NUR2633 PEDS exam 3 study guide FINAL DRAFT

PEDS exam 3 study guide FINAL DRAFT Croup (laryngotracheitis) Signs & Symptoms are related to the extent of upper airway involvement and the infectious agent responsible for the croup. Croup can lead to obstruction because children have a narrow larynx, such that a decrease in airway diameter causes a decrease in airflow, leading to the symptoms of croup. Acute laryngotracheitis ⦁ Usually viral (parainfluenza, adenovirus, RSV) ⦁ Peak age is 3 to 36 months ⦁ Gradual, acute onset during the night ⦁ URI symptom ⦁ Seal-bark cough ⦁ Mild to moderate dyspnea ⦁ Symptoms worse at night ⦁ Low-grade fever ⦁ Respiratory rate less than 50 Treatment: NO ANTIBIOTICS. Most important goal in the treatment of children with croup is maintaining the airway and providing adequate respiratory exchange. ⦁ Cool Mist - Cool mist is thought to moisten airway secretions to facilitate clearance, soothe inflamed mucosa, and provide comfort and reassurance to the child thereby lessening anxiety. ⦁ NEBULIZED RACEMIC EPINEPHRINE (Micronefrin or Vaponefrin) - to cause mucosal vasoconstriction and consequently decrease subglottic edema, thus relieving the symptoms- steroid breathing treatment ⦁ l-epinephrine - to cause mucosal vasoconstriction and consequently decrease subglottic edema, thus relieving the symptoms ⦁ Corticosteroids are also given to children to decrease the edema in the laryngeal mucosa through their anti-inflammatory action. IM dexamethasone (Decadron) and nebulized budesonide (Pulmicort) are widely used ⦁ Antibiotic therapy is indicated for epiglottitis and bacterial tracheitis. Combinations of ampicillin and sulbactam (Unasyn) are the drugs most often prescribed. Antibiotics are not used in the management of viral croup. Nursing interventions: The nurse stays at the child's side to reduce child and parent anxiety, observes for worsening symptoms, and helps the child maintain a position that supports maximum airway and respiratory exchange. Key areas of nursing responsibility include maintaining the airway, providing rest and humidification, monitoring fluid balance, and administering medications as prescribed. Dealing with Temper Tantrums Ensure safety, walk away. Get a tired child to rest or feed a hungry child to decrease her frustration level. If a tantrum does develop, there are coping strategies that a nurse can teach a parent. When the child is wailing and thrashing, but not doing any harm, ignore her. Often this is not possible, and it may be necessary for the parent to intervene quickly and decisively to remove the child to a quieter or safer place. Touching and distractions may help soothe a tantrum for one child. Another child may need to continue the tantrum under the watchful eye of the parent. The latter requires that the parent be present but not engaged in direct communication with the child. The goal is for the child to feel (and be) safe without being negatively or positively reinforced for having a tantrum. NUTRITION IS MOST IMPORTANT PART OF GROWTH IN KIDS GIRLS GROW SOONER, AND BOY GROW FASTER LATER STREP: finish full regimen of antibiotics, if not resolved can lead to endocarditis Developmental milestones, language, play, social development, and anticipatory guidance for infant, toddler, preschooler, school-age child, and adolescent (next few pages)...38 more pages full document download below