Ati Pediatrics Chapters

ATI PEDIATRICS CHAPTERS Chapter 1 family centered nursing care Traditional nuclear family—married couple and their biologic children Nuclear family—2 parents and their children—biologic, adoptive, step, foster Single parent family—one parent and 1 or more children Blended family—1 steppartent, stepsibling, or half sibling Extended family—parent, onr or more children, and individulas –might not be related Gay/lesbian family—child or children who have been place in an approved living environment away form the family of origin Binuclear—parents who have terminated spousal roles but continue their parenting roles Communal family---individuals who share common ownership of property and goods Dictatorial/authoritarian—control behaviors and attitudes with UNQUESTION RULES Permissive—little to no control over child. Consult WITH CHILD on making decisions Demorcratic or authoritative—direct the child behavior by setting rules and EXPLAIN why Passive—uninvolved, indifferent, and emotionally removed. Chapter 2 physical assessment findings Take time and report BEFORE starting exam Explain each step Doll and puppets or paper drawings AGE Temp Pulse Respiration BP Recommend Routes 3 month 97.7-99.5 120-180 30-60 60-80/ 40-50 6 month 97.7-99.5 70-150 30-60 60-80/ 40-50 1year 97.7-99.9 70-150 25-30 83-114/ 38/67 3yr 97.7-99.0 60-110 21-25 86-117/ 47-76 5yr-6 97-98.6 60-110 19-21 91-122/ 54-83 7yr-8 97-98.2 60-110 19-21 9yr-10 97-98.1 60-110 19-21 98-129/ 59-88 11yr-12 97-98.1 50-90 16-19 13yr 97.-97.9 50-90 16-19 Hair loss or balding on infant—to much time in 1 position Infant nails are FLEXIBLE Lymph nodes—small palpable, NONTENDER, mobile Fontanels should be flat Posterior fontanel closes 6-8weeks Anterior fontanel closes 12-18months Iris will have permanent color at 6-12months Tumbling E or HOTV test for visual acuity if can read letters Ishihara for color blind test Top of pina should be inline with eyes 3yrs and lower pull down and back 3yr pull up and back Teeth—6-8 by 1yr. 20 deciduous and then 32 permanent Breast—10-14yrs start to develop Pulses—infants—brachial, temporal, femoral --children/adolescents—like adults Reflexes-- Rooting stroke cheek 4months Palmar grasp place object in palm 3month Plantar grasp place object in plantar 8month Moro fall back action 4month Startle reflex clap hands. Abduction occurs 4month Tonic neck head turns left/right arms and legs follow 3-4month Babinski stroke bottom of foot 1year Stepping hold upright and feet move 4 weeks Infants/toddlers—round abdomen Scrotum—rugose appearance. Left testicle hangs lower Cranial nerves Olfactory smells Optic look at face and tracks with eyes visual acuity, peripheral, color oculomotor blinks to light, PERRLA PERRLA Trochlear looks at face and tracks with eyes look down and in Trigeminal has rooting sucking reflex clench teeth, feel facial touch Abducens looks at face tracks with eyes see laterally Facial facial movements are symmetrical salty and sweet Acoustic tracks sound, blinks to noise no vertigo Glossopharyngea l Gag reflex Vagus no difficulty swallowing speech clear, uvula midline Accessory moves shoulders equal strength in shoulders Hypoglossal no prob swallowing tongue midline Toddlers and younger—bowlegged or knock knee NORMAL NORMAL NORMAL Chapter 3 Health promotion 2days -1Year Head—33-35cm 2cm/month to 3months. 1cm/month til 6th month. 0.5cm/month til 12th month Length—48-53cm 1in per month for 6mth. 50% increase of birth height by 1yr Weight—g, 6-9lbs Lose 10% of birth—regains 10-14days later Gains—doubled at 6mth. Tripled at 12month AGE Gross motor Fine Motor 1 month Head lag grasp reflex 2 month lifts head off mattress PRONE holds hands in open position 3 month head/shoulders off mattress prone/ slight head lag no long grasp reflex 4 month rolls from back to side. No head lag grasp both hands 5 month front to back Uses palmar grasp dominantly 6 month back to front HOLDS BOTTLE 7 month bears full weight on feet. Sits by LEANING FORWARD object from hand to hand 8 month Sits UNSUPPORTED PINCER grasp 9 month pulls standing position. Crawls Crude pincer grasp 10 month prone to sitting Grasp rattle 11 month Cruises along furniture puts objects into container 12 month Sits down from standing 2 block tower UNSUCCESSFUL turn pages in book Teeth pain—frozen rings, ice cube in wash cloth, Tylenol, Advil, ibuprofen over 6month age Piaget—sensorimotor stage—birth to 2 year Separation, object permanence Vocalizes cooing by 3-4months Laughs at 4months, Car seat 45deg 3-5words by 1yr Erikson—Trust vs Mistrust birth to 1year Separation anxiety and stranger fear Vaccine Hep b birth, 2, 4, 6 IPV-polio—2, 4, 6 RV-rotavirus—2, 4, 6 PCV-pneumococcal—2, 4, 6 Dtap—2, 4, 6 influenza 6 and 12 Birth—Hep B 2mth—B DR HIP 4mth—DR HIP 6mth—B DR HIP 12mth—Flu Breast feed first 6months. No cows milk 12months Iron supplements 6months 4-6oz juice max Citrus fruit, meat, eggs and other after 6months. 1 at a time per week Sleep—3-4monts—nocturnal sleep. Infants 14-15hrs. 4month 9-11hrs night sleep Chapter 4 health promotion for toddlers 1-3 years Weight—30month 4x birth weight Height—3inch per year Head circumference—equal to chest by 1-2yr Piaget—sensorimotor transitioning into preoperational stage at 24months Play house Language 300words by 2yr and multi words 3yr—several words sentence Erikson—AUTONOMY vs Shame====independence Solitary to parallel play Finger paint, look at books, puzzle, Age Gross motor Fine motor 15mth walks without help Cup use. Successful 2 block tower 18mth runs, throws ball OVERHEAD. Jumps on 2 feet Spoon use, 3pages turned. 3- 4block tower 2year Stairs BOTH FEET at a time 6-7 block tower, 1 page at a time 2.5yr stands on 1 foot momentarily draws circles 12-15month polio, influenza, MMR, varicella 12-23month Hep A, 15-18month DTAP 12-36month Flu yearly Nutrition—milk 24-28oz/day. 1Tbsp each year. Choking hazard—peanut butter, carrot, meat, popcorn hot dogs, nuts, grapes Sleep 11-12hrs Chapter 5 3-6years Preschoolers 4.5-6.5lbs per year Height—2.5-3.5in per year Age Gross motor 3yr Tricycle, Jumps off bottom step. 1 foot stand momentarily 4yr Skips, hops 1 foot, Over head throw 5yr Catches, walks backwards Piaget—preoperational phase—intuitive though. Ego Magical thinking, animism—lifelike quality to inanimate objects, centration—one aspect at time Erikson—initiative vs guilt Words 2100 by 5th year Pretend play PARALLEL play Play—ball, tricycles, paint, read, sand box. Skating, musical Vaccine 4-6yr DTap, MMR, polio, varicella Nutrition—1800cal/day 12hr sleep Chapter 6 School age—6-12yr Weight 4.4-6.6lbs/year Height—2in/year Puberty—girls 9yr Piaget—concrete operation—tell time, perspective of others Erikson—industry vs inferiority Peer groups Competitive and cooperative play Board games, hopscotch, jump rope, ride bicycles Scoliosis screening Fear of death and harm Chapter 7 Adolescents 12-20year Acne Growth—boys stop at 18-20. Girls stop at 17yr Girls— pubes, boobs, pits, period for puberty Boys—balls, pits, face, voice Piaget—formal operations—idealistic Erikson—identity vs role confusion Caring for pets, sports, read, movies, dances 16-18yr-Meningococcal booster Need additional calcium, iron, protein, zinc Chapter 8 Meds Administer meds on side of mouth Put into applesauce, sherbert. Use nipple for infants Optic—supine. Ointment before bed Otic—prone or supine. Massage outer area—tragus Nasal—head extended Aerosol—mask Rectal—hold buttocks together 5-10min after Intradermal—26-30gauge, 15deg Subcu—26-30gauge, 45-90deg IM—22-25gauge, ½ to 1 inch needle EMLA cream 1hr prior. Chapter 9 pain management Young infant—cry, withdrawal Under 4yr—don’t accurately report pain 7yr—number scale FLACC for 2mth-7yr—Face, Legs, Activity, Cry, CONSOLABILITY—0-3 each. 0 is no pain Faces for 3yr and greater. 0-5—0 is no pain Fentanyl if 12yr Distraction—computer game, movie, jokes Relaxation—rock them, breathing technique Guided imagery—describe details Chapter 10 hospitalization, illness, play Protest—scream and clinching Despair—withdrawal, depression Detachment—plays with others School age—seeks information. Fear loss of control Encourage family to stay with child when hospitalization Toddlers—offer choices. Onlooker—child observes others Solitary, parallel Associative—play together WITHOUT organization Cooperative play—ORGANIZED play SCHOOL AGE Chapter 11 Death and Dying Infant/toddler—mirror parental emotions, no concept Preschool—ego, magical thinking they caused it. Separation is punishment School age—adult concept, irreversible. Fear of illness and death Adolescent—adult concept. Difficulty accepting death Manifestations of death Sensation of heat when body feels cool Decreased sensation and movement of lower extremities Senses go Low appetite and thirst Dysphagia, loss of bowel/bladder control Bradycardia, low BP. Cheyne stokes Regular scheduled meds for pain Chapter 12 acute neurological disorders Meningitis—viral and bacterial SS—photophobia, nausea, irritable, HA. Poor tone, low sucking, fever. BULGING fontanels late sign—increased ICP High pitched cry, nuchal rigidity, Brudzinski and Kernig’s , seizure. Petechia. Bacterial—cloudy. Elevated WBC, protein. LOW glucose Viral—clear. ELEVATED WBC, protein. NORMAL glucose LP—L3&L4. Empty bladder, EMLA. Cannon ball side lying. Fentanyl and midazolam to sedate Isolation for 24 after starting antibiotics up to 10days Steroids, analgesic, Reye’s syndrome—affects LIVER and BRAIN Virus and ASA given SS—lethargy, irritable, confusion, delirium, PROFUSE VOMIT, seizures ALT/AST. Ammonia elevated. CSF to rule out meningitis IV fluids, IUC, HOB 30deg. Meds—mannitol, Vit K(SUBCU), Chapter 13 seizures Febrile, cerebral edema, infection, LEAD POISON, hypoglycemia, hypocalcemia., hyponatremia, hypernatremia, hypomagnesemia Generalized—both hemispheres Tonic-clonic—LOC, arms legs flexed, violent jerking Postictal state—30min. Vomit, HA, visual/speech difficulty Absence seizures—petite mal LOC, daydream, fall, lip smacking, twitching eye lid Myoclonic—contraction brief. No postictal Atonic, akinetic seizure—muscle tone lost—FALL West Syndrome—infantile spasms Partial(focal/local) Simple partial—eyes and head turn away with LOC Tingling numbness, pain. Hypertonia Complex—altered behavior, can’t respond, confusion. AMS Labs—lead, WBC, glucose, electrolytes. Side lye, loosen clothes, remove glasses, O2, After—assess, reorient Meds—diazepam, phenytoin(10-20), carbamazepine, valproic acid, fosphenytoin, topiramate, lamotrigine, clonazepam Focal resection—epileptogenic zone Hemispherectomy—1 side of brain Corpus callosotomy—separation of hemispheres Vagal nerve stimulator Chapter 14 Head injury Concussion—injury to brain Contusion—bruising Laceration—tearing SS—amnesia, LOC, pallor, vomit, irritable, confused, VS change, Severe—ICP, high pitched cry, poor feeding, N/V, HA, blurry, Cheyne-stokes. flex, extends Tx—30deg HOB, padded restrains, NPO, IUC, stool softeners, IV fluids Meds—mannitol, antiepileptics, antibiotics, analgesics Craniotomy, burr hole Epidural hematoma—LOC, wake up then could go back to coma from accumulation & pressure Subdural hematoma—irritable, vomiting, lethargic, seizures, coma Cerebral edema—ICP up Brain herniating—loss of blinking, gag, and pupil’s reaction. Bradycardia, RR arrest Chapter 15 cognitive and sensory impairments Myopia—nearsighted Want Biconcave lenses Hyperopia—farsighted Want biconvex lenses Astigmatism—uneven vision. HA lenses Anisometropia—Different refractive strengths in each eye. HA, Vertigo lenses Amblyopia—LAZY eye Strabismus—cross eyed. Patch the stronger eye Esotropia—inward deviation of eye Exotropia—outward deviation of eye Cataracts—opacity of lenses Glaucoma—IOP increased. RED EYE, loss of peripheral Visual screening—Snellen, tumbling E, picture chart 10 ft from chart. HEELS on the line Both eyes open and cover one eye at a time. Glasses on if needed 20/70-20/200 partial impairment 20/200 is legally blind Conductive loss—sound transmission problem. Otitis media, infection, wax, foreign body Sensorineural loss—nerve pathway problem. Defect, infection, ototoxic drug, Constant noises Hearing problem SS—lack startle reflex, absence of vocalization to 7months, yelling, withdrawn DS-Down Syndrome—Trisomy 21 SS—separated sagittal suture, small round head, enlarged anterior fontanel, flat forehead, high palate, congenital heart defect, fifth finger incurved(clinodactyly), hypotonic, Prenatal—Alpha-fetoprotein Low mental capacity, hip subluxation, patella dislocation, Hirschsprung disease, sight and hearing prob. Thyroid prob. Reduce growth, RR infection higher Chapter 16 oxygen and inhalation therapy Pulse ox—earlobe, fingertip, toe Move probe q 4-8 hours Nebulizer—10--15min. Take slow dep breaths Metered dose inhaler—remove cap, shake 6x, attach spacer, take deep breath and then exhale. Tilt head back. Press inhaler as you slowly begin a deep breath that last 3-5sec. HOLD BREATH 5-10SEC, Open mouth method—inhaler 3-4cm away from mouth Closed mouth method—inhaler btw lip Wait 1min btw buffs Dry powder inhaler—Don’t shake. Breath then out. Place to lips and deep breath. Hold 5-10sec. Rinse inhaler and cap and spacer 1 TIME A DAY with warm running water Fungal infection—Steroids Rinse mouth after Chest physiotherapy—schedule before meal or 1hr after, and bedtime Give neb/bronchodilator BEFORE Apical section of upper lobe—Fowlers position Posterior section of upper lobe—sitting position and LEANING FORWARD Superior segments of both lower lungs—PRONE, hips elevated. 20-30min in position 3-4x per day Hypoxemia—tachypnea, tachycardia, restless, pallor, accessory muscles used Late—confused, cyanosis, bradypnea, bradycardia, hypotension Discontinue oxygen GRADUALLY Oxygen hood—small plastic hood that fits OVER head—4-5L Pediatric face mask—covers nose and mouth—5-10L. SHORT TERM THERAPY NO WOOL OR SYNTHETIC Oxygen toxicity—to much oxygen for to long. Hypoventilation and increased PaCo2 Suctioning—nasal—clean technique, mushroom tip cath --Oral—clean tech. hard catheter tip put into SIDE OF MOUTH Endotracheal, Tracheal —aseptic catheter with diameter ½ the diameter of trach Hyperoxygenation first Limit to 5sec for infants Limit to 10sec for children Limit to 15sec for Adults REST FOR 30-60SEC BTW Tracheostomy for epiglottitis, croup, foreign body. Will soften and form for child’s trachea VS hourly, Humidification, Suction when—secretions, crackles, restless, tachypnea, up HR. Oral hygiene q2hr. Cuff 20mm Hg Tracheostomy care q8hr Change nondisposable q6-8wks Accidental decannulation—most prevalent in first 72hr Home care—clean with soap and water Chapter 17 acute and infectious RR illness Tonsillitis—highly vascular Palatine tonsils—both sides of the oropharynx—tonsillectomy Pharyngeal tonsils—Adenoids—Adenectomy Acute tonsillitis—both red an swollen. Can be chronic Viral or bacterial SS—sore throat, dysphagia, Hx otitis media. Mouth odor, mouth breathing, Fever, Snore Test—Group A bet hemolytic streptococci—GABHS Tx—salt water. Antipyretic. Hydromorphone for painful swallowing. Tonsillectomy—HOB up if awake. Clear of throat, restless, bright red emesis, tachycardia, pallor bleeding REPORT IT Tetracaine lollipops, ice collar, ice chips Soft and bland foods NO red, milk, citrus NO BLOWING NOSE, CLEAR THROAT, OR STRAWS. Full recovery 14days GABHS—can pose threat to rheumatic fever and kidney infection Common RR illness—infants 3-6months—moms antibodies wear off. Viral is more in toddler and preschooler til age 5 Short stature, middle ear with short route to lungs than adults, 2nd hand smoke. Seasonal—asthma—cold months. RSV winter and spring PNA in autumn and early winter Use cool air vaporizer to provide humidity, Rest Nasopharyngitis—Common cold—4-10days SS—Fever, low appetite, restless, nasal inflammation Tx—antipyretics, rest, cool mist, decongestants NO ANTIHISTAMINES Acute streptococcal pharyngitis—GABHS infection======STREP THROAT SS—Pharyngitis, HA, Abd pain, inflamed tonsils with EXUDATE 2nd day Throat culture or rapid antigen testing Tx—penicillin for 10days or amoxicillin Allergy to penicillin take Erythromycin Bronchitis—Self limiting—inflammation SS—persistent dry HACKING cough Resolves in 5-10days Tx—antipyretics, cough suppressant, cool mist Bronchiolitis—RSV is cause SS—rhinorrhea, intermittent fever, pharyngitis, cough, Wheeze Turns to increased cough, tachypnea (70), retractions, listless, cyanosis Tx—O2, antibiotic No bronchodilator, steroid, CPT Allergic rhinitis—seasonal to allergens Autumn or Spring SS—rhinorrhea, itchiness, snoring, HA Test—nasal smear for eosinophils Tx—nasal steroids, antihistamines, montelukast, cromolyn, ipratropium, albuterol PNA—viral or bacterial HIGH fever, retractions, dull percussion, Abd pain, diarrhea, low app, cough Elevated antistreptolysin titer. CXR Tx—cool mist, antipyretics, CPT. Antibiotics for bacterial Complication pneumothorax—dyspnea, CP, back pain. --pleural effusion—fluid in pleural space Bacterial epiglottitis—MEDICAL EMERGENCY SS—absent cough, drool, Tripod position, tongue out, Froglike croak, Stridor, HIGH fever Tx—Avoid throat culture, intubate, humidified O2, steroid, IV fluids, antibiotics DROPLET precautions Laygnotracheobronchitis—from RSV, flu, PNA SS—low fever, hoarse, barky cough, nasal flare, retractions Tx—cool mist, nebulized epinephrine, steroids, IV fluids Acute spasmodic laryngitis—from allergens. ATTACKS mainly at night SS—Croupy barky cough, restless, hoarse, night time laryngeal obstruction Tx—cool mist, nebulized epinephrine, steroids, IV fluids Flu—A and B SS—Sudden fever and chills, dry throat, flushed, photophobia, myalgia Test—fluorescent antibody and immunofluorescent antibody staining Tx—ret, Tylenol/ibuprofen, Amantadine, rimantadine, zanamivir, oseltamivir, Vaccine Vaccines—0-6months B DR HIP Toddler 6mth to 3yr—IM HPV Preschool 3-6yr—DIM School—THMTIV FLU CHAPTER 18 asthma Risk—LBW, smoke, overweight Triggers—mold, cockroach, dust, gras, pollen, smoke, odors, exercise, cold air, ASA, NSAIDs, antibiotic, betablocker SS—CP, dyspnea, cough, wheezing, crackles, mucus production, sweat, anxiety PFT—most accurate test for Dx asthma Test q 1-2yr Tx—SABA, LABA, anticholinergics—atropine, ipratropium Watch for tremors, tachycardia, dry mouth, steroid inhaled fluticasone, Leukotriene modifier—zafirlukast, montelukast Mast cell stabilizer—cromolyn Monoclonal antibodies—omalizumab ---12yr for allergic asthma Steroids with food Peak flow meter—blow out fast and hard. Do x4. 30sec btw each= Record highest number Want regular exercise for asthma Status asthmaticus—life threatening SS—wheezing, dyspnea, nasal flare, JVD, accessory muscle Tx—high fowlers, 3 nebs 20 min apart, IV, Mag IV to lower inflammation Heliox—mix of helium and oxygen Chapter 19 cystic fibrosis Inherited mutated gene—BOTH PARENTS carry Leads to obstruction of organs Increase in sodium and chloride IN SWEAT SS—meconium ileus at birth, distended abd. Thin extremities Wheeze, rhonchi, coughdyspnea, paroxysmal cough, emphysema, atelectasisbarrel chest, clubbing LARGE frothy bulky GREASY stool—steatorrhea Low weight, anemia. Sweat chloride test—2 sites of sweat Chloride 40 and sodium 70 Tx—IV, O2, tobramycin, ticarcillin, gentamicin, CPT, forced expiration, bronchodilator, ipratropium fluticasone, Dornase alfa, Nutrition—high protein and calories Pancreatic enzymes within 30min of food Supplements of Vit A,D,E K Chronic cough can lead to prolapse rectum Chapter 20 cardiovascular disorder CHD-Congenital Heart Disease—ASD, VSD, PDA, tetralogy of Fallot, tricuspid atresia, coarctation of aorta Risk—alcohol, DM during pregnancy VSD-Ventricular septal defect—hole btw ventricles, SS—loud harsh murmur, HF Can close spontaneously Tx—patch with cardiac cath ASD-Atrial septal defect—hole btw atria SS—loud harsh murmur with fixed split second, HF Tx—patch with cardiac cath PDA-Patent ductus arteriosus—conduit btw pulmonary artery and aorta stays open SS—murmur machine hum, Wide pulse pressure, Bounding pulse, HF Tx—indomethacin, coils, repair Pulmonary stenosis—narrowing of pulmonary valve or pulmonary artery SS—cyanosis, cardiomegaly, HF, Tx—Balloon angioplasty with cardiac cath. Brock procedure, pulmonary valvotomy Aortic stenosis—narrowing of aortic valve====low cardiac output holds it back SS—faint pulse, low BP, tachycardia, CP, DOE Tx—Norwood procedure, aortic valvotomy Coarctation of the aorta—narrowing of lumen of aorta Elevated in arms, bounding pulse in BUE, low in BLE, cool skin and weak femoral pulse Tx—balloon angioplasty, stent Tricuspid atresia—complete closure of tricuspid valve SS—cyanosis, dyspnea, tachycardia, hypoxemia, clubbing Tx—ShuntGlenn procedureFontan procedure Tetralogy of Fallot—4 defects—pulmonary stenosis, VSD, overriding aorta, right Ventricular hypertrophy SS—Tet spells—cyanosis at birth, murmur Tx--shunt Transposition of great arteries—Aorta is connected to right ventricle instead of left Truncus arteriosus—failure of septum formation Hypoplastic left heart syndrome—underdeveloped left heart SS—Cold hands/feet, lethargy, Tx—Norwood, Glenn, Fontan Pulmonary artery HTN—progressive and fatal SS—Dyspnea, CP, syncope Avoid high altitude and give supplemental oxygen Infective endocarditis—inner lining of heart—from strep Strep viridians and staph aureus SS—fever, murmur, HA, diaphoretics, weight loss, trouble feeding Labs—ESR, UA, cultures, CBC Tx—antibiotics 2-8weeks. Prophylactically before dentist and procedures Cardiomyopathy—myocardium abnormalities SS—tachycardia, dysrhythmias, dyspnea, HEPATOSPLENOMEGALY, low growth. Shock—cardiogenic and anaphylactic SS—dyspnea, grunting, low BP, tachycardia, weak pulse Hypoxemia—cyanosis, poor weight, tachypnea, dyspnea, clubbing, polycythemia Cardiac cath—repair and evaluate dysrhythmias Extremity straight for 4-8rs after Digoxin—hold if 70 for children. Hold if 90 infant Captopril, enalapril—watch hyperkalemia Rheumatic fever—GABHS—throat culture After upper RR infection SS—fever, tachycardia, cardiomegaly, murmur, CP, pericardial friction rub, joints, macular rash, chorea—involuntary purposeless movements. Test—Throat culture, CRP, ESR, atnistreptolysin-O titer Jones criteria—1 major or 2 minor Major—carditis, polyarthritis, chorea, rash, subcu noduels Minor—fever, arthralgia Meds—penicillin Dyslipidemia—disorder of lipid metabolism Lipid profile—fast 12hr Meds—cholestyramine, colestipol Kawasaki—systemic vasculitis Acute phase SS—HIGH FEVER, irritable, Red eyes, tongue, lips. Rash, bilateral joint pain, large lymphs, Desquamation of perineum Subacute SS —irritable, peeling of skin of palms and soles Labs—CBC, CRP, ESR, albumin Tx—IV gamma globulin, ASA, IV fluids Chapter 21 hematologic disorder Epistaxis—nosebleed Risk—low humidity, trauma, meds Tx—sit up, tilt head forward, pinch for 10min Iron deficiency anemia—low intake, adolescent rapid growth, milk (toddler), low absorption SS—tachycardia, pallor, brittle nails, fatigue, murmur CBC low Tx—supplements, vit c helps absorption, transfusion, Supp—1hr before or 2hr after milk. Take on empty stomach, straw and diluted Z track if IM Foods—dried bean, lentil, peanut butter, GLV, breads, flour poultry, Red meat Sickle cell anemia—homozygous an dmost common SCD Increased viscosity, hypoxia, pain SS—SOB, pale, jaundice, cold hand/feet, HA Vaso-occlusive crisis—severe pain in bone and joints with swelling. HEMATURIA, jaundice, vision Chronic—retinal detachment/blind, RR infection and osteomyelitis Sequestration—excessive pooling of blood in spleen, hypovolemic shock Aplastic crisis—extreme anemia, jaundice, retulocytosis Hemoglobin electrophoresis—Dx sickle cell Tx—IV fluids, oral fluid, blood, NSAID’s and opioids(severe), Can cause CVA Acute chest syndrome—CP, back pain, Abd pain, fever, cough, dyspnea Hemophilia—bleed easy A—factor 8 B—factor 9—Christmas disease SS—joint pain and stiff, easy bruising, DOE, hemiarthorsis, slurred speech, HA Tx—DDAVP, factor 8/9, pooled plasma, steroid, No ASA Chapter 22 Acute Infectious GI Rotavirus—most common for 5yr SS—viral, fever watery stool, Transmission—Fecal to oral Yersinia enterocolitis—bacterial SS—mucoid bloody diarrhea, Abd pain, fever, vomit Transmission—pets and food Escherichia coli—bacterial SS—watery diarrhea for 2days, cramping Transmission—E. coli Salmonella—bacterial SS—N/V, Abd cramp, bloody diarrhea, fever, HA, confused Transmission—person to person, undercooked food C.diff—bacterial SS—watery diarrhea, leukocytosis, hypoalbuminemia, high fever Transmission—spores Clostridium botulinium—bacterial SS—Abd pain, diarrhea, CNS prob Transmission contaminated food Shigella—bacterial SS—sick appearance, fever, anorexia, cramp Transmission—contaminated water Caliciviruses—viral SS—Abd cramp, N/V, malaise Tansmission—contaminated water Staphylococcus—bacterial SS—Diarrhea, n/v, Transmission—undercooked, or refrigerated food Enterobius vermicularis(pin worm)—helminthic SS—perianal itching, enuresis, sleepiness, restless Transmission—fecal to oral Oral rehydration therapy—40-50ml/kg Meds—metronidazole, tinidazole for C.diff, lamblia Mebendazole, albendazole, pyrantel pamoate for Enterobius vermicularis NO BRAT diet, broth, caffeine, fruit, soda, gelatin Chapter 23 GI inflammatory disorder Cleft lip—incomplete fusion of oral cavity Cleft palate—incomplete fusion of the palates Risk—alcohol, smoke, anticonvulsants, retinoids, steroids DURING PREGNANCY Cleft lip repaired within 2-3months Cleft palate repaired 6-12months Isolated cleft lip—wide nipple bottle feed or squeeze the infant’s cheeks together Cleft palate or cleft lip and palate—position upright while cradling head during feeding Specialized nipple, Burp frequently Post op—avoid nipple and pacifiers, NO SPOONS, Cleft lip—on back and upright. Elbow restraints Cleft palate—clear liquid 24hr, elbow restraints GERD—spitting up forcefully, irritable, excessive crying, arch back, RR prob. Test—scintigraphy Tx—small frequent meals, thicken formula, NO Peppermint, spicy, fried Nissen fundoplication Hypertrophic pyloric stenosis—thickening of pyloric sphincter—obstruction SS—vomit after feeding, nonbilious vomit with blood. No weight gain OLIVE shaped mass in RUQ Tx—Pylorotomy, IV fluids, Hirschsprung’s disease—congenital. Lack ganglionic cells Newborn—no meconium within 48hr, vomit bile, refuse to eat, Abd distention Infant—FTT, constipation, vomit Child—Abd distention, Visible peristalsis, palpable fecal mass Ribbon like stool Rectal biopsy to confirm SS—high protein, high calorie, low fiber. SS—surgical removal Intussusception—telescoping intestines Common in 3months to 6yrs Sausage shaped Abd mass, vomit, fever Appendicitis—RLQ pain, rigid abdomen, fever, Shallow RR No heat, no enemas or laxatives Meckel’s diverticulum—failure of omphalomesenteric duct to fuse Rectal bleeding and PAINLESS, bloody stool Surgery chapter 25—GU tract chordee—ventral curvature of penis surgery to release fibrous band bladder exstrophy—eversion of posterior of bladder bladder exstrophy hypospadias—urethral opening below glans penis, ventral side epispadias—widened pubic symphysis and urethra opening on dorsal side phimosis—narrowing of preputial opening of foreskin. Cannot pull back cryptorchidism—undescended testes hydrocele—fluid in scrotum varicocele—elongation, dilation, and tortuosity of veins in spermatic cord superior to testes ambiguous genital Chapter 26 Renal disorder Acute glomerulonephritis— SS—oliguria, edema, HTN, hematuria, proteinuria, tea urine, lethargy, periorbital edema, Fluid restrictions, diuretics, antihypertensives. Nephrotic syndrome—Alt in glomerular membrane allowing proteins out SS—weight gain, facial edema that decreases throughout the day. Ascites, frothy urine, lethargy. Labs—proteinuria, hyaline cast, RBC urine. Elevated Hct, Hgb, and platelets Do biopsy Tx—steroid, furosemide, albumin, cyclophosphamide. Hemolytic uremic syndrome—acute renal failure, hemolytic anemia and thrombocytopenia Clogging the kidneys with clots SS—loss app, pallor, bruising, rectal bleed, anuric, HTN, proteinuria, hematuria Tx—transfusion. Plasma infusion. AKI—cant excrete waste, hold electrolytes, and concentrate urine SS—oliguria, edema, drowsy, hyperkalemia, hyponatremia, hypocalcemia. Metab acidosis. Elevated BUN creatinine Tx—mannitol, furosemide, calcium gluconate (for hyperkalemia), sodium bicarb, glucose 50% and insulin, nitroprusside, labetalol, clonidine, hydralazine CKD—fatigue, anorexia, pale, low or high output, anemia, weight loss, puffy face, amenorrhea, confusion Na restrictions Diuretics, folic acid, sodium bicarb, Vit d Chapter 28 muscle congenital disorder Clubfoot—positional—intrauterine crowding --Syndromic—other syndromes --congenital—idiopathic Talipes varus—inversion Talipes valgus—eversion Talipes calcaneus—dorsiflexion Talipes equinus—plantar flexion Talipes equinovarus—toes facing inward and lower than heel Legg calve perthes—aseptic necrosis of femoral head Hip stiff, limited ROM, painless limp, muscle wasting Tx—abduction brace, cast, PT, osteotomy of hip/femur Developmental dysplasia of hip—acetabular dysplasia—delay in acetabular development --subluxatio—incomplete dislocation --dislocation—femoral head does not have contact Positive ortolani—Hip is reduced by abduction Positive barlow—hip is dislocated by adduction Tx—pavlik harness from newborn to 6months --bryant traction, hip spica cast Osteogenesis imperfecta—bone fractures, BLUE SCLERA, hearing loss Surgery with rods for correction Scoliosis--