Peds T2 ch 10, 13, 16

kwashiorkor

malnutrition d/t protein deficiency

marasmus

malnutrition d/t protein and calories deficiency

mineral imbalance

zinc, Ca, Phos, Na+, K, chloride, iron

refeeding syndrome

caloric intake progresses too rapidly

nursing management of protein energy malnutrition (PEM)

1. rehydration

2. antibiotics

3. energy intake (calories)

   1. watch for refeeding syndrome

food allergy

IgE mediated immune response

common

• nuts, eggs, wheat, soy, fish, milk (2.5% of infants)

food intolerance

non IgE mediated immune response - you’ll live

ex: lactose intolerance

failure to thrive (FTT) / growth failure causes

inadequate caloric intake & absorption

increased metabolism

defective utilization of provided energy / nutrients

failure to thrive (FTT) / growth failure management

prognosis (wtv causing it)

nursing care

• correct

• catchup

• restore

• educate

diaper dermatitis (diaper rash)

common

usually d/t irritation of urine, feces, detergents, or chemical

folds / creases in groin unaffected

diaper candidiasis

folds / creases in groin affected

satellite lesions apparent

atopic dermatitis (AD)

AKA eczema - begins in infancy

hereditary tendency

associated a/ hx of food allergy, allergic rhinitis, asthma

seasonal implications

infantile eczema

2 - 6 months

spontaneous resolution by 3 yrs

childhood eczema

2 - 3 yrs

90% resolve by 5

preadolescent & adolescent eczema

12 yrs - early adulthood

seborrheic dermatitis

cradle cap

chronic, recurrent inflam reaction of skin

unknown cause

can be seen on eyelids, nasolabial folds, & ears

cradle cap tx

remove crusts

antiseborrheic shampoo

colic

perisomal abdominal pain

most common < 3 months (crying 3’s)

sympt increase in late afternoon

tx - specific / personalized to child , small feeds

SIDS

high risk

• AA, american indian / alaskan natives

• maternal smoking

• co sleeping

• prone sleeping

• bedding

• car seats

plagiocephaly

flat head

regular repositioning important

apparent life threatening event (ALTE)

near miss death

s/s

• apnea - stimulate the trunk

• change in colour or muscle tone

• choking, gagging, coughing

requires significant intervention

affected infants go home with apnea monitors

parents taught CPR

infant apnea

concerning when it occurs when > 37 wks gestation

clinical presentation of ALTE

tx

• trunk stimulation

• theophylline, caffeine (IV, stimulates breathing)

• home apnea monitors

• CPR training

acetaminophen

most common accidental ingestion

toxic - > 150 mg/kg

tx

• N-acetylcysteine

• mucomyst - oral or IV

monitor

• liver function test

• coagulation panels

lead poisioning

inhaled or ingested

rarely symptomatic, affects renal, neuro, & hematologic (bone marrow systems)

diagnosis

• anemia

• blood lead lvl (BLL) ≥ 10 dL

• cognitive impairment

screen for poisoning @ 1 & 2 yrs

chelation therapy

• > 70 ug/dL

• monitor kidneys. IM

child maltreatment

neglect (75.2% of cases)

• phys &/or emotional

intention phys abuse (17.2%)

• shaken baby syndrome, etc

emotional abuse (6.9%)

• destroys or impairs child’s self-esteem

sexual abuse of children (8.4%)

munchausen syndrome by proxy

medical child abuse (Gypsy Rose)

caregiver exaggerates or fakes s/s of illness in child for attention or ego

caregiver demands instead of collaboration

enuresis

bed wetting

more common in boys

usually stops 6 - 8 yrs

diagnosis

• chronologic or developmental age > 5 yrs

• 2x/week or for 3 months

• may have urgency or frequency

medical evaluation to rule out underlying causes

primary enuresis

onset of wetting in children who have never been dry for extended period of time

secondary enuresis

onset of wetting after established urinary continence

monosymptomatic enuresis

most common

dry during day, wet @ night

polysymptomatic enuresis

daytime urgency

norm child bladder capacity

300 - 350 mL sufficient to hold nights urine

childs age + 2 - expected bladder capacity in ounces

encopresis

repeated in / voluntary shitting not in the toilet

more common in males

not d/t physiologic effect. but maybe d/t constipation or impaction

primary > 4 yrs

secondary > 4 yrs after being trained 

bacterial STI

trichomonas

gonorrhea

syphilis

viral STI

herpes

HPV

HIv

hepatitis

pelvic inflam disease

uterus, tubes, rarely ovaries affected

↑ risk

• ectopic pregnancy

• chronic pain

• infertility

obesity

> 95th percentile for age, gender, & height

overweight

> 85th & < 95th percentile for age, gender, & height