438 Final

pediatric differences for endocrine

more suseptable to f&e changes, less tolerance for stress, risk for cv collapse

what is water deprivation test used for (which disease)

DI

DI sx

polyuria, polydipsia, dehydration, f&e imbalance

DI

low ADH, uncontrolled pissing

labs for DI

hypernatremia

treatment for DI

DDVAP, hormone replacement (ADH)

nursing diangosis for DI

fluid volume deficit, electrolyte imbalance

SIADH

overproduction of ADH, kidney reabsorbs water

sx of SIADH

low u/o, anorexia, vomiting, seizures, stupor, edema

labs for SIADH

Na < 120, low serum osmolality, BUN low

treatment for SIADH

fluid restriction, oral Na replacement, diuretics

SEIZURE PRECAUTIONS

nursing diagnosis for SIADH

fluid volume excess, risk for injury: seizures

cushing syndrome

too much cortisol, usually by too much steroid therapy

sx of cushings

excessive hair growth, moon face, buffalo hump, weight gain

POOR WOUND HEALING

labs for cushings

inc cortisol, acth, hyperglycemia, hypoglycemia

nursing diagnosis cushings

risk for infection, body image

acute adrenal insufficiency

not enough cortisol to meet stress response of infection

sx of acute adrenal insufficiency

weak, n/v, headache - early

cv collapse, weak rapid pulse, hypotension, - late

labs for acute adrenal insufficiency

dc cortisol, inc acth, hyponatremia, hypoglycemia

treatment for acute adrenal insufficiency

hydrocortisone IV, EKG,

nursing diangosis for acute adrenal insuffiency

risk for dc cardiac output, risk for sepsis

DKA

body cannot store glucose for nrg so it breaks down fat and releases ketones which are acidic

DKA sx

dehydration, fruity breath, kussmal resp

DKA labs

glucose high, low K, low bicarb, glucose and ketones in urine

treatment for DKA

1. fluid bolus

2. recheck glucose

3. insulin infusion with NS

nursing diagnosis for DKA

fluid and electrolyte imbalance, risk for injury

iron deficiency sx

pallor, fatigue, tachy, poor muscle tone, pale pink skin

iron deficiency labs

low h&h, low mcv and mch, normal Wbc

iron defiency anemia nursing diagnosis

nutrition less than body requirements

sickle cell anemia

inc rbc destruction, autosomal recessive

sickle cell sx

painful swelling extremities, abd pain, acs, hematuria, dehydration

sickle cell labs

acidosis, low rbc, hg, hct, inc rectic count

sickle cell treatment

no codeine or meperidine, penicilin, folic acid, pain meds

sickle cell nursing diagnosis

altered comfort, impaired gas exchange (if resp sx)

aplastic anemia

ineffective production of bone marrow, all of the anemias

sx of aplastic anemia

infection, bleeding, fatigue, tachy

labs for aplastic anemia

low rbc, wbc, plt, bone marrow is yellow/fatty

nursing diagnosis for aplastic anemia

risk for bleeding, infection

immune thrombocytopenia

immune attacks plts, low plt

sx of immune thrombocytopenia

bleeding, petechaie, hemtaturia

treatment for immune thrombocytopenia

RICE, rest ice compress, elevate, ivig, prednisone

no contact sports

nursing diagnosis for immune thrombocytopenia

risk for bleeding

hemophilia A

x-linked recessive disorder, dc factor VIII

sx of hemophilia A

hemarthrosis, bleeding,

labs for hemophilia A

low factor VIIII, inc ptt, normal h&h

treatment for hemophilia A

replace factor VIII, head to toe assess

RICE

nursing diagnosis for hemophilia a

bleeding risk

HIV/AIDS sx

recurrent infections, parotitis, oral candidiasis

labs for hiv/aids

low h&h, high viral load, high neutrophils

treatment for hiv/aids

antiretroviral agents

nursing diagnosis for hiv/aids

infection risk

SCID

severe combined immuno deficiency

scid sx

chronic infections, otitis media, pneumonia, herpes, candiasis

labs for scid

low ig, low h&h, low wbc

nursing diagnosis for scid

infection risk

when to avoid lumbar puncture

inc icp, infection l3-l5

what does CT help see

calcifications, tumors, edema, hemorrhage

what does mri help see

cerebral blood flow

cushings triad

dc hr, inc bp, periodic breathing

inc icp sx infant

tense fontanel, inc head circumference, poor feeding

inc icp sx child

headache, nausea, vision changes, lethargy

tbi sx

low bp, low rr, high hr, altered loc

tbi labs

low na, free phenytoin, low urine gravity

nursing diagnosis tbi

dc cerebral adaptive capacity, risk for injury seizure

treatment tbi

antiseizure med, vasopressor, 3% saline bolus

hydrocephalus sx infant

sunsetting eyes, bulging fontanel , inc head circumference

hydrocephalus sx child

morning headache, emisis w/o food, fever

what is the number 1 sign of failed shunt

fever

nursing diagnosis hydrocephalus preop

dc cerebral adaptive capacity

nursing diagnosis hydrocephalus postop

infection risk

bacterial meningitis sx under 2yo

anorexia, bulging fontanel, hypothermia, vomting

bacterial meningitis sx over 2

nuchal rigidity, kernig/brudinski signs, photophobia

bacterial meningitis labs

csf cloudy, low na, low glucose

when are droplet precautions placed for bacterial meningitis

1st 24 hrs antibiotic

bacterial meningitis tx

vancomycin

nursing diagnosis bacterial meningitis

dc cerebral adaptive capacity, infection risk

viral encephalitis sx

incontinence, low gcs, tremors

viral encephalitis labs

viral pcr, inc wbc,ebistein barr virus?

viral encephalitis nursing diagnosis

dc cerebral adaptive capacity, seizure risk

Reye syndrome

acute metabolic encephalopathy with liver dysfunction

reye syndrome sx

cerebral edema, fever, pain vomiting

reye syndrome labs

inc pt, ptt, inc INR, abnormal coag study

reye syndrome nursing diagnosis

dc cerebral adaptive capacity , BLEEDING RISK

spina bifida sx

inc icp, paralysis, overflow incontinence, bowel dysfunction

nursing diagnosis for spina bifida

impaired urinary elimination

treatment for spina bifida

glycol laxative, straight cath, oxybutin

cerebral palsy

non progressive disorder, spastic brain injury

cerebral palsy sx

infant reflexes, arching back, altered tone, chronic pain

what meds do we give when seizures last more than 5 mins

diazepam or lorazepam

medications to prevent seizures

topiramate, levetiracetam

status epilepticus

seizure over 30 mins, child not able to regain base loc

febrile seizure

no hx of seizure, rapid rise in body temp

nursing diagnosis for seizure disorder

risk for injury

ketogenic diet

pedatric differences oncology

immune system less developed, tumors are fast growing

what is the best prognosis to have

stage 1

nursing care for radiotherapy

give antienemic 30 mins before, no lotion, wash skin with mild soap

oestosarcoma

grows around the bone, starburst appearance

ewing sarcoma

grows in the bone marrow, onion flaked appearance, secretes erythropoietin

nursing diagnosis for ewing sarcoma

risk for infection

acute lukemia

malignant bone marrow, blood, lymph system