Pedia Notes
POISONING- common in toddlers. (falls- common to infant)
1. determine substance taken, assess LOC
2. unless poison is corrosive, caustic (strong alkali such as lye) or a hydrocarbon,
vomiting is the most effective way to remove poison.
• Give syrup 1 pecac to induce vomiting
1. 1 pecac – oral emetic
• 15 ml – adolescent, school age & pre school
• 10 ml to infant
1. UNIVERSAL ANTIDOTE- charcoal, milk of magnesia & burned toast
2. Never adm charcoal before 1 pecac
3. antidote for acetaminophen poisoning – acetylsysterine ( mucomyst)
4. caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit
prepare tracheostomy set
5. Gas- mineral oil will coat intestine
Lead poisoning
Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney
functioning
Accumulation of anemia = Encepalopathy
Sx:
1. beginning sx of lethargy
2. impulsiveness, learning difficulties
3. as lead increases, severe encepalopathy with seizure and permanent mental
retardation
Dx:
1. Blood smear
2. abd x ray
3. long bones
Mgt:
1. remove child from source
2. if > 20 ug/dL – need chelation therapy = binds with led & 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
Epispadias- urinary meatus located dorsal or above 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 of glands penis – due smegma
Mgt:
Circusicion
Hydroseal – fld filled scrotum
Tst of Dx:
Transillumination with use of flashlight - glowing sign
Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)
Renal Disorder Cause Sx Tx NSG CARE
NEPHROTIC infectious 1. Anasarca- Prednisone Focus of care:
gen edema monitor edema
SYNDROME 2. massive Diuretic
protenuria • weigh
3. microscopic daily
or no
hematuria
Diet:
4. serum
CHON
decreased Increase CHON
5. serum lipid
increased Increase K- OJ,
6. fatigue beef broth, banana
7. normal or Decrease Na
decreased
BP
AGN ( acute Autoimmune 1. (PPP) 1. anti HPN 1. weigh daily
Glomerulo primary drug
Nephritis) Grp A beta peripheral 2. monitor BP &
hemolytic periobital - neurologiuc status
3A’s; streptococcus edema hydralazine
2. moderate or apresoline 3. Diet: decrease
AGN, protenuria K, decrease Na
3. gross 2. iron
hematuria
autoimmune, ( smokey
urine)
Grp A 4. serum K
increased
5. fatigue
6. increase BP
Complication :
1. hypersensive
encephalopathy
2. anemia
BACK- check for flatness & symmetry
Open Neural Tube Defect- decreased Folic Acid intake
SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to fuse
Sx: dimpling of back , Abnormal tufts of hair
SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac
Types:
1. Meningocele – protrusion of CSF & Meninges
2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most
dangerous)
3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele
or myelomeningocele
Most common problem
• rupture of sac
• prone pos
• sterile wet dressing
Most common complication - infection
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. uneven hemline
2. bend forward- 1 hip higher
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. syndactyly – webbing of digits
2. polydactyly – extra digits
3. olidactyly – lack of digits
4. Amelia – total absence of digits
5. pocoamelia- absence of distal part of extremities
ErQ duchennes – paralysis- brachial plexus injury or brachial palsy
• birth injury caused by lateral & excessive traction during a breech injury
Sx:
1. unable to abduct arms from shoulders, rotate arm externally or supinate forearm
2. absence or asymetrical moro reflex
Mgt:
1. abduct arm from shoulders with elbow flex.
CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum
Types;
1. subluxated – most common type
2. dislocated
Sx:
1. shortening of affected leg
2. asymmetrical gluteal fold
3. limited movement – earliest sx
4. (+) ortolanis sign – abnormal clicking sound
5. when able to walk – child limps – late sx- trendelenburg sign
Goal of Mgt:
Facilitate abduction
Mgt.
1. triple diaper
2. carry baby astride
3. Frejka splint
4. Pavlik harness
5. Hip Spica Cast
TALIPES – "clubfoot"
a. Equinos – plantar flexion – horsefoot
b. Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior
leg
c. Varus- foot turns in
d. Valgus- foot turns out
Equino varus- most common
Assessment:
1. Straighten legs & flexing them at midline 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. Swing Through
2. Swing to
• no weight bearing are allowed into lower ext
1. Three point Gait
- wt bearing is allowed in 1 ext
2. Four point gait
3. Two point Gait
- wt bearing allowed in 2 lower ext
