jade mod.8 notes

Atopic Dermatitis

• A chronic inflammatory skin disease.
• Food allergies can be a major trigger, warranting a food allergy evaluation for diagnosis.
• Signs and symptoms include pruritus and scratching that disrupts sleep.
• Triggers include heat, sweating, tight clothing, and contact irritants that increase pruritus.
• Assessment includes evaluating epidermal barrier defects, skin eruptions, erythema, crust, yellow secretions, poor nutrition, and discomfort. Monitor for secondary infections of open lesions indicated by low-grade fever, white fluid-filled lesions, and tender lymph nodes.
• Therapeutic management involves decreasing allergen exposure, adjunct, anti-inflammatory, antimicrobial, or immunosuppressive treatments, hydrating skin, and antihistamines.
• Older children may experience hyperpigmentation, glossy fingernails, and an increase in lesions, treated with hydrocortisone, phototherapy, and ultraviolet light. Assess the stages of healing and psychosocial status.

Drug and Food Allergies

• A drug may become an allergen when combined with a protein from the patient's body.
• Signs and symptoms include urticaria, angioedema, allergic contact dermatitis, flushing, pruritus, purpura, thrombocytopenia, and hemolytic anemia.
• Respiratory signs and symptoms include wheezing rhinitis.
• Monitor for anaphylactic shock.
• Injectable drugs involved in an allergic reaction include cephalosporin and penicillin.
• Discontinue the drug if a reaction occurs. For urticaria, give an antihistamine (diphenhydramine hydrochloride). For anaphylactic shock, give epinephrine.
• Food allergies involve an abnormal immune response caused by exposure to a particular food protein.
• IgE-mediated or cell-mediated Type I hypersensitivity is involved.
• Signs and symptoms include urticaria, angioedema, flushing, and pruritus.
• Significant signs and symptoms may require epinephrine auto-injector and an anaphylaxis plan.
• Common food allergies include peanuts, egg whites, milk, wheat, soy, seafood, and tree nuts.
• Assess for hives, swelling, vomiting, and atopic dermatitis.

Stinging Insect Hypersensitivity

• Can result in a serum sickness reaction.
• Therapeutic management includes immunotherapy, extract venom, epinephrine, and ice at the site to minimize venom absorption.

Lyme Disease

• A tickborne illness.
• Signs and symptoms include a "bulls-eye rash," fever, fatigue, muscle aches, and a red bump.
• The incubation period is 3-30 days.
• Not communicable from person to person.
• There is no active vaccine.
• Passive immunity is achieved through immune globulin.
• Causative Agent: Borrelia burgdorferi (spirochete).
• Stages:
  • Stage 1 (erythema migrans).
  • Stage 2 (flu-like syndrome, heart block, meningitis [7th cranial nerve || facial nerve]).
  • Stage 3 (Lyme arthritis).
• Diagnosis is through enzyme-linked immunosorbent assay || “EIISA.”
• For symptomatic children, treatment involves amoxicillin.

Helminthic Infections

Roundworms (Ascariasis)

• Patients experience malnutrition and gastrointestinal signs and symptoms.

• The incubation period is 8 weeks.

• Assess the patient's travel history.

• Where do parasites live: The intestinal tract

• Signs and symptoms include nausea, vomiting, intestinal obstruction, and anemia.

• Prevention involves the sanitary disposal of feces to prevent contamination.

• Treatment: Albendazole, Mebendazole, or pyrantel pamoate, with therapy for anemia if needed.

Hookworms

• Common in children living in areas with poor sanitation and a tropical climate.
• Often found in human feces.
• Where do parasites live: The intestinal villi, where they suck blood from the intestinal wall.
• Signs and symptoms include abdominal pain, nausea, diarrhea, and eosinophilia (4-6 weeks after exposure).
• Treatment: Albendazole, Mebendazole, or pyrantel pamoate, with additional therapy for anemia.

Enterobiasis (Pinworms)

• Where do parasites live: The cecum

• Signs and symptoms include anal itching; children may awaken crying and scratch the area.

• Diagnosis is made with cellophane tape against the anus, followed by microscopic inspection.

• Treatment: Albendazole, Mebendazole, or pyrantel pamoate. Educate children to avoid nail-biting and promote proper hand hygiene.

Sickle Cell Anemia

• An autosomal recessive inherited disorder carried on the beta chain of hemoglobin.
• Characterized by elongated and crescent-shaped cells (sickle), low blood pH (acidosis), acute pain, and cell destruction.
• Diagnosed prenatally through chronic villi sampling or cord blood during amniocentesis.
• Sickle Cell Crisis: Sudden severe onset of sickling causing tissue hypoxia beyond the blockage, dehydration, and respiratory infections (decreased oxygen exchange). Hemoglobin will be at 6-8g.
• Serious complications include aseptic necrosis (severe joint pain), stroke (artery blockage), and kidney issues (blood in urine or flank pain).
• Types of Crisis:
  • Sequestration: Spleen or liver traps sickled cells leading to anemia and shock.
  • Hyperhemolytic: Folic acid or Vitamin B deficiency leads to poor RBC production.
  • Aplastic: Temporary stoppage of red blood cell production triggered by infection or anemia.
• Assessment: In a child of 6 months: fever, anemia, hand-foot syndrome (swelling), swollen abdomen. Monitor for infections like pneumonia or meningitis. Assess the liver for cirrhosis, vision loss, and priapism.
• Therapeutic Management: Pain relief (morphine, acetaminophen), hydration (IV fluids), oxygen (helps hypoxia), electrolyte replacement, antibiotics, blood transfusion, Medication (Hydroxyurea), stem cell transplant, exchange transfusion
• Avoid IV potassium.

Disseminated Intravascular Coagulation (DIC)

• A blood clotting disorder from excessive trauma or acute infection.
• Signs and symptoms include petechiae, uncontrolled bleeding from puncture sites (injection/IV), and ecchymoses. Monitor for increased bleeding.

Hemophilia A/B/C

Hemophilia A

• Deficit of coagulation factor VIII (antihemophilic), sex-linked recessive trait.
• The blood still clots, just takes much longer than normal.
• Assessment includes heavily bruised lower extremities, excessive bleeding during circumcision, soft tissue bleeding, and painful hemorrhage into joints (swollen/warm), hemarthrosis.
• Therapeutic Management: Transfusion, desmopressin, aminocaproic acid, Factor IX concentrate (Proplex/Konyne).

Hemophilia B

• "Christmas Disease" || IX deficit, sex-linked recessive trait.
• Treatment: Concentrate of IX (available for home administration).

Hemophilia C

• XI deficit (plasma thromboplastin antecedent deficit), autosomal recessive trait.
• Signs and symptoms: Bleeding episodes.
• Treatment: Desmopressin, transfusion (blood/plasma).

Celiac Disease

• Immune-mediated abnormal response to gluten, a protein in wheat related to proteins in rye, barley, and oats.
• When kids ingest gluten, the villi of the small intestines prevent the absorption of foods, so if undiagnosed, children may develop steatorrhea (bulky, foul-smelling, fatty stools) which can lead to malnutrition and failure to thrive for the child
• Individuals with a higher predisposition may have Diabetes Mellitus type 1, IgA deficiency, or Down syndrome.
• Assessment: Look for signs of poor growth, bulky stools, malnutrition, distended abdomen, and anemia.
• Diagnosis involves serum analysis of antibodies against gluten and biopsies of the small intestinal mucosa (endoscopy).
• Therapeutic Management: Gluten-free diet.

Cleft Lip/Palate

• A disorder affecting the structure of the face and oral cavity.
• Parents should be referred for genetic counseling.
• Cleft palate involves the opening of the palate, occurring when the palatal process does not close as usual (around 9-12 weeks).
• Assessment: Can be detected by a sonogram, apparent on inspection of the mouth, and assess for congenital anomalies.
• Therapeutic Management: If the infant is still in utero, fetal surgery can repair the condition. After birth, it can be repaired surgically at the time of the initial hospital stay. Deviation of the lip interferes with sucking.

Crohn's Disease

• Can affect any part of the GI tract from the mouth to the anus.
• Symptoms depend on the severity and location of the inflammation.
• Signs and symptoms include abdominal pain, diarrhea (with or without blood), and weight loss.
• Treatment: Oral/IV medications, surgery (remove strictures or repair fistulae).
• Monitor for malnutrition and vitamin/iron deficit.
• Assessment: Diarrhea, steatorrhea, unabsorbed fluid, inflamed portions, blood in the stool, weight loss, and growth failure.
• Therapeutic Management: Oral medications, correct vitamin/mineral deficits, bowel rest, and enteral/total parenteral nutrition.
  • Diet after resting period: High protein, high-carb, and high vitamin to replace nutrients.
  • Medications include corticosteroids, infliximab, and mesalamine.

Pyloric Stenosis

• Condition where the muscle around the stomach's exit (pyloric sphincter) becomes too thick due to hypertrophy (enlargement) or hyperplasia (increased cell growth), blocking food from passing from the stomach to the small intestine,

• Assessment: 4-6 week infant (vomiting after each feeding; smelly & projectile vomit), dry mouth, sunken fontanelles, fever, decreased urine output, poor skin turgor, weight loss

• Physical exam (firm round "olive-sized” mass in the epigastrium, visible gastric peristaltic waves moving left to right w/infants drinking)

• Monitor for metabolic imbalance. Alkalosis can lead to hypokalemia and hypopnea (slow breathing). The body compensating for the imbalance may cause tetany (muscle spasms).

• Less common in breast/chest-fed infants than formula-fed infants

• Diagnostic test: Ultrasound and endoscopy

• Therapeutic management: IV fluid therapy, pyloromyotomy (monitor for infections due to the incision located near the diaper area).

Diarrhea and Dehydration

Diarrhea

• Acute: usually associated with infection. If chronic, it is more related to malabsorption or inflammatory causes. Infants experience sudden lossof water. Breastfeeding help prevent diarrhea
• Mild: Occurs along w normal & diarrheal stool characteristics, also w/irritability, maybe fever, lose watery bowel movement times day
• Severe: Leads to dehydration and hospitilaztion, fever, weak pulse respirations pale and cool skin, lethargic, sunken eyes

Dehydration

• Excessive loss of fluid
• Isotonic dehydration: water and salt loss in equal amounts, leads to lower blood volume/dehydration
• Hypertonic Dehydration: More water loss than salt, making blood more concentrated, extreme thirst, lethargic behavior, warm skin
• Hypotonic Dehydration: More salt loss, excessive urination, causes vomiting, moderate thirst.

Hepatitis A/B/C/D/E

• Inflammation and infection of liver
• Fever, dark urine, pain, pale stools
• Vaccinations for hepatitis, newborn, breastfeeding, avoid contat.

Hepatitis A

• Causative agent: hepatitis A virus (HAV)
• 25 day incubation period
• Ingention spreading

Hepatitis B

Causative hepatitis B and virus, Transfusions. Transision/injection spread

Hepatitis C

• single strain RNA. Mother/Fetal transfer

Cerebral Palsey

• Nonprogressive, results in motor dysfunction
• Genetic
• Causes: Abnormal brain development.
• Assessment: Vision problems, speech issues, attention deficit

Meningitis

• Infection of the cerebral meninges, Cause: Infection of cerebral meninges

Neural Tube Disorders

• Malformation
• Types; Spina Bifida and etc

Anencephaly

• Severe malform/ absence of the cerbral harmaphsere
• Elevated MFAP diagnosis

Microcephaly

• Brain is developed

Encephalocele

• Brain tissue

Seizure Disorders

Absence Seizures

• Seizures in newborns, infats

Amblyopia

• Condition where or eyes, donr dvelop a proper vision

Otitis Media

• Inflammation of the middle ear