Pedia Notes POISONING- common in toddlers. (falls- common to infant) 1. determ determine ine subs substan tance ce taken taken,, asses assesss LOC 2. unless unless poison is is corrosive, corrosive, caustic caustic (strong (strong alkali alkali such such as lye) or or a hydrocarbon, hydrocarbon, vomiting is the most effective way to remove poison. •
Give syrup 1 pecac to induce vomiting
1. 1 pec pecac ac – oral oral eme emeti ticc • •
15 ml – adolescent, school age & pre school 10 ml to infant
1. 2. 3. 4.
UNIVERSAL UNIVERSAL ANTIDOTEANTIDOTE- charcoa charcoal, l, milk milk of magnesia magnesia & burned burned toast toast Never Never adm charcoal charcoal before before 1 pecac pecac antidote antidote for acetaminophen acetaminophen poisoni poisoning ng – acetylsy acetylsysteri sterine ne ( mucomyst mucomyst)) caustic caustic poisoning poisoning ( muriati muriaticc acid ) neutraliz neutralizee acid by giving giving vinegar vinegar . Don’t vomit vomit prepare tracheostomy set 5. GasGas- miner mineral al oil oil will will coat coat inte intesti stine ne Lead poisoning
Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning Accumulation of anemia = Encepalopathy Sx: 1. begi beginn nnin ing g sx of leth lethar argy gy 2. impuls impulsive ivenes ness, s, learni learning ng diffic difficult ulties ies 3. as lead lead increases, increases, severe severe encepalo encepalopathy pathy with with seizure seizure and permanent permanent mental mental retardation Dx: 1. Blood smear 2. abd x ray 3. long bo bones Mgt: 1. remo remove ve chi child ld from from sour source ce 2. if > 20 ug/dL – need need chelation chelation therapy therapy = binds with led led & excreted excreted by kidney
=nephrotoxic Amogenital
Female: Pseudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood – rape/ child abuse Rape- Report within 48 h Shape pubic hair in inverted triangle ( female) Male: Undescended testes – cyrptorchidism -common to preterm surgery – orchidopexy assess scrotum- warm room & hands baby – pee within 24 h -check for arch of urination E pispadias- urinary meatus located dorsal or a bove glans penis Hypospadias- urinary meauts loc ventral or below glans penis
Hypospadias with chordee- fibrous band causing penis to curb downward Mgt: Surgery Phimosis- tight foreskin Balanitis-infection Balanitis-infection of glands penis – due smegma Mgt: Circusicion Hydroseal – fld filled scrotum
Tst of Dx: Transillumination Transillumination with use of flashlight - glowing sign
Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)
Renal Disorder
NEPHROTIC
Cause
Sx
infectious
1. 2.
SYNDROME
3.
4.
5. 6.
AGN ( acute Glomerulo Nephritis) 3A’s;
Autoimmune Grp A beta hemolytic streptococcus
normal or decreased BP
1.
(PPP) primary peripheral periobital edema moderate protenuria gross hematuria ( smokey urine) serum K increased fatigue increase BP BP
3.
autoimmune, Grp A
Anasarcagen edema massive protenuria microscopic or no hematuria serum CHON decreased serum li lipid increased fatigue
7.
2.
AGN,
Tx
4. 5. 6. Complication : 1.
hypersensive encephalopathy
2.
anemia
BACK- check for flatness & symmetry Open Neural Tube Defect- decreased Folic Acid intake
SPINA BIFIDA OCCULTAOCCULTA- failure of post laminae of vertebrae to fuse
Prednisone
NSG CARE
Focus of care: monitor edema
Diuretic •
weigh daily
Diet: Increase CHON Increase K- OJ, beef broth, banana Decrease Na
1. anti HPN drug hydralazine or apresoline 2. iron
1. weigh daily 2. monitor BP & neurologiuc status 3. Diet: decrease K, decrease Na
Sx: dimpling of back , Abnormal tufts of hair SPINA BIFIDA CYSTICACYSTICA- failure of post laminae of vertebrae to fuse with a sac Types:
1. Meningocele – protrusion of CSF of CSF & Meninges 2. Myelomeningocele – protrusion of CSF of CSF & Meninges & spinal cord ( most dangerous) 3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or myelomeningocele myelomeningocele Most common problem • • •
rupture of sac prone pos sterile wet dressing
Most common complication - infection Myelomeningocele – Myelomeningocele – genitourinary complication- urinary & fecal incontinence Nsg care: always check diaper Orthopedic complication – paralysis of lower extremities Surgery to prevent infection Post op – prone position SCOLIOSIS- lateral curvature of the spine
2 types: 1. structural – rye neck 2. postural – improper posture
Dx: 1. 2.
unev uneveen heml hemliine bend bend for forwa ward rd-- 1 hip hip high higher er 1 shoulder blade more prominent
Nsg care:
1. conservative – avoid obesity, exercise 2. preventive – Milwaukee brace - worn 23 h a day 3. corrective surgery – insert Harrington rod post op- how to move log rolling- move client as 1 unit EXTREMITIES:
check # of digits = 20 1. 2. 3. 4. 5.
synda syndacty ctyly ly – webb webbing ing of digits digits poly polyda dact ctyl yly y – ext extra ra dig digit itss olid olidac acty tyly ly – lack lack of of dig digit itss Ameli Ameliaa – total total absenc absencee of digit digitss pocoameli pocoameliaa- absenc absencee of distal distal part part of of extrem extremities ities
ErQ duchennes – paralysis- brachial plexus injury or brachial palsy •
birth injury caused by lateral & excessive traction during a breech injury
Sx: 1. 2.
unable unable to abduct arms arms from shoulde shoulders, rs, rotate rotate arm extern externally ally or supina supinate te forearm forearm absenc absencee or asymet asymetric rical al moro moro reflex reflex
Mgt: 1.
abduct abduct arm arm from from shoul shoulder derss with with elbow elbow flex. flex.
CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum Types;
1. 2.
sublux subl uxat ated ed – mos mostt comm common on typ typee dislocated
1. 2. 3. 4. 5.
shor shorte teni ning ng of of affe affect cted ed leg leg asym asymme metr tric ical al glu glute teal al fol fold d limite lim ited d move movemen mentt – ear earlie liest st sx (+) (+) ortola ortolanis nis sign sign – abno abnorma rmall clicki clicking ng sound sound when able to to walk walk – child child limps limps – late late sx- trendelen trendelenburg burg sign sign
Sx:
Goal of Mgt: Facilitate abduction
Mgt. 1. 2. 3. 4. 5.
triple di diaper carr carry y bab baby y astr astrid idee Frejka sp splint Pavlik vlik har harnes ness Hip Spica pica Cast ast
TALIPES – "clubfoot"
a. b. c. d.
Equino Equinoss – planta plantarr flexi flexion on – horsef horsefoot oot Calcaneo Calcaneous us – dorsiflexion dorsiflexion – heal lower lower that foot anterior anterior posterior posterior of foot foot flexed flexed towards towards anterior anterior leg Varu Varuss- foot foot turn turnss in in Valg Valgus us-- foot foot turn turnss out out
Equino varus- most common Assessment: 1.
Straig Straighte hten n legs legs & flexin flexing g them them at midli midline ne pos pos
Mgt: 1. Corrective shoe- Dennis brown shoe, spica cast Fx: of cast – - to immobilize • •
bone alignment prevent muscle spasm
lead pencil – mark area to be amputated cold H20 – hasten setting process hot H20- slow setting process After cast application – how to move pt: - use open palm not fingers- fingers will cause indention • •
dry cast – natural air not blower priority check : neurovascular check
C- circulation M- motion S- sensation
Cast – with bleeding - mask with ball pen edge of blood to know if bleeding is on going sign cast is dry = resonant sound, cast cold to touch do petaline – making rough surface of cast smooth CRUTCHES
Fx: To maintain balance •
To support weakened leg
Principles in crutches • • •
wt of body on palm! Brachial pulsing – if wt of body in axila Do palm exercise- squeeze ball
Different crutch Gaits:
1. 2.
Swing Th Through Swing to
•
no weight bearing are allowed into lower ext
1.
Thre hree poi point nt Gait ait - wt bearing is allowed in 1 ext
2. 3.
Four our poin pointt gait gait Two poi point Gait ait - wt bearing allowed in 2 lower ext