Pediatric Nursing PDF
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Centro Escolar University
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Summary
These notes cover pediatric nursing topics. They discuss various conditions such as increased intracranial pressure (ICP), seizures, meningitis, and head trauma, providing details on signs, symptoms, and management.
Full Transcript
- Head to To e - CUSHING'S FRIAD - WIDENED PULSE PRESSURE - BulbINd FONTANELS - ↑ /(P = ↑IOP = blindness PEDIATRI...
- Head to To e - CUSHING'S FRIAD - WIDENED PULSE PRESSURE - BulbINd FONTANELS - ↑ /(P = ↑IOP = blindness PEDIATRIC NURSING CEPHALOCAUDAL Neurologic Disorders of the pedia Increased ICP (Intracranial pressure): normal (5-15mmhg) - Cushing’s Triad (hypertension, bradycardia, bradypnea) - widened pulse pressure - subtraction Shock Triad Normal: 30-40 · SIGNS&SYMPTOMS YOUNG CHILDREN EARLY SIGNS OF INCREASED ICP Infant - High pitched cry moti BULGING FONTANELS AGGREVATED By GRYING · CRYING- MINIMIZE - Anterior: diamond - CLOSES 12-18 mrs Child - Irritability/ agitation - Posterior: triangular -CLOSES 2-3 mos Adult - Restlessness High pitched cry/shrill cry: Early Sign Geria - Confusion Increased head circumference: tape measure on bed side Headache: Initial sign Projectile vomiting: medulla - CTZ (Chemoreceptor trigger zone: vomiting center)- cerebral edema Diplopia (double vision): inc ICP = inc IOP - Optic nerve damage - blurring of vision - blindness Pupillary changes: PERRLA (Pupil Equally Round and Reactive to Light And Accommodation) - anisocoria - uneven pupils - brain damage 00 - dilated - shock 00 - constricted - narcotic overdose 00 Sunset eyes # Anorexia, nausea, weight loss Seizures - inc neuronal firing - erratic transmission of electrical impulses - vomiting - dec fluid levels - DHN - inc temp - convulsions (seizures) MANAGEMENT: position: semi fowlers (head over bed) - dec ICP by use of gravity 1. Na = H2O follows 2. Inc fluid = Inc pressure Coughing and sneezing is avoided limit fluid intake 1,200-1,500ml/day PHARMACOTHERAPY Diuretics - K-wasting - Hypokalemia - Lasix - loop - loop of henle (localized) - Mannitol - osmotic - osmosis: pulling (generalized) Decadron (dexamethasone) - prevent cerebral edema Anticonvulsants: prevent seizure episodes Antacids: neutralize acidity - stress level - use of decadron - Mg: diarrhea - Mg TAE - Al: consiptipation - Al ang TAE Anticoagulants: prevents clumping of blood - Heparin: IV/SubQ - ptt (partial thromboplastin time) - warfarin: oral - pt (prothrombin time) *** REMEMBER: Opiates and Sedatives are C/I in inc ICP *Cushing’s Triad (hyper brady brady) *o SEIZURE DISORDER/EPILEPSY - erratic transmission of electrical impulses TYPES: 1. Grand Mal (generalized) tonic (mild) - clonic (severe): “during”- dyspnea, salivation, urination (flat/ supine - protect the head) Post ictal (exhaustion): “after” (side lying/recovery) 2. Petite Mal/Absent blank facial expression, automatisms, lips smacking 3. Jacksonian tonic-clonic of a group of muscle - grand mal seizure 4. Psychomotor mental clouding and intoxication 5. Febrile (common in pedia) under 5 38.5 - 39 - 40C 6. Status Epilepticus last for 30 mins / on&off, tuloy tuloy Brain damage could occur MANAGEMENT: Hydantoin: Phenytoin ***WOF: Gingival hyperplasia (soft bristled toothbrush/ meticulous oral care)/ pinkish red urine (inform SO/significant other) Benzodiazepines: “pam/lam” - minimizes seizure episodes Iminostilbenes: carbamazepine (refractory seizures) - prevent seizure reoccurrence Valproates: valproic acid (last resort) ***hepatotoxicity ***never given in pregnancy: cause NTD’s (neural tube defects) 1st semester - organogenesis SURGERY: Neurectomy: surgical resection of he cranial nerve involve in the seizure BACTERIAL MENINGITIS Infection of the meninges (supports and nourishes the brain) - rigidity DIAGNOSTICS: Lumbar puncture: L3, L4, L5 (position: C-shape/Fetal/Kneechest: genupectoral) - CSF analysis - COLOR: CLEAR CSF Analysis: Meningitis - cloudy - elevated WBC - elevated CHON (by product of bacteria) CAUSATIVE AGENT: Neisseria meningitides SIGN & SYMPTOMS: Kernigs: K(nee) - flex - plain in the hamstring, back, neck = + kernigs (bad sign) Brudzinski: B(atok)/nape - flex - pain in the neck, back = + brudzinski Nuchal rigidity: stiff neck Seizures Opisthotonus: arching of the back: position: side lying MANAGEMENT: Antibiotic therapy - finish the duration - to prevent drug resistance HEAD TRAUMA Concussion: jarring of the brain - forceful contact in a rigid skull ***transient loss of consciousness Contusion (bruising): structural alteration - extravasation of blood MANAGEMENT: 1. Safety: bike helmets, seat belts, safe driving, infant car seat 3y/o: front/forward facing booster seat 2. Assess for cerebral functioning: GCS/ PERRLA ***most important prognostic indicator: LOC 3. Assess cervical neck injury (+): do not move the patient - immobilize - prevent further damage (-): HOBE: 30 degrees (dec ICP = gravity) CARDIOVASCULAR DISORDERS OF THE PEDIA LAYERS OF THE HEART 1. Endocardium: inner 2. Myocardium: muscle - contraction - cardiac output (amount of blood) 3. Pericardium: outer visceral: inner pericardial space - pericardial fluid (prevents friction rub) parietal: outer CHAMBERS OF THE HEART · ↑ way : NORMAL 2 way : Regurgitation VALNULAR PROBLEMS ③ Ductus ARTERIoSus Acyanotic: absence of cyanosis, 1 problem Cyanotic: presence of cyanosis, 2 or more problems PATENT DUCTUS ARTERIOSUS (PDA) Acyanotic SIGNS&SYMPTOMS: machinery like murmur (pathognomonic/hallmark) s/sx of heart failure poor feeding - fatigue poor weight gain - 6mos: birth weight is doubled - 12mos: birth weight is tripled Irritability: cerebral hypoxia MANAGEMENT: DOC: Indomethacin (prostaglandin inhibitor) - facilitate closure of the PDA ***secondary: Ibuprofen SEPTAL DEFECTS - Acyanotic ASD (Atrial Septal Defect) VSD (Ventricular Septal Defect) o SIGNS&SYMPTOMS: fatigue - poor feeding dyspnea on exertion (activity intolerance) failure to thrive s/sx of heart failure MANAGEMENT: Surgery by suture (by pass) Dacron Patch (Daks) - tissue: dec rejection rate (favorable) - plastic: inc rejection rate - (matibay) COARCTATION OF AORTA - Acyanotic narrowing of aorta (descending) Inc pressure, dec output SIGN&SYMPTOMS: # PULSE SURGERY : BALLOXTANGOPLASTY 1 I CORONARY STENTYNG in ↓ REPAIR SCAFFOLD/support ↓ I HORTA MESH - # SHARE HART IDECHO-BOOT TETRALOGY OF FALLOT - Cyanotic I PROBLEMS 1. Pulmonary Stenosis 2. Right ventricular hypertrophy 3. Overriding of Aorta 4.VSD QUESTIONS: Primary problem? Comp mech? Allows mixing of blood? Keeps the patient alive? SIGNS&SYMPTOMS Cyanosis: ineffective tissue perfusion Squatting - dec venous return - dec cardiac workload - cardiac rest - conserve o2 in the upper body area (vital organs) Tet spells: group of s/sx - dec oxygenation (pathog) - irritability, blackouts, convulsions, pallor (hypoxemia) Cardiomegaly Clubbing (fingernails) - chronic hypoxia Pan systolic murmur DIAGNOSTICS: 2D Echo - Boot Shaped Heart MANAGEMENT: Allow the child to squat Surgery: 1. Pallative: relieves s/sx - GOAL: oxy > unoxy ***Blalock Taussig Shunt: anastomosis of pulmonary artery and aorta (subclavian artery) 2. Curative: cures the condition/resolve the problems ***Intracardiac surgery/ Brocks Procedure - Balloon Angioplasty P - Dacron Patch - USD , OE TRANSPOSITION OF THE GREAT ARTERIES (TOGA/TGA) - Cyanotic Mechanism: Right ventricle - aorta Left ventricle - pulmonary artery ***PDA: Keeps the patient alive i SIGNS&SYMPTOMS: Severe respiratory depression - cyanosis Failure to thrive No murmur MANAGEMENT: Prostaglandin: keeps the PDA open/maintains PDA SURGERY: Arterial switch/ Jatene Surgery: - done during the first week of life - more than 90% RHEUMATIC HEART FEVER Cause by GABHS (Group A Betahemolytic Streptococcus) - sore throat/AGN (acute glomerulonephritis) Jones Criteria 2 Major Symptom + Hx of GABHS OR 1 Major + 2 Minor + Hx of GABHS MAJOR MINOR 1. Carditis 1. Low grade fever. 2 Polyarthritis 2. Arthralgia - uslo swelling. 3 Chorea-St. VITus Dance (wormlike. PASO 3 titer (Anti streptolysin O titer SubQ Nodules knuckles knees elbows inflammatory markers 4 4. Elevation of - , , Erythema marginatum redness in thrunk ESR-ERytHROCYTE = Area 5. -. SERIMENTATION RATE CRP-C-reactive protein - MANAGEMENT: DOC: Penicillin (5-10 days) ***if with allergy: Clindamycin/ Erythromycin ***exacerbation and remission: treatment is continued up to 10 years 4A’s of ASA Salicylates (ASA): pain and swelling Antiplatelet - monitor bleeding Antipyretic Corticosteroids: relieve carditis Analgesic Anti-inflammatory HEART FAILURE: insufficient cardiac output RSHF (right sided) LSHF (left sided) Simi ***Concept of Backflow NAR RSHF LSHF Peripheral/dependent/piting edema Dyspnea Exection - - on ↳ Activity Intolerance weight gain - distented neck Veins - ORTHOPNE -. (Jugular Vein Distention ( -crackles/rales hepatomegaly HPN cough - - > - ↳ ESOPHAGEAL VARICES Tachycardia (compensation) ↳ ASCITES early ↳ HEMORRHOLDS BODY WEAKNESS - ANOR EXIA NAUSEA =. , DIAGNOSTICS: CXR: Cardiomegaly 2D Echo: Hypokinetic heart (late) - decrease movement of the heart Pulse Oximetry: decrease o2 saturation - (N:95-100%) PCWP (Pulmonary capillary wedge pressure): LSHF (4-12 mmhg) CVP (Central Venous Pressure): RSHF (8-12 mmhg) MANAGEMENT: Fowlers: maximize lung expansion - inc o2 Administer high o2 (venturi mask: precise and accurate) Inotropic - strengthens contraction - inc Cardiac Output Lanoxin/Digoxin Toxicity Digibind Nausea Urine output and intake monitoring Anorexia Record daily weight SAME Visual Disturbances/ vomiting Time Diarrhea Edminister Diuretics Clothes Abdominal cramps Weighing scale Patient KAWASAKI DISEASE mucocutaneous lymph node syndrome (altered immune response) Multisystemic vasculitis (inflammation of the blood vessels) SIGNS&SYMPTOMS: High spiking fever (hyperpyrexia) Strawberry red tongue: blisters (pathog) Photophobia (high sensitivity to light) - hyperemia of conjunctiva - blood pooling (dark colored glasses/large brim hats/sunvisors) Polymorphous rash (rashes in diff shapes Palmar desquamation DIAGNOSTICS: Elevated ESR MANAGEMENT: Immunoglobulins: enhance immune response Aspirin as ordered Clear liquid diet - opacity to light CPR: Risk for Coronary Artery Disease GASTROINTESTINAL DISORDERS OF THE PEDIA CEPHALOCAUDAL - mouth to anus CLEFT LIP CLEFT PALATE Lalake/Lawit Heredity Pemale / Pempem Maternal Males smoking Female Diff Feeding. Risk for Aspiration Risk for Infection CURTI) Responsibilities Large Nipples Cup medicine dropper , ↳ easier to suck ↳ precise/accurate ↳ criss cross Fluid flow Surgery CHELLOPLASTY - RULE AF 15 PALATO PLASTY/Pulatraphy 10KWBCC RULF · 10 WKS - - : - libs-10 gmddeciliter not to early-re-open not to late speech problem I POST OP - : - innaffected side - louz4 most Post-op : Prone position Both mouth & Throat operation FrequentSwallowing (signs of bleeding GASTROESOPHAGEAL REFLUX DISEASE (GERD)/ CHALASIA Incompetent LES/ Cardiac Sphincter SIGNS&SYMPTOMS: Forceful vomiting Heartburn (chest pain): damage linings Bitter taste in the mouth (oral care every episode of vomiting) Dysphagia: difficulty of swallowing Odynophagia: painful swallowing Hoarseness: Laryngeal affectation DIAGNOSTICS: Barium Swallow (>2 days: if more than = obstruction) - excretion - inc OFI and Laxatives as ordered) MANAGEMENT: Low fat, high fiber (inc peristalsis) SFF (small frequent feeding) increase in stretch = increase in contraction Avoid: spicy foods, tobacco, caffeine, alcohol (GI Irritants) MEDS: - Antacids: Neutralizes acidity - H2 blockers: “tidine” - blocks HCL production - PPI (proton pump inhibitor): “prazole” - blocks HCL production + protective covering HOBE: 6-8 during sleeping - prevents regurgitation 14 PYLORIC STENOSIS Narrowing of pyloric sphincter SIGNS&SYMPTOMS: Vomitus: blood tinged, with gastric contents no bile No anorexia, with good appetite but with vomiting Weight Loss Upper abdominal distention: olive shaped mass Visible peristaltic (left to right) malnutrition and DHN Metabolic alkalosis MANAGEMENT: Monitor feeding patterns Assess the vomitus (without bile) Inc OFI Prevent aspiration: feed slowly Burp frequently: prevent gas retention High fowlers (prevents regurgitation) SURGERY: Pyloromyotomy: incision that splits the obstruction Hobstruction CELIAC DISEASE/ CELIAC SPRUE/ GLUTEN SENSITIVE ENTEROPATHY Cause: malabsorption of gluten IRREVERSIBLE SIGNS&SYMPTOMS: Acute diarrhea Steatorrhea: FFF (foul fatty feces) Anorexia - vomiting Severe abdominal distention (gas retention) Body wasting (cachexia) Retarded growth Failure to thrive (delayed milestones) DIAGNOSTICS: Bowel biopsy: flat mucosal surface with hyperplastic villous atrophy (confirmatory) Elevated IgG and IgA MANAGEMENT: AVOID: BROW (Barley, Rye, Oat, Wheat) ALLOW: Meat, Eggs, Milk products (milk, cheese, cream), all fruits and vegetables, rice, corn, corn flakes ***BDAY party: bring own cake ***Gluten FREE DIET FOR LIFE