Practice Peds Exam 2

Intracranial Pressure (ICP)

• Sudden onset headache and vomiting in the morning are potential warnings of increasing ICP
• High ICP leads to brain herniation and death if not managed quickly
• Causes include: bleeding (low INR), tumors, anything increasing cranium pressure
• Mechanism: swelling pushes medulla into C1/C2, compressing it, causing breathing/heartbeat cessation
• Symptoms: headaches, nausea, vomiting (body's pressure reduction attempt), hypertension
• Treatment: elevate head of bed

Child vs. Adult Neuro Systems

• Child development: Rapid brain development, myelin sheath formation needs whole milk until age 2
• Fontanelles: Anterior fontanelles close by 18 months
• ICP risk (children): Risk of ICP after falls is prominent after 18 months due to skull closure
• Neurological impairments: Conditions like ???? lead to bowel/bladder dysfunction and inability to walk
• Skull sutures: Do NOT need to memorize skull sutures
• Craniosynostosis: Sutures close prematurely, leading to head deformation
• Deformational plagiocephaly: Flat back of the head, potentially from prolonged positioning
• Microcephaly: Cognitive impairments, head circumference significantly below normal
• Hydrocephalus: CSF buildup in the brain; no bulging or firmness; sunken head indicates dehydration in babies; treatment is VP shunt (measuring head/abdomen circumference to ensure appropriate functioning)
• Intracranial Arteriovenous malformations (AVMs): Abnormal connections between arteries and veins
• Meningitis: Viral/bacterial infection; potential sepsis, different treatments depending on type (Viral is self-limiting, Bacterial: antibiotics, isolation precautions, life-threatening)
• Kernig/other sign: Specific meningitis symptoms (look for the full detail)
• Reye Syndrome: Rare multi-organ failure; avoid aspirin in young children
• Encephalitis: Inflammation of meninges (viral); seizure precautions
• Seizures: Electrical disturbances; focal (one spot), generalized (whole brain), status epilepticus (seizure longer than 5 minutes requires intervention)
• Epilepsy: Two unprovoked seizures more than 24 hours apart; vagal nerve stimulator used if medication is ineffective
• Seizure Precautions: Don’t put hands in mouth; intermittent suction; side rails up
• Status Epilepticus: Urgent action; IV fluids, oxygen, IV meds (lorazepam, diazepam)
• Febrile Seizures: Common in children under 7; due to high temperature; self-limiting; EEG for diagnostic testing
• Antiepileptic Medications: Carbamazepine is example
• Head Trauma: Glasgow Coma Scale (GCS) used for head injury severity; 8 or lower needs intubation. Observe for posturing (decorticate)
• Headaches: Keep headache journals (children) to determine the cause, Abortive medicines are taken during headache onset
• Eye disorders: Nystagmus (abnormal eye movement) and strabismus (cross-eye): occlusion therapy for strabismus
• Nasolacrimal Duct Obstruction: Fluid buildup in tear duct region (self-limiting, redness, conjunctivitis)
• Periorbital Cellulitis: Eyelid/tissue infection; very serious; IV antibiotics and hospitalization; blindness is possible without treatment; facial infections increase likelihood
• Hearing Deficits: Suspect hearing loss at 6 months if no startle response/verbal stimuli response

Respiratory

• Respiratory failure: Quick onset in pediatrics; assess rate, rhythm, pain, contractions, cough
• Assessment: Lung sounds (wheeze, stridor, crackles); odors (breath, mucus); mucus characteristics (color, consistency); positioning (head of bed elevation)
• Croup Disorders: Laryngotracheobronchitis (viral, common): steroids, fluids, racemic epinephrine; Spasmodic Laryngitis (not seen after age 8, viral, self-limiting, cool mist)
• Epiglottitis: Bacterial infection; airway obstruction; medical emergency (tripod positioning, drooling, "croaking," steeple sign on x-rays); immediate intubation and antibiotics
• Pertussis (Whooping Cough): Prolonged duration; starts like a cold-like infection then progresses to coughing fits
• Pneumonia: Lower airway infection/inflammation (bacterial or viral); fever, tachypnea, cough, nausea, vomiting, irritability, lethargy; antibiotics if bacterial; monitor respiratory distress
• RSV Bronchiolitis: Respiratory symptoms get worse after 2 days, congestion
• Asthma: Airway inflammation; prioritize medications, triggers, education; peak-flow meter
• Cystic Fibrosis: Genetic; thick, sticky mucus in lungs; manifestations; pancreatic enzymes
• Acid-Base Imbalances: Understand pH scale, blood pH range (7.35-7.45); respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis
• Foreign body aspirations: Small objects obstruct airway; symptoms of silent cough, dyspnea, stridor, hoarseness.

Cardiac

• Newborn blood pressure (BP) and heart rate (HR): 65-85/45-55 mmHg and 110-160 bpm respectively (0-3 months)
• Prostaglandin E: Relaxes smooth muscle; used to keep patent ductus arteriosus open
• Indomethacin: Inhibits prostaglandins used to close PDA
• Inotropes: Alters force/strength or slows rate of contractions to improve CO
• Conditions with heart: Increased/decreased pulmonary blood flow, obstruction to systemic blood flow, mixed flow
• Increased pulmonary blood flow: Arterial septal defect (ASD), Ventricular septal defect (VSD)
• Decreased pulmonary blood flow: Pulmonic stenosis, Tetralogy of Fallot (cyanosis, knee-to-chest/squat position for tet spell); antibiotics preemptively before dental cleaning
• Obstruction to systemic blood flow: Coarctation of the aorta (increased upper extremity BP, decreased lower extremity BP—diminished pules in the feet, cap refill delay in feet, poor feet color)
• Mixed flow: Transposition of the great arteries (extreme cyanosis – immediate surgical intervention)
• Heart Failure Interventions: Maintain oxygenation and CO; cardiac glycosides (digoxin); monitor apical pulse (infant HR needs to be 90 or higher before administration)
• Rheumatic fever: Autoimmune response to untreated infections (strep, scarlet fever)- inflammation of joints, skin, and heart; possible valve replacement (pig valve, usually mitral valve.)
• Kawasaki Disease: Inflammation of vessel walls, leading to aneurysms, heart attacks; autoimmune; IVIG therapy, aspirin; strawberry tongue, body rash, skin peeling; high risk of death in acute stage

Pediatric Fluids

• Fluid needs: 100ml/kg/day first 10kg, 50ml/kg/day second 10, 20 ml/day for every kg over 20. Example calculations for different weights

Skin

• Infant skin: Thicker, greater body surface area than adults

• Skin integrity promotion: Preventing infection, promoting comfort, and wound care

• Impetigo: Staph aureus infection (Bullous vs. Non-bullous); topical antibiotics

• Folliculitis: Staph aureus infection; topical antibiotics

• Cellulitis: Infection in skin and tissues requiring oral/IV antibiotics

• Measles: Highly contagious viral infection; droplet precautions; Koplik spots

• Mumps: Self-limiting viral infection; parotid swelling, potentially airway issues; MMR

• Rubella: MMR vaccination; pregnant women needs to avoid contact to prevent congenital rubella syndrome.

• Varicella (Chickenpox): Contagious herpes virus until all lesions are crusted; can reactivate as shingles

• Contact dermatitis (irritant/allergic): Manage exposure from irritant; treat with topical/oral corticosteroids, antihistamines

• Erythema Multiforme: Hypersensitivity reaction

• Urticaria (Hives): Self-limiting; antihistamines

• Infestations (lice/scabies): Treatment with permethrin; family treatment to prevent res infection; hygiene measures

Burns

• Burn classification: Superficial, superficial partial-thickness, deep partial-thickness, full-thickness
• Body surface area (BSA) percentages: 9% for head, arms, chest/back, each leg; 1% for groin

Nursing Interventions for Burns

• Promoting wound healing: Change dressings; silver impregnated dressings
• Prevent infection: Tetanus vaccination.
• Psychosocial support: Important for affected individuals
• Monitor urine output: Important for fluid management