Peds Exam #4
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? A. Cracked lips B. Normal appearance C. Conjunctival hyperemia D. Desquamation of the skin
C. Conjunctival hyperemia
The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? A. Pallor B. Cough C. Tachycardia D. Slow and Shallow breathing
C. Tachycardia
The pediatrician has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? A. During sleep B. When changing the infant's diapers C. When the mother is holding the infant D. When drawing blood for electrolyte level testing
D. When drawing blood for electrolyte level testing
What is treatment/interventions for Acute Laryngotracheobronchitis (LTB) or Spasmodic Laryngitis?
Interventions: - Humidification - Fluids - Careful observation for worsening symptoms - Teach parents to avoid cough suppressants - Provide assurance to parents Treatment: mostly supportive - Racemic epinephrine &/or steroids to ↓ airway swelling may be used if needed
What are common reasons for Iron deficiency anemia or anemia in children?
Iron deficiency Anemia - Seen a lot in infants & toddlers who are consuming large amounts of milk (but not necessarily having Fe+ fortified formula or supplementation) Anemia - Seen a lot in older kids- maybe eating habits or maybe menstruating (so losing blood)
What is status asthmaticus?
Life-threatening episode of airway obstruction & resp. distress that is unresponsive to vigorous therapeutic measures
What are common causes of head injury?
Unintentional (Teach prevention: Car seats, helmets, etc.): - Motor Vehicle Collisions - Falls - Bicycles - Sports Intentional (Evaluate for abuse)" - Non-Accidental Trauma (NAT) - 'Shaken Baby Syndrome' (1) Subdural hematoma (2) Retinal hemorrhages
What is management of Respiratory presentation of Cystic Fibrosis?
o Daily Exercise o Bronchodilators (albuterol) o Mucolytics - Dornase Alfa (pulmozyme) & Hypertonic Saline o Chest physiotherapy (postural drainage) - Vest & metaneb o Inhaled Abx (tobramycin, Castin) o Inhaled steroids o NEW MED= Trikafta: enables affected protein to help Na+ & Cl- exchange
What is management of Gastrointestinal presentation of Cystic Fibrosis?
o High calorie, high protein diet o Pancreatic enzymes w/every meal/snack to help w/fat absorption o Fat soluble vitamins o Extra Na+ intake
What are common Respiratory presentation for Cystic Fibrosis?
• Copious thick secretions • Frequent pneumonia - need for "tune ups" •Some CF bugs can only be passed b/w CF pt.s so they aren't allowed to be together • Chronic crackles, wheezing, hypoxia, dyspnea, clubbed fingers, barrel chest, productive cough
What are some Seizure triggers?
• Emotional stress • Sleep deprivation • Fatigue • Fever • Illness • Flickering lights • Menstruation • Alcohol • Photo/Pattern sensitivity All ↓ resistance so ↑ likely will have a seizure
What are possible causes to seizures?
• Infection (Febrile - most common b/w 6mo-3yr) • Metabolic • Electrolyte imbalances • Severe hypoglycemia • Traumatic • Toxic ingestion • Genetic disorders • Brain malformations • Intracranial lesions or hemorrhage
What are common Gastrointestinal presentation for Cystic Fibrosis?
• Thick secretions -> intestinal obstructions (Often meconium ileus in NBs) • Stools are foul-smelling & greasy • Malnutrition & failure to thrive • Pancreatic fibrosis -> Diabetes • Deficient in fat-soluble vitamins A, D, E, K
What are questions to ask if c/o of seizures?
• What was the behavior during the event? • What time of day? • Did anything precipitate it? • How long did it last? • What happened after? • Have the parent/caregiver show you what the seizure looked like.
What are dietary interventions for anemia for ages: - Birth-6 mo.? - 6mo-12mo? -Toddlerhood? -Remainder of life?
•Birth- 6 mo -breastmilk, Fe+-fortified formula, or Fe+ supplements •6 mo-12mo - refrain from using cow's milk (doesn't have iron they need) •Toddlerhood - Limit cow's milk but ↑ Fe+-rich foods •Remainder of life - varied diet w/necessary iron WIC - program w/routine Hgb levels & supplies Fe+ fortified formula for 1st yr.
What are the valves of the heart and where are they located?
'TP My Ass' Tricuspid Valve: b/w RA & RV Pulmonic Valve: b/w RV & Pulmonary Artery (to lungs) Mitral Valve: b/a LA & LV Aortic Valve: b/w LV & Aorta (to body)
What is the treatment of acute epiglottis?
- Corticosteroids (IV, PO, Inhaled to ↓ inflam) - Fluids - Abx (b/c bacterial infection) - Cool mist O2 (↓ inflam while give O2 needed)
What does a respiratory assessment look like in pediatrics?
- Diagnostic Tests - ABGs - Rhythm, Rate - Pulse Ox & Wave - Observe Work of Breathing (Nasal flaring, ↑ RR, Supraventricular & intercostal retractions) - Listen to lungs (front & back) - Body positioning - tripod
What are interventions for respiratory distress?
- Ease respiratory effort (Humidification, Oxygenation & Positioning) -> towel under neck to open up airway - Promote rest (Limit activity) -> esp. if virus - Promote comfort (Suction, May promote feeding) - Provide nutrition - Prevent spread if infectious (Handwashing, Kept home, Taught to blow nose) - Reduce temp. [Anti-pyretic (>6mo) educate, Cool liquids] - Promote hydration [Small amt. at frequent intervals, Continue breast feeding (Abs.)]
What are nursing interventions for otitis media?
- Encourage fluid intake - Abx as prescribed - Reduce body temp. (bath & anti-pyretics) - Have child lie w/affected ear down - Teach preventative care
What are the S/S of Cerebral Palsy
- Feeding difficulties - Abnormal motor performance - STIFF/Rigid arms or legs - Abnormal posturing - Delayed developmental milestones
What is part of a neuro assessment?
- General appearance/activity (moving? favoring side?) - Vital signs ∆ - Skin -> breakdown if immobile - Eyes -> Pupil check - Motor Function If sedated, may have to take out briefly to assess
What is Sickle Cell Anemia?
- Genetic condition w/∆s to the Hgb structure of the RBCs - Hgb A (normal RBC) is replaced w/Hgb S (highly sensitive to ∆s in oxygenation in blood cells) - So when Hgb S senses insufficient O2 then will turn into sickle shape & clump up -> leading to obstruction of veins & capillaries causing insufficient oxygenation to that area
What is expected Hydrocephalus post-op care?
- Monitor VS & Neuro checks - Position on un-operated side - Observe for ↑ ICP (Emergency) - Measure head circumference - Monitor for signs of infection - Provide comfort measures/pain meds
What is included in prevention of otitis media?
- Pneumococcal vaccine & annual Flu - Reduce exposure to allergens - Breastfeeding for at least 1st 6 mo. of life - Feed upright (shorter Eustachian tube that is straighter so if poor positioning during feeding, can go into sinuses) - No second-hand smoke - Isolating from other sick indiv.s
What is the immediate care for Myelomeningocele (Neural Tube Defect)?
- Sx typical w/1st 24-72 hrs. of life (only IVF until Sx, maybe NGT) - Infection prevention! - Measure head circumference, voiding, monitoring movement - Radiant Warmer while keeping pt. naked - Sterile, moist, non-adherent dressing - No rectal temp. - PRONE position! - ROM - check w/HCP & PT
What body systems are commonly affected in a Scikle Cell Vaso-Occlusive Crisis?
-Spleen - ↑ infarcts (block off passageways) -> can lead to scarring of spleen (↑ susceptibility for infections -may need prophylactic Penicillin) - Liver - causes altered function & necrosis (depending on extent) - Kidneys - inability to concentrate urine & necrosis - Skeletal system - osteoporosis, kyphosis, lordosis, & Osteomyelitis - CNS - mini strokes in brain - Cardiac - heart has to work harder than usual b/c sickles can't carry O2 in the same way; cardiomegaly - Genitals - Priapism (painful erections) - Skin integrity - have to watch b/c of poor circulation
What are the 4 defects of Tetralogy of Fallot?
1. Ventricular Septum Defect (hole b/w RV & aorta) 2. Pulmonary Stenosis (narrowing of the pulmonary valve b/w RV & lungs) 3. Overriding Aorta (more in front of heart than normal) 4. Right Ventricular Hypertrophy (thickening of muscles from working so hard)
What are considerations for Iron Supplementation used for Anemia?
3-6 mg/kg/day - Have to take 3x/day -> Take inb/w meals & @ least 1 hr. before bedtime - citrus juice will help absorption of Fe+ - May stain teeth, so maybe use straw - Stools may be black/green - Don't crush/break/chew med.
What is asthma?
A reactive airway disease that is chronic - Response to stimuli = Edema d/t mucus, Spasm of smooth muscle, & remodeling resulting in cellular damage - Bronchial hyperresponsiveness - Underlying Inflam process
What is a Patent Ductus Arteriosus?
A-cyanotic Defect where there is a hole b/w pulmonary artery & the aorta - Blood flow from Aorta -> Pulmonary Artery - Usually Asymptomatic (so MD just watches) Closure of Defect: - Interventional Cardiology - Surgical (Cath or Thoracotomy) -> can do thoracotomy on side (instead of right in middle) - Indomethacin - inhibits prostaglandins to try & close up hole - Nitrous Oxide - ↓ pulm vein resistance (newer research)
What is an Atrial Septum Defect?
A-cyanotic Defect where there is a hole b/w the RA & LA - Blood flows from LA -> RA - Usually Asymptomatic Closure of Defect: (MD watches for yrs until older or closes.): - either Intervention cardiology laparoscopy or Sx
What is a Ventricular Septal Defect?
A-cyanotic Defect where there is a hole b/w the RV & LV - Blood flows from LV -> RV - Usually Asymptomatic but may have ventricular hypertrophy from extra pumping (& tire on exertion) Closure of Defect (MD just watches for yrs.): - either Intervention cardiology or Sx
Which response would the nurse provide the parent of a 2-year-old child with newly diagnosed cystic fibrosis who expresses concern about the child's frailty and low weight? A. 'Digestive enzymes will be given to help your child digest food.' B. 'Your child appetite will improve once respiratory therapy is started.' C. 'Your child's coughing and SOB prevent the adequate chewing of food' D. 'I suggest that you offer baby foods to your child b/c they are more easily digested'
A. 'Digestive enzymes will be given to help your child digest food.'
What are 2 acquired Cardiovascular illness?
Acquired CV Illness (Not born with) - Rheumatic Fever - Kawasaki's Disease
What defects are included in the group of A-cyanotic defects?
- Atrial Septal Defect (hole b/w RA & LA) - Ventricular Septal Defect (hole b/w RV & LV) - Patent Ductus Arteriosus (hole b/w aorta & pulmonary artery)
What are 3 lower tract infections?
- Bronchiolitis (RSV) - Asthma - Cystitis Fibrosis
How to manage a Vaso-Occlussive Crisis?
#1) IV Fluids -> ↑ volume in veins & get those sickled clumps moving - Electrolyte replacement (if Metabolic Acidosis) - Treat infection (if present) - PAIN Management - Acetaminophen, Ibuprofen, Ketorolac, Morphine/Hydrocodone, PCA (↓ pain (keep comfortable) as well as ↓ metabolic needs) - Transfusion - Give O2 -> to ↓ O2 need (help sickles carry as much O2 as poss) ·Breathing, Distraction Heating Pads, Guided Imagery
What is the treatment for Heart Failure?
'4 D's' - Correct underlying cause of HF 1) Diet (low Na+ & high Cal) 2) Digitals (Improve Cardiac contractility) 3) Diuretics (Reduce preload; Furosemide) 4) Dilators (Reduce afterload; ACE)
What is Acute Laryngotracheobronchitis (LTB), Spasmodic Laryngitis?
'Croup' which is normally VIRAL & 'sounds worse than looks' - Cause: Parainfluenza, RSV, Influenza, Mycoplasma pneumonia S/S (GRADUAL): - Stridor, hoarseness, cough, restlessness
What is Acute infectious pharyngitis?
'Strep throat' - enlargement of pharynx/tonsils - viral or bacterial (Group beta strep) If untreated can progress to.... - Rheumatic Fever - Glomerulonephritis S/S: sore throat, enlarged/red tonsils, white patches, fever, nausea, anorexia Dx: throat culture
What cardiac defects are included in the group of obstructive defects?
- Coarctation of the Aorta - Aortic Stenosis - Pulmonic Stenosis - Tetraology of Fallot
What is the management for Acute streptococcal pharyngitis?
- Compresses to the neck (warm or cold) - Saline gargles (help pull out bacteria) - Get rid of toothbrush - Take all Abx - Contagious for 24 hrs.
What is non-pharmacological treatment for Asthma?
- Continuous Care - regular PCP visits - Trigger Avoidance: ↓ exposure to allergens (cockroach mites, mold, pets, etc.) & sick indiv.s - Exercise, rest, & well-balanced diet - Edu. on med.s & home monitoring
What is Beta Thalassemia?
- Genetic disorder (autosomal recessive) w/ defective Hgb chain - means shortened RBC lifespan, so will produce more immature erythrocytes - Most seen in people w/Mediterranean descent TX: - blood transfusion every 3-5 wks. Depending on Hgb levels - if getting a lot of blood transfusions - then have higher Fe+ levels -> so give Chelation therapy (↓ amount of Fe+ in the blood)
What are S/S of Hemostasis Defects?
- Hemarthrosis (bleeding into joint) --- Maybe deformities in joint --- Stiffness/tingling/achiness --- So ↓ ROM (to help clotting) & watch signs of inflam - Subcutaneous hemorrhages - Hematuria - Cranial bleed - stroke - GI tract - obstruction - Hematomas on spinal column - paralysis
What factors r/t to family history can influence cardio defects in children?
- Hereditary diseases - Family hx of sudden fetal loss, sudden infant death, sudden adult death - Syndromes (ex. Down's Syndrome)
What nursing care is expected for Cardiac Catheterization?
- Hold pressure & put on dressing & watch (ICU-> floor) - Check dressing q5-15min for 1st hr. & then frequently - Check distal: Pulses (bilaterally) & Temp. & color (bilaterally) - Vital Signs - Keep extremity straight for 4-6hrs., must lay flat, don't move - Pain Management
What is the treatment for a pt. with status asthmaticus?
- Humidified O2 - Inhaled short-acting beta agonist (SABA) 3 times (20-30min apart) - Continuous nebulizer may be indicated (continuous albuterol) - Anticholinergic (for allergens) - IV start for fluids & corticosteroids - Monitor blood gases & serum electrolytes (risk of hyperkalemia)
What is the management for Asthma?
- ID & avoid triggers (allergies affect persistence & severity) - Anti-inflam agents
What are some factors that could cause respiratory distress in pediatrics?
- Infectious agent (viral or bacterial) - Age (protected 1st 3 mo) - Size (close structures, smaller ear tubes, smaller diameter) - Pre-existing factors (2nd hand smoke, asthma, CF, Chronic resp. illness infections) - Seasonal varieties (i.e. RSV, Flu) - Premature Babies (more at risk, esp 1st 5 yrs.)
What is the post-op care for a Scoliosis pt.?
- Log rol when turning to keep spine aligned (no twisting) - Immobilization brace/cast may be present - Neurovascular Assessment & VS frequently - Ambulate ASAP Pain management (PCA pump) - Morphine, Hydromorphone, Fentanyl (have Naloxone nearby)
What are diagnostic tests used in Neurologic exams?
- MRI/CT - Structure of the brain (must lie still so may have to sedate, so should be NPO) - Labs - Electroencephalogram (EEG) - leads on brain to check seizure activity
What is the long-term care and treatment for Neural Tube Defects?
- Severity of deficits depend on nerve involvement at birth - High risk for latex allergy - Musculoskeletal issues- could be paralyzed or issues walking Neuropathic bowel & bladder - Incontinence - Regular emptying - Medication - oxybutynin chloride for urinary retention & stool softeners for ease of BMs - Sometimes require daily self-catheterizations (risk for chronic UTIs) Surgical options: - Vesicostomy = surgical opening in bladder to the outside of body (lower belly) for urine to drain, preventing UTI or damage to kidneys. (Temp. tx.) - Colostomy
For safe Digoxin administration: - What should you do before admin? - What should you watch after admin? - When bpm indicates Digoxin should be held?
- Take Apical Pulse for 1 min. before admin - 2 RN check; in mcg not mg - Watch K+ levels w/use of Digoxin & Furosemide - Watch Digoxin toxicity = Vomiting, Arrhythmias, Bradycardia, Hypokalemia Held for: - Infants @ 100bpm - Preschoolers/school-aged @ 70 bpm - Adolescents @ 60bpm
What is the care after a tonsillectomy for tonsillitis?
- Visualize back of throat (that intact) - Prone or side-lying to promote drainage - Watch for recurrent swallowing -> Bleeding!!!! - Assess vomit - Ice collar for pain - No straws, forks - Clear fluids (no red, non-citrus) - Limit dairy products for 2-3 days (coast so swallow more) - Administer medications (pain & infection) Indicated for tonsillectomy if: airway obstruction or febrile seizures
Info about Ticks
- Wear long-sleeves & pants, w/socks over pants in long grass - Wear light-colored clothing - Check children after being in high-risk areas - Follow paths instead of walking in tall grass/shrubs - Apply insect repellant containing dietyltolumade & permethrin - keep yards at home trimmed & free of leaves/brush - Apply tick repellant to dogs - Save tick for later ID - To remove tick - grasp at closest point to skin w/tweezers & pull straight up; remove any remaining parts w/sterile needle
What are S/S of Asthma?
- Wheezing - SOB - Cough - Tachycardia - Chest tightness - Pale & wet skin
What are the goals for a pt. with status asthmaticus?
- ↑ Ventilation - ↓ Airway resistance - Relieving bronchospasm - Correcting dehydration (b/c breathing out fluids) - Diminish anxiety - Treating concurrent infection
What is the difference between congenital and acquired cardio defects?
Congenital = born with; primarily anatomical abnormalities resulting in abnormal cardiac function - Consequences of HF & hypoxemia Acquired = occur after birth from infection, autoimmune responses, environ factors, familial tendencies
What is the management of care for kids with head injuries?
Goal: Keep ICP low - Elevate HOB - Quiet - Frequent VS, Neuro & LOC checks - Balance of Sedation/Analgesia - b/w comfort & ability to assess LOC
How is Sickle Cell Anemia diagnosed?
1) Amniocentesis in utero 2) NB screening then Hgb electrophoresis to confirm (determine if carrier or have disease) - 'Sickledex' - finger prick back in 3min - Electrophoresis - finger printing protein
What is the management for Kawasaki Disease?
1) High doses of IV IG - immunoglobulins to ↓ inflammation - Frequent VS & monitor for allergic reaction 2) Salicylate / Aspirin 3) Maybe steroids MIS disease (post-covid inflam) - very similar to Kawasaki's - Treatment is the same, but important to know cause
What are interventions for Anemia?
1) Minimize energy expenditure (↓ tissue O2 needs) 2) Iron supplementation (3-6mg/kg/day 3x/day) - if unsuccessful - consider malabsorption or noncompliance (have to take at certain times, tastes bad) - Teach about long-term effects of supplementation (psychomotor development & cognitive function) 3) Diet - teach what foods are high in Fe+ so can ↑ amounts 4) If hemorrhage -> transfusion (RBCs 2-3mL/kg) 5) SEVERE anemia -> supplemental O2, bed rest, IVF
What is the diagnostic evaluation of Cystic Fibrosis?
1) Newborn Screening 2) Chloride Sweat Test - Chloride Sweat = >60mEq/L where normally <40mEq/L 3) Pancreatic Enzymes = in stool fat (72-hr. sample)
What is the treatment for treatment for Hydrocephalus?
1) Remove obstruction (Sx) 2) Shunt - Before shunt, use External Ventricular Device
What type of care is need for the unconscious child?
1) Thermoregulation - Antipyretics & Blanket warmers 2) Elimination - Catheters & Stool softeners 3) Hygiene - Bathing & ∆ing Diapers 4) Position & Exercise - Turning & ROM exercises 5) Stimulation - Calm environ, low lights, etc. 6) Treatment for disorder (depend on condition) - Abx - infection - Corticosteroids - Inflam - IVIG - immune response - Osmotherapy - Too much Na+ - Anti-epileptics - Seizures - Sedatives
Which intervention is important in the care of a hospitalized toddler with cystic fibrosis? A. Discouraging coughing B. Performing postural drainage C. Encouraging active exercise D. Providing small, frequent feedings
B. Performing postural drainage
What are A-cyanotic Defects?
Group of disorders - defects results in blood being shunted from LEFT -> RIGHT (oxygenated blood (already been to lungs) -> that is sent back to right side of heart) - Means NO deoxygenated blood circulating w/in system (why called A-cyanotic defects- 'w/o deoxygenated blood in the system')
What are obstructive defects?
Group of disorders where they have intact vascular system but have some type of obstruction (either stenosis or obstruction) that is preventing free flow of blood through the heart
What is acute epiglottitis?
BACTERIAL infection that 'Looks worse then sounds' --- EMERGENCY situation!! Cause = inflam of epiglottis from H. Influenzae S/S (ABRUPT): - Fever - Large, swollen epiglottis - 4 D's: 1) Dyspnea 2) Drooling 3) Dysphonia (hard to make noise) 4) Dysphagia - Tripod posturing - Resp. distress: inspiratory Stridor, retractions, tachycardia, tachypnea
Which client would the nurse assess first after a shift report? A. A 6-month-old with a croupy cough and inspiratory stridor with exertion B. A 2-year-ol with asthma who required a PRN albuterol treatment 2 hours ago C. A 3-year-old with cystic fibrosis and pneumonia who required 22% O2 all night D. A 20-month-old with bronchiolitis and bilateral crackles who is receiving 23% O2
A. A 6-month-old with a croupy cough and inspiratory stridor with exertion
Which treatment would the nurse anticipate for an infant admitted with bronchiolitis caused by RSV? A. Humidified cool air & adequate hydration B. Postural drainage & O2 by hood C. Bronchodilators & cough suppressants D. Corticosteroids & broad-spectrum Abx
A. Humidified cool air & adequate hydration
A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, which education would the nurse provide the parent? A. Offer crushed ice chips B. Encourage the intake of ice cream C. Keep the child in the supine position D. Gargle with a diluted mouthwash solution
A. Offer crushed ice chips
What is the difference b/w management of Bacterial and Viral Meningitis?
Bacterial: - Isolation (droplet)** - Antimicrobial therapy** - ↓ stimulation - Fluids - Neurologic Exam Viral (supportive): - Acetaminophen** - Fluids - Antimicrobial therapy (until dx confirmed)** - Continue monitoring neurologic status • Both will remain on Droplet Precautions until diagnostics return
Which education would the nurse provide the parent of a 3-year-old child who has recurrent acute spasmodic laryngitis (spasmodic coup) about why this is a disorder of young children? A. They have small airways B. They are mouth breathers C. They have immature immune systems D. They are prone to upper respiratory infections
A. They have small airways
The nurse is closely monitoring the intake and output of an infant with HF who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? A. Weighing the diapers B. Inserting a urinary catheter C. Comparing intake with output D. Measuring the amount of water added to formula
A. Weighing the diapers
What is Rheumatic Fever and what does it affect?
Acquired illness from an immune response where inflammation to the body after strep infection - Immune response sends inflammation to body that affects connective tissue in heart, skin, joints, blood vessels, CNS - Most serious complication = affect on heart valves (1/2 leads to Rheumatic Heart Disease - may be so bad that need valve replacements)
What is Coarctation of the Aorta?
An obstructive defect where there is narrowing of aorta as it goes to extremities - Will have ↑ blood flow to UE's but ↓ blood flow to LE's - Check this on all NBs - pulse ox & BP on hand/arm & foot/leg to see if dif. - Then go in w/ECHO or TEE to confirm dx - If not caught -> older kids w/ headaches & nosebleeds (esp. on exertion -> b/c having high BP in upper extremities) Opening of Defect: - either Intervention cardiology or Sx
What is the assessment for an Otitis media?
Assess for: - Fever - Pain (pulling at ear, crying, irritable, loss of appetite) - Enlarged lymph nodes - Purulent ear discharge from ear - Red, opaque, bulging, immobile tympanic membrane on otoscope exam
What is the assessment for Developmental Hip Dysplasia?
Assess: - if accompanied by Spina Bifida - Asymmetry of skin folds on back of legs - Asymmetry of femur length - Screening done by HCP - Ortolani & Barlow Definitive Dx = X-ray or US
Info about Lyne Disease
Assessment: • Ring-shaped rash (can appear anywhere on the body) is the classic sign but not everyone develops a rash Interventions: • Remove tick w/tweezers (insuring you removed the whole tick) & wash skin • Preform a blood test w/in 4-6 wks. after bite • Abx are started before blood tests result to prevent later disease
What are Seizure Precautions at home and at the hospital?
At home: • Medical ID bracelet • Swim w/companion • Careful if potentially hazardous activities • Alert all caregivers of precautions At hospital: • Raise all side rails (padded) when sleeping/resting • Remove hard objects • Have suction & O2 set-up (NOT NC, Bag O2) • Time the seizure episode • If sitting/standing, ease child to floor & place side-lying & remove things around them • Prepare to admin. PRN med. (call-out for RN for med) • Remain w/child until recovers fully
What is Cystic Fibrosis?
Autosomal Recessive gene mutation leads to production of a malfunctioning protein & results in inability of chloride molecule to cross cell membrane - Na+ & H2O transport problem
What is the management for Sickle Cell Anemia?
Avoid infection (causes increased metabolic needs of body -- Poss prophylactic Abx (not everybody) -- Stay current on current & routine vaccinations Promote normal RBC production -- Folic acid -- Transfusions (w/caution b/c could cause ↑ Fe+ or hypersensitivity) -- Hydroxyurea med. - can ↓ amount of sickling -can interfere w/normal growth & is carcinogenic ·Maintain Hydration - drink above normal maintenance -likely for blood cells to get caught into veins, so more fluid to help blood flow smoothly ·Adequate oxygenation - so take breaks
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? A. " A balance of rest and activity is important" B. "I can apply lotion or powder to the incision if it is itchy" C. "Activities in which my child could fall need to be avoided for 2-4 weeks." D. "Large crowds of people need to be avoided for at least 2 weeks after surgery"
B. "I can apply lotion or powder to the incision if it is itchy"
Which intervention would the nurse provide a 3-month-old infant hospitalized with RSV? A. Administering an antiviral agent B. Clustering care to conserve energy C. Administering a bronchodilator every 4 hours D. Providing an antitussive agent whenever necessary
B. Clustering care to conserve energy
Which treatment would the nurse anticipate for an infant admitted with acute laryngotracheobronchitis? A. IV Abx & hydration B. Corticosteroids & nebulized racemic epinephrine C. Antiviral medication & O2 D. Nasopharyngeal suctioning & antipyretics
B. Corticosteroids & nebulized racemic epinephrine
Which action would the nurse include in the plan for care for a 6-month-old infant with RSV who is in respiratory distress? A. Begin a clear fluid diet B. Maintain droplet and contact precautions C. Administer prescribed antibiotic immediately D. Allow parents and siblings to room in with the infant
B. Maintain droplet and contact precautions
Which condition would the nurse expect when assessing an 11-month-old infant sitting on the parent's lap crying and tugging at the right ear? A. Child abuse B. Otitis media C. Hearing impairment D. Upper respiratory infection
B. Otitis media
What is the difference b/w Bacterial and Viral Meningitis?
Bacterial: - VACCINE (Hib & Meningococcal) - PREDCEDED BY: febrile illness - Fever, chills, headache, vomiting, nuchal rigidity - Dx: lumbar puncture (CSF) & see: ↑ WBCs, Cloudy, ↓ Glucose, ↑ Protein, & GRAM STAIN + (bacteria) Viral - VACCINE (MMR, FLU) - Fever, chills, headache, vomiting, nuchal rigidity - Dx: lumbar puncture (CSF) & see: ONLY SLIGHT ↑ WBCs, NORMAL Glucose, ONLY SLIGHT ↑ Protein, GRAM STAIN - * Check nuchal rigidity by asking pt. to put 'chin to chest'
What can be expected to be seen in Left-Sided Heart Failure?
Blood backs up from LV -> LA & then back into lungs -> pulmonary venous congestion - May hear rails, rhonchi, wheezes - Pulmonary edema
What can be expected to be seen in Right-Sided Heart Failure?
Blood backs-up from RV -> RA & then back into venous system (IVC to BODY) - Ascites - Hypertension - Edema
How are triggers for Asthma diagnosed in a clinical setting?
Bronchoprovocation, skin prick, exercise challenge
The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hyperactivity C. Activity intolerance D. Gastrointestinal disturbances
C. Activity intolerance
Which assessment finding would indicate a possible asthma exacerbation? SELECT ALL THAT APPLY> A. Fever B. Strider C. Wheezing D. Tachycardia E. Hypotension
C. Wheezing D. Tachycardia Bronchial constriction with mucous production causes wheezing. With decrease in arterial oxygenation associated with asthma, the HR ill increase (tachycardia). Hypertension, not hypotension, may occur with asthma
Which is worse, a Open Head Injury or Closed Head Injury?
Closed Head Injury is worse b/c of chance of ↑ of intracranial pressure (ICP) - Open Head injury involves fracture to cranium - Closed Head Injury = cranium remains intact
What is Status Epilepticus?
Continuous seizure lasting > 30min or a series of seizures w/o return to pre-seizure LOC
What is the premature closure of the the fontanelles and sutures?
Craniosynostosis - Need Sx to open back-up so brain can grow appropriately
What is Scoliosis?
Curvature &/or rotation of the spine - ↑s w/adolescents during puberty growth spurt - Can be accompanied by other dx (Cerebral Palsy, Muscular Dystrophy) - 1 scapula protruding over the other - Uneven shoulder &/or hip height If severe, can have resp. or cardiac compromise Management: - Bracing (small & some only @ night), Exercises - Sx if bad enough (rods, bone grafts for fusion to stabilize) - still might have to wear brace after sx
A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. "Has the child complained of back pain?" B. "Has the child complained of headaches?" C. "Has the child had any nausea or vomiting?" D. "Did the child have a sore throat or fever within the last 2 months?"
D. "Did the child have a sore throat or fever within the last 2 months?"
The nurse provides home care instructions to the parents of a child with HF regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? A. "I will not mix the medication with food" B. "If more than 1 dose is missed, I will call the MD" C. "I will take my child's pulse before administering the medication" D. "If my child vomits after medication administration, I will repeat the dose"
D. "If my child vomits after medication administration, I will repeat the dose"
The nurse reviews the laboratory results for a child with suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? A. Immunoglobulin B. Red blood cell count C. White blood cell count D. Anti-streptolysin O titer
D. Anti-streptolysin O titer
Which action would be the priority for the nurse caring for a child with acute laryngotracheobronchitis? A. Initiating measures to reduce fever B. Ensuring delivery of humidified O2 C. Providing support to reduce apprehension D. Continually assessing the respiratory status
D. Continually assessing the respiratory status
Which statement must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge? A. A cold, dry environment is desirable B. Limits should not be placed on the child's behavior C. The health problem is gone when symptoms subside D. Medications must be continued even when the child is asymptomatic
D. Medications must be continued even when the child is asymptomatic
The risk for which condition is reduced by avoiding prone positioning of an infant during sleep? A. Otitis media of the ear B. Conjunctivitis of the eye C. Infantile colic or baby colic D. Sudden infant death syndrome
D. Sudden infant death syndrome
A 2 year old child recently diagnosed with hemophilia A is discharged home. What information should the nurse include in a teaching plan about home care? A. Minimize interactive play with other children to lessen chances for injury B. give low-dose children's chewable aspirin in orange flavor for joint discomfort C. use a firm and dry toothbrush to clean teeth at least twice per day D. apply pressure and ice for bleeding while elevating and resting the extremity.
D. apply pressure and ice for bleeding while elevating and resting the extremity. Hemophilia, a blood disorder, causes joint bleeding which is treated with rest, ice, compression, and elevation (RICE)
What is the difference between Decerebrate and Decorticate?
DeCOREticate - bringing limbs in to 'core'
What is Anemia?
Decrease # of RBC or Hgb concentration that is below normal for that age (don't have enough O2-carrying supplying compacity in blood) - risk for low oxygenation/perfusion to tissues
What is clubfoot?
Deformity of the foot - Can be accompanied by other dx (Spina Bifida) - Unilateral or Bilateral - R/t fetal malposition & some r/t familial incidence 'Talipes equinovarus' = plantar flexed & pointed outward Tx = Serial casting - To stretch ligaments & tendons ('Ponseti' Method) - Start slowly after birth & exchanged every 1-2 wks. - Teach parents to look for '6P's: (1) Pulselessness, (2) Pallor, (3) Pain, (4) Paresthesia, (5) Paralysis, & (6) Pressure
What is Cardiac Catheterization?
Diagnostic - look at structures of the heart w/camera - Stick tube up femoral vein (groin) & stick up camera all the way up inferior vena cava (IVC) into heart - sterile procedure -> risk for infection - can insert dye; check pressures & oxygenation Intervention - can use this method to do laparoscopic sx (so won't need to cut open chest - not an option for every pt./condition)
What is Celiac Disease?
Intolerance to gluten - protein component in wheat, barley, rye, & oats - Over time can affect absorption of nutrients Interventions: avoid gluten, instruct parents on gluten sources Assessment: Eating gluten can cause diarrhea, abd. pain, vomiting Examples of food that contain gluten = Breads, Baked goods, Cereals, Pasta, Sauces, Soups, Roux, Salad dressings
What is the diagnoses and management of Rheumatic Fever?
Dx = 'JONES CRITERIA' = Endocarditis, inflammation of joints, coria (involuntary movement of body), rash that starts at trunk & moves outward - Followed by strep ASO TITER (to see if had strep) - ECHO to look at heart valves Management: - ABX if never got them for original strep infection - SALICYLATES or anti-inflammatory agents (to help w/ inflammation around the body)
What is a EKG?
Electrocardiogram - Looks at electricity of the heart - May see 3-5 leads on chest w/12-lead EKG - also on arms & legs (full view of electricity of heart)
What are Intracranial Pressure (ICP) monitoring considerations?
External Ventricular Device - temp. until shunt (placed via Sx) - Keep Midline/@ same level - avoid neck compression - HOB at 30° - Must keep device at draining level (set by HCP; normally ear level)
T/F Meningitis, inflam of the meninges by infectious process of CNS, is only caused by a bacterial infection.
FALSE - Can be Bacterial or Viral
T/F Bronchiolitis is a bacterial infection of the lower tract?
FALSE - VIRAL
What are the 2 holes that are present in the fetal heart and not in the newborn heart?
Foramen ovale - in Right Atrium Ductus Arteriosus - inb/w Pulmonary Artey & Aorta When born & takes 1st breath, both holes are supposed to close
What is Cerebral Palsy?
GROUP of disorders characterized by impaired movement, posture, &/or muscle tone - Caused by abnormality in extrapyramidal or pyramidal motor systems - Most common type = Spastic Cerebral Palsy
What are the different types of Seizures?
Generalized - Tonic-clonic (stereotypical; 'full/shaking') - Absence (completely disconnected & can't call out) Partial Seizures - Depends on specific area in the brain & has limited symptoms (could be as small as finger twitching repetitively) Febrile Seizure - b/c infection & quick fever (most common in 6 mo.-3yrs.)
What is the management for Cerebral Palsy?
Goal = early interventions to maximize child's abilities: - PT (motor), OT, Speech therapy (swallowing), etc. Use mobilizing devises to reduce deformities (braces) Provide a safe environment (likely to fall) Anti-spasmodic med.s can be used for muscle spasms
What is Developmental Dysplasia of the Hip?
Hip socket does not cover the ball portion of the joint -> Dislocated hip -R/t fetal malposition, some r/t familial incidence, may accompany spina bifida
What is the treatment for Developmental Hip Dysplasia?
If <6 mo (tx before crawling) = Pavlik harness 23h/day - Harness to keep hips wide If >6 mo. (or if Pavlik is ineffective) = Spica cast - cast from ankles -> mid abd. w/cut-out for bathroom & bar across ankles • Tx is for wks. -> mo.s
What is the treatment for recurrent Otitis media?
If recurrent, Myringotomy to drain fluid Tympanostomy for chronic OM (3 in 6mo, 6 in 12mo or 6 by 6yo)
What is Hydrocephalus?
Imbalance of CSF absorption or production Poss. causes: malformation, tumors in ventricles, hemorrhage - Dilation of ventricles - Impaired absorption - Obstruction - Brain compression
What are S/S of increasing Intracranial Pressure (ICP) for infants and children?
Infants: - Non-specific: poor feeding, vomiting, irritability, lethargy - ∆s in LOC, ↑ HEAD CIRCUMFERENCE /separated sutures /bulging fontanels, 'sunsetting' eyes, shrill cry, seizures Children: - Headache, visual ∆s, behavior ∆s, lethargy, papilledema (swelling of optic nerve), N/V, & seizures LATE S/S for BOTH (all lead to COMA): - ↓ LOC, bradycardia, alterations in pupil size & reactivity, & abnormal posturing (decerebrate & decorticate)
What is Kawasaki Disease?
Inflammation of all the vasculature (arterioles, venules, capillaries) - If pt. comes in (usually under 5yo) w/prolonged FEVER (usually very high) that doesn't have any other cause - May be an immune response to viruses (POST-VIRAL) but don't always know - HUGE ANEURYSM RISK -> b/c all inflamed -> watch closely for aneurysms/strokes Dx: Echo or scan to see inflammation
What are the S/S of Bronchiolitis initially & as disease progresses?
Initially: - Rhinorrhea - Eye or Ear drainage - Pharyngitis - Coughing - Sneezing - Wheezing - Intermittent fever Manifestations as Disease Progresses - ↑ coughing & wheezing - Signs of air hunger - Tachypnea & retractions - Periods of cyanosis Manifestations in Severe Illness - Tachypnea of 70+ breaths/min - ↓ breath sounds & poor air exchange - Listlessness - Apneic episodes
What is the management for Hemophilia A lack Factor VII?
Management = replace missing factor - synthetic Factor A 'Vasopressin' or DDAVP via IV (every 8 wks.) to help ↓ risk of bleeding Manage symptoms - Corticosteroids or NSAIDs to ↓ swelling (b/c ↑ risk of joint bleeding) - Exercise programs to strengthen muscles for hemarthrosis
What are maternal history factors might influence cardio defects in children?
Maternal History of: - Diabetes - Lupus - Phenytoin - Alcohol or illicit drug use - Exposure to infections
What is the Glasgow Coma Scale?
Measure brain response - Eye Opening - Verbal Response - Motor Response Best=15, Min=3
What is Spina Bifida?
Neural tube defect affecting the meninges, caused by low folic acid in utero Spina Bifida Occulta - open vertebral body but no protrusion - No herniation of spinal cord - Not visible - Tuft of hair Meningocele - protrusion of meninges - Saclike cyst of meninges filled w/spinal fluid protrudes through skin - No herniation of spinal cord in sac Myelomeningocele - protrusion & open spinal cord - Saclike cyst of meninges, spinal fluid &and spinal cord protrudes through skin
What is the treatment for Bronchiolitis?
No Abx; Only supportive care - O2 (if needed) - Humidification - Suctioning - Ensure fluid intake - HOB up 30° - Isolation -> Contact & Droplet precautions - Maybe steroids • Synagis (monthly IM inj.) -> rare; for high-risk infants • Ribavirin (anti-viral) -> for infants at high-risk of mortality • RSV vaccine for pregnant women
What is Epistaxis?
Nose bleeds Causes: trauma, foreign bodies, nose picking, mucosal inflam Intervention: • Keep child calm to prevent more bleeding due to tachycardia • Child remain upright & lean forward slightly • Continuous pressure applied to nose for at least 10 min.s • Can insert wadded tissue into nostril or apply ice to assist w/ clotting •Call 911 if bleeding cannot be controlled
What is Tetralogy of Fallot?
Obstructive defect w/ 4 conditions - 4 conditions: ventricular septal defect, pulmonary stenosis, overriding aorta, & right ventricular hypertrophy. - Blood flow RV -> LV (CYANOTIC) (b/c stenosis of pulmonary valve creates increased pressure in right ventricle so back-up of blood & means some of deoxygenated blood goes thru hole in ventricle taking it from right side to left side, so it circulates deoxygenated blood throughout body)) Complications: - TET spells - baby upset & cries after strain of feed/poop, so ↑ lung pressure so ↑ blood into right side of heart -> ↑ unoxygenated blood in body (combat w/knee-chest) - Polycythemia - body compensates for cyanosis by ↑ RBCs - Clubbing - due to LT cyanosis Tx: - Squat or knee-Chest - Surgical repair (staged)
What is Aortic Stenosis?
Obstructive defect w/narrowing of aortic valve - Less blood flowing from heart to body (↓ perfusion throughout b/c ↓ CO) Complications: - Left Ventricular Hypertrophy - b/c have to pump even harder to get past stricture - Pulmonary Congestion -If bad enough Opening of Defect: - either Intervention cardiology (balloon to open up) or Sx (like valve replacement)
What is Pulmonic Stenosis?
Obstructive defect w/narrowing of pulmonary valve (right side) - Less blood flow to lungs Complications - Right Ventricular Hypertrophy - if severely narrow could turn into = Cyanotic Disease (blood can't reach heart to perfuse) Opening of Defect: - either Intervention cardiology (balloon to open up) or Sx (like valve replacement)
What pediatric populations is anemia seen more often in?
Preterm infants & Infants of multiple pregnancies (Fe+ not stored until 3rd semester so insufficient stores) Toddlers (picky eaters - 'white food' eaters) Adolescents (vegetarian)
What is the Outpatient and Inpatient treatment for Status Epilepticus?
Outpatient: • Buccal midazolam • Rectal diazepam (preset & pre-lubricated) Inpatient: • 1st) IV Diazepam/Lorazepam • 2nd) Phosphenytoin/Phenobarbital (high risk for apnea - resp. support) • Continuous EEG
What is the Pharmacological and Non-Pharmacological treatment/management for Seizures?
Pharmacologic (all have sedative effect) • ↑ Dosage gradually until seizures controlled • If seizure free for 2 yrs. - adjustments/taper • Common types: Levetiracetam (Keppra), Phenytoin, Phenobarbital, Zonisamide, etc. Non-pharmacologic • Vagus nerve stimulator (magnet in chest that shocks vagus nerve) • Ketogenic diet (high fat, NO sugar) - only effective for 30% • Surgical -> check EEG, send radioactive isotope during seizure, then MRI (has to be EXACT)
When does the suture lines unify and the posterior & anterior fontanelles close?
Posterior fontanelle closes @ 8 wks. Suture lines unify @ 6 mo. Anterior fontanelle closes @ 18 mo.
What is the movement of pressure and resistance in the heart?
Pressure moves from HIGH -> LOW pressure - L > R - Left side has greater pressure than Right side Resistance: takes path of least resistance - Systemic > Pulmonary (aorta has greater pressure)
How is Asthma diagnosed?
Primarily through history, physical exam, labs Pulmonary function tests (>5 years of age) - Spirometry! (how much you exhale) - Evaluate presence & degree of lung disease, as well as response to therapy Peak Expiratory flow rate - measures max volume of air forcefully expelled from lungs in 1 quick exhale - Accuracy is dependent on child's cooperation - like Taber video
What is prophylaxis/Avoidance for Hemophilia A lack Factor VII?
Prophylaxis = Risk prevention / Avoid bleeding - No contact sports (football, soccer) -> instead swimming, fishing, bowling - Teach good oral care w/soft toothbrush - School preparation
What are interventions for acute epiglottis?
Protect airway (likely to spasm) - So don't visualize throat / No oral temps/swabs Assess resp. status Do not leave child unattended (1:1) Avoid supine Avoid agitation!! Have intubation & tracheotomy supplies ready (if don't get corticosteroids then may need tracheostomy)
What are medications that are included in the treatment plan for Asthma?
Quick-relief (rescue) = Albuterol - Short-acting B2 agonist (SABA), anticholinergic, systemic corticosteroids Long-term control = Sympicort (Budesonide) - bronchodilator - Inhaled corticosteroids, cromolyn sodium, long-acting B2 agonists (LABA), methylxanthines, & leukotriene modifiers Written action plan w/detail of escalating symptoms & the coordinating amount of puffs of med. for the severity - Should be shared w/school, babysitter, Gma, etc.
What is Bronchiolitis?
RSV - Inflam of the lower tract (bronchiolar level) that builds up & causes obstruction - Most at risk: <6 mo. & immunocompromised (esp. Preemies w/immature lungs) - Highly contagious
What are the effects of Cystic Fibrosis on the body?
Resp.- ↑ mucus = persistent cough, wheezing, repeated lung infections, sinusitis Digestive - Blocked Pancreas - lack of digestive enzymes, greasy stools, poor weight gain, intestinal blockage, inability to absorb certain fat-soluble vitamins/minerals Endocrine - Blocked pancreas -> CF-related DM Musculoskeletal - Lack of mineral absorption -> osteoporosis CV - ↑ pressure in lungs -> cor pulmonale Urinary - Nephrotoxic med.s are taken so kidney need to be watched Integumentary - High Na+ in sweat, electrolyte imbalance & dehydration concern Reproductive - delay puberty; fertility issues w/viscous cervical secretions & blocked vas deferens
What is Echocardiogram (ECHO)?
Same as ultrasound but on the heart; able to see the dif. b/w oxygenation & deoxygenated blood flowing through the heart (w/colors) - Not invasive, no pain, can do on awake pt.s
Scabies Prevention
Scabies = a parasitic skin disorder - Incubation periods can be 4-5 wks. so if household is exposed, could have LT effects - When 1 person has it, household members & contacts should also be treated w/topical med. - ∆ all clothing, bedding, & pillowcase Daily & washed/dried on hot - Non-washable toys must go in sealed bags for at least 4 days
What is a Seizure?
Sudden excessive excitation & loss of inhibition w/neuronal circuits, allowing circuits to amplify their discharges simultaneously. May inc. unconsciousness, altered consciousness, involuntary movements, ∆s in perception or sensation.
T/F Many cases of Otitis media are preceded by a viral respiratory infection
TRUE
T/F The skull has a set amount of space, so a change in the Brain (80%), Blood (10%), or CSF (10%), results in a compensatory change in another.
TRUE Change could be caused by: - Injury -> brain swells & others go ↓ - CNS infection - Tumor - Excess CSF (hydrocephalus) -> CSF ↑s so brain gets mushed
What is a Respiratory Viral Panel (RVP)?
Test for all virus & bacteria (RSV, Pertussis, COVID) - May require sample of phlegm (If can't cough up them use tool to get from base of lungs through nose)
What are Hemostasis Defects?
These diseases have dif. missing factors (along the clotting sequence) -> meaning increased risk of bleeding 1) Von Willebrand disease lack vWD 2) Hemophilia A lack Factor VIII 3) Hemophilia B lack Factor IX
What is a TEE?
Transesophageal ECHO - same as echocardiogram but put ultrasound down esophagus to see an inside view of the heart - more in-depth look; needs pt. sedated
What is the treatment for otitis media?
Tx = Watchful waiting for 72 hrs. (>6mo.) Abx? - If < 6 mo. = Amoxicillin for 10 days - 6 mo.-2 yrs. - depends on severity & ID of bacteria - 2 yrs.+ = Watch & see & supportive measures (acetaminophen & ibuprofen)
How would you get a Venous Blood Sample and a Capillary Blood Sample?
Venous Blood Sample - Venipuncture - Aspirate from peripheral IV (may shorten line of access) - Central line Capillary blood sample (may clot so false high K+) - Heel stick (Osteochondritis risk - inflam of bone) - Finger stick
What is surgical intervention for hydrocephalus?
Ventriculoperitoneal (VP) Shunt OR Ventriculoatrial (VA) Shunt - Internal Shunts chosen by HCP - VP Shunt - goes to Abd. to be absorbed in GI & excreted - VA Shunt - ends in heart to be absorbed in blood & excreted - Can be permanent - may outgrow but leave-in b/c not worth risk of infection Concerns over time: • Risk for infection (directly in brain) • Obstruction - kink in line • Outgrowing shunt - replace it Signs of shunt issue = ↑ ICP (Emergency) - CT & quick interventions to avoid brain death
What is the treatment for Acute streptococcal pharyngitis?
Viral - no Abx; supportive measures Bacterial: Penicillin G(IM inj), Penicillin V(PO), or Amoxicillin(PO) - 10 day course F/Up if: - High fever doesn't respond to antipyretics (worry of febrile seizures) - Extremely sore throat - Refuses liquid
What are signs of Digoxin Toxicity?
Vomiting, Arrhythmias, Bradycardia, Hypokalemia
What are S/S of respiratory distress in pediatrics?
o Poor feeding -> breathing so fast so hard to swallow o Restlessness o Tachycardia o Tachypnea o Diaphoresis o Nasal flaring o Retractions (Supraventricular & intercostal) o Use of accessory muscles o Cyanosis &and pallor o Vomiting