Flashcards: Pediatrics Final exam

flat, distinct, discolored area of skin. It usually does not include a change in skin texture or thickness.

solid or cystic raised spot on the skin that is less than 1 centimeter (cm) wide. It is a type of skin lesion

ring shaped

itching

fluid filled

loss of outer layer

uraised red patches covered with a whitish buildup of dead skins cells called scale

Bacterial- caused by strep A & B hemolytic streptococcus

Fungal

Viral

Jock itch

-affecting groin

athletes foot

-affecting feet

affecting any other parts of the body

-change diapers frequently

-avoid harsh soaps, baby wipes with fragrance/preservatives

-allow child to go diaper less for periods of time

-blow dry rash area (we don't want it wet)

Causes

-Antigenic substance exposure

-Allergy to nickel or cobalt in clothing, hardware, or dyes

-Exposure to highly allergenic plants: poison ivy, oak, and sumac

Complications

-Secondary bacterial skin infection

-Lichenification (thick and leathery) or hyperpigmentation

-Turf burns

-Towel sharing

-Participation in team sports

-Attendance at day care or outdoor camps

-Foods

-Drugs

-Animal stings

-Infections

-Environmental stimuli

-Stress

-Promoting oxygenation and ventilation

-Restoring and maintaining fluid volume

-Preventing hypothermia

-Cleansing the burn

-Preventing infection

-Managing pain with atraumatic care

-Treating infected burns

-Providing burn rehabilitation

-Antibiotics (topical, systemic)

-Corticosteroids (topical)

-Antifungals (topical, systemic)

-Topical immune modulators (moderate to severe atopic dermatitis)

-Antihistamines

-Isotretinoin (cystic or severe acne)

-Coal tar preparations (psoriasis, atopic dermatitis)

-Silver sulfadiazine 1% (burns)

50% chance of child having affected genes

25% chance of having child affected

•Maternal age older than 35 years or paternal age older than 50​

•Repeated premature births, breech delivery - Congenital hip dysplasia​

•Abnormalities found on ultrasound or in prenatal blood screening tests​

•Amniotic fluid abnormalities​

•Multiple births​

•Exposure to medications and known teratogens​

•Decreased fetal movement​

Recommend Genetic counseling - allows families the opportunity to prepare for special needs of an unborn child and to consider options for current and future pregnancies​

type 1 most common (von Recklinghausen disease) tumors grow on nerves; skin changes, bone deformties; progressive disease; diagnosis = two or more clinical signs including – 2 or more neurofibromas, tumor on optic nerve, more than 6 café-au-lait spots(brown spot) > 5 mm diameter à high level of suspicion; treament is supportive

rare; usually presents in 30-40’s; progressive breakdown of nerve cells in brain; muscle problems, abnormal eye movements, impaired gait

affects connective tissue effects the heart, eyes, blood vessels, and bones; tall and thin with long arms, legs, fingers, and toes; treatment includes medications to keep blood pressure low, eyeglasses or contact lenses, and surgery.

brittle bone

•Headaches​

•Hydrocephalus​

•Scoliosis​

•Cardiac defects, hypertension, seizures​

•Vision and hearing loss​

•Neurocognitive deficits​

•Higher risk for neoplasms ​

affects the cells that produce mucus, sweat, and digestive juices. It causes these fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.

amino acid called phenylalanine to build up in the body; untreated phenylketonuria can lead to brain damage, intellectual disabilities, behavioral symptoms, or seizures; Treatment includes a strict diet with limited protein

destroys nerve cells in the brain and spinal cord; typically found in people with certain ancestry, such as Eastern European Jews; A fatty substance in the brain destroys nerve cells; Symptoms of slowed development usually appear around six months of age. Symptoms progress until they lead to death, often around age four; There is no cure

prolonged bleeding due to insufficent clotting factors; hemophilia A, associated with a low level of factor 8 (factor VIII

reduced ability to distinguish between certain colors.

progressive muscular weakness, typically in boys; no cure, but steroids may control symptoms 

(The way they get up- gawar sign)

Cause​

•Presence of all or part of an extra 21st chromosome​

Characteristics​

•Some degree of intellectual disability​

•Characteristic facial features​

•Other health problems (e.g., cardiac defects, visual and hearing impairment, intestinal malformations, and an increased susceptibility to infections)​

•Have your child evaluated by a pediatric cardiologist, including an echocardiogram​

•Take your child for routine vision and hearing tests. By 6 months have your child seen by a pediatric ophthalmologist​

•Make sure your child gets regular medical care, including recommended immunizations and a thyroid test at 6 and 12 months and then yearly​

•Have your child follow a regular diet and exercise routine​

•Make sure the child gets a cervical radiograph between 3 and 5 years of age to screen for atlantoaxial instability (C1 and C2). 

Recommend genetic counseling

oMultidisciplinary care

Iron deficiency, folic acid deficiency, pernicious anemia (deficiency in B12)

-lead poisoning

toxic effect on bone marrow, interferes with synthesis of heme- precursor to hgb

failure of bone marrow to produce cells- acquired as an adverse reaction to medication (chemo, anticonvulsants).

-rare congenital bone marrow failure (fanconi anemia- autosomal recessive )

sickle cell anemia, thalassemia

-red meat

-tuna & salmon

-eggs

-tofu

-leafy green veggies

-dried beans, peas and fruit

-enriched grains

-iron fortified breakfast cereals

History

Exposure to myelosuppressive medications or radiation therapy

Detailed family, environmental, and infectious disease history

Epistaxis, gingival oozing, or increased bleeding with menstruation

Headache, fatigue

Physical examination

Ecchymoses

Petechiae or purpura

Oral ulcerations

Tachycardia

Tachypnea

Lower levels-Behavioral problems-Learning difficulties

Higher levels (requires chelation treatment)-Encephalopathy-Seizures-Brain damage

Thalassemia - inherited blood disorder that causes less hemoglobin; anemia; can be mild to severe

Sickle cell disease (SCD)- inherited, most common in autosomal recessive, African, Mediterranean, middle eastern, and Indian descent, hemoglobin SS disease is most common (crescent shaped blood cells)

Types of SCD:

Hemoglobin Ss (Hbss)

Hb "S" gene (abnormal form of hemoglobin) from each parent → sickle cell anemia;

More of the Hb is abnormal

more severe form of the disease

Hemoglobin SC (HbSC) - less severe form

one HbS gene and one HbC gene (another abnormal type)

Sickle cell trait-

Only have HbS from one parent

-Anemia

-Pain/sickle cell crisis

-acute chest syndrome

-stroke

-jaundice

-splenic pooling

-priapism

-pain medication

-hydration

-blood transfusions

-vaccinations

-folic acid for anemia

-eye exams to assess retinopathy

-Hydroxyurea- medication that may reduce frequency of pain crisis and ACS; makes RBC less likely to turn into sickle shape

-Bone marrow transplant- for children with severe complications

alpha-thalassemia -severity depends on number of gene mutations you inherit; ; synthesis of the a chain of the hemoglobin protein is affected

beta-thalassemia- severity depends on part of the hemoglobin molecule is affected. the B-globulin chain in hemoglobin synthesis is reduced or entirely absent; severe hemolytic anemia and chronic hypoxia

Thalassemia minor (also called B-thalassemia trait): leads to mild microcytic anemia; often no treatment is required.

Thalassemia intermedia: child requires blood transfusions to maintain adequate quality of life.Thalassemia major: to survive the child requires ongoing medical attention, blood transfusions, and iron removal; Cooley's Anemia

Left untreated, B-thalassemia major is fatal by age 5 years, but use of blood transfusions and chelation therapy increases life expectancy of these children

Excessive supply of iron; accumulation in tissues

Result of rapid hemolysis of RBCs, decrease in hemoglobin production, increased absorption of dietary iron in response to the severely anemic state.

excess iron is deposited in the body's tissues, causing bronze pigmentation of the skin, bony changes, and altered organ function, particularly in the cardiac system, splenomegaly, endocrine abnormalities, osteoporosis, liver and gallbladder disease, and leg ulcers.

PRBC transfusions(blood transfusion) as prescribed to maintain an adequate level of hemoglobin for oxygen delivery to the tissues

-Excess iron is removed by chelation therapy. Administer the chelating agent deferoxamine with the transfusion.

Deferoxamine binds to the iron and allows it to be removed through the stool or urine. Oral deferasirox may also be prescribed.

G6PD -an enzyme that helps RBC's work properly is insufficient or abnormal; X-linked recessive

causes red blood cells to break down (hemolysis) in response to certain medications, infections, or other stressors.

Triggers that may result in oxidative stress and hemolysis-

• bacterial or viral illness

exposure to certain substances such as medications (e.g., sulfonamides, sulfones, malaria-fighting drugs [such as quinine], or methylene blue [for treating urinary tract infections]), naphthalene (an agent in mothballs), or fava beans.

• Tea colored urine, splenomegaly

* Administer 02; improve one trigger or illness is removed

-Idiopathic thrombocytopenia purpura (ITP)

-Henoch-Schonlein purpura

-Disseminated intravascular coagulation (DIC)

-Factor deficiencies

-Hemophilia A (factor VIII deficiency)

-von Willebrand disease

Immune response following viral infection that destroy platelets

-Normal platelet count -150,000 to 450,000 platelets per microliter of blood

-Petechiae:Pinpoint hemorrhages occurring on the body that do not blanch to pressure,

-Purpura:Larger purplish areas of hemorrhage in which blood collects under the tissues; complication = bleeding into organs and intracranial pressure - although both rare

* Platelet counts below 10,000/mm3, corticosteroids may be administered for 2 to 3 weeks

• Single dose of intravenous immunoglobulin (IVIG) may be used as an adjunct

-Platelet transfusions are not indicated unless life-threatening bleeding is present.

-Refer the child for follow-up care with a pediatric hematologist.

-Usually, self-limiting

Mostly male children

Associated with viral or bacterial illness- often respiratory

Vasculitis with immunoglobulin A (IgA) -dominant immune deposits affecting small vessels in the skin, gut, and kidney

Benign in most children and resolves with no issues

nephrotic syndrome may occur as a result of renal injury, and those children may have

hypertension.

Pulmonary, cardiac, and neurologic complications can also occur.

Treatment with corticosteroids, such as prednisone, may be helpful in children with severe joint or GI manifestations

Complex condition leads to activation of coagulation

Usually occurs in critically ill childrenSeptic shock, endotoxins, viruses, tissue necrosis, cancer treatments

Deficiencies of coagulation and anticoagulation pathways occur

Hemorrhage and organ tissue damage result and can be irreversible if not recognized and treated immediately.

Treat underlying issue -ex. infection → antibiotics

group of X-linked recessive disorders that result in deficiency in one of the coagulation factors in the blood

transmitted by carrier mothers to their sons, so usually only males are affected by hemophilia

coagulation factors in the blood are essential for clot formation either spontaneously or from an injury, and when factors are absent bleeding will be difficult to stop

The most common= hemophilia A - deficiency of factor VIII

Prevent bleeding

Helmets, avoid contact sports, medical alert bracelet

Mild bleeding disorder

• genetically transmitted bleeding disorder that may affect both genders and all races

deficiency in von Willebrand factor (vWF)

serves two functions:bind with factor VIII, protecting it from breakdownserve as the "glue" that attaches platelets to the site of injury

-The most common childhood cancers in order of frequency-

-Leukemia, CNS tumors, lymphoma, neuroblastoma (adrenal glands), rhabdomyosarcoma (muscles), Wilms tumor (kidney), bone tumors, and retinoblastoma

Warning signs of cancer-

-most often related to changes in blood cell production; changes in blood cell production may result in fatigue, pallor, frequent or severe infection, or easy bruising

-a result of compression, infiltration, or obstruction caused by the tumor; infiltration, obstruction, or compression by a tumor may result in bone or abdominal pain, swelling, unusual discharge

1. carry oxygen throughout body

2. clotting

3. fight infection

Low erythrocyte/rbc- anemia(pica, pale, tired)

Low platelets- prolonged bleeding

Passive

-Antibodies received from an external source (mother to baby, IVIG)

Cellular

-Antibodies produced by native T-cell lymphocytes (thymus)

Humoral

-Antibodies produced by native B-cell lymphocytes (bone marrow)

History of petechiae

• Bloody diarrhea or bleeding episode in the first 6 months of life

History of hematemesis or intracranial or conjunctival hemorrhages

Eczema

Laboratory findings of low IgM concentration, elevated IgA and IgE concentrations, and normal IgG concentrations

Four or more new episodes of acute otitis media in 1 year

Two or more episodes of severe sinusitis

Treatment with antibiotics for 2 months or longer with little effect

Two or more episodes of pneumonia in 1 year

Failure to thrive in the infant

Recurrent deep skin or organ abscesses

Persistent oral thrush or skin candidiasis after 1 year of age

History of infections requiring IV antibiotics to clear

Two or more serious infections such as sepsis

Family history of primary immunodeficiency

-Failure to thrive

-Recurrent bacterial infections

-Opportunistic infections

-Chronic or recurrent diarrhea

-Recurrent or persistent fever

-Developmental delay

-Prolonged candidiasis

-dairy (cows milk)

-eggs

-penuts

-tree nuts

-fish and shellfish

-wheat

-soy

Wiskott-Aldrich Syndrome/ Deficiency -X-linked genetic disorder; defective gene that results in immunodeficiency, eczema, and thrombocytopenia, autoimmune hemolytic anemia, neutropenia, skin or cerebral vasculitis, arthritis, inflammatory bowel disease, and renal disease

Severe Combined Immune Deficiency (SCID) - X-linked or autosomal recessive disorder; it can occur in girls or boys. SCID is

characterized by absent T-cell and B-cell function.

-Chronic diarrhea

-Failure to thrive

-History of severe infections early in infancy

-Persistent thrush

-Adventitious sounds related to pneumonia

-Lab findings of very low levels of immunoglobulins

-Avoiding infection

-How can we avoid infection?

-Promoting compliance with the medication regimen

-Promoting nutrition

-Providing pain management and comfort measures

-Educating the child and caregivers

-Providing ongoing psychosocial support

-SLE definition: chronic multisystem autoimmune disorder with periods of exacerbation and remissions; inflammatory response

Laboratory testing includes:

-CBC (decreased Hgb, Hct)

-Platelet count (decreased)

-WBC (decreased)

Treatment and support - treating the inflammation; NSAIDs, corticosteroids, antimalarials (can reduce autoantibodies), dialysis if in renal failure

(molar/butterfly rash (erythema on cheeks))

Growth hormone deficiency

Precocious puberty

Delayed puberty

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion

-hypopituitarism or dwarfism, is characterized by poor growth and short stature

-result of the failure of the anterior pituitary or hypothalamic stimulation on the pituitary to produce sufficient GH.

-lack of GH impairs the body’s ability to metabolize protein, fat, and carbohydrates.

-injury to, or destruction of, the anterior pituitary gland or hypothalamus; tumor, trauma, infection

-genetic syndrome, such as Prader–Willi syndrome or Turner syndrome, or the result of a genetic mutation or deletion

Goal = 3 to 5 in in linear growth in the first year of treatment Treatment stops when the epiphyseal growth plates fuse

-Development of sexual characteristics before the usual age of pubertal onset ->secondary sex characteristics develop in girls before the age of 8 years and in boys younger than 9 years

-more common in females, majority of the time the cause is unknown in females

-premature activation of the hypothalamic–pituitary–gonadal system

-Short stature if untreated ->premature closure of growth plates

-Must determine the cause; GnRH analog to halt or reverse growth and development

-delayed secondary sexual development

-Girls -if the breasts have not developed by age 12

-boys when no testicular enlargement or scrotal changes have occurred by age 14

-constitutional delay- most common cause, hereditary pattern of growth and development (or a “late bloomer”)

-Therapeutic management involves administering testosterone (males) or estradiol-conjugated estrogen; usually necessary for only a short time to get puberty started

Too much ADH- HYPONATREMIA

-Causes water retention(low urinary output), decreased serum sodium due to hemodilution, and extracellular fluid volume expansion. 

-Caused by CNS infections such as meningitis, head trauma, brain tumors, intracranial surgery, and certain medications such as analgesics, barbiturates, or chemotherapy.

-May be caused by excessive treatment of DI

Therapeutic management -correcting the underlying disorder, fluid restriction, and intravenous sodium chloride administration to correct hyponatremia and increase serum osmolality

Rare in children

excessive T3,T4

TSH low

Treated with destruction of thyroid gland

Symptoms

-diarrhea

-bulging eyes

-tachycardia

-weight loss

-amenorrhea

-localized edema

-always hot

can be congenital or acquired

-Certain populations at risk (Downs, maternal hypothyroidism)

-Decreased thyroid hormones

Decreased T3, T4

TSH usually elevated

Lifelong thyroid supplementation

Symptoms

-lethargy

-dry skin

-constipation

- always cold

-facial edema

-brittle nails/hair

-weight gain

bradycardia

•Hashimoto

•antibodies develop against the thyroid gland, causing the gland to become inflamed, infiltrated, and progressively destroyed

•Management involves oral sodium L-thyroxine, Synthroid

Symptoms-

•goiter -enlargement of the thyroid gland

•Deep tendon reflexes may be sluggish and the face, eyes, and hands may be edematous

•thinning or coarse hair, muscle hypertrophy with muscle weakness, and signs of delayed or precocious puberty. 

•Diagnostic evaluation involves serum thyroid function studies 

•Hyperfunction of the thyroid gland, excessive levels of circulating thyroid hormones

•Uncommon in children, 5 times more in girls than boys

•increased rate of growth; weight loss despite an excellent appetite; hyperactivity

•Usually develop a goiter

•Congenital hyperthyroidism -neonatal thyrotoxicosis - occurs in infants of mothers with Graves disease- life threatening,  self-limiting disorder lasting 2 to 4 months

•Therapeutic management –decrease thyroid hormone levels. Current treatment involves antithyroid medication, radioactive iodine therapy, and subtotal thyroidectomy. First-line treatment involves methimazole (MTZ, Tapazole) - blocks the production of T3 and T4

-adrenal glands don’t produce enough cortisol, adrenal gland enlarges to compensate

-Males=enlarged penis, puberty by 2-3; females = ambiguous genitalia(can't tell if boy or girl), fertility issues

-Treatment = hormone replacement, steroids

adrenal insufficiency – weakness, fatigue, fragile and thin skin

testosterone production by the ovaries and adrenal cells is excessive, causing hirsutism, balding, acne, increased muscle mass, and decreased breast size.

-A hormone made by the islet cells of the pancreas

-Controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy.

autoimmune disorder

-Destruction of beta cells of pancreas ->inadequate insulin secretion ->hyperglycemia

-Kidneys try to lower blood glucose ->glycosuria and polyuria

-Protein and fat are used for energy -> buildup of ketones and acidosis

Pancreas produces insulin but:

-Body is resistant to insulin or there is inadequate insulin produced

-Overtime, insulin production decreases

•blood glucose monitoring

•Hemoglobin A1C – shows blood glucose control over previous 3 months

• daily injections of insulin and/or administration of oral hypoglycemic medications

• a realistic and well-balanced diet

•an exercise program

•self-management and decision-making skills.

Rapid acting- 15 min

Short acting- 30 min-1hr

Intermediate acting- 2-4 hrs

Long acting- 2-4hrs

Damage to nerves and vessels d/t prolonged exposure to high blood glucose levels

•Failure to grow

•Delayed sexual maturation(erection)

•Poor wound healing

•Recurrent infections (especially of the skin)

•Retinopathy

•Neuropathy

•Vascular complications

•Nephropathy

•Cerebrovascular disease

•Peripheral vascular disease

•Cardiovascular disease

d. Glucose monitoring. Glucose monitoring is an intervention appropriate for managing diabetes.

b. Serum osmolality greater than 300 mOsm/kg. Serum osmolality greater than 300 mOsm/kg is a clinical manifestation of diabetes insipidus.

Swimming

Discontinue the transfusion.

Keep him away from people with known infections

"Do not palpate abdomen."

"It is better to avoid large groups right now."

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

lymph node biopsy

A 15-year-old adolescent who has heavy menstrual periods

Assess the client's airway and breathing rate

an upper respiratory viral infection

“Side effects, such as drowsiness and dryness, do not indicate an allergy.”

Administer epinephrine.

eggs

penuts

milk

Be certain the child has not received an antihistamine in the past 8 hours

“If my child has gastrointestinal upset, my child is not having anaphylactic shock.”

-behavioral therapy

-play therapy

-cognitive-behaviorla therapy

-dialectical behavioral therapy

-family therapy

-group therapy

-milieu therapy

-individual therapy

-hypnosis

•Set limits and hold child responsible for behavior

•Do not argue, bargain, or negotiate about the limits set

•Provide consistent caregivers and establish a daily routine

•Use a low-pitched voice and remain calm

•Redirect the child’s attention when needed

•Ignore inappropriate behaviors

•Praise the child’s self-control efforts

•Use restraints only when necessary

Most common neurodevelopmental disorder of childhood

-Disruption in learning ability, socialization, and compliance, -> high demands on the child, parents, teachers, and community

Often have a comorbidity 

-such as oppositional defiant disorder

-conduct disorder

-anxiety disorder

-depression

-less severe developmental disorder

-auditory processing disorder

-learning or reading disabilities

•Careless mistakes on schoolwork

•Doesn’t listen

•Doesn’t follow through

•Doesn’t complete tasks

•Doesn’t understand instructions

•Poorly organized

•Avoids, dislikes, or fails to engage in activities requiring mental effort

•Loses things needed for task completion

low body weight, fear of gaining weight, distorted body image

-characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise

distortion of body image, bouts of extreme overeating followed by purging, fasting, over-exercising

-refers to a cycle of normal food intake, followed by binge eating and then purging; callouses, redness on knuckles

craving & chewing substances with no nutritional value

-Fluid and electrolyte imbalance

-Decreased blood volume

-Cardiac arrhythmias

-Esophagitis

-Rupture of the esophagus or stomach

-Tooth loss

-Menstrual problems

-Mortality rate may be as high as 18%

•Previous suicide attempt

•Change in school performance, sleep, or appetite

•Loss of interest in formerly favorite social or school activities

•Feelings of hopelessness or depression

•Statements about thoughts of suicide

•Giving away belongings

•Having a plan for suicide or self-harm!!!

•Generalized anxiety disorder (GAD) -unrealistic concerns over past behavior, future events, and personal competence.

•Social phobia -persistent fear of speaking or eating in front of others, using public restrooms, or speaking to authorities

•Selective mutism -persistent failure to speak in social situations 

•Obsessive-compulsive disorder (OCD) - compulsions the child performs to reduce anxiety about obsessions

•Posttraumatic stress disorder (PTSD) -occurs after a child experiences a traumatic event, later experiencing physiologic arousal when a stimulus triggers memories of the event.

-Pharmacologic agents and psychological therapies

-Anxiolytics or antidepressants are the most common pharmacologic approaches

-Cognitive-behavioral therapy; individual, family, or group psychotherapy; and other behavioral interventions such as relaxation techniques

associated with the development of anxiety and depressive disorders, suicidal ideation and attempts, and alcohol and drug use

injuries that are intentionally inflicted

oinvolvement of the child in any activity meant to provide sexual gratification to an adult.

failure to provide a child with appropriate food, clothing, shelter, medical care, and schooling

•Child with one or more illnesses that do not respond to treatment or that follow a puzzling course; a similar history in sibling

•Symptoms that do not make sense or that disappear when the perpetrator is removed or not present; the symptoms are witnessed only by the caregiver

•Physical and laboratory findings that do not fit with the reported history

•Repeated hospitalizations failing to produce a medical diagnosis, transfers to other hospitals, discharges against medical advice

•Parent who refuse to accept that the diagnosis is not medical

d. Cognitive therapy. Cognitive therapy involves coaching the child to change reactions by replacing automatic negative thought patterns with alternative ones.  

True. Bulimia refers to a cycle of normal food intake, followed by binge-eating and then purging.

D) Neglect

C) Frequent absences from school without explanation

C) Report your suspicions to the appropriate authorities as mandated by law

C) Mandated reporters can face legal consequences for failing to report suspected abuse.

D) It is acceptable to promise the child confidentiality to encourage them to disclose abuse.

•Smaller airways than adults

•Underdeveloped immune systems

•Lack motor coordination to save self after falling into water

•Susceptible to choking on food and small objects

•Higher risk for sudden infant death syndrome

•Maintaining a patent airway

•Providing supplemental oxygen

•Assisting ventilation

•Monitoring for changes in status

•Offering support and education to the child and family

Airway Evaluation and Management – patency(clear), secretions, obstructions

Breathing Evaluation and Management – look, listen, feel; resp distress 100% O2 and begin ventilation, may need intubation

Circulation Evaluation and Management - HR, pulses skin color and temperature, (BP), cardiac rhythm,and level of consciousness; brachial artery in infant

AVPU

•Alert

•Responsive to Voice

•Responds to Pain

•Unresponsive

AHA has recommended that an AED can be used for children who are older than age 1 year who have no pulse and have suffered a sudden, witnessed collapse- arrhythmia often cause

Two fingers placed one finger breadth below nipple line

One person CPR

-30 Compressions to 2 breaths

Two person CPR

-15 compression to 2 breaths

Heal of hand pressing on sternum at nipple line (adult position for larger child)

One person CPR

-30 compressions to 2 breaths

Two person CPR

-15 compressions to 2 breaths

if cervical spine injury suspected

DO NOT US HEAD TILT-CHIN LIFT

-Peripheral IV route

-Central IV route

-Saphenous vein cutdown

-Intraosseous access (anterior tibia preferred)

Primary Survey

-Airway

-Breathing

-Circulation

Secondary Survey

-Disability

-Exposure

•Evaluate level of awareness (sensorium) in an older child

•Evaluate interest in environment in an infant

•Evaluate the child’s head

•Assess the eyes

•Evaluate the child’s face

•Evaluate spontaneous movement of extremities

•May use Pediatric Glasgow Coma Scale

•Life threatening condition brought on by sudden drop in blood flow through the body

Signs and symptoms:

•Pallor

•Hypotension

•arrythmias

•Respiratory distress

•Delayed capillary refill

•Weak distal pulses

Septic shock – severe infection leads to cardiac dysfunction

Hypovolemic shock– blood loss

•Respiratory arrest

•Shock

•Cardiac arrhythmias and arrest – brady, tachy, asystole

•Near drowning – 3^rd leading cause of preventable death

•Poisoning – suspect toxic ingestion if sudden deterioration

Traumatic injury - leading cause of death in children and adolescents is unintentional injuries 

Tachypnea

•Increased respiratory rate

Hypoventilation

•Decrease in depth and rate of respiration

Periodic breathing

•Regular breathing with occasional short pauses

Increased work of breathing

•Use of intracostal muscles or presence of retractions

Compensated SVT-hr 220

Uncompensated SVT- hr 220

Ventricular tachycardia- normal to 220

•Electrolyte abnormalities

•Toxic drug ingestion

•History of a serious primary congenital or acquired cardiac defect

•Potentially lethal arrhythmias, such as prolonged QT syndrome

•Hyper- or hypotrophic cardiomyopathy

•Traumatic cardiac injury or a sharp blow to the chest, known as commotio cordis

Arterial or capillary blood gases

•Measures the amount of oxygen, carbon dioxide in blood. It also checks the acidity or pH level.

Pulse oximetry

Chest radiograph

•Alterations in normal anatomy or lung expansion

•Evidence of pneumonia, tumor, or foreign body

1.Prevention of cardiac arrest and injuries

2.Early CPR

3.Early access to emergency response system

4.Early advanced care (pediatric advanced life support [PALS])

5.Integrated post–cardiac arrest care

Narcan

Opioid overdose treatment

Nasal spray

Displacement

•Tracheal tube is displaced from the trachea

Obstruction

•Tracheal tube is obstructed (e.g., with a mucous plug)

Pneumothorax

Equipment failure

•Disconnected oxygen supply

•Leak in the ventilator circuit

•Loss of power

“LEAN”

-L: lidocaine

-E: epinephrine

-A: atropine

-N: naloxone

d. Laryngeal mask airway. Using this method, the nurse inserts the rubber connecting tube of an inflatable silicone mask blindly into the airway to form a seal.

False. The femoral route is best for obtaining central venous access while CPR is in progress.

b. Hypoventilation. A child who is being treated with narcotics for pain related to leukemia should be monitored for hypoventilation.

Basic trust versus mistrust.

autonomy versus shame and doubt

·      Learning to do for themselves

·      Independence

Initiative versus guilt

·      Pride in accomplishments; guilt when not capable

Industry versus inferiority

·      Interested how things are made

·      Success on personal/ social tasks

·      Outside activities

·      Peers

·      Learning

identity versus identity confusion

·      Focus on body changes, importance of peer culture become primary

Weight

Double weight by 4-5 months (6 months)

Triple weight by 12 months

(grow rapidly first 6 months)-lenght increased by 50% by 12 months

Anterior fontanelle-12-18 months

Posterior fontanelle-2 months

Common developmental concerns

o   Colic- constant crying

o   Spitting up

o   Thumb sucking, pacifiers

o   Teething

present at birth

develop as soon as primitive reflexes disappear

Resp- 30-60 newborn (20-30 12 monthly)

Pulse- 120-40 newborn (100 1 year old)

BP- 60/40 (newborn) (110/5 12 month old)

-  1 month- lifts and turns head when prone, head lag

-  2 months- raises head and chest

-  3 months- raises head 45 degrees in prone, slight head lag

-  4 months- lifts head and looks around, rolls from prone to supine

-  5 months- rolls supine to prone and back, sits upright w/ support

-  6 months- tripod sits

-  7 months- sits alone with use of hands

-  8 months- sits unsupported

-  9 months- crawls, abdomen off floor

-  10 months- pulls to stand, cruises

-  12 months- sits from standing, may walk independently

-  1 month- fists clenched, involuntary hand movement

-  3 months- hold hand in front of face, hands open

-  4 months- bats at object

-  5 months- grasps rattle

-  6 months- releases object in hand to take another

-  7 months- transfers object from hand to another

-  8 months- gross pincer grasp

-  9 months- bangs objects together

-  10 months- fine pincer grasp, puts objects into containers and takes out

-  12 months- feeds self with cup/spoon, mark paper, pokes with index

- Become clingy when approached by strangers

-  Begins around 8 months

Respiratory rate 24-40 (decreased)

Blood pressure increases

Parallel play- play alongside another child

Developmental concerns

o   Negativism- saying no

o   Temper tantrums

o   Sibling rivalry

o   Toilet teaching

-Initial walking with “toddler gait

-  Later includes running, climbing, jumping, pulling toy, throwing ball, tricycle

-Holding and pinching to managing utensils, holding crayon, work a puzzle, use touch screen

·Motor skills development

o   3 years- climb well, runs easily, up and down stairs, bend over without falling

o   4 years- throws ball, kicks ball, catches bounced ball, hops on one foot, stands on one foot for 5 seconds, alternates feet using stairs, moves forward/backwards with agility

o   5 years- stands on one foot for 10 seconds, swings/climbs, skips(maybe), somersaults, learn to skate/ swim

·Fine motor skills

o   3 years- undresses self, builds tower (9-10 cubes), holds pencil, screws/unscrews lids, turn book pages

o   4 years- uses scissors, capital letters, draws circles/squares, learning diamond, draws a person figure with 2-4 parts, laces shoes

o   5 years- draws 6 person parts, dresses/undresses without help, learning to tie laces, fork, spoon, cares for toileting needs

3 years- Vocabulary-200 words

5 years- vocab 2100 words

Developmental issues

o   Lying

o   Sex education

o   Masturbation

·      6-12 years old

Gross motor skill

o   Encourage physical activity

o   Coordination, balance rhythm improves

o   Ride bike, jump rope, dance, sports, skating, swimming

Fine motor skill

o   Hand usage improves

o   Eye-hand coordination and balance improve

o   Write, print words, sew, build models

o   Take pride in activities

o   Vocabulary expands to 8000 to 14000

o   Self-esteem development

o   Body image

o   School age fears

Puberty

o   Girls 9-10

o   Boys 10-11

Developmental concerns

-Changes in body image

-  Peer groups

-  Violence

-  Suicide

-  Homicide

-  Substance use

Developmental concerns

-  Changes in body image

-  Peer groups

-  Violence

-  Suicide

-  Homicide

-  Substance use