Peds Exam 1

Sensible fluid loss

Measurable loss - urine, stool, vomit, wounds

Insensible fluid loss

Unable to measure - sweat, tears

Isotonic dehydration

Water and sodium loss are equal

Hypertonic dehydration

Greater loss of water than sodium

Hypotonic dehydration

Greater loss of sodium that water

Mild dehydration characteristics

Up to 5% weight loss, alert, restless, normal BP, regular pulse, normal skin turgor, moist mucous membranes, normal UOP, slightly increased thirst, normal fontanels, normal capillary refill, regular respirations, normal eyes

Moderate dehydration characterisitcs

6-9% weight loss, irritable, lethargic, normal or low BP, rapid pulse, poor skin turgor, dry mucous membranes, decreased UOP, moderatley increased thirst, sunken fontanels, delayed capillary refill >2 seconds, rapid respirations, slightly sunken eyes

Severe dehydration characteristics

10% or more weight loss, lethargic to comatose, low to undetectable BP, rapid or unpalpable pulse, very poor skin turgor, parched mucous membranes, very decreased or absent UOP, greatly increased thirst, sunken fontanels, delayed capillary refill >3-4 seconds, changing rate and regularity respirations, deeply sunken eyes

Sodium

Maintains fluid balance and blood volume, controls BP, important for muscle and nerve excitability

Hypernatremia S/S

Fever, restlessness, fluid retention, edema, hypertension, dry mouth, seizures, decreased LOC, thirst, decreased UOP

Hypernatremia treatment

Hypotonic IVF, treatment of underlying disorder

Hyponatremia S/S

Decreased LOC, seizures, increased ICP, limp muscles, decreased tendon reflexes, thready pulse, dizziness, hypotension

Hyponatremia treatment

Restrict water intake, hypertonic IVF

Potassium

Responsible for water balance, muscle contraction, nerve function, brain cell communication, BP

Hyperkalemia S/S

Muscle weakness, hypotonia, decreased cardiac output, rhythm changes

Hyperkalemia treatment

Dialysis, furosemide, sodium bicarbonate, IV insulin - glucose - calcium gluconate

Hypokalemia S/S

Lethargy, low respirations, limp muscles, leg cramps, increased UOP

Hypokalemia treatment

IV or oral potassium

Calcium

Controls muscle excitability

Hypercalcemia S/S

Decreased neuromuscular excitability, constipation, n/v, polyuria, confusion

Hypercalcemia treatment

Increase fluids, Lasix

Hypocalcemia S/S

Increased neuromuscular excitability, tetany, cardiac dysrhythmias, Ckvostek and Trousseau’s sign

Hypocalcemia treatment

Oral or IV calcium, treatment hypomagnesium

Magnesium

Muscle relaxation

Hypermagnesemia S/S

Decreased muscle irritability, hypotension, bradycardia, drowsiness, weak or absent DTR

Hypomagnesemia S/S

Tetany

Hypomagnesemia treatment

Magnesium, treatment of underlying cause

Normal pH

7.35-7.45

PaCO2

35-45

HCO3

22-26

Respiratory Acidosis

CO2 retention, caused COPD, opioid overdose, hypoventilation

Respiratory Alkalosis

Too much CO2 blown off, caused hyperventilation, anxiety, pain

Metabolic acidosis

Too much acid- caused by DKA, diarrhea, renal failure

Metabolic alkalosis

Too much base, caused by vomiting, diuretics, NG suction

Gastroenteritis

Inflammation of the digestive tract d/t Rotavirus

Oxygen tent

Delivers 30-50% FiO2, significant chance of loss with tent

Oxygen hood

40% FiO2, for smaller infants when NC doesn’t work

Apnea

Cessation of breathing for at least 20 seconds

Sudden Infant Death Syndrome

Sudden death during death during sleep of an infant under 1 year of age that remains unexplained after a thorough investigation

Croup

Viral or bacterial infection of the upper airway

Croup S/S

“Seal-like barking deep cough”, inspiratory stridor, respiratory distress, wheezing, symptoms that are worse at night

Treatment of croup

Supplemental oxygen, nebulized epinephrine, corticosteroids, fluid, Heliox, no cough medication to children <12

Epiglottitis

Inflammation of the epiglottis - emergency

Epiglottitis S/S

Abnormal positioning, dysphagia, difficulty speaking, anxiety, increased temperature, rapid onset, nasal flaring, use of accessory muscles, retractions, stridor, enlarged epiglottis, abrupt onset fever, tripoding, drooling, dysphonia,

Epiglottitis treatment

Do not examine throat, airway management, decrease anxiety, position for comfort, antibiotics, hydrations

Bronchitis

Inflammation of the trachea and bronchitis

Bronchitis s/s

Dry and hacking cough, chest and rib soreness, coarse breath sounds, fine crackles

Bronchitis treatment

Home unless extreme, antiviral

Bronchiolitis

Lower respiratory tract illness that occurs when bacterial organism causes inflammation and obstruction of the bronchioles; RSV most common cause

Bronchiolitis S/S

Wheezing, effort, tachypnea, tachycardia, flared nostrils, retractions, grunting

Bronchiolitis treatment

Ribavirin (anti-viral med; r/f birth defects and hemolytic anemia), bronchodilators, steroids, Synagis (RSV immunoglobulin, has strict criteria to be met before taking)

Pneumonia

Inflammation or infection of the bronchioles and alveolar spaces of the lungs; can be community acquired or hospital acquired

Pneumonia treatment

Airway management, fluids, rest, pain and fever control, amoxicillin if bacterial

Bronchopulmonary Dysplasia BPD

Scarring on the alveoli/lungs from continuous and high pressure oxygen; Supplemental oxygen for at least 28 days after premature birth

BPD S/S

Tachypnea, nasal flaring, grunting, retractions, wheezing, crackles

BPD treatment

Bronchodilators, corticosteroids, albuterol, CPT, nebulized saline, antibiotics if bacterial, tracheostomy if needed

Tuberculosis

Infection caused by mycobacterium tuberculosis that’s spread through air particles

Latent Tuberculosis Infection LTBI

Carrier of the bacteria but noncontagious and symptomatic

Pulmonary tuberculosis

Most common, contagious bacterial infection; Persistent cough, weight loss, fever, fatigue, wheezing, decreased breath sounds; Commonly seen in community living, recent international travel, foriegners, autoimmune diseases

Disseminated Tuberculosis

Starts in the lungs and spreads throughout the body

Asthma

Common disorder of the lungs that inflames the airway, cannot diagnose till >2

Asthma patho

Exposure to trigger, cells respond by released inflammatory mediators, mast cells release histamine, bronchoconstriction, airway edema, mucous secretions, spasm of smooth muscles, airway obstruction, air trapping

Asthma s/s

Difficulty breathing, accessory muscle use, tripoding, short speech, restlessness, irritability, orthopnea, prolonged expiration

Peal flow meter

Helps predict asthma attacks; have patient stand, enclose lips around mouth piece, blow out as hard and fast as possible, write down number, repeat twice

Cystic Fibrosis

Autosomal recessive disorder of the exocrine glands characterized by increased viscosity of mucous secreting glands

CF diagnosis

Sweat chloride test (pilocarpine iontophoresis) >60 meq/L, child must be at least 4-6 weeks old

CF S/S

Newborn meconium ileus, malabsorption, chronic respiratory infections, fecal impaction, cough, sputum, hemoptysis, clubbing, hypoxia, barrel chest, steatorrhea

Treatment of CF

CPT, exercise, pulmozyme, prevent infections, adequate nutrition, increase sodium intake, pancreatic enzymes, prevent GI blockage, ibuprofen

Otitis media

Inflammation of the inner ear

OM with effusion

Fluid that trapped behind the tympanic membrane, can be asymptomatic

S/S OM

Pain, fever, irritability, diarrhea, vomiting

Treatment of OM

Amoxil, Augmentin, PE tubes

Tonsilitis and Pharyngitis

Inflammation of areas in the throat

T & A post op considerations

Cannot perform if <3, do not disrupt naturally forming clot at surgical site, no carbonation, avoid red foods, no straws, no hard foods, soft diet for 3 weeks, ice collar, watch for increased swallowing, pain should decline after day 4, takes approx. 3 weeks to fully heal

Neoplasm

Uncontrolled growth and spread of abnormal cells

Childhood cancer warning signs

Pallor, generalized bone pain, lumps, swelling, unexplained weight loss, fever, persistent cough, SOB, night sweats, eye changes, fatigue, changes in behavior, dizziness

Neutropenia

Low WBC, initiate precautions if <1500

Neutropenic precautions

Sign on the door, PPE, double door isolation, positive pressure room, no unpasteurized products, no fresh produce or flowers, hang hygiene, hibiclens baths, soft bristle tooth brush

Thromboctopenia

Low platelets, initiate bleeding precautions if <50,000

Bleeding precautions

Soft bristled toothbrush, no floss, no hot or spicy foods, no rectal temps, no digital exams, no tampons, no meds that can trigger bleeding, use electric razor

HSCT

Lethal doses od chemo and radiation, then manually resupplying the body with stem cells

Solid tumor

Abnormal clump of cells; Does not contain liquid or cysts, most common sites are CNS and brain, exposure to radiation is a known risk factor

S/S brain tumors

Headache, n/v, abnormal gait, dizziness, change in hearing and/or vision, fatigue, educational or behavioral changes

Neuroblastoma

Abnormal growth from immature nerve cells; Most commonly in abdomen, adrenal glands, thorax or cervical spine

Neuroblastoma S/S

Smooth, hard, nontender mass in the abdomen, neck or chest, bone pain, bruising around the eyes, majority of the time metastasis is already present

Treatment of neuroblastoma

S1 and 2 is surgical removal, S3 and 4 is chemo and radiation; When treatment is successful, Vitamin A (retinoic acid) is added to decrease risk of relapse

Osteosarcoma

Bone cancer

Osteosarcoma S/S

Pain that awakens child from sleep, swelling, limp, most commonly in metaphysis, “sun-burst” pattern on xray

Osteosarcoma treatment

Limp salvage, amputation, chemo

Ewing sarcoma

Cancer in the bones or soft tissue around the bones

Ewing sarcoma S/S

Swelling, lump and pain around site, fever, bone pain, limping, fractures,”moth eaten bone” or “onion skin”,elevated ESR and CRP

Ewing sarcoma treatment

tumor biopsy, chemo, then surgery then and/or radiation

Hodgkins

Cancer of the lymphatic system; Reed-sternberg cells, spreads contiguously, non-tender and firm lymphadenopathy, better prognosis; Treatment is 4 drug chemo combo, radiation, HSCT

Non hodgkins

Cancer of the lymphatic system; Multiple lymph node involvement in noncontiguous spread, B symptoms; Treatment tailored to type and stage, GSCT if recurrent

Retinoblastoma

Intraocular malignancy of the retina

Retinoblastoma s/s

First sign is white pupil, squinting, change in iris color, red or inflamed eye, poor vision

Retinoblastoma treatment

Removal of eye, cryotherapy or laser therapy to eliminate remaining cells after surgery

ALL

Cancer of WBCs, develops from T and B cells, most common cancer in children aged 2-4, 85-90% cure rate after 10 years in remission, treatment is chemo and radiation

AML

Cancer of the WBCs, develops from cells that become RBCs, platelets, granulocytes and monocytes, second most common cancer in children, harder to treat, treatment is chemo and bone marrow transplant

Leukemia S/S

Fever, fatigue, s/s of bleeding, bone and joint pain, petechiae, pale, tired, anorexia, enlargement of spleen and liver