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Peds Exam 2: Ppt info
Flashcards based on Peds powerpoints
57
Nursing
Undergraduate 3
10/20/2013

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Term
Respiratory distress
Definition
Compensated state that may precede respiratory failure, the patient is able to maintain adequate gas exchange by increasing breathing rate and depth.
Term
Signs and symptoms of respiratory distress
Definition
-Diaphoresis
-Pallor/Cyanosis
-Nasal flaring
-Tachypnea
-Noisy breathing
-Retracting
-Grunting
Term
What is the difference in respiratory distress in a small child?
Definition
-Smaller and shorter airways
-Airways easily blocked
-Hyper-reflexive = spasms
-Easily fatigued decreases cough
-Immune unsophisticated
-Limited alveolar surface area
-Poor/weak respiratory muscles
-Poor fluid volume control
Term
What are possible causes of obstructive respiratory failure?
Definition
-Foreign body (vomitus)
-Infection (epiglottis)
-Tonsils/adenoids
-Laryngospasm
Term
What are possible causes for restrictive respiratory failure?
Definition
-Thick secretions, foreign body
-Infection (Pneumonia)
-Alveolar rupture (pneumothorax)
-Chemical pneumonitis
-Pleural effusion
-Near-drowning event
Term
What are possible causes of primary ineffecient gas transfer respiratory failure
Definition
-Anemia
-Hemorrhage
-Over-sedation
-Cerebral trauma
Term
Upper Respiratory Tract Illnesses
Definition
-URI or URTI
-Nasopharyngitis
-Pharyngitis
-Tonsilitis
-Influenza
-Otitis Media
-Infectious mononucleosis
Term
Croup- what do we do?
Definition
Treat with cool mist or steam therapy
-Can usually be treated at home
Term
Respiratory Syncitital Virus
Definition
-80%-90% cause of bronchiolitis seen in infants
-Seasonal
-Treatment airway management and fluids
-Frequent hospitalization for infants (at risk infants receive Synagis)
Term
Reactive Airway Disease
Definition
Inflammatory reponse initiated in airways
-Involves mast cells, eosiniophils, and T lymphocytes
-End result means increased mucous production, inflammation to lower airways and bronchospasm
-When it keeps reocurring is means Asthma
Term
Asthma
Definition
-Chronic inflammatory disorder of airways
-Bronchial hyperresponsiveness
-Episodic
-Limited airflow or obstruction that reverses spontaneously or with treatment
Term
Asthma triggers
Definition
-Inhalants
-Airborne pollens
-Stress
-Weather changes
-Exercise
-Biral or bacterial agents
-Food additives
-Lots of other things . . .
Term
Reccomendations for asthma care and management
Definition
-Obtain objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained.
-Education for a partnership in asthma care
-Control of environmental factors and comorbid conditions that affect asthma
-Pharmacologic therapy
Term
Long term medications
Definition
-Corticosteroids-(inhaled) pumicort
-Cromlyn sodium (intal)-Mast cell stabilizer
-Immunomodulators-(Xolair) decrease IgE response
-Leukotreine modifiers-(Accolate)
-LABA's (long-acting bronchodilator) Serevent or Salmeterol (12 hours)
-Methylxanthine-theophyline
Term
Quick relief for asthma
Definition
-Anticholinergics (Atrovent)-blocks constriction (parasympathetic)
-SABA: short-acting bronchodilators (Albuterol)- stimulates dilation (sympathetic)
-Systemic corticosteroids-Methylprednisone/Solumedrol
Term
Cystic Fibrosis
Definition
Inherited autosomal recessive trait
-Cystic fibrosis transmembrane Conductance Regulator
--Critical loss of chloride ion transport
--Upsets the sodium and chloride ion balance
--Disrupts the normal, think mucus layer that is easily removed by cilia lining the lungs and other organs
Term
Problems associated with Cystic Fibrosis
Definition
-Thick sticky secretions
-Pool in bronchioles = atlectasis
-Clogs pancreatic ducts, impairs digestion & absorption of nutrients
-Leads to biliary cirrhosis
-Retarded G & D, delayed puberty
-Terminal, median age is 37
Term
Respiratory management for cystic fibrosis
Definition
-Large amounts of mucous and increased viscosity increase likelihood of respiratory tract infections
-Recurrent pulmonary infection in the child with CF results in damage to the airways. (bronchiectasis)
-Mucolytics, brocnhodilators, kalydeco
-Antibiotics for infections
-Chest PT
-Avoid pulmonary treatments after meal
Term
GI management for Cystic Fibrosis
Definition
-Assess nutritional status
-Provide high protein & calorie diet
-Administer pancreatic enzymes
-Vitamins (esp. fat soluble)
Term
Reasons for vomiting in children
Definition
-Allergies to foods
-Over-eating
-Persistent coughing
-Intestinal obstruction
-Viral illness
Term
Rotavirus
Definition
Rotavirus is very common, especially in children under the age of 2
-Watery diarrhea most common symptom
-Other symptoms include vomiting and fever
-Passed through fecal-oral route
-Also can be passed through indirect contact such as child touches toy or if someone doesn't wash hands after changing a diaper
-Usually develops symptoms 1-3 days after contact
-No specific tx, children usually recover on own
-Can detect antigens in stool
-Diarrhea usually lasts 3-7 days
-Treatment with flavored oral rehydration
-May need IV
-Start back slow with diet (BRAT)
Term
Hirschsprungs Disease
Definition
Congenital Aganglionic Megacolon
-Absence of ganglioncells in one or more segments of the colon
-Etiology not fully understood
-Symptoms: Dont pass menium; Distension; Ribbon like stools
Term
G.E. Reflux Disease
Definition
Relaxation or incompetence of the lower esophageal sphincter
-Vomiting
-Weight loss
-Respiratory problems (RAD)
-GI bleeding
Term
3 Inflammatory GI Disorders
Definition
1. Appedicitis
2. Ulcerative Colitis
3. Crohn's disease
Term
Appendicitis
Definition
Signs and symptoms:
-Abdominal pain-per umbilical to right lower quadrant
-Local rebound tenderness
-Vomiting
-Constipation or diarrhea
Term
Hepatic disorders
Definition
Acute hepatitis
Cirrhosis
Biliary atresia
-Etiology unknown
-Healthy infant at birth
-Jaundice occurs within 2wk-2mo
-Alcohlic stools (puttylike, clay)
-Increased bilirubin levels
Term
3 Structural defects in children (GI)
Definition
-Cleft lip and palate
-Esophageal atresia
-Hernias
Term
Structural defects: Cleft lip and cleft palate
Definition
Failure of the premaxillary adn maxillary processes to come together in fetal life
-Cleft lip surgery (first 3 months)
-Cleft palate repair (6mos to 5 yrs)
Term
Esophageal atresia with tracheoesophageal fistula
Definition
-Esophageal atresia: the esophagus ends in a blind pouch or stops; does not connect with the stomach
-Tracheoesophageal fistula: a fistula is present connecting the esophagus with the trachea
Term
3 GI Obstructive Disorders
Definition
1. Hypertrophic pyloric stenosis
2. Intussusception
3. Malrotation
Term
Obstructive Disorders: Pyloric Stenosis
Definition
Muscle around the pylorus enlarges and leads to obstruction during the first three months of life
-Projectile vomiting
-hunger
-Weight loss
-Dehydration with F/E Disturbances
-Increased Abdominal distention with peristalsic waves
-Palpable Olive Shape Tumor in Epigastric Area
-Diagnosed by ultrasound
-Emphasis on restoring and correcting fluid and electrolyte problems
-POst-op: Infant may still vomit, advance diet as tolerated, rare to have complications
Term
Intussusception
Definition
Telescoping of one portion of the intestine into another
-Frequent cause of intestinal obstruction
Signs and Symptoms:
-Acute abdominal pain with tender abdomen
-Vomiting
-Normal stool to red currant jelly like stool (lovely!)
-Abdominal distention
-Sausage shape mass in riq
-Child can become acutely ill with fever and S&S fo peritonitis
-Dx is made by xray, ultrasound, or barium enema
-Surgery if b.e. is not successful
Term
Examples of age-related skin mansifestations
Definition
-Infants: birthmarks
-Early childhood: atopic dermatitis
-School-age children: ringworm
-Adolescents: acne
Term
Impetigo
Definition
-Common peds problem
-Treated with topical antibiotic if localized to small area
-Bacterial: strep or staph
-Wash crust off with soap andwater and apply topical antibiotic
-May be treated with oral antibiotics if has spread (still wash lesions)
-Very contagious
Term
Viral skin infections
Definition
-Most communicable diseases of childhood have characteristic rash (rubeola, rubella, chicken pox)
-Other ex: verruca (warts), herpes simplex type
Term
Fungal skin infections
Definition
Superficial infections that live on the skin
-AKA dermatophytoses
-Transmission from person to person or from infected animal to human
-EX: tinea capitis, tinea corporis, tinea pedis, candidiasis
Term
Contact dermatitis
Definition
-Inflammatory reaction or skin to chemical
-Initial reaction in the exposed region
-Characteristic sharp delineation between inflamed and normal skin
-Primary irritant
-Sensitizing agent
-Ex: Diaper dermatitis, reaction to wool, reaction to specific chemical
Term
Atopic dermatitis
Definition
A type of pruritic eczema that begins during infancy
-Hereditary tendency
-Often associated with history of food allergies, allergic rhinitis, and asthma
Term
Diaper Dermatitis
Definition
Pathophysiology and clinical manisfestations
-Usually from irritation of urine and feces
-Detergents inadequately rinsed from clothing
-Chemical irritation
-Nursing considerations: alter wetness, pH, and fecal irritants
-Differentiate from Candidiasis of diaper area (candidiasis has characteristic excoriated red papules with satellite lesions)
Term
Drug reactions
Definition
-Adverse drug reactions are most often seen in skin (rashes most common reaction)
-May be immediate or delayed following administration of drug
-Treatment: discontinue drug, antihistamines, corticosteroid therapy if very severe
Term
Acne
Definition
-Predominately in adolescents
-Pathophysiology
--Involves hair follicles and sebaceous glands
--Black heads
-Therapeutic management
--General measures/overall health
--Medications
Term
Burns
Definition
-Toddlers: hot water scalds
-Older children: flame-related burns
-Child abuse
-Child with matches or lighters accounts for 1 in 10 house fires
Term
Growth hormone deficiency
Definition
-Hypopituarism
--Failure of the pituitary to produce sufficient growth hormone to sustain normal growth in children.
-Familial patterns
-Review growth charts
-GH products are currently labeled for use in children who have growth failure due to an inadequate of normal GH.
-Administered at night to correspond with normal release time of GH
Term
Growth hormone replacement management
Definition
-Children should be managed by a pediatric endocrinologist
-Height and weight is obtained every 3 months and plotted on the growth chart
-Bone age study yearly
Term
Precocious puberty
Definition
-Development of sexual characteristics before the usual age of onset of puberty.
Girls: Breast development, pubic hair, and/or menses before 8 years
Boys: Secondary sexual characteristics before age 9
-Tanner scale: true precocious puberty is characterized by 2 signs of puberty
Term
Pediatric blood glucose target levels
Definition
-Toddler and preschool: 100 to 180 mg/dL
-School-age: 90-180 mg/dL
-Adolescents (13 to 19 years): 90 to 130 mg/dL
Term
Insulin
Definition
-Short-acting: often used to cover extra carbohydrate consumption
-Combination of regular and intermediate-acting insulin
-Children on mixed insuling dosage schedules tend to experience hypoglycemic episodes at 11:30 adn 2:30 as peaking of insulin occurs.
Term
Hypoglycemia
Definition
Symptoms:
-Rapid onset
-Shaky feeling, hunger
-Dizziness
-Headache
-Vital signs-shallow respirations, tachycardia
-Tremors
-Glucose = low, below 60
-Ketones = negative
-Urine output: normal, sugar negative, negative ketones
Term
Treatment of hypoglycemia
Definition
Day time hypoglycemia:
-Simple concentrated sugars such as honey by mouth (older than 1 year), hard candy, sugar cubes, or glucose tablets will elevate the blood sugar immediately. OJ or sugar containing soda or fruit drink.
-Identify reason for hypoglycemia. In children it is often increase in activity without increase in food intake.
Term
Hypoglycemia prevention
Definition
-Using rapid-acting or Lispro insulin
-Infusion pump (8 to 10 years)
-Night time snack
-Check blood glucose before bedtime. Make sure the blood glucose is 100-120 mg/dL before going to bed.
-Do not skip snacks.
-Eat an extra snack on days of strenuous exercise.
Term
Hyperglycemia and DKA
Definition
Symptoms: Lethargic, confused, weak
-Thirsty
-Abdominal pain often with nausea and vomiting
-Signs of dehydration
-Vital signs: deep, rapid respirations, fruity acetone breath, and weak pulses
Term
DKA symptoms
Definition
-Altered LOC
-Dehydration
-Electrolyte disturbances
-Dysrrhythmias
-Shock
-Complete vascular collapse
Term
Life management of patients with DM
Definition
-Management by endocrinologist
-Insulin
-Blood sugar monitoring
-Diet
-Exercise
-Screen for retinopathy: opthalmologic exam annually
Term
Exercise for those with Diabetes Mellitus
Definition
-Vital component to management of child with diabetes
-May decrease the amount of insulin required.
-Enhances insulin absorption.
-Important for normal growth and development
Term
Type 2 diabetes
Definition
-85% of children with Type 2 are obese
-Age of onset is middle to late puberty-around 13 years
-Minority populations have an especially high rate of type 2 diabetes
-Strong family history
-The rate of new cases among youth was 5.3 per 100,000 for type 2 diabetes
Term
Assessment of children with type 2 diabetes
Definition
-Obesity: BMI greater than 30 (normal range is 15 to 17 in the pediatric population)
-Waist to hip ratio: apple shape
-Acanthosis nigricans: hyper-pigmentation and thickening of the skin into velvety irregular folds in the neck and flexural areas
-HTN
-+ family history of type 2 diabetes
-Ethnicity
Term
Interdisciplinary Interventions for children with DM type 2
Definition
-Comprehensive education on importance of regular exercise and how to self-monitor for blood glucose levels.
-Dietary management
-Glucose-lowering agent: drugs that improve insulin sensitivity such as Glucophage (Metformin)
-A few may need Insulin to initiate control
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