Week 6 - Pediatric conditions Flashcards
When dealing with pediatric conditions, how should care be delivered?
Family-centered
For bloodwork, what sites are used based on age?
Heel pokes for under 18 months
Finger pokes for most routine tests
Chronic inflammatory disorder of the airways resulting from a complex interaction of airway obstruction, bronchial hyper-responsiveness and inflammation
asthma
Asthma causes _______ airway obstruction.
reversible
In asthma, what will you hear when listening to breathing?
Expiration wheezes
Exacerbations of this illness is the leading case of pediatric hospital admission
asthma
most children who present to the ER with an asthma exacerbation are
5
Why is it that most asthma exacerbations are for children less than 5?
Not diagnosed yet more active don't follow med schedule unaware of triggers smaller airways
What time of the year do asthma exacerbations peak?
September when they go back to school (peaks 17.7 days after Labour day) - exposed to germs and may have low adherence to asthma meds at this time
What are some common viruses that could cause asthma exacerbations?
Rhinovirus, coronavirus, influenza, parainfluenza, RSV
What is the biggest trigger for asthma?
Second hand smoke or dust
What are some triggers for asthma?
environmental allergens (pollen, dust), dry and cold air, exercise, second hand smoke
If asthma exacerbation is suspected, what should we do?
Ask the parents if they had it before
vitals - ox sats
sit them up
don PPE (may be pneumonia)
What two instruments are used in dx of asthma?
Spirometry/pulmonary function test
Peak flow monitoring
Measures the total volume of air that is inhaled and exhaled.
Forced vital capacity (inhaled) and forced expiratory volume (exhaled)
Spirometry
Spirometry is difficult to accomplish in children under the age of ?
6
Describe peak flow monitoring
Patient takes a full breath, blows out quickly and as hard as they can
This is repeated 3x and the highest value is recorded
Peak flow is compared to normal values or patient’s personal best to see whether they need to go to the ER
Why would peak flow be used? Why wouldn’t it?
Readily available BUT
less sensitive measure of airway obstruction and may be unreliable for children under 10
When a child presents with suspected asthma, what questions should you ask?
Have they had this before/been to ED before/PCCU before?
Do they have puffers?
Any allergies?
What has the family tried?
What assessments are completed for children with asthma?
Vitals + head to toe + resp assess
Look for lower oxygen sats, tachypnea and more breaths per minute
Look for skin colour, LOC, use of accessory muscles, anxiety, diaphoresis
listen for breth sounds
What nursing interventions might be completed for asthma?
Oxygen spirometry/peak flow [ABGs] - rarely used BW (lactate, acidosis, PCO2) [CXR - rarely used]
Is a CXR common for asthma?
What about blood gases?
No, unless the clinician suspects complications (e.g. pneumothorax)
Blood gases rarely checked unless they do not respond to aggressive therapy –> normal capillary carbon level despite persistent respiratory distress is a sign of respiratory failure
What is the order of puffers for asthma management?
Salbutamol/blue puffer - bronchodilator (ventolin - SABA)
Beclomethastone - corticosteroid
Long acting beta agonist - Advair/serevent
LTRA (leukotriene receptor antagonist - singulair - chewable tablet with min sides
IV/PO steroids - e.g. dex
How does one breathe when using salbutamol/blue puffer?
How about the disk/advair?
Salbutamol - do not breathe in hard and fast
Avair disk - hard and fast inhalation (particulate)
6 blue puffer; 6 little green puffer
What is the impact of asthma on the child?
o Impact ability to be active – teaching about that
o Grow up fast – get used to administering own meds
o Bullying – QOL might be impacted
What is the impact of asthma on the family?
o Stress/anxiety
o Pets
o Meds and supplies can be expensive (but covered in Ontario)
o Traveling may be impacted
What can we do to manage the impact of asthma on the child and family?
o Number one thing we can do is teaching
o Plan centered around the patient
o Teen – taking more control of care; mobile apps for asthma; how they can monitor it themselves
What does Ryan’s Law required?
• The law requires Ontario school boards to establish standardized asthma policies:
o Reduce risk of exposure to asthma triggers
o Provide regular training for staff on recognizing and managing asthma symptoms
o Allow students to carry their own asthma medication with physician and parental approval
o Require school principals to develop individual asthma plans for children
o Allow staff to administer asthma medication if it is believed a student is experiencing an asthma attack
Describe CF
Autosomal recessive
thickened secretions in sweat glands, GI tract, pancreas and respiratory drug due to CFTR mutation
What happens when there is increased prodiction of chloride in sweat glands/body?
Blood becomes acidic
What are the main reasons for admissions to hospital with CF?
Infections
Describe exacerbation management for CF
Clear secretions (chest physio) and Abx
Describe activity tolerance for CF
Encourage physical activity which can help manage exacerbations
Describe respiration for CF on auscultation.
wheezing, low sats
clubbing if chronic
Inspiratory crackles > expiratory wheezing
may have DBS to bases
What are some diagnostic tests for CF?
sweat tests, CXR
Pediatric oncology stats
- number _____ cause of death by disease in children
- survival rate?
- Average age of diagnosis is ____
- 3 out of 5 who survive pediatric cancer will have late effects from chemo such as?
1
1 in 5
6
heart failure, secondary cancers and infertility
What are the most common pediatric cancers?
AML and ALL
Which is more common, AML or ALL?
AML
neoplastic proliferation of leukocyte precursor cells in the bone marrow
AML
What is the difference between hodgkin’s and non-hodgkin’s lymphoma?
Hodgkins - only B cells involved
non- also has T cells and NK cells
What is the difference between leukemia and lymphoma?
Leukemia - neoplasm in bone marrow; progenitor cells
lymphoma - neoplasm in lymph node or lymphatic tissue - end cell line
the second most common cancers in children, making up 26% of childhood cancers
brain and CNS tumours
Why is osteosarcoma most common in teens?
This is when the bones are growing the quickest.
This type of cancer can start anywhere but usually starts in the belly (abdo) whre it is noticed as swelling. It can also cause bone pain and fever.
NB
starts in cells that normally develop into skeletal muscles; can start nearly any place in the body
Rhabdomyosarcoma
What are some diagnostic tests for cancer?
BW, imaging, biopsy, cytology
For neurological tumours, what is the usual presenting symptom?
Seizures
What are some symptoms that might lead to a cancer diagnosis?
lumps, energy loss, swelling, brusing, fever, unexplained continuous illness and headaches
how closely they look like normal cells or tissues
grading
What are treatments for cancer?
- Chemotherapy
- Surgery
- Radiation
- Immunotherapy
- Bone marrow transplant
Why are portacaths chosen over PICC lines?
o More convenient for kids
o Doesn’t require constant sterile dressing changes
o Infection rates – big one – once you deaccess, completely closes over
sometimes used to help control side effects from other cancer treatments
immunotherapy
What are the two primary ways that BRMs work in immunotherapy
Active immunotherapies - stimulate immune system
passive - supplement the immune system
What are the four common BRMs?
cytokines, ILs, CSF, Mab
Pediatric oncology treatment protocols are based on what?
Clinical trial protocols
Tx plans for pediatric oncology are bsaed on what?
Maximize destruction of cancer and minimize damage to host cells - magic bullet
Dosage based on BSA
Tx based on Ca type
Tx is stopped if side effects are intolerable or there is no response
What is used to help with mouth sores/stomatitis?
- Lidocaine (Koolstat) – swish and spit
- Alcohol free mouthwash after meals
- Soda water – tonic water for mouth wash
What is used for thrush?
nystatin swish and spit; fluids through a straw
What are signs of TLS?
hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia – creatinine
Occurs after the initiation of therapy when tumour cells release their contents into the bloodstream, either spontaneously or in response to therapy, leading to the characteristic findings of hyperuricemia, hyperkalemia, hyperphospatemia and hypocalcemia (only 2+ of the latter must be present).
TLS
When is clinical TLS present?
when lab tumor lysis syndrome is accompanied by an increase in Cr, seizures, cardiac dysrhythmia, or death
