Pediatric Nursing PDF

 - 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