Peds Exam 2 LN

how long to wash hands

20 seconds

standard precautions are for who

all pts

standard precautions include what

hand hygiene, proper PPE, safe injection practices

droplet precautions for what diseases

flu, meningitis, adenovirus, rhinovirus, group A strep

droplet precautions include what

single pt room, standard face mask for staff if closer than 3 ft, pt should wear mask when out of room

contact precautions for what diseases

excessive wound drainage, C.diff, VRE, MRSA

contact precautions includes what

single pt room, gown and gloves for staff, remove all PPE into trash before exiting room

airborne precautions for what diseases

TB, Sars-Cov, rubella, varicella

risk factors for infection in infants

low birth weight, premature birth, immature immune system, lack of developed skin and mucosal barrier

what is polio

an infectious viral illness resulting from a member of the enterovirus genus that primarily affects the nervous system, leading to paralysis in severe cases

polio transmission

fecal-oral route, droplets from infected individual

polio risk factors

unvaccinated, infant/young child, immunocompromised, travel outside of US

polio symptoms

mild flu symptoms for 3-5 days, small portion of cases causes paralytic polio

paralytic polio

damage to CNS causes muscle weakness or paralysis, typically in legs, that can lead to respiratory failure

polio prevention

IPV vaccine, can be oral (OPV)

polio treatment

supportive care, PT to prevent atrophy, mobility devices, adequate nutrition and hydration, respiratory support/mechanical vent

viral meningitis most common viral causes

enterovirus, herpesvirus, adenovirus

viral meningitis risk factors

close contact with infected person, crowded settings, immunocomrpomised

how does meningitis act on ICP

increases ICP

viral meningitis s/s infants/young children

less severe than bacterial - fever, irritability, poor eating/vomiting, lethargy, bulging anterior fontanel, photophobia, headache, nuchal rigidity, diplopia/blurred vision, flu-like symptoms

why are infants with an infection hypothermic

their immature immune system doesn't know that you need to respond to an infection by raising body temp to kill bacteria

viral meningitis treatment

typically resolves on own unlike bacterial

abx until bacterial is ruled out with lumbar puncture

IV antiviral (acyclovir)

let run course

monitor neuro status and ICP

viral meningitis prevention

good hygiene, handwashing, avoiding close contact with anyone with viral infection

bacterial meningitis

inflammation of meninges due to bacterial infection, typically meningococcus, pneumococcus, or group B strep

bacterial meningitis pathways

sharing saliva with infected person or migration of bacteria from else in the body like URI or ear infection

bacterial meningitis risk factors

close contact with an infected individual, living in communal settings (such as college dormitories), being unvaccinated or under-vaccinated, immunocompromised

bacterial meningitis can lead to

sepsis, hearing loss, hydrocephalus, death

bacterial meningitis general s/s

acute onset, high fever, petechial rash, nuchal rigidity, blurred vision/diplopia, severe confusion and lethargy, Brudzinski + Kernig signs, increased ICP, photophobia, seizures

bacterial meningitis treatment

prompt hospitalization, is a medical emergency, IV abx broad spectrum until culture confirms type, analgesics, antipyeretics, corticosteroids, ICP monitoring

bacterial meningitis prevention

pneumococcal, meningococcal, Hib vaccines

good hygiene

avoid contact with infected

Measles (Rubeola)

viral infectious disease that 1st effects lymph nodes and can spread to organs

measles risk factors

unvaccinated, direct contact with infected droplets, immunocompromised, malnourished

measles s/s

3 Cs = cough, conjunctivitis, coryza (rhinorrhea/nasal congestion), fever, URI symptoms, Koplik spots (small red spots with white centers in mouth), distinctive rash that starts at hairline and moves downward

measles treatment

supportive care, 2 day vitamin A supplement, nutrition and hydration, airborne precautions

measles prevention

MMR vaccine, herd immunity, contact tracing

MMR vaccine dosing

2 doses - first at 12-15 months, second at 4-6 years

MMR vaccine contraindications

is live vaccine so contraindicated if pregnant, immunocompromised, previous allergy to vaccine or to neomycin

MMR vaccine adverse effects

fever, mild rash, febrile seizures

giardia

GI disease that results from infection with Giardia duodenalis

giardia risk factors

poor sanitation, contaminated water supply, poor hygiene, contact with infected person

giardia s/s

water diarrhea, abdominal distention, abdominal cramps, fatigue, weight loss

giardia treatment

antimicrobials (metronidazole), proper hydration, nutritional support, IV fluid replacement

giardia prevention

public health measures for safe water, proper sanitation and hygiene, filter or boil water intended for drinking

pinworms

parasitic infection that enters body through egg consumption, eggs remain in GI tract before becoming worms in 4-8 weeks

pinworms risk factors

egg ingestion through contaminated hands, bedding, clothing, surfaces

pinworms s/s

itching around anus that worsens at night, irritability, disturbed sleep, abdominal discomfort

pinworms dx

scotch tape test - tape over anus at night to check for eggs in morning

pinworms treatment

antihelmintic (mebendazole), follow up dose of mebendazole 2 weeks after initial dose, wash all bedding, clothes, and towels in hot water to kill parasites

pinworms prevention

good personal hygiene, handwashing after toileting and before eating, daily showers, regularly cleaning and disinfecting living spaces

scabies

contagious skin disease where smal mites burrow inder skin and lay eggs

scabies risk factors

direct contact with infected individuals or linens, can spread within 10 mins of skin to skin contact

scabies s/s

intense itching typically at wrists, genitals, and interdigital spaces

itching most severe at night

tiny, linear burrows or papules

impetigo or cellulitis due to papules getting infected

scabies treatment

topical meds to kill mites - prometherin cream

same treatment for close contacts

wash all bedding and linens in hot water and vaccuum

scabies prevention

prompt treatment of close contacts, close monitoring, hygiene and sanitation

anencephaly

absence of dome of skull and an entirely or mostly absent brain; brain and skull don't fully develop

anencephaly patho

fetal skill is underdeveloped and any developing brain tissue is exposed to amniotic fluid which degrades it down > lack all essential brain functions and can't maintain homeostasis; no affected newborn survives longer than 2 weeks

anencephaly risk factors

diabetes, fever in early pregnancy, genetic syndromes, folic acid deficiency

anencephaly treatment

no treatment

who does anencephaly mostly effect

females and hispanics

anencephaly prevention

folic acid supplements during pregnancy

trisomy 13

genetic condition caused by extra 13th chromosome

trisomy 13 s/s

holoprosencephaly (brain doesn't divide into 2 hemispheres), cleft lip, cleft palate, aplasia cutis (no skin in spots), heart malformations, polycystic kidney, polydactyly

trisomy 13 prognosis

6-12% make it past 1 year

trisomy 13 diagnosis

chromosome analysis after birth, screenings during pregnancy

common causes of death in trisomy 13

central apnea (brain doesn't send signals to breathe or beat heart), cranial and facial malformations lead to airway obstructions and aspiration

trisomy 13 risk factors

advanced maternal age, genetic screening

cystic fibrosis

An inherited disorder of exocrine glands characterized by thickened secretions

cystic fibrosis patho

gene mutation of 7th chromosome causes increased reabsorption of sodium in exocrine glands > salty skin and water is retained in cells instead of releasing into mucus > thick secretions

how does someone get cystic fibrosis

is recessive - both parents must be carriers

what systems does CF effect

GI, respiratory, reproductive

CF life expectancy

40 years, likely need lung transplant

how does CF effect respiratory system

creates mucus plugs that can't be expelled, makes pt susceptible to bacterial infections, pathogens are easily stuck in mucus and can't be expelled from lungs

muscular dystrophy

umbrella term used to describe a set of inherited disorders of the muscle cell plasma membrane, leading to progressive muscle loss over time

muscular dystrophy s/s

muscle wasting, muscle weakness, scoliosis, delayed motor development, excessive sleepiness, mild intellectual disability, seizures, arrhythmias, and heart failure

2 main tyoes of childhood onset muscular dystrophy

Duchenne's and Becker's

why is muscular dystrophy more common in males

inheritence is x-linked, so females have a backup set (XX) whereas males don't (XY)

Becker's muscular dystrophy onset

10-20 y/o

Duchenne's muscular dystrophy onset

3-5 y/o

Duchenne Muscular Dystrophy (DMD)

most common form of muscular dystrophy; progresses rapidly so that most are unable to walk by age 12 and later need a respirator to breathe, 20-30 year life expectancy

Becker muscular dystrophy (BMD)

very similar to but less sever than Duchenne muscular dystrophy, slower onset, 50-60 year life expectancy

most common cause of death in muscular dystrophy

respiratory failure - weakness in diaphragm and accessory muscles, limited lung expansion due to scoliosis

pts with muscular dystrophy are high risk for

respiratory failure, cardiac issues like heart block/HF, and malignant hyperthermia

malignant hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs

burnout in nurses is characterized by

emotional exhaustion, depersonalization or lack of empathy, and feeling unsuccessful in one's profession

nurse burnout risk factors

younger age, fewer years of experience, lower education level, anxiety, and working nights

nursing burnout prevention

avoid poor leadership, inadequate​​​​ administrative support, understaffing, and excessive non-clinical work

frequent grief scale measurements

formal education for coping with grief

facilitated discussion about traumatic experiences

engage in mindfulness strategies

prioritize debriefing grief with healthcare team

Develop and participate in organization supported support services (EAP)

Attend continuing education on death and dying and coping

nursing actions for parents with dying children

involve child in treatment plan

maintain routine and normality

respect family values

consult palliative care and hospice ASAP

schedule decisive appointments in advance to help prepare

include siblings in daily activities

Stimulate parents to seek social support and contact with peers

Assess their knowledge of the situation and offer clarification for any gaps in their understanding

Focus on helping family understand without giving them false hope

A decision to discontinue life sustaining measures should be framed as a change in the focus of care, not a withdrawal of care

encourage self care and therapy

things to tell a parent about end-of-life care

its not a withdrawal of care, its a change in focus of care

assure they will be cared for

grief is not linear, not expected time frame to grieve

what not to tell a parent about end-of-life care

there's nothing more we can do

give false hope

when to consider hospice

terminal illness with 6 months or less to live

where can you do hospice

hospitals, homes, hospice centers, medical homes

hospice goals

alleviate discomfort, improve quality of life for pt and family, provide assistance with decision making

what is palliative care

Provides similar services as hospice but pts have more than 6 months to live and are still receiving curative treatments

palliative care goals

alleviate discomfort, improve quality of life, pain management, help meet spiritual and personal needs

when to consider palliative care

as soon as possible

s/s if impending death

decreased appetite, decreased LOC, changes in rate and character of breathing (apnea, noisy or rattling breathing), changes in skin appearance (paleness/blotchiness), irregular HR, loss of bladder/bowel control

nursing actions for care of dying child

swab and moisturize mouth, reassure family about comfort measures, position to promote oral secretion drainage, regularly change linens and absorbent padding

Importance of support groups & counseling

key component of bereavement care

Nurses should be aware of local and national resources to share with families

Supportive care should also include siblings, grandparents, and other family members

Can provide peer-to-peer support

Can share experiences with people who know exactly what they're going through

s/s of worsening cystic fibrosis condition

recurrent/worsening lung infections

respiratory distress - wheezing, labored breathing, hypoxia

respiratory failure

increased steathorrhea (greasy, pale foul-smelling stools) caused by decreased fat absorption

weight loss/FTT

salty skin and dehydration

systemic infection

why do people with cystic fibrosis have fatty stools

Ducts of pancreas, liver, gallbladder obstructed with mucus → increased acidity of stomach → malabsorption of fat-soluble vitamins = fat in stool