Pediatrics Exam 1 Study Guide PDF

Preview

Summary

This document includes topics covering; gastrointestinal, musculoskeletal, genitourinary/elimination, integumentary, genetics, pain, infection, atraumatic care, and daily fluid maintenance calculations ...

Description

Peds Exam- 3 Study Guide

Gastrointestinal 1. Anatomy and Physiology of the GI system a. Mouth i. Highly vascular, entry point of infection b. Esophagus i. LES not fully developed until age 1, causing regurgitation/reflux c. Newborn stomach capacity only 10-20 mL d. Intestines i. Small intestine not mature at birth e. Biliary system i. Liver relatively large at birth ii. Pancreatic enzymes develop postnatally, not reaching adult levels until 2 years old f. Fluid balance and losses i. Proportionately greater amount of body water compared to adults ii. The margin for significant dehydration progressing to hypovolemic shock is much fjfjfjfjfjfjfjf jlower for children than in adults iii. Newborn: 75% total water, 45% ECF, 30% ICF iv. Infant: 65% total water, 25% ECF, 30-40% ICF v. Child/Adolescent: 50% total water, 10-15% ECF, 40% ICF 2. Daily Fluid Maintenance Requirements a. Calculate the child’s weight in kilograms i. Allow 100 mL/kg for the first 10 kg of body weight ii. Allow 50 mL/kg for the second 10 kg of body weight iii. Allow 20 mL/kg for the remaining kilograms of body weight 3. GI Disorders a. Affect children of all ages b. Range from acute to chronic and from non-life threatening to life threatening i. Even acute, non-threatening illnesses can become dangerous without proper nursing fjfjfjfjfjfjfjf a ssessment and interventions c. Dehydration i. Most common effect of GI illness ii. Oral rehydration is most common, but in cases requiring hospitalization intravenous fjfjfjfjfjfjfjf fluid therapy is key. iii. goals for the infant or child with dehydration are aimed at restoring fluid volume fjfjfjfjfjfjfjf a nd preventing progression to hypovolemia. iv. Provide oral rehydration to children for mild to moderate states of dehydration. v. Children with severe dehydration should receive intravenous fluids. Initially, fjfjfjfjfjfjfjf administer 20 mL/kg of normal saline or lactated Ringer, and then reassess the fjfjfjfjfjfjfjf hydration status d. It is important to take all GI disorders seriously until S/S are well controlled

4. Assessment a. Health history b. Physical exam c. Hydration status d. Mental status e. Abdominal size/shape f. Rebound tenderness i. Pain upon release of pressure during palpation g. Common tests and labs (abdominal US, KUB, small bowel series, barium enema, fjfhemocult, stool for O&P) i. Close monitoring for infection is important in children with inflammatory bowel fjfjfjfjfdisease, autoimmune hepatitis, or liver transplant who are being treated with fjfjfjfjfimmunosuppressants and/or corticosteroids 5. Data collected in the physical assessment a. Auscultation i. Hyperactive/ hypoactive bowel sounds b. Percussion i. Dullness, flatness, tympany c. Palpation i. Reserve for last in sequence, palpable kidneys may indicate tumor or fjfjfjfjf fjfjfjf jfhydronephrosis; RLQ pain may warn of appendicitis 6. Common Medical Treatments a. Hydration (oral, enteral, IV). b. Providing adequate nutrition (oral, enteral, IV) i. The child with a chronic GI disorder may require intravenous TPN or enteral tube fjfkfkfkfkfk f eedings to exhibit appropriate growth ii. Children need additional calories to recover from illness in addition to the caloric fjfkfkfkfkfk n eeds related to growth. c. Enemas and bowel preparations d. Probiotics i. support/replace intestinal microbial flora e. Medications f. Ostomies i. Surgical opening into a digestive organ g. Surgical intervention i. necessary for many acute or congenital GI disorders, such as pyloric stenosis, fjfkfkfkfkfkomphalocele, gastroschisis, cleft lip and palate, appendicitis, Hirschsprung disease, fjfkfkfkfkfkand intestinal malrotation ii. may be curative treatments for some children

7. Classes of Medications to Manage GI disorders a. Histamine-2 blockers, proton pump inhibitors, prokinetic agents i. used to treat disorders in which gastric acid is a problem, such as esophagitis,  fjfkfkfkfkfkGERD, and ulcers. b. Prokinetics c. Antibacterial/antibiotics d. Corticosteroids, immunosuppressants e. Stimulants, laxatives f. Antidiarrheals and antiemetics g. Anti-inflammatories

8. Common laboratory tests a. Abdominal ultrasonography b. Barium swallow, small bowel series c. Blood work: amylase, electrolytes, lipase, LFTs i. Monitoring the blood count, electrolyte levels, and liver function tests is necessary d. Esophageal manometry/ esophageal pH probe e. Endoscopy (gastroscopy, colonoscopy) f. Hemoccult, stool sample/culture, stool O&P g. Hepatobiliary(HIDA) scan h. Liver biopsy i. Lactose tolerance test, urea breath test 9. Stool Collection techniques a. If the child is in diapers, use a tongue blade to scrape a specimen into the collection fjfkfkfk c ontainer b. If the child has runny stool, a piece of plastic wrap in the diaper may catch the stool fjfkfkfk s pecimen i. Very liquid stool may require application of a urine bag to the anal area to collect fjfkfkfk s chool c. The older ambulatory child may first urinate in the toilet, and then the stool specimen fjfkfkfk m  ay be retrieved from the new or clean collection container that fits under the seat at the fjfkfkfk b ack of the toilet d. Bedridden child i. collect the stool specimen from a clean bedpan (do not allow urine to contaminate fjfkfkfk t he stool specimen) 10. Risk Factors for GI Disorders a. Prematurity b. Family history c. Genetic syndromes d. Chronic illness e. Prenatal factors f. Exposure to infectious agents

g. Foreign travel h. Immune deficiency, chronic steroid use 11. Risk factors for Dehydration a. Diarrhea i. Recent ingestion of undercooked meats ii. Foreign travel iii. Day care attendance iv. Well water ingestion b. Vomiting i. Exposure to viruses, use of certain medications, and overfeeding in the infant ii. Is a symptom and should be characterized by volume, color, relation to meals, fjfkfkfk d uration and associated symptoms c. Decreased oral intake d. Sustained high fever e. Diabetic ketoacidosis f. Extensive burns 12. Oral Rehydration Therapy a. Should contain 75 mmol/L sodium chloride and 13.5 g/L glucose (standard ORS fjfkfkfk fjfkfkfk s olutions include Pedialyte, Infalyte, and Ricelyte) b. Tap water, milk, undiluted fruit juice, soup, and broth are NOT appropriate for oral fkfkfkfkrehydration c. Children with mild to moderate dehydration require 50 to 100 mL/kg of ORS over 4 fkfkfkfkhours d. After re-evaluation, oral rehydration may need to be continued if the child is still fkfkfkfkdehydrated e. When rehydrated, the child can resume a regular diet 13. Acute GI Disorders a. Dehydration, vomiting, and diarrhea b. Oral candidiasis and oral lesions c. hypertrophic pyloric stenosis d. Necrotizing enterocolitis e. Intussusception, malrotation, and volvulus f. Appendicitis i. RLQ pain and rebound tenderness of the abdomen ii. Considered a surgical emergency 14. Vomiting a. Nonbilious and bilious types i. Bilious vomiting is the main symptom of conditions resulting in bowel obstruction, fjfkfkfk s uch as malrotation with volvulus ii. Often accompanied by nausea b. Therapeutic management

i. directed toward detection and treatment of the causes c. Nursing management i. Major focus on observation and reporting ii. Instruct children to rinse mouth or brush teeth after vomiting 15. Diarrhea a. Caused by an inflammatory process of infectious origin b. a toxic reaction to ingestion of poisonous substances, dietary indiscretions, or infections fjfkfkfk o utside the alimentary tract. c. The primary treatment of diarrhea is the use of oral rehydration solutions. d. Acute diarrhea i. 10 degrees b. Multiple types i. Idiopathic ii. Neuromuscular iii. Congenital iv. May be congenital, associated with other disorders or acquired c. Management i. Exercise ii. Braces (multiple types based on severity) iii. Surgical repair for severe cases (Harrington rod) ↳ Rods are fused to the vertebrae and connected to a distracting rod to rotate the fkfkfkfk v ertebral column d. Therapeutic management i. Team approach to treatment e. Nursing care i. Concerns of body image ii. Concerns of prolonged treatment of condition f. Pre/Post-operative care i. To prevent complications after a spinal fusion for scoliosis correction, use the fkfkfkfk l og-roll method for turning the child to prevent back flexion 15. Legg-Calve-Perthes Disease a. Self-limiting condition that involves avascular necrosis of the femoral head i. interruption of the blood supply to the femoral head results in bone death, and the fkfkfkfk s pherical shape of the femoral head may be lost. ii. Swelling of the soft tissues around the hip may occur. As new blood vessels fkfkfkfk d evelop, the area is supplied with circulation, allowing bone resorption and fkfkfkfk fkfkfkfk d eposition to take place iii. Dur ing this period of revascularization, which takes 18 to 24 months, the bone is fkfkfkfk soft and more likely to fracture. Over time, the femoral head reforms. b. Goal is to maintain normal femoral head shape and to restore appropriate motion c. Treatment i. includes anti-inflammatory medication

d. most often affects children between 4 and 8 years of age, but it can occur as early as 18 fkfkfkfkmonths and up until skeletal maturity d. Activity limitation may be prescribed e. Sometimes bracing, casting, or traction is recommended to contain the femoral head f. Serial x-ray follow-up determines progress of the disease g. If surgery becomes warranted (rarely done), osteotomy may be performed 16. Compartment Syndrome a. painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

Genitourinary/Elimination 1. Differences in A&P of children affecting Genitourinary system a. Kidney i. large in relation to the stomach; prone to injury b. Urethra i. shorter; risk for bacteria into bladder (UTI). c. Glomerular filtration rate i. slower in infant; risk for dehydration d. Bladder capacity i. 30 mL in newborn e. Expected urine output i. infant and child: 1 to 2 mL/kg/hour, with average 1-year-old voiding about 400 to fkfkj500 mL per day. ii. teenager: 800 to 1,400 mL per day f. Reproductive organs i. immature at birth until adolescence 2. Common Medication Classes for GU disorders a. Antibiotics b. Anticholinergics c. Desmopressin(DDAVP) d. Diuretics e. Corticosteroids f. ACE inhibitors and other antihypertensives g. Imipramine (tricyclic antidepressants for enuresis h. Immunosuppressants(for renal transplants) i. Albumin (IV) 3. Common Medical Treatments for GU disorders a. Urinary diversion b. Foley catheter c. Ureteral stent d. N  ephrostomy tube e. Suprapubic tube f. Vesicostomy g. Appendicovesicostomy h. Bladder augmentation i. Dialysis (hemodialysis and peritoneal 4. Common Laboratory and Diagnostic Tests a. CBC, Blood urea nitrogen (BUN), electrolytes, creatinine, total protein, albumin b. Urinalysis → clean catch, suprapubic, or catheterized; culture and sensitivity (Urine fkfkfkfkC&S) c. Creatinine clear ance

d. Timed urine collections (24 hours) for creatinine, total protein e. Cystoscopy, urodynamic studies f. Voiding cystourethrogram (VCUG) g. Renal ultrasound, intravenous pyelogram (IVP) 5. Hypospadias/Epispadias a. Hypospadias i. a urethral defect in which the opening is on the ventral surface of the penis rather fkfkfkfkfkf t han at the end of the penis b. Epispadias i. a urethral defect in which the opening is on the dorsal surface of the penis c. The opening may be near the glans of the penis, midway along the penis or near the base (A): Hypospadias (B): Epispadias

6. Vesicoureteral Reflux a. condition in which urine from the bladder flows back up the ureters b. This reflux of urine occurs during bladder contraction with voiding c. May occur in one or both ureters d. If reflux occurs when the urine is infected, the kidney is exposed to bacteria and fkfkfkf fkfkfkfkpyelonephritis may result 7. Urinary Tract Infection (UTI) a. One of the most common conditions of childhood; 10% of children have a febrile UTI in fkfkfkfkthe first 2 years of life b. The diagnosis of UTI depends on a high degree of suspicion, evaluation of the history fkfkfkfkand physical examination, and urinalysis and culture i. A presumptive UTI diagnosis can be made on the basis of microscopic examination fkfkfkfkm o f the urine, which often reveals pyuria (5 to 8 white blood cells/ml of fkfkfkfk fkfkfkfk u ncentrifuged urine) and the presence of at least one bacterium in a Gram stain. ii. A normal urinalysis may also be present in conditions of asymptomatic bacteriuria. fkfkfkfkfkiii. Detection of bacteria in a urine culture confirms the diagnosis of UTI. c. Urine with a possible infection appears cloudy, hazy, or thick with noticeable strands of fkfkfkfkmucus and pus; it also smells fishy and unpleasant, even when fresh i. Most important host factor is urinary stasis ii. Uncircumcised males are at higher risk in infancy iii. Structure of the lower urinary tract is believed to account for the increased f kfkfkfk fkfkfkfk i ncidence of bacteriuria in females

d. Clinical Manifestations i. Symptoms vary depending on age ↳ a complaint of enuresis has greater significance at age 8 years than at age 4. ↳ In the newborn, urinary tract disorders are associated with a number of obvious fkfkfkfk malformations of other body systems, including the curious and unexplained fkfkfkfk but frequent association between malformed or low-set ears and urinary tract fkfkfkfk fkfkfanomalies. ii. Urinary frequency iii. Fever (in some cases) iv. Odiferous urine v. Blood or blood-tinged urine vi. Even with significant bacteria, a peds patient may have no symptoms or fkfkfkfk fkfkfkfk nonspecific symptoms such as fatigue or anorexia e. Organisms that commonly cause UTI’s i. Escherichia coli i s the most common pathogen (80% of cases) ii. Streptococci iii. Staphylococcus Saprophyticus iv. Occasionally, fungal and parasitic pathogens f. Anatomic or physical causes i. Short urethra in girls ii. Uncircumcised males g. Physiologic and mechanical defense mechanisms that maintain sterility i. Emptying the bladder ii. Normal antibacterial properties of the urine and tract iii. Ureterovesical junction competence iv. Peristaltic activity h. Alteration of defense mechanisms increases the risk of UTIs I. Organisms are usually introduced via an ascending route from the urethra i. Less common routes → Bloodstream, Lymphatic system j. Laboratory and Diagnostic tests i. Urinalysis clean catch, suprapubic, or catheterized): may be positive for blood, fkfkfkffkkfknitrites, leukocyte esterase, white blood cells, or bacteria (bacteriuria) ii. Urine culture: will be positive for infecting organism iii. Renal ultrasound: may show hydronephrosis if child also has a structural defect iv. VCUG: not usually performed until the child has been treated with antibiotics for at fkfkfkffkkfk l east 48 hours, as infected urine tends to reflux up the ureters anyway ↪VCUG performed once the urine has regained sterility may be positive for VUR 8. Enuresis a. continued incontinence of urine past the age of toilet training b. Nocturnal enuresis generally subsides by 6 years of age; if it does not, further fkfkfkkfinvestigation and treatment may be warranted c. Occasional daytime wetting or dribbling of urine is usually not a cause for concern, but fkfkfkkffrequent daytime wetting concerns both the child and the parents

d. Nocturnal enuresis may persist in some children into late childhood and adolescence, fkfkfkkfcausing significant distress for the affected child and family e. Primary enuresis i. enuresis in the child who has never achieved voluntary bladder control. f. Secondary enuresis i. urinary incontinence in the child who previously demonstrated bladder control over fkfkfkkf a period of at least 3 to 6 consecutive months. g. Diurnal enuresis i. daytime loss of urinary control. h. Nocturnal enuresis i. nighttime bedwetting 9. Acute Glomerulonephritis a. Immune mechanisms cause inflammation, which results in altered glomerular structure and function in both kidneys b. Often occurs following an infection, usually an upper respiratory or skin infection c. Most are postinfectious (pneumococcal, streptococcal, or viral) BUT may be a fkfkfkkf fkfkfkk m  anifestation of a systemic disorder (Systemic lupus erythematosus (SLE) or Sickle cell) fkfkfkkfdisease d. Acute poststreptococcal glomerulonephritis (APSGN) i. condition in which immune processes injure the glomeruli ii. caused by an antibody–antigen reaction secondary to an infection with a f kfkfkkf fkfkfkkf nephritogenic strain of group A β-hemolytic streptococcus iii. occurs more frequently in males than females and with a peak prevalence occurring fkfkfkkf around 5 to 6 years of age

10. Dialysis a. Peritoneal Dialysis i. uses the child’s abdominal cavity as a semipermeable membrane to help fkfkfkfk fkfkfkfk r emove excess fluid and waste products b. Hemodialysis i. removes toxins and excess fluid from the blood by pumping the child’s fkfkfkfk fkfkfkfk b lood through a hemodialysis machine and then reinfusing the blood into the child ii. Needles to remove and reinfuse the blood are inserted into an arteriovenous fistula fkfkfkfk o r graft, usually located in the child’s arm

11. Male Reproductive Disorders a. Phimosis i. Foreskin of the penis cannot be retracted b. Paraphimosis i. more serious disorder characterized by retraction of the phimotic prepuce, which fkfkfkfkfkkfcauses a constricting band behind the glans of the penis and results in incarceration fkfkfkfkfkkfif left untreated c. Cryptorchidism i. Also known as undescended testicles ii. Occurs when one or both testicles do not descend into the scrotal sac d. Hydrocele i. Fluid in the scrotal sac ii. Usually a benign and self-limiting disorder → should go away on its own c. Varicocele i. a venous varicosity along the spermatic cord is often noted as a swelling of the fkfkfkfkfkkfscrotal sac. Complications of varicocele include low sperm count or reduced sperm fkfkfkfkfkkfmotility, which can result in infertility d. Testicular torsion i. when the spermatic cord (from which the testicle is suspended) twists, cutting off the fkfkfkfkfkkftesticle's blood supply, a condition called ischemia ii. Surgical emergency e. Epididymitis i. Inflammation of the epididymitis ii. Ice packs to the scrotum relieves pain

Integumentary 1. Difference in Skin between Children vs. Adults a. Infant’s epidermis is thinner and blood vessels are closer to the surface i. Infant loses heat more readily through skin surface ii. Allows substances to be absorbed through skin quicker iii. More accessible to bacterial invasion iv. Does not reach adult thickness until late teen years b. Infant’s skin contains more water i. Epidermis is loosely bound to the dermis ii. Friction may easily cause separation of layers, resulting in blistering or skin rkddkdkdkdk breakdown c. Infant’s skin is less pigmented, therefore at risk for UV damage d. Sebum production increases in the preadolescent and adolescent years, contributing to rkddkd the development of acne at that time 2. Alterations in Integument a. Macule i. a discolored patch of skin that is not elevated and is less than one centimeter in fkfkfkfkfkk diameter b. Papule c. Annular i. ring shaped d. Pruritus e. Vesicle, pustule f. Scaling, plaques g. Hypo-, hyperpigmented h. Erythematous 3. Types of Infections of the Skin a. Bacterial i. bullous and nonbullous impetigo, folliculitis, cellulitis, MRSA, Staphylococcal fkfkfkfkfkkfscalded skin syndrome ii. Often caused by Staph aureus o r group A β-hemolytic streptococcus (normal flora) iii. Most bacterial skin infections are caused by Staphylococcus aureus and group A fkfkfkfkfkkf β  -hemolytic streptococcus b. Fungal:multiple types of tinea (pedis, corporis, versicolor, capitis and cruris), Candida fkfkfkf albicans i. May require up to several weeks of treatment c. Viral i. viral exanthems, Herpes simplex

(this is an example of bacterial impetigo, note honey colored crusting)

4. Fungal Infections a. Tinea pedis i. fungal infection on the feet b. Tinea corporis (ringworm)...