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Common Problems Ages 1-18 Years

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Title: CHILD WITH A PHYSICAL DISORDER Author: Nelson Last modified by: leslie Lehmkuhl Created Date: 5/19/2005 7:02:07 PM Document presentation format – PowerPoint PPT presentation

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Title: Common Problems Ages 1-18 Years


1
Common Problems Ages 1-18 Years
White 2nd ed Christensen 5th ed
Leslie Lehmkuhl, RN 2008
2
Terms
  • Acanthois nigricans
  • Comedome
  • Encopesis
  • Epistaxis
  • Gowers sign
  • Rhinorrhea

3
Upper Respiratory Infections (viral or
bacterial) See Table 57-1
ii
  • Nasopharyngitis (common cold) is viral
  • 6-9 colds per year
  • Tx symptoms (e.g. rhinorrhea, congestion,
    sneezing, fever, muscle aches) and usually self
    resolves in 3 days
  • Pharyngitis viral or bacterial
  • Most common in 4-6 yo
  • Tx symptoms (e.g. sore throat, inflammation, HA)
    and if caused by streptococcal infection teach
    parents to finish all ATBs.
  • Note enlarged lymph nodes, tender cervical lymph
    nodes.
  • Influenza viral
  • Treat symptoms (e.g. chills, fever, mylagia,
    cough, congestion, HA
  • Highest among school age children.
  • With all three enc. rest, use non-ASA
    antipyretic/analgesics, PO decongestants, nasal
    saline gtts, warm salt water gargle, humidifier,
    fluids, clear or bland liquids, tea and honey.

4
Allergic Rhinitis
0
  • Commonly called "hay fever,"
  • Irritation of the nose where the inside of the
    nose becomes inflamed after being exposed to an
    allergic trigger.
  • It often is associated with asthma and sinusitis.
  • Familial predisposition
  • Etiology dust, fomites e.g. mop head, feathers,
    animal dander, spores
  • Manifestations itchy nose, mouth breathing, dark
    circles under the eyes from congestion, allergic
    salute (transverse crease from pushing nose
    upward and backward in attempt to relieve
    itching).

5
Allergic Rhinitis (continued)
  • Management allergy skin testing, CBC with
    elevated eosinophil count
  • Immunotherapy includes allergy shots
  • Antihistamines, decongestants
  • Avoid wool and down blankets, humidifier in home,
    keep pets outside if possible

allergic salute
6
Tonsils
  • Tonsil glands are located in the back of the
    throat. They contain immune cells which fight
    infection.
  • Tonsils progressively enlarge at 2-10 years old
    and is considered normal.
  • By pre-adolescence they reduce in size.

7
Inflamed Tonsils
  • Tonsillectomy is advisable when tonsillitis
    attacks are so frequent (5 or more a yr) or
    severe that they affect a child's general health
    or interfere with school, hearing, or breathing.
    However, tonsillectomies are thought to be done
    more often than necessary, so a second opinion
    should be obtained when there is any doubt.

8
Tonsillectomy
  • Under general anesthesia, the ear-nose-throat
    (ENT) surgeon holds the mouth open and pulls the
    tongue forward to reveal the tonsils. The tonsils
    are pulled away from the back of the throat and
    then removed by being cut away. Bleeding is
    controlled, and often the cut heals naturally
    without stitches.

9
Tonsillits
  • Inflammation of palatine tonsils in throat
    resulting from pharyngitis.
  • Etiolgy viral or bacterial
  • Note 2-10 years of age tonsil are normally
    enlarged and reduce in size during pre
    adolescence.
  • Manifestations sore throat, cough, vomiting,
    muscle ache, difficulty swallowing, tonsils
    enlarged and bright red, mouth breathing, if
    adenoids enlarged May have sleep apnea, hearing
    problems

10
Tonsillitis
  • Tests CBC, CS of throat
  • Streptococcus is cause of 15 of pharygitis for
    children under 3 years
  • Peak age is 4-7 years
  • Spread is by droplets
  • Antibiotics for management
  • Surgery for recurrent infection
  • Post surgery monitor for frequent swallowing,
    elevated pulse rate, restlessness not related to
    pain
  • No red liquids, popsicles, straws, carbonated
    drinks, citrus, very hot or very cold fluids
  • Often vomit from anesthesia, ice collar
  • Soft diet when able to swallow

11
Tonsillitis
  • Bleeding most common
  • Within 24 hours of surgery
  • 7-10 days post surgery when the tissue sloughs
    off from the scar site
  • Watch for restlessness, anxiety, frequent
    swallowing and rapid pulse.
  • Call if temp 101 or above, earache, bleeding,
    avoid crowds for 2 weeks

12
Asthma
13
Bronchial asthma
  • Leading cause of absenteeism school and most
    common admitting diagnosis.
  • More common in boys until puberty
  • S/S dry hacking cough or productive, wheezing
    and difficulty breathing.
  • Reactive airway dz that causes narrowing or
    obstruction of the airway.
  • Highest incidence in first year of life
  • Affects 9 million children under 18 years
  • Affects 10 of all school age children

14
Asthma
  • Etiology history of allergies in family, smoke,
    stress, exercise, trees, peanutsdo not have to
    have allergies to have asthma
  • Assess triggers to prevent future episodes and
    cause no further damage.
  • Reversible airway obstruction
  • Tests pulmonary function, ABG,CBC,CXR
  • Management bronchodialators-albuterol,
    theophylline (narrow therapeutic range, watch for
    irritability, restless, insomnia, HA, V, D)
  • Cromolyn sodium-nonsteroid anti-inflammatory-may
    prevent asthma.
  • Prednisone a corticosteriods

15
Asthma
  • Children's airways are narrower than those of
    adults. This means that triggers that may cause
    only a slight problem in an adult can create more
    serious problems in children. In children, an
    asthma attack can appear suddenly with severe
    symptoms. For this reason, it is important that
    asthma be diagnosed and treated correctly. Some
    children may need to take medicine every day,
    even when they do not have symptoms.

16
Foreign Body Aspiration
  • Manifestations sudden violent spasmodic
    coughing, vomiting, gagging, wheezing, may have
    brief episode of apnea, cyanosis, resp distress.
  • Management laryngoscopy, bronchoscopy
  • Cool mist for 24-48 hours, bronchodilators,
    corticosteroids
  • Inhaling any foreign object into respiratory
    tract.
  • At risk when playing, running, laughing
  • Most frequent age 6 months to 4 years
  • Etiology popcorn, peanuts, dry beans, grapes,
    coins, toys, balloons, earrings, hot dog

17
Rheumatic fever
18
Rheumatic Fever
  • Multi-system (e.g. heart, joints, lungs, brain)
    autoimmune condition
  • From an untreated group B hemolytic
    streptococcus infection (e,g. strp throat,
    scarlet fever).

19
Rheumatic fever
  • In connective tissue, heart, joints, brain..
  • Manifestations high fever, headache, chills,
    acute
  • Tonsillitis, red strawberry tongue by day 4, red
    painless rash, warm erythematous joints,
    inflammation of endocardium, valves, myocardium,
    small nontender lesions on tendon sheaths of
    joints, murmur

20
Rheumatic Fever
  • Minor S/S
  • Fever
  • Listlessness
  • Anorexia
  • Pallor
  • Wt loss
  • Muscle
  • Joint or abd pain
  • Major S/S
  • Polyarthritis
  • Carditis
  • Erythema marginatum (red skin lesions)
  • Subcutaneous nodules
  • Elevated ASO titer

21

22
Rheumatic Fever
Subcutaneous skin nodules
23
Rheumatic Fever
Skin rash (erythema marginatum)
24
Rheumatic Fever
25
Rheumatic Fever
  • Because this disease has different forms, there
    is no specific test that can firmly diagnose it.
    Your doctor will perform a careful exam, which
    includes checking your heart sounds, skin, and
    joints.
  • Your doctor may also do an electrocardiogram
    while testing your heart.
  • You may have blood samples taken to test for
    recurrent strep infection (such as an ASO test),
    complete blood counts, and sedimentation rate
    (ESR).
  • Several major and minor criteria have been
    developed to help standardize rheumatic fever
    diagnosis. Meeting these criteria, as well as
    having evidence of a recent streptococcal
    infection, can help confirm that you have
    rheumatic fever.

26
Rheumatic Fever
  • Goal is to treat any existing strep infection
  • Rx PCN, Salicilytes for pain, fever reduction
    and inflammation, Corticosteriods for carditis,
    dig and diuretics for CHF
  • Low Na diet
  • BR to reduce cardiac workload can be weeks even
    months depending on the severity of heart status.
  • Heat and cold packs to affected joints

27
Leukemia cells
28
Acute lymphoblastic leukemia
  • Highest in age 3-5 3,000 new cases a year
  • Etiology genetic altered stem cell and cells
    produce the defective cell rapidly forms
    increased number of immature or blast cells
  • Blast cells released into circulation
    .Replication continues

29
Leukemia
  • Patho bone marrow replaced by malignant blast
    cells, neutropenia, decreased RBCs, platelets
    producing anemia, thrombocytopenia
  • All acute leukemia lymphocytic-originates in B
    lymphocytes and T lymphocytes

30
Leukemia
  • Manifestations pallor, excessive bruising,
    leg/bone pain, abdominal pain, fever, malaise,
  • Hepatosplenomegaly, abnormal elevation of WBC
    (lymphocytes), anemia, neutropenia?? and
    decreased RBCs.
  • Complications bleeding, death, sepsis, anemia

31
Leukemia
  • Tests CBC, bone marrow aspirate, lumbar puncture
    for mast cells, electrolytes, uric acid level,
    bone scan
  • Managementcombination of chemo over 2-3 years,
    prednisone, vincristine over 2-3 years,
  • Prognosis is good if remission occurs.

32
Bone Marrow Aspiration
                                                  
                                                  
                    
  • A small amount of bone marrow is removed during a
    bone marrow aspiration. The procedure is
    uncomfortable, but can be tolerated by both
    children and adults. The marrow can be studied to
    determine the cause of anemia, the presence of
    leukemia

33
Leukemia
  • Daily and weekly doses of medication
  • Bone marrow aspirate and spinal puncture in 30
    days after chemo
  • Chemo, radiation effects
  • Anemia, bleeding, urinary tract infection, hair
    loss, nail loss

34
Idiopathic Thrombocytopenia Purpura (ITP)
  • Bleeding disorder characterized by too few
    platelets in the blood. This is because platelets
    are being destroyed by the immune system.
  • Blood Platelets under 20,000
  • More common in age 2-4 years
  • Auto immune disorder often preceded by a viral
    infection
  • Child may not feel bad
  • Manifestations nose bleed, hematuria, melana,
    hematemesis, subarrachnoid hemorrhage

35
Idiopathic Thrombocytopenia Purpura (ITP)
  • The disease occurs when immune system cells,
    called lymphocytes, produce antibodies against
    platelets. Platelets are necessary for normal
    blood clotting. They clump together to plug small
    holes in damaged blood vessels.
  • The presence of antibodies on platelets leads to
    their destruction in the spleen. A characteristic
    skin rash, easy bruising, abnormal menstrual
    bleeding, or sudden and severe loss of blood from
    the digestive tract may occur.
  • Usually, no other abnormal findings are present.
    In children, the disease sometimes follows a
    viral infection, and usually runs its course
    without treatment (self limiting), with the
    platelet count returning to normal within 6
    months without therapy.

36
Idiopathic thrombocytopenia..
  • Tests CBC, platelet count
  • Replace blood, blood products, gama globulin
  • Spleenectomy if needed to modify disease
  • No ASA or ASA products, soft bristle tooth brush

37
Hemophilia
38
Hemophilia
  • Hemophilia refers to a group of bleeding
    disorders in which it takes a long time for the
    blood to clot. This may cause abnormal bleeding.
    In most cases, the disorder is passed down
    through families (inherited) and most often
    affects males.

39
Hemophilia
  • Sex linked heredity disorder carried by x
    chromosome
  • Male inherits from mother
  • Bleeding problems by age 4 yr (however neonatal
    bleeding from the umbilical cord or circumcision
    site may be an early manifestation of severe
    hemophilia).
  • Hemophilia A lack of factor viii
  • Hemophilia B Christmas disease lack of factor ix

40
Hemophilia
  • Bleeding after surgery, trauma or from no
    apparent reason
  • Tests PT, ptt, fibrinogen level platelet count,
    factor viii, factor ix, cbc, platelet count,
    coagulation profile

41
Hemophilia
  • Medication to stop bleeding desmopressin
    acetate, amicar, cyclokapron
  • No asa or asa products factor viii or factor ix
    replacement
  • Prognosis good
  • No contact sports, ID bracelet

42
Hemophilia
  • Care with bicycling, hiking, bowling, golf,
    running, prevent falls
  • Watch for intracranial bleed
  • Headache, vomiting, disorientation

43
Common GI Problems
  • Constipation
  • Intestinal Parasitic Infections

44
Constipation
  • Infrequent or difficult passage of hard dry
    stools d/t to medication, low fiber diet,
    decreased fluid intake
  • Manifestations hard dry stool , cramping, pain
    without abd dist, blood in stool, paplpable fecal
    mass inside retum, xray.
  • Management increase fluid, fiber, increase fruit
    and vegetables, daily exercise, toilet training,
    allow plenty of time to defecate.
  • Impaction use enema
  • Stool softners, laxatives, mineral oil may be
    used
  • Prognosois is good

45
Parasites
46
Giardiasis
  • Giardiasis is an intestinal infection caused by a
    protozoan and is spread by contaminated water or
    contact with an infected person. People who are
    travelling or hiking should assume water sources
    are contaminated and either purify drinking water
    or drink bottled water..

47
Parasitic infections
  • Giardiasis
  • Transmission
  • Person to person
  • Untreated water
  • Contaminated food
  • Animals
  • Soil
  • Feces
  • Anal sex with infected person
  • Manifestations diarrhea, weight loss, abdominal
    cramping
  • Fecal smear

48
Institutional Hygiene

49
Pinworm, Close-up of the Head
  • This is the head of a pinworm. Pinworms are most
    common in children. They are easily transmitted
    and sometimes appear in small outbreaks among
    school children.


50
Pinworm Eggs
  • Pinworms are a common problem in children and may
    spread to adults (typically the parents or other
    care-givers). The eggs may be easily seen under a
    microscope. To obtain a sample, a piece of
    cellophane tape is pressed against the patient's
    anal opening. The sticky side of the tape picks
    up the pinworm eggs and the tape is then stuck to
    a microscope slide. The eggs can be viewed under
    the microscope, as seen above.


51
Parasitic
  • Pinworm is a white threadlike worm
  • Transmission
  • Person to person
  • Ingest or inhale eggs
  • Untreated water
  • Poor hygiene
  • Common in school age children
  • Manifestations itching around anus, irritability
  • Cellophane tape to capture eggs early am

52
Roundworm
  • The adult worms multiply by producing eggs called
    ova or larvae.
  • The eggs usually become infectious
  • soil
  • Intermediate host before humans are infected.
  • It is interesting to note that unless the worm
    infection is heavy, many individuals do not show
    signs of infestation.

53
Parasitic
  • Roundworm pink worm 9-12 inches
  • Transmission eggs passed hand to mouth
  • May migrate to liver or lungs
  • Manifestations abdominal pain, abdominal
    distention, vomiting, jaundice, pneumonitis
  • Fecal smear

54
Parasitic
  • Hookworm
  • Transmission skin penetration and contact with
    contaminated soil
  • May migrate to lungs
  • Manifestations anemia, dermatitis, pneumonia,
    malnutrition
  • Well balanced diet with increase protein and Fe
    to replace lost nutrients.
  • Fecal smear

55
Hookworm
  • This is the mouth part of the hookworm
    Ancyclostoma duodenale. The hookworm uses sharp,
    curved cutting plates to attach to the lining of
    the intestine where it sucks blood for nourishment

The oral opening of this species contains cutting
"plates" as opposed to "teeth".
56
Endocrine
Type 2
Type 1
57
DM
Type 1
Type 2
58
Diabetes Mellitus in Children
  • Children often manifest with polyuria,
    polydipsia, polyphagia
  • Weight loss, fatigue and blurred vision
  • Children may need glucose or snacks after
    exercise
  • Toddlers are difficult to control as they can
    refuse to eat
  • Type 1 formally called juvenile onset diabetes
    and/or insulin-dependant diabetes
  • Most common is type 1 increase of number in type
    2 associated with childhood obesity

59
Diabetes Mellitus in Children
  • Most school-age children are able to learn and
    give their own insulin injections.
  • Diet and exercise for DM II. However, most may
    need drug therapy eventually.
  •  
  •  

60
Musculoskeletal D/Os in Childhood
  • Scoliosis
  • Legg-Calve-Perths
  • Duchenne Muscukar Dystrophy
  • Juvenile Arthrirtis
  • Fractures

61
Scoliosis
62
Signs of Scoliosis
  • One shoulder appears to be higher than the other,
    there is a curvature in the spine, or the pelvis
    appears to be tilted. The treatment of scoliosis
    can involve the use of a brace or surgery.
    Treatment is determined by the cause of the
    scoliosis, the size and location of the curve,
    and the stage of bone growth of the patient

63
Scoloisis
  • Lateral curvature of the spine more in female
    adolescents
  • Manifestations
  • Unequal hip and shoulder height, rib asymmetry
  • Scapular and rib prominence
  • Posterior hump when child bends forward at the
    waist

64
Forward Bend Test
  • The forward bend test is a test used most often
    in schools and doctor's offices to screen for
    scoliosis. During the test, the child bends
    forward with the feet together and knees straight
    while dangling the arms. Any imbalances in the
    rib cage or other deformities (e.g. uneven
    shoulder or pelvic heights, posterior rib hump)
    along the back could be a sign of scoliosis.

65
Scoliosis
  • Test x-ray
  • Management
  • curvature under 20 degrees- no treatment
  • Orthotic brace boston or thoracolumbosacral
  • Surgery-spinal fusion and stabilizing rod as
    harrington rod or l rod
  • With brace continuous monitering of curvature.
    Suspect non-compliance if curavture becomes more
    pronounced.
  • Post operative log roll q2h, vs, pain level,
    wound care, monitor for bleeding, bowel and
    bladder function, neuro checks with vital signs
    (warmth, color, sensation, movement, pulses,
    swelling, burning)in legs

66

67
Legg-Calve-Perthes Disease
  • Etiology decreased blood supply to femoral head
    resulting in epiphyseal necrosis and degeneration
    of femoral head and calcification
  • Unknown cause
  • Ages 4-8 yr caucasion boys most affected
  • S/S include pain, limp, limited rom, worse with
    activity
  • Decreased pain with rest
  • Tests x-ray
  • Management traction, bed rest, cast, brace or
    harness
  • Goal to maintain head of femur in acetabulum and
    preserve normal shape as regeneration occurs

68
Blood Supply to Bone
  • Bones require their own blood supply which
    travels through the periosteum to the inner bone
    marrow.
  • Surgical tx is often treatment of choice as it
    reduces time and eliminates compliance issues.

69
Legg-Calve-Perthes
70
Duchennes Muscular Dystrophy
  • Sex-linked (X-link recessive) inherited disease
    with progressive muscle wasting, and weakness
  • Ages 2-4.. Onset of disease almost exclusively in
    males.
  • Onset subtle and later progresses rapidly
    waddling gait, difficulty running, climbing..
  • By 12 years the child may lose the ability to
    walk.
  • Genetic Counseling is recommended for parents,
    female siblings and maternal Aunts.

71
Genetic Counseling and Prenatal Diagnosis

72
Muscular dystrophy
73
Juvenile arthritis
  • JRA occurs in 50-100 per 100,000 children in the
    United States. It usually occurs before age 16.
  • S/S- stiffness, edema, loss of motion, synovial
    thickening, macular rash on trunk, pain, joint
    swelling
  • Tests ESR erythrocyte sedimentation rate
  • Prognosis is good if caught early

74
Juvenile arthritis
  • Drug therapy- nonsteroidal anti-inflammatory
    medication as naprosyn, motirn, aspirin, gold,
    corticosteroids(sparining), cytoxic meds,
  • Rest, normal exercise, heat

75
Greenstick Fracture
  • Only one side of the bone has been broken. The
    bone usually is "bent" and only broken of the
    outside of the bend. It is mostly seen in
    children because of incomplete ossification, and
    is considered a stable fracture due to the fact
    that the whole bone has not been broken. As long
    as the bone is kept rigid healing is usually
    quick.

76
Fractures
  • Common sites long bones, wrist, clavicle,
    fingers, skull
  • Can be complete or incomplete fracture
  • Nx intervention calm and reassure child, assess
    pain, color, sensation, motion, pulses
  • management cast or splint

77
Fracture
78
Immune System/ Communicable Diseases
  • Chix pox
  • Diptheria
  • Fifth disease
  • Hep B
  • Mesles
  • Mono
  • Mumps
  • Whooping Cough
  • Poliomyelytis
  • Roseola
  • German measles
  • Scarlet fever
  • tetanus

79
Varicella
  • Chicken pox, varicella zoster (Viral)
  • Transmission direct contact with resp tract
    secretions
  • Manifestations low grade fever, pururtic rash,
    starts as a macule progressing to fluid filled
    papule, vessicles rupture and ooze, crusting
    lesions occurs
  • Treat with antihistamines, oatmeal baths and
    lotion to deter itching.
  • Vaccine available

80
Varicella-Zoster
Macular rash that progresses to papules to
crusted lesions
81
Diptheria
  • corynebacterium dipheriae
  • Direct contact (e.g.nasal drainage),or indirect
    through contaminated atrticles.
  • Pharyngitis, anorexia, low grade fever, laryngeal
    cough..
  • Complications airway obstruction,
    thrombocytopenia
  • Treat with antibiotics and analgesics
  • Vaccine available

82
Diptheria
Membraneous lesions on tonsils
83
Erythema Infectiosum
  • Fifths disease human parovirus b 19
    transmission resp tract secretions, blood
  • Manifestaions fever, malaise. Fiery-red cheeks
    (slapped face). Rash red rash on
    facemaculopapular, rash on upper extremities to
    trunk and thighs.
  • Lasting 1 week or more
  • Treatment supportive measures
  • No vaccine available

84
Erythema infantosum
85
Hepatitis B
  • Transmissionvia blood and sexual contact
  • Flu like symptoms, jaundice
  • Hep B vaccine available

86
Rubeola
  • Measles paramyxovirus
  • Transmission via direct contact from resp
    secretions, blood, urine of infected person
  • Manifestations malaise, kopilks
    spots-blue/white spots with a red base in buccal
    mucosa.
  • Maculopapular red rash, lasting 7 days
  • Rash begins behind the ears or at the hairline
    and spreads downward on body
  • Supportive treatment
  • Vaccine Available

87
Mononucleosis
  • Epstein-barr virus
  • Transmission via saliva, blood products
  • Manifestations fever, sore throat, enlarged
    lymph nodes, hepatospleenomegaly
  • Treatment includes supportive care, antipyretics,
    analgesics
  • No vaccine available

88
Mononucleosis
89
Mumps or Paratitis
  • Etiology paramyxovirus
  • Transmitted by direct contact of respiratory
    secretions
  • S/S fever, malaise, headachetenderness of
    parotid gland unilateral or bilateral edema
  • Treat w/ supportive care, antipyretics and
    analgesics
  • Vaccine available

90
Mumps or Paratitis
Enlarged parotid gland, earache aggravated by
eating ususally accompanied w/fever
91
Pertussis
  • AKA Whooping cough.
  • Bordetella pertusis
  • Respiratory droplets transmission, including
    running nose.
  • Manifestations cough, dry, hacking cough
    paroxysms of coughing, followed by prolonged
    inspiratory whoop, sound when child takes a
    breath, lasts 1-2 weeks
  • Complications otitis media, atelectasis,
    pneumonia, weight loss, hemorrhage from
    expistaxis
  • Management antibiotics, anti-seizure treatment
    for those with seizures, iv therapy, cool mist
  • Prevention vaccine

92
Pertussis
Paroxsmal cough, followed by a whoop sound
93
Roseola infantum 6th disease
  • Children age 6-24 months
  • Sudden onset, high fever last to 4 days child
    seems well
  • Rose-pink macular rash on trunk going to rest of
    body
  • Lasts 1-2 days
  • Complication febrile seizures
  • Treat with antpyretics and supportive care

94
6th disease
95
Rubella
  • German Measles, 3 day measles
  • Airborne, direct contact with droplets,
    transplacental
  • S/S fever, HA, malaise, running nose,
    maculopapular rash progressing fro head to
    extremities.
  • Supportive care
  • Vaccine available

96
Rubella
Maculopapular rash over entire body
97
Rubella
98
Scarlet Fever
  • Group A hemolytic strep
  • Airborne, resp droplets and contaminated items
  • S/S strawberry tounge, abd pain, sore throat,
    skin that peels on hands

99
Scarlet Fever
  • Treat with PCN, antipyretics, analgesics

100
Tetanus
  • Lockjaw
  • Direct contact of skin wound w/contaminated soil
    of a bactyeria spore
  • S/S Stiffness of neck and jaw, difficulty
    breathing.
  • Supportive care
  • Vaccine available

101
Tetanus
102
Integ
  • Impetigo
  • Cellulitis
  • Fungal infections
  • Viral infections
  • Infestations
  • Animal bites
  • Spider bites
  • Tick bites
  • Insect bites
  • Contact dermatitis
  • Acne
  • Burns

103
Impetigo
  • Common skin infection, often begins in open skin
  • S/S macules that change to papules vesicles that
    rupture with crusty honey colored over red base.
  • See 57-11

104
Impetigo
105
Cellulitis
  • Cellulitis staph a strep b
  • Haemophilus influenzae
  • Manifestations pain, redness, edema, lymph node
    enlargement
  • Managementantibiotics, moist compresses,
    hydration, bedrest, may elevate affected extremity

106
Tinea capitis, tinea corporis, tinea cruis..
  • Fungal infections of the skin
  • Tinea capitis-scalp
  • Corporis-trunk and extremities
  • Cruis-inguinal area
  • Pedis- athletes foot
  • Treatment antifungal medication, lotritmin,
    monostat, oxistat
  • Treatment antifungal medication, lotritmin,
    monostat, oxistat

107
Tinea capitis
108
Herpes Simplex Type 1
  • HSV-1 in 30-60 of youth
  • Termed cold sore, fever blister
  • Virus that remains dormat within nerve cells and
    is reactivated by fever, stress, trauma, sun
    exposure immune suppressed
  • Transmitted by direct contact with body fluid

109
Pediculosis
  • Head lice , pediculosis capitus
  • Causes intense pruritus
  • Louse attaches to skin and sucks blood .. lays
    eggs in hair shaft..
  • Eggs hatch in 7-10 days
  • Treatment kwell, rid, pronto, triple x, repeat
    in 1-2 weeks
  • Check head and body
  • Lice cannot transmit from hand to hair so the use
    of gloves is unecessary.

110
Pediculosis
111
Parasitic
  • Scabies are mites that burrows under the skin
    with feces and eggs left under skin papular
    rash with pruritus
  • Transmission by direct contact
  • Management kwell/lindane rid, elimite
    retreat in 1 week
  • Wash all clothing in hot water

112
Scabes
113
Traumatic injuries
  • Human bites
  • Insect bites
  • Sunburn
  • Dogs laceration/avulsion
  • Cats puncture
  • Bite area face, scalp, upper extremities

114
Dog bite
115
Animal Bites
  • Children under 4 years of age are often biten
    most frequently because of their ht and close
    proximity to a dogs face.
  • Atb, tetnus

116
Spider Bites
  • Black widow red edematous area, dizziness,
    weakness, abd pain, paraylsis, shock, renal
    failure
  • Brown reculse bite causes a necrotic ulcer that
    takes months to heal, nausea, vomiting, joint pain
  • These spiders are nonaggressive, avoid light
    (e.g. closets, woodpiles) and bite only in self
    defense

117
Black widow
Venom is neurotoxic and may cause dizziness,
weakness Abd, pain, paralysis, seizures, and
possibly death.
118
Black widow bite
119
Brown recluse spider
Venom is necrotoxic, with the bite progressing to
a necrotic Ulcer within 1-2 weeks. This bite
is not fatal, but ulcer may take months to heal.
120
Brown recluse bite
121
Skin
  • Impetigostaph aureus infection
  • Honey crusting over an ulcerated base
  • Mouth and nose
  • Manifestations lesions bleed if crusting removed
  • Soak off crusts wash with soap and water 3 times
    a day

122
Contact dermatitis
  • Inflammatory reaction to allergens soap, wool,
    dyes, citrus, bubble bath
  • Manifestations dry, inflamed pruritic skin, may
    have macules or papules
  • Tests skin testing for allergen
  • Management cool wet dressings of burows
    solution or aveeno bath, ad, desitin,
    antihistamines
  • To not use caladryl (benedryl) due to possible
    toxicity calamine recommended for children
  • Steroid 1 cream BID

123
Contact Dermatitis
124
Acne Vulgaris
  • Inflammatory process common in adolescence
  • Involves face, neck, shoulders, back, upper chest
  • Management retin-a, tretinoin
  • Use sunscreen
  • Topical benzoyl peroxide inhibits organism growth
  • Management antibiotics for topical use
    clindamycin, erthromycin, metronidazole
  • Systemic antibiotics if local do not work
    tetracycline, erythromycin, clidamycin
  • Accutane monitor for depression

125
Acne Vulgaris
126
Burns
  • Carless adults, children curiosity, increasing
    mobility, failure to adequately supervise
    contribute to high incidence of burns in children.

127
Urinary tract infection
  • Infection of kidney, ureters, bladder..
  • Bacteria, congenital anomaly manifestations
  • Painful urination, flank pain, hematuria,
    vomiting, fever, weight loss, feeding problems
  • Tests cs of urine
  • Management antibiotics, push fluids, repeat
    urine culture after antibiotics completed
  • Complications kidney infection, renal failure

128
Acute glomerulonephritis
  • Inflammation of glomeruli of kidney
  • Patho strep, pneumococcal, viral, hemolytic
    beta strep, throat infectionstrep fixed to
    glomeruli of kidneyedema occurs.. Filtration
    decreases.. Accumulate sodium and water in blood
    causes edema and circulary congestion..Protein
    escapes in urine

129
Glomerulonephritis
  • S/S Hematuria, proteinuria, hypoalbuminemia,
    oliguria, urine brown to tea colored , abd pain,
    pallor, low grade fever, hypertension, heart
    failure

130
Glomerulnephritis
  • Tests urinalysis, culture and sensitivity,
    antistreptolisin titer for strep management
  • Bed rest, restrict fluid, sodium and potassium
  • VS, weight, IO, antibiotic, antihypertensive
    medication..
  • Prognosis good, No treatment lab values usually
    self resolve in 6-12 weeks.

131
Glomerulnephritis
132
Nephrosis Nephrotic Syndrome
  • Protenuria, edema, hyperlipidemia,
    hypoproteinemia
  • Types primary or idiopathic
  • Secondary or caused by another disease
  • congenital
  • Patho autoimmune response
  • Allows protein to escape in urine ..Proteinuria
    and low level in blood or hypoproteinemia
  • Decreased osmotic pressure allows fluid to leak
    interstitualedema

133
Nephrosis..
  • Low fluid volume-retention of sodium and
    water-increases edema
  • Manifestations preorbital edema, weight gain,
    anasarca, decreased urine output, pallor
  • Tests cbc, urine-fat bodies in urine, bun,
    creatinine, serum protein level..
  • Flu and pneumonia vaccinations recommended when
    the child is in remission.

134
Nephrosis
  • Management low sodium intake, bed rest,
    prednisone for 7-21 days to initiate remession,
    diuretics, increase protein
  • Monitor urine output, elevated glucose,
    abdominal pain, check urine for protein, vs,
    weight

135
Nephrosis
136
Enuresis
  • Involuntary urination after control has been
    established
  • Etiology urinary tract infection, stress,
    pinworms, diabetes mellitus, sexual abuse, sickle
    cell anemia
  • Management ua, cs, fluid restriction after 6pm,
    ditropan

137
Review
  • Obestiy
  • Anorexia
  • Bulemia
  • Attention deficit
  • Suicide

138
Obesity
139
Obesity
  • Obesity is a term used to describe body weight
    that is much greater than what is considered
    healthy. Excessive body fat gt20.
  • Factors overeating, lack of parental knowledge
    on nutrition and food preparation, unstructured
    mealtime, genetic predisposition, peer pressure.

140
Anorexia
141
Anorexia and Bulimia
  • Eating d/o that is self inflicted starvation
  • Binge eating and purging
  • Body wt , 15 IBW
  • Higher incidence in caucasion girls in higher
    socioeconomic class.
  • Antidepressants
  • Wt gain at a teady rate 0.1-0.2 kg QD until
    desired wt is achieved

142
Autism
  • Autism is a developmental disorder that appears
    in the first 3 years of life, and affects the
    brain's normal development of social and
    communication skills.
  • Behavior modification
  • Consistent care schedules.
  • Prognosis varies good if caught early.
  • Many autistic children achieve independence by
    adulthood.

143
Hyperactivity
144
ADHD
  • D/O with limited attention spans, overactive,
    easily distracted, excessive talking, difficulty
    following instructions.
  • Modifying bx, setting limits, consistant routine,
    reward system, praise
  • Ritalin, cylert, dexdrine stimulate concentration

145
Suicide
146
Suicide
  • 3rd leading cause of death in adolescents
  • Males complete suicide 75 more than females
  • Males use lethal methods
  • Females drug OD or slit wrists
  • No Suicide contracts, chemical restraints-
    benadryl, mellaril, thorazine, ativan.
  • Psychotherapy

147
Child
148
Hodgkins
  • Treatment radiation therapy chemo surgery
  • High success in early diagnosis
  • 75 success rate in advanced cases 90 success
    in early diagnosis

149
Patent ductus arteriosus
  • Failure of ductus arteriosus to close completely
    after birth
  • Abnormal blood flow from aorta to pulmonary
    artery
  • Left to right shunt
  • Chf, endocarditis, tachypnea, retractions,
    hypoxemia, murmur

150
Patent ductus
  • Normallly closes 10-18 hours after birth
  • Complications chf, endocarditis, pulmonary
    vascular obstructive disease-later in life,
  • Management diuretics, digoxin
  • Surgery

151
Ventral septal defect
  • Abnormal opening in interventricular septum
    resulting in blood flow from left to right
    ventricle
  • Heart failure, holosystolic murmur
  • Diuretics for chf, digoxin

152
Ventral septal defect
  • Other treatments
  • Pulmonary artery banding
  • Surgery- repair with a dacron patch

153
Tetrology of fallot
  • Pulmonary stenosis, ventral septal defect, right
    ventricular hypertrophy, overriding aorta
  • Right to left shunt
  • Severe cyanosis, poor growth, syncope, chronic
    hypoxemia, harsh murmur

154
Tetrology
  • Monitor for anemia, dehydration
  • Blalock-taussing shunt.. Close ventral septal
    defect
  • Redirects blood flow back into lungs and allows
    oxygenation
  • Crates artificial connection between pulmonary
    artery and aorta

155
Tetrology
  • Repair overiding aorta
  • Long term complications heart block, ventricular
    arrhythmias, severe right ventricular
    dysfunction, sudden death
  • Complications phrenic nerve injury

156
Transportation of the great vessles
  • Pulmonary artery arises from left ventricle and
  • Aorta rises from right ventricle
  • Venous blood returns to right side of heart from
    aorta without being oxygenated

157
Transportation
  • Unoxygenated blood returns from the pulmonary
    system and returned to pulmonary artery to lungs
  • Management createing an atrial septal defect or
    surgery to correct the vessels to proper position

158
Coarctation of the aorta
  • Defect narrowing the lumen of the aorta
  • Increased pressure to head and arms
  • Lower pressure to body and legs
  • Which is reverse of normal

159
Coarctation
  • Manifestations bounding pulse in legs, heart
    failure, leg cramps with exertion
  • Treat for chf, digoxin, diuretics, baloon
    dilation of aorta - graft replacement if
    narrowing extensive

160
Iron deficiency anemia
  • Most common blood disorder in infancy, early
    childhood
  • Etiology decreased iron in diet malabsorption
    syndrome, diarrhea
  • Decreased rbc production or premature destruction
    of rbc
  • Milk without iron

161
Iron deficiency
  • Patho bone marrow produces rbcs but hemoglobin
    is decreaed and ineffective to carry o2
  • Too little o2 increases work load of heart
  • Manifestations pallor, tired, tachycardia,
    irritability
  • Iron therapy oral liquid given with straw or
    dropper vit c

162
Iron deficiency
  • Medication ferrous sulfate, ferrous gluconate,
    ferrous fumarate, fer-in-sol
  • Iron rich foods liver, cream of wheat, dark
    green leafy vegetables, dried fruit, egg yolks
    give with vitamin c foods

163
Sickle cell anemia
  • Genetic disorder sickle hemoblobin
  • Inherited autosomal recessive disease african
    american, mediterranean, middle east..
  • Life long disease
  • Each parent has trait50 change of each child
    carrying the trait

164
Sickle cell
  • 25 chance of each child without the trait, and
    25 chance of each child having the disease
  • Newborn screening cbc,
  • Path low oxygen causes shape to sickle and slump
    together

165
Sickle cell
  • Lifespan of cell reduced from 120 days to 12 days
  • Manifestations
  • Pallor, jaundice, delayed growth, renal
    dysfunction crying when joint touched, fever,
    fatigue

166
Sickle cell
  • Eye, liver, kidney, lungs, skin affected
  • Sickled cells cause occlusion of small vessles
  • Usually not diagnosed until 6 months

167
Sickle cell crisis
  • Joint pain bone pain, fever, cough swelling of
    hands/feet, seizures tachycardia, pripism, pallor
  • Iv fluids, pain management
  • Antibiotics due to high infection rate,
    pneumoccal vaccine at 1,2,5 yr h influenza at
    2 mos hepatitis b positive response to bone
    marrow transplant in some

168
Sickle cell crisis
  • Complications
  • Spleen often removed as it is not functioning
  • Septicemia cause of deat from 1-3 year olds
    highest period of mortality to infection
  • Child is susceptible to infection

169
Aplastic anemia
  • Etiology failure of cell generating ability of
    bone marrow
  • All elements of blood are defective, not
    developed or absent
  • Related to toxic chemicals, neoplastic disease of
    bone marrow
  • Some antibiotics, radiation

170
Aplastic anemia
  • Tests bone marrow aspiration
  • Manifestations severe anemia, thrombocytopenia,
    leukopenia
  • Treatment bone marrow replacement is treatment
    of choice

171
Hodgkins disease
  • Malignant lymphoma
  • Highest in 15-19 year olds
  • Manifestations painless growth of lymph tissue
    in neck, weight loss, fever, night sweats
  • Success depends on stage of disease

172
Hiv
  • Etiology human immunodeficiency virus
  • Transmission breast milk, blood, urine, body
    fluid
  • From mother to infant before or during birth via
    placenta
  • Infant can be positive at birth and negative at
    18 months

173
Hiv
  • Manifestations failure to thrive, viral
    bacterial infection, pneumonia
  • Kaposis sarcoma rare in adolescents
  • Over 18 months diagnosed by elisa and western
    blot

174
Hiv
  • Management
  • Antiretroviral meds to prevent reproduction of
    virus
  • Combination of medication due to drug resistance
  • Monitor cd4 count

175
Respiratory distress syndrome
  • Hyaline membrane disease
  • Patho lack of surfactant in newborn making
    lungs difficult to inflate
  • Alveoli collapse at end of expiration

176
Respiratory distress
  • Manifestations nasal flaring, expiratory grunt,
    tachpnea, low body temperature
  • Tests abg
  • Management oxygen, pulmonary surfactant,
    respiratory support

177
Bronchopulmonary dysplasia
  • Patho chronic pulmonary disorders associated
    with meconium aspiration
  • Lung becomes thicker and necrosis of alveolar
    walls with o2 impairedalveoli can collapse

178
Bronchopulmonary dysplasia
  • Manifestations wheezing, nasal flaring,
    irritability, cyanosis
  • Management tpn, feed by lavage when infant able,
    mechanical ventilation, oxygen bronchodilators.

179
Laryngotracho bronchitis
  • Croup common 3 mos to 3 yrs
  • Patho viral or bacterial as h influenza
  • Manifestations hoarsness, inspiratory stridor,
    tachypnea, nasal flaring, barking cough

180
Larygotracheo bronchitis
  • Tests cbc, cs of tracheal secretions, cs of
    blood
  • Management cool mist, oxygen, epinephrine by
    aerosol, npo, iv fluids, antibiotics, fowlers
    position
  • Epiglottal edema reduced after 24 hours

181
Acute epiglottitis
  • Definition bacterial infection of epiglottis
    in older child cause can beh influenzae
  • Manifestations epiglottis cherry red, can
    obstruct airway, drooling, respiratory distress
    treatment
  • Cool mist, iv fluids, antibiotics

182
Acute bronchiolitis
  • Patho inflammation of bronchioles inflammation
    causing edema often to respiratory synctial virus
  • Most in child under 2 yr
  • Manifestations tachypnea, rstractions, wheezing,
    fussy,

183
Bronchiolitis
  • Eating problems, fever
  • Test x-ray
  • Treatment high humidity, mist tent, oxygen , iv
    therapy, liquify secretions, corticosteroids
  • Lasts 3-10 days
  • Prognosis good

184
Respiratory synctial virus
  • Associated with bronchiolitis
  • Rsv or respiratory synctial virus
  • Causes an infection usually
  • More infall and peaks in winter
  • Tests x-ray shows atelectasis, hyperinflation

185
Respiratory synctial virus
  • Nasal secretions positive for elisa and
    immunofluorescent antibody ifa
  • Ribavirin has antiviral activity
  • Respiratory isolation, good handwashing
  • Prognosis good

186
Pulmonary tuberculosis
  • Etiology mycobacterium tuberculosis
  • Many strains resistant to medication
  • Seen in young, old, those with hiv, immune
    suppressed
  • Test tb skin test, chest x-ray, cultures

187
Tb
  • Some children have no signs of disease
  • Success dependent on compliance to therapy and
    parent to give medication for as long as ordered

188
Sudden infant death syndrome
  • Etiology unknown
  • Child under 1 year peak age 2-4 months
  • Most occur in sleep
  • More during winter

189
Sids
  • Associated with maternal smoking, premature
    birth, respiratory infections, prone position for
    sleep
  • Prevention
  • Place infant on back or side to sleep

190
Pharyngitis
  • Inflammation of the pharynx
  • Etiology viral bacterial
  • Common age 4-12yr
  • Manifestations low grade fever, malaise,
    anorexia, pharyngeal erythema, cough, hoarseness,
    rhinitis..

191
Pharyngitis
  • Managementcs of throat, cool liquids, saline
    gargles, warm compress to neck, tylenol
  • Viral treated symptomatically
  • Strep causes high fever, white exudate on
    posterior pharynx

192
Pneumonia
  • Acute inflammation of pulmonary tissue
  • Etiology viral bacterial
  • Often foreign body aspiration
  • Manifestations cough, wheeze, respiratory
    distress, anorexia, irritability

193
Pneumonia
  • Tests cbc, cs of blood, urine, and sputum
  • Management oxygen, chest physiotherapy, suction
    as needed, fluids, bronchodilator, antipyretic
  • Prognosis good

194
Cystic fibrosis
  • Inherited disease autosomal recessive traitboth
    parents must have gene for child to be affected
    patho
  • Abnormal thick mucus obstructs organs producing
    resp, digestive, integumentary, and reproductive
    dysfunction

195
Cystic fibrosis
  • Stasis of secretions-bacterial growth-chronic
    infection-actelectasis and fibrosis-lung
    destruction
  • Hypoxia-increased pulmonary resistance-right
    heart failure
  • Pancrease ducts blocked-trypsin, amylase, lipase
    not secreted for digestion islets of
    langerhans can be decreasedinsulin dependence

196
Cystic fibrosis
  • Sweat glands secrete excess sodium and
    chloridechloride over 60meq/l
  • In forearm
  • Wheezing, bronchitis pneumonia, copious mucus
    with infections, hypoxia, crackles,steatorrhea
  • Growth failure, corpulmonale, chf, clubbing of
    nailbeds

197
Cystic fibrosis
  • Tests prenatal testing
  • Sweat test, pancreatic enzymes
  • Management high calorie, high protein diet,
  • High salt in diet
  • Breathing exercises, blow bubbles

198
Cystic fibrosis
  • Pancreatic enzymes before meals, pulmonary
    therapy, postural drainage, immunization,
    nurtition, prevent exposure to persons with
    respiratory disease, emotional suppport
  • Many live into adulthood with antibiotics

199
Cleft lip cleft palate
  • Patho failure of medial nasal and maxillary
    process to join
  • Unilateral or bilateral
  • Feeding problems, gagging, choking, otitis media
  • Surgical closure of cleft lip at 1-2 months
    cleft palate repaired before 1 year

200
Cleft lip cleft palate
  • Special feeding nipple with head of child
    elevated
  • Burp frequently as child swallows air can feed
    by syringe
  • Post surgery npo until anesthesia gone.. Rubber
    tip used with syringe to feed and clean mouth..
    No pacifiersclean mouth with water after feeding

201
Gastroesophageal reflux
  • Regurgitation of stomach contents into esophagus
  • Begin within 1 week of birth
  • Occurs immediately after infant lies down
    manifestations
  • Spitting up, pneumonia, anemia, hematemesis,
    growth and weight gain problems

202
Gastroesophageal reflux
  • Tests barium swallow, bronchoscopy
  • Management feed upright, cereal added, antacids,
    head elevated surgery- nissen fundoplication

203
Hypertrophic pyloric stenosis
  • Etiology unknown patho congenital
    hypertrophied pyloric muscle that surrounds the
    valve between stomach and duodenum
  • Manifestations forceful vomiting projectile
    noted at 4-6 weeks
  • Vomiting shortly after eating, hunger, sunken
    fontanel, decreased urine, weight loss..

204
Pyloric stenosis
  • Tests ultrasound, barium swallow
  • Management ng to empty stomach, iv fluids,
    pyloromyotomy-release obstruction

205
Pyloric stenosis..
  • Feed pedialyte in 4-6 hours then ½ strength
    formula or undiluted breast milk, advance
    formula as tol
  • Complications dehiscence,
  • Obstruction
  • Prognosis good

206
Dehydration
  • Number one killer of children world wide
  • Causes bacterial, viral, parasites, irritable
    bowel syndrome .. patho increased motility,
    loss of water, electrolytes
  • Vomiting, diarrhea, pyloric stenosis,
    malabsorption

207
Dehydration
  • Fluid loss- isotonic fluid and eletroyte loss
  • Etiology burns, fever, diarrhea, malabsorption
    syndrome, cystic fibrosis..
  • Manifestations 3-5 loss mild
  • 6-9 loss moderate 15 or more severe

208
Dehydration
  • Manifestations weight loss, decreased urine
    output, sunken fontanels, no tears, low bp, rapid
    respirations.
  • Weigh diapers and count, iv fluid, io,
    electrolytes, daily weight
  • Fluids and electrolyte replacement

209
Diarrhea gastroenteritis
  • Etiology bacterial, viral, parasites,
    salmonella..
  • Loss of water and electrolytes in stool
  • Manifestations large volume of stool, light in
    color greasy foul smelling sunken fontanels,
    rapid pulse

210
Diarrhea
  • Management
  • Npo, iv solution -- in 24 hours begin pedialyte,
    gatorade
  • Antibiotics as needed
  • brat dietbanana, rice cereal, applesauce, toast
  • Io, electrolytes, stool for c difficile, cbc,
    ova and parasites

211
Intussecption
  • Common cause of intestinal obstruction 3 mos to 6
    yr
  • Patho telescoping of one part of the bowel into
    another part of the bowel often at distal ileum
    manifestations
  • Vomiting, lethargy, abd pain, currant jelly
    stools..

212
Intussecption
  • Tests
  • Barium enema, rectal exam
  • Barium enema can correct the problem or
  • Bowel resection with end to end anstamosis
  • Post surgery npo, iv, vs, bowel sounds, oral
    feedings when peristalsis returns

213
Hirschsprungs disease
  • Congenital aganglionosis or megacolon
  • Absence of ganglion cells in rectum and in colon
  • Patho ganglions provide parasympathetic nerve
    action to colon
  • Constipation, ribbonlike stool, poor weight gain

214
Hirschsprungs
  • Management stool softeners, enema, oral
    antbiotics, colostomy or ileostomy to rest the
    bowel and regain tone
  • Later colostomy closure
  • Fluid and electrolyte replacement, monitor bowel
    sounds, vs, stools

215
Hernias
  • Protrusion of a portion of an organ through a
    structural defect
  • Complication circulation to organ impaired
  • Incarceratedcannot be reduced
  • Strangulatedcirculation impaired

216
Hernias
  • Types diaphragmaticprotrusion of stomach
    through part of diaphragm
  • Hiatalprotrusion of stomach through esophageal
    opening in diaphragm
  • Inguinalprotrusion of organ through inguinal
    ring
  • Umbilicalprotrusion of intestine through weak
    abd wall

217
Hernias
  • Manifestation buldging sac
  • Management most have surgical repair
  • Inguinal may have scrotal truss or surgical repair

218
Urinary
  • Define
  • Hypospadiaurethral opening along ventral surface
    of shaft
  • Epispadiaurethralopening along dorsal surface of
    shaft
  • Phimosisnarrowing of opening of foreskin

219
Urinary..
  • Hydrocelefluid in scrotal sac
  • Cryptorchidismfailure of one or both testes to
    descend into scrotum

220
Wilms tumor
  • Nephroblastoma
  • Most common renal or intrabdominal malignant
    tumor of childhood
  • Peak age 2-3 yeaars
  • Patho/etiology most common in left kidney both
    hereditary and non hereditary origin

221
WilmS
  • Manifestations
  • Asymptomatic enlarging abdominal mass, abd pain,
    hematuria, fever, hypertension, weight loss,
    fatigue
  • Metastasis liver, lungs, lymph nodes, brain, bone

222
Wilms
  • Tests x-ray, abdominal ultrasound, abdominal and
    chest ct, chemistry, biopsy
  • Management surgical resection 24-48 hours after
    diagnosis
  • Radiation therapy, chemotherapy treatment ranges
    6-15 months

223
WilmS
  • Post operative monitor vs, renal output, bowel
    sounds,parents feelings regarding diagnosis,
    avoid contact sports, prompt treatment of
    geniturinary symptoms

224
Hypothyroid
  • Hypothyroid to decreased production of thyroid
    hormone
  • By thyroid gland
  • Patho congenital or acquired
  • Insufficient stimulation of gland or systemic
    resistance to hormone

225
Hypothyroid
  • Manifestations
  • Lethargy, poor appetite, dyspnea, hypothermia,
    delayed growth, dry skin, constipation, mental
    slowness
  • Management
  • Thyroid hormone replacement

226
Hyperthyroid
  • Patho autoimmune, unknown etiology
  • Manifestations nervousness, tremors,
    irritability, hypertension, tachycardia,
  • Tachpnea, heat intolerance
  • Tests tsh, t3, t4, radioactive iodine uptake

227
Hyperthyroid
  • Management
  • Antithyroid medication propylthioracil,
    tapazole
  • Subtotal thyroidectomy
  • Post-op monitor breathing, bleeding, calcium
    levels, head elevated, trach tray at bedside

228
Dysplasia of the hip
  • Developmental abnormality of the femoral head,
    acetabulum or both associated with other problems
  • Associated with first pregnancy, spina bifida,
    breech presentation
  • Subluxation or incorrect position of the femoral
    head in acetabulum is the most common in infants

229
Dysplasia of the hip
  • Manifestations click when hip moved thigh and
    gluteal folds are not even when infant prone
  • Shorter femur on affected side
  • Older child can have affected leg shorter or
    waddling gaint or limp

230
Dysplasia of the hip
  • Tests sonography, x-ray
  • Management varies with severity of deformity
  • Pavlik harness-for infants under 6 months to
    maintain hip in abduction and alignment
  • Hip spica cast-infants 6-18 months
  • Other open reduction, osteotomy, arthroplasty

231
Hip dysplasia
  • Nursing maintain position of hip joint, prevent
    complications, provide stimulation, involve
    parents in caring for child, neurovascular
    assessment of extremity, report erythema,
    tenderness, teach cast care smooth edges of cast
    with tape

232
Taipes
  • Clubfoot
  • Congenital deformity of foot and ankle
    unilateral/bilateral
  • Cause unknown
  • Noted at birth may be related to environmental
    conditions, intrauterine position, restricted
    movement in uterus

233
Talipes
  • Special shoes, short leg cast
  • Passive stretching exercises, corrective splints,
    brace
  • Corrective shoes
  • Management neurovascular check on feet, check
    cast edges for rough edges

234
Septic arthritis
  • Infection of a joint
  • From bacteria or existing osteomylitis, bit
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