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General
A. Respiratory infections (illustration )
1. Etiology: bacterial, viral; often influenced by age, season, preexisting disorder, living
conditions
2. Findings: increased respiratory and heart rate, fever, nausea/vomiting, nasal discharge
and blockage, mucus production, coughing, adventitious lung sounds
3. Nursing care goals:
a. child will not exhibit findings of respiratory distress, will be able to clear
secretions, and remain comfortable with a patent airway
b. child will not spread infection to others
c. child will ingest adequate fluids, and maintain hydration
4. Management:
a. medications: antibiotics, antipyretics
b. possible: anti-inflammatory, anti-mucolytics, bronchodilators, oxygen as
needed
c. chest physiotherapy
d. nutrition and fluids
B. Respiratory failure: inability to maintain adequate oxygenation
1. Predisposing factors
a. obstructive anomalies, aspiration
b. infections, tumors, anaphylaxis
c. restrictive conditions: respiratory distress, cystic fibrosis, pneumonia,
pneumothorax
d. paralytic conditions
2. Findings
a. restlessness, mood changes
b. changes in LOC
c. increasing rates of respiration and pulse
d. dyspnea
3. Management
a. frequent observation and physical exams, with pulse oximeter
b. correct hypoxemia, maintain ventilation and deliver oxygen
c. monitor for side effects and expected outcomes of therapy
C. Airway obstruction and basic life support
1. Cardiac arrest is usually due to prolonged hypoxemia secondary to inadequate
ventilation, oxygen or circulation
2. When following guidelines for pediatric life support, consider not just the child's age, but
his or her size. Individual anatomy and development will vary.
3. Airway clearance techniques
a. determine conscious versus unconscious child
b. for infants and toddlers: back blows and chest thrusts
c. for preschool and school-age: modified Heimlich maneuver ("astride")
J. Tonsillitis
1. Etiology: bacterial, viral in association with pharyngitis
2. Pathophysiology: infection and inflammation enlarge tonsils; as airway narrows, it
hinders swallowing and breathing
3. Findings
a. "kissing tonsils"
b. sore throat
c. halitosis
d. mouth breathing; snores at night
e. fever
4. Diagnostics: history, physical exam, throat culture
5. Management
a. supportive: antibiotics, fluids, rest, antipyretics, analgesics
b. surgery - tonsillectomy
6. Concern: teach parents that, post tonsillectomy for several days, child needs quiet
activity, monitoring for bleeding, antipyretics and analgesics (no aspirin).
7. Adenoidectomy may be done with tonsillectomy, if adenoiditis is present
K. Croup syndromes (including laryngitis, tracheitis, epiglottitis)
1. Definition: several airway-blocking infections, common in children (illustration )
a. signs of croup:
1. inspiratory stridor
2. harsh/brassy cough, barking cough
3. hoarse voice
4. respiratory distress
b. types, by primary area affected:
1. subglottal area: acute spasmodic croup, laryngitis,
laryngotracheobronchitis (LTB), tracheitis
2. supraglottal area: epiglottitis (illustration )
2. Etiology
a. usually viral
b. occasionally bacterial (tracheitis, epiglottitis)
c. younger children with "true croup" (spasmodic croup)
d. older children with tracheitis and epiglottitis
3. Pathophysiology: mucosa inflamed; edema narrows the airway
4. Findings
a. classic: "barky" harsh cough, stridor, hoarseness,fever, purulent secretions,
dyspnea if severe
b. bacterial: child looks "sicker"
c. epiglottitis manifests the four "D's"
1. drooling
2. dysphagia (difficulty swallowing)
3. dysphonia (hoarse voice)
4. distressed inspiratory efforts
D. Epilepsy
1. Definition: chronic seizure disorder with recurrent & unprovoked seizures.
2. Etiology: unknown. international classification: partial and generalized
a. partial: limited to a particular local area of the brain
b. generalized: involves both hemispheres of the brain
L. Head trauma
1. Etiology: force to the scalp, skull, meninges, or brain
2. Pathophysiology
a. directly related to force of impact and secondary forces
b. types: primary and secondary
c. cerebral function depends on oxygen, glucose and blood flow to brain; cerebral
edema and hypoxia can occur quickly
3. Findings: neurological status depends on ICP
4. Management
a. acute
i. control ICP: medications, ventilatory support, positioning, fluids
ii. surgical repair of fractures
b. long-term rehabilitation
5. Complications: hemorrhage, infection, cerebral edema and herniation through the
tentorium
a. epidural hemorrhage
b. subdural hemorrhage
2. The endocrine system
L. Three types of tissues
1. cells that send chemical message via hormones
2. target cells in end organ that receive chemical message
3. environment: medium through which chemical message travels from the site of synthesis
to area of cellular action
M. Endocrine function
1. endocrine + autonomic systems = neuroendocrine system
2. neuroendocrine system: synthesizes and releases chemical substances that then regulate
bodily function: messages are carried by nerve impulses in the nervous component and
by blood in the endocrine system. (illustration )
3. the two systems function synergistically. Impulses transmitted via the nervous system
stimulate the hypothalamus to secrete releasing or inhibiting factors
N. Hypopituitarism
1. Definition: diminished or deficient secretion of pituitary hormones
2. Etiology: tumors, hypoplasia, auto-immune, congenital, acquired, irradiation,
malnutrition, trauma
3. Pathophysiology: leads to gonadotropin deficiency
4. Findings
a. usually dependent on hormone involved and age of onset
b. absence or regression of secondary sex characteristics
c. example: slow growth, short stature, normal intelligence; delayed puberty
5. Management
a. depends on cause
b. hormone replacement therapy: growth hormone
O. "Precocious puberty"
1. Definition: manifestations of sexual development before age nine in boys or age eight in
girls
2. Etiology: brain lesions, inflammatory disorders, idiopathic
3. Pathophysiology
a. premature activation of hypothalamic-pituitary-gonadal axis
b. early increased release of LH and FSH
c. early acceleration of linear growth with early closure of growth plates
d. ultimate height less than if puberty had been normal
4. Findings
a. development of breasts in prepubertal females
b. early development of sexual hair
c. isolated menses
d. development of secondary sex characteristics
5. Management
a. directed toward specific cause
b. hypothalamic - pituitary origin: luteinizing hormone - releasing hormone
(LHRH) injections monthly
P. SIADH: syndrome of inappropriate antidiuretic hormone
1. Definition: hypersecretion of antidiuretic hormone or ADH (vasopressin)
2. Etiology: infections, head trauma, or brain tumors
3. Pathophysiology
a. kidneys reabsorb too much free water
b. decreased urine output, increased specific gravity (SG), and decreased serum
sodium
4. Findings
a. urine SG > 1.030
b. anorexia, nausea, weakness, stomach cramps
c. increased weight (edema)
d. decreased serum sodium
5. Management
a. restrict fluids to correct hyponatremia
b. correct underlying etiology
c. monitor I & O, electrolytes, neuro status
d. observe for signs of fluid overload
Q. Hypothyroidism (illustration )
1. Definition: deficiency of thyroid hormone (TH); common childhood endocrine disorder
2. Etiology
a. congenital or acquired deficiency in thyroid hormones
b. thyroid irradiation
3. Pathophysiology
a. absent or underdeveloped gland
b. decreased triiodothyronine (T3) or thyroxine (T4)
4. Findings: depend on extent of dysfunction and age of child at onset
a. lethargy, constipation, feeding problems
b. hypotonia, large tongue
c. dry skin, weight gain, puffy eyes, sparse hair
d. intolerance to cold
e. slowed growth, developmental delay and/or retardation if T4 low at birth and
thyroid replacement not started
f. if findings develop after two to three years, when brain has grown, no mental
retardation
5. Diagnostics:
a. history and physical
b. increased TSH
c. decreased serum T3 and T4
d. anemia
e. decreased BMR (basal metabolic rate)
f. increased cholesterol and triglycerides
g. hypoglycemia
6. Management:
a. lifelong hormone replacement (levothyroxine)
b. rest
c. protect client from cold
R. Hyperthyroid: "Graves' disease"
1. Definition: hypersecretion of thyroid hormones, causing increased BMR or hyperactivity
of thyroid gland
2. Etiology: auto-immune response to TSH (thyroid-stimulating hormone) receptors;
idiopathic; familial
3. Findings
a. increases in: BMR, appetite, nervousness, heart rate
b. gradual weight loss despite voracious appetite
c. lowered tolerance to heat
d. exophthalmos (eyes bulge)
e. myopathy
f. personality changes, poor school performance, mood instability
g. linear growth and bone age accelerated
h. insomnia
i. increased blood pressure
4. Diagnostics
a. history and physical
b. palpable thyroid enlargement (goiter)
c. elevated serum T3 and T4 levels
d. elevated radioactive iodine uptake
e. presence of thyroid antibodies
f. decreased TSH levels
5. Management
a. antithyroid therapy
b. surgery (subtotal thyroidectomy)
6. Concern: thyrotoxicosis or "thyroid storm" from sudden release of hormone:
a. can be life threatening
b. findings
i. acute onset of severe irritability
ii. vomiting
iii. diarrhea
iv. hyperthermia
v. hypertension
vi. tachycardia
vii. prostration
c. treat with: cooling blanket
d. propranolol (inderol), potassium iodine (thyro-block)
e. antithyroid drugs
S. Diabetes mellitus - type 1
1. Definition: deficiency of hormone insulin
2. Etiology: genetic, auto-immune response; usually with viral trigger
3. Pathophysiology:
a. trigger directs islet cell antibodies against cell surfaces
b. antibodies destroy the insulin-secreting Beta cells -
c. less insulin means glucose is blocked from intracellular space
d. when glucose level exceeds kidney's threshold (about 180 mg/dl), result is
hyperglycemia
e. kidney then "spills" glucose into urine, producing osmotic diuresis
f. starved for glucose, body instead breaks down fats, producing ketones
4. Findings
a. hyperglycemia:
i. the three "polys" of diabetes: polydipsia, polyuria, polyphagia
ii. additional findings: fatigue, hunger, weight loss, enuresis
T. Management
1. medications: insulin (regular, NPH); glucagon (hypoglycemic emergency only)
2. other: diet (carbohydrate counting, age-appropriate), activity levels
3. blood glucose monitoring
U. Concerns: "honeymoon period" and insulin regulation, compliance, sick day management, ketones
V. Complications:
1. DKA (diabetic ketoacidosis) or extreme hyperglycemia (blood sugar > 350 mg/dl)
a. etiology: not enough or no insulin
b. findings
i. fruity breath, decreased level of consciousness
ii. nausea/vomiting, abdominal pain
iii. 10 percent dehydration
iv. increased urine output
v. Kussmaul's respirations
2.management
a. fluids; control the level of serum osmolality
b. regular insulin (IV drips and then subcutaneous)
c. frequent monitoring of blood glucose
d. frequent monitoring of electrolytes; neuro checks
W. Hypoglycemia:
1. etiology: most common occurrence of insulin therapy and bursts of physical activity,
without additional food or with missed meals.
2. findings
a. fatigue
b. nervousness
c. pallor
d. sweating
e. palpitations
f. funger
g. loss of coordination
h. seizures
i. coma
3. management
a. 10 to 15 mg of simple carbohydrate
b. followed by complex carbohydrate such as slice of bread or crackers
c. occasionally glucagon is prescribed
X. Dehydration (illustration )
1. Occurs when total output of fluid exceeds total intake
2. Compared to adults, children
a. are less able to concentrate urine
b. as infants, they have immature kidney and immune-regulatory systems
c. have a higher metabolic rate
d. have more body surface in relation to body mass
e. because more of body weight is fluid, children need more fluid and lose more
urine per Kg of body weight
3. Types of dehydration (serum sodium determines type)
a. isotonic: occurs in conditions in which electrolyte and water deficits occur in
balanced proportions
b. hypotonic: occurs in conditions in which electrolyte deficit exceeds the water
deficit
c. hypertonic: occurs in conditions in which water loss exceeds electrolyte loss
4. Pathophysiology
a. decreased fluids and electrolytes from ECF (extracellular fluid)
b. leads to eventual loss of fluid from ICF (intracellular fluid)
c. cellular dysfunction, shock
5. Complications
a. fluid losses: monitor urine output and specific gravity
b. electrolyte losses: monitor sodium, potassium, chloride, calcium
c. acid-base disturbance: metabolic acidosis
6. Findings of dehydration
7. Management of pediatric dehydration
a. monitor the 4 first signs and 3 second signs of dehydration
b. administer fluids (oral, NG, IV)
4 First Signs:
Lower weight
Altered electrolytes
And dehydration quickly affects three systems: cardiac, respiratory and neuro. So monitor for 3 second signs:
B. Edema
1. Definition: excess fluid swells interstitial tissues
2. Etiology
a. defect in homeostasis
b. renal disease; liver disease; nephrotic syndrome
c. starvation
d. burns
e. decreased colloidal oncotic (swelling) pressure
3. Pathophysiology: increased venous pressure - increased capillary permeability, decreased
plasma proteins; contributing to the edema may be obstructed lymph flow or sodium
retention
a. findings: pitting edema, increased heart rate
i. can be localized or generalized swelling
ii. pitting edema - more common with localized
iii. increased heart rate
b. management - treat underlying cause
C. Vomiting
1. Definition: forceful ejection of gastric contents through the mouth
2. Etiology: infection, obstruction, allergy, psychological causes, motion sickness,
neurologic lesions
3. Pathophysiology
a. cause stimulates emetic center of brain
b. mechanism of vomiting involves antonomic nervous system:
i. salivation, sweating
ii. pallor, increased heart rate
iii. contraction of stomach antrum & duodenum
c. types of vomiting: regurgitation, forceful, projectile
4. Management
a. detect and treat the underlying cause
b. prevent dehydration, electrolyte loss and acid-base disturbance
c. provide anti-emetic medications
Upper GI Disorders
Lower GI Disorders
G. Constipation
1. Definition: infrequent passage of firm or hard stools
2. Etiology
a. triggered by diet, medication, dehydration, emotions, or neurogenic
b. structural disorders (Hirschsprung's disease) (illustration )
c. systemic disorders (hypothyroid)
3. Findings
a. abdominal pain and cramping
b. palpable, movable fecal mass
c. malaise, anorexia, nausea
4. Diagnostics: abdominal x-rays, rectal exam, palpation & percussion
5. Management
a. prevention (higher fiber diet, fluids, exercise, regular toileting habits)
b. medications (stool softeners, enemas, laxatives)
H. Diarrhea
1. Etiologies: intestinal infections (bacterial, viral, parasitic); food intolerance; overfeeding;
medications; stress; malabsorption; colon disease
2. Pathophysiology:
a. causative factor - irritates mucosal lining
b. damages microvilli, increases secretion and decreases absorption
c. abnormal intestinal water and electrolyte transport
d. increased intestinal water permeability and dehydration in younger children.
e. possible metabolic acidosis
f. can be acute or chronic
3. Findings
a. dehydration (mild, moderate, severe)
b. increased stooling
c. increased heart & respiratory rate
d. dry hot skin
e. dry mucous membranes
f. decreased urine, decreased tearing in infants
4. Management
a. goals: restore fluid and electrolyte balance and return bowel to normal
functioning
b. fluids: oral rehydration or parenteral rehydration
c. medications: antibiotics, antidiarrheals
I. Celiac disease = gluten-sensitive enteropathy (GSE) = celiac sprue
1. Etiology: absorption problem with genetic predisposition, possibly immune abnormality
2. Pathophysiology
a. inability to digest gliadin (byproduct of gluten); permanent intolerance of
gluten.
b. increasing levels of glutamine in the intestine, toxic to mucosal cells
c. atrophy of villi and decreased absorptive surface (illustration )
d. malabsorption of fats, carbohydrates, vitamins and electrolytes
e. gluten is found in the grain of wheat, barley, rye, and oats
3. Findings (most often appears between ages of one and five years)
a. diarrhea (stools: pale and watery, offensive odor)
b. abdominal distention
c. failure to thrive
d. vomiting
e. muscle wasting
f. steatorrhea
g. anorexia
h. abdominal pain
4. Diagnostics:
a. history (symptoms occur three to six months after infant begins eating grains)
b. serum anti-gliadin antibody (AGA)
c. jejunal biopsy
5. Management
a. diet: gluten-free with vitamin supplements
b. crisis: IV fluids, steroids
J. Intussusception: one of the most frequent causes of intestinal obstruction between ages of three
months and five years
1. Etiology: unknown - possible hypertrophic response to virus
2. Pathophysiology
a. trigger - bowel "telescopes" inside itself causing obstruction
b. pressure on bowel leads to bleeding
c. possible mesenteric ischemia
d. edema and possible bowel necrosis, perforation, peritonitis, or shock
e. most common site: ileocecal valve
3. Findings
a. sudden acute abdominal pain
b. bilious vomiting
c. currant jelly stools
d. sausage-shaped abdominal mass
e. lethargy
4. Management
a. priority goal: restore bowel to normal position and function quickly, and
stabilize fluids
b. non-surgical hydrostatic reduction (barium, water-soluble contrast, air pressure)
c. if not successful, surgery
5. Concerns
a. fluid status
b. pain
c. ischemia
d. monitor for barium excretion
K. Hirschsprung's disease
1. Definition / etiology: congenital aganglionic megacolon
2. Pathophysiology
a. absence of autonomic (parasympathetic) ganglion cells, usually at rectum and
part of large intestine
b. intestine does not propel stool
c. stool builds up; colon dilates, constipation results with risk of intestinal rupture
3. Findings
a. newborn: failure to pass stool or merconium in first 24 hours of life, reluctance
to ingest fluids, bile-stained vomitus, distended abdomen, "ribbon-like" stools -
flat, wide, and wavy
b. later: failure to thrive, distended abdomen, constipation, signs of fecal
impaction
4. Diagnostics: history and physical exam, radiographic barium enema, rectal biopsy,
anorectal manometry
5. Management
a. surgical correction: remove aganglionic portion
b. temporary ostomy for three to six months, then reanastomose
Associate "Hir"schsprung's with a girl, "her," who wears "ribbons" in her hair - to recall that "ribbon-like" stools are a
classic finding.
Genitalia Problems
J. Cryptorchidism
1. Definition: failure of one or both testes to descend normally through inguinal canal into
scrotum
2. Etiology/pathophysiology
a. abnormal testes, or
b. decrease in the hormonal stimulation necessary for descent
3. Management: wait up to one year for descent, medications (HCG) to assist in descent, or
surgery (orchiopexy).
K. Hypospadius
1. Definition: urethral meatus below normal placement on glans penis or anywhere along
ventral (underside) surface of penile shaft
2. Etiology: idiopathic - related to genetics, environment, hormonal
3. Pathophysiology: incomplete development in utero
4. Management: surgical correction (with urinary catheter and stents post-op), post-op
pressure dressing must not be removed by anyone other than the health care provider
5. Concerns: stenosis, chordee, body image/self esteem
L. Clubfoot (illustration )
1. Etiology: congenital malformation of one or both feet
2. Findings: plantar-flexed foot/feet, with inverted heel and adducted forefoot.
3. Management: serial manipulation and casting after birth; possible surgery
M. Genu varum (bowleg) and genus valgum (knock knee)
1. Etiology: congenital
2. Findings
a. bowlegs (genu varum) common in infants and toddlers
b. knock knees common in preschool age and older.
3. Management: most resolve spontaneously - pathologic forms may require night splints,
manual manipulation, casting or surgery.
N. Hip dysplasia
1. Definition: developmental dysplasia of the hips (DDH), or dislocation
2. Etiology: congenital, pre- and post-natal positioning
3. Pathophysiology: head of femur is improperly seated in acetabulum in hip (illustration
)
4. Clinical manifestation
a. limited abduction
b. short femur on affected side (Galeazzi's sign)
c. asymmetry of gluteal skin folds,
d. waddling gait (bilateral dislocations)
e. for children already walking, increased laxity
5. Diagnostics
a. physical exam/screening at birth
b. check for Ortolani maneuver and Barlow's test
c. radiographic studies
6. Management: Pavlik harness, spica cast, traction, surgery, Bryant's traction
7. Concerns: compliance, skin integrity, avascular necrosis from improper positioning of
harness
O. Scoliosis (illustration )
1. Definition: lateral curvature of the of spine and rotation of vertebral bones
2. Etiology
a. idiopathic
b. associated with neuromuscular disorders or trauma (paralytic)
c. congenital
d. most commonly diagnosed during adolescent growth spurt
3. Pathophysiology
a. dependent on type (idiopathic, congenital, paralytic)
b. curved spine deforms rib, body develops compensatory curve to maintain
posture and balance.
4. Findings
a. visible curve (either C or S shaped curves)
b. "rib hump," or asymmetric rib cage
c. legs are different lengths
d. waist angles uneven
5. Diagnostics: screening, radiographic studies
6. Management:
a. initially, exercise and bracing to hold curve (Milwaukee brace - rarely used,
Boston brace - plastic shell, or TLSO - custom-molded jacket)
b. if curve progresses, surgery
7. Concerns
a. body image/self esteem, pain and discomfort
b. compliance with exercises and bracing; skin integrity, airway clearance
P. Osgood-Schlatter disease
1. Etiology: idiopathic - possibly due to repetitive stress from sports related activity plus
overuse of immature muscles and tendons. Usually self-limiting.
2. Findings
a. knee pain/tenderness
b. edema of tibial tubercle
c. exacerbated by running and jumping
3. Diagnostics: physical exam, history, radiographic studies
4. Management
a. avoid certain activities
b. use elastic bandage on affected knee
c. rest, ice, NSAID's
Q. Legg-Calve-Perthes disease: osteochondritis
1. Definition: aseptic necrosis of femoral head
2. Etiology: unknown - possible growth disorder
3. Pathophysiology
a. disturbance in blood supply
b. ischemic aseptic necrosis of femoral head, usually self-limiting (illustration
)
4. Findings
a. insidious onset
b. intermittent painful limp on one side
c. increased pain after extended period of activity
d. decreased range of motion
5. Diagnostics: history, radiographic studies, bone scan, MRI
6. Management
a. bed rest
b. non weight-bearing range of motion
c. containment devices such as braces, casts, traction
d. possible surgery
7. Concerns: permanent deformity, decreased activity, skin integrity
C. Hodgkin's disease
1. Definition: malignancy of the lymph nodes
2. Pathophysiology
a. neoplasm of lymphatic system
b. characterized by giant, multinucleated cells (Reed-Sternberg cells) (illustration
)
3. Findings
a. characterized by painless enlargement of lymph nodes, particularly in
supraclavicular area
b. anorexia, weight loss, malaise; painless; night sweats
c. fever
4. Diagnostics: lymph node biopsy
5. Management
a. chemotherapy and radiation
b. treatment based on staging of disease (stages I-IV)
D. Non-Hodgkin's lymphoma (illustration )
1. Pathophysiology:
a. proliferation of either B- or T- lymphocytes
b. staging I-IV
2. Findings
a. painless, enlarged lymph nodes in cervical or axillary region
b. bone marrow and/or mediastinal involvement
3. Therapeutic management: combination of chemotherapy and radiation
E. Brain tumors: medulloblastoma, astrocytoma, ependymoma, glioblastoma
1. Pathophysiology
a. solid tumors of the nervous system
b. most common solid tumor in children
2. Findings
a. headache, vomiting, increased intracranial pressure, ataxia
b. visual changes, seizures, bulging fontanel in infants, behavioral changes
3. Therapeutic management
a. surgical debulking
b. radiation
c. chemotherapy
F. Neuroblastoma
1. Pathophysiology
a. solid tumor found only in children under four years old
b. primary sites are adrenal gland or retroperitoneal because it starts from
embryonic neural crest cells of the adrenal gland and sympathetic nervous
system.
c. often has metastasized by the time it is diagnosed
2. Findings
a. firm, nontender mass in the abdomen that crosses the midline
b. distant metastasis may cause periorbital edema (swelling around eyes)
3. Therapeutic management
a. treatment is dependent on staging criteria
b. surgical debulking, chemotherapy, radiation
Other Tumors
G. Osteosarcoma (illustration )
1. Pathophysiology
a. originates from bone-forming mesenchyme
b. creating malignant osteoid tissue
c. most common in distal femur
d. metastasis to lung
2. Findings: localized pain, limp, decrease in physical activity
3. Therapeutic management: surgical approach
a. limb salvage with prosthetic bone replacement; or amputation
b. plus combination chemotherapy before and/or after surgery
H. Wilm's tumor
1. Pathophysiology
a. solid tumor of the renal system
b. possibly genetic in some cases
c. most often affecting the left kidney
d. tumor encapsulated for extended period
e. is staged I-V at time of resection
2. Findings
a. abdominal mass
b. characteristically firm, non-tender
c. confined to one side
3. Therapeutic management
a. surgical resection
b. combination chemotherapy, irradiation
c. highest survival rate of all pediatric malignancies
I. Retinoblastoma
1. Pathophysiology: congenital malignant tumor of the retina, with evidence of genetic
inheritance in certain cases
2. Findings: cat's eye reflex (whitish glow in pupil); strabismus; red, painful eye
3. Therapeutic management
a. radiation therapy, enucleation, chemotherapy
b. treatment depends on stage of tumor, stages I-V
Viral Infections
• Viruses are parasites that cannot reproduce or meet own metabolic needs.
• Skin cells react to virus with swelling, "vesiculation," or proliferation, sometimes warts.
• Most viruses are associated with rashes (characteristic of each disorder, such as chicken pox, rubella, roseola)
Pediatric Neurology
Pediatric Cardiovascular
• In a cardiac history, include poor weight gain, chronic respiratory infection, activity intolerance, and fatigue
during eating.
• Oxygen is a drug that requires a prescription and frequent monitoring.
• Cardiac catheterization serves many purposes: diagnostic, interventional and electrophysiologic. It also
monitors cardiac oxygen saturation, pressure changes and anatomic defects.
• CHF signs usually show either left or right sided heart disorders. These signs may include increased heart
rate, adventitious lung sounds, cyanosis, edema, hepatosplenomegaly, and distended neck veins.
• Acquired cardiac disorders include bacterial endocarditis, acute rheumatic fever, hyperlipidemia, Kawasaki
disease, and cardiomyopathy.
• Electrodes for cardiac monitoring are usually color coded: white (upper right), black (upper left), green
(lower right), and red (lower left).
• In cyanotic heart disorders, major concerns are polycythemia or increased hemoglobin and hematocrit. These
can lead to thrombus.
Pediatric Respiratory
• The principal functions of the respiratory tract are to allow air movement (ventilation) and exchange
(diffusion) of oxygen and carbon dioxide.
• Children's airways are smaller, more flexible and shorter than adult's and are therefore more prone to
obstruction than adults.
• Stridor usually indicates an upper airway concern, while wheezing indicates a lower airway disorder.
• Conditions that increase or decrease compliance and/or resistance will make breathing harder. Signs of
increased breathing work are tachypnea, retractions, abnormal positioning, shortness of breath and fatigue.
• Respiratory rate is an important indicator of respiratory status.
• Central cyanosis in a newborn usually means severe hypoxia and possible cardiac etiology.
• Acrocyanosis is a common finding in a newborn.
• Asthma is not a disease but an inflammatory disorder.
• Asthma is not wheezy bronchitis.
• The incidence and severity of respiratory tract infections and disorders is related to the child's age, size,
natural defenses, underlying disorder and agent involved.
• After a tonsillectomy child may bleed for up to several weeks.
• Epiglottitis, acute tracheitis and status asthmaticus are acute medical emergencies.
• The best way to stop the spread of RSV is meticulous hand washing. RSV is transmitted by direct contact
with the fomite.
Pediatric Endocrine
• The body secretes hormones at various times during the day (influences of diurnal and circadian rhythm).
• Normal hormone levels are related to age and stage of puberty.
• The pituitary gland stimulates target organs to produce specific hormones; when sufficient, these in return
signal pituitary to stop stimulation (negative feedback loop).
• Untreated infant hypothyroidism will lead to mental retardation.
• Associated terms for hypopituitary function include: short stature, constitutional delay, dwarfism.
• A major concern of precocious puberty is rapid bone growth, which can result in early fusion and short
stature.
• Children with SIADH develop an expanded circulatory volume but not edema.
• Because oral potassium tastes very bitter, mix it with a little strongly flavored fruit juice.
• For a child with an endocrine disorder, never discontinue medication abruptly.
• The vast majority of children with new-onset diabetes mellitus type 1 (IDDM) will experience a
"honeymoon" period when their bodies secrete insulin and their need for exogenous insulin decreases.
• Blood glucose monitoring by finger-stick reflects glucose currently and for last several hours; glycosylated
hemoglobin levels indicate long-term compliance and true diabetic status.
• Never freeze, heat or vigorously shake insulin.
• When insulin is absent, the body cannot properly metabolize fats, proteins and carbohydrates.
• The focus of diabetic management is the inter-relationship of diet, activity and insulin administration.
Pediatric Gastrointestinal
• Infants and children have a much smaller stomach capacity than adults.
• Peristaltic waves may reverse occasionally during infancy; gastric esophageal reflux is very common in
infants.
• Secretory cells don't reach adult levels until two to three years of age.
• The GI tract has both intake (fluid, minerals, vitamins, etc.) and output functions.
• Whenever a newborn coughs, chokes and turns blue with feeding, suspect tracheoesophageal fistula.
• Any newborn failing to pass meconium stool within the first 24 hours of life and who is prone to constipation
or decreased frequency of stooling in the first month of life, should be evaluated for Hirschsprung's Disease.
• The treatment of metabolic acid-base disturbance is oriented toward correcting the underlying problem.
• Dehydration can lead to shock.
• Dehydrated infants and children face greater morbidity risk than adults because children differ in body
composition and metabolic rate, and their fluid-regulation systems have not matured.
• Potassium should only be added to IV fluids when the urine output is sufficient.
• One Gm of diaper weight = one cc of urine.
• When assessing diarrhea or constipation, remember the acronym ACCT: amount, color, consistency, and time
(duration).
• Bilious vomiting indicates source below the ampulla of Vater.
Pediatric Genitourinary
• The kidney's function is to maintain, in equilibrium, the composition and volume of body fluids.
• Kidney function in an infant is nearly that of an adult by 12 months of age.
• Children with urine output less than one ml/Kg/hour should be closely monitored for possible renal failure.
• Acute renal failure should be suspected in a child with decreased urine output, edema and/or lethargy, and
who is dehydrated, recovering from surgery or in shock.
• In managing HUS, the goals are to control hematologic manifestations and any renal complications.
• UTI management aims to eliminate the underlying cause, detect and correct abnormalities, and prevent
recurrences.
• The effects of hypokalemia or hyperkalemia can be devastating.
• UTIs are extremely common in young children, girls more than boys.
• In a child with ambiguous genitalia, the criterion for choice of gender and rearing is not genetic sex, but the
infant's anatomy.
Pediatric Musculoskeletal
• Since many musculoskeletal disorders begin with trauma, it is important to assess ABC (airway, breathing
and circulation) first.
• Open fractures increase the risk of infection.
• Immobilization has multi-system effects.
• For a child with a fracture, it is important to assess the five P's of ischemia:
1. Pain and point of tenderness
2. Pulse - distal to the facture
3. Pallor
4. Paresthesia
5. Paralysis
• Children with structural defects/disorders require regular follow-up evaluation until they reach skeletal
maturity.
• Children in casts or traction need to be monitored for alterations in skin integrity routinely.
• Children under one year of age generally do not experience fractures.
• Because children's soft tissues are so resilient, dislocation and sprains are less common.
Pediatric Temperature-Related
• The extent of a burn injury is expressed as percentage of total body surface area (TBSA)
• The larger the percentage of TBSA that is burned, the greater the risk for burn shock.
• In managing alterations in skin integrity, it is necessary to individualize the type of treatment and medications
to the particular causative agent.
• If you wouldn't put it into an eye, don't put it into a wound.
• Wounds heal by the process of moist wound healing and occlusion.
• Dry wounds do not heal.
• Wound debridement promotes healing and prevents infection.
• Immediate care for a major burn is ABC: airway establishment and patency, breathing and absence of
respiratory distress, and circulation with fluid initiation.
• Potassium should not be administered during the initial oliguric phase of a burn injury, but should be added
when diuresis occurs.
Pediatric Hematology
• For a child with altered platelet function or bleeding disorder, do not administer acetylsalicylic acid (aspirin,
ASA) or take rectal temperatures. Perform invasive procedures very cautiously.
• Children with low WBC may not exhibit common findings of infection such as purulent drainage. In a febrile
client with granulocytopenia, give antibiotics immediately because this child risks rapid, overwhelming
sepsis.
• Morphine is the medication (or opioid) of choice for pain in children with sickle cell disease.
Pediatric Oncology
• Findings of pediatric malignancies vary according to the child's age, location and type of tumor, and extent of
disease
• Cure rate is improving for most types of pediatric malignancies; however the late effects of treatment are of
increasing concern and incidence.
• Children typically have longer treatment plans than adults due to their increased metabolic rate and rate of
cell turnover.
• Leukemia affects not only the blood, but can metastasize to major organ systems (extramedullary disease),
including the central nervous system.
• Nursing care includes monitoring the child for the development of acute complications of treatment including
fever, bleeding, and anemia.
• Pediatric oncologic emergencies include: acute tumor lysis syndrome, superior vena cava syndrome, septic
shock.
anasarca
anergy
apocrine glands
Arnold-Chiari deformity
automaticity
azotemia
bactericidal
bacteriostatic
chordee
chronotropic
compartment syndrome
craniosynostosis
crepitation
cretinism
decerebrate posturing
decorticate posture
eccrine sweat glands
eschar
euthyroid
graft-versus-host reaction (GVHR)
hemostasis
Hering reflex
histamine
involucre
jaundice
McBurney's point
Meckel diverticulum
meconium
melena
microcephaly
mucokinesis
mucositis
neuroleptic malignant syndrome (NMS)
neutropenia
oncogenes
perfusion
phimosis
polydactyly
pulse oximeter
reticulocyte
sequestrum
surfactant
ultrafiltration
urethritis
vesicant
Pediatrics