Peds Exam 3 Concept Maps

Sweaty + problems eating

cardiac

VSD

hole between ventricles, SIZE matters, acyanotic, increased pulmonary blood flow, risk for bacterial endocarditis, CHF, gets extra dose of Synagis to prevent RSV, can be caused by Dilantin

vomiting while on Dig

dig toxicity

dig considerations

never repeat dose even if vomited up or missed, increase in K+ = decrease dig level, Decrease K+ = increase dig level, NO HALO SIGNS IN KIDS

CHF left side

lung crackles

CHF right side

edema, increase wt, decrease perfusion

CHF signs

change in murmur, decrease feeding, decrease LOC, increase sweat, edema, lung crackles

treatment of VSD

decrease workload -

small frequent meals q3h

feed when looks hungry

soft nipple (heiberman)

gauvage feeding after 30 mins

HOB up

check temp

digoxin q12h (monitor HR), lasix (check K+)

child heart rate for digoxin

>8YO - >60

1-8YO - >70-80

<1YO - >90-100

TET/TOF

cyanotic, decreased pulmonary blood flow, VSD is part of it (4 parts), has spells, check for CHF and bacterial endocarditis

TET/TOF 4 parts

1) Pulmonary stenosis (right ventricle goes to aorta NOT lungs)

2) VSD

3) overriding aorta

4) R. ventricle hypertrophy

TET spell

triggered by stress - sick/fever, crying, pooping, feeding

increase RR and HR, Increase cyanosis

TET spell treatment

1) knee-chest position

2) morphine IV or SQ

calm, comfort, O2, check for fever or illness

TET prevention

feed q3h, increase calories, 30 mins feed then gauvage, feed when looking hungry, keep calm, HOB up, check temp

bacterial endocarditis symptoms

fever, emboli in nails, change in murmur, SOB

bacterial endocarditis treatment

culture and ABX, check WBC's

TET/TOF treatment

OR for repair, normally done <1 YO, increase chance for cardiac arrhythmias

TET/TOF diagnosis

boot shaped heart on Xray, HCT <60

coarctation of the aorta (CoA)

acyanotic, obstruction of blood from ventricles, frequent when mother is on antidepressants, increase blood flow head and arms, decrease blood flow legs, can cause CHF, size of aorta matters

coarctation of the aorta treatment

digoxin and lasix, maybe aldactone, OR, balloon angioplasty, increase BP after OR

coarctation of the aorta signs

murmur, Upper extremity HTN and bounding pulse, dizziness, lower extremity hypotension, cool, weak pulse, pale

infants 4 point BP catches most cases

transposition of great arteries TGA

mixed blood type (oxygenated and deoxygenated), cyanotic, moms hx of DM, has hole in heart and vessels attached wrong places, want O2 level >75%

transposition of great arteries TGA temporary treatment

1) ductal dependant - IV prostaglandins

2) Cath lab to increase size of hole

transposition of great arteries TGA treatment

arterial switch, chest tube, ET/vent, IV, CVC, dressing

transposition of great arteries TGA symptoms

dusky, decrease feeding, sweety when feeding, murmur, progressively worse each shift, increase HR and RR

Acute Rheumatic Fever

autoimmune response to group A strep (pharyngitis, scarlet fever), NOT IMPETIGO, attacks connective tissue (joints, cardiac mitral valve, skin, CNS), can recur, Jones criteria for diagnosis

Acute Rheumatic Fever symptoms

murmur, chest pain, friction rub, muffled sounds, CHF, malaise, decrease appetite, decrease wt

Acute Rheumatic Fever treatment

1) PCN for 10 days

2) ASA - monitor for reyes syndrome (or roids if ASA unavailable)

3) bedrest

4) (if chf) dig and lasix

5) chorea - halopridol

Acute Rheumatic Fever prevention

PCN 5-10 years or until 21 YO, decrease activity, dental hygiene

Acute Rheumatic Fever diagnosis criteria

1) previous strep infection

2) 2 major jones criteria or 1 major and 2 minor

Jones criteria - major (ARF)

1) polyarthritis (arthritis that switches between joints)

2) carditis

3) erythmiamaginta (skin rash)

4) subq nodules - painless

5) chorea (random movements)

jones criteria - minor (ARF)

1) fever

2) arthralgia

3) increase PR interval on EKG

4) increase ESR and CRP

kawasaki disease

acute systemic vasculitis of unknown cause, >8YO higher complications, once has it -> cant get again, leads to aneurism and thrombosis, 3 phases, check for CH

kawasaki disease phase 1 acute

~10 days

want to diagnose here

fever with no change with ABX

5 signs

1) conjunctivitis

2) swollen feet

3) red membranes and pain

4) rash of trunk

5) cervical lymph node >1cm

also irritable

kawasaki disease phase 2 subacute

~10 days - 3 wks

decrease symptoms with no fever

peeling of hands and feet

slowly decreased lymph node sign

still irritable

kawasaki disease phase 3 convalescent

~3wk - 2mos

all symptoms resolved, normal labs, not irritable

kawasaki disease disease

increase WBC, platelets increase, echo ad diagnosis and a 2nd one 1 week later to check for thrombosis and aneurism

kawasaki disease DC education

heart problems, irritability, cardio follow-up, risk for reyes disease, NO LIVE VIRUSES 11 months

kawasaki disease treatment

IVIG - check BP

high dose ASA with fever

low dose ASA without fever

IV fluids

monitor for reyes syndrome

Reye's syndrome

Sudden onset of mental status changes, emesis, and liver dysfunction after taking aspirin.

sickle cell anemia

autosomal recessive, carries have traits, no roomate, has HgbS

HgbS

decrease life span, decrease hgb in cells, sticky and clumpy, spleen removes them and enlarges (eventually fails), increase rate of infection

sickle cell crisis

1) vaso occlusion - pain, swelling, warmth, CVA tenderness, pneumonia s/s, appendicitis

2) splenic sequestration - OR or transfuse blood

3) aplastic - bone marrow goes on strike, self resolves

sickle cell treatment

fluid, blood, opiod pain meds, ABX, folate supplement

Too much Fe

from transfusions, chelation therapy is Tx

kawasaki disease diagnosis

sickledex, newborn screening, decrease hgb (6-9), decrease Hct, transcranial doppler

kawasaki disease home treatment

increase fluid, opioids, exchange therapy q3 weeks

kawasaki disease body symptoms

dactylitis, pale, murmur, increase HR, mild edema, enlarged liver and spleen, jaundice, cirrhosis, gall stones, bone marrow overworked, osteomyelitis, CVA, retinal myopathy, priaprism

dactylitis

inflammation of the fingers and/or toes

hemophilia

bleeding disorder, x-linked recessive, normally boys, bleed longer not faster, platelets still work

hemophilia symptoms/bleed spots

skin, joints, HEENT, CNS, GI - anemia, spine, no petechiae

hemophilia ASA and tylenol

NO ASA, tylenol okay

hemophilia labs

DNA testing, factor 8 low, APPT/PTT abnormal

severe factor 8 - 0%

moderate factor 8 - 1-5%

mild factor 8 - 5-20%

hemophilia treatment

factor 8 (recombinant)

amicar (used for surgery)

steroids

joint bleed:

RRICE

Recumbent factor 8

Rest

Ice

Compression

Elevation

after bleeding stop, then use heat pack

prevent hemophilia problems

DDAP, can only be done if some facor 8 present in body, can be done at home

hemophilia education

exercise good, not contact sports, car seats, bike helmet, oral care, venipuncture not heal stick, plan for school

nephrotic syndrome

80% idiopathic, 10% caused by meds or disease, exacerbations until puberty then no more, decreased protein caused massive edema and dehydration, increased risk for infection (resp, cellulitis, peritonitis, NOT UTI)

nephrotic syndrome symptoms

edema of the eyes, face, body, scrotum

ascites, increased wt, increase HR, decrease BP, palpable liver/spleen, dark and frothy urine like beer

nephrotic syndrome labs

increase in urine protein, little blood, increased specific gravity

decreases serum protein and albumin, increased cholesterol (causes heart problems later in life)

nephrotic syndrome and AGN best friend

urine dipstick

long term steroid use monitoring/side effects (generally related to nephrotic syndrome)

monitor for renal failure, decreased ht, increase risk for GI bleeds, increased BP, increased risk for infection

nephrotic syndrome treatment

monitor for proteins with urine dipstick, steroids (6 weeks with 6 week taper), albumin and lasix at same time for symptom relief, low sodium diet, +/- fluid restriction, high calorie diet, Cytoxan medication as backup drug

nephrotic syndrome proteins in urine at home

bring in for treatment

nephrotic syndrome nursing considerations

daily wt, ht, and abd girth, check for infections, extra vaccines such as PPSU-23

nephrotic syndrome and infections

respiratory, cellulitis, peritonitis, NO UTI

nephrotic syndrome simple

low BP, high protein in urine, urine looks like beer, dehydrated but on fluid rest, creatine normal, ascites

AGN simple

high BP, bloody urine, urine looks like tea/cola, hydrated, high creatine

AGN

secondary to previous strep infection, sick -> well for 10-21 days -> AGN, can develop nephrotic syndrome and renal failure, decrease kidney function, leads to edema

AGN and infections

No UTI

AGN s/s

edema of face legs eyes or genitals, anorexia, decrease nutrition, diarrhea, increase BP and possible headache, urine is cola/tea-colored (rich in blood)

Complains of headache

check BP and if high give BP medication

AGN labs

UA high in blood, can have some protein, increase specific gravity, increase creatinine, titer positive, C3 (if higher than patient is doing better)

Titer for strep

ASO, strep design, ADC aceB

AGN nursing considerations

check BP often, check I+O, labs and lytes, u/a

AGN treatment

BP meds, lasix, low sodium diet

hypospadias

only boys, urethra comes out of wrong spot, severity is based on position and other complications, can have chordee

chordee

a downward curvature of the penis, often associated with hypospadias

hypospadias signs

not peeing straight, check all newborns, often comes with other VACTERAL problems such as external bladder

hypospadias treatment goals

appearance, void standing, sexual function

Hypospadias and circumcision

no circ! need skin to repair hole

hypospadias treatment

OR, can have stent, no bathing or bathtubs, can have spasms and increased constipation postop (might need stool softener), no straddling postop

hypospadias stent

used to drain bladder while urethra heals, can have reflux, no baths or bathing, might have bladder spasms

Wilms tumor

solid tumor of the kidneys, don't palpate abd -> can burst, mets 1) lungs 2) liver, +/- family history, VACTERAL disease

wilms tumor signs

large abg mass, +/- hematuria erythropoietin and high BP, tired, increased temp, wt loss, resp+GI symptoms

wilms tumor diagnosis steps

check tumur, check other kidney, check for mets

wilms tumor treatment

OR then chemo unless bilateral then; chemo then OR

+/- clips for radiation

wilms tumor education

car seat, check for UTI's, no contact sports (all because will only have 1 kidney postop)

wilms tumor stages (5)

1) kidney

2) beyond kidney

3) into abd

4) mets

5) bilateral

wilms tumor nursing considerations

postop constipation common, dont palpate!

UTI/VUR

bacterial (ecoli), <3mos boys, >3mo girls, sexually active more common, wipe front to back,

VUR (vesicoureteral reflux)

<1YO, risk for scaring, graded 1-5 with 1-3 being outgrown and 4-5 needing surgical repair, not all UTI have VUR but VUR always comes after UTI

VUR follow up

1-2 mos post UTI, US, voiding cystogram, DMSA test

UTI risks

girl, poor hygiene, decreased PO intake, incomplete emptying, inflammation, nylon underwear

UTI symtpoms

faver, frequency, urgency, pain, small, CVA tenderness, nocturese or day wetting

UTI symptoms newborn

+/- temp, fussy, diarrhea, jaundice, diaper rash

UTI diagnosis

straight cath <3YO, clean catch >3YO, + nitrite and WBC's are diagnostic

UTI treatment

abx 7-10 days PO

UTI prevention

wipe front to back, cotton under, increase PO intake, voiding regularly

cryptorchidism

undescended testicles, higher risk with premies, increases risk for testicular cancer if unfixed (r/t heat), can have retractile (shy) or anorchism (no balls in sack),

cryptorchidism symptoms

can't palpate testicles - can apply pressure and retry - can also have cross legs or squat and retry