Pediatric Study Guide

8/6/2019 Pediatric Study Guide

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Pediatric Differences

Larger surface area to size higher propensity to hypothermia

Short, narrow trachea susceptible to FBO

Cardiac output rate dependent

Kidneys do not concentrate urine effectively electrolyte secretion/absorption issues

Brain cells all present at birth, further development and myelinization first year

Bones are soft and easily bent or fractured

Blood volume is weight dependent

Fontanels posterior closes 2-3 months, anterior 18 months

Assessment

Foot to-head in children, adults head-to-toe

Sitting in moms lap

Flexible with sequence, genitals last, cardiac/respiratory while quiet

Assess skin turgor on abdomen, forearm or thigh

Ears in line with medial canthi

Head circumference until 3 years old

Include birthing history (pre-term, vaginal vs. C-section, complications)

Therapeutic Play

Learn about care, express anxiety, gain control over frightening situation

Drawing determine what child knows about injury or illness

RN demonstrate on drawing what will happen (surgery or procedure)

Dramatic Play

Child uses safe equipment to reenact procedure

Outlet for anxiety over stressful/confusing situation

RN sees childs perception of illness and can clarify misconception

Pain Assessment

Up to 6wks old - NIPS - Facial Expression Cry Quality Breathing patterns Arm/Leg position

Until 2-3 years old - FLACC Face Legs Activity Cry Consolibility

3 years old crayon on body diagram

3 years old to adolescent Faces (drawing) or Oucher (face photographs)

Who Pain Ladder

1. Non-opiods (aspirin)2. Mild opiods (codeine)3. Strong opiods (morphine)

Give meds around the clock for effectiveness


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Growth & Development

Growth Quantitative

Development Qualitative

Cephalocaudal Growth head down

Proximodistal Growth center of body outward (arms before fingers)

Critical periods if missed, interfere with future development, can identify other issues (neuro)

Stage Basic Conflict ImportantEvents

Outcome

Infancy (birthto 18 months)

Trust vs.Mistrust

Feeding Children develop a sense of trust when caregivers provireliabilty, care, and affection. A lack of this will lead to

mistrust.

Early Childhood(2 to 3 years)

Autonomy vs.Shame and

Doubt

Toilet Training Children need to develop a sense of personal control ovphysical skills and a sense of independence. Success leadfeelings of autonomy, failure results in feelings of shame

doubt.

Preschool (3 to5 years)

Initiative vs.Guilt

Exploration Children need to begin asserting control and power over environment. Success in this stage leads to a sense of

purpose. Children who try to exert too much powerexperience disapproval, resulting in a sense of guilt.

School Age (6to 11 years)

Industry vs.Inferiority

School Children need to cope with new social and academicdemands. Success leads to a sense of competence, whi

failure results in feelings of inferiority.

Adolescence(12 to 18 years)

Identity vs.Role Confusion

SocialRelationships

Teens need to develop a sense of self and personal identSuccess leads to an ability to stay true to yourself, whifailure leads to role confusion and a weak sense of self

Respiratory structures

Cyanosis late sign of distress, ALOC better can child be comforted, what do parents think of mental statu

Tongue large in comparison to small oral cavity; can block airway

Thyroid, Tracheal muscles immature, easily collapsed

Larynx, glottis higher up, increase risk of aspiration

Alveoli size and number are fewer, less 02 reserve

Respiratory Issues

Respiratory illness common source of illness >5

Shorter eustation tubes infection leads to otitis medialung, floppy epiglottis vulnerable to swelling with resulting obstruction

RSV most common illness

Factors 2nd

hand smoke, day care, allergies, siblings, CF or asthma


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Ped Respiratory Assessment

Retractions,

Nasal Flaring

Grunting (very serious)

Chest movement Synchronicity bilaterally and versus chest/abdomen

Rapid breathing increased work to maintain barely adequate levels

Discharge Clear/bilateral (allergy), serous/unilateral (SF, basular skull fracture)

Mucoid bilateral (URI), unilateral (FBO)

Urgent Respiratory Threats

LTB

Laryngotracheobronchitis

A viral invasion of the upper airwaythat extends to throughout the

larynx, trachea and bronchi

Epiglottitis An inflammation of the epiglottis caused by a bacterial invasion Hib

Vaccine

Asthma A chronic inflammatory disorder of the airway with airway obstruction

that can be partially or completely reversedStatus Asthmaticus Unrelenting, severe respiratory and bronchospasm that cannot be

relieved

Apnea A cessation of respiration lasting 20 seconds or longer or any pause in

respiration associated a color change, Cyanosis (blue), Pallor or

Ruddiness, Hypotonia or Bradycardia

ALTE

Apparent Life Threatening

Event

An episode of apnea accompanied by

a color change that requires resuscitation

Lower Airway DisordersBPD

Bronchopulmonary Dysplasia

The most chronic and seriousrespiratory disorder that begins during

infancy. Direct result of treatment to premature and term infants.

Secondary to RDS,leaves chronic scaring of respiratory system (fibrosis).

Requires intensive O2 therapy and lung development

Bronchiolitis Most common cause of RSV, Lower respiratory tract illness causes

inflammation and obstruction of small airways, the bronchioles

Cystic Fibrosis Inherited autosomal recessive disorder of the exocrine glands that

result in physiologic alterations in the respiratory

Tuberculosis Systemic symptoms include fever, chills, night sweats, appetite loss,

weight loss, pallor, and fatigue. Spread by droplet.

Gastrointestinal

Rotavirus oral-fecal, most common cause of diarrhea in children. Live vaccination 2 months

Pinworms

Shigella fecal oral, N/F/V/D, seizures in children. Severe cases treat with fluoroquinolones such as ciproflox

and rehydration.

Salmonella contaminated undercooked meat, diarrhea, no ABX.

Giardia contaminated food, water, dirt, diarrhea, excess gas, stomach or abdominal cramps, upset stomach

and nausea


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Impetigo Roseola Ringworm Varicella (chickenpox)

Bactroban ointment Griseofulvin ointment Caladryl

Scabies Head Lice

Stevens Johnson Syndrome

Cell death of the epidermis, begins with fever, sore throat, and fatigue; can be caused by infection, react

to ABX or autoimmune. Dermatological emergency, supportive measures topical pain anesthetics and

antiseptics, maintaining a warm environment, and intravenous analgesics.

Kawasaki Disease

Occurs after 1-2 weeks high fever, non-responsive to Tylenol/ibuprofen; red eyes, strawberry tongue,

cracked lips, conjunctivitis, red palms/soles, tachycardia. Treat with aspirin and IV immunoglobulin.

Systemic necrotizing vessel vasculitis seen in children


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Volume to be Infused x Drip factor (on tubing) = Rate

Time (in minutes)

Insulins

Onset Peak Duration

Rapid Lispro 10-15min 1hrs 2-4hrs

Short (regular) Humalog R -1hr 2-3hrs 4-6hrsIntermediate NPH 2-4 hrs 4-12hrs 16-20hrs

Lentel 3-4 hrs 4-12hrs 16-20hrs

Long Acting Lantus 1 hr Continuous 24 hrs

Immunizations

1 day Hep B

1 month Hep B

2 months RV, DTaP, Hib, PCV, IPV

4 months RV, DTaP, Hib, PCV, IPV

6 months RV, DTaP, Hib, PCV,

12 months Hib, PCV, IPV, MMR, Varicella, Hep A,Flu

MCV 2-3 years

Live RV

Live Attenuated MMR, Varicella

Inactive DTaP, Hib, IPV, Flu, Hep A

Conjugate PCV, MCV

Equivalents

1 mL 30 oz

1 tsp 5 mL

3 tsp 1 Tbsp

1 grain 60 mg

1000 mg 1 gram

1mg 1000 mcg


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Rinse mouth after inhalers avoid triggers

UTI Antibiotics

Bactrum

Sulfonamide

Acute UTI

Caution for allergic reaction, photosensitivity, inactive in acidified urine (no

cranberry)

Rocephin

Cephalosporin (3rd

generation)

1 big IM dose more effective due to non-compliance

Penicillin Patients can be allergic to Penicillin if allergic to Keflex

UTI Antiseptics for Chronic UTI

Furadantin Daily medication for use with indwelling catheters (quad/paraplegic)

Metabolizes into a fomaldyhyde

Supresses flora, lowering bacterial effects

Cardiac Medications

Digoxin

Lanoxin

Assess for bradycardia, monitor for digitoxicity

Rapid onset loading dose

Monitor K+

Catopril/Enalopril

ACE Inhibitors

ACE inhibitors block conversion from Angio I to Angio II, reducing BP

Reduces afterload

K+ Retention

Dry cough

0xygen Pulmonary vasodilation

Morphine Respiratory depression

Furosemide/Lasix

Diuretics

Monitor BP, intake and output

Removes fluid and sodium

Reduces pre-load pressure

Diuril

Thiazides

Maintenance Diuresis

Monitor labs, intake and output

Spironolactone

Aldactone

Potassium sparing Maintenance Diuresis

Propranolol

Inderal

Increases contractility

Monitor VS, tissue perfusion, sodium is restricted

Carvedilol

Coreg

Systemic vasodilation, improves left ventricle function

Monitor liver, digoxin levels, dizziness and hypotension

Respiratory Medications

Bronchodialators Albuterol Rescue drug

Serevent Long acting, Maintenance

Advair Plus corticosteroid

Corticosteroids Reduce/Suppress inflammation

Leukotriene Inhibitor Singulair Corticosteroid enhancer, for chronic asthmatics >2 years old

Allergy shots Reduces to sensitivity to triggers

Diuretics Remove excess fluid, reduces work of lungs;

Can cause electrolyte imbalance (K+)

RSV immunization


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Documents

Pediatric Study Guide