Pediatrics-Common Dx and Nursing Care

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Information extracted from N4502 Notes in preparation for exam 1.

Epilepsy

D/O: More than 2 afebrile seizures w/o known cause

Epilepsy Dx work up

EEG sleep deprived, or long term monitoring, MRI, Surgical Evaluation

Epilepsy Nursing Care

Monitor for seizure activity
Ensure safe environment
Administer antiseizure medications
Sx of medication toxicity
Document S/Sx, duration, intervention and response to intervention.

Asthma triggers

Virus
Cold
Smoke
Exercise
Allergens

Asthma medications

Controller medications: Flovent, Pulmicort, Advair
Rescue Medications: Albuterol, Xopenex
Hospitalized: IV or oral corticosteroids

Asthma Nursing Care

Monitor Respiratory Rate, Breath Sounds, SaO2, Push Fluids, Manage Medications, Educate

Bronchiolitis S/Sx

Harsh congested cough, tachypnea, anorexia, N/V, Febrile

Bronchiolitis Dx Workup

Symptomatic, CXR

Bronchiolitis Tx

Albuterol via nebulizer
Sx treatment, comfort, humidity, fluids

Bronchiolitis Nursing Care

Contact & Droplet Precautions
Airway- O2, bulb syringe/suction
Hydration, I/O

Croup

Seal-like bark, expiratory stridor, Respiratory distress, retractions, hoarse, nasal flare.

Croup Nursing Care

Contact/Droplet Precautions
Pt. must wear mask outside of room.
ABCs

Croup Dx

characteristic cough
Neck x-ray

Croup Tx

Humidity
Steroids
Nebulizer
Fluids

Pneumonia Sx

Febrile
Cough
Tachypnea
Crackles
Retractions/Nasal Flare
Chest Pain
Anorexia
Abd Pain

Pneumonia Dx

CXR
Physical exam
CBC and cultures

Pneumonia Tx

Viral: supportive, hydration, respiratory support
Bacterial: Ab.s, Fluids, Respiratory support

Pneumonia Nursing Care

Isolation Precautions: organism specific
ABCs, IV access PRN, Ab's

Respiratory Synctial Virus RSV

Rhinorrhea
Pharyngitis
Cough/sneeze
Wheeze
Eye/ear Infxn
Febrile
Tachypnea/apnea
Retractions/Cyanosis
Listlessness

RSV Dx

Nasal RSV wash
Seasonal: Oct thru April
May progress to Pneumonia or Bronchiolitis if unDx.

RSV Tx

Fluids
Humidity
O2 PRN
Meds: albuterol/epinephrine/neb
Antivirals w/in 3 days of Dx: Ribavirin

Congestive Heart Failure

Back up of blood in venous system causes lack of O2 Blood to circulation.
Infant Sx: anorexia, malnutrition, tachypnea, diaphoresis.
Child Sx: Fatigue, SOB, Periorbital and Peripheral Edema, behind peers.

CHF Nursing Care

Limit Child's energy expenditure: group cares, limit feeding length, avoid stress.
Elevate HOB and reduce exposure to respiratory Infxn.
Small frequent feedings of High caloric formula/BF.
Proper wt gain before surgery
Cardiac medications require attention to fluid balance.

Gastroenteritis

Bacterial (Salmonella), or Rotavirus most common: foul odor of watery stools, Fluid deficit r/t V/D, Abd cramps, anorexia, febrile.

Gastroenteritis Nursing Care

Monitor I/O
Maintain Fluid status.
Skin care
Dietary mgmt.
Infxn control

GastroEsophogeal Reflux GER

Acid backup from stomach to esophagus.
Esophogeal inflammation/stricture
May lead to aspiration pneumonia.
May resolve w/age.

GER Nursing Care

Position
Med mgmt: Proton pump inhibitors (Prevacid)

UTI S/Sx

Cloudy, foul odor of urine.
Dysuria & Urgency.
Hematuria.
Lower ABD discomfort
Febrile
Infants:irritable, colic, vomiting.

UTI Dx

Urinalysis or Urine Culture before antibiotic Tx.
Voiding cystourethrography VCUG to detect reflux r/t repeat UTIs.

UTI Tx

Antibiotics: oral/IV for bladder infxn.
IV for kidney infxn.
Fluids and antispasmodics

Incomplete Fractures

Greenstick or Bend fractures

Complete Fractures

Transverse, Spiral, Oblique, Comminuted
May be open or closed.

Types of casts

Fiberglass is quick to dry, water resistant, lightweight, can Xray.
Plaster is heavier, dries slower, breathable, is less rigid.
Skin and pressure!
Neurovascular Checks: color, sensation, motion.

Sepsis Workup

Blood cultures: line or stick
Urine/sputum/throat/skin cultures
Prophylactic Antibiotics like ampicillin or gentamycin.
Monitor Pt closely.

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