Peds Exam 2

MMR and varicella vaccination age

12-15 months

Tdap vaccination age

11-12

when does flu vaccination begin?

6mo, yearly after

vaccines completed in early childhood

• DTaP

• Hib

• Hep B

• PCV-pneumococcal

• IPV-polio

• RV-rotavirus

• MMR

• varicella

• Hep A

nursing considerations for vaccines

• rash or fever 2-3 weeks after

• do not give if child is immunocompromised or allergic

• Gardasil can be cloudy

  • Kolpick spots = sign of measles

palliative vs hospice care

• palliative

  • pain and symptom relief while curative tx continues

  • physical comfort

  • family support

• hospice

  • provided when child is expected to live for 6> months

  • emphasis of quality of life rather than curative tx

  • family centered

  • often provides care at home

how do preschoolers view death?

view death as temporary

when do children start to understand death

school ages, 9-10

signs of impending death

• agonal breathing

• coma

• mottled skin

complicated grief

grief that lasts >1year with an inability to cope

grief stages

• denial

• anger

• bargaining

• depression

nephrotic syndrome manifestations

• nephrotic

  • massive edema

  • massive proteinuria

  • HTN

  • ascites

  • tachycardia

  • lethargy

glomerular nephritis manifestations

• APSGN

  • HAD STREP

  • HTN

  • antistreptolysin O antibody titer

  • decreased GFR

  • swelling of hands and face

  • tea colored urine

  • recent strep infection

  • elevated BUN/creatinine

  • proteinuria-mild

nephrotic syndrome vs acute glomerulonephritis patho

• nephrotic

  • between ages 2-7

  • increased permeability of membrane causes basement membranes to lose their charge allowing lagre amounts of proteins out

• APSGN

  • type III sensitivity response after a strep infection whihc causes the body to form antigen-antibody complexes in the glomerulus

poisoning considerations

• 1st priority = ABCs

• PREVENTION

• consider developmental level

• know poison control number

• antidotes for

  • acetaminophen

  • CO2

  • opioids

  • benzos

  • digoxin

  • snake/spider bites

• acetaminophen = N-acetylcysteine (Mucomyst)

• CO2 = O2

• opioids = naloxone (narcan)

• benzos = flumazenil (romazicon)

• digoxin = digoxin immune fab (digibind)

• snake/spider bites = anti-venom

lead poisoning sources

• lead paint or paint chips

• unglazed pottery

• lead pipe water

• cigarette butts

• ashes and smoke

• pool chalk

lead poisoning manifestations

• neuro changes

• cognitive impairments

• change in behavior

• kidney and liver damage

lymphoma/leukemia patho and complications

• unrestricted proliferation of immature WBC, high number of immature WBC which compete with other healthy cells

• complications

  • anemia

  • neutropenia

  • bleeding

  • infection

ALL

• ALL

  • immature non-fixed lymphoblasts dominate bone marrow production, so it cannot produce enough RBC/platelets, causing anemia, neutropenia, thrombocytopenia, pallor, SOB, and bruising

  • most common childhood leukemia

AML

• AML

  • increased myeloblasts production causes replacement of malignant myeloblasts in bone marrow leading to depletion of fixed WBC, RBC, and platelets causing s/s of DIC and bleeding

neuroblastoma patho and manifestations

• comes from embryonic neuro crest cells in utero that cause malignant cells in the abdomen on the adrenal gland and metastasize early on

  • firm, irregular, nontender abdominal mass

  • fever

  • proptosis(bulging eyes)

  • increased SNS activity

  • DO NOT PALPATE ABDOMEN

medulloblastoma manifestations

• balance problems

• positive Babinski

• weakness and spasticity

• nystagmus and diplopia

• increased BP, decreased RR and HR

• ICP

retinoblastoma manifestations

• most commonly unilateral

• leukocoria (cat eye appearance)

• white pupils

• poor vision

• lazy eye

• redness

• swelling

• involuntary eye movements

ANC equation

ANC = total WBC x (segments + bands)

ANC risk levels

• normal: < 1500

• minimal: 1000-1500

• moderate: 500-1000

• severe: <500

normal platelet range

150,000-400,000

ABG ranges

electrolyte ranges

• sodium: 135-145

• potassium: 3.5-5

• calcium: 8.5-10.5

tumor lysis syndrome complications

can increase potassium, pH, and nucleic acids which leads to kidney failure, cardiac problems, seizures, and more

acne patho

• increased sebum and apocrine sweat gland production

  • open comedone: black head

  • closed comedone: white head

atopic dermatitis patho/manifestations

• IgE sensitization-type 1 hypersensitivity reaction

  • dry itchy skin

  • brown and graying hues

  • red skin

  • rashes can ooze

typical atopic dermatitis sites

• face

• neck

• elbows

• wrists

• groin

• knees

• ankles

atopic dermatitis tx

• short baths

• moisturize skin

• topical steroids

• antihistamines

• decreased exposure to latex

• short nails

• avoid triggers

• allergic diet

• cool compress

hemophilia patho and manifestations

• x recessive disorder causing a deficiency of coagulation factor VIII

  • hemarthrosis

  • hematuria

  • bruising

  • prolonged bleeding time

hemophilia nursing interventions and tx

• protect joints- if hemoarthrosis occurs RICE

• regular exercise

• PT

• careful with dental care and procedures

• low-impact sports

• tx = DDAVP (desmopressin)

sickle cell tx

• HOPS

  • hydration

  • oxygen

  • pain relief

  • support and rest

sickle cell types of crises

• vaso occlusive: obstruction caused by RBC, which causes ischemia

• acute chest syndrome: occlusion of pulmonary vessels, causes fluid build up

• aplastic: not making enough RBC in general

• sequestration: blood pooling in liver and spleen

• hyperhemolytic: rapid breakdown of RBC

pediculosis treatment

• boil combs and brushes

• wash everything on high heat

• permethrin

• malathion

• provide comfort and embarrassment

• do not share hats

type 1 diabetes

• type 1 diabetes

  • beta cells aren’t able to make insulin

  • 3ps: polyuria, polydipsia, polypahgia

  • weight loss

  • blurred vision

  • tx insulin

type 2 diabetes

• type 2 diabetes

  • insulin resistance

  • acanthosis nirgicans: dark skin in folds

  • 3ps

  • tx= metformin, diet and exercise, insulin if more moderate or severe problem

DKA glucose level

>250

HHNS glucose level

>600

rule of 15

• used for hypoglycemia

• consume 15g of carbs, wait 15 min and reassess glucose levels

teratology of Fallot four factors

• PROV

  • pulmoary stenosis

  • right ventricular hypertrophy

  • overriding aorta

  • ventricular septal defect

primary HTN patho and tx

• BP is the result of cardiac output and peripheral vascular resistance

• lifestyle changes first

• hydrochlorothiazide, ACE inhibitors, ARBs, calcium channel blockers

rheumatic heart disease patho

• results from untreated strep infection causing antigen antibody complexes in the mitral valve that are lodged in the mitral valve in the heart

CHDs that cause increased pulmonary BF

• patent ductus arteriosus (PDA)

• atrial septal defect (ASD)

• ventricular septal defect (VSD)

increased pulmonary BF manifestations

• tachycardia

• frequent respiratory infections

• tachypnea

• murmur

• diaphoresis

• heart failure

CHDs that cause decreased pulmonary BF

• pulmonic stenosis

• tetralogy of Fallot

• pulmonary atresia

• tricuspid atresia

decreased pulmonary BF manifestations

• cyanosis

• poor weight gain

• hypercapnic episodes

• polycythemia

CHDs that cause obstruction to systemic BF

• coarctation of the aorta

• hypoplastic left heart syndrome

• mitral stenosis

• interrupted aortic arch

CHDs that cause obstruction to systemic BF manifestations

• diminished pulses

• delayed cap refill

• poor color

• heart failure

• pulmonary edema

CHDs that cause mixed BF

• transposition of the great arteries: need surgery, blood doesn’t mix until surgery

CHDs that cause mixed BF manifestations

• cyanosis

• poor weight gain

• pulmonary congestion

• heart failure

iron deficiency anemia patho

• RBCs can’t carry enough iron, microcytic hypochromic decreased MCV and MCH

iron deficiency anemia tx

• increased iron rich foods: broccoli, red meat, greens, dark chocolate

• iron supplements

  • ferrous sulfate: give with VIT to increase absorption, plenty of fluids, rinse mouth, do not take with calcium

asthma interventions

• peak flow meter

• asthma action plan

• avoid triggers

asthma meds

• SABA: albuterol

• LABA: salmeterol

• IV dexamethasone for extreme cases

• leukotreine inhibitor: montelukast

hypersensitivity types

• type I: IgE

  • anaphylaxis

• type II: antibodies react to substance from another body

  • transfusion reaction

• type III: antigen antibody complex

  • post streptococcal glomerular nephritis

• type IV: contact

  • poison ivy

ADHD tx

• stimulants

  • check growth, height, weight, HR, BP

child abuse manifestations

• suspicious bruising

• blood in underwear/genital pain

• torn frenulum

• adult sized bite marks

• pattern injury-hand, wire hanger, etc

• fractured ribs

• spiral fractions

• purposeful burns

child abuse risk factors

• colicky baby

• really young or old parents

• children with disabilities

• poverty

• infants

classic shaken baby finding

retinal hemorrhage