Peds Exam 4 Combined

1st degree burns: (4)

• Superficial thickness: sunburns

1. erythema and pain 2-3 days

2. intact skin

3. no blisters

4. sloughs off

2nd degree burns: (3)

superficial partical thickness; epidermis and part of dermis

1. blisters burst/weep!!

2. moist/shiny

3. heals w/in 3 weeks

3rd degree burn s/s: (5)

1. white/pale tissue

2. huge blisters

3. pale dermis visible

4. heals w/in 3-9 weeks

5. may need excisions and grafts

*deep partial thickness

4th degree Full thickness burn s/s: (3)

1. destroys epidermis, dermis layer

2. may damage nerves, bones, muscle (doesnt feel any pain)

3. eschar visible (thick black tissue)

Rule of 9’s for children: (2)

• Lund Brunder chart

1. Head is proportionally larger in children

• subtract 1% from head for each yr over 1 y/o

2. Legs are proportionally smaller in children

• add ½ % to each leg for each yr over 1 y/o

Minor burn interventions: (4)

1. superficial: soak in tepid water (luke warm water)

2. partial thickness w/ blisters: soak in tepid water

3. no greasy lotion, ice or butter

4. dont break blisters!!!

What fluids would u give major burn victim first?

Lactated Ringers!!! for first 24 hrs

• has more electrolytes than NS

Priority care for major burns: (4)

1. Airway & ventilation!!

• soot in airway

• stridor

2. 100% O2

3. Fluid replacement LR 1st 24 hrs

• burns → hypovolemic shock

4. maintain urine output: 0.5-1 mL/kg/hr if child < 30kg

• low output = shock and loss of fluids

Why protect airway in burns? (2)

1. rapid airway edema → obstruction

2. inhalation injury can cause pneumothorax or hypoxia

• Singed nasal hairs

• soot

What causes burn shock? (3)

1. massive edema

2. ⬇ perfusion → organ failure!!

3. fluids shifts out of vessels

ideal urine output range for major burn patient?

if child weighs < 30 kg, ideal range is 0.5-1 mL/kg/hr

• if child is 23 kg, pee has to be around 11-23 mL/hr

Infection prevention for Burns: (3)

1. aseptic dressing change 2x daily

2. wound cultures 2x weekly

3. topical antimicrobial agents

• SILVER nitrate

• SILVER sulfadiazine

• Sylfamyoin

When are 2 nurses needed for burn care? (2)

1. burn injuries > 80% of body

2. dressing changes to face/neck of intubated child

• trache care

how does impetigo begin and end?

• starts as minor cuts, insect bites, broken skin around mouth/nose

  • sores/blisters rupture→ oozing and crusts over

Impetigo key points:

• how contagious?

• causes? (3)

1. HIGHLY contagious

2. will STOP being contagious after 24 hrs abx

3. cause: (3)

• crowded areas (Schools/daycare)

• climate (tropical)

• poor hygiene

what causes cellulitis: (2)

• s/s (4)

• tx

• strep, staph, after skin breaks

1. redness/warmth

2. swelling

3. tender

4. fever

• tx: antibiotics

scabies cause and tx:

• scabies mites, through direct contact

• 5% permethrin or Ivermectin cream

scabies parent education: (4)

1. apply 5% permethrin cream to all of body (leave overnight, wash in morning)

2. no home remedies

3. wash everything in HOT water

4. if cant wash, put in bag for 14 days

Pediculosis Capitis (lice) tx: (3)

1. 1% permethrin shampoo

2. benzyl alcohol

3. comb through hair daily for nits

• can take months

• boil brushes

Diaper dermatitis causes (3)

• tx (barrier, antifungals, severe)

causes:

1. urine/feces friction

2. irritants: detergents

3. candida albicans (yeast infections)

• long term use of abx

tx:

1. zinc oxide (barrier)

2. antifungals (nystatin, clotrimazole)

3. severe→ hydrocortisone

atopic dermatitis (eczema) tx: (3)

1. hydrate skin (non scented)

2. tepid baths

3. fragrance free lotion

DM labs if diabetic: (4)

1. 8 hr fasting glucose will be >120 mg/dL

2. random blood glucose will be > 200mg/dL

3. oral tolerance is >200 mg/dL

4. HgA1c is >6.5%

• okay range: 6.5%-8% in children

• over a 3 month period

Hypo/Hyperglycemia glucose level:

< 60mg/dL hypo

>250 mg/dL hyper

hypoglycemia signs: (10)

1. hunger

2. shaky/dizziness

3. pallor

4. diaphoresis

5. tachycardia/palpitations

6. tremors

7. slurred speech

8. shallow respirations

9. blurred vision

10. ⬇LOC (lethargic→ comas)

hypoglycemia management: (3)

1. give 10-15 g simple carbs (1 TBsp sugar)

• 4 oz OJ

• 4 oz regular soft drink

• 8 oz milk

• 2-3 glucose tablets

2. re-check glucose after 15 mins

3. follow with complex carbs

• PB crackers

• turkey club sandwich

• cheese and crackers

if child is unconscious/cant swallow in hypoglycemic episode, what do u do?

admin IM glucagon!!!

• then give simple carbs if tolerated

• watch vomiting

hyperglycemia s/s: (8)

1. poly-uria, dipsia, phagia

2. rapid, deep breathing & acetone/fruity odor & positive ketones (Kussmauls)

3. oliguria (later)

4. recurrent yeast infx (means early T2 DM)

5. warm, dry, flushed skin

6. dry mucous membranes

7. weak pulse

8. ⬇DTR

hyperglycemia management: (3)

"DRY”

1. Dehydrated: oral fluids

2. Raise insulin: give rapid acting (Lispro)

3. You monitor ketones, K+

DM personal hygiene: (6)

1. NO wearing sandals

2. NO being barefoot outside

3. Wear shoes with socks

4. clean any cut w/ warm water, mild soap & dry dressing

5. examine child’s eye yearly

6. regular dental care

children playing sports snack times: (2)

1. teams sports: 30 mins before activity

2. prolonged sports (running): need food every 45-60 mins

Management for SICK child with diabetes: (3)

1. monitor blood glucose & ketones in pee q3 hrs

• bad: glucose >250 mg/dL; positive ketones

2. sugar-free, non caffeinated drinks (keep hydrated)

3. eat soft carbs (rice, mashed potatoes, pasta, bread)

Educate families on insulin: (4)

1. rotate site for every 4-6 injections

2. 90 degree angle

3. mixing: short acting 1st, then longer acting 2nd (clear then cloudy)

4. boluses can be given b4 meals

Rapid insulin

• name

• onset

• peak

• duration

• Lispro

• onset: 15-30 mins

• peak: 30 min-3 hrs

• duration: 3-5hrs

Short insulin

• name

• onset

• peak

• duration

• Regular

• onset: 30 mins-1hr

• peak: 1-5 hrs

• duration: 6-10 hrs

Intermediate insulin

• name

• onset

• peak

• duration

• NPH

• onset: 1-2 hrs

• peak: 4-14 hrs

• duration: 14-24 hrs

Long insulin

• name

• onset

• peak

• duration

• Glargine

• onset: 1-4 hrs

• peak: NONE

• duration: 24 hrs

DKA glucose level:

• what happend in DKA?

> 330 mg/dL

• pH 7.3 (acidic)

• bicarbonate < 15

• yikes

→ body burns fat (turns into ketones) instead of glucose

DKA hallmark signs: (3)

1. fruity breath

2. ketones in pee

3. rapid deep respirations

Electrolyte to monitor in DKA:

potassium!!

1. initially high → give insulin

2. drops (hypok+)

• monitor K+ bc correcting acidosis too fast→ hypoK

3. give sodium bicarb if severe acidosis (blood pH <7)

4. give O2 to children whose cyanotic and < 80%

congenital hypothyroidism s/s? (7)

1. short, thick neck

2. hypotonia w/ ⬇reflexes

3. jaundice

4. enlarged tongue (macroglossia)

5. sleep alot

6. poor sucking

7. abd distention/constriction

• baby born w/ low TH levels

nurse care for congenital hypothyroidism: (4)

1. give synthetic TH (levothyroxine)

2. give vitamin D (supports bone growth and development)

3. monitor TH levels (T3,T4, TSH), weight, resp status

4. monitor feeding

what does it mean for mom if she tests positive for PKU?

• what happens if she doesnt follow?

1. strict diet from 3 months b4 conception throughout pregnancy

2. if dont follow→ baby retardation

• microcephaly

• cognitive impairment

• heart defects

PKU signs: (5)

1. musty odor pee

2. microcephaly

3. blue eyes & very fair skin w/ light blonde hair

4. FTT

5. heart defects

PKU screening requirements: (3)

1. normal level: phenylalanine 0.5-1 mg/dL

2. repeat screen @ 1-2 weeks

3. newborn metabolic screen w/in 2 days of birth

PKU dietary restrictions: (5)

1. NO high PKU foods: eggs, meat, milk/yogurt, soy products, beans (no high protein)

2. EAT fruits/veggies, low protein grains (bread, pasta, rice)

3. initiate regimen ASAP or w/in 7-10 days of birth

4. formula low in PKU

5. can breastfeed in moderation

• contains protein

whats the intake of PKU/ kg of body weight/day:

• whats the ideal PKU level for PKU pts?

limit intake to 20-30 mg PKU/kg of body weight/day

• PKU level for PKU pts: < 8mg/dL ideal

Whats growth hormone deficiency?

Hypopituitarism

• low secretion of pituitary hormone

signs of Hypopituitarism: (4)

1. short stature but proportional

• child is shorter than expected for their age, but their body proportions are normal

2. delayed epiphyseal closure

• growth plates at the ends of long bones stay “open” longer than usual

3. ⬆insulin sensitivity

• body responds more strongly to insulin, meaning blood sugar is used efficiently

4. delayed dentition, jaw, sexual development

• Teeth come in later than normal

• Jaw growth may be slower

What are common peds fractures? (3)

1. greenstick: incomplete fracture

2. plastic deformation: bone bent no more than 45 degrees and doesnt break

3. buckle (torus): one side bulges (like dent)

Risk factors for peds fractures? (4)

1. obese

2. bad nutrition

• low calcium/vitamin D (milk and sun)

3. developmental stage

• learns to walk

4. normal play

• falls

• sports

s/s of fractures: (5)

1. edema

2. crepitus

3. deformed

4. ecchymosis

5. wont use limb

nurse care for fractures: (6)

1. immobilize (splints)

2. elevate to decrease swells

3. ice first 24 hrs

4. look for shock

5. take stuff off (bracelets etc)

6. monitor fat embolism s/s (SOB, petechiae)

compartment syndrome causes: (5)

1. tight cast/dressing

2. skin traction

3. trauma

4. burns

5. IV infiltration

→ due to ⬆pressure in muscle and cuts off blood flow (ischemia)

signs of compartment syndrome: (6)

6 P’s

1. pulselessness

2. pain

3. pallor

4. paresthesia

5. paralysis

6. poikilothermia

• body can’t regulate temp → matches environment

nurse interventions for compartment syndrome (3)

1. check limb q4hrs for 1st 24 hrs

2. make sure 1 finger fits under cast

3. loosen tight dressings

osteomyelitis signs: (5)

1. edema

2. pain ⬆w/ mvmt

3. wont use limb

4. tender/warm to touch

5. fever/irritablility/tachycardic

• infx of bone d/t fractures etc

pt education abt osteomyelitis: (5)

1. watch for ototoxicity!! (side effect of abx)

2. limit mvmt duh..

3. proper nutrition (high protein+cals→ tissue healing and immunity)

4. no weight bearing stuff

5. finish long term abx treatment

Clubfoot (talipes equinovarus) findings: (4)

1. affected foot shorter + smaller w/ empty heel pad

2. visible plantar crease

3. calf atrophy

4. unilateral deformity

types of clubfoot: (4)

1. talipes varus: inversion

2. talipes valgus: eversion

3. talipes calcaneus: dorsiflexion

4. talipes equinus: plantar flexion

nurse care clubfoot: (3)

1. parents hold/cuddle baby

2. do neurovascular checks and skin integrity checks (redness/blisters)

• 6 p’s

3. cast care

• keep dry

• dont shove anything in it

• no scratching

• regular cast changes

proper cast care: (8)

1. keep it dry (water weakens it→ skin irritation/bateria)

2. cover in plastic when showering

3. no lotions/powders

4. no inserting objects in cast

5. check circulation in fingers and toes

6. elevate limb and ice it

7. turn q2 hrs

8. soak limb in warm water after removal

whats osteogenesis imperfecta?

• s/s: (4)

“brittle bone disease”

1. multiple bone fracture

2. blue sclera

3. early hearing loss

4. small, discolored teeth

Osteomyelitis imperfecta education: (6)

1. oral care (soft toothbrush)

2. fix positions frequently

• dont pull them

• prevents contractures

3. help w/ braces and splints

4. NO LIVE vax

5. monitor heart and dysrhythmias!!

6. meds: bisphosphonates→ strengthens bones

adverse effects of biphosphorous: (8)

1. hypoK+

2. hypoMag+

3. hypoCa+

4. hypoP+

5. thrombocytopenia

6. neutropenia (so no live vax)

7. dysrhythmias (bc of electrolytes)

8. kidney failure

scoliosis findings: (3)

1. asymmetry in scapula, ribs, flanks, shoulder, hips

2. bad fitting clothes (one leg shorter than other)

3. more common in females (8-15 y/o)

scoliosis tx: (2)

1. bracing: slows curvature

2. surgery: spinal fusion w/ rod placement if severe (>45 degrees)

what could be complications of scoliosis? (3)

• and post op complications? (6)

1. breathing difficulties

• can compress lungs

2. low self esteem

3. superior mesenteric artery syndrome

• compression of the duodenum by the aorta and superior mesenteric artery, leading to obstruction.

  • “squeezes intestines”

postop complications: (6)

1. Spinal cord or neuro injury

2. Pneumothorax (decreased mobility)

3. Atelectasis (decreased mobility)

4. Ileus (decreased mobility)

5. Hypotension (blood loss)

6. Infection (wound)

scoliosis pt pre and post op teachings:

• pre (3)

• post (5)

pre op:

1. teach respiratory techniques: IS, turning, coughing, deep breathing to prevent complications.

2. teach PCA pump use

3. inform pt abt autologous (self-donated) blood donations if blood loss happens during surgery

post op:

1. go to PT (ROM)

2. log rolling

• roll pt like log so spine stays aligned

3. keep favorite things w/in reach (helps them be independent)

4. ambulate on 2nd-3rd day post op

5. check for pressure ulcers