeutic management for asthma
allergen control and avoidance drug therapy to prevent or relieve bronchospasm maintain health and prevent complications promote self-care support child and family
26
What are long term control meds for asthma?
- inhaled corticosteroids - cromolyn sodium and nedocromil - long-acting B2-agonist - Flovent, Alvesco
27
What are quick-relief (rescue) medications for asthma?
Bronchodilators - short-acting B2-agonists (salbutamol) - anticholinergics (Ipratropium) - systemic steroid (prednisolone)
28
What are 2 IV meds given for asthma?
IV Magnesium sulphate IV salbutamol
29
What have inhaled medications for asthma?
MDI w/ spacer Nebulizer
30
What is the significance of using a spacer when administering MDI?
A spacer/chamber holds the puff from the MDI in a tube or “chamber” for a few seconds, so that you don't have to both breathe in AND spray the MDI exactly at the same time. This helps get more medicine into your lungs
31
What are the signs of mild asthma exacerbation?
- Breathlessness while walking - talking in sentences - may be agitated - increased RR - moderate expiratory wheezes - pulse < 100 - pulsus paradoxus: absent or < 10 mmHg
32
What are the signs of moderate asthma exacerbation?
- breathlessness at rest, prefers sitting - softer and shorter cries in infants - talking in phrases - agitated - increased RR - accessory muscle use - loud expiratory wheezes - pulse: 100-120 - pulsus paradoxus: may be present, 10-25 mmHg
33
Signs of severe asthma exacerbation?
- breathlessness at rest - infant stops feeding - talking in words - agitated - RR > 30 - accessory muscle use present - loud wheezes on inspiration and exhalation - pulse >120 - pulses paradoxus: present, 20-40 mmHg
34
What are some visible late warning signs of asthma exacerbation?
- flared nostrils - blue or grey skin around the mouth - tracheal tug - skin under ribs pulled inward
35
Signs of severe respiratory distress in children w/ asthma
- sitting upright, refusing to lie down - younger one stops feeding - talk with few words only - agitated - diaphoresis - pale - fast RR
36
What PRAM score do you assign to a child presenting with suprasternal indrawing, wheezing on exhalation, widespread decreased air entry, and a SpO2 reading of 92%
suprasternal indrawing - 2 expiratory wheezes - 1 widespread diminished air entry - 2 92% O2 - 1 total: 6 (Moderate)
37
What PRAM score do you assign to a child coming in with suprasternal indrawing, scalene retractions, audible wheezing, widespread decrease in air entry, and O2 sat of 88%
2 + 2 + 3 +2 + 2 = 11 (Severe)
38
What are the PRAM scores for mild, moderate, and severe asthma?
mild: 0-4 moderate: 5-8 severe: 9-12
39
How do you manage someone w/ a PRAM score of 2
2 = mild - give salbutamol every 20 mins, 1-2 doses in the first hour delivered via an MDI and spacer - reassess 20 mins after each dose of salbutamol - observe for at least 1 hr after the last dose of salbutamol; if the PRAM score remains mild, provide asthma teaching and discharge instructions
40
How do you manage someone with a PRAM score of 5
5 - Moderate - Salbutamol every 20 minutes, X 3 doses delivered via MDI and spacer - Ipratropium every 20 minutes, X 3 doses delivered in the first hour only, 3 delivered via MDI and spacer - Give oral corticosteroid before or immediately after the first dose of salbutamol - reassess 20 mins after each dose - if PRAM score is still greater than or equal to 4, give salbutamol every 30-60 minutes
41
How do you manage someone w/ a PRAM score of 9
9 = severe 1. Call MRP Immediately 2. Salbutamol continuous nebulization with oxygen * Bronchodilators delivered continuously for 60-180 minutes via aerosol result in more rapid improvement compared to intermittent delivery 3. Ipratropium nebulized every 20 minutes for 3 doses if not already given 4. Establish IV access, run maintenance fluids 5. Methylprednisolone IV 1 mg/kg/dose every 6 hours even if a previous steroid has been given 6. Continuous cardio/respiratory/SaO2 monitoring 7. Consider chest X-ray If PRAM score is still severe after reassessment: - Magnesium Sulfate IV * In addition to continuous bronchodilator therapy * Consider 0.9% sodium chloride bolus IV of 20mL/kg over 20 minutes to vent hypotension - consult pediatrician and RT
42
What is cystic fibrosis?
- Exocrine gland dysFN - an autosomal recessive genetic disease (abnormal gene on chromosome 7) - affects the respiratory and GI systems d/t pancreatic enzyme deficiency
43
How is CF diagnosed?
Thorough PMHx + testing - newborn screening - genetic testing - sweat chloride test - chest radiography - History + physical exam
44
Explain the pathophysiology of CF
Pancreatic enzyme deficiency that results in increased viscosity of mucous gland secretion - thick secretions = mechanical obstruction - mostly affecting the respiratory tract and pancreas
45
How does CF affect the respiratory tract?
Thick stagnant mucus in the respiratory tract - increased risk of bacterial colonization (Pseudomonas aeruginosa) --> destruct the lung tissues - secretions difficult to expectorate --> obstructs the bronchi/bronchioles - causes impaired gas exchange --> hypoxia, hypercapnia, acidosis - compression of pulmonary blood vessels and progressive lung dysFN leading to pulmonary HTN, cor pulmonale, resp. failure, and death
46
what are interventions for CF on the respiratory system?
bronchodilators - open the airway mucus thinners - hypotonic saline (inhalation form), or adding extra salt into the airways (to pull water into the airways)
47
What is the effect of CF on the GI tract?
thick secretions block the pancreatic ducts --> cystic dilation --> degeneration --> diffuse fibrosis - scarring (fibrosis) prevents pancreatic enzymes from reaching the duodenum - impaired digestion/absorption of fat + protein - pancreatic fibrosis/scarring ==> diabetes - focal biliary obstruction results in multilobular biliary cirrhosis - impaired salivation
48
What are the clinical manifestations of CF?
Trouble gaining weight, stunted growth, failure to thrive meconium ileus in the early postnatal period pancreatic enzyme deficiency progressive COPD associated w/ infection sweat gland dysFN - gradual respiratory deterioration
49
CF respiratory management
remove excessive mucous secretions - chest PT - bronchodilator medication - forced expiration (breathing exercise) aggressive treatment of pulmonary infections - home IV antibiotic therapy - aerosolized antibiotics steroid use/NSAIDs Transplant
50
What are goals for CF patients?
- prevent and minimize pulmonary complications - adequate nutrition for growth - assist in adapting to chronic illness
51
CF gastrointestinal management
- replace pancreatic enzymes - high protein, high calorie diet (150% of RDA) - prevent/manage intestinal obstruction - salt supplementation - oral glucose-lowering agents or insulin injections - diet and exercise management
52
What is sickle cell anemia
- hereditary hemoglobinopathy - autosomal recessivee - RBCs are sickle cell --> carry less O2
53
What is the most serious type of sickle cell anemia?
SS
54
In which ethnicity is sickle cell anemia most prevalent?
African ancestry - also seen in children of the middle east, Mediterranean, and South Asia
55
Explain the pathophysiology of sickle cell
- partial or complete replacement of normal Hgb w/ abnormal - RBCs are elongated (sickle) shape - sickled cells are rigid and can block capillary blood flow --> micro obstructions can lead to tissue ischemia - hypoxia occurs and causes sickling - large tissue infarctions occur --> organ damage - spleen sequestration: RBCs are trapped; may require splenectomy
56
How is Sickle Cell treated?
NO CURE (except bone marrow transplant) supportive care - prevent episodes immunocompromised - treat infections
57
What is hydroxyurea? What is it used for?
A chemotherapy drug - also used for sickle cell anemia; prevents: - pain crisis, episodes of acute chest syndrome, blood transfusions, hospital stays
58
What causes a sickle cell crisis?
- anything that increases the body's need for O2 or alters the transport of O2 - trauma - infection, fever - physical and emotional stress - increased blood viscosity d/t dehydration - hypoxia (from high altitude, poorly pressurized planes, hypoventilation, hypothermia)
59
What are the types of sickle cell crisis?
Vasoocclusive thrombotic (VOC) - painful episodes caused by the stasis of blood - blood clumps --> ischemia --> infarction - signs: fever, pain, tissue engorgement Splenic sequestration - when blood pools in the spleen --> spleen enlarged - hb levels drop significantly --> can result in death within hours - signs: profound anemia, hypovolemia, shock Aplastic crises - Diminished production and increased destruction of RBCs - triggered by viral infection (Parvovirus B19) or depletion of folic acid - signs: anemia, pallor
60
What is Acute chest syndrome?
similar to pneumonia VOC or infection results in sickling in the lungs causes chest pain, fever, cough, tachypnea, wheezing and hypoxia
61
How is ACS managed?
A medical emergency - aggressive tx of infection: give IV broad-spectrum antibiotics, prophylactic w/ oral penicillin - pain management - Monitor CBC and reticulocyte count to evaluate bone marrow function - blood transfusion - exchange transfusion
62
What part of the GI tract is impacted by Crohn's disease vs Ulcerative colitis?
Crohn's: any part of GI tract UC: colon + rectum
63
What are the s/s of Crohn's disease?
stomach pain vomiting loss of appetite fever diarrhea weight loss poor growth mouth ulcers swollen lips
64
What are major differences between crohn's disease and UC?
fistulas, strictures, and anal lesions - rare in UC - common in Crohn's Rectal bleeding - common in UC - uncommon in Crohns
65
How is Crohn's disease and UC managed?
Medications: - 5-ASAs - corticosteroids - immunomodulators - antibiotics - biologic therapy

Peds - Growth and Development (7 decks)

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