Quiz 3

BUN and creatnine

BUN: 5-20 mg/100mL creatine: 0.7-1.5 mg/100 mL

candidiasis

Candida albicans is a yeast that reproduces by budding and in well infants causes oral and skin manilla or candida infections oral candidiasis -white plaques on an erythematous base on the buccal membrane and surface of the tongue. (milk curds, unable to wipe away) -skin candidiasis -severe, bright red, sharply circumscribed rash -generally in diaper area treatment -antifungal drugs (nystatin, clotrimazole, naftifine

anthrax

Causative agent: Bacillus anthracis, a bacteria Incubation period: 1 to 7 days (inhalational), 1 to 12 days (cutaneous), 1 to 7 days (gastrointestinal) Mode of transmission: originally contracted from contact with the feces of infected cows or sheep; not transmissible from person to person Types of immunity: unstudiedActive artificial immunity: At present, the anthrax vaccine is not used in children but is available for adults 18 to 65 years of age who work with anthrax in the lab, certain vets who handle animals or animal products contaminated with anthrax, and only some members of the military Passive artificial immunity: not available -cutaneous, inhalation or gastrointestinal -flu like symptoms followed by dyspnea, severe systemic shock and mediastinal widening and pleural effusion cutaneous: skin lesion begins as papule and passes through a vesicle stage, fever, malaise, headache, regional swollen lymph nodes gastrointestinal: eating underwood meat and infection severe abdominal pain, fever, diarrhea, septicemia treatment: older than 18 get ciprofloxacin younger kids get doxycycline

whopping cough (pertussis)

Causative agent: Bordetella pertussis Incubation period: 5 to 21 days Mode of transmission: highly contagious by direct or indirect contact Period of communicability: greatest in catarrhal (respiratory illness) stage; eliminates contagiousness within 5 to 7 days of treatment, but it continues for weeks in the untreated patient Immunity: contracting the disease offers lasting natural immunity Active artificial immunity: pertussis vaccine given as part of DTaP vaccine Passive artificial immunity: pertussis immune serum globulin s/s -thick nasal secretions 1. catarrhal stage- coryza, sneezing, lacrimation, cough and low-grade fever (1-2 weeks) 2. paroxysmal stage (2-6 weeks) cough changes to short rapid coughs with rapid inspiration causing the "whoop" cough. will become distressed, cyanotic or red faced 3. convalescent phase- gradual cessation of coughing and vomiting treatment -<3 months will be admitted for 48 hrs to see disease course progress and poor oxygen levels -avoid environmental factors -small frequent meals -10 day course of erythromycin or azithromycin -droplet precaution until 5 days after starting antibiotics prevention: immunize pregnant woman from 27 weeks-36 weeks to maximize maternal antibody transfer epistaxis, subconjunctival bleeding, seizures complications:

Lyme disease

Causative agent: Borrelia burgdorferi, a spirochete Incubation period: 3 to 30 days Period of communicability: not communicable from one person to another Mode of transmission: deer tick Active artificial immunity: none available; Lyme vaccine discontinued Passive artificial immunity: immune globulin s/s -erythematous papule that spreads to become large with a round ring with raised swollen border -systemic involvement leading to cardiac, musculoskeletal and neurological symptoms treatment: -amoxicillin less than 8 years old -doxyclicline for over 8 years old

tetanus (lockjaw)

Causative agent: C. tetani Incubation period: 3 days to 3 weeks Period of communicability: none Mode of transmission: direct or indirect contamination of a closed wound Immunity: development of the disease gives lasting natural immunity Active artificial immunity: tetanus toxoid contained in DTaP vaccine Passive artificial immunity: TIG -enters trough open wound -first symptoms: stiffness of neck and jaw -24-48 hours: muscle rigidity of the trunk and extremities -back becomes arches and abdominal muscles are stiff and board-like, wrinkling of the forehead and distortion of the corners of the mouth (sardonic grin) -paroxysmal spasms with any stimulation treatment: -quiet, stimulation free room -TPN, sedation and muscle relaxation -would clean with soap and water -tetanus immune globulin with lateral penicillin or metronidazole -may need to be intuited and mechanical ventilation to begin prevention: booster every 10 years

Rocky Mountain spotted fever

Causative agent: Rickettsia rickettsii Incubation period: 3 to 12 days Period of communicability: not communicable from one person to another Mode of transmission: wood, dog, or rabbit tick Active artificial immunity: Rocky Mountain spotted fever (RMSF) vaccine is not available. RMSF is transmitted by ticks and is a common rickettsial disease seen in the United States s/s -malaise, nausea, vomiting, myalgia -rash, fever and tick bite history -abdominal pain, persistent headache and confusion -rash- blanching pink, macular rash on the palms, soles, arms, legs and trunk; petechial rash develops by 5-6 days treatment- most common fatal rickettsial disease -doxycicline 7-10 days within first 5 days of symptoms

henoch-schonlein syndrome nephritis, lupus, hemolytic-uremic syndrome, acute renal failure, chronic kidney disease

Henoch Schonlein syndrome -purpura, proteinuria, rapidly progressing glomerulonephritis. -most recover completely, few develop chronic symptoms and long term kidney disease lupus -autoimmune disease cause deposits of complement in kidney glomerulus -develop acute or chronic glomerulonephritis -tx; corticosteroids or cytotoxic agents or kidney transplant hemolytic-uremic syndrome -glomerular arterioles become inflamed and swollen -recent exposure to ecoli -diarrhea, very high fever, oliguria proteinuria, hematuria. pale, easy brushing increased serum creatine and BUN, extensive edema -tx: renal replacement therapy. can be treated with peritoneal dialysis. most children recover completely but some die and continue to have chronic renal involvement acute renal failure -sudden body insult (prolonged anesthesia, hemorrhage, shock) -oliguria (less than 1 mL/kg of weight per hour) -azotemia (accumulation of nitrogen wastes from breakdown of proteins in the bloodstream) -uremia (extra accumulation of nitrogen wastes (urea) in the blood, additional toxic symptoms) -1.010, hyperkalemia, acidosis, high phosphorus and hypocalcemia -tx: underlying condition, furosemide chronic kidney disease -polyuria, enuresis, hypocalcemia, hyperphosphatemia, anuria, osteodystrophy -tx: low-protein, low-phosphorus, low-potassium diet. may need supplemental calcium, no meats or milk, possible fluid restriction, dialysis until transplant.

immunoglobulins types

IgM, IgG, IgA, IgD, IgE IgM- agglutinating antigens and lysing cell walls; discovered early in the course of infection in the blood stream and is first response to pathogenic antigens IgG- most frequently occurring antibody in plasma; during secondary response it is the major immunoglobulin to be synthesized. Diffuses across the placenta to supply passive immune protection to the fetus until the infant can effectively produce immunoglobulins. Neutralizing bacterial toxins and activating phagocytosis. IgA- saliva, sweat, tears, mucus, bile and colostrum. Provides defense against pathogens on exposed mucosal surface IgD- found in place, may be the receptor that binds antigens to lymphocyte surfaces but its true function is unclear IgE- immediate hypersensitivity reaction, associated with allergy and parasitic infections

enuresis, postural proteinuria, kidney agenesis, polycystic kidney, renal hypoplasia, prune belly syndrome

enuresis -involuntary passage of urine past the age when the child should be potty trained -ask how family has tried to correct the problem -tx: limit fluids 2 hr before bed, stress relief. desmopressin. behavior modification therapy postural proteinuria -spill albumin into urine when they stand upright for extended period -no therapy needed kidney agenesis -lack of growth, no organ found in utero -potter syndrome- accompanying misshapen lungs -incompatible with life unless renal transplantation polycystic kidney -large fluid-filled cysts have formed in place of normal kidney tissue -kidneys feel soft and spongy -associated with cerebral aneurysm, liver is filled with identical cysts -tx: surgical removal of kidney if only one is cystic, if both are cystic= renal transplantation renal hypoplasia -amniotic fluid volume; physical appearance -reduced growth, small and underdeveloped, hypertension of the renal arteries may develop -if bilateral, may need kidney transplant later in life prune belly syndrome -bilateral undescended testes, dilated development of bladder and upper UI tract, renal dysplasia. -deficient abdominal muscle tone -abdomen appear wrinkled, teach parents to avoid abdominal trauma -some children need kidney transplant as soon as they reach school age

common childhood viral infections

exanthem subitum (roseola), rubella (German measles), measles (rubeola), chickenpox (varicella), herpes zoster, erythema infectiosum (fifth disease), mumps (epidemic parotitis), infectious mononucleosis, and cat-scratch disease others: poliomyelitis (now almost extinct), herpesvirus infections, verrucae (warts), rabies, West Nile virus disease, and Zika virus

female circumcision, imperforate hymen, polycystic ovary syndrome, toxic shock syndrome, vulvovaginitis, pelvic inflammatory disease

female circumcision -cultural thing, not done here imperforate hymen -totally occludes vagina, preventing escape of vaginal secretions and menstrual blood -no symptoms before menarche -lower abdominal mass, building hymen is evident -tx: surgical incision or removal of hymenal tissue polycystic ovary syndrome -most common cause of ovulation failure today -irregular, missed period, acne, excessive hair growth, overweight, male pattern baldness, type 2 diabetes, absence of ovulation -tx: relieve symptoms, weight loss, COC may be prescribed toxic shock syndrome -infection usually by s.aureus -tampons in for too long -high temp, vomiting, diarrhea, hypotension, severe muscle pain, decreased platelet count, macular rash that desquamates on palms and soles tx: iodine douche cephalosporins, oxacillins or clindamycins -recovery in 7-10 days with adequate therapy vulvovaginitis -inflammation of vulva or vagina w/ pain, odor, pruritis and vaginal discharge -local antibiotic, warm bath , cotton underwear, antibiotic if needed, hygiene pelvic inflammatory disease -75% of cases come from sexually transmitted diseases -lower abdominal pain, heavy purulent discharge, fever, -tx: analgesia and doxycycline or clindamycin

staphylococcal infections

furunculosis/ carbunculosis -infection of single hair follicle, single or multiple yellow pustule forms at site. redness, pain and edema -may need incision to drain puss cellulitis -inflammation of dermal and subcutaneous layers of skin warmth, tenderness and erythema. treatment is systemic antibiotic MRSA -resistant to broad-spectrum antibiotics -tx: vancomycin, clindamycin or trimethoprim sulfamethazole for community infections -standard precaution -good hand hygiene scalded skin disease -ritter disease -infants -rough-textured skin and general erythema on areas that encounter friction -large bullae (vesicles) fills with clear fluid form -separates in large sheets and desquamates, leaving red, raw, glistening and scalded looking surface (Nikolsky sign)

types and functions of white blood cells

granular forms- neutrophils, eosinophils, basophils neutrophils- 60% at birth, 33% at 2 years, 60% thereafter. origin at bone marrow. activate in acute bacterial infections eosinophils- 1-4%. origin at bone marrow. increased in parasitic infection basophils- 0.0-0.5% organ at bone marrow. increased with inflammation nongranular forms- lymphocytes and monocytes lymphocytes- 30% at birth, 50% at 2 years, 30% thereafter. origin at bone marrow. t lymphocytes (in thymus gland) direct react with invading antigens. B lymphocytes from bone marrow produce antibodies that inactivate antigens monocytes- 5-10%. origin at bone marrow. serve as a backup for neutrophils in acute infections; macrophages are mature form

pituitary gland disorders (GH and ADH)

growth hormone deficiency -can't grow to full size, below 3rd percentile height/weight, infantile face, crowded teeth, high pitched voided, delayed onset of puberty, decreased levels of GH -tx: IM recombinant growth hormone at bedtime (somatropin) suppression of luteinizing hormone release (to delay epiphyseal closure) supplemental gonadotropin or other pituitary hormones growth hormone excess -over production of GH, fontanels close late or not at all, acromegaly, enlarge tongue that may protrude through mouth -Tx: removal of tumor if present, GH antagonist (bromocriptine or octreotide) supplement of thyroid extract, cortisol, gonadotropin hormones diabetes insipidus -decreased release of ADH, less reabsorption of fluid in kidneys -urine becomes dilute -polydipsia (thirst), specific gravity of 1.001-1.005, polyuria, hypernatremia (irritable, weak, fever, lethargy, headache) -tx: removal of tumor if present or desmopressin IV, PO or nasally syndrome of inappropriate ADH -decreased urine production, water intoxication, hyponatremia, weight gain, concentrated urine, nausea, vomiting, coma, seizures, brain edema -tx: fluid restriction and sodium supplement, demeclocycline

types of immunity

humoral- created by antibody production or B-lymphocyte production (IgM made around 6 days) memory cells are created after first exposure can immediately when exposed (can't get sick with same disease twice) complement activation- 20 proteins that activate with antigen-antibody contact. increased vascular permeability, smooth muscle contraction, phagocytosis and lysis. inflammatory response= red swollen and warm autoimmunity- can't distinguish self from non self and react against normal cells cell-mediated- t-lymphocyte activity, cytotoxic T cells destroy antigens when chemical compounds, wheal-and-flare response

pyloric stenosis

hypertrophy or hyperplasia of the muscle surrounding the pyloric sphincter making it difficult for the stomach to empty symptoms at 6 weeks for breastfed and 4 weeks for formula. s/s -vomiting -appear hungry after vomiting -signs of dehydration, hypochloremia, hypokalemia and starvation tx -surgery or laparoscopic procedure -4-6 hours small amount of ORS into bottle -24-48 hours post op can take full formula diet or breastfed

hypersensitivity types

immediate -IgE -decreased BP and edema, if not treated with epinephrine will cause shock or death -ex: allergies, asthma, atopic dermatitis, anaphylaxis cytotoxic -IgG and IgM -immunoglobulins attack and destroy -ex: hemolytic anemia, transfusion reaction, erythroblasrosis fatalis, tumor cells are destroyed with this process immune complex disease -IgG and IgE -involving complement and initiates inflammatory response -rheumatoid arthritis, systemic lupus delayed -T lymphocyte -ex: Mantoux or PPD test, contact dermatitis, transplant graft reaction

celiac disease

immune mediated, abnormal response to gluten -steatorrhea (bulky, foul-smelling stools) -failure to thrive -malnutrition -distended abdomen -anemia (6-18 months) treatment -eliminate gluten from diet, correction of any vitamin or mineral deficiencies

appendicitis

inflammation of the appendix -anorexia, pain or tenderness in the right lower quadrant, nausea vomiting, elevation of temp, leukocytosis pain is late symptom fever is late symptom redound tenderness McBurney's point- point of sharpest pain 1/3 way between anterior superior iliac crest and umbilicus Tx: removal of appendix before ruptures if ruptured -semi-fowler position and antibiotics, IV fluids and s/s peritonitis ng tube

the body immune response to organisms

innate immunity -nonspecific -neutrophils are first line of defense -activate monocyte to macrophage to clean debris and kill infecting organisms -complement and cytokine signal specific cellular and humeral immunity to add in host defenses adaptive immunity -TH1 help activate microphages, enhance cytotoxic T cell function, produce cytokines and recognize infecting agent -TH2 release cytokines and enhance antibody formation phagocytosis produces pus -small amount= infection is resolving -large amount= overwhelming the immune response and can tier the blood and lymphatic system

intussusception

invagination of one portion of the intestine into another s/s -sudden drawing up of legs and cry in severe pain and vomiting bile -repeated pain episodes every 15 minutes -stool "red currant jelly"** -distended abdomen treatment -surgical emergency -installation of water-soluble solution, barium enema or air into bowel -needs to be held and rocked r/t constant pain

types of dehydration

isotonic- loses more water than it absorbs, or absorbed less fluid is excretes -diarrhea and nausea/vomiting s/s: mild thirst, poor skin turgor, dry skin, cool temp, decreased urine output, irritable, normal sodium hypotonic- water is lost in greater proportion than electrolytes, RBC and hematocrit increase. -nausea and fever, profuse diarrhea s/s: moderate thirst, very poor skin turgor, clammy skin, cool temp, decreased urine output, lethargic, reduced sodium hypertonic- high loss of electrolytes in proportion to fluid loss -vomiting adrenal cortical insufficiency or diabetic ketoacidosis -s/s: extreme thirst, moderate skin turgor, moderate skin consistency, warm temp, decreased urine output, very lethargic, increased sodium overhydration -excessive fluid intake usually through IV. can lead to CV and cardiac failure

menstrual disorders: Mittelschmerz, dysmenorrhea, menorrhagia, metrorrhagia, menstrual migraine, endometriosis, amenorrhea, premenstrual dysphoric disorder

mittelschmerz -pain caused by blood spilling into abdominal cavity -pain in one side of abdomen accompanied by vaginal spotting -tx: acetaminophen dysmenorrhea -painful menstruation bloated, abdominal pain, diarrhea, mild breast tenderness, nausea, vomiting, headache -tx: ibuprofen, reduce salt, may take COC menorrhagia -abnormally heavy menstrual flow (>80mL per menses or soaks up more than one pad an hour) metorrhagia -abnormal uterine bleeding between menstrual periods -if occurs for more than one menstrual cycle and not taking COC, need to be referred to primary care provider -tx: NSAIDs and COC menstrual migraine -sharp headache accompanied by nausea or vomiting, vision changes tx: NSAIDS or discontinue COC endometriosis -abnormal growth of endometrial cells -main cause of dysmenorrhea -painful coitus -pelvic exam shows uterus is displaced by tender, fixed, palpable nodules -tx: medical or surgical depending on extent. amenorrhea -absence of menstrual flow -can result from tension, anxiety, fatigue, chronic illness, extreme dieting or strenuous exercise premenstrual dysphoric disorder -relieved by onset of menses -anxiety, fatigue, abdominal bloating, headache, irritability or depression -tx: keep a diary when mood changes, COC

west nile virus

most common arboviral disease -majority is asymptomatic, encephalitis, meningitis, acute flaccid paralysis

vomiting

most common cause: mild gastroenteritis (infection) -obtain through assessment -treatment: hydration -icechips then water in small amount -1 Tbsp q 15 mins 4 times 2 Tbsp q 30 min 4 times -small sips of clear liquid (broth etc) -2nd day soft diet -3rd day regular diet oral rehydration (pedialyte) for infants and younger children

tick borne diseases, parasitic and helminthic infections

tick: Rocky Mountain spotted fever and Lyme disease parasitic: pediculosis capitis (head lice), pediculosis pubis, and scabies helminthic roundworms, hookworms, and pinworms. Fungal infections are tinea capitis and tinea corporis, both of which are forms of ringworm

constipation

two or less bowel movements per week that causes distress in child encopresis s/s -abdominal pain -decreased appetite -stools are often large, hard and painful to pass tx: soften stools polyethylene glycol, sit on toilet after meals, avoid enemas

type 1 vs type 2 diabetes

type 1 -autoimmune, deficiency of insulin -abrupt onset, marked weight loss often initial sign -polydipsia, polyphasia, polyuria, fatigue, blurred vision, mood changes -tx: hypoglycemia agents never effective, insulin required. should count carbs plus evaluate blood glucose. foot care is important -period of remission 1-12 months (honey moon period) after initial diagnosis type 2 -40-65 years, gradual onset related to obesity -polydipsia, polyuria, fatigue, blurred vision, mood changes -tx: diet, oral hypoglycemic agents, insulin. nutrition concentrated on no excess weight gain and balanced intake of carbs, protein, fat. meticulous skin and foot care necessary -period of remsission no demonstrable

inflammatory bowel disease

ulcerative colitis and chrons disease UC -mucosal lining of colon, cramping abdominal pain, urgency, tenesmus and frequent blood stools, anemia, surgery to remove colon CD -abdominal pain, diarrhea with or without blood, weight loss, fistulae on bowel to skin or perineal area

hantavirus pulmonary syndrome infection

virus infects rodents fever, chills, cough, myalgia, gastrointestinal symptoms of diarrhea, vomiting and headache capillary leak develops in lung resulting in pulmonary edema hypotension leads to cardiac dysfunction and subsequent death tx: rodent control and vaccines

intestinal disorders

volvulus -twisting of the intestines -intense crying, pulling up on legs, abdominal distension, vomiting -surgery is an emergency necrotorizing enterocolitis -necrotic areas in the bowel leading to perforation of bowel short-bowel/short-gut syndrome: absorptive disorder which there is not sufficient bowel surface area in the small intestine for proper nutrition absorption

blood infection

when pathogenic organisms in the blood stream cause nonspecific bacteria without any signs of organ failure can lead to more serious systemic inflammatory response system, 1. sepsis syndrome with alteration in temp, RR, HR or WBC 2. septic shock with organ dysfunction, hypotension and hypoperfusion 3. severe sepsis with hypotension despite vigorous treatment

atopic disorders

*allergic rhinitis -s/s congestion, sneezing, nasal drainage, pale mucous membrane, nose rubbing (allergic salute), Dennie line (crease on nose), allergic shriners (black under ryes related to increased pressure) -risk for asthma sleep impairment and poor school performance -tx: avoid allergens, antihistamines, leyukotrine inhibitor corticosteroids *atopic dermatitis (infantile eczema)- highly pruritic, chronic inflammatory skin disease -may go on to develop allergic rhinitis and asthma -vesicles rupture and exude secretions that form crust as they dry and secondary infections occur -s/s: rash on neck, face, and extensor surfaces -poor sleep patterns, poor intake and increase need of energy -tx: reduce exposure link to food keep skin hydrated to reduce pruritis, antihistamines, low dose steroid for maintenance, high dose steroid for exacerbation *atopic dermatitis in the older child -flexor surface of the extremities and dorsal surfaces of the wrists and ankles, in eyebrows, itch-scratch cycle -depigmentation or hyperpigmentation as lesions fade tx: prescription soap or none at all, swimming in chlorinated pool, shower after sweating, hydrocortisone of phototherapy with UV light

Primary immunodeficiencies humoral deficiency

*humoral deficiency -well until 4-6 months of age when antibodies from Mom wears off ,child fails to produce ownantibodies -B cells can't produce antibodies - types: selective IgA deficiency, agammaglobulinemia, common variable immunodeficiency -tx for agammaglobulemia and CVD: regular infusion of polled human immunoglobulin IV ,monitor s/s infection CVID- at risk for autoimmune disease and lymphoreticular cancer *T-lymphocyte deficiency -inadequate number or function of lymphocytes -DiGeorge syndrome (congenital heart disease, abnormal facies, aplastic or hypo plastic thymus, hypocalcemia, cleft lip or palate) *Combined T-and B-lymphocyte deficiency -severe combined immunodeficiencies -children cannot respond directly to antigen invasions and no antibodies are produced -Tx: hematopoietic stem cell transplant possibly from cord blood -on reverse precautions (you don't want to give anything to child, they are high infection risk)

tests for detection of hypocalcemia

-immature infants, neuromuscular irritability -Chvostek sign- when skin anterior to external ear is tapped, facial muscles surrounding eye, nose and mouth contract unilaterally -trousseau sign- when upper arm is constricted by tourniquet for 2-3 min and area becomes balanced, carpal spasm is elicited (hand abducts wrist flexes, thumb is position across cupped palm) -peroneal- when fibular side of leg over perineal nerve is tapped, foot abducts and doriflexes -tx: increase calcium in body. oral 10% calcium chloride or IV 10% calcium gluconate, anticonvulsant therapy, vitamin D supplementation

hepatitis

-increased AST, ALT and alkaline phosphate levels A; fecal-oral route. headache, fever, anorexia. last for 1 week and will have full recovery B; aching, right upper quadrant pain, headache, pruritis, brown urine, eyes become jaundice C asymptomatic but similar to B tx: vaccinations for A and B, hand washing, don't share needles. rest and maintenance of good caloric intake. can spread from mom to baby

stages of the infections process

-incubation period: time between invasion or organism and onset of symptoms (when organism grows and multiplies) -prodromal period: time between the beginning of nonspecific symptoms (malaise, low-grade fever, fatigue and arthralgia) to disease specific symptoms. May be infectious during the prodromal period -illness: when specific symptoms occur -convalescent period: time between when symptoms first begin to fade and when the child returns to a healthy baseline

giardiasis

-most common intestinal parasitic infection transmission occurring from ground water contaminated -fecal-oral route from fecal contaminated in water and stool -person to person or person to animal -asymptomatic or symptomatic- diarrhea, weight loss, abdominal cramps, bloating and weight loss tx -mentronidazole, nitazoxaide, tinidazole prevention hand washing for 20 seconds improved sanitation at daycare adequate chlorine in pool and drinking water camping water decontamination

herpesvirus infections

-mucocutaneous lesions in children and adolescents -HSV1 more common in oral region, HSV2 in genital region causative agent: type 1 or type 2 virus incubation: 2 said to 2 weeks peak of communicability: greatest early in the course of the infection mode of transmission: direct contact with persons with active lesions immunity: herpes viruses like VZV have viral latency -acute herpetic gingivostomatitis: 6 months to 5 years sudden onset of pain, drooling, anorexia and high fever 105. swollen, reddened gum line, white shallow ulcers, tender cervical lymph nodes need antipyretic and nonirritating foods -contact precaution herpes simplex -cold sore or fever blister -cluster of painful, grouped vesicles -oral acyclovir for treatment acute herpetic vulvovaginitis (genital herpes) -HSV type 2 spread through sexual contact

Chain of infection

-reservoir: place where organism grows and reproduces. (another person, contaminated objects. Fomites- inanimate objects than can also transmit infections from one person to another without direct human vector) -portal of exit: route by which organism leaves infected Childs body (through excretions, feces, vomitus, saliva, urine, vaginal secretions, blood or lesion secretions) may need to wear gown, gloves or mask wash after contact. with any body secretion cover cough/sneeze hand washing -mean of transmission: direct or indirect. Fomites (soil, food, water, bedding, towels) vectors (insects, rats, vermin). most common indirect contact is through sneezing, breathing, coughing, kissing, sharing drinks wash hands before between and after pt care paper cups separate toothbrushes different towels portal of entry- opening through which a pathogen can enter the body. inhalation, ingestion, breaks in skin (bites, abrasions or burns) wash hands after sneezing or coughing, before eating and after using bathroom wipe front to back wash dirt from cuts with soap and water susceptible host- very old or very young, gender (females get more UTI, body defenses, infants who are breastfed are less susceptible to infection)

average child urine output in 24 hours

6 months- 2 years: 540-600mL 2-5 yrs: 500-780mL 5-8 years: 600-1200 mL 8-14 years: 1000-1500 mL over 14: 1500 mL

drug and food allergies

drugs -toxic reaction: too much of drug -side effect: known to occur -allergic effect- range of unpredictable symptoms occur -aspirin, antibiotics and NSAIDs allergies are common PO meds -s/s urticaria, angioedema, allergic contact dermatitis, flushing, pruritis, purapura. wheezing, rhinitis -tx: discontinue treat urticaria and anaphylaxis food allergies -s/s vary but can include urticaria, angioedema, flushing, pruritis -can be seconds or hours after ingesting -peanut, egg whites, milk, wheat, soy, seafood, tree nuts -keep a food diary of what they eat and any symptoms -tx: eliminate food vaccines- do not give MMR or influenza vaccine to those allergic to eggs milk intolerance- shown during infancy- unable to gain weight, diarrhea, vomiting and abdominal pain tx: supplement with hydrolyzed-protein based formula or can breast feed peanut hypersensitivity- avoid peanuts until 3 years. high risk infants are those 7-11 months diagnosed with egg allergy and severe eczema

what are some national health goals related to infectious diseases

reduce, eliminate or maintain elimination of vaccine-preventable diseases such as measles achieve and maintain effective Vaccination coverage levels for university recommended vaccines increase states that use electronic data from rabies surveillance to inform public health prevention programs reduce central-line bloodstream infections reduce invasive health care associated MRSA

gastroeshophgeal reflux

regurgitation of stomach secretions into the esophagus through the lower esophageal sphincter infants: very common, effortless vomiting, self-limiting, unusually no tx required tx: small frequent feedings or formula thickened with rice cereal, upright 30 min, no tight clothing, no smoke. surgery is done if it is not resolved on its own children/adolescents less common, dietary changes promote a healthy lifestyle OTC antacid. heartburn 30-60 mins after meal and regurgitation -tx: don't lay down 3 hrs after a meal, avoid acidic food, sleep with upper body elevated.

helminthinic infections

roundworms (ascariasis)- loss of appetite, nausea and vomiting -prevention- sanitary disposal of feces -albendazole with food, nitazoxanide BID for 3 days or single dose of ivermectin hookworks -asymtomatic and common in warm climates -attach to intestine and suck blood -abdominal pain, nausea, diarrhea, eosinophilia treatment: albendazole, mebendazole, pyrantel pamoate enterobiasis (pinworms) -small white threadlike worms that live in cecum -anal area to itch and can be carried from fingernails to mouth and repeat the cycle -can bee seen if buttocks are spread treatment: mebendazole or pyrantel pamoate. underclothing, bedding, towels and clothes should be washed. can be spread person to person

dialysis types

seperation and removal of solutes from body and fluid by diffusion through semi-permeable membrane peritoneal- catheter is placed into peritoneal cavity. can be done continuously every 12-72 hrs. continuous cycling peritoneal dialysis -permanent catheter attached to bag of dialysis fluid -higher risk of infection, dehydration or hypernatremia hemodialysis -catheter into artery to remove blood through dialysis coil -2-3x a week

peptic ulcer disease

shallow excavation formed in the mucosal wall of the stomach, pylorus or duodenum. includes gastritis commonly seen in childhood s/s: pain, blood in stool and vomiting with blood -tx: amoxicillin and clarithromycin or PPI- omeprazole

STDs; candidiasis, trichomoniasis, bacterial vaginosis, chlamydia, HPV, herpes genitalis

candidiasis- vulvar reddening, burning, itching, thick cream-cheese discharge, internal white patches -tx: anti fungal miconazole, clotrimazole trichomonias -thin, irritating frothy, gray-green discharge, strong, putrid odor; itching -tx: metronidazole or tinidazole bacterial vaginosis -intensely pruritic, milky-white to gray discharge -tx: metronidazole 7 days chlamydia -watery, grey-white vaginal discharge; vulvar itching HPV -genital warts on external vulva, vagina or cervix -cauliflower like lesions -related to penile and cervical cancer -can remove some lesions herpes genitalis -pinpoint vesicles on erythematous base, become moist, painful, draining, open lesions -tx: baths with dilute sodium bicarbonate, acyclovir or valacyclovir gonorrhea slight yellowish vaginal discharge, bartholian glands become enlarged tx: IM ceflaxone, doxycycline, azythromycin syphillis -deep ulcer on genitalia, mouth, lips. swollen lymph nodes -tx: benzathine, penicillin, erythromycin, tetracycline

rabies

causativa agent: RABV incubation: 1-3 months period of communicability: 3 to 5 days before the onset of symptoms through the course of the disease mode of transmission: the bite of a rabid animal; rarely through saliva from an infected animal being transferred to an open lesion immunity: contracting disease offers immunity, but few people survive most common cause is bats s/s prodromal stage: malaise, fever, anorexia, nausea, sore throat -anxiety, radicular pain pursuits, hydrophobia, dysautonomia, paralysis treatment: -almost always fatal -prevention is key -rabies vaccine and RIG

impetigo

causative agent- b-hemolytic streptococcus group A or s.aureus incubation period: 7-10 days period of communicability- from outbreak of lesions until lesions are healed mode of transmission: direct contact with lesions (common to see several children in a family with this) s/s -honey-colored crusts with local erythema -face and extremities treatment -mupirocin ointment 7-10 days -retapamulin for children over 6 months BID for 5 days

diphtheria

causative agent: Corynebacterium diphtheriae (Klebs-Löffler bacillus) Incubation period: 2 to 5 days with a range of 1 to 10 days Period of communicability: In untreated persons, the organism is contagious from nares, throat, skin, and eyes for 2 to 6 weeks following infection; 48 hours after initiation of antibiotics in treated children and adults. Mode of transmission: direct contact or indirect contact droplets Immunity: Contracting the disease gives lasting natural immunity. Active artificial immunity: diphtheria toxin given as part of diphtheria, tetanus, and pertussis (DTaP) vaccine Passive artificial immunity: diphtheria antitoxin s/s -rare illness -gray membrane of nasopharynx -purulent nasal drainage and brassy cough -skin lesions treatment- equine antitoxin -IV penicillin or erythromycin -complete bed rest -droplet precaution -assess airway obstruction -endotracheal intubation may be necessary

epstein-barr infectious mononucleosis

causative agent: Epstein-Barr virus incubation period- shorter than 30-50 days in children period of communicability- direct contact with saliva mode of transmission: direct contact and through blood transfusions immunity s/s -anorexia chills, malaise, fever, enlargement of cervical nodes and tonsils treatment: pain and fever with acetaminophen or NSAID -rest when fatigue and avoid contact sports for 4 week

cat scratch disease

causative agent: bartonella henselae bacteria which is slow growing incubation period: usually 1-2 weeks period of communicability: unknown mode of transmission: bite or scratch from more commonly or a kitten -preschool children who roughly play -first symptom- skittle skin or pustule at site of inoculation -lymphadenopathy by 1-2 weeks treatment -azithromycin to decrease lymph node size -symptomatic may need antimicrobials -do not need to destroy cat

exanthema subitem (roseola infantum)

causative agent: human herpesvirus 6 (HHV-6) incubation period: 9-10 days period of communicability: during febrile period mode of transmission: unknown immunity: contracting the disease offers lasting natural immunity; no vaccine is available assessment: -first symptom if fever -cervical adenopathy with mild injection of pharynx -fever will fall after 3-5 days -rash of discrete, rose-pink macule after fever falls on trunk, fade on pressure and last 1-3 days can cause febrile seizures, encephalitis, encephalopathy and building fontanels treatment: -acetaminophen or ibuprofen over 6 months for fever -follow standard precaution

Measles (Rubeola)

causative agent: measles virus incubation period: 8-12 days from time of exposure to onset of any symptoms with a range from 7-21 days period of communicability: 4 days before or after rash appears mode of transmission: direct contact with droplets or airborne spread immunity: contracting the disease offers lasting natural immunity activate artificial immunity: attenuated live measles vaccine (MMR) passive artificial immunity: immune serum globulin assessment -febrile illness associated with cough, coryza, conjunctivitis -confluent maculopapular, erythematous rash starting being ear and spreads to feet -koplik spots- small white spots with bluish white center on erythematous background -prodromal period: post auricular, cervical and occipital lymph nodes become enlarged, low grade fever, malaise, photophobia, cough, coryza, mild GI symptoms -koplik spots develop on the buccal mucosa complications: otitis media, pneumonia, croup diarrhea treatment -comfort measures for rash -antipyretic for fever -lubricating jelly under nose -buckwheat honey for over 1 yr -drawing curtains or wearing sunglasses -airborne precautions for duration of illness

non polio enteroviruses

causative agent: member of the enteroviral family incubation period: most common is between 3-6 days, which hemorrhagic conjunctivitis having a shorter incubation of 24-72 hrs. period of communicability: uncertain mode of transmission: respiratory tract secretion, fecal-oral, vertical transmission from mother to baby at the time of birth; possibly breastfeeding immunity: none enteroviruses, echoviruses meningitis, diarrhea, acute respiratory illness and maculopapular rashes usually benign and self limiting -tx: antipyretic, comfort for rash -contact precautions coxsackievirus -hand-foot-mouth disease -herpangina (fever, difficulty swallowing need a bland, soft diet or nonirritating liquid when they have mouth lesions asso

mumps

causative agent: mumps virus incubation period: 16-18 days, 12-25 days period of communicability- 5 days from onset of the swollen parotid gland mode of transmission: direct contact with respiratory droplets immunity: contracting the disease gives lasting natural immunity active artificial immunity: attenuated live mumps vaccine in combination with MMR passive artificial immunity: mumps immune globulin s/s -fever, headache, anorexia, malaise -parotid gland enlargement without erythema -inability to open mouth (truisms) -boys may develop testicular pain and swelling after puberty treatment: -fever and pain control with acetaminophen, NSAID, soft bland diet -droplet precaution

herpes zoster

shingles -reactivation of HSV as a result of aging or immunosuppression symptoms -first: paresthesia and pain -vesicular lesions in different stages of healing along a dermatomal distributions treatment -varicella-zoster vaccine for people over 50 years old -analgesia for pain and reducing pruritis -acyclovir to eliminate disease and given within 72 hours of the start of the rash -varicella-zoster immune globulin (VZIG) within 96 hours for immunocompromised children and minimize symptoms (prob not common in children)

common streptococcal disease and staphylococcal infections

strep:streptococcal pharyngitis, scarlet fever, and impetigo staph: impetigo, furunculosis (boils), cellulitis, and staphylococcal scalded skin syndrom

fungal infections

superficial fungal infections: tine cures, pedia, capitais, corporis tinea cruris- jock itch brownish to erythematous patch on the groin, inner thigh, and scrotum. treated with antigunfal agent tinea pedis- athletes foot, pruritic pinpoint vesicles with fissures between the toes and plantar surface. treated with clotrimazole tinea capitis: patchy alopecia, demarcated scaling erythematous patch, yellow crusting with heavy hair loss or kerion or boggy circular area of hair loss. treatment: oral anti fungal and topical shampoo tinea corporis superficial, well-demarcated, mildly erythematous, ring-like infection of the epidermal layer of the skin characterized by slightly scaly central clearing and raised popular boarders

liver transplantation

surgical replacement of malfunctioning liver by a donor liver prep- best physiologic condition possible post-op may be ventilated, given mofetil, cyclosporine, tacrolimus before transplantation

erythema infectious (Fifth disease)

causative agent: parvovirus B19 incubation period: most common between 4-14 days, period of communicability: uncertain mode of transmission: respiratory tract secretion, blood transfusion, vertical transmission from mother to baby immunity: none s/s -HIV patients get symptomatic anemia -hemolytic anemia its can develop dangerously low hemoglobin leading to cardiac failure -fetal death in pregnant woman well child can be asymptomatic "slapped cheek" appearance following rash- lacy-appearing rash on the arms, thigh, and buttocks may appear that can fade and intense depending on Childs activity level other: petechial, papular purpuric stocking and glove distribution or respiratory illness without rash treatment -antipyretics and analgesics -droplet precaution -can go back to school as soon as rash appears

poliovirus infections: poliomyelitis

causative agent: poliovirus incubation period: non paralytic polio: 3-6 dys peak of communicability: greatest shortly before and after clinical symptoms, contagious as long as present in feces mode of transmission: respiratory secretions and feces immunity: contracting the disease causes active immunity against the one strain of virus causing the illness active artificial immunity: inactivated polio virus vaccine no passive artificial immunity s/s -asymptomatic, or goes into GI tract-> fever, headache, nausea, vomiting, abdominal pain, constipation and malaise (less than 1% go on to get paralyzed) Treatment -bedrest and antipyretics -long term ventilation may be necessary -PT to prevent contracture and promote strength

rubellea (German measles)

causative agent: rubella virus incubation period: 14 days range of 12-23 days period of communicability: 7 days before and after rash appears mode of transmission: direct and indirect contact with droplets immunity: contracting the disease offers lasting natural immunity a high rubella antibody titer reveals infection has occurred active artificial immunity: attenuated live virus vaccine (MMR) passive artificial immunity: immune serum globulin is considered for pregnant woman exposed to virus assessment -young children: rash with no prodrome -rash is discrete, pink-red maculopapular rash on face and spreads to trunk and extremities -older children. 1-5 day prodromal period: low-grade fever, headache, malaise, anorexia, mild conjunctivitis, upper respiratory symptoms, lymphadenopathy. prodrome is followed by a rash that disappears by 3rd day complications: congenital rubella syndrome (mom to baby), arthralgia, arthritis, encephalitis, orchitis, neuritis and hemorrhagic manifestation treatment -comfort measures -acetaminophen or ibuprofen for fever or joint pain -droplet precaution for 7 days after onset of rash -can cause fetal death

small pox (variola)

causative agent: small pox incubation period: average of 12 days period of communicability: 1 day before rash and continues until all lesions are dried up mode of transmission: airborne symptoms -febrile prodrome not seen in varicella -pustular stage- firm and deeply embedded into dermal layer -crusting stage- lesions are contagious -spread directly or indirectly -prodrome period: high fever (102-104), headache, abdominal pain, malaise, severe fatigue -within 24 hours, skin lesions start on face and spread down the body to the forearm, trunk and legs. -face and distal extremities are the most affected treatment -vaccina immune globuline -antibiotics to prevent secondary infection of lesions -O2 for cardiac function

scarlet fever

causative agent: streptococci, group A incubation: 2-5 days for streptococcal pharyngitis period of communicability: greatest during acute phase of respiratory illness mode of transmission: direct contact from person to person s/s -school age, 7-8 years -streptococcal pharyngitis, fever, sore throat, headache, chills, rapid pulse, malaise -skin rash red with pinpoint lesions that blanch on pressure -enlarged tonsils with white exudate -strawberry tongue by day 4 or 5 treatment -penicillin or amoxicillin -tylenol or ibuprofen -soft diet -hydration

chicken pox (varicella)

causative agent: varicella-zoster virus incubation period: 10-21 days period of communicability- 1 day before rash and 5-6 days after initial appearance mode of transmission: highly contagious, spread by direct or indirect contact of saliva or open vesicles immunity: contracting the disease offers lasting natural immunity to chicken pox, can later become shingles when reactivated active artificial immunity: attenuated live virus vaccine passive artificial immunity: varicella-zoster immune globulin within 72 hours with those who are immunosuppressed assessment -rash with low-grade fever and malaise -macule, papule, vesicle appearing at same time on trunk progressing to arms, face, legs and mucosal surfaces including genitalia -2-3mm vesicle on erythematous base -all four stages of lesions present at same time treatment -decrease scratching -oatmeal-based creams -diphenhydramine can reduce pruritus -acetaminophen for fever -acyclovir in high-risk patients to reduce number and shorten illness -airborne and contact precautions until all lesions are crusted -may return to school as soon as all lesions are crusted complications: secondary infections of the lesions, pneumonia and encephalitis

zika virus disease

caused by yellow fever mosquitos -fever, arthralgia, conjunctivitis, eye pain, myalgia, rash headache tx: screen blood donors and use condoms, avoid mosquitos

Secondary (acquired) immunodeficiency

caused from other factors *HIV -attacks CD4 helper T-cells. -transmission: blood, body secretions, mother to fetus -s/s: frequent infections, fever, swollen lymph nodes, respiratory tract infection, oral candidiasis -cant' resist common cold -tx: High active antiretroviral therapy, hand hygiene, avoid sick contacts AIDS- severely symptomatic

warts (verrucae)

caused human papilloma viruses incubation period: 3 months mode of transmission: direct contact -flesh-colored, dirty-appearing papule generally on dorsal surface of the hands also on soles of feet -can be cosmetically removed treatment: -OTC creams with salicylic acid solution -carbon dioxide snow, liquid nitrogen, electrodessication, laser, cryotherapy

bile duct obstruction

causes: congenital biliary atresia, stenosis or absence of duct. bile accumulates in the liver and enters the blood stream s/s -jaundice at 2-6 weeks of age -elevated direct bilirubin -AST is normal then becomes abnormal -poor absorption of calcium and vitamin A,D,E,K -tx: liver transplant or Kasai procedure where atresia of bile duct is corrected and stools with darken and jaundice will resolve

thyroid gland disorders congenital hypothyroidism, acquired hypothyroidism and hyperthyroidism

congenital -nonfunctioning thyroid gland in newborn -symptoms at 3 months formula fed, 6 months brestfed -sleeping excessively, respiratory difficulty, noisy respirations or obstruction. suck poorly, cool dry scaly extremities, does not perspire. prolonged jaundice and anemia may result, dry brittle hair, short neck, umbilical hernia, generalized obesity -tx: may fade by 3 months, PO sodium levothyroxine acquired hypothyroidism (Hashimoto disease) -10-11 years, may be family history and occurs more in girls than boys -caused by development of an autoimmune phenomenon -goiter, increased level of TSH, obesity, lethargy and delayed sexual development, impaired growth, antithyroid antibodies in serum, nodular thyroid -Tx: sodium levothyroxine, possible vitamin D, family/pregnant education hyperthyroidism (graves disease) -autoimmune reaction resulting in overproduction of IgG -nervousness, tremors, loss of muscle strength, easy fatigue, BMR, BR and HR all increase, skin is moist and they freely perspire, always feel hungry and do not gain weight, goiter, exophthalmia -Tx: B-adrenergic blocking agent (propranolol) antithyroid drug (propylthiouracil or methinmazole) monitor for leukopenia. radioiodine ablative therapy and thyroidectomy followed by supplemental thyroid hormone

contact dermatitis

delayed or type IV hypersensitivity -first symptom: erythema then develop into pruritic papules then vesicles diaper-washing area, poison ivy, allergy to latex -must not be taking a corticosteroid at the time of patch testing, can take antihistamine tx: removing allergen. dress with water, saline or brows solution. calamine and caladryl lotions for itching. baths with baking soda or oatmeal

infections and related conditions of the urinary system

UTI's -more in female -urine culture -change diapers frequently -s/s; pain on urination, frequently burning, hematuria. confined to bladder (cystitis) will have low-grade fever, mild abdominal pain and enuresis. pyelonephritis- high fever, abdominal or flank pain, vomiting and malaise -tx- sulfamethoxazole trimethoprim or amoxicillin "honeymoon" cystitis -UTI after sexual relations caused by irritation and inflammation -pee after to prevent infections -antibiotic and education vesicoureteral reflex -retrograde flow of urine from the bladder into the ureters (from birth or due to recurrent UTIS) -voiding cystrourethrogram, CT scan, MRI, cystoscopy or cystography with contrast -s/s: recurrent UTIs -tx: mature on its own. teach double voiding, antibiotics. if not corrected on its own, may need surgery hydronephrosis -enlargement of the pelvis of the kidney with urine as a result of back pressure in the ureter -fetal ultrasound, VS -most common at 6 months -s/s asymptomatic with recurrent UTIs, -tx: surgical correction before any destruction occurs

inguinal hernia

a protrusion of a section of the bowel into the inguinal ring s/s -lump in the right or left groin, sometimes only apparent when crying -painless tx: surgical repair

Hirschsprung disease agagnlionic megacolon

absence of ganglionic innervation to the muscle of a section of the bowel resulting in chronic constipation or ribbonlike stools s/s: malnourished, one bowel movement per week. ribbonlike or watery stools tx: removal of the affected section 2 stage surgery

breast disorders: accessory nipples, breast hypertrophy, breast hypoplasia, fat necrosis, fibrocystic breast disease, fibroadema mastitis

accessory nipples -additional nipples along nipple line in male or female -can be cosmetically removed breast hypertrophy- enlargement of breast tissue breast hypoplasia -below average breast size fat necrosis -breast tissue is struck during a fall or traumatic injury resulting in tender, painful, inflamed or reddened. necrosis occurs in the fatty layer a few days later and produces a lump -fibrotic areas should be biopsies and excised fibrocystic breast disease -older adolescents -round, fluid-filled freely movable cysts -common benign breast condition -tx: lower sodium, diuretic before menses, no smoking, acetaminophen, warm compress, no trauma fibroadenoma -round, weds delineated, painless, freely movable -can be surgically removed mastitis -inflammation or infection of the breast

nonalcoholic fatty liver disease and cirrhosis

accumulation of fatty deposits in the liver and usually associated with obesity -cirrosis: scarring of the liver -children will have large fatty stools r/t decrease in bile production -tx: cholestyramine to reduce reabsorption of bile into circulation to minimize itching esophageal varies- distended veins in the esophagus, a complication of cirrhosis -if ruptured, will be a medial emergency

metabolic acidosis and alkalosis

acidosis -result of diarrhea, loss of NA+ -pH <7.35 -HCO3 <22 -hyperpnea to blow off CO2 -urine becomes acidic alkalosis -result of vomiting -low H+ -slow respirations -HCO3 > 26 -pH >7.45 -hypokalemia may accompany (K+ are exchanges for H+)

adrenal gland disorders: acute adrenocortical insufficiency, congenital adrenal hyperplasia, salt-losing form of congenital adrenocortical hyperplasia, Cushing syndrome

acute adrenocortical insufficiency -adrenal gland becomes unproductive -BP drops, ashen gray, weak pulse, elevated temp, dehydration and hypoglycemia, sodium an chloride drops. potassium elevates, death can occur without treatment -tx: medical emergency, immediate replacement of corisol (hydrocortisone sodium succinate) administer deoxycorticosterone acetate, D5NS, treat shock with vasoconstrictor congenital adrenal hyperplasia -inherited, adrenal glands can't make cortisol and overproduce androgen -male genitals overgrow, bone age will advance and epiphyseal lines will close. untreated 3-4 yr olds get acne, deep voice , pubic hair and enlargement of male organs. masculinizes female organs -tx: hydrocortisone indefinitely, analysis of serum cortisol and growth measurements, additional doses during stress salt-losing form of congenital adrenogenital hyperplasia -without adequate aldosterone, salt is not retained by the body and fluid is not retained -vomiting, diarrhea, anorexia, loss of weight and extreme dehydration. if not treated, can lead to collapse and death by 48-72 hrs of birth -weigh infants regularly -tx: hyrdrocortisone, increased salt, synthetic aldosterone Cushing syndrome -overproduction of cortisol -6-7 years but can occur in infancy -fat accumulates in the face cheeks, chin and trunk causing a moon-faced, stocky appearance. muscle wasting of extremities, susceptible to infections, red cheeks, poor wound healing, weight gain, polyuria, pendulous abdomen, abdominal striae, easily bruised (ecchymoses) -tx: surgical removal of causative tumor, cortisol therapy, replacement of all pituitary hormones

acute streptococcal glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome

acute streptococcal glomerulonephritis -inflammation of glomeruli of kidney after having strep -5-10 yrs -sudden onset of hematuria and proteinuria. urine is tea-colored, reddish brown or smoky. abdominal pain, low-grade fever, edema, anorexia, vomiting or headache, cardiac involvement -tx: runs its course 1-2 weeks. antibiotic if needed chronic glomerulonephritis -proteinuria, hypertension, RBC and WBC casts and occult blood in urine and low specific gravity. increased BUN and creatine -alport Syndrome- hearing loss and ocular changes -bed rest if edema, hematuria, hypertension of oliguria -should not engage in contact activities -tx: antihypertensive drugs eventually leads to renal insufficiency and renal failure -on dialysis before transplant **nephrotic syndrome -autoimmune process, normal at 3 years of age. 1 congenital autosomal recessive disorder 2 secondary as a progression of glomerulonephritis 3 idiopathic (most common) -proteinuria, edema, hypoalbuminemia and hyperlipidemia, periorbital edema, ascites (lead to poor nutrition and growth r/t pressure) -tx: reduce proteinuria and edema. corticosteroids IV methylprednisone or oral predisone, may need diuretic. -prognosis varies. some may respond to steroid therapy and others may need renal transplant

diarrhea

acute- infection chronic- related to malabsorptive or inflammatory cause bacterial causes: salmonellosis, listeriosis, shigellosis, c.diff, e.coli, staphylococcal food poisoning mild: anoretic, irritable and unwell, fever of 101-103. 2-10 loose watery BM a day, dry warm mucous membrane, rapid pulse, normal urine output TX; can go home, pedialyte, continue breastfeeding, probiotics, reduce temp, hand washing, might use lactose free formula severe diarrhea -obviously ill -temp of 101-104, weak rapid HR and RR, pale cool skin, apprehensive, listless and lethargic. depressed fontanelle, sunken eye, poor skin turgor -tx: oral or iV rehydration. it over 24 hours, a culture is taken replacing fluid deficit <5% --> 50 mL/kg 10% --> 100mL/kg 12-15% --> 125 mL/kg

ambiguous genitalia, delayed puberty and precocious puberty

ambiguous genitalia -not defined as male or female and presence of absence of gonadal tissue is unknown -assessed through DNA analysis -reconstructive surgery might be done precocious puberty -early development of breasts or pubic hair before 8 in gurls and 9 in boys -menstrual bleeding, increased breast and genital development -tx: hormone therapy delayed puberty -secondary sex characteristics after 14 for girls and 15 for boys -patient education and patience

common allergic reactions

anaphylactic shock -life threatening type 1 hypersensitivity -exposure to milk, egg, peanut, tree nuts -s/s: SOB, throat tightness, blue/pale, decreased HR, decreased BP, dizziness, LOC, shock, hives, swelling, itch -tx: epinephrine IM, must be observed 4 hrs after urticaria- hives macular wheals, intensely pruritic angioedema -edema of skin and subcutaneous tissue, eyelids, hands, feet genitalia and lips -not dependent and occurs with urticaria -tx: IM epinephrine or oral histamine

male reproductive disorders: balanitis, phimosis/paraphimosis, hydrocele, varicocele, testicular torsion, testicular cancer

balanitis- inflammation of glans and prepuce of penis r/t poor hygiene or uncircumscised -heat application and antibiotic ointment phimosis- inability to retract foreskin paraphimosis- inability to replace the prepuce over the glans (emergency situation) cryptorchidism -undescended testes -surgery to correct or may close spontaneously hydrocele -fluid in the scrotum (common at birth) varicocele -dilation of veins in the spermatic cord and may cause infertility therefore are removed surgically testicular torsion -twisting of the spermatic cord. scrotal pain, nausea, vomiting, tender and edema begins to develop testicular cancer -painless testicular enlargement and feeling of heaviness in the scrotum -orchiectomy (removal of the testis) followed by radiation and chemotherapy -surgical emergency

Stinging insect hypersensitivity

bee, wasps, hornets, yellow jackets -hyposensitization by Immunotherapy after first reaction. an extract of wasp, hornet, yellow jacket or honeybee venom accomplishes this. -if not hyposensitized, IM epinephrine tx: ice site, avoid scented preparations, moving the lawn, taking out trash, leaving soda cans or juice bottles open, don't walk barefoot

normal blood glucose ranges for children with type 1 diabetes

before a meal - 70-110 1 hr after meal - 90-180 2 hr after meal - 80-150 between 2 am and 4 am 70-120

methods by which infections spread

blood- anthropod vectors, injection into blood stream. prevention: decreasing exposure to vectors blood sampling/transfusion prevention: careful handling of blood sampling equipment, prescreening of blood for organisms respiratory secretion. airborne droplets. fomites. respiratory tract entry. prevention: mask, droplet airborne precautions handwashing feces. water, food, fomites means of transmission. GI tract entry. prevention: hand washing before eating, after using bathroom or after handling diapers exudate from lesions- direct contact, contact with soiled dressing. entry vectors such as flies, skin, mucous membranes. prevention: contact precaution, self-screening for sexual contacts, gloves

oliguria, anuria and creatnine

oliguria- significant decrease in urine production anuria- absence of urine production creatnine- released during cell metabolism

major organs and cells of the immune system

organs: thymus, liver, bone marrow, spleen, tonsils lymph nodes and blood phagocytosis destroy pathogen macrophages ingest pathogen inflammatory response is activated to rid pathogen B lymphocytes produce antibodies (immunoglobulins) to destroy specific antigens T lymphocytes cell-mediated immunity fight against fungi viruses and parasites, cytotoxic T cells, helper T cells and suppressor T cells

structural abnormalities of urinary system,

patent urachus -fistula between bladder and umbilicus -clear fluid draining at the base of the umbilical cord -ultrasound confirmation -may close spontaneously or need surgery exstrophy of bladder -bladder lies on exposed anterior abdominal wall -bladder is bright red and continually drains urine -detected fetal ultrasound -wide pubic diastasis -tx: surgical closure 24-72 hours of life hypospadias- lower aspect of penis (should not be circumcized!) (ventral) epispadias- upper aspect of penis (dorsal)

metabolic disorders phenylketonuria, maple syrup urine disease, galactosemia, glycogen storage disease, tay-sachs disease

phenylketonuria -inherited, excessive phenyl aline levels build up and cause permanent damage to brain tissue -mousy odor, becomes blue-eyed, fair skin. -screened at birth by blood spot analysis after 2 full days of breast or formula feeding -tx: dietary restriction of phenylketonuria (avoid orange juice, bananas, potatoes, lettuce, spinach, peas) lofenalac can be used in formulas maple syrup urine disease -rare inherited disorder -feeding difficulty, loss of moro reflex and irregular respirations, generalized muscular rigidity and seizures. infant screening at birth. urine becomes odor of maple syrup -tx: diet high in thiamine and low in leucine, isoleucine and valine. hemodialysis or peritoneal dialysis may be necessary galactosemia -large amounts of galactose in blood and urine -lethargy, hypotonia, diarrhea, vomiting, cirrhosis of liver, jaundice, bilateral cataracts, can die by age 3 if not treated -tx: galactose free diet or formula made with milk substitutes glycogen storage disease -altered production and use of glycogen in the body -student growth, brain damage, epistaxis, hypoglycemic episodes, protruding abdomen -tx: high-carb diet with snack between meals, continuous NG or G feeding at night to prevent hypoglycemia, liver transplantation may be possibility but not a cure tay-sachs disease -ashkenzai jews -extreme moro reflex and mild hypotonia, lose head control at 6 months and unable to sit up or role over, cherry-red macula, -tx: no cure, most die of cachexia or pneumonia by age 3