Pediatric Conditions & Infections

Pharyngitis

inflammation of the throat (sore throat)

Streptococcal Pharyngitis

strep throat

What can cause pharyngitis?

viruses, bacteria, fungi, environmental factors, many others

What are ulcers usually indicative of when it comes to infection?

indicates a viral infection

What are some manifestations of bacterial pharyngitis?

rapid onset, dysphagia, red pharynx, strawberry tongue, petechiae of the soft palette, vomiting

Scarlatiniform Rash

red sandpaper rash which follows an untreated strep infection; indicates progression to scarlet fever

Treatment for Strep Throat

abx, increase fluids, analgesics, glucocorticoids, NSAIDs

What are some education points for parents about strep throat?

adhere to abx, child can return to school after 24 hours of starting abx, change tooth brushes after a few days, transmit infection through secretions

Scarlet Fever

hypersensitivity reaction following strep throat

What are some manifestations of scarlet fever?

sore throat, high temperature, characteristic rash (red, sand-paper like), inflamed coated tongue

How is scarlet fever treated?

same as strep throat

Tonsil-Adenoidectomy

surgical removal of the tonsils and adenoids due to recurrent infection, obstruction, abscesses, middle ear infection

What is the most worrisome complication of tonsilectomy?

bleeding

What are some signs of bleeding post tonsilectomy?

excessive swallowing, apparent blood

What are some diet recommendations after a tonsilectomy?

clear liquids, lots of fluids, do not give anything red (can interfere with noting bleeding)

When is bleeding most likely following a tonsilectomy?

within 7-10 days post op

What are some signs of airway obstruction?

drooling, restlessness, agitation

What vaccines protect against pertussis?

dtap (young children), tdap (adults)

For whom is pertussis most severe?

for those under 6 months, those who are immune compromised

Pertussis

whooping cough; infection which causes a staccato cough

Manifestations of Pertussis

staccato cough, posttussive vomiting, apnea with seizures, high pitched whooping, exhaustion

Should cough suppressants be given to children?

no

What isolation precaution is used for pertussis?

droplet

What is important about treating pertussis?

all close contacts must be treated too

Treatment for Pertussis

abx, O2

Epiglottitis

inflammation of the epiglottis caused by the Hib bacteria; life threatening

What is the hallmark sign of epiglottitis?

drooling

What can protect against epiglottitis?

hib vaccine

What is important about the assessment of epiglottitis?

do not try to visualize the throat; having the child say "ah" or trying to get a throat culture can occlude the airway completely

What are some manifestations of epiglottitis?

tripod positioning, stridor, retractions, drooling

Treatment for Epiglottitis

airway stabilization (may require an advanced airway); oxygen maintenance, anti-inflammatories, antimicrobials

Imeptigo

highly contagious bacterial infection of the skin

Nonbullous Impetigo

most common; honey-colored crust surrounds patches of vesicles

How is impetigo diagnosed?

culture of the fluid

Treatment of Impetigo

gently wash exudate with abx soap; topical creams; oral abx (if more severe)

When can normal close-contact activity be resumed with impetigo?

24 hours after initiation of treatment

Irritant Contact Dermatitis

caused by the diaper; NOT in the inguinal creases

Candidiasis

yeast infection; involves the inguinal creases

What are some risk factors for hip dysplasia?

mechanical factors (breech, low amniotic fluid, swaddling, multiple gestation), family hx, more common in females

What is noticed on assessment of the infant with hip dysplasia?

clunking, jerking or popping during diaper changes

Ortolani Sign

clunk and sliding when flexing and abducting

Barlow Sign

clunk and dislocation with flexion and adduction

When can a Pavlik harness be taken off?

only for baths, for a total of less than 1 hour

How often should the Pavlik harness be on?

23 hours per day

What is important to remember about the Pavlik harness?

ONLY the doctor can adjust velcro, the family CANNOT

Can the Pavlik harness be removed for diaper changes?

no

Hip Spica Cast

a specialized cast used to immobilize the hip and one or both legs

What are some nursing interventions for hip harnesses?

ensure the skin is not irritated

What is the most prominent symptom of RSV Bronchiolitis?

nasal congestion

What are some signs of respiratory distress?

nasal flaring, retractions, head bobbing

What part of the airway does RSV effect more?

lower

RSV Bronchiolitis

lower respiratory infection

When is RSV Bronchiolitis most severe?

around day 3-4

What are some beginning, mild symptoms of RSV bronchiolitis?

nasal congestion, rhinorrhea, wet cough, difficulty feeding

What might be auscultated with RSV Bronchiolitis?

coarse crackles, ronchi

What is one important intervention with RSV Bronchiolitis?

suctioning

What portion of the airway does croup most effect?

upper

Croup (Laryngotracheobronchitis)

inflammation and viral infection of the epiglottis, larynx, trachea and bronchi

What is the hallmark sign of croup?

stridor

What are some manifestations of croup?

stridor, barking cough which can be heard without a stethoscope

Treatment for Croup

position of comfort, racemic epinephrine, corticosteroids

What is racemic epinephrine>

nebulized epi which decreases inflammation and increased bronchodilation; can rebound after 1-2 hours