pediatrics - final

• acute laryngotracheobronchitis


  croup refers to infection of the upper airway, which becomes narrow, making it harder to breathe.

  - cough sounds like barking

  - when a cough forced through this narrowed passageway, swollen vocal cords produce a noise like a seal barking. Taking a breath produces a high-pitched whistling sound called stridor.
• acute laryngotracheobronchitis: symptoms


  - low grade fever

  - restlessness

  - hoarseness

  - barky cough

  - dyspnea

  - inspiratory stridor

  - retractions
• acute laryngotracheobronchitis: treatment


  - provide humidity with cool mist

  - administer oxygen if needed

  - monitor continuous oximetry

  - administer nebulized racemic epinephrine as prescribed

  - administer corticosteroids: oral, IM or nebulizer

  - encourage oral intake if tolerated

  - administer IV fluids as prescribed
• tonsillectomy pre-operative nursing actions

  maintain NPO status
• tonsillectomy post-operative nursing actions: positioning

  - place in position to facilitate drainage.

  - elevate head of bed when child is fully awake.
• tonsillectomy post-operative nursing actions: assessment


  assess for evidence of bleeding =

  
  

  frequent swallowing

  clearing the throat

  restlessness

  bright right emesis

  tachycardia

  pallor.
• tonsillectomy post-operative nursing actions: comfort measures

  - administer liquid analgesics or tetracaine lollipops as prescribed.

  - provide an ice collar.

  - offer ice chips or sips of water to keep throat moist.

  - administer pain medication on a regular schedule.
• tonsillectomy post-operative nursing actions: diet

  - encourage clear liquids and fluids after a return of gag reflex, avoiding red-colored liquids, citrus juice, and milk-based foods initially.

  - advance the diet with soft, bland foods.
• tonsillectomy post-operative nursing actions: instruction

  - discourage coughing, throat clearing, nose blowing to protect the surgical site.

  - avoid straws as they can damage the surgical site.

  - alert the guardians that there can be clots or blood-tinged mucus in vomitus.
• sickle cell anemia


  sickle cell disease is a group of inherited RBC disorders that affect hemoglobin, protein that carries oxygen throughout body.

  - less healthy RBC circulating in body, person becomes anemic
• sickle cell anemia symptoms

  - family history of sickle cell anemia or trait.

  - reports of pain.

  - shortness of breath, fatigue

  - pallor, pale mucous membranes

  - jaundice

  - hands and feet cool to touch.

  - dizziness

  - headache
• sickle cell anemia: cause of pain crisis (vaso-occlusive)


  - occurs suddenly when body is under stress from infection, fever, or dehydration.

  - anything that reduces amount of oxygen in the blood, such as vigorous exercise or an illness may bring sickle cell crisis.
• sickle cell anemia: pain crisis symptoms

  - worsening of anemia

  - pain (often in abdomen or long bones of arms and legs)

  - fever

  - shortness of breath

  - abdominal pain may be severe.

  - vomiting may occur.
• sickle cell anemia: pain crisis treatment

  - promote rest to decrease oxygen consumption

  - administer oxygen as prescribed if hypoxia is present

  - provide intense hydration therapy while maintaining fluid imbalance

  - administer blood products, usually packed with RBCs

  - treat and prevent infection
• sickle cell anemia complications: sequestration

  - spleen traps the abnormal red blood cells and get very large (splenomegaly) may also occur in the liver (hepatomegaly)

  - reduced circulating blood volume results in hypovolemia and can progress to shock.
• sickle cell anemia complications: aplastic crisis

  - body temporarily does not make enough red blood cells, which can cause severe anemia.

  - triggered by infection with virus.

  
  

  signs include:

  paleness

  extreme tiredness

  fast heartbeat.
• sickle cell anemia complications: acute chest syndrome


  - sickling occurs in the chest. Can be life-threatening. Sickled cells stick together and block the flow of oxygen in the tiny vessels in the lungs.

  - resembles pneumonia and can include fever, pain, and a violent cough.
• sickle cell anemia complications: acute chest syndrome symptoms


  - chest, back or abdominal pain

  - fever of 38.5 C (101.3 F) or higher

  - cough

  - tachypnea

  - dyspnea, wheezing

  - retractions

  - decreased oxygen saturations.
• sickle cell anemia complications: acute chest syndrome client education


  - may need blood transfusion.

  - take antibiotics as prescribed.
• asthma medications: bronchodilators


  beta 2 agonists

  anticholinergics

  methylxanthines

  
  

  (BAM)
• beta 2 agonists: moa


  bind to beta 2 receptors in lungs and relax airway muscles
• beta 2 agonists: short acting beta 2 agonists (saba)

  albuterol, levabuterol, terbatuline

  - used asthma exacerbations

  - prevention of exercised-induced asthma
• beta 2 agonists: long acting beta 2 agonists (laba)


  foradil, salmeterol

  - used to prevent asthma exacerbations

  - might be used along with anti-inflammatory therapy

  - cannot be used to treat asthma exacerbations
• anticholinergics


  atropine, ipratropium

  - block the parasympathetic nervous system, relaxing airway muscles
• methylxanthines


  theophylline, aminophylline

  - can cause fast heart rate

  - risk for toxicity
• asthma medications: anti inflammatory

  steroids

  leukotriene inhibitor

  mast cell stabilizer
• steroids


  beclomethasone, methylprednisolone, prednisone, fluticasone

  - oral can be given for short periods 3-10 days

  - inhaled steroids are administered daily as preventative measure

  - monitor child's growth (suppress bone growth)
• leukotriene inhibitor


  zafirlukast, montelukast

  - decrease airway resistance
• mast cell stabilizer


  cromolyn

  - long term control
• monitoring a child's asthma with peak flow meter

  - encourage to use same time every day.

  - keep a record of PEFR results. Reading overtime show the child's best efforts and provide a warning of increased airway impairment. "Best score" is determined over a 2-week period.

  - learn how to interpret PEFR results and what measures to take for their zone.

  - learn how to recognize asthma exacerbation
• recognize asthma exacerbation with peak flow meter

  decreased PEFR

  increased use of SABA

  difficulty speaking or eating
• peak flow meter zones: green

  80-100%

  - "go" asthma is under control, take usual long term meds only
• peak flow meter zones: yellow

  50-79%

  - warns of acute attack (need to mellow out asthma)

  - take SABA according to asthma action plan.

  - if peak flow rate / symptoms do not return to green zone in 1 hour, make take more meds to call HCP.
• peak flow meter zones: red

  less than 50%

  - emergent action is needed.

  - take SABA (albuterol) or oral corticosteroid according to asthma action plan.

  - call doctor if still in red zone after 15 min.
• blood glucose diagnostic levels: fasting

  > 125 mg/dl
• blood glucose diagnostic levels: glucose tolerance test

  > 200 mg/dl
• blood glucose diagnostic levels: a1c

  > 6.5%
• hypoglycemia


  blood glucose levels < 70 mg/dl
• hypoglycemia: symptoms


  - hunger, lightheadedness, shakiness.

  - anxiety and irritability

  - pallor, cool skin

  - diaphoresis

  - irritability

  - normal or shallow respirations

  - tachycardia and palpitations

  - strange or unusual feelings

  - decreasing level of consciousness

  - change in emotional behavior.

  - slurred speech

  - headache and blurred vision

  - seizures leading to coma.
• hyperglycemia


  blood glucose > 200 mg/dl