Exam 2 Peds PDF

Exam 2 Peds 1. Know the recommended options for a child with a common cold and dry nasal passages. Viral rhinosinusitis is also called the common cold. Management involves: supportive care, saline nose drops, and humidifier. Common viruses associated with viral sinusitis are rhinovirus, Influenza...

Exam 2 Peds 1. Know the recommended options for a child with a common cold and dry nasal passages. Viral rhinosinusitis is also called the common cold. Management involves: supportive care, saline nose drops, and humidifier. Common viruses associated with viral sinusitis are rhinovirus, Influenza A and B, parainfluenza virus, RSV, and adeno, corona and enteroviruses. 2. Know the recommended treatment for a child with bacterial rhinosinusitis. The child with bacterial rhinosinusitis is treated with antibiotics. First line treatment includes Amoxicillin or Amoxicillin Clavulanate. If allergies to PCN then use Levofloxacin or Clindamycin plus Cefixime Bacterial rhinosinusitis s/s: Periorbital edema; sinus pain; clear, mucoid, or purulent discharge Halitosis, erythematous oropharynx with drainage, nasal quality of speech, cough (wet or dry). Common bacterial organisms associated with bacterial sinusitis in children is S. pneumoniae, Haemophilus influenzae and S. aureus. 3. Know what names croup in children are called. Laryngotracheobronchitis- an inflammatory condition resulting in laryngeal and subglottic swelling. Occurs in younger children; can lead to significant airway obstruction. Parainfluenza virus is the most common pathogen (for 75% of cases), RSV, and other common resp. Viruses. s/s: Hoarseness; inspiratory stridor; barking or brassy cough; suprasternal, supraclavicular, and substernal retractions. Tachypnea; coarse crackles; wheeze or rhonchi on expiration. tx: involves supportive care, nebulized racemic epinephrine, or in moderate to severe cases use prednisolone (Oralpred 0.1 to 2mg/kg/day in divided doses 1 to 4 times a day). 4. Know signs and symptoms of epiglottitis. s/s: tripod sitting, muffled voice or cry, trismus, dysphagia, drooling, cyanosis, retractions, stridor, high fever, sore throat, hoarse voice Life-threatening infection. Swelling results in airway obstruction. In children, epiglottitis is usually caused by the bacteria Haemophilusinfluenzae (H influenzae) type B. Do not attempt to inspect the oropharynx; use a tongue depressor or elicit a gag reflex. TX: Provide 100% oxygen by blow-by. Intubation occurs in the operating room. Administer ceftriaxone or amoxicillin/clavulanate. 5. Know the first line treatment for Pertussis. Treatment of pertussis is largely supportive: including oxygen, suctioning, hydration, and avoidance of respiratory irritants. Parenteral nutrition may be necessary as the disease tends to have a prolonged course.  Exam 2 Peds ABX: Macrolides: Erythromycin, Azithromycin, clarithromycin 6. Know what the physical exam of a child with pharyngitis/tonsillitis. PE: findings - Fever; erythema of the mouth, tongue, tonsils; petechiae on palate; enlarged tonsils; cervical lymphadenopathy Pharyngitis, inflammation of pharynx; tonsillitis, inflammation of the tonsils. Cause of pharyngitis is often group A ß-hemolytic streptococcus (GABHS). Untreated GABHS may lead to acute rheumatic fever or glomerulonephritis. For positive GABHS, Penicillin is first-line treatment. If PCN allergy and not anaphylactic, an Alternative is Cephalexin and Cefadroxil. Use Clindamycin or Azithromycin if there is a known PCN anaphylactic allergy. 7. Know what about mononucleosis in children. - Caused by Epstein-Barr virus (EBV). Systemic infection, affecting every organ system. Usually lasts 2 to 3 weeks. Spread via saliva. - PE: Fever, eyelid edema, injected pharynx and tonsils, tender posterior or cervical lymphadenopathy, hepatomegaly, splenomegaly - If suspected perform a CBC with diff, AST and ALT, Monospot count, EBV serology (Positive rapid mononuclear heterophile testing) TX: Supportive care with rest, avoid activity, corticosteroids - If the child is > 5 and in sports, keep the child out of sports until infection resolves and physical findings are negative. - 8. Know infectious respiratory disorders versus noninfectious. Noninfectious: Asthma, CF, CPAM, BRUE, Pneumothorax, Sleep Apnea Infectious: Pertussis, PNA, Bronchioloitis, TB, common cold 9. Know how an APRN should manage a child with a foreign body of nose. Soft or smooth foreign bodies may be expelled by occluding the opposite naris and having the child blow the nose. Positive pressure from parent’s mouth to child’s mouth has also been successfully used. 10. Know how and why epistaxis in children present (2 questions). Common and self-limiting. Determine blood pressure and pulse. Check for an unusual presence or number of petechiae or bruises. Caused by: local trauma from digital manipulation, mucosal drying and crusting, or local inflammation from an upper respiratory infection.  Exam 2 Peds Treatment: Elevate head of bed; have child gently blow nose to expel clots. Apply pressure by pinching the nostrils without interruption for 5 to 10 minutes. If the bleeding does not stop, apply a topical decongestant and hold pressure as before. If bleed site identified, cauterize. Recurrent epistaxis: Cochrane review (Calder N, Kang S, Fraser L, et al., 2009) in children shows no difference in effectiveness between antiseptic nasal cream, petroleum jelly, silver nitrate cautery, or no treatment. Silver nitrate cautery followed by 4 weeks of antiseptic cream may be better than antiseptic cream alone. 11. Know the first line treatment for community acquired pneumonia in a young child. If bacterial pneumonia suspected Amoxicillin/Amoxicillin Clavulanate is the first line for community-acquired pneumonia; If bacterial pneumonia suspected Amoxicillin/Amoxicillin Clavulanate is the first line for community-acquired pneumonia; Macrolides if atypical or suspect mycoplasma pneumonia (more common in school age child); maintain hydration. 12. Know the symptoms of TB in children and the risk factors for TB in children (2 questions). - Caused by: Mycobacterium tuberculosis (AFB) or bovis - Pediatric TB should be regarded as a spectrum of exposure through infection to disease because progression from an infected person (exposure) to infection and disease can occur much faster (within 1 to 6 months) in children 3 years old should have their BP measured at least once a year. Children with increased risk for hypertension should have their BP measured at every health care encounter. Children 3 years of age or prior if patient history requires. –Defined as SBP or DBP ≥95th percentile on repeated measurements Elevated BP: 1 to 13 year-old: SBP and/or DBP readings that are ≥90th but