Peds Exam 3 Review

Bacterial conjunctivitis

Purulent drainage - mild pain - inflammed -

TX: antibiotic drops/ointment

Viral conjuctivitis

Watery - mucoid - inflammed - PHOTOPHOBIA - tearing -

TX: supportive care

Allergic conjuctivitis

inflammed - WATERY OR STINGY - ITCHING -

tx: antihistamines

Conjuctivitis diagnostic and complication

clinical exam - culture if severe

KERATITIS - inflamm of the cornea causing pain, redness. blurry vision - light sensitivity - can lead to scarring or blindness

Otitis Media

Infection of the middle ear due to fluid

Otitis Media Manifestations

pulling of the ear - ear pain - fever - irritability

Otitis Media Diagnosis

OTOSCOPIC EXAM - examining the middle of the ear

Otitis Media Complications

hearing loss - speech delay

Otitis Media Management

• Pain control 

• Antibiotics if bacterial 

Otitis Media Evaluation

 Relief of pain, normal ear exam – CHRONIC EAR INFECTION CAN LEAD TO HEARING LOSS  

Asthma Pathophysiology

Chronic airway inflammation + bronchoconstriction 

S/S of Asthma

Wheezing, coughing, SOB, chest tightness 

Asthma diagnosis

 Spirometry, peak flow 

Complications of asthma

Status asthmaticus (emergency) 

Asthma Management

• Rescue: short-acting bronchodilators 

• Control: corticosteroids 

Asthma Evaluation

Improved breathing, normal oxygen levels 

Bronchiolitis (RSV) Pathophysiology

Viral infection causing airway inflammation 

Bronchiolitis S/S

Wheezing, crackles, nasal flaring, retractions 

Bronchiolitis Diagnosis

Clinical + RSV test 

Bronchiolitis Complications

Respiratory failure 

Bronchiolitis Management

Supportive (oxygen, fluids) 

Bronchiolitis Evaluation

Improved oxygenation 

Croup Pathophysiology

Upper airway inflammation 

Croup S/S

Barking cough, stridor 

Croup Diagnosis

Clinical

Croup Complications

Airway obstruction

Croup Management

• Humidified air 

• Corticosteroids 

• Epinephrine (severe) 

Croup Evaluation

Reduced stridor 

Pneumonia Patho

Infection of lungs (viral/bacterial) 

Pneumonia S/S

Fever, cough, tachypnea, crackles 

Pneumonia Diagnosis

Chest X-ray 

Pneumonia Complications

Pleural effusion 

Pneumonia Management

• Antibiotics (bacterial) 

• Supportive care 

Pneumonia Evaluation

Clear lung sounds 

Acyanotic (↑ pulmonary blood flow) 

 VSD: Ventricular Septal Defect

ASD: Atrial Septal Defect

PDA: Patent ductus arteriosus

Acyanotic (↑ pulmonary blood flow) S/S

Murmur, HF signs, poor feeding

Acyanotic (↑ pulmonary blood flow) COMPLICATIONS

Heart failure

Acyanotic (↑ pulmonary blood management

Medications, surgery

Cyanotic (↓ oxygenation)  Tetralogy of Fallot S/S

Cyanosis, “tet spells”

Tetralogy of Fallot Management

• Knee-to-chest position 

• Oxygen 

• Surgery

Heart Failure in Children S/S

Tachycardia, poor feeding, sweating, edema 

Heart Failure in Children Management

• Digoxin 

• Diuretics 

Heart Failure in Children Evaluation

Improved feeding, weight gain

Iron Deficiency Anemia Patho

Low iron → ↓ hemoglobin 

Iron Deficiency Anemia S/S

Fatigue, pallor 

Iron Deficiency Anemia Diagnosis

Low Hgb/Hct 

Iron Deficiency Anemia Management

Iron supplements

Iron Deficiency Anemia Evaluation

Increased Hgb

Sickle Cell Disease Patho

Abnormal hemoglobin → sickling of the cells

Sickle Cell Disease S/S

Pain crisis, anemia, swelling 

Sickle Cell Disease Complications

Stroke, infection

Sickle Cell Disease Management

• Hydration 

• Pain control 

• Oxygen 

Sickle Cell Disease Evaluation

Pain relief, stable labs

Leukemia Patho

Cancer of blood-forming cells

Leukemia S/S

Fatigue, bruising, infections 

Leukemia Diagnosis

Bone-marrow biopsy

Leukemia Complications

 Infection, bleeding

Leukemia Management

Chemotherapy/surgery 

Leukemia Evaulation

Remission status

If one has a nasal lesion with conjuctivitis, what should be done?

TAKE TO ER

Ventricular Septal Defect (VSD)

LOUD HARSH murmur at left sternal border 

Atrial Septal Defect (ASD)

soft/ no murmur

Patent Ductus Arteriosus (PDA

MACHINE LIKE SYSTOLIC MUMUR  

All Left to Right Shunts Management  

• Increase calorie intake and decrease work of feeding  

• Digoxin – increases contractility – HOLD IF APICAL PULSE <90 BPM FOR INFANTS <60 BPM FOR ADOLESCENTS  

Coarctation of the Aorta  

Obstructive acyanotic defect 

• S/S: Upper extremities: BP elevated – bounding radial pulses  

• Lower extremities: BP decreased – weak/absent pulses in legs  

Infective Endocarditis  

Microbial infection of the endothelial surfaces of the heart’s chambers, septum, or valves  

• Risk factors for bacterial endocarditis: congenital heart defects, prosthetic valves, central venous catheters, IV drug use  

Acute Rheumatic Fever  

Inflamm disorder of connective tissue that follows initial infection by some strains of GROUP A BETA HEMOLYTIC STREPTOCOCCI  

• Manifestations: Sydenham chorea – aimless movement of the extremities and facial grimacing  

• Education: continue drug therapy – limit activities and plan quiet activities – ADVISE DENTIST OF HISTORY – PROVIDE PROPHYLACTIC ANTIBIOTIC THERAPY  

 

Cardiomyopathy  

A disease of the heart muscle that hinders its ability to pump blood efficiently, often leading to heart failure, arrhythmias, and fluid retention 

• Risk factors: CHD, cardiac transplatation, surgery – hx of myocarditits – hiv infection – or kawasaki disease – htn – drugs – alcohol/radiation exposure – maternal diabetes - 

• S/S: heart thickens, hardens, enlarges  

Kawasaki Disease  

Acute systemic vasculitis, most common in children 6mths to 5 years of age during winter and summer  

• Self-limiting syndrome; can cause cardiovascular complications: CORONARY ARTERY ANEURYSM AND CARDIOMYOPATHY  

• S/S: High fever for 5 days – unresponsive to antibiotics – bilateral conjuctivitis without exudate – distinctive rashes: strawberry tongue, palmar erythema, maculopapular rash – desquamation of perineum, fingers, and toes  

• Management: Aspirin to reduce cardiac complications and immune globulin; ingredient of blood that helps the child’s body fight off infection  

• Promoting comfort: Cool compress – quiet – lubricate lips – popsicles  

Nephroblastoma (Wilms tumor) 

A rare kidney cancer, most common in children aged 5 or younger. It causes abdominal swelling, pain, or fever, often caused by genetic mutations during development. Treatment, usually involving surgery and chemotherapy 

• Manifestations: rapid enlargement of kidney – abd pain and large mass  

• Hypertension  

• DO NOT PALPATE – seeding can occur – metastasis of mass  

Neoplastic Disorders Management  

• Manifestations: mouth sores, N/V, anemia, anorexia, constipation, alopecia, emotions  

• Giving iron to a child – twist the top give to baby in the buccle area  

• Giving iron to a bigger kid – give with OJ  

Management 

• Prevent infection – injury – pain relief – deal with anxiety – teaching – offer activities  

Retinoblastoma 

It starts in the retina due to a mutation in the gene, often presenting as a white pupil (leukocoria) in photos 

Tonsillitis  

Infection/inflammation of the palatine tonsils – viral or bacterial  

• S/S: frequent throat infections with persistent redness and enlargement of nodes  

• Post care – tonsilectomy: elevate HOB – if awake – place child in side-lying or prone position  

• Maintaining fluid volume: DISCOURAGE COUGHING – THROAT CLEARING – NOSE BLOWING – encourage fluids – avoid citrus/brown/red 

Epiglottitis 

Inflamm of the epiglottitis often caused by the H. influenzae type B – LIFE-THREATENING UPPER AIRWAY OCCLUSION  

• 4 d’s and s: dysphagia, dyspnea, drooling, distress, stridor  

• DO NOT INSPECT THE CLIENT – laryngospasm – nothing in mouth since throat closing  

• TRIPOD POSITION  

• Tracheostomy might be necessary

 

Foreign Body Aspiration  

Caused by food items, toys, etc  

• S/S: stridor, drooling, ASYMMETRIC WHEEZING,  

• Diagnostics: May be revealed with XRAY  

• Management: IMMED BLS – HIT THE BACK OF THE BABY  

Acute Respiratory Distress Syndrome 

Occurs following a primary insult such as sepsis, pneumonia, smoke/drowning 

• S/S: bilateral infiltrates on CXR, nasal flaring, retractions, TACHY 

• Management: ventilatory support – likely intubated  

Cystic Fibrosis  

Inherited disorder affecting the exocrine glands – mucus production  

• GI/reproductive tract: cannot digest food properly – deficiency of ADEK vitamins  

• Respiratory tract: increased mucus in bronchioles  

• Manifestations: MECONIUM ILEUS (abd distention, vomiting, inability to pass 1st stool, large frothy bulky greasy foul-smelling stools – steatorrhea) 

• Diagnostics: SWEAT CHLORIDE TEST – suspicious if level is above 50 and diagnostic if the level is above 60