Peds LO's Exam 2

Chapter 16: Attention-Deficit/Hyperactivity Disorder (ADHD)

Clinical Characteristics of ADHD

• Definition: ADHD is characterized by developmentally inappropriate degrees of:

  • Inattention: difficulty sustaining attention, careless mistakes, forgetfulness in daily activities.

  • Impulsiveness: hasty actions that occur in the moment without forethought, possibly leading to harm.

  • Hyperactivity: excessive movement that is not appropriate to the setting.

Types of ADHD

• Inattentive Type:

  • Careless mistakes

  • Forgetfulness in daily tasks

  • Difficulty focusing on tasks

  • Easily distracted by extraneous stimuli

  • Disorganization in work and activities

  • Frequently misplacing belongings.

• Hyperactive/Impulsive Type:

  • Fidgeting or tapping hands or feet

  • Inability to stay seated in appropriate situations

  • Running or climbing in inappropriate contexts

  • Talking excessively

  • Interrupting others or intruding on their conversations.

Diagnosis

• Assessment: ADHD is diagnosed through a multi-diagnostic evaluation rather than a single method.

Patient-Centered Care for ADHD

Approaches to Management

• Clear Rules and Expectations: Establish and communicate rules consistently.

• Routine Maintenance: Having a structured routine can provide a sense of security for the child.

• Constant Direction: Repeating instructions may be necessary.

• Minimizing Stimuli: A calm environment with reduced noise and dim lighting can help.

Non-Pharmacologic Therapies

• Behavioral Therapy:

  • Prevents undesired outcomes through structured support.

  • Strategies for implementation:

    • Effective Reward Systems: Using sticker charts for positive reinforcement.

    • Parenting Skills: Training on effective communication and discipline.

    • Positive Reinforcement: Encouraging good behavior with rewards.

    • Age-Appropriate Consequences: Applying consequences that fit the developmental level of the child.

Pharmacologic Therapies

• Meds: Dextroamphetamine and methylphenidate are commonly prescribed to enhance focus and functionality.

Chapter 30: Increased Intracranial Pressure (ICP) in Infants and Children

Clinical Manifestations of Increased ICP

Infants:

• Early Signs:

  • Tense bulging fontanelle

  • High-pitched cry

  • Irritability and restlessness

  • Drowsiness or sleeping excessively

  • Poor feeding

  • Setting-sun sign (eyes appear downward)

Children:

• Typical Symptoms (similar to adults):

  • Headaches

  • Nausea and forceful vomiting

  • Changes in vision

  • Seizures

  • Increased sleepiness or indifference

  • Decreased physical activity and motor performance.

Assessment of Altered States of Consciousness

• Pediatric Glasgow Coma Scale: Assesses the level of consciousness and guides clinical judgment in monitoring for improvement or deterioration.

Chapter 3: Glasgow Coma Scale and Head Trauma Management

Glasgow Coma Scale Overview

• Usage: Assesses the level of consciousness post-head injury for children, especially under 5 years.

• Components:

  • Eye opening: Max score 4

  • Motor response: Max score 6

  • Verbal response: Max score 5

• Scoring:

  • Highest total score is 15; scores < 8 indicate severe impairment.

Head Injury Management

• Common Approaches: Neuroprotective measures to keep ICP low.

• Nursing Interventions:

  • Frequent neurological checks and vital signs.

  • Assessing for signs of CSF drainage or bleeding.

  • Maintaining the head in a midline elevated position to optimize blood flow.

  • Minimizing strenuous activities and environmental stimuli.

  • Administering medications to manage pain, sedation, and reduce ICP.

Chapter 4: Management of Submersion Injury

Importance of Time in Submersion Incidents

• Prognosis Related to Duration Underwater:

  • < 5 minutes: potential for good recovery.

  • 6 minutes: poorer prognostic outcomes.

  • 10 minutes: likely nonviable.

• Complications: May include hypoxia and pneumonia due to aspiration.

Bacterial Meningitis: Clinical Evaluation and Management

Diagnostic Approach

• Diagnosis: Confirmed via lumbar puncture.

• Precautions: Restricted to droplet precautions to prevent spread during patient interaction.

Therapeutic Management

• Medications: Involves antibiotics and corticosteroids to manage inflammation.

• Symptoms: Look for signs such as fever, nausea, vomiting, irritability, and sensitivity to light.

Classification of Seizures

Types and Management

• Generalized vs. Focal Seizures:

  • Generalized: affects the whole brain and body; involves various manifestations like shaking and loss of consciousness.

  • Focal seizures: localized effects and specific body part involvement.

Febrile Seizures

• Triggering Factors: Often result from fever in infants and young children, particularly viral infections.

• Management: Antipyretics can reduce fever but do not prevent seizure recurrence.

Epilepsy Management

Unclassified Seizures

• Forms: Including West Syndrome and Lennox-Gastaut Syndrome.

• Management: Often involves multiple drug therapies and behavioral interventions; education for families is crucial for recognizing signs and when to seek help.

Hydrocephalus: Pathophysiology and Management

Clinical Manifestations

• Symptoms in infants include bulging fontanelles and rapid increase in head circumference.

• Diagnosis is made using CT or MRI.

Treatment Approaches

• Surgical Interventions: Involves placement of VP shunts to regulate CSF flow.

Immunizations

Definitions and Recommendations

• Key Terms:

  • Immunization: process to ensure immunity; vaccines help prevent diseases.

  • Natural vs. Acquired Immunity: Distinguishing between natural, through infection, and acquired, from vaccines.

Routine Immunization Schedule

• Specific Vaccines: Hep B, MMR, DTaP, Varicella, etc., indicated at various developmental stages.

Conjunctivitis: Definition and Management

Types

• Bacterial vs. Viral: Understanding clinical signs such as purulent discharge for bacterial versus watery for viral.

Management**

• Bacterial: More aggressive treatment with topical antibiotics.

• Viral: Typically self-limiting with supportive care.

Respiratory Infections in Children

Recognizing Symptoms

• Common signs include cough, nasal congestion, and fever; need for timely evaluation of acute distress symptoms.

• Focus on proper management of bacterial versus viral infections including supportive care and antibiotic use where indicated.

Bronchodilator Therapies

• Use for conditions like asthma and bronchiolitis, alongside hydration and monitoring of respiratory status.

Asthma Management

Long-Term and Short-Term Management

• Medications: SABA for acute control, inhaled corticosteroids for long-term management.

• Nursing Role: Education on medication use, avoidance of triggers, and understanding peak flow measurements.

Cystic Fibrosis Overview

Clinical Manifestations and Management

• Clinical Signs: Thick mucus secretions, frequent lung infections, and nutritional deficiencies.

• Treatment: Involves ongoing pulmonary therapy, enzyme replacement, and nutritional support to enhance quality of life.