Exam 3 ppt study guide pediatrics RN PDF

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Exam 3 ppt study guide pedś With Diabetes you have type I and type II ́ In children you will almost always see type I Diabetes Mellitus (DM) ́ DM is a chronic disorder of metabolism characterized by hyperglycemia and insulin resistance. ́ Clinical Manifestations of Type 1 Diabetes Mellitus ́ Polyph...

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Exam 3 ppt study guide peds ´

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With Diabetes you have type I and type II ´ In children you will almost always see type I Diabetes Mellitus (DM) ´ DM is a chronic disorder of metabolism characterized by hyperglycemia and insulin resistance. ´ Clinical Manifestations of Type 1 Diabetes Mellitus ´ Polyphagia ´ Polyuria ´ Polydipsia ´ Weight loss- children look sick which helps to identify something is wrong Enuresis or nocturia HYPERGLYCEMIA With a deficiency of insulin, glucose is unable to enter the cells and its concentration in the bloodstream increases. The increased concentration of glucose (hyperglycemia). Ketonuria in the presence of hyperglycemia is an early sign of ketoacidosis. ´ Insulin management is key for children with Type I diabetes However, there is a condition when the blood sugar can go too high which can require hospitalization ´ This is DKA- Diabetic Ketoacidosis – Must be treated in and intensive Care Unit LIFE THREATENING!!! ´ Signs and symptoms ´ Drowsiness ´ Decreased skin turgor ´ Acetone breath “Fruity smell”- THIS IS KEY Hypotension and Bradycardia

Hypoglycemia Sometimes too much insulin can lower the blood sugar to a dangerous level As a nurse being able to identify signs of hypoglycemia is very important ´ Nausea ´ Vomiting ´ Jittery/Restless /Shaky ´ Sweaty (Diaphoresis) ´ What can you do as a nurse to intervene with Hypoglycemia? You need to administer a quick source of sugar to raise the glucose level and stop the symptoms of hypoglycemia ´ Give 6 ounces of orange juice ´ Sugar cubes ´ Hard candy like a life saver The Pituitary Gland ´ The pituitary gland is divided into two lobes • the anterior (adenohypophysis) • the posterior (neurohypophysis) ´ ´

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Each lobe is responsible for secreting different hormones Clinical manifestations of pituitary dysfunction depend on the hormones involved and the age of the patient. • Hyperpituitarism is excess growth hormone (GH) before the closure of the epiphyseal shafts which results in proportional overgrowth of the long bones until the individual reaches a height of 8 feet or more. Observe for signs of tumors. • Hypopituitarism is diminished secretion of one or more pituitary hormones and depends on the degree of the dysfunction. May require GH injections daily.

Hypopituitarism - Pituitary Gland ´ Hypopituitarism can cause children to not grow as expected ´ They may require growth hormone to treat-daily subcutaneous injection at a specific time of the day ´ Most common organic cause of pituitary under secretion is a tumor in the pituitary or hypothalamic region, especially in the craniopharyngiomas. ´ Genetic causes or congenital cause. ´ Not all short children have a GH deficiency it may be familial Hyperpituitarism ´ Precocious puberty- development of secondary sex characteristics at an earlier age than normal ´ Diabetes Insipidus ´ Only 2 of the Poly’s – Polyuria, Polydipsia, and sometimes confusion ´ These kids can excrete large amounts of fluid causing electrolyte imbalance ´ Key nursing priority- ASSESS CURRENT VITAL SIGNS ´ Hyposecretion of somatotropin- undergrowth ´ Syndrome of inappropriate antidiuretic hormone (SIADH)- overproduction of antidiuretic hormone that results in decreases in urine production and water intoxication Treat with fluid restriction until the electrolytes and osmolality return to normal They will be swollen-will have urine retention Daily weights, I/O, sodium restriction Thyroid Dysfunction ´ Hyperthyroidism ´ Graves Disease- occurs as a result of the overproduction of thyroid hormones. Peak age is 12 to 14 years ´ A complication of Graves disease is leukopenia as many children are treated with propylthiouracil ´ Do you know what Leukopenia is???-low WBC ´ Treat leukopenia with glucocorticoids---Just an FYI-steroids ´ Another treatment for hyperthyroidism that is the least invasive is Radioactive iodine procedure-ablates and will have to take meds for life

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Thyroid dysfunctionHypothyroidism is one of the most common endocrine problems in childhood. It may be congenital or acquired and represents a deficiency in secretion of the thyroid hormone. ´ Decelerated growth ´ Dry skin ´ Puffiness around the eyes ´ Sparse hair ´ Constipation ´ Sleepiness ´ Mental decline

Adrenocortical Insufficiency ´ Cushing Syndrome – uncommon in children ´ Caused by overproduction of the adrenal hormone cortisol…..this results in increased glucose production which causes fat to accumulate on the cheeks, chin, and trunk causing a moon-faced stocky appearance ´ Cortisol is also catabolic so protein wasting occurs this leads to muscle wasting leading to thin extremities appearing to be emaciated, but they are NOT. ´ Cushing syndrome can cause hyperpigmentation to the face leaving a child with very red or ruddy cheeks (very red in appearance)

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Neurologic Dysfunction Neurologic Examination ´ The purpose of the neurologic examination is to establish an accurate, objective baseline of neurologic information ´ The neurologic examination would be documented in a descriptive and detailed fashion which is essential when charting Many things can affect the cerebral function of the child ´ Lumbar puncture ´ Head injuries ´ Bacterial Meningitis ´ Cerebral Edema – which causes increased intercranial pressure ´ Hydrocephalus ´ Seizures

Seizures in Children ´ A seizure is a “transient occurrence of signs and/or symptoms due to abnormal excessive and synchronous neuronal (electrical) activity in the brain” ´ Seizures are the most common pediatric neurologic disorder ´ The manifestation of seizures depends on the region of the brain in which they originate and may include unconsciousness or altered consciousness, involuntary movements, and changes in perception, behaviors, sensations, and/or posture ´ Seizures are a symptom of an underlying disease process

Epilepsy is a condition characterized by two or more unprovoked seizures more than 24 hours apart and can be caused by a variety of pathologic processes in the brain ´ A single seizure event is not classified as epilepsy and is generally not treated with longterm antiepileptic drugs What causes a seizure? ´ Potential causes of a seizure include ´ Infections ´ Intracranial lesions or hemorrhage ´ Metabolic disorders ´ Trauma ´ Brain malformations ´ Genetic disorders ´ Toxic ingestion ´ Fever ´

Some seizures may result from an acute medical or neurologic illness and cease after the illness is treated ´ In other cases, children may have one or more seizures without the cause ever being known (idiopathic) ´ The number one nurse’s Priority action when caring for a child having a seizure is to MAINTAIN A SAFE ENVIORNMENT no matter what type of seizure. § Keeping a child safe during a seizure is the 1st priority, airway management is a priority as well but not the highest in this case ´ A priority treatment goal when planning for discharge is to keep a child safe from injury so teaching this to the parents is very important. Types of Seizures in Children ´ See BOX 46.7 on pages 1379-1380 in your textbook. ´ Simple partial seizures with motor signs ´ Simple partial seizures with sensory signs ´ Complex partial seizures ´ Generalized seizures or Tonic-Clonic seizures (formerly Grand Mal) ´ Moving from flexion to extension posturing in the seizure ´ Absence seizures (formerly Petit Mal or Lapses) ´ Atonic and Akinetic seizures (Drop Attacks) ´ Myoclonic seizures ´ Infantile spasms Cerebral Palsy (CP) ´ CP is a group of permanent disorders of the development of posture and movement, causing activity limitation attributed to nonprogressive disturbances that occurred in the developing fetus and infant brain. See page 1456 (BOX 49.1) ´ Types of CP would include: ´ Dyskinetic (non-spastic) (variable movement that is involuntary) ´ Spastic (Pyramidal)(abnormal muscle tightness due to prolonged muscle contraction) ´

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Ataxic (Unsteady, shaky movements or tremor · Difficulties maintaining balance). Mixed type

Head Injury in the Child ´ Head injury is a pathologic process involving the scalp, skull, meninges, or brain as a result of trauma ´ The three major causes of brain damage in childhood, in order of importance, are falls, motor vehicle injuries, and bicycle or sports-related injuries ´ The pathology of brain injury is directly related to the force of impact § Although nerve tissue is delicate, it usually requires a severe blow to cause significant damage. ´ Primary head injuries are those that occur at the time of trauma and include skull fracture, contusions, intracranial hematoma, and diffuse injury § Subsequent complications include hypoxic brain damage, increased ICP, infection, and cerebral edema. The predominant feature of a child's brain injury is the amount of diffuse swelling that occurs ´ As a nurse caring for a child with a head injury it is important to monitor for a change in LOC, like acting strange or confused. Other signs to watch for are if a child vomits more than 3 times, has pupillary changes, double or blurred vision, has trouble walking, or a headache that becomes more severe or wakes them from sleep. Nursing observation of a child with head injury ´ As a nurse caring for a child with a head injury it is important to monitor: § A change in LOC or mental status changes; like they act strange or confused § Vomits more than 3 times, § Has pupillary changes, § Double or blurred vision, § Has trouble walking, § Complains of headache that becomes more severe or wakes them from sleep § Fixed, dilated pupil is a neurologic emergency § Call Dr. immediately § Meningitis and the Lumbar Puncture ´ Bacterial meningitis is an acute inflammation of the meninges (3 layer covering of the brain and spinal cord) and CSF ´ Suspected bacterial meningitis is a medical emergency, and immediate action must be taken to identify the causative organism and to initiate prompt treatment ´ A lumbar puncture is preformed to collect CSF of someone suspected of having meningitis ´ The CSF is evaluated to provide a definitive diagnosis ´ Findings would include low glucose, increased WBC, and increased protein which would have a cloudy appearance ´ Following a lumbar puncture, a child may develop a spinal headache due to reduction in the CSF volume or invasion of a small air pocket that may develop

during the puncture. Headaches are seen less frequently in young children than in adolescents. ´ The nurse should encourage the child to lie flat and still for at least 30 min. Meningitis and ICP ´ Caring for a child with Meningitis requires: ´ Administration of IV fluid, antibiotics, and minimal stimulation. ´ YOU MUST MONITOR FOR CEREBRAL EDEMA ´ The child with meningitis is already at increased risk for cerebral edema and increased ICP due to inflammation of the meningeal membranes ´ CAREFULLY MONITOR FLUID INTAKE AND OUTPUT to avoid fluid overload ´ Strict isolation for the first 24 hours of antibiotics ´ Cluster care and minimal stimulation to prevent seizures ´ Management of the child with increased ICP is a complex and important task ´ Monitoring change in LOC, lethargy, headache and projectile vomiting is KEY ´ In infants monitor for bulging fontanels and lethargy More about the brain ´ Children should NOT receive Aspirin as it puts them at an increased risk for Reye’s Syndrome ´ Reye’s Syndrome is a rare disorder that causes brain and liver damage mostly in children, and typically occurs in children following a viral illness such as the flu or chicken pox…. ´ Hydrocephalus is a condition caused by an imbalance in the production and absorption of CSF in the ventricular system of the brain ´ Treatment of hydrocephalus is directed toward relief of ventricular pressure in the head ´ Many children will have VP shunts placed-as they grow it has to be changed, which puts them at risk for infection ´ As a nurse you may care for these kids post operatively and it is important to position them on the unaffected side, monitor for signs of increased ICP, and asses for signs of an ileus and constipation ´ Comatose child…The number one nursing priority is airway management (and good skin care) ´ How to assess pain…Look for altered VS (increased heart rate), increased agitation and rigidity Near Drowning or Submersion Injury ´ Submersion injury is a major cause of unintentional injury related death in children 1 to 19 years of age, with the highest rate occurring in children 1 to 4 years of age… ´ Near Drowning is defined as survival for at least 24 hours from suffocation by submersion ´ Aspiration of water causes the plasma to be pulled into the lungs resulting in hypoxemia, acidosis, and hypovolemia The respiratory status is the PRIORITY ASSESSMENT

Gastrointestinal Issues in the Child ´ The extensive surface area of the gastrointestinal (GI) tract and its digestive function represent the major means of exchange between the human organism and the environment ´ Disorders that impair the functional integrity of the GI system have the potential to cause serious alterations in fluid and electrolyte balance ´ Disorders that involve GI losses of large amounts of fluid, absorption disorders, inflammatory disorders, and decreased or excessive water intake have the potential to cause fluid and electrolyte imbalance in infants and children ´ Dehydration poses a serious threat to life and demands immediate attention ´ When an infant or child is vomiting and cannot be given oral rehydration therapy you must start an IV for replacement of water and electrolytes. ´ ´ Projectile Vomiting in babies is serious…big difference in spiting up and projectile vomiting ´ Pyloric Stenosis is typically classified by projectile vomiting , dehydration. There is visible peristalsis and an olive shaped mass in the epigastric area. Congenital problem corrected by a surgical procedure known as a pyloromyotomy. ´ Meckel’s Diverticulum is an outpouching or bulge in the lower part of the small intestine which causes bleeding. Standard therapy is surgery to remove the diverticulum and surrounding small intestine. ´

Appendicitis is still common in the pediatric patient; a ruptured appendix calls for emergency appendectomy, but even if it does not rupture, they will remove the appendix-rebound tenderness, RLQ Pain, mcburney pt ´ If it ruptures the child at risk for PERITONITIS ´ Postoperatively IVF will be maintained, and child will remain NPO ´ NG tube is kept on low continuous gastric decompression until bowel activity resumes ´ Possibly a drain if appendix was ruptured and frequent dressing changes ´ Analgesics as required ´ Iv antibiotics as ordered

Hirschsprung’s Disease ´ Hirschsprung disease is a congenital anomaly that results in ´ mechanical obstruction from inadequate motility of part of the intestine; also known as ‘Megacolon’ ´ The child will have ribbon-like stool ´ Requires that the aganglionic portion of the infant’s colon be removed ´ This may lead to a temporary colostomy to allow rest and recoil for a specified length of time. ´ Later the colostomy can be closed and the two ends of the intestine rejoined; reanastomosed

Hepatitis A is a significant health problem in a child-care setting…. ´ WASH YOUR HANDS The HepA vaccine is recommended for children 12 months and older, followed by a second dose at least 6 months later. HepA can be given as early as 6 months of age if a baby will travel to a place where hepatitis A is common ´ Celiac Disease is an autoimmune disease in which the immune system overreacts to gluten ´ Avoid gluten– breads, cakes, pie, wheat, oats, cereals, barley, and rye rice and potatoes-Don’t have potatoes. Issues with Malabsorption ´ There are many different disorders that can cause malabsorption ´ Celiac Disease ´ Cystic Fibrosis ´ Crohn’s Disease ´ Lactose Intolerance ´ Chronic Pancreatitis ´ Peptic Ulcer Disease ´ Irritable bowel ´ condition caused by inadequate vitamin C Scurvy´ lack of iron causes -----anemia ´ lack of Vitamin D Rickets can be caused from a Marasmus- is a form of severe malnutrition that occurs as a result of deficiency in calories and protein ´

Celiac Disease and the Gluten Free Diet ´ Celiac Disease is a permanent intestinal intolerance to dietary gluten, a protein present in wheat, barley, oats, rye, and ingredients used to batter fried foods. When gluten is eaten by these patients is causes damage to the villi in the small intestines. ´ Dietary management is the best way to control celiac disease and some patients may need a nutrition council to be able to stay on a correct diet on no gluten products. ´ These patients have ´ Impaired fat absorption ´ Impaired nutrition absorption ´ Behavioral changes Celiac crisis

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Gastrointestinal Reflux (GER) GER is described as the transfer of gastric contents into the esophagus. This may occur throughout the day, most frequently after meals and at night. Peak incidence in children is age 4 months and then it spontaneously resolves by 12 months. Children o Chronic cough o Heartburn o Abdominal pain

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Noncardiac chest pain Dysphagia Nocturnal asthma Recurrent pneumonia

Genitourinary Problems in Children As in most disorders of childhood, the incidence and type of kidney or urinary tract dysfunction change with the age and maturation of the child In addition, the presenting complaints and the significance of these complaints vary with age ´ For example, a complaint of enuresis has greater significance at 8 years of age than at 4 years of age ´ In newborns, renal abnormalities may be associated with several other malformations, for example, obvious neural tube defects to the subtle abnormal shape or position of the outer ear ´ Failure to thrive in children may be a sign of impaired renal function Some children may need cystourethrogram to evaluate the filling of the bladder and collapsing of the bladder upon emptying ´ is an X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating ´ With this procedure the child will need to void during the test, so they need to be well hydrated Children and Dialysis Some kids will be on a form of dialysis due to renal failure As a nurse you can educate on the type of dialysis that will allow the child to live a more normal lifestyle § Peritoneal dialysis as it can be done at home § However, there is a lot of education that is involved as this is done 7 days a week § Parents need to know when to notify the nurse or practitioner § Key nursing interventions is when a parent notifies the nurse with cloudy dialysate drainage as it indicates an infection…this warrants a call to the provider immediately Nephrotic Syndrome Nephrotic syndrome is a clinical state that includes: ´ Massive proteinuria ´ Hypoalbuminemia ´ Hyperlipidemia ´ Edema- during this stage salt is usually restricted ´ PRIORITY nursing diagnosis would be excess fluid volume related to excessive protein loss in the urine All this happens due to the excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane

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Acute Glomerulonephritis (AGN) Acute glomerulonephritis (AGN) may be a primary event or a manifestation of a systemic disorder that can range from minimal to severe Common features include: ´ Oliguria, ´ Edema, ´ hypertension and ´ circulatory congestion, ´ hematuria ´ proteinuria- Most cases are postinfectious and have been associated with pneumococcal, recent strep throat, and viral infections. Genitourinary – Urinary Tract Infection Urinary tract infections ´ Most common in little girls due to short urethra ´ Increased fluid intake and frequent bladder emptying ´ offer protective measures ´ Wearing cotton underpants helps prevent UTI in young girls ´ Decrease the amount of bubble baths taken Congenital Abnormalities ´ Hypospadias- which is when the meatal opening is located on the ventral surface of the penis ´ Epispadias – when the meatal or u...