Pedia Notes

Pedia Notes POISONING- common in toddlers. (falls- common to infant) 1. determine substance taken, assess LOC 2. unless poison is corrosive, caustic (strong alkali such as lye) or a hydrocarbon, vomiting is the most effective way to remove poison. •

Give syrup 1 pecac to induce vomiting

1. 1 pecac – oral emetic • •

15 ml – adolescent, school age & pre school 10 ml to infant

1. 2. 3. 4.

UNIVERSAL ANTIDOTE- charcoal, milk of magnesia & burned toast Never adm charcoal before 1 pecac antidote for acetaminophen poisoning – acetylsysterine ( mucomyst) caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit prepare tracheostomy set 5. Gas- mineral oil will coat intestine Lead poisoning Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning Accumulation of anemia = Encepalopathy Sx: 1. beginning sx of lethargy 2. impulsiveness, learning difficulties 3. as lead increases, severe encepalopathy with seizure and permanent mental retardation Dx: 1. Blood smear 2. abd x ray 3. long bones Mgt: 1. remove child from source 2. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney

=nephrotoxic Amogenital Female: Pseudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood – rape/ child abuse Rape- Report within 48 h Shape pubic hair in inverted triangle ( female) Male: Undescended testes – cyrptorchidism -common to preterm surgery – orchidopexy assess scrotum- warm room & hands baby – pee within 24 h -check for arch of urination Epispadias- urinary meatus located dorsal or above glans penis Hypospadias- urinary meauts loc ventral or below glans penis Hypospadias with chordee- fibrous band causing penis to curb downward Mgt: Surgery Phimosis- tight foreskin Balanitis-infection of glands penis – due smegma Mgt: Circusicion Hydroseal – fld filled scrotum Tst of Dx: Transillumination with use of flashlight - glowing sign

Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)

Renal Disorder NEPHROTIC

Cause

Sx

infectious

1. 2.

SYNDROME

3. 4. 5. 6.

AGN ( acute Glomerulo Nephritis) 3A’s;

Autoimmune Grp A beta hemolytic streptococcus

normal or decreased BP

1.

(PPP) primary peripheral periobital edema moderate protenuria gross hematuria ( smokey urine) serum K increased fatigue increase BP

3.

autoimmune, Grp A

Anasarcagen edema massive protenuria microscopic or no hematuria serum CHON decreased serum lipid increased fatigue

7.

2.

AGN,

Tx

4. 5. 6. Complication : 1.

hypersensive encephalopathy

2.

anemia

BACK- check for flatness & symmetry Open Neural Tube Defect- decreased Folic Acid intake SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to fuse

Prednisone

NSG CARE Focus of care: monitor edema

Diuretic •

weigh daily

Diet: Increase CHON Increase K- OJ, beef broth, banana Decrease Na

1. anti HPN drug hydralazine or apresoline 2. iron

1. weigh daily 2. monitor BP & neurologiuc status 3. Diet: decrease K, decrease Na

Sx: dimpling of back , Abnormal tufts of hair SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac Types: 1. Meningocele – protrusion of CSF & Meninges 2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most dangerous) 3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or myelomeningocele Most common problem • • •

rupture of sac prone pos sterile wet dressing

Most common complication - infection Myelomeningocele – genitourinary complication- urinary & fecal incontinence Nsg care: always check diaper Orthopedic complication – paralysis of lower extremities Surgery to prevent infection Post op – prone position SCOLIOSIS- lateral curvature of the spine 2 types: 1. structural – rye neck 2. postural – improper posture

Dx: 1. 2.

uneven hemline bend forward- 1 hip higher 1 shoulder blade more prominent

Nsg care:

1. conservative – avoid obesity, exercise 2. preventive – Milwaukee brace - worn 23 h a day 3. corrective surgery – insert Harrington rod post op- how to move log rolling- move client as 1 unit EXTREMITIES: check # of digits = 20 1. 2. 3. 4. 5.

syndactyly – webbing of digits polydactyly – extra digits olidactyly – lack of digits Amelia – total absence of digits pocoamelia- absence of distal part of extremities

ErQ duchennes – paralysis- brachial plexus injury or brachial palsy •

birth injury caused by lateral & excessive traction during a breech injury

1. 2.

unable to abduct arms from shoulders, rotate arm externally or supinate forearm absence or asymetrical moro reflex

Sx:

Mgt: 1.

abduct arm from shoulders with elbow flex.

CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum Types; 1. 2.

subluxated – most common type dislocated

1. 2. 3. 4. 5.

shortening of affected leg asymmetrical gluteal fold limited movement – earliest sx (+) ortolanis sign – abnormal clicking sound when able to walk – child limps – late sx- trendelenburg sign

Sx:

Goal of Mgt: Facilitate abduction

Mgt. 1. 2. 3. 4. 5.

triple diaper carry baby astride Frejka splint Pavlik harness Hip Spica Cast

TALIPES – "clubfoot" a. b. c. d.

Equinos – plantar flexion – horsefoot Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior leg Varus- foot turns in Valgus- foot turns out

Equino varus- most common Assessment: 1.

Straighten legs & flexing them at midline pos

Mgt: 1. Corrective shoe- Dennis brown shoe, spica cast Fx: of cast – - to immobilize • •

bone alignment prevent muscle spasm

lead pencil – mark area to be amputated cold H20 – hasten setting process hot H20- slow setting process After cast application – how to move pt: - use open palm not fingers- fingers will cause indention • •

dry cast – natural air not blower priority check : neurovascular check

C- circulation M- motion S- sensation

Cast – with bleeding - mask with ball pen edge of blood to know if bleeding is on going sign cast is dry = resonant sound, cast cold to touch do petaline – making rough surface of cast smooth CRUTCHES Fx: To maintain balance •

To support weakened leg

Principles in crutches • • •

wt of body on palm! Brachial pulsing – if wt of body in axila Do palm exercise- squeeze ball

Different crutch Gaits: 1. 2.

Swing Through Swing to

•

no weight bearing are allowed into lower ext

1.

Three point Gait - wt bearing is allowed in 1 ext

2. 3.

Four point gait Two point Gait - wt bearing allowed in 2 lower ext