NUR 106 Module G1: Wallace Guide to Pediatric Nursing Foundations

NUR 106 Module G1: Wallace Guide to Pediatric Nursing Foundations sleeping on stomach, smoking in household and prematurity, Between 1 month and 1 year - SIDS risk factors Brainstem abnormalities, along with environmental stressors - Hypothesis of SIDs supine sleeping position, avoid cigarette smoke, firm bedding, exclusive Bret feeding for any amount of time, pacifier use - SIDS prevention giving no indication of wrongdoing, abuse, or neglect; making sensitive judgments concerning any resuscitation efforts for the child; and comforting the family members as much as possible. Call the OB and pediatrician so that no appointments are made or questions about how the baby is when mother returns for visits, must have an autopsy - Family support for sids restlessness, anxiety, tachycardia/ tachypnea - respiratory symptoms early bradycardia, extreme restlessness, severe dyspnea - respiratory symptoms late Fever, Poor feeding (anorexia),Vomiting, Diarrhea, Color change, sweaty/clammy - Symptoms of respiratory tract infections flaring nostrils, retractions, grunting, adventitious breath sounds (or absent breath sounds), use of accessory muscles, head bobbing , decreased Po2, elevated Pco2, cyanosis and pallor - Other signs of respiratory distress in children H&H, clear airway, enhance lung expansion, isolate if needed, fever and pain management - Respiratory Management "Common cold" - nasopharyngitis "Soar throat" - Pharyngitis Rapid strep, throat culture - Streptococcal Pharyngitis diagnostic Full course antibiotic ,check urine for protein in 2 weeks - Streptococcal Pharyngitis therapeutic management Avoid citrus, ice cream, red liquids, dairy products - Tonsillectomy/adeniodectomy Affects children less than 5 yrs Usually viral Stridor Cool mist (tent or hood), nebulized epinephrine, corticosteroids Assessment extremely important Fluids, rest, reduce agitation - Acute Laryngotracheobronchitis - Caused by RSV, influenza A&B, M. pneumoniae - Sx: Low-grade fever, restlessness, hoarseness, barky cough, inspiratory stridor, retractions - Acute Laryngotracheobronchitis causes Inflammation of the epiglottis; H influenzae type b is the most common cause, especially in nonimmunized children, Causes airway obstruction - Acute Epiglottitis Assess airway, manage airway, anti-infammitories, maintain child in upright position - Acute Epiglottitis therapeutic viral infection the bronchioles that is characterized by thick secretions - Bronchiolitis (RSV) contact isolation, monitor pulse ox/CR, maintain airway - RSV Palivizumab (Synagis) monoclonal antibody, which is given monthly in an IM injection for a maximum of five doses to prevent hospitalization - Prevention of RSV An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid - pneumonia Rest, antibiotic administration for bacterial strain, position changes - Pneumonia treatment Asphyxiation, respiratory tract infection - Foreign body aspiration problems Leading cause of fatal injury in children younger than 1 year, most common in children 1-3 years - Foreign body aspiration Fun foods, sharp objects, balloons - Common foreign body aspirates chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, bronchial hyperresponsiveness, and an underlying inflammation process - Asthma Shortness of breath, Prolonged expiratory phase, Audible wheeze, May have a malar flush and red ears, Lips deep, dark red color, May progress to cyanosis of nail beds or circumoral cyanosis, Restlessness, Apprehension, Prominent sweating as the attack progresses Older children sitting upright with shoulders in a hunched-over position, hands on the bed or chair, and arms braced (tripod) Speaking with short, panting, broken phrases - Clinical manifestation of asthma Avoid exacerbation Avoid allergens Relieve asthmatic episodes promptly Relieve bronchospasm Monitor function with peak flow meter Self-management of inhalers, devices, and activity regulation - Goals of Asthma Management ID and control triggers - Non parm interventions of asthma Cromolyn, nedocromil - Asthma Long term "control" (anti-inflammatory) drugs Albuterol, Xopenex - Asthma Short term "rescue" (bronchodilator) drugs is a medical emergency that can result in respiratory failure and death if untreated. Children who continue to display respiratory distress despite vigorous therapeutic measures, especially the use of sympathomimetics (e.g., albuterol, epinephrine), are in status asthmaticus. The condition may develop gradually or rapidly, often coincident with complicating conditions, such as pneumonia or a respiratory virus, that can influence the duration and treatment of the exacerbation - status asthmaticus Epinephrine, B2 agonis, determine cause, Humidified oxygen is recommended and should be given to maintain SaO2 greater than 90% - Status asthmaticus treatment Genetic transmitted by an autosomal recessive trait, most common lethal GENETIC illness among Caucasian children - Etiology of cystic fibrosis Respiratory, GI, and pancreatic ducts - Organ systems affected by CF Mobilize secretions through breathing exercises and medications (mucolytic, bronchodilator, and anti inflammatory), - Respiratory Manifestations of CF high in calories and protein -take pancreatic enzymes with meals -take vitamin supplements (ADEK) - GI management of CF Estimated life expectancy 30-50 years - prognosis of cystic fibrosis acute systemic vasculitis of unknown cause. It is seen in every racial group, with 75% of the cases occurring in children younger than 5 years old. - Kawasaki disease CRAS H and BURN Conjunctivitis Rash Adenopathy (unilateral) Strawberry tongue Hands and feet (red, swollen, flaky skin) BURN fever lasting for at least 5 days - Kawasaki disease mnemonic high-dose intravenous immunoglobulin (IVIG) along with salicylate therapy. Aspirin is used in an anti inflammatory dose (80 to 100 mg/kg/day in divided doses every 6 hours) to control fever and symptoms of inflammation - Management of Kawasaki Disease In the initial phase, the nurse must monitor the child's cardiac status carefully. Intake and output and daily weight measurements are recorded. Although the child may be reluctant to eat and therefore may be partially dehydrated, fluids need to be administered with care because of the usual finding of myocarditis. The child should be assessed frequently for signs of HF, including decreased urinary output, gallop rhythm (an additional heart sound), tachycardia, and respiratory distress - Nursing care for Kawasaki disease Most common Hematologic disorder in children, Decreased number of RBC/ hemoglobin concentration - Anemia anemia resulting when there is not enough iron to build hemoglobin for red blood cells, can also be impaired absorption/excessive demands Vit E deficiency - iron deficiency anemia Pale skin. Irritability or fussiness. Lack of energy or tiring easily (fatigue) Fast heart beat. Sore or swollen tongue. Enlarged spleen. - Signs and symptoms of iron deficiency anemia provide rest, oral iron (ferrous sulfate), limit milk, dietary sources-meat. leafy greens, fish, liver, whole grains, legumes, fortified cereal and formula for infants - Nursing care for iron deficiency anemia a genetic disorder in which erythroctyes take on an abnormal curved or "sickle" shape, occurs primarily in African Americans - sickle cell anemia Splenic sequestration(blood pools in spleen), Aplastic crisis (decreased production), Hyperhemolytic crisis - sickle cell crisis No cure(expect bone marrow transplant) frequent bacterial infections may occur due to immunocompromise - Sickle cell prognosis (1) seek early intervention for problems, such as fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of stroke, splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. - Nursing management sickle cell A hereditary disease where blood does not coagulate to stop bleeding - Hemophilia Hemophilia A Hemophilia B Von Willebrands disease - Types of hemophilia Close supervision and safe environment Dental procedures in a controlled situation Shave only with an electric razor For superficial bleeding, apply pressure for at least 15 minutes and ice to promote vasoconstriction If significant bleeding occurs, transfusion for factor replacement No aspirin use NSAIDS carefully - Interventions for hemophilia Most common form of childhood cancer More frequent in males Peak onset between 2&6 years old - Leukemia unrestricted proliferation of immature white blood cells in the blood-forming tissues of the body. Although not a "tumor" as such, the leukemic cells demonstrate the neoplastic properties of solid cancers. Thus the resultant pathologic and clinical manifestations of the disease are caused by infiltration and replacement of any tissue of the body with nonfunctional leukemic cells. Highly vascular organs, such as the spleen and liver, are most severely affected - Pathophysiology of leukemia Anemia from decreased RBCs Infection from neutropenia Bleeding tendencies from decreased platelet production Spleen, liver, and lymph glands show marked infiltration, enlargement, and fibrosis Bone tissue destruction - Consequences of Leukemia Evaluation is usually suspected from the history, physical manifestations, and a peripheral blood smear that contains immature forms of leukocytes, frequently in combination with low blood counts. Bone marrow aspiration or biopsy - Diagnostic evaluation of leukemia (1). Induction: 4-6 weeks; achieves a complete remission or less than 5% leukemic cells in the bone marrow. (2). CNS prophylactic: prevents leukemic cells from entering the CNS. (3). Intensification therapy (consolidation): eradicates residual leukemia cells, followed by delayed intensification, which prevents emergence of resistant leukemic clones. (4). Maintenance therapy, which serves to maintain the remission phase. - Four phases of Leukemia therapy. Prepare child and family Prevent complications (infection, hemorrhage,anemia) Bone pain/fractures Skin integrity Medication side effects (stomatitis, neuropathy) Body image (Alopecia, steroid body changes) - Nursing considerations for leukemia (HSCT, Bone marrow transplant - Hematopoietic Stem Cell Transplantation Stem cells harvested from bone marrow, peripheral blood, or umbilical vein of placenta Stem cells given to patient by IV transfusion Newly transfused stem cells repopulate ablative bone marrow - HSCT Morbidity/mortality Graft vs. host disease Severe organ damage - Risks of HSTC Higher risk for imbalance Higher body water content (more ECF) Higher surface area Higher BMR Immature kidney function Tighter balance of F&E - Fluid and electrolyte imbalance in children infections,allergies, toxins, GI obstruction, increased intracranial pressure - Vomiting Find and treat cause, fluid replacement, monitor electrolytes, positioning, rinse mouth, monitor hydration - Management of vomiting Leading cause of illness in children under the age of 5 20% of all deaths in developing countries - diarrhea Dehydration, metabolic acidosis, increased respirations/ketosis - Clinical Manifestations of diarrhea Isolation if indicated, strict I&O, accurate weights, NPO, monitor IVF no K+ until void,skin care, specimen collection - Nursing Considerations for diarrhea Vomiting,weight loss, respiratory infections, bleeding, gagging or chocking, - GER symptoms Positioning, modify feedings, medications, surgery(last resort) - Therapeutic Management of GER inflammation of the appendix symptoms pain in lower right quadrant, sudden relief of pain indicated a rupture - appendicitis malabsorption syndrome caused by an immune reaction to gluten, inflammation and intestinal damage, malabsorption - celiac disease (1) steatorrhea (fatty, foul, frothy, bulky stools), (2) general malnutrition, (3) abdominal distention, and (4) secondary vitamin deficiencies - Manifestation of celiac disease Helminthes(worms) Young children at risk, frequent hand to mouth, poor hygiene - Intestinal parasitic diseases Hand washing/wash all cloths Vermox is drug of choice but not under age 2 Povan,Antiminth- stains stool bright red - Treatment of pinworms Most resolve spontaneously Hand washing Tindamax bitter taste, upset GI Flagyl- expensive, side effects - Treatment of giardiasis Salicylates,hydrocarbons,corrosives, acetaminophen,iron, lead - Poisons aspirin,wintergreen oil, pepto bismol Hyperventilating, increased metabolism, metabolic acidosis Chronic- tinnitus, dehydration, disorientation, diaphoresis - Salicylates Petroleum products Danger in aspiration - Hydrocarbons Lye, batteries, bleach Tissue damage, necrosis and strictures - Corrosives Most common Liver damage - Acetominophen Most common by peeling lead paint Inhaled or ingested Affects renal,Hematologic, and neurological systems - lead poisoning Early-anorexia, abdominal pain, vomiting,fever, headache Late-anemia, renal damage, mental retardation, blindness, paralysis, convulsions, coma death - Manifestation of lead poisoning chelation therapy, calcium disodium edetate( causes free lead to be excreted in the urine) Succimer(oral chelating agent given over 19 days) BAL(British anti lewisite, dimercaprol) more effective in removing Pb from CNS because it penetrates the blood brain barrier - Treatment of lead poisoning Strict I&O Monitor neuro status Monitor renal labs ca+ and Pb Psych care Education and support - Nursing considerations for lead poisoning Chicken pox primary secretions through respiratory tract skin lesions also contagious Airborne and contact precautions 2-3 week incubation period - Varicella Fever, malaise, and anorexia rash very pruritic begins as a macule and rapidly progresses to a papule then vesicle - clinical maifestations of varicella Antiviral- Zovirax Secondary infections(encephalitis, and varicella pneumonia) - Treatment of varicella Fifth disease caused by human parovirus B19 transmitted through respiratory system and blood 4-14 day incubation - Erythema infectiosum Rash appears in 3 stages ema on face 2. Maculopapular red spots 3. Rash will subside then reappear - fifth disease Self limiting arthritis Anemia, hydrops, or fetal death if mother infected while pregnant - Complications of fifth disease measles transmitted through respiratory tract,blood, urine Airborne precautions 10-20 day incubation - Rubeola Fever, malaise, cough, Rash, Koplik spots - Rubeola clinical manifestations MMR vacation, bed rest, antipyretics, vit A supplementation, - Management of rubeola Transmission from nasopharyngeal secretions,blood,stool,and urine incubation 14-21 days - Rubella (German Measles) Rash begins on face and spreads downward rapidly Pinkish red maculopapular rash - Clinical Manifestations of rubella Transmitted through healthy adults saliva Year round, peak occurrence in 6-15 month old 5-15day incubation - Exanthem Subitum (Roseola) High fevers, bulging Fontanels, rash, cervical and post-auricular lymphadenopathy, inflamed pharynx, cough and coryza - Clinical Manifestations of roseola antipyretics during febrile period and reassurance - Treatment of Roseola Paramyxovirus transmitted through the saliva of infected individual, contact and droplet precautions, 14-21 day incubation - Mumps Low grade fever, myalgia, headache, then parotid gland pain and swelling - Clinical Manifestations of mumps Preventative- MMR vaccine Supportive- antipyretic, analgesics - Treatment of mumps deafness, meningitis, encephalitis, sterility, hepatitis - Complications of mumps Transmitted through respiratory tract infection of infected person Direct contact or droplet 6-20 day incubation - Pretussis (whooping cough) Catarrhal stage: Begins with symptoms of upper respiratory tract infection, such as coryza, sneezing, lacrimation, cough, and low-grade fever; symptoms continue for 1 to 2 weeks, when dry, hacking cough becomes more severe Paroxysmal stage: Cough most common at night, consists of short, rapid coughs followed by sudden inspiration associated with a high-pitched crowing sound or "whoop;" during paroxysms, cheeks become flushed or cyanotic, eyes bulge, and tongue protrudes; paroxysm may continue until thick mucus plug is dislodged; vomiting frequently follows attack; stage generally lasts 4 to 6 weeks, followed by convalescent stage - Clinical Manifestations of pretussis Preventive: Immunization; current belief is that childhood immunizations for pertussis do not confer lifelong immunity to adolescents and adults, so a pertussis booster is recommended for adolescents Refer to the CDC Immunization Guidelines, Antimicrobial therapy (e.g., erythromycin, clarithromycin, azithromycin), Supportive: Hospitalization sometimes required for infants, children who are dehydrated, or those who have complications, - Management of pretussis Acute, self-limiting infection of B lymphocytes transmitted by saliva through personal contact Incubation of 30-50 days - infectious mononucleosis Mild analgesics and rest/ warm gargles, and warm drinks Avoid contact sports Refrain from antibiotic therapy - Management of infectious mononucleosis Prevention in Kawasaki disease, Rubeola,RSV, lymphocytic leukemia - IGIV 1 year of age. - SIDS happens in children under what age? Unexpected, UNEXPLAINED death - SIDS is explained as Autopsy - SIDS remain unexplained even after... -Maternal Smoking -Poor prenatal care -Low maternal age -Prematurity -Low birth weight -More common in boys -Extremes in age: (Really young, and really old moms) -Prone sleeping & -Co-sleeping & -Soft bedding - Risk factors for SIDS The cause is unknown; there are no symptoms, and it occurs in infants aged 1 to 12 months. - What causes SIDS Cigarettes smoked Secondhand smoke - There is a direct correlation to SIDS in _______ _________ by mom in utero and by ___________ _______________ 90% of SIDS cases are between the 2-4th month. - Critical age for SIDS Vaccines Sleep apnea Apnea of prematurity - SIDS is not caused by: -Sleep position (Prone) *always recommend to sleep on back. -Bed sharing -Thermal stress -Head covering -Winter months causes more cases of SIDS -There is typically more than one stressor present - Environmental stressors that could cause SIDS *Starts with education and prenatal care -ABC: sleeps ALONE, on BACK, in CRIB -Handwashing and preventing respiratory problems and good nutrition -NO exposure to secondhand smoke -Don't overheat the baby. (cannot dissipate the heat) - 6months NO bed rail padding (bumper pads) -Rooming in is good. (Baby doesn't sleep as hard) -Breastfeeding -Swaddling. No blankets just in bed. -Offering a pacifier to go to sleep with. (They do not sleep as hard). - Prevention of SIDS -Defect in CNS. These babies are not able to self correct. Babies with SIDS cannot wake up and say hey there is a pillow in your face. Cannot respond to change in their homeostasis or change in breathing. - Critical age. Under one year of age. 90% b/w 2-4 months of age. ( a lot of growth and development during this time. Temp control, CNS, Homeostasis) -Environmental stressors: oxygenation, sleep-wake pattern, temp control. Then they do not have the ability to overcome. - Hypothesis for SIDS -It provides the babies antibodies -The babies eat more often (which does not allow the baby to get into the super deep sleep when SIDS normally occurs). - why do we recommend breast feeding to reduce SIDS SMOKING: our #1 goal is prevention. - #1 risk factor of SIDS After the first few days after birth after the feeding is going well. - When is offering a pacifier okay? Required by law. It does need the consent form, but the state will do it without it. - An autopsy on a SIDS baby is? -Increased WOB -Tachycardia/Tachypnea -Adventitious sounds (upper and lower) -Secretions (Nasal) *remember obligate nose-breathers for months. -Activity intolerance (according to developmental stage) (Newborn trying to feed, if hard to feed = Activity intolerance. -Sweating/clammy -Upper airway-stridor -Coughing (productive/non-productive) -Color change: Could see pallor, mottling, then late sign of cyanosis. - Pediatric respiratory signs and symptoms *parent usually finds the child. (Devastation) -Ask factual questions -Allow family time -Refer to support groups, follow up call, give parents a phone number of who to contact (typically family HCP) - Family support after SIDS -VS Frequently -Rate, WOB, HR -Temp (many are infectious) -Clear airway -Must assess: History, meds -Appearance - Respiratory Assessment Breath sounds Positioning Retractions Nasal flaring Tripoding Grunting - WOB Includes: Tone Interactiveness Gaze Cry Consolability - Respiratory assessment appearance: Pallor Mottling Cyanosis (Late finding) - How to assess circulation: VIRAL - Most respiratory problems are... Aspirin - Remember no_______ in kids -Frequent assessments -H&H (Humidity and Hydration) -Clear airway (suction, mists, saline preferred) start with bulb syringe (least invasive). -Enhance lung expansion -Activity/feeding: We get them active, it mobilizes secretions. -isolation (depends on disease) -Fever and pain management (controls fluid loss) -Splint with a teddy bear when coughing - We want coughing as long as it is effective** - Common respiratory management/interventions: -Blow up balloons -Blow card across the table - What are some ways you can get a child to deep breathe: -Symptoms vary with age (Nasal inflammation, dryness, and irritation of nasal passages, and the pharynx). Fever, decreased appetite, restlessness. -Use antipyretics -Home management -Use vaporized air -Educate on complications (ear infections) -Use nasal decongestants -Stay away form antihistamines: It typically overstimulates and over-dries. -Keep them hydrated - Nasopharyngitis (common cold) More feeding - In an infant hydration means: Sore throat Abdominal pain Fever Red tonsils Enlarged tonsils Petechiae in mouth - Group A Beta Hemolytic Streptococcus manifestations: Rapid Test Throat culture - Diagnostics for Streptococcal pharyngitis: ****FULL COURSE OF ANTIBIOTICS**** -Check urine in 2 weeks for protein -Hydration -Treat fever with (motrin, tylenol) -No acidic foods -No carbonated drinks -Avoid caffeine - Management of Strep Throat: lymph - Tonsular system is a part of the ______ tissue *Atraumatic care: What to expect. -Assess child's breath sounds, loose teeth, hx of bleeding.(Tonsils are very vascular). - Pre-op teaching/assessment for T&A Developmental age. Keep younger kids NPO less amount of time. **High risk for dehydration. - NPO depends on: Maximize airway: Prone, side lying, also raise HOB - Post op positioning of a T&A -Breathing (Breath sounds) -Pulse ox -LOC -VS -Gag and swallow reflux return -Watch for bleeding (seeing them swallow a lot, they are bleeding*** -FIRST VITAL SIGN FOR BLEEDING IS.... HR - Post-op assessment of T&A -Once they are conscious advance diet to clear liquid -No milk products for 1st 24 hours -No red juice/popsicles -No straws - Food and fluids after T&A Tylenol/opioids Ice collar (don't force) NSAIDs effect platelet (No ibuprofen) - Comfort measures and home teaching for T&A: -Dehydration (watch output) -Avoid infection and infected people - Reasons for readmit tonsillectomy: hoarseness, "barking" cough, inspiratory stridor, and varying degrees of respiratory distress. They are usually viral and generally affects children 5 years old. - Croup syndromes are characterized by larynx, trachea, bronchi - Croup affects At night - Croup always gets worse when? VIRAL - Acute laryngotracheobronchitis is usually -Inspiratory stridor (very loud/noisy) -Barking or SEAL-LIKE COUGH -Increasing mild respiratory distress including retractions and hypoxia -Lungs will typically sound CLEAR, but you may hear REFERRED sound. -SUBGLOTTAL EDEMA: LUMP IN THROAT -Can progress to respiratory acidosis, respiratory failure, and death - Manifestations of LTB: -No antibiotics -use a humidifier or put child in bathroom with hot shower on -anti-inflammatories. Steroids -Racemic EPI - How do you treat croup? An acute bacterial infection, with rapid onset, severe inflammation, hyper-reactive epiglottis. - Acute epiglottitis is: Haemophilus Influenza type B (HiB) - Most common cause of acute epiglottitis is: -Fever- Significantly high -sore throat -Dysphagia -Drooling -Refuse to swallow -Tripod position-thrusting chin out -Rising sun sign: You can see the epiglottis coming up in the back of the throat. (DO NOT TOUCH IT) ** MUST ID QUICKLY** - Clinical manifestations of acute epiglottitis: **Keep child calm -Assess -Airway management -Antibiotics -Anti-inflammatories (May have to sedate) -Need trach tray at bedside -Prepare for ET Intubation -Steroids -(After about 24 hours the swelling should go down. -Must run IV fluids, the patient will not drink anything, after swelling subsides, the pt. will start drinking. - Therapeutic management of Acute Epiglottitis: -Dry persistent cough (a dry persistent cough is not common in infants, they are usually a moist cough, so this is a red flag). -Nasal congestion that worsens suddenly. Thick mucous yellow to green. The mucous is also hard to keep mobilized especially in younger kids (hard to cough it up). -Tachypnea -Distress (wheezing, grunting, and retractions). May become cyanotic and apneic. -**very common virus -**Growing premature infants and cardiac babies are an ^ risk. - Respiratory Syncytial Virus (RSV) (Bronchiolitis) manifestations -Isolation: Large (droplet) precaution and contact -Monitor: (Cardiac/respiratory monitor) -May use antibiotics if xray is suspicious for secondary pneumonia. -Prevention (synagis)- Monoclonal antibody-IM X1 a month -May need intubation - Management of RSV: Synagis injection once a month Prevent exposure, good handwashing, and no smoking. - How do you prevent RSV Sudden onset of fever Chills Dry Cough Loss of appetite Rapid/difficult breathing headaches wheezing Pneumonia will cause wheezing in bases potentially **Goal is to get the cough to be productive - pneumonia manifestations -Antibiotics- only for bacterial -Continuous respiratory assessment -Isolation -(Only give anti-tussive at bed time) we want the cough to move the secretions. -Position changes frequently to mobilize secretions. -CPT and postural drainage if ordered - - Management of pneumonia: Foreign body aspiration - What is the leading cause of fatal injury in children younger than 1 year? Fun foods= worst offenders. Sharp and irritating objects. Balloons. Children under 5 should not eat small, round, hard foods. - Major problems with foreign body aspiration Recognize coughing/choking Use emergency techniques 1 year = Back thrust X5 then chest thrust X5 - Immediate management of foreign body aspiration Bronchoscopy Antibiotics Humidity after removal Prevention - After immediate management of aspiration, what do you do next? Before the child gets mobile. - When do you educate parents about choking prevention? -Inflammation of airways** -Chronic inflammatory disorder of airways -Episodic exacerbations -Etiology: (does tend to run in families) -Causes chronic lung changes - Asthma OUT. Causing Co2 retention - Asthma makes it hard to move air... Tenacious mucous. From the inflammation thick and sticky secretions. Leading to infection. - Asthma patients have what kind of secretions? Periodic Bronchospasm that is responding to irritant It narrows the airway - Asthma patients have episodic bronchoconstriction which are: Intermittent Mild persistent Moderate persistent Severe persistent - Asthma diagnoses are categorized based on symptoms and how often they have it: - Triggers of asthma are non-specific -Non-productive chronic cough -cough even when not sick -Adventitious sounds (almost) always present, typically coarse rhonchi, then wheezing in worsening asthma. -Short inhale-prolong expiratory - clinical manifestations of asthma 5 - We classify asthma in children ____ years and older Pulmonary function test - The most accurate test for diagnosing asthma and it's severity Early ID Control Inflammation Prevent exacerbations: (ID and relieve promptly) Education/Monitoring - Goals of asthma management: decrease secretions. You do this by controlling allergies by pharmacologic (montelukast), and non-pharmacologic (getting rid of the animal) ways. - Keeping inflammation under control in asthma patients will In the home. Education is important and it takes A LOT of education. - Asthma is mostly treated where? Peak flow value: Green=80-100 Yellow=50-80% = moderate asthmatic attack Red=50 - Home monitoring of Asthma long-term control includes: -Inhaled corticosteroids: By inhaling it only affects locally, no adverse reactions systemically. Disadvantage of inhaled steroids: ^ risk of thrush and yeast. After they use inhaled steroids must brush and rinse. -Use of Nsaids- cromolyn and nedocromil -Leukotriene modifiers: (singulair)- Anti-inflammatory and anti-allergenic. -Long-acting beta2 agonists: If we stimulate the beta cells it's affecting the sympathetic nervous system. - Asthma medications long-term control: (Bronchodilators) -Short acting beta2 agonists -Albuterol, Xopenex -Corticosteroids: Only PRN, not rapid acting. Only use in the event of an asthma attack (or pneumonia or bronchitis) and can't get the regular bronchodilator down the airway. Only to be used short term 2-3 days. - Short term "rescue" asthma meds: A spacer is an essential for a child using an aerosol inhalant. You shoot the aerosol into the canister of the spacer then take deep breaths on the other end of the spacer. - What is a spacer? Life-threatening episode of airway obstruction that is unresponsive to common treatment. An asthma attack that has not been prevented. Respiratory distress continues despite vigorous therapeutic measures. - What is status asthmaticus? -Inhaled beta2 agonist, then epinephrine (opens airway) then will begin steroids, for inflammation control (iv then wean). -There is sometimes a concurrent infection in some cases. Or it is caused from: Stress/anxiety/non-compliance -Always ask what could have caused the attack - Emergency treatment of status asthmaticus An autosomal recessive trait: Both parents have to carry the trait. This is the most common lethal disease in caucasian kids. - Cystic Fibrosis (CF) is -Thick inspissated mucoprotein accumulates to form concentrations in glands and ducts. -Results in mechanical obstruction -Respiratory tract and pancreas are predominantly affected. - Pathophysiology of CF -Newborn screen: Every baby born is tested for CF -Genetic testing can be done on both parents -Sweat chloride test: Sweat is 2-5x higher in Na and Cl in CF kids. - Diagnostic tests for CF: -Pancreas: Blocked pancreatic ducts. Decreased digestive enzymes. Could lead to type 1 diabetes. -Lungs: Thick sticky mucous buildup, bacterial infections. -Intestines: Cannot fully absorb nutrients, develops muscle weakness, and the immune system fails. - Body systems affected by CF NO - Is there a cure for CF -Prevent/minimize pulmonary complications -Adequate nutrition for growth -Assist in adapting to chronic illness - Goals of CF patients -Mobilize secretions -Keep away from sick people -CPT, breathing exercises (pursed-lip), and hydration -Medications: Mucolytics, bronchodilators, anti-inflam. -Prevent/early dx and treatment of respiratory infections -Home IV therapy -Transplantation: Typically will need pancreas and heart transplant as well. -ZERO exposure to Cig smoke decreases cilia and increases risk of infection. **CPT is not an option you must teach paprents how to do. *******Mucolytics, hydration, and CPT******** - Respiratory management of CF patients: high in calories and protein -take pancreatic enzymes (oral PO) with ALL meals -take vitamin supplements (ADEK) -Salt supplementation (poring salt and H20 out ) -Keep an eye on A1c and Glucose due to pancreas failure. - GI management of CF Estimated life expectancy for child born with CF is 30-50 years. They will need genetic counseling. There has been new research and there is hope for the future. - Prognosis of CF: -Primarily because the lose body water faster and more readily - their insensible loss is much higher, and if they are not eating or drinking well they don't replace what they have lost -In addition - their kidneys are very immature - even toddlers and preschoolers, and they can't conserve fluid as they are eliminating waste - even if they are dehydrated - Why are children at higher risk for fluid and electrolyte imbalances? - we want to provide carbs for energy so the body doesn't breakdown protein: juices, Gatorade - whatever sounds good to the child cut back on caffeine - eliminate if possible, or make deals with the child We can use some anti-emetics - Zofran is drug of choice - Phenergan should 4 not be used in a child under age 12yrs - How to treat vomiting in the child: vomiting - protect the airway - position on side or with the head elevated, and have suction at the bedside rinse the mouth after an emesis - both for comfort and to protect the teeth - acid from frequent vomiting can erode the enamel frequent assessment of hydration - VS, I&O, mucus membranes, turgor, daily weight, behavior and activity - Other considerations with children and vomiting: Metabolic acidosis - We develop ______ ________ from diarrhea Metabolic alkalosis - We develop _____ ______ from vomiting -Mucous membranes -Check turgor for tenting in the abdomen and the groin area. -in an infant the fontanels will be sunken in - How do you tell a child is dehydrated? 1ml/1kg/1hr - Urine output in an child should be Oral-least invasive. - Most recommended form of replacement fluids? a birth defect in which there is a deep groove of the lip running upward to the nose as a result of the failure of this portion of the lip to close during prenatal development. This is a closure defect. Happens early in gestation. More common in parents who smoke, some medications and higher incidence in boys. - Cleft lip So it has little effect on speech. - Why do we do the surgery for cleft lip young? -Breast feeding is preferred. -Does better with breasts over bottles typically -There is a cleft palate nurser, it has a longer nipple to reach the back of the throat. -Sit baby up right to feed -sucks a lot of air. Burping is needed more often. -Keep upright after feeding - - Feeding the cleft palate baby -airway, raise HOB, and they need to lay on their back. -Educate parents what to expect post-op during pre-op: such as elbow restraints. - Biggest priority post op for cleft lip baby Speech and OT therapy - A cleft baby will need what two types of therapy post-op Elbow restraints & logans bow - Most post-op cleft patients will have -projectile vomiting, PROGRESSIVE -Healthy otherwise, hungry -Weight loss, dehydration. - hypertrophic pyloric stenosis (HPS) symptoms Constriction of the pyloric sphincter with obstruction of the gastric outlet. Cause is unknown and they are genetically predisposed to it. - What is hypertrophic pyloric stenosis telescoping of the intestines. One part of the intestine is moving into the other part of the intestine. You can sometimes palpate a sausage-like mass. - intussusception absent ganglion cells. Causes mechanical obstruction from inadequate motility of intestine. Causes diarrhea, horrible odor, green vomiting. - Hirschsprung disease