Peds Study Guide Test 3 PDF

PEDS Failure to thrive Definition of failure to thrive (FTT) State of inadequate growth Weight below 5th percentile ○ Maybe malnourished Characteristics of child with FTT Organic ○ Has disease as basis for the cause ○ Ex: Congenital heart disease Has cancer Neurologic lesion ○ May have problem with...

PEDS Failure to thrive Definition of failure to thrive (FTT) State of inadequate growth Weight below 5th percentile ○ Maybe malnourished Characteristics of child with FTT Organic ○ Has disease as basis for the cause ○ Ex: Congenital heart disease Has cancer Neurologic lesion ○ May have problem with suck swallow reflex Inorganic ○ Unrelated to to any disease process maternal-child bonding/interactions Poor feeding technique (mom was young, didn't know how to feed properly) Nutrition misinformation Poverty #1 factor for inorganic FTT Economics (formula might be expensive so mom dilutes formula) Abuse/Neglect Signs ○ Malnourished ○ Won't make eye contact ○ Not sociable ○ Hx of developmental delay Significant weight loss, chart shows the trend Irritability Vomit every feed Weight below the 5th percentile/ Significant weight loss Treatment of child with FTT Assessment ○ Clinical manifestations ○ Parental maladaptive behaviors toward the infant Talk to mom about her feelings during pregnancy How does mom responds to baby’s need like does she changes baby’s diaper right away Observe parent-child interactions, especially during feedings Management ○ Nutritional management Correct nutritional deficiencies Allow for catch up growth If it’s organic cause there may be a need for increased calorie intake supplements added to formula Weigh the child daily and maintain strict records of intake and output ○ Parental teaching Feeding technique How often the child should be fed Positioning of child during feeding Breastfeeding technique If formula feeding ○ How to fix the delusional rate Maintain eye contact during feeding Environment should be distraction free Should not force feeding Hydrocephalus Hydrocephalus signs and symptoms Irritability Lethargy Poor feeding Vomiting Complaints of headache in older children Altered, diminished, or changes in LOC Visual disturbance Broadening of forehead Bulging fontanel Large head size Positive Macewen sign (cracked pot sound when tapping on the junction of the frontal, temporal, and parietal bones). S/S of shunt infection: ○ elevated vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity, and signs of local inflammation within the tract ○ can happen anytime, most common after 1-2 months of placement ○ treated with IV antibiotics ○ if persistent, shunt will be removed and external ventricular drainage system will be put into place S/S of shunt malformations: ○ vomiting, drowsiness, headache - can occur due to kinking, clogging, or separation of the tube ○ blockage is most common reported complication ○ shunt that has been placed in past year is higher risk for malfunction ○ early recognition/operative intervention are essential Early Signs & Symptoms of increased intracranial pressure: ○ Headache ○ Vomiting, possibly projectile ○ Blurred vision, double vision (diplopia) ○ Dizziness ○ Decreased pulse and respirations ○ Increased blood pressure or pulse pressure ○ Pupil reaction time decreased and unequal ○ Sunset eyes - “sclera visible above the iris” ○ In infant will also see: Bulging, tense fontanelle Wide sutures and increased head circumference Dilated scalp veins High-pitched cry Late Signs & Symptoms of intracranial pressure: ○ Lowered LOC ○ Decreased motor & sensory responses ○ Bradycardia ○ Irregular respirations ○ Cheyne-Stokes respirations (rapid breathing followed by periods of apnea) ○ Decerebrate or decorticate posturing ○ Fixed and dilated pupils There are more EARLY than late signs Hydrocephalus - recognizing complications Complications: ○ Infection ○ Obstruction ○ Increased pressure on the brain Ventricles in the brain are not draining the CSF or producing too much Increased CSF which causes increased pressure Myelomeningocele Risks for child with myelomeningocele increased risk for meningitis hypoxia, and hemorrhage Presence of neurogenic bladder makes for frequent catheter insertion - increased risk for UTI, pyelonephritis, and hydronephrosis Hydrocephalus - due to improper development and downward displacement of the brain into the cervical spine Risk for infection related to the meningeal sac and potential rupture Risk for altered nutrition, less than body requirements related to restrictions on positioning of the infant before and surgery Paralyzation from waist down- long term complication Controlling bowels Interventions for child with myelomeningocele Teach parents about catheters ○ children can catheter themselves as a teen if needed. Can do as often as needed, to make sure the bladder is not getting too full and make sure the bladder is fully emptying. Cerebral Palsy Types of Cerebral Palsy Spastic: ○ description: hypertonicity and permanent contractures; different types based on which limbs are affected hemiplegia: both extremities on one side quadriplegia: all 4 extremities: diplegia/paraplegia: lower extremities ○ characteristics: most common form poor control of posture/balance exaggeration of deep tendon reflexes hypertonicity of affected extremities continuation of primitive reflexes failure to progress to protective reflexes - in some children Athetoid/dyskinetic: ○ description: abnormal involuntary movements ○ Characteristics: infant is limp/flaccid uncontrolled, slow, worm-like movements affects all 4 extremities possible involvement of face, neck, and tongue movements increase during periods of stress dysarthria and drooling may be present Ataxic: ○ description: affects balance and depth perception ○ Characteristics: poor coordination unsteady gait wide-based gait motor milestones and language skills delayed Mixed: ○ description: combination of above ○ Characteristics: most common is spastic and dyskinetic Interventions for a child with cerebral palsy Main goal maximize the function they have Multidisciplinary care (Nursing, PT, OT, Speech, Ortho, orthotics, neurology, nutrition) Surgery to correct contractures CP patients may also have hydrocephalus requiring a shunt Promote mobility with therapies and medications Administering medications for spasticity Diet modification or G-tube may be required for nutrition Parents need extensive education and support Allergies/ Eczema Interventions for a child with allergies and eczema If pt has eczema they are can get asthma and allergic rhinitis Allergies: ○ Maintain patent airway: Nasal washes with normal saline to keep nasal mucus from becoming thickened Administer corticosteroids nasal sprays as prescribed to decrease inflammatory response to allergens ○ Providing family education: ○ Learn to avoid known allergens ○ Children may need allergen desensitization Eczema/atopic dermatitis: ○ Promoting skin hydration: Avoid hot water and any skin/hair product containing perfumes, dyes, or fragrances Use mild soaps like cetaphil or dove for sensitive skin Slightly pat dry the child after bath Apply prescribed ointments Apply fragrance free moisturizer like aquaphor; apply multiple times a day ○ Maintaining skin integrity and avoid infection: Cut fingernails short and clean Avoid tight clothing Use 100% cotton Prevent child from scratching Behavior modification like hand held clicker Use diversion, imagination, play Positively reinforce/reward desired behavior Asthma Interventions for a child with asthma exacerbation Triggers ○ Dust ○ Respiratory infection ○ Exercise ○ seasonal allergen (dust mite, weather etc, grass. pollen) Avoid triggers!!! ○ Changing blinds ○ Avoiding carpet, avoiding pets, wrapping bed mattresses up w cover Child oxygen is 85, oxygen first!! then Albuterol (bronchodilators) Wheezing breath sounds for pt with asthma but if diminished it is a worsening sign of no air movement. DIMINISHED IS NOT GOOD Don't need to avoid exercise Teaching for metered-dose inhalers and peak flow meter Spacer to get most the medication 1. shake the inhaler, 2. attached the inhaler, 3. breath out completely 4. Face on place, make sure right size 5. Press it, do the dose Clean it will water after use Cystic fibrosis Low sodium -> can cause seizures Interventions for a child with cystic fibrosis We do test sputum to check what bacteria they have before giving antibiotics Chest PT everyday, shakes everything up, loosen the mucus. This is everyday, sick or not. 2 hrs after meals best time to do it Diet for a child with CF Make sure enough calories High calorie and protein pancreatic enzymes Salty snack for pt during exercise (For CF pt that are playing a lot of sports) Increased-calorie, high-protein diets are recommended GERD Assessment findings in infants with reflux, How do they present FTT - will have weight loss or poor weight gain ○ This is if its untreated Begins early in life often in these infants Pyloric sphincter is weak and child gets overfed Lots of pressure - stomach can’t hold all Backs up through weak pyloric sphincter into esophagus If becomes something that occurs a lot, we need to worry about esophagitis Stomach contents coming up so there is a lot of acid that causes bleeding Older child: ○ Dyspepsia: heartburn ○ Dysphagia ○ Eructation: belching after meals and will stay persistent for a couple hours after meals and complain of pain ○ Pain Health history: Wont sleep Crying all night Vomiting Staying up Hungry all the time even though they just ate Manifestations: 1. Vomiting 2. Fussy 3. colic Interventions for infant with reflux Goal ○ Weight gain ○ Decrease spit up-normal ○ Educate parents is important If parent is worried about child not growing, show them the growth chart Risk ○ Failure to thrive for untreated Sit them up (30 mins) Burp them Small frequent feeds Thicken formula with rice cereal Sickle Cell Factors that can bring on a sickle cell crisis Triggers ○ Stress or traumatic event Example: infection, fever, dehydration, physical exertion, excessive cold exposure, hypoxia, illness ○ Dehydration ○ Cold (keep them warm) ○ Illness or infection What are somethings you need to do prevent infection for pt with sickle cell: prophylactic penicillin (under 5 years only), hand hygiene, update on vaccines(rsv vaccine, flu,) Manifestation H/H, platelets, RBC, iron, WBC (Know normal values!) ○ Low hemo (depends on the baseline) if it’s lower than normal then it’s concerning Trend dropping very concerning More exposed to blood products, they get more allergic Intervention for a child in sickle cell crisis (Acute) Hemoglobin, hematocrit, platelets, RBC , iron, WBC know normal values They usually have low hemoglobin (bc they dont have same capacity to carry hemoglobin and oxygen) depending on the baseline, if its lower than their normal its concerning If there's a trend dropping very concerning The more exposed to blood products, they can start becoming allergic to them. Has to be type and crossed matched exactly Emergency: ○ Acute chest syndrome -sickle cell crisis in the lungs, causing chest pain, clot in the vessels of the lungs not in the heart ○ priapism -prolonged rigid erection. If not resolved, the tissue will die (Penis). Intervention for a child with sickle cell disease (Chronic) Pain medications, lookout for respiratory distress if pt is on a high dose of narcotics. Most PT will be on PCA, they give themselves a dose. Manifestations of all types (Neoplastic) Acute lymphocytic leukemia ○ Fever ○ Recurrent infection ○ Fatigue ○ Pallor ○ Unusual bruising or bleeding ○ Abd pain ○ Headache Acute myeloid leukemia ○ Recurrent infections ○ Fever ○ Fatigue ○ Pallor ○ Headache ○ Visual disturbance ○ WBC is elevated Brain tumors ○ nausea/vomiting ○ Headache ○ Unsteady gait ○ Blurred or double vision ○ Seizures ○ Motor abnormality ○ weakness/atrophy ○ Swallowing difficulties ○ Behavior or personality changes ○ Irritable, FTT, developmental delay Neuroblastoma ○ Presenting s/s depend on location of primary tumor ○ Often swollen/asymmetrical abdomen ○ bowel/bladder dysfunction ○ Neurological symptoms ○ Bone pain ○ Anorexia ○ Vomiting ○ Weight loss ○ Neck or facial swelling Osteosarcoma ○ Pain ○ Limp ○ Limitation of motion ○ Dull bone pain may be present for several months - eventually progressing to limp or gait changes Ewing Sarcoma ○ intermittent pain that progressively gets worse ○ history for fever ○ Pain might become constant and severe that it interferes with sleep Rhabdomyosarcoma ○ Can discover asymptomatic mass ○ Note recent illness Wilms tumor ○ Abdominal pain ○ Constipation ○ Vomiting ○ Anorexia ○ Weight loss ○ Difficulty breathing Retinoblastoma ○ cat’s eye reflex - whitewash glow on affected eye ○ Headache ○ Vomiting ○ Erythema ○ Orbital inflammation ○ Hyphema ○ Diagnostic tests for all types (Neoplastic) Neuroblastoma ○ Check BMA (24 hr urine collection) on neuroblastoma to differentiate what type of cancer it is The levels will be elevated Interventions for a child with neoplastic disease Complications of chemo: ○ fever, neutropenia, bleeding, psychiatric issues- body issues, depression, thoughts of self harm, mouth sores, weight loss due to decreased appetite, cancer is a risk for failure to thrive Wilms tumor ○ Don’t palpate their abdomen Levels of disability (s/s of mild, moderate, severe ID)