Peds Exam #3

Bottle fed vs breast fed babies → who is more likely to get diaper rash?

Bottle feeding has a higher incidence

Diaper Rash Nursing Interventions

-Use Barrier Creams → A & D ointment, triple paste, destin

-Put all the ointment on, never too much (FROST THE CAKE)

-Use soap and water instead of diaper wipes (diaper wipes are alcohol-based and can be harsh)

Thick yellow patches on the scalp of an infant is called

Seborrheic Dermatitis (contact dermatitis)

Seborrheic Dermatitis (contact dermatitis) Nursing Care

-Mineral oil with a fine tooth brush through hair

-Daily scalp care and hair hygiene

-Cradle Cap

-Hair will be lost!!!

Chronic skin inflammation in the skin folds, cheeks, which are associated with itchiness, redness, from allergies, asthma, and are heredity

Eczema (Atopic dermatitis)

Eczema (Atopic dermatitis) Nursing Care

-Hydrate skin and avoid moisture loss

-Hydrocortisone used on affected areas only

-Reduce flare-ups/identify allergy triggers (mild detergents)

-Standard precautions → Isolation only if the skin is weeping

What is the most common skin condition in adolescence

Acne

Acne Medications

Tretinoin → Small pea-sized amount, Minimize sun exposure

Benzoyl Peroxide → Bleaches linings & clothing

Isotretinoin (Accutane) → Can cause nosebleeds, tetrogenic (birth control), sun protection!!

Who are most at risk for pediatric burns

Ages 5 and younger due to having thinner skin and are more curious

Does the rule of 9’s apply to children for burns?

-No → Due to children having a higher % of body fluid to mass than adults

-Burns greater than 10% of the body require fluid resuscitation

Burn Nursing Intervention Step By Step Process

1) Stop the burning process

2) Assess ABC’s

3) Begin resuscitation measures

4) Remove burned clothing and jewelry

5) Cover wounds with a clean cloth

6) Keep the child warm

7) Transport to ER

Burn that is minor signifigance, redness, pain and no blisters is what degree

Heal in 3-4 days

1st Degree (Superficial)

Burn that is painful, moist red, and blistered is called what degree

Heals in 14 days

2nd Degree (Partial-thickness)

Burn that destroys follicles, sweat glands, nerve endings, and generally not painful is what degree

3rd Degree (Full thickness)

Burn that damages all layers of the skin that extends to muscle, fascia, and bones, no pain is considered what degree

Heals in months

4th Degree Burn (Deep Full Thickness)

Chemical vs Dry Chemical Burns vs Noxious Fumes

Chemical → Flush with copious amounts of water

Dry Chemical → NO WATER, just brush off

Noxious Fumes → Singed nose hairs

Nursing Care for Major Burns

-Establish Airway

-HOB elevated at 30 degrees

-Large bore IV fluids, LR or NS “colloids” → Cap seal, look for cap refill

-Monitor Electrolyte

-Burns above 25% of BSA lead to enteral nutrition (high-calorie, high-protein)

-Antibiotics (silver sulfadiazine) only if infection occurs

Different types of Skin Grafts

Allografts → Human Cadaver

Autografts → Patient’s Own

Synthetic Skin Covering → Xerofrom, Duoderm, Biobrane

-Impetigo

-Pyoderma

-Folliculitis

-Furuncle

-Carbuncle

-Cellulitis

-Staphylococcal scalded skin syndrome

What type of skin infection?

Bacterial

-Verruca (warts)

-Verruca Plantaris

-Cold sore

-Genital herpes

-Herpes Zooster

-Molloscum Contagiosum

What type of skin infection?

Viral

Any Tinea or Candida is what type of skin infection?

Fungal

Impetigo (bacterial)

-Caused by Staphylococcus or B hemolytic strep

-CM → Erythematous macule that becomes vascular

-CM → HONEY CRUSTED LESIONS AROUND MOUTH AND FACE

-Management → Topical Antibiotic & frequent handwashing, change towels and bed linens

-Isolation → Contact

Pyoderma (bacterial)

-Deeper infection into the dermis

-CM: 5 P’s → Painful, Progressive, Purple, Pretibial, Pathergy

Management → Bactroban, systematic antibiotics, wash hands, towels, bedding

Folliculitis (bacterial)

-Caused by Staph aureus and MRSA

-Infection of the hair follicle

-Management: Clean skin twice a day, warm compress, and topical antibiotics

Furuncle & Carbuncle (bacterial)

-Caused by Staph aureus

-Carbuncle: Multiple boils on face, buttocks, and neck

-Furuncle: Large, swollen erythematous lesion of a single hair follicle

-Management → Incision and drainage and soak in bleach baths

Cellulitis (bacterial)

-Firm, swollen, erythematous area of the skin and subcutaneous tissue

-CM: Look for streaking up leg → SEPSIS!!!

Management → Oral or IV antibiotics, central line if systemic

Staphylococcal Scalded Skin Syndrome (bacterial)

-Rough textured skin with macular erythema

-CM: Epidermis becomes wrinkled with large bullae that occurs after birth

-CM: Hypothermia, large fluid loss, fever

-Management → Systematic IV, Compresses of Silver Nitrate, IV fluids

Verruca (viral)

-Warts

-CM → Elevated, rough, gray-brown, firm papules

-Managment → Destructive Therapy and Sylicyic acid

Cold sores, fever blisters, genital herpes (viral)

Herpes Simplex Virus Type 1 → Face

Herpes Simplex Virus Type 2 → Genital

-CM → Itching and burning of lips, nose, buttocks, genitallia

Management for Type 1 → Acyclovir

Management of Type 2 → Valcylovir

Herpes Zooster & Shingles (viral)

-CM → Rash, vesicular lesions that appear near afferent nerve endings

-CM → Develops on one side of the face

-Management → Analgesics, moist compress, and zooster vaccine for individuals who are 50

Molloscum Contagiosm (viral)

-Caused by poxvirus

-CM → Flesh colored papules on face , extremities and trunk

-Management → No towel sharing, usually goes away, but if bothersome have direct removal therapy

Tinea Capitis (fungal)

-Ringworm of the scalp

-CM → Scaly circumscribed lesion on scalp, alopecia present

Management → Selenium sulfide shampoos & oral griseofulvin (take with greasy foods!)

Tinea Corpis (fungal)

-Ringworm of the body

-CM → Round or oval erythematous with scaling, patching and central clearing

-Management → Topical anti fungal, oral griseofulvin (take with greasy foods!) & treat infected pets

Tinea Pedis (fungal)

-Athlete’s Foot

-CM → Between toes or plantar surface of the feet

-Management → Topical anti fungal & keep feet clean and dry

Tinea Cruris (fungal)

-Jock itch

-Management → Topical clotimazole & loose fitting underwear

Candidiasis (fungal)

-Found on moist areas of the skin

-CM → White exudate in the mouth or vagina

-Management → Topical antifungal or oral (Diflucan) & make sure bottles and pacifiers are sterilized

Nursing care for arthropod bites

-Place pt in dependent position

-Administer antivenin

-Stay calm

-Transfer to PICU

Brown recluse spider bite nursing care

-Pain for 2 to 8 hours after the bite

-Star-shaped purple area in 3 to 4 days after bite

-Necrotic ulceration in 7 to 14 days

-Treatment → Cool Compress, keep area clean and dry, antibiotics and steriods

Bee, wasp sting or fire ant bite nursing care

-Erythematous wheel & warm to the touch

-Can cause anaphylaxis → use EPI Pen

-Pull the stinger out

-Cleanse with soap and water, and apply a cool compress with baking soda

-Topical and oral antihistamines

Tick nursing care

-Attaches to the skin with the head embedded, making a firm nodule at the site

-Pull the tick out with tweezers and pull straight up.

-How to prevent → Insect repellent that contains DEET (must be at least 6 months or older), wear long sleeves, hats, long socks, follow the path, have dogs use insect repellent.

Lyme Disease different stages

-Stage 1 (3 to 30 days): Bulls eye rash, chills, fever, headache

-Stage 2 (3 to 10 weeks): Systematic involvement like paralysis in the face, myalgia, splenomegaly

Stage 3 ( 2 to 12 months): Advanced systematic involvement, arthritis, deafness, cardiac complications, encephalopathy

Nursing treatment for Lyme Disease

Antibiotics

-Younger than 12 years → Amoxicillin

-Older than 12 years → Doxycycline

-Any allergies to those above use→ Cefuroxime

Scabies Clinical Manifestations

-Pruritic, papular rash between the fingers, popliteal region and inguinal regions

-Fine, greyish erythmatous lines “pencil-like marks on skin.”

-Intense itching at night

Scabies Nursing Care

-Kids over the age of 2 → Lindane or permethrin that is applied 30 minutes after a cool bath

-DO NOT APPLY IT TO THE HEAD (below the head to the soles of the feet)

-All clothing and bedding, washed and changed daily for one week

-Non washable toys in sealed bags for four days

-All household members need to be treated

Head Lice Nursing Care

-CM → Gray and observable, kids scratch head vigorously

-No brushing, need to be plucked off

-No sharing hats, bedding, towels, clothes

-Permerthin Shampoo

How to assess kidney function in kids

Renal Function Test (BUN & Creatinine)

What is the average age of toilet training and when is the bladder awareness present in a child

Toilet Trained → 36 months

Bladder Awareness → 5 years old

Incontinence of urine past the age of toilet trained

“Can’t Control Bladder”

Enuresis

Nursing care for Enuresis

-Increase fluids during the day

-Schedule bathroom beaks in the day (every 2 hrs)

Medications for Enuresis

Desmopressin acetate & Trcyclic Antidepressents (older kids)

What are the biggest contributors to Urinary Tract Infections

-Urinary Stasis → Holding because they don’t want to miss anything

-Wiping from back to front

-Constipation

Infant vs Child Clinical Manifestations of UTI’s

Infants → Fever, vomiting, frequent voiding, strong-smelling urine (non-specific)

Children → Fever, Enuresis, dysuria, urgency

What is pyleonphritis and what are its clinical manifestations

-Uters and kidney infection “Upper”

-High fever, vomiting, flank pain, and chills

-Pt is hospitalized for IV antibiotics

Screening for UTI’s

Urinary Analysis is cloudy, has nitrates and is positive leukocytes

Repeated episodes call for VCUG

Nursing Care for UTI’s

-No bubble baths

-Wipe front to back

-Take time to finish

-Cotton clothing

-Loose-fitting underwear

-Increase fluids

Medication to treat UTI

-Bactrim (sun covering)

-Septra

-Augmentin

Electrolytes: Sodium, Potassium, Calcium, Chloride

Renal: BUN, Creatinine

Other: CO2

BMP (Basic Metabolic Panel)

Electrolytes: Sodium, Potassium, Calcium, Chloride

Renal: BUN, Creatinine

Liver: ALT, AST, ALP, Billirubin, Albumin, Globulin

Other: CO2, Total Protein

Comprehensive Metabolic Panel

Ventral curvature of the peen, which is surgically fixed through the release of the fibrous band.

Chordee

Nursing Teaching for Chordee

-No straddle toys

-Lift penis up when changing diaper

-No pools

Bladder Exstrophy

-Surgery happens within 1-2 days to close the bladder.

-Cover with a sterile, non-adherent, moist dressing, and cover with plastic.

-Use barrier ointment (NO PETROLEUM)

Epispadias vs Hypospadias

Epispadias → Dorsal (top) placement of urethral opening → High risk for UTI

Hypospadias → Ventral (bottom) placement of urethral opening → High risk for UTI

Phimosis Nursing Care

-Tight foreskin on the peen

-Disappears with normal growth and development

-Cleanse the foreskin daily

-The foreskin should not be FORCEIBLY retracted → Cause tourniquet.

Failure of one or both testes to descend is called

Cryptorchidism

-If not dropped by age 1, then surgery is needed.

-Freq asociated with inguinal hernia and preterm infants

Presence of fluid in the scrotum is called

Hydrocele (it can transluminate)

Nursing care for Hydrocele

-Ice bags to the scrotum to reduce swelling

-Scrotal support → Tightee whitees

-Avoid tub baths until the incision heals

-Avoid strenuous activity

Elongation, dilation, and tortuosity of the veins of the spermatic cord above the testicles with pain during sexual stimulation

Varicocele

Treatment → Varicoelectomy (put ice on it lol)

Severe acute pain that radiates to the groin area and is caused when the testes are twisted and not attached to the vascular structures

EMERGENCY

Testicular Torsion

What is the nursing goal for ambiguous genitalia

1st Goal is to preserve/create urinary and or sexual function.

2nd Goal is to provide education and emotional support.

Children who have had a post beta hemolytic strep infection are at risk of getting what disease

(Also pts with a hx of pharyngitis or tonsillitis)

Glomerulonephritis

Pathophysiology of Glomerulonephritis

Inflammation is a result of an antigen-antibody reaction produced by an infection elsewhere in the body

Clinical manifestations of Glomerulonephritis

-Periorbital Edema

-BP AFFECTED

-Oliguria

-Tea Colored urine

-Proteinuria (foamy)

-Abdominal and flank pain

-Azotemia (Increase in BUN and Creatinine)

Nursing Care for Glomerulonephritis

Hypertensive = Hospital care

-Assess for fluid overload manifestations (JVD, weight, bounding pulse, fluid/Na restriction).

-Seizure precautions, antihypertensives, and antibiotics for 10 days, assess for edema

Normal BP = Can be cared for at home (monitor for fluid volume overload)

What is the most common presentation of glomeular injury in children

Nephrotic Syndrome

Clinical Manifestations of Nephrotic Syndrome

-Rapidly accumulating Edema (especially in the genital area)

-Ascetics

-BP NOT AFFECTED

-Elevated lipids

Nursing Care for Nephrotic Syndrome

-Weight every 12 hours and monitor I & O’s.

-Monitor urine specific gravity and protein

-Regular diet without added salt

-Immunosuppressed so avoid crowds!

-1) Steroids 2) Immunosuppressants (cyclophosamide)

Hemolytic Uremic Syndrome (HUS)

Damaged red blood cells due to viruses clog the filtering system within the kidneys

The 3 Clinical Manifestations of Hemolytic Uremic Syndrome (HUS)

1) Anemia

2) Thrombocytopenia

3) Kidney failure

(Hemorrhagic manifestations → Bruising, petechia, jaundice, bloody diarrhea)

Hemolytic Uremic Syndrome (HUS) Nursing Care

Hemo or peritoneal dialysis and blood product support

Overall Renal Nursing Care

-Strict I and O

-Daily Weights

-Limit PO intake

-Monitor hypertension

-IV fluid

-Bed Rest

Neutropenia, Anemia, Thrombocytopenia, Myleosuppression

Neutropenia → Low WBC

Anemia → Low RBC (low hemoglobin and hematocrit)

Thrombocytopenia → Low platelets

Myelosuppression → Decrease in bone marrow suppression

What are the cardinal signs of cancer

-Unexplained loss of energy

-Enlarged lymph nodes

-Prolonged or unexplained fever

-Excessive weight loss, anorexia

-Frequent headaches or sudden vision changes

What is the most common intra-abdominal cancer in children that usually metastasis to the lungs

Wilms Tumor

(peak incidence at age 3)

Clinical Manifestations of Wilms Tumor

-Swelling in the abdomen

-Firm, non-tender, deep unilateral flank pain

-HYPERTENSION

-Difficult to diagnose because toddlers are belly breathers

Pre-operative care for Wilms Tumor

-DO NOT PALPATE ABDOMEN

-Surgery occurs, and then chemotherapy is started

A tumor that is usually found in the abdomen that develops on the adrenal gland (that can press on others spots such as spinal cord and chest) and affects children younger than the age of 10

Neuroblastoma

Neuroblastoma Clinical Manifestation

-Firm non-tender mass that crosses the midline

-Intracranial lesions → neurological impairment

-Thoracic masses → Resp. Obstruction

-Spinal Cord lesions → Paralysis

-Adrenal → Flushing, HTN

Neuroblastoma chemotherapy drug of choice

Cyclophosphamide (watch out for hemorrhage with this drug)

A broad group of malignant diseases of the bone marrow and lymphatic system that have unrestricted proliferation of immature WBC

-Peak onset between 2 to 6 years old and peaks in the teen years

Leukemia (ALL is most common)

Diagnosis of Leukemia (ALL)

-Bone marrow biopsy → bone marrow depression “myelosuppression.”

-Elevated WBC

-Decreased platelet and RBC “Thrombocytopenia & Anemia”

Chemotherapy Administration

-Good handwashing

-Pre-hydration via IV

-Administer Antiemetics (Zofran around the clock or Emend pill 3x a day)

-Wear PPE (gloves, gown, eye shield, chemo gloves)

-Cover the toilet because chemo lasts 24 hrs

3 Stages of Chemotherapy

-Induction (4-6 weeks) → Central line placed and chemotherapy is initiated

-Intensification or Consolidation (first 6 months) → CNS prophylaxis

-Maintenance Phase (2-3 years) → Prevent reemission

How to calculate ANC????

(segs + bands “make sure they are in decimal”) x (WBC) = ANC

-ANC less than 500 means high risk for infection

Chemotherapy side affects/complications for patients

-Bone Marrow Suppression

-Hair loss (alopecia)

-Mucositis

-GI Stripping

-Constipation

Mucositis Nursing Care

-Risk factors → Dental caries, poor oral hygiene, immunosuppression

Teaching → Good oral and dental hygiene & use of a soft bristle tooth brush

What is the big concern about constipation

-Bowel perforation

-Make sure the patient has a bowel movement every day!

Infection prevention for patients with myelosuppression

-Handwashing

-Clean the patient’s environment

-Avoid Crowds

-A family member or nurse who is ill cannot come into the room

-No live vaccines

-Avoid raw and undercooked veggies, fruits, and meats

Nutritional therapy for chemotherapy

-High protein, high-calorie foods

-Bland, moist diet

Mucosal irritation therapy

-Rinse 30 minutes before eating

-Avoid lemon swabs and oral temps

-Sponge instead of toothbrush

Body image fears for preschoolers, school-age, and adolescents for cancer and chemotherapy

-Preschoolers → Body mutilation “vampire”

-School-age → Bullying

-Adolscents → Body image