Pediatric Healthcare Notes PDF

Pediatrics 3 H’s of peds on why they code Hypoxia Hypothermia Hypoglycemia Symptoms of hypoxia Difficulty eating, sternal retractions, nares flaring Urinary output Infants and children should be 1-2 mL/kg/hr Vaccines No LIVE vaccines for immunocompromised children Varicell...

Pediatrics 3 H’s of peds on why they code Hypoxia Hypothermia Hypoglycemia Symptoms of hypoxia Difficulty eating, sternal retractions, nares flaring Urinary output Infants and children should be 1-2 mL/kg/hr Vaccines No LIVE vaccines for immunocompromised children Varicella-zoster Measles/mumps/rubella Rotavirus Yellow fever Immunizations Ask if pt has an allergy to eggs before flu shot and MMR vaccine Child can still receive immunizations if they have a cold Children with HIV: avoid Polio and Varicella vaccinations (live). Can still get pneumococcal and influenza Avoid MMR only if the child is severely immunocompromised Varicella (Chickenpox) Viral disease that cause itchy skin lesions Airborne precautions; Spread by direct contact & droplet Meds: acyclovir, analgesic, antihistamine Rubeola (Measles) High contagious viral disease characterized by rash, Koplik’s spots (lesions in the mouth), photophobia Airborne precautions “10 day measles” NI: bed rest, encourage fluids, ensure pt has short nails (protect skin), antipyretics, keep skin moist with prescribed lotion Rubella (German Measles) Viral disease characterized by rash that starts on face and spreads, low grade fever, sore throat, enlarged lymph nodes Droplet precautions “3 day measles” NI: keep infected pt away from pregnant women as they are a risk to the fetus Pertussis (Whooping Cough) Infectious respiratory disease characterized by uncontrollable coughing, respiratory distress, cyanosis, exhaustion Droplet precautions NI: Abx, oxygen and suction as needed Neutropenic Precautions Wash hands often Avoid contact with sick people, those recently vaccinated, and large crowds No milk, yogurt (live cultures), fresh fruit, or vegetables Lead poisoning Assess if child lives in a home built before the 1950’s Elevated blood lead levels >5 mcg/dL requires follow-up blood work Chelatin therapy given if blood lead levels are high  Pediatrics Ears Pull pinna down and back for kids < 3 years old when putting in eardrops Otitis Media Infection of the middle ear To prevent: Feed upright, breastfeed for first 6 months, immunizations S/sx: fever, child may pull ear, enlarged lymph nodes, discharge from ear NI: abx, reduce body temp through tepid bath, position child on affected side, may need tympanostomy tubes placed Lice S/sx: itchy scalp, irritability, red bumps on affected areas NI: Use PPE to assess scalp, behind ears, base of neck, and crown of head for lice, use Wood’s lamp (black light) to find lice, apply pediculicide shampoo, comb hair with nit comb, change linen and clothes daily Impetigo Red sores around nose and mouth caused by bacteria (typically staphylococcus). Sores rupture, ooze, then turn yellow-brown Risk: children aged 2-5, close contact with others, warm/humid weather NI: Contact precautions, keep sores open to air, abx (topic and oral), promote proper hygiene Cleft Lip/Palate Pt born with opening in roof of mouth and/or lip due to failure of bone/soft tissue to fuse ESSR Cleft lip repair done at 3-6 months; cleft palate repair E Enlarge Nipple done 6-24 months S Stimulate infant to suck Pt at risk for otitis media and speech impairment S Swallow NI: promote family bonding and grieving, teach family R Rest surgery is available, assist with feeding using ESSR, bulb syringe at bedside to remove oral secretions Esophageal Atresia with Traceoesophageal Fistula Congenital abnormality in which the esophagus does not fully develop 3 C’s of TEF - coughing, choking, cyanosis; also causes excess salivation Surgical emergency NI: NPO, IV fluids, gastrostomy tube care, suction, give pacifier to promote developmental needs Post op- monitor for dysphagia, drooling, regurgitated food Pyloric Stenosis Swelling of the pylori (muscle b/w stomach and intestines) that occurs between birth - 6 months. Causes forceful vomiting → dehydration Treated with surgery - pyloromyotomy Intussusception Part of intestine telescopes inside another, resulting in partial or complete obstruction S/sx: abd pain (raises legs up to abd), currant jelly stools, sausage shaped mass in RUQ, vomiting NI: assess for shock and perforation, IV fluids, barium enema, I&O’s Hirschsprung’s Disease Absence of ganglion cells in colon and rectum → S/sx Perforation peristalsis → obstruction S/sx: no meconium within 24 hrs after birth, vomiting distended abd, constipation, ribbonlike stools increased abd pain (older children) abd distention Pre-op: bowel cleansing, measure abd girth, cyanosis assess for perforation dyspnea Post-op: Teach family temporary colostomy care  Pediatrics Reye Syndrome Disorder that causes severe encephalopathy and hepatic dysfunction Causes: pt recovering from viral infection (flu or chickenpox), aspirin use S/sx: lethargy, n/v, diarrhea, confusion NI: neuro assessment, give mannitol (if prescribed), I&O’s HIV Children born from HIV positive mothers should be given antiretroviral treatment Source of infection: perinatal transmission, breast milk, HIV infected blood procedures, sexual abuse Sickle Cell Anemia Main interventions: fluids and pain relief Leukemia Cancer of the blood or bone marrow May cause epistaxis (d/t low platelets), hyperplastic gums (overgrowth of gum tissue around teeth), increase in WBC count, weakness Hemophilia X linked recessive disorder characterized by the inability to form clots S/sx: increased bleeding, bruising, epistaxis, blood in stool or urine NI: assess for bleeding, administer clotting factors Von Willebrand disease Genetic bleeding disorder that inhibits coagulation d/t low levels of von Willebrand factor S/sx: bleeding of mucus membranes, epistaxis, heavy menstrual bleeding Epiglotitis Medical emergency that causes airway obstruction Tripod Do NOT examine throat (can lead to spasm → obstruction) Position S/sx: fever, barking cough, dysphagia, drooling, restlessness, Sitting upright child assumes tripod position with chin out, NI: maintain airway, do not leave child alone, keep pt in tongue protruding upright position, cool mist O2, prepare for intubation/trach, IV abx, do NOT measure oral temp Bronchiolitis Respiratory virus typically caused by RSV that is characterized by thick secretions S/sx: cough, rhinorrhea, congestion, tachypnea, wheezing Teach parents to use saline nose drops and suction nares with bulb syringe NI: Contact isolation, monitor respiratory status, suction airway with bulb syringe, O2 as needed, oral and IV fluids Cystic Fibrosis Autosomal recessive disorder that causes secretions to be thicker and stickier CF severely damages the lungs, digestive system, and reproductive system d/t thick mucus causing obstruction Typically occurs in white infant or children S/sx: recurrent respiratory infx, pulmonary congestion meconium ileus at birth, steatorrhea (excessive fat, greasy stools), bad smelling bulky stools, skin that tastes salty NI: monitor respiratory status, IV abx, pancreatic enzymes (take with food), fat-soluble vitamins (ADEK), respiratory treatments: oxygen, nebulizer, vest, teach pt they will need a diet high in calories, protein, mod-high fat, low carbs, exercise  Pediatrics Congestive Heart Failure (CHF) Heart is unable to meet the demand’s of the body S/sx: SOB, tachypnea, cyanosis, weight gain & edema, difficulty feeding, hepatomegaly NI: daily weights, vital signs, elevate HOB, O2 as needed, diuretics and digoxin as prescribed, I&O’s, low sodium and/or fluid restriction Weigh pt daily at the same time and on the same scale Cyanotic Heart Disease Acyanotic Heart Disease Cyanotic Acyanotic Unoxygenated blood enters Oxygenated blood enters systemic systemic circulation circulation Both acyanotic and cyanotic have abnormal circulation. Kawasaki Disease Systemic vasculitis that causes damage to vessels, mucus membranes, lymph nodes, and skin S/sx: Strawberry tongue, rash on trunk and genitals, redness or peeling of hands/feet, high fever, n/v, joint pain NI: administer IVIG and aspirin, antipyretics, I&O’s, mouth care, place cool compresses and lotion on skin Rheumatic Fever Inflammatory disease that affects the tissues of the heart, blood vessels, joints, and skin Occurs weeks after untreated strep throat or scarlet fever Ask parents if the child was recently sick S/sx: SOB, chest pain, fever, migratory joint pain, chorea (irregular involuntary movements), rash, subcutaneous nodules over bony prominences NI: abx, aspirin (for anti-inflammatory and anticoagulation), bed rest, vital signs  Pediatrics Cerebral Palsy Irreversible disorder that causes neuromuscular issues of dyskinesia (involuntary movements) or spasticity S/sx: involuntary movements, poor sucking, abnormal posture, scissoring of legs, seizures, delayed developmental milestones NI: PT/OT/ST, place pt in upright position when eating (prevent aspiration), provide support to family, anticonvulsant meds, diazepam (muscle spasms) Hydrocephalus Abnromal buildup of CSF within the ventricles in the brain → pressure on brain tissue Toddlers and children show signs of ICP: increased BP, Increased Shock decreased HR ICP vs Increased ICP is the opposite of shock Decreased HR Increased HR Infants with increased ICP: enlarged head Increased BP Decreased BP circumference, lethargy, irritability, bulging fontanels, sunset eyes, widening suture lines S/sx: irritability, change in LOC, waking up w/headache, vomiting, unequal pupil size, seizures NI: assess pt’s baseline data to compare new s/sx of ICP, seizure precautions, elevate HOB, prep for ventricular shunt placement (drains excess fluid) Spina Bifida Neural tube defect that occurs when the spinal cord fails to form properly Prevention: teach women in childbearing years to take minimum 400 mcg folic acid daily S/sx: dimple at base of spine, presence of sac on lumbar, flaccid paralysis NI: screen pt for latex allergy Post-op: teach family and pt (if applicable) to self catheterization, give continence meds, high fiber diet, increased fluids, assess skin integrity, ROM exercises Hypospadias Opening of urethra is located on the ventral side of the penis, not the tip S/sx: altered voiding stream, undescended testes, inguinal hernia NI: surgery needed, monitor urinary drainage post op, IV fluids, teach family home care for catheterization Infant Feeding Regimen Breastfeed from birth - 6 months Introduce solid foods b/w 4-6 months Wait 5-7 days after introducing new foods to assess for allergic reactions Cow’s milk ok to give at 1 year old Nutrition Notes Do NOT give honey to pts under 1 years old. They are at risk for botulism Look out for questions regarding how much milk they are drinking (more than 3-4 cups/day). Too much milk reduces the amount of iron they intake so watch for anemia. Patients with PKU cannot break down phenylalanine. Avoid high protein foods - meat, dairy, nuts, legumes. Do NOT give them aspartame. Additional Notes: Normal urine output for infants and children is 1-2 mL/kg/hr The usage of ipecac for poison removal is no longer recommended by the American Academy of Pediatrics. The nurse should teach parents to not induce vomiting, as it may be more harmful Do NOT use tongue blade during a seizure, as it can damage oral cavity