Peds CPA 3: Comprehensive Pediatric Clinical Practice Assessment Guide | Edition

Peds CPA 3: Comprehensive Pediatric Clinical Practice Assessment Guide | Edition flex neck causing hip an knee flexion when meningitis present brudzinski Most common causes of illness and hospitalization in children respiratory Respiratory dysfunction in children tends to be more severe than in adults T or F true what is the most common cause of respiratory infections in children viruses Do children or adults deteriorate faster from respiratory issues children/infants How long are infants nose breathers? 4 weeks what is most important during assessment chief complaint are labs always drawn during peds assessments yes what do you first assess in peds assessment skin color peds respiratory anatomy -nasal passage -airway lumen size -larynx size -is airway compliant -Cannot automatically open their mouth to breathe if the nose is obstructed -Nasal passages are narrower -Airway lumen is smaller in infants and children than adults -Larynx is smaller and funnel shaped -Airway is highly compliant T or F: Makes it susceptible to dynamic collapse if the airway is obstructed true alveoli amount at birth-8 years Born with 150 million alveoli and increase to 300 million around 8 years of age 3 things you get ordered for peds check up ►Blood work ►X-rays ►Flu and strep tests High-pitched sound that usually occurs on expiration wheezing Crackling sounds on inspiration, expiration, or both rales nasal cannula amount 1/8 to recommended 4 L/min oxygen hood amount 10 to 15 L/min Provides 80-90% oxygen tent Provides high humidity up to 50% simple mask amount 6 to 10 L/min 35-60% non re breather mask amount 10 to 12 L/min 95% ventilatory oxygen amount 100% highest age group that has upper respiratory infections and when -Children in day care -School age children (winter) how is the flu spread -Inhalation of droplets -Contact with fine-particle aerosols what should parents do after 24 hours of antibiotics throw the kids toothbrush away parent teaching about common cold and how to treat -treat symptoms -Antibiotics is not indicated -Frequent hand washing, -Avoid second-hand smoke and crowded places -Healthy diet and rest Inflammation of the throat mucosa pharyngitis -15 to 25% of cases of peds pharyngitis -Usually self limiting -requires antibiotic therapy -Tonsillitis often occurs with pharyngitis Group A streptococci assessment of child with pharyngitis Abrupt onset Fever Sore throat, Difficulty swallowing Headache Abdominal pain Pharynx inflammation Rapid strep test bacterial or viral: -swollen uvula -white spots -red tonsils -sore throat -gray furry tongue bacterial come be seen at clinic bacterial or viral: -red swollen tonsils -red throat viral/not bacterial treat at home and gargle with salt water -Asymmetric swelling of tonsils -Shifting of the uvula to one side -Palatal edema Peritonsillar Abscess -Airway obstruction acute rheumatic fever -Acute glomerulonephritis Retropharyngeal abscess Streptococcal pharyngitis treatment (what is prescribed and what is treatment rule) Complete course of antibiotics: Penicillin is generally prescribed After 24 hours of antibiotic treatment: -Discard child's toothbrush -May return to school Tonsillitis treatment if bacterial antibiotic therapy tonsillar hypertrophy enlarged tonsils post tonsilectomy care: positioning diet/what to avoid how to manage pain hemorrhage risk and signs what to discourage 1. Promote airway clearance Place side-lying or prone, Suction very carefully Dried blood on teeth and nares, Old blood in emesis 2.Maintain fluid volume Encourage any fluids they desire/Popsicles and Ice chips Avoid: Citrus juice, Brown or red fluids 3. Relieve pain First 24 hours very sore Ice collar, Analgesics, Narcotics 4. Hemorrhage Unusual: can occur immediately up to 10 days after surgery, S/S: Continuous swallowing, Tachycardia, Pallor, Restlessness, Frequent throat clearing, Emesis of bright red blood 5. Discourage Coughing, Clearing the throat, Blowing the nose, Using straws -Between 3 months and 3 years -Cough that developed during the night -Sounds like barking -Mild URI symptoms -Inspiratory stridor -swollen tissue in trachea croup responsible for most cases of Laryngotracheobronchitis Parainfluenza -3 months to 3 years of age -Mucus production contributes to the airway obstruction -Narrowing of the subglottic area of the trachea -edema of layrnx Laryngotracheobronchitis Laryngotracheobronchitis s/s (breath sounds/voice/type of cough) -audible inspiratory stridor -hoarseness -barking cough t or f: epiglottitis is just sometimes an emergency false -Respiratory arrest and death may occur if the airway becomes completely occluded -Complications include pneumothorax and pulmonary edema -drooling -holding neck hyperextended -tripod position -not associated with cough -stridor is a late finding -tachypnea -anxiety epiglottitis do you visualize the throat with epiglottitis? no, can cause layrngospasm what do you do upon epiglottits episode? (positioning, oxygen, what surgery) Do not leave alone Keep child calm Allow the child to sit in a position of comfort Do not place supine Provide 100% O2 Ensure emergency equipment is available Emergency tracheostomy viral infection virus that spreads quickly through respiratory droplets from coughing or sneezing respiratory syncytial virus RSV s/s -fever -dry cough -loss of appetite -refusal to be breast feed or bottle fed -wheezing RSV treatment -Supplemental oxygen -Nasal and/or nasopharyngeal suctioning (Bulb suctioning, Nasal wash) -Oral or intravenous hydration -Antipyretics -Inhaled bronchodilators -Ventilator support lung infection that affects air sacs and interferes with oxygen delivery pneumonia (Inflammation of the lung parenchyma) is viral pneumonia more common in younger or older kids younger presence of bacteria in blood bacteremia a condition where fluid builds up in the pleural space, the thin cavity between the lungs and the chest wall Pleural effusion lung disease that results from damage to the walls of the alveoli in your lungs. A blockage (obstruction) may develop, which traps air inside your lungs. emphysema how can you prevent pneumococcal infection vaccine physical assessment of infant respiratory distress -tachycardia -tachypnea -nasal flaring -hypoxemia -crackles -see saw breathing most common chronic illness in children asthma -Airway hyper-responsiveness -Airway edema -Mucus production -Symptoms associated with vigorous activity -cough worse at night asthma -The most common debilitating disease of childhood among those of European descent -Median age of survival is 30's -Generalized dysfunction of the exocrine glands thickened, tenacious secretions -Sweat glands, Gastrointestinal tract, Pancreas, Respiratory tract cystic fibrosis cystic fibrosis manifestations meconium ileus, -salty skin -lung infections -chronic respiratory issues -rectal prolapse -clubbing -barell chest When is the neural tube formed on fetus? by week 4 causes of brain and spinal cord issues in fetus -Infection -Trauma -Malnutrition -Teratogen exposure increased muscle tone hypertonia decreased muscle tone hypotonia -sluggish deep tendon reflexes what is the earliest detection regarding improvement or deterioration of neurological status level of consciousness a network of neurons and nuclei in the brainstem that coordinates many vital brain functions reticular system abnormal neuro findings -extreme irritability -Lethargy -Lack or response to painful stimuli -Can indicate life-threatening condition (Report immediately) conditions that cause alterations in vital signs -Cerebral infections -Increased ICP -Coma -Brain stem injury -Head injuries what do you observe in head/face/neck -Skull shape -Head circumference -Symmetry -Alterations in range of motion what cranial nerves do you assess regarding dolls eye -III -IV -VI who all. do you assess dolls eye reflex on Assessing infant uncooperative child comatose child what does negative dolls eye reflex mean possible ICP horizontal or vertical nystagmus: -lesions in the brain stem -Certain medications like Phenytoin horizontal horizontal or vertical nystagmus: -brain stem dysfunction vertical -Sclera is showing over the top of the iris -May indicate increased ICP -hydrocephalus common -abnormal pupilary response sunsetting eyes how do you assess heads Assess bilaterally and compare how is posture characterized? extreme rigid muscle tone what kind of damage is associated with decorticate posture -flexor or extensor -cerebral cortex -flexor what kind of damage is associated with decerebrate posture -flexor or extensor -brain stem -extensor what do you assess when checking posture issues -reflexes -senses (touch, pain, vibrations, heat/cold) Pressure of the cerebral spinal fluid (CSF) in the subarachnoid space between the skull and the brain ICP EARLY or LATE signs of ICP Headache, Vomiting, Deceased pulse and respirations Increased B/P or pulse pressure, Pupil reactions decreased and unequal Sunset eyes, Changes in LOC Irritability – infant, Seizure activity early EARLY or LATE signs of ICP Headache, Vomiting, Deceased pulse and respirations Increased B/P or pulse pressure, Pupil reactions decreased and unequal Sunset eyes, Changes in LOC Irritability – infant, Seizure activity late S/S ICP Irritability Bulging, tense fontanel Wide sutures and increased head circumference Dilated scalp veins High-pitched cry 3 vital signs of ICP Hypertension with widening pulse pressure Bradycardia Irregular respiratory pattern (Cheyne-Stokes) cushings triad increased bp, decreased hr, irregular respirations what do you need to monitor regarding ICP hyperthermia and neurostatus what will you give to treat cerebral edema Analgesia and sedation What is recommended if ICF is not fixed craniotomy fraction of seizures that are caused by epilepsy 1/3 T or F: seizures only affect certain body parts and seizures are just convulsions false Clonic or Tonic: -Repeated jerking -Movements cannot be stopped by restraining or repositioning the arms or legs -Rare clonic clonic or tonic: -Tone is greatly increased in the body, arms, or legs make sudden stiffening movements -Consciousness is usually preserved -Most often occur during sleep and usually involve all or most of the brain -If standing will fall -Usually last less than 20 seconds tonic Account for a majority of childhood seizures Two types - Simple and Complex partial simple or complex -Clonic or tonic movements involving the face, neck, and extremities -10-20 seconds -Remains conscious and simple simple or complex: -Common and may or may not have a preceding aura -Consciousness will be impaired -purposeful movements complex simple or complex: children: Pulling at sheets or rubbing objects Running or walking in a nondirective and repetitive fashion Can be difficult to control Infants - Lip smacking, Chewing, Swallowing complex Sudden jerk followed by stiffening infantile spasms Sudden cessation of motor activity or speech with a blank facial expression absence seizure Extremely common Associated with an aura LOC preceded by a piercing cry tonic-clonic Sudden, brief, massive muscle jerk myoclonic Sudden loss of muscle tone atonic -Most common type of seizure seen during childhood -Usually affect children less than 5 -More common in boys -Increased risk if there is a family history -Usually benign but can be very frightening -May be a sign of a dangerous infection (Meningitis Sepsis) febrile Seizure dos and donts -Protect the child from harm during the seizure -If standing ease child to the ground, place on side -Loosen tight clothing and jewelry Do not restrain the child Remove hazards in the area Do not forcibly open jaw with tongue blade or fingers Document length and movements during seizure Remain with child until fully recovered 2 main causes of meningitis aseptic (viral cause) septic (bacterial caused what age is most common regarding septic issues 1 month-2 years is result of pathogen migrating into CSF and into the subarachnoid space. The body reacts with severe inflammatory response and WBC proliferation. Preceding events are often otitis media, a penetrating wound, cellulitis of the scalp or face, dental carries, pharyngitis, and orthopedic procedures septic what 2 signs can indicate meningitis brudzinkski kernig inability to fully extend the knees with hips flexed. kernig droplet precaustions -surgical mask -eye protection -gown and gloves viral; occurs with febrile illness; ticks/mosquitos/herpes encephalitis Disorientation, Confusion, Headache High fever, Photophobia, Lethargy Aphasia, Hallucinations, Seizures Nuchal rigidity, Coma encephalitis do you percuss/suction a seizure patient no Children younger than 15 years Recovering from a viral illness Brain swelling Liver failure Death in hours if treatment not initiated reyes syndrome Leading cause of traumatic death and morbidity during infancy shaken baby syndrome average age of shaken baby syndrome less than 9 months shaken baby syndrome s/s -pale/blue -lethargy -poor feeding -difficulty arousing -bulging fontanel -Common illness in children -Infection of fluid in the middle ear -Frequently precede upper respiratory infections -Travels upward to invade the middle ear space -Fluid behind the eardrum -Acute fever and pain Acute Ottis Media Treatment perforation of tympanic membrane can lead to hearing loss acute otitis media s/s Fever Complaints of otalgia (ear pain) Fussiness or irritability Crying inconsolably Batting or tugging at the ears Rolling the head from side to side Poor feeding Difficulty sleeping Fluid draining from the ear T or F When fluid loss occurs water loss occurs more rapidly in peds Larger amounts of water loss Fever increases fluid loss true deydration s/s -sunken fontanel -reduced LOC -eyes sunken in -tachypnea -reduced cap refill -dry muscous membrane -tenting -no tears what does right upper quadrant tenderness possibly mean liver enlargement what does right lower quadrant mean with rebound tenderness mean possilbe appendicitis nausea and signs of autonomic nervous system stimulation prodromal vomitting stage the leading cause of death for children worldwide acute infectious diarrhea how long is chronic diarrhea lasts more than 2 weeks what do you treat parasitic diarrhea with anti parasitic Most common cause of emergent abdominal surgery in children -emergency appendicitis Vague abdominal pain, Nausea, and vomiting Small, frequent, soft stools, Fever Children often appear anorexic and ill Often cannot walk or climb apenndicitis Halitosis hoarseness/sore throat celiac disease diet nos Strict gluten-free diet for life: avoid rye, wheat, barley, oats, Any creamed or breaded vegetables, canned baked beans, Dried fruit, frozen yogurt Any meats prepared with wheat, canned meats, commercial salad dressing, soups, condiments, flavored coffee, alcohol distilled from cereals, licorice foods you can eat on celiac diet -meat -peanutbutter -rice -milk and cheese -potato/corn chips -seafood urinary structure differences adult vs child: kidneys (smaller or larger in relation to size)? more or less protected? urethra shorter or longer? UTI risk? urine more concentrated? GFR faster or slower? increase or decreased risk for dehydration? urine output? -Kidney is large in relation to size -Less well protected -Urethra is shorter -Increased risk for UTI -Urinary Concentration -GFR is slower -increased risk of dehydration -Urine Output 30ml newborn to 400-500ml in 1 year old 800-1400ml in Teens most common cause of UTI e coli peds UTI s/s Fever Nausea or Vomiting Abdomen, back, or flank pain Lethargy Urgency (urge to void immediately) or Frequency (needing to void often) Dysuria (difficulty or pain with voiding) Frequency (needing to void often) Foul smelling urine or blood in the urine urinary stasis stoppage of urine flow; urinary stagnation Has never achieved voluntary bladder control Secondary to diabetes, sickle cell, ectopic ureter, or urethral obstruction primary enuresis Incontinence after previously demonstrated bladder control (at least 3-6 months) secondary enuresis Daytime loss of urine control Urine -concentrating, UTI, constipation, and emotional distress diurnal enuresis Nighttime bedwetting High fluid intake at night, obstructive sleep apnea, sexual abuse, or family history nocturnal enuresis Cause Inflammation Alters glomerular structure and function in both kidneys Often follows an infection, usually an upper respiratory or skin infection More frequent in males Peak prevalence around 5 to 12 years of age Most serious complication is uremia and renal failure s/s: Fever Lethargy Headache Decreased urine output Abdominal pain Vomiting Anorexia Acute poststreptococcal glomerulonephritis where does infection act on; temp increased or decreased? vasoconstriction or dialation with cold response? -Acts on the hypothalamus Triggers prostaglandin production Increases the body's temperature set point Triggers the cold response Shivering, Vasoconstriction Decreases peripheral perfusion to help decrease heat loss are blood cultures collected in sterile procedure yes Symptoms that occur between early manifestations of disease and over clinical syndrome prodromal symptoms are air borne rooms positive or negative room pressure? negative air borne diseases -covid -TB -measles -varicella are droplet rooms private and how many feet close do you wear a mask yes; 3 feet droplet diseases -pertussis -strep -influenza -mumps •Red bump or skin area •swollen •painful •warm to touch •maybe fever •purulent drainage •Lesions sudden red and raised (insect bite) Methicillin-resistant Staphylococcus Aureus (mrsa) -fever more than 101 -chills -body ache -thick strawberry red tounge -sun burn like rash -tonsil exudagte scarlett fever Nose, larynx, tonsils, or pharynx Pseudo membrane forms over the pharynx, uvula, tonsils, and soft palate Causes airway obstruction and suffocation Neck becomes edematous Lymphadenopathy •Routine infant immunization can prevent the disease •Strict droplet precautions •Standard precautions •Bed rest diptheria whooping cough pertussis Acute, often fatal neurologic disease Toxins produced by Clostridium Tetani Increased muscle tone Spasms Enters through a wound, burn, IV drug use 1 - 10 cases result in death tetanus Rare - Local muscle spasm within the area of the wound local tetanus - Associated with recurrent otitis media and head trauma Rare, Affects the cranial nerves, especially facial nerves cephalic tetanus Most common Spasms progress in a descending fashion Beginning at the jaw muscles Neck and back profoundly affected generalized tetanus Transmitted by direct or indirect contact with droplets Highly contagious Signs and symptoms Fever Cough Coryza Conjunctivitis Koplik spots (bright red spots with blue white centers on mucous membranes) Erythematous maculopapular rash Proceeds from head downward and outward measles Transmitted by contact with infected droplets Sign and symptoms Fever Parotitis (inflammation and swelling of the parotod gland) 50% postpubertal boys develop orchitis Inflammation of the testicle Leads to testicular atrophy 5% of females develop oopharitis Ovarian inflammation mumps Transmitted Direct or indirect contact with droplets Mother to fetus Signs and symptoms Lymphadenopathy Rash-Begins on face and spreads down the neck, trunk, and extremities Disappears in the same order Mild pruritus Maternal rubella during pregnancy Miscarriage Fetal death Congenital malformations rubella Transmitted: Direct contact with infected fecal mater Oral secretions Mostly through saliva fever Complications Dehydration Meningitis Pulmonary edema football shaped red sores hand foot mouth Intense pruritus (especially at night) Erythematous, papular rash with excoriations Hands, feet, and in body folds scabies Source- bacterial usually staphylococcus Spreads easily Daycares—can become epidemic Signs and symptoms Found on and around the mouth Lesions begin as a vesicle or pustule Honey-colored exudate Pruritus Nursing care Prevent spread to others Administer oral antibiotics for widespread infection, topical for localized Good handwashing impetigo Infection with S. aureus that produces a toxin Abrupt onset Causes diffuse erythema Common in infancy Staphylococcal scalded skin syndrome ways to prevent diaper dermatitis Change diapers frequently Avoid rubber pants Wash with soft cloth, avoid harsh soaps Avoid wipes that contain fragrance Allow the infant to go diaperless Blow-dry are with dryer set on warm (not hot)for 3-5 minutes For Candidal diaper rash an Antifungal topical agent may be ordered cradle cap seborrhea the 3rd leading cause of death from unintentional injury in children between the ages of 1 and 4 years of age burns superficial burn treatment Run cool water over area Do not apply ice Do not apply -Butter -Ointment -Cream Cover with clean nonadhesive bandage Administer acetaminophen or ibuprofen Take to Doctor within 24 hours extensive burns care Remove clothing if comes off easily Check ABC's Perform CPR if necessary Do not apply butter, ointment, ice, or cream Cover with clean, lint free bandage or sheet Avoid applying large, wet sheets Mild to severe Warning signs: Not babbling by 12 months Not pointing or using gestures by 12 months No single words by 16 months No two-word utterances by 24 months Losing language or social skills at any age autism Most common neurodevelopmental disorder of childhood ADHD third leading cause of death among ages 15-24 teen depression Girls are twice as likely to be affected as boys regarding depressive disorders T or F? true Most commonly diagnosed psychiatric conditions among children and adolescents anxiety disorders most common cause of peds acute renal failure decreased renal perfusion most common cause of shock in peds hypovolemic shock which dialysis: Uses the abdominal cavity to help remove excess fluid and waste products Advantages - improved growth, increased independence in activities, steadier electrolyte balance Risks -infection, hypertension, seizures, hyperglycemia, parental stress and burnout peritoneal dialysis which dialysis: Removes toxins and excess fluid from the blood Advantages - frees parents from performing the dialysis Risks - Takes 3-6 hours 2-4 times a week, uremia, infection, occlusion, and stricter diet hemodialysis best option for the patient to live a normal life for end stage renal disease kidney transplant most common cause of pediatric death regarding child abuse 78% neglect alarming behavior signs in the child regarding possible abuse •History of hurting self or others, running away, attempting suicide •Chronic sore throat or difficulty swallowing •History of genital burning or itching •Low self-confidence, sleep disturbance, hypervigilance, headaches, or stomachaches •General appearance, affect, and behavior •Neurologic signs - shaken baby