NUNP 6541 Pediatric Final Exam

NUNP 6541 Pediatric Final Exam Recommended treatment for RSV in a 7 month old (outpatient) - Use of saline drops and suctioning of the nares. Indications of when to use antipyretics. Signs of respiratory distress or dehydration. Guidelines for feeding an infant with signs of mild respiratory distress which includes smaller more frequent feedings; monitoring of the respiratory rate; and guarding against vomiting. The parents should be educated that the child may have the symptoms over the course of 2-3 weeks Epiglottitis s/s - Acute and rapid onset of high fever, chills, and toxicity. Severe sore throat and drooling saliva. Will not eat or drink, muffled (hot potato) voice, and anxiety. Sitting posture with hyperextended neck with open-mouth breathing. Stridor, tachycardia, and tachypnea Epiglottitis prevention - Haemophilus influenzae type B (Hib) vaccine Steeple sign - a radiologic sign found on radiograph where the subglottic tracheal narrowing produces a shape of a church steeple which supports a diagnosis of croup Foreign body aspiration antibiotic? - Depends on the nature of the material aspirated, plus the location and degree of obstruction. Bronchial or laryngeal foreign body aspiration, a bronchoscopy must be performed for removal of the foreign body Antibiotics for bronchiolitis? - Use of saline drops and suctioning of the nares. There is no evidence to support the routine use of antibiotics Antibiotics for croup? - Nebulized epinephrine, corticosteroids (dexamethasone oral or IM), blow by oxygen or heliox in severe croup. Racemic epinephrine with the use of corticosteroids to limit rebound swelling Antibiotics for epiglottitis? - Establish an airway preferably by nasotracheal intubation. Administer IV antibiotics such as rocephin to cover H.influenzae. Administer oxygen and respiratory support. Antibiotics should be continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single dose (maximum of 600 mg) for 4 days for infants and children, 600 mg once a day for adults for 4 days. Should be provided for household contacts who are at risk (Younger than 4 years old who is non-immunized or incompletely immunized, children less than 12 months who have not received primary series of Hib, and immunocompromised children. Asthma treatment - The pharmacological management of asthma in children is based on the severity of asthma and the child's age. After initial control, decrease treatment to the least amount of medication needed to maintain control. Systemic corticosteroids may be needed at any time and stepped up if there is a major flare-up of symptoms. Step 1 Asthma management for children 0-4 years old - Step 1: SABA (Short acting beta2-agonist) PRN: With viral respiratory symptoms short acting beta 2-agonist should be used every 4-6 hours up to 24 hours (longer with a physician consult). Consider NUNP 6541 Pediatric Final Exam short course of oral systemic corticosteroids if severe exacerbation. Frequent use of SABA may indicate the need to step up treatment Step 2 Asthma management for children 0-4 years old - Step 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids. Step 3 asthma mgmt for children 0-4 yrs - Step 3: Medium-dose of inhaled corticosteroids Steps 4-6 asthma mgmt for children 0-4 yrs - Step 4: Medium-dose ICS and Long acting beta2-agonist or montelukast. Step 5: High dose ICS and Long acting beta 2-agonist or montelukast. Step 6: High dose of ICS and LABA or montelukast and oral corticosteroids Steps 1-3 asthma mgmt for children 5-11 yrs - Step 1: SABA (Short acting beta 2- agonist) PRN: Increasing the use of short-acting beta 2-agonist or use greater than 2 days a week for symptom relief generally indicates inadequate control and the need to step up treatment. Step 2: Consider consultation with asthma specialist. Low dose of inhaled corticosteroids. Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose of inhaled corticosteroids. Steps 4-6 asthma mgmt for children 5-11 yrs - Step 4: Medium-dose ICS and LABA or medium dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. . Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid and leukotriene receptor antagonist or theophylline. . Step 6: High dose of ICS and LABA and oral corticosteroids or high dose of inhaled corticosteroids and leukotriene receptor antagonist or theophylline and oral corticosteroids. ** Theophylline levels must be monitored. Differentials for patient with sore throat - Strep pharyngitis Peritonsillar abscess Viral pharyngitis Infectious mononucleosis Epiglottitis NUNP 6541 Pediatric Final Exam small-for-gestational-age infants: which type of chromosomal analysis should be included? - Trisomy 18 Holt-Olram Trisomy 13 Turner Syndrome Trisomy 21 Prader-Willi Syndrome heart defects associated with Down syndrome - Atrioventricular Septal Defect Ventricular Septal Defect Persistant Ductus Arteriosus Tetrology of Fallot Contact sports with Down's Syndrome - Do not recommend due to atlantoaxial instability Diagnosing Down Syndrome - Usually identified at birth by the presence of certain physical traits: low muscle tone, a single deep crease across the palm of the hand, a slightly flattened facial profile and an upward slant to the eyes. Because these features may be present in other babies, a chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a karyotype, doctors draw a blood sample to examine the baby's cells. They photograph the chromosomes and then group them by size, number, and shape. By examining the karyotype, doctors can diagnose. Another genetic test called FISH can apply similar principles and confirm a diagnosis in a shorter amount of time Diagnosing Trisomy 18 (Edwards Syndrome) - A sample of the baby's dna is extracted from a blood sample or other bodily cells or tissue and is cultured to examine a picture of the chromosomes called a karyotype. In order to get this picture, the chromosomes are isolated, stained, and examined under the microscope. Most often, this is done using the chromosomes in the white blood cells. A picture of the chromosomes is taken through the microscope. A visible extra 18th chromosome confirms a Trisomy 18 diagnosis Diagnosing Holt-Oram Syndrome - A diagnosis may be suspected when a person is found to have changes in the way the bones of the wrist and other bones of the upper limb are formed. The diagnosis can be confirmed if a person has specific bone changes and a personal or family history of an atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to establish the diagnosis, a doctor may order tests including an x-ray of the hands, wrists, and arms, a echocardiogram, and an electrocardiogram. The diagnosis may also be confirmed with genetic testing of the TBX5 gene Diagnosing Trisomy 13 - Parents who are at risk to have a translocation due to their family history can have a blood test called a karyotype, which can determine if a translocation is present