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What vaccine can be used to prevent epiglottitis in children?
Hib vaccine
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What does "Silent Chest" indicate?
Worsening of Acute Asthma (decreased wheezes)
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How is bronchiolitis diagnosed?
RSV antigen detection by nasal secretions
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What are some contraindications for ribavirin (antiviral) when treating bronchiolitis?
- teratogenic- no pregnant providers
- No contact lenses
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What are some signs and symptoms of bronchitis?
- dry, hacking cough
- cough may become productive after 2-3 days
- cough is worse at night
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What is used prophylactically in high risk infants to prevent RSV?
RSV-IGIV (IV immunoglobulin)
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what immunization prevents Pertussis?
dTap or Tdap
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what are major culprits of foreign body aspiration?
grapes, hot dogs, and peanut butter
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What illness would you not just treat the child with it, but the whole family as well?
Pertussis
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What children are at increased risk for aspiration pneumonia?
- Children with feeding difficulties such as:
- reflux
- cleft palate
- TEF
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what illness is characterized by recurrent episodes of wheezing, coughing, tightness of the chest, and SOB?
Asthma
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what are some diagnostic tests performed with Asthma?
- Pulmonary function tests (PFTs) upon initial assessment every 1-2 years
- Personal best Peak Flow Test
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what are the "rescue" meds for Asthma?
Bronchodilators: Albuterol, Zopenex
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What are the "prevention" meds given for Asthma?
- inhaled corticosteroids
- leukotriene inhibitors
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What are diagnostic tests performed with suspected Allergic Rhinitis?
- Hisotry
- RAST test: determines the IgE antibodies to specific allergen
- Blood sample for eosinophils and total IgE
- Skin testing
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What are the signs and symptoms associated with Allergic Rhinitis?
- clear runny nose; sneezing
- Itchy nose, itchy watery eyes
- Allergic shiners; allergic salute
- congestion; chronic nasal obstruction
- Pallor of nose; cobblestoning
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Cerebral Palsy
chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system
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What should be at the bed side when a patient is in the hospital with Spina Bifida?
a bottle of normal saline to keep sac covered with a moist, sterile dressing to prevent breakdown of skin and infection
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what is the earliest sign of Cystic Fibrosis?
meconium ileus in a newborn
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What are some signs and symptoms of GER?
emesis and heart burn
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What are some treatment goals associated with GER?
- small, frequent feedings every 3 hours
- thickened formula with rice cereal (1 oz of formula to 1 TBS of cereal)
- Prone positioning after feeding but NOT when sleeping
- Older child: left side position with head of bed elevated
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What medications help treat GER?
- PPIs: lansoprazole (suppress acid)
- H2 receptor agonists (cimetidine)- for esophagitis
- Antacids
- Cholinergics (bethanechol/metoclopramide)- increase gastric emptying
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What illness is the surgical procedure Nissen Fundoplication suggested for ?
GER
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Encopresis
constipation with soiling
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How is the diagnosis of Hirschsprung Disease confirmed?
Lung biopsy
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What are some surgical procedures that help manage Hirschsprung Disease?
- Temporary colostomy (relieves dilation)
- Soave endorectal pull-through (infant must be 9 kg!)
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What are the nursing considerations associated with managing Hirschsprung disease?
- monitor for progressive abdominal distention (girth at umbilicus, leave tap in place)
- Preop Bowel emptying
- Teach colostomy care
- goal: return of normal bowel
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acute obstruction of lumen with hard feces
Acute Appendicitis
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What is the most important sign of Acute Appendicitis?
Focal Abdominal tenderness at McBurney's point in RLQ
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Rosving Sign
RLQ pain with palpitation or precussion of other quadrants
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Ruptured apendix results in?
Peritonitis
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what are the signs of a ruptured appendix?
sudden, brief relief of pain & high fever
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what are the treatment methods for a ruptured appendix?
- 5-7 days of antibiotics and IV fluids
- NG suction for decompression
- drain or surgery for abscess formation
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What illness causes Gastric outlet obstruction?
Hypertrophic Pyloric Stenosis
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Which acid base imbalance would have to be corrected before surgery of Hypertrophic Pyloric Stenosis?
metabolic alkalosis
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Pyloromyotomy
- used for HPS
- Incise circular muscle & open pylorus (RUQ incision)
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What should the postoperative care be following a pyloromyotomy?
gradually progress oral feedings
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What is the most frequent cause of bowel obstruction in children 1 months-3 years old?
Intussusception (more common in cystic fibrosis)
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What is intussusception?
Telescoping or invagination of one portion of intestine into another (ileocecal valve)
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currant jelly stools; sudden, crampy pain; and a sausage shaped mass on palpation is indicative of what?
intussusception
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What is the non-surgical treatment modality of intussusception?
Hydrostatic reduction with air or contrast enema
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What teaching is most important regarding intussusception?
Educating parents and child on the risk of recurrence
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What is it called when the bowel is not fixed in position in-utero?
Malrotation
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What does volvulus result in?
volvulus (intestines become twisted) -- decreased blood supply -- necrosis, peritonitis, perforation & death
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Abnormal rotation of the intestines around the superior mesenteric artery?
Malrotation which leads to bowel obstruction
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gluten-induced enteropathy
Celiac disease (genetic intolerance of gluten-protein in wheat)
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What are the four characteristics of Celiac disease?
- steatorrhea
- abdominal distention
- general malnutrition
- vitamin deficiencies
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What dietary management is associated with Celiac Disease?
- life-long dietary management
- Substitutes for wheat products
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What are the treatment goals of Short Bowel Syndrome?
- preserve bowel strength
- stimulate bowel adaptation
- optimal nutritional and growth as bowel adapts
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What are the phases of nutritional therapy associated with Short Bowel Syndrome?
- 1st phase- TPN
- 2nd phase- introduce enteral feeding
- final phase- enteral feedings alone sustain growth
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in SBS, what is taught to children in regards to developing oral muscles (speech)?
Nonnutritive sucking
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what is the main symptom of Pinworm ingestion?
Intense anal itching
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what is the diagnostic tool for Pinworms?
Tape Test-collect eggs in morning after child awakens using clear tape over the anus
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What medication is given to all family members (>2) when one member has pinworms?
One dose of Oral Mebendazole
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How can Pinworms be prevented?
- Handwashing after toileting and before meals
- Careful diapering
- Short nails
- Stop scratching
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the failure of the esophagus to develop a continuous passage is called?
Esophageal atresia
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the VACTERL mnemonic associated with Esophageal Atresia stands for?
- V- vertebral anomalies
- A- imperforate anus or anal atresia
- C- cardiac anomalies
- TE- tracheoesophageal fistula
- R- renal anomalies
- L- limb anomalies
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What is the diagnosis based on in Esophageal Atresia?
if an infant has at least three or more of the VACTERL anomalies
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an infant presenting with frothy saliva, drooling, choking, coughing, along with cyanosis and apnea r/t aspiration is indicative of
Esophageal atresia
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What are the nursing considerations of an infant with Esophageal Atresia?
- NPO
- Maintain Patent Airway
- Prevent Aspiration
- Monitor surgical repiar/anastomosis postoperatively
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Persistent cloaca
an anorectal malformation in females where the rectum, vagina, and urethra drain into perineum via one channel
-
Imperforate anus
an anorectal malformation in males and females where there is no obvious opening (with or without a fistual)
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What are the surgeries associated with anorectal malformations and their indications?
- Short-term : temporary colostomy for fecal elimination
- Long-Term: anorectoplasty and colostomy take down
- wait for 24 hours after birth to perform surgery if the anorectal malformation is not life-threatening
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what nursing action can be done to identify anomalies in a newborn?
Watch for the first stool
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Kasai drainage
use in Biliary atresia to drain bile
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What is the definitive life-saving treatment of Biliary Atresia?
Liver Transplantation
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Biliary Atresia can lead to?
- Cirrhosis and death by age 2 if not treated
- Jaundice that persists after age 2 weeks
- Elevated conjugated bilirubin
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What is the most serious complication associated with Kawasaki Disease ?
Cardiac involvement; aneurysms can develop
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chorea, carditis, erythema marginatum, polyarthritis, fever with history of sore throat, abdominal pain, and subcutaneous nodules are associated with what illness?
Rheumatic Fever
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the child showing signs of exercise intolerance, chest pain, and dizziness when standing for long periods of time is associated with what specific cardiovascular disorder?
Aortic stenosis
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Jones Criteria
- Major: Carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
- Minor: Fever, arthralgia elevated ESR or positive CRP level, prolonged P-R interval
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What are the two objective of treating CHF?
- reducing workload
- increasing cardiac output
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What is the prophylaxis for recurrence of Rheumatic Fever?
Penicillin G (Bicillin)
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What is a major risk factor for the cause of Cerebral Palsy?
Low birth weight
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A dimple with or without hair tuft at base of spine?
Spina Bifida Occulta
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Spina bifida is associated with what major problem?
Hydrocephalus
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the signs of increased ICP are? (opposite of shock)
- Increased ICP- decreased pulse and increased BP
- Shock- increased pulse and decreased BP
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