NR 602 Final Pediatric StudyGuide Topics ch 35- 36 New
Update 2022/2023
Eye disorders: Chalazion (caused by noninfectious occlusion) or Hordeolum (caused
by infection). However, a hordeolum will be painful. Both can be treated with
heat compresses.
At birth the maxillary and ethmoid sinuses are typically developed and pneumatized.
By 9 months to a year of age the sphenoid sinuses typically become
pneumatized, and by 5 years of age, the frontal sinuses are pneumatized.
Frontal sinuses continue to grow as the face grows and may be larger in boys. Up to 10% of
the population does not develop frontal sinuses.
Nosebleeds can be traumatic for both parents and children. A small amount of
blood can look like a great deal, which can be frightening. Quite vascular, at
Kiesselbach's plexus in the front- septal area.
Common site for bleeds to occur. Causes of epistaxis include but are not limited to
picking, trauma, dry environment, treatment with topical nasal steroids, and
vigorous rubbing or blowing.
Even though less than 5% of children with reoccurring epistaxis have a bleeding
disorder, this should not be excluded from the differential in cases of repetitive and
significant epistaxis.
Treatment includes having the patient sit up and then apply gentle-pinching
pressure to the soft area of the nose below the nasal bones for at least 5
minutes. If still bleeding take to MD.
Soft packing, such as gel foam, can be inserted to absorb and prevent further
bleeding.
Prevention includes keeping the nares moist with saline nasal gel or
spray daily, humidifying the environment, and ensuring that nasal
medications are being used appropriately
Bulbar or palpebral conjunctival injection is a common presentation, which
can be unilateral or bilateral. The differential diagnosis should include
allergy, conjunctivitis, infection, foreign body, chemical exposure, or
systemic inflammatory disease, irritation of the conjunctiva or cornea, and
congenital glaucoma. Therefore, a good examination for symptoms
associated with each is needed. Discharge from the eye varies based on
cause. Watery discharge can occur with allergies, nasolacrimal obstruction,
foreign bodies, viral infection, and iritis. However, purulent or mucoid
discharge can be noted with chronic dacrocystitis or nasolacrimal
obstruction. Even advanced allergic conjunctivitis can have some mucoid
production. To differentiate, microscopic investigation of discharge may lead
to other clues.
The eye is one of the most sensitive areas of the body and pain can occur for
many reasons. The NP should always complete a thorough exam for trauma,
,foreign bodies, even trichiasis. Photophobia is a symptom common of
trauma and in infants with glaucoma or retinal disease. Other non-eye
related causes of photophobia include migraines and meningitis.
,A white pupil, or leukocoria, is a serious finding and demands immediate
referral to the pediatric ophthalmologist. Causes of leukocoria include retinal
detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in
newborns retinoblastoma. All newborns should have a fundoscopic
examination within 24 hours of birth and yearly on physical examinations.
Some children are at higher risk for the need of glasses, including those with
Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. Visual
screening in all children at least once between the ages of 3 and 5 is a
formal recommendation of the USPSTF (2011).
Summary of Recommendations and Evidence Population Recommendation
Grade Children, Age 3-5 Years. The USPSTF recommends vision screening
for all children at least once between the ages of 3 and 5 years, to detect
the presence of amblyopia or its risk factors. B Children, <3 Years of Age
The USPSTF concludes that the current evidence is insufficient to assess the
balance of benefits and harms of vision screening for children <3 years of
age.
Common eye traumas that may present to primary care are as
follows:
o Scratch or laceration to the cornea
o Blunt trauma to the orbit; note that an orbital fracture can cause muscle
entrapment, compartment syndrome
o Hyphema
o Chemical or heat-related burns
o URIs often have peak incidence in winter and spring
months when communicability from indoor exposure is
highest.
o Common symptoms include congestion, sore throat, rhinorrhea that
can progress in color and amount as the URI progresses, but does not
mean that bacterial sinusitis is present, and cough. Also, symptoms
may include possibly sneezing, myalgia, or low-grade fever.
o Current treatment, particularly for young children, is hydration and
over-the- counter antipyretics for low-grade fever or myalgia as
directed by the provider.
o Normal saline rinse of the nares may be of some benefit and clearing
congestion but may not be well tolerated by some children. Currently,
cold and cough recommendations are not recommended in children
younger than age 4.
, o Complications of URIs include otitis media and sinusitis. Presumptive
antibiotics should not be given to prevent these complications.
Sinusitis in children cannot be diagnosed until at least 10 to 14 days
with lack of symptom improvement or development of new
symptoms, such as facial pain.
o Children with Asthma should be monitored for exacerbation and may
need home monitoring of peak flow and symptoms or initiation of their
asthma action plan for changes in the airway.
Bacterial Rhinosinusitis
Caused by common URI infection. These children typically worsen after 5 to
7 days of a URI or are not resolved in 2 weeks.
Children with a history of respiratory allergies or trauma may be at higher
risk. Symptoms should be present more than 10 days or worsen within 10
days after initial improvement and include purulent nasal congestion, nasal
drainage, facial pain, headache, purulent posterior pharyngeal drainage, and
fever.
Musculoskeletal Injuries – assessment and treatment: Ch 43
● Bone age – radiographs of left hand and wrist
➢ Used to determine somatic maturation, and Measure of growth tempo
● Skeletal growth spurt in adolescents
➢ Tanner stage 2 in girls, and Tanner stage 3 in boys
● Long bones have growth plate (physis); blood supply through epiphysis; damage to epiphysis
can stop growth of bone (Fig. 43.1)
● Bone, muscle development influenced by use
➢ Protein, calcium, vitamin D necessary for growth and development of
musculoskeletal system
● Pathophysiology: Systemic problems
➢ Infection – viral, bacterial, tubercular
➢ Hemophilia, sickle cell disease, arthritic disease
➢ Malignancy
● Genetic problems
➢ Osteogenesis imperfecta
Update 2022/2023
Eye disorders: Chalazion (caused by noninfectious occlusion) or Hordeolum (caused
by infection). However, a hordeolum will be painful. Both can be treated with
heat compresses.
At birth the maxillary and ethmoid sinuses are typically developed and pneumatized.
By 9 months to a year of age the sphenoid sinuses typically become
pneumatized, and by 5 years of age, the frontal sinuses are pneumatized.
Frontal sinuses continue to grow as the face grows and may be larger in boys. Up to 10% of
the population does not develop frontal sinuses.
Nosebleeds can be traumatic for both parents and children. A small amount of
blood can look like a great deal, which can be frightening. Quite vascular, at
Kiesselbach's plexus in the front- septal area.
Common site for bleeds to occur. Causes of epistaxis include but are not limited to
picking, trauma, dry environment, treatment with topical nasal steroids, and
vigorous rubbing or blowing.
Even though less than 5% of children with reoccurring epistaxis have a bleeding
disorder, this should not be excluded from the differential in cases of repetitive and
significant epistaxis.
Treatment includes having the patient sit up and then apply gentle-pinching
pressure to the soft area of the nose below the nasal bones for at least 5
minutes. If still bleeding take to MD.
Soft packing, such as gel foam, can be inserted to absorb and prevent further
bleeding.
Prevention includes keeping the nares moist with saline nasal gel or
spray daily, humidifying the environment, and ensuring that nasal
medications are being used appropriately
Bulbar or palpebral conjunctival injection is a common presentation, which
can be unilateral or bilateral. The differential diagnosis should include
allergy, conjunctivitis, infection, foreign body, chemical exposure, or
systemic inflammatory disease, irritation of the conjunctiva or cornea, and
congenital glaucoma. Therefore, a good examination for symptoms
associated with each is needed. Discharge from the eye varies based on
cause. Watery discharge can occur with allergies, nasolacrimal obstruction,
foreign bodies, viral infection, and iritis. However, purulent or mucoid
discharge can be noted with chronic dacrocystitis or nasolacrimal
obstruction. Even advanced allergic conjunctivitis can have some mucoid
production. To differentiate, microscopic investigation of discharge may lead
to other clues.
The eye is one of the most sensitive areas of the body and pain can occur for
many reasons. The NP should always complete a thorough exam for trauma,
,foreign bodies, even trichiasis. Photophobia is a symptom common of
trauma and in infants with glaucoma or retinal disease. Other non-eye
related causes of photophobia include migraines and meningitis.
,A white pupil, or leukocoria, is a serious finding and demands immediate
referral to the pediatric ophthalmologist. Causes of leukocoria include retinal
detachment, cataract, retinal dysplasia, retinopathy of prematurity, and in
newborns retinoblastoma. All newborns should have a fundoscopic
examination within 24 hours of birth and yearly on physical examinations.
Some children are at higher risk for the need of glasses, including those with
Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. Visual
screening in all children at least once between the ages of 3 and 5 is a
formal recommendation of the USPSTF (2011).
Summary of Recommendations and Evidence Population Recommendation
Grade Children, Age 3-5 Years. The USPSTF recommends vision screening
for all children at least once between the ages of 3 and 5 years, to detect
the presence of amblyopia or its risk factors. B Children, <3 Years of Age
The USPSTF concludes that the current evidence is insufficient to assess the
balance of benefits and harms of vision screening for children <3 years of
age.
Common eye traumas that may present to primary care are as
follows:
o Scratch or laceration to the cornea
o Blunt trauma to the orbit; note that an orbital fracture can cause muscle
entrapment, compartment syndrome
o Hyphema
o Chemical or heat-related burns
o URIs often have peak incidence in winter and spring
months when communicability from indoor exposure is
highest.
o Common symptoms include congestion, sore throat, rhinorrhea that
can progress in color and amount as the URI progresses, but does not
mean that bacterial sinusitis is present, and cough. Also, symptoms
may include possibly sneezing, myalgia, or low-grade fever.
o Current treatment, particularly for young children, is hydration and
over-the- counter antipyretics for low-grade fever or myalgia as
directed by the provider.
o Normal saline rinse of the nares may be of some benefit and clearing
congestion but may not be well tolerated by some children. Currently,
cold and cough recommendations are not recommended in children
younger than age 4.
, o Complications of URIs include otitis media and sinusitis. Presumptive
antibiotics should not be given to prevent these complications.
Sinusitis in children cannot be diagnosed until at least 10 to 14 days
with lack of symptom improvement or development of new
symptoms, such as facial pain.
o Children with Asthma should be monitored for exacerbation and may
need home monitoring of peak flow and symptoms or initiation of their
asthma action plan for changes in the airway.
Bacterial Rhinosinusitis
Caused by common URI infection. These children typically worsen after 5 to
7 days of a URI or are not resolved in 2 weeks.
Children with a history of respiratory allergies or trauma may be at higher
risk. Symptoms should be present more than 10 days or worsen within 10
days after initial improvement and include purulent nasal congestion, nasal
drainage, facial pain, headache, purulent posterior pharyngeal drainage, and
fever.
Musculoskeletal Injuries – assessment and treatment: Ch 43
● Bone age – radiographs of left hand and wrist
➢ Used to determine somatic maturation, and Measure of growth tempo
● Skeletal growth spurt in adolescents
➢ Tanner stage 2 in girls, and Tanner stage 3 in boys
● Long bones have growth plate (physis); blood supply through epiphysis; damage to epiphysis
can stop growth of bone (Fig. 43.1)
● Bone, muscle development influenced by use
➢ Protein, calcium, vitamin D necessary for growth and development of
musculoskeletal system
● Pathophysiology: Systemic problems
➢ Infection – viral, bacterial, tubercular
➢ Hemophilia, sickle cell disease, arthritic disease
➢ Malignancy
● Genetic problems
➢ Osteogenesis imperfecta
