Pediatrics HESI MBG

Pediatrics HESI Celiac Disease  Gluten free diet: NO RYE o Rice is allowed  Manifestations: o Delayed growth, weight loss, foul smelling stools  Profuse watery diarrhea and vomit  ROW: o (NO) RYE, OATS, WHEATS  Potatoes are okay Stages of development:  3-year-old: o Gross motor skills:  Jump, kick ball, walk up and down stairs o Can draw circles and turn pages of a book one at a time  2-3-year old: o Fine motor skill:  Learning to dress self o Can talk in 1 or 2 sentences  1-2-year-old: o Fine motor skill:  Scribbles on paper o Gross motor skill:  Push-pull toys o 18-month:  Can eat with a spoon o 1 y/o:  Develops separation anxiety; this will resolve with the development of language and vocabulary skills o 2 y/o:  Are capable of making a three word sentence  Preschool age: o Toys:  Dolls and toys  School age: o Toys:  Jigsaw with 100 pieces  Board games o If hospitalized: school involvement should be continued Hydrocephalus  TX: shunt placement o Notify physician if child has:  Low grade fever  Seizures

 Malaise or irritability o Constipation should be avoided as it can increase ICP Scoliosis:  Most commonly occurs in adolescent females o Occurs between 10-15 y/o’s  If left untreated it can cause respiratory difficulty  Mild scoliosis: 10-20 degrees o TX: exercises to improve posture and muscle tone  Moderate scoliosis: 20-40 degrees o TX: bracing  Teach how to apply brace and that it should be worn for 23 hours a day  Suggest clothing modifications  Severe scoliosis: >40 degrees o TX: surgery  Leg rolling Cystic fibrosis  SS: steatorrhea o Foul smelling, fatty stools  Chest physiotherapy: o Usually done 2-3 times per day o Cup hand and clap on specific area of chest wall for 3-5 minutes o Ask child to cough to mobilize secretions (do this before changing to a different position) o Should be done 2-3 after meals or prior to eating o Administer bronchodilators before therapy o Start with the upper lobes and move down  Diet: o ADEK vitamins o High cal, high protein diet o Pancreatic enzyme replacement therapy Hypothyroid:  Lifelong supplemental therapy will be needed  HR of 100 BPM= do not give med  Increase fruits and vegetables to avoid constipation  Manifestation: o Weight gain, constipation, delayed growth o Cool extremities o Early sign: cessation of growth in a child that had been normal Hyperthyroidism:  SS: assessment of physiological state is a priority on assessment o Nervousness, apprehension, hyperexcitability o Palpitations, weight loss, exophthalmos Strabismus:  TX: vision therapy in form of eye exercises o Patching unaffected eye for 1-2 hrs each day

 Hypokalemia may occur as K+ will shift to the cells o Manifestation:  Hyperglycemia: fruity breath odor and decrease LOC  Dehydrated state, hypotension  Management: o Teach the child the process of glucose testing if they are able to understand  Hypoglycemia: o Rapid releasing glucose (honey), followed by complex carb and protein such as bread or peanut butter cracker o Unconscious: cake frosting onto gums, or administer glucagon if the blood sugar does not go up Iron:  Place the medication in a dropper on the back of throat and follow with OJ  Teach patient that black tarry stools may occur Half strength juice can be used as an oral rehydration solution  This will be more effective than clear water because it will not be absorbed as well since it lacks electrolytes Cardiac cath:  Child should be kept on bed rest for 4-6 hours with the leg straight o Followed by limited activity for 24 hours  Encourage quiet play for the first 24 hours after the procedure CPR:  Assess the breathing and pulse after 5 cycles of 30 compressions, 2 breaths each Intussusception:  Telescoping of a portion of the bowel into another o Usually the colon  SS: o Severe abdominal pain which is intermittent  Colicky abdominal pain in a child between 3-17 months is the classic presentation  Tender, distended abdomen o Vomiting (NOT PROJECTILE) o Bright red blood and mucous stools (currant jelly) o Sausage shaped mass in upper right quadrant while lower right quadrant is empty  Passage of currant jelly stools means the condition is worsening o This is secondary to compression of the bowel vasculature  NG tube is used to decompress the intestine and should be assessed for patency  Barium enema: hydrostatic pressure from contract moves bowel back into place resolving the intussusception Jones criteria: Rheumatic Fever:  Polyarthritis  Chorea: involuntary movement of muscles  Carditis  Subcutaneous nodules  Lab findings:

o Elevated sed rate o C- reactive protein o Elevated antistreptolysin o titer Lumbar puncture:  Severe headache may indicate a spinal fluid leak and the physician should be notified  Bedrest is prescribed to help prevent onset of spinal headache Lyme disease:  Antibiotics should be taken (can take up to 4 weeks of tx) o Patient should be taught to avoid sun exposure while taking these  Can be contracted from tick of a deer Lice:  Shampoo should be applied to dry hair  Pediculicide shampoo is used immediately and repeated in 7-10 days  Wash bedding in hot water and dried in drier for 20 mins GER:  Hold the baby upright for 20-30 mins after every feeding  Thicken formula with cereal  Offer frequent, small volume feeds  Zantac: o SE: rash  Measure weight daily * Strep throat infection:  Treated with antibiotic  One side effect is acute post infectious glomerulonephritis o Occurs due to an immune reaction o Abrupt onset w/ flank pain and hematuria o Mild periorbital edema + edema of the feet acute post infectious glomerulonephritis  Child should be on fluid restriction until renal function returns to normal  Periorbital edema and expiratory crackles indicate fluid overload Von Willebrand disease:  Client will be deficient in clotting factor:  Inform dentist prior to routine care as bleeding will occur with dental procedures  Girls may have excessive menstrual bleeding Diaper dermatitis:  Severe: o parents should change the diaper every 2 hours during the day o Change the diaper once during the night o Do not wash the area w/ soap as it can exacerbate the dermatitis Seborrheic dermatitis:  SS: red patches and greasy scales  TX: baby’s hair should be washed daily with baby shampoo and patches should be removed o Selenium sulfide shampoo used IF the condition persists w/ regular washings Duchenne:  SS: toe walking, frequent falls, easy fatigue, waddling gait

o Palivizumab for high risk children (younger than 2) o Position child w/ head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm CHF:  Early signs: o Tachycardia, tachypnea, diaphoresois, resp distress, sudden weight gain o Cushing’s syndrome:  Weight gain, delayed growth Developmental dysplasia of hip (DDH)  Risk factors: breach position, oligohydramnios  SS: asymmetrical thigh or gluteal folds, limb length discrepancy, restricted motion  Assessment: Ortolani and Barlow test o Ortolani: elicits sensation of dislocated hip reducing o Barlow: detects unstable hip dislocating from acetabulum  TX: o Pavlik Harness:  Should be worn 24 hours a day  A bodysuit (or t-shirt and socks) should be worn under the harness Plagiocephaly:  Asymmetrical flattening of the back of the head due to sleeping on the back  Prevent it by: supervised tummy time, special exercises and corrective helmets Amblyopia: (LAZY EYE)  Using an eye pact or occlusion therapy for 2-6 hours a day Seizures:  Phenytoin: o Can cause gingival hyperplasia: instruct parents to do dental checkups o Adequate intake of Vit D and calcium is important Perforated appendix:  Parenteral antibiotics for 7-10 days to prevent spread of infection  Child should be NPO  Discharge usually occurs in 7 days; activity should be limited DTAP Vaccine:  5 series injection for children: 2 mo, 4mo, 6mo, 15-18 mo, and 4-6 years.  Contraindications: allergic reaction or fever of 101.5 or greate o Guillain barre, seizures  Low grade fever is common and should be treated with acetaminophen Sinus arrhythmia:  Heart rate is faster upon inspiration and slower w/ expiration Murmur:  Abnormal sound created by blood passing through a defective valve, great vessel or other heart structure Sickle cell anemia:  Vaso-occlusive crisis: o Do not palpate the child’s abdomen  may cause spleen rupture

o Promoting tissue oxygenation is a priority o Prophylactic antibiotics (penicillin) are indicated until the child turns 5 Growth hormone deficiency:  Child drops 2 percentage points or more in the growth scale  Growth hormone TX: o Adverse symptoms: polyuria and polydipsia Excessive diarrhea:  Causes loss of bicarbonate ions which can lead to acidity and metabolic acidosis  Breathing frequency increases (tachypnea) Vomiting:  Can lead to metabolic alkalosis Esophageal atresia w/ tracheoesophageal fistula  This is a surgical emergency  Three C’s: o Chocking, cyanosis, coughing  Preop: NG tube, IV Fluids, aspirate NG Tube q 5-10 mins o Infant is kept supine or prone w/ HOB elevated Glomerulonephritis:  Causes: streptococcal infection  Edema: mild, usually around eyes  BP: elevated  Urine: dark, cola colored  Blood: normal serum protein  Manifestation: dark, smoky, cola-colored urine o Elevated BUN + Creat o Mild-mod elevation in protein o HTN due to fluid vol overload Nephrotic syndrome:  Edema: severe, generalized  BP: normal  Urine: dark, frothy yellow with massive proteinuria  Blood: decreased serum protein  Manifestation: o Hypoalbuminemia, edema, proteinuria, weight gain o Elevated serum lipids, pallor, anorexia Cryptorchidism:  Condition in which testes fail to descend  Surgical correction may be necessary but sometimes it may resolve on its own o All vigorous activity should be restricted for 2 weeks after surgery  HCG may be given to aid in descent SIADH:  Carefully assess for changes in LOC  TX: o Loop diuretics (furosemide) o Fluid replacement after they are peeing with 3% NaCl