Transcript Document 7127312

Common Problems
Ages 1-18 Years
White 2nd ed
Christensen 5th ed
Leslie Lehmkuhl, RN 2008
Terms
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Acanthois nigricans
Comedome
Encopesis
Epistaxis
Gowers’ sign
Rhinorrhea
ii
Upper Respiratory Infections
(viral or bacterial)
See Table 57-1
Nasopharyngitis (common
cold) is viral
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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
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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 ATB’s.
Note enlarged lymph nodes, tender
cervical lymph nodes.
Influenza viral
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Treat symptoms (e.g. chills, fever,
mylagia, cough, congestion, HA
Highest among school age
children.
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With all three enc. rest, use nonASA antipyretic/analgesics, PO
decongestants, nasal saline gtts,
warm salt water gargle,
humidifier, fluids, clear or bland
liquids, tea and honey.
0
Allergic Rhinitis
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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
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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).
Allergic Rhinitis (continued)
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Management:
allergy skin testing,
CBC with elevated
eosinophil count
Immunotherapy
includes allergy
shots
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Antihistamines,
decongestants
Avoid wool and
down blankets,
humidifier in home,
keep pets outside if
possible
“allergic salute”
Tonsils
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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.
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.
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.
Tonsillits
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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
Tonsillitis
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Tests: CBC, C&S 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
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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
Tonsillitis
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Bleeding most common:
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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.
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Call if temp 101 or
above, earache,
bleeding, avoid crowds
for 2 weeks
Asthma
Bronchial asthma
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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
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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.
Asthma
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Etiology: history of allergies 
in family, smoke, stress,
exercise, trees, peanuts…do
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 sodiumnonsteroid antiinflammatory-may prevent
asthma.
Prednisone a
corticosteriods
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.
Foreign Body Aspiration
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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
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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
Rheumatic fever
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).
Rheumatic fever
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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
Rheumatic Fever
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Minor S/S
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Fever
Listlessness
Anorexia
Pallor
Wt loss
Muscle
Joint or abd pain
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Major S/S
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Polyarthritis
Carditis
Erythema
marginatum (red
skin lesions)
Subcutaneous
nodules
Elevated ASO titer
*
Rheumatic Fever
Subcutaneous skin nodules
Rheumatic Fever
Skin rash
(erythema marginatum)
Rheumatic Fever
Rheumatic Fever
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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.
Rheumatic Fever
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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
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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
Leukemia cells
Acute lymphoblastic
leukemia
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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
Leukemia
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Patho: bone marrow replaced by
malignant blast cells, neutropenia,
decreased RBC’s, platelets producing
anemia, thrombocytopenia
All –acute leukemia lymphocyticoriginates in B lymphocytes and T
lymphocytes
Leukemia
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Manifestations: pallor, excessive bruising,
leg/bone pain, abdominal pain, fever, malaise,
Hepatosplenomegaly, abnormal elevation of
WBC (lymphocytes), anemia, neutropenia??
and decreased RBC’s.
Complications: bleeding, death, sepsis,
anemia
Leukemia
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Tests: CBC, bone marrow aspirate,
lumbar puncture for mast cells,
electrolytes, uric acid level, bone scan
Management:combination of chemo
over 2-3 years, prednisone, vincristine
over 2-3 years,
Prognosis is good if remission occurs.
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
Leukemia
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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
Idiopathic Thrombocytopenia
Purpura (ITP)
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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
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More common in age 24 years
Auto immune disorder
often preceded by a
viral infection
Child may not feel bad
Manifestations: nose
bleed, hematuria,
melana, hematemesis,
subarrachnoid
hemorrhage
Idiopathic Thrombocytopenia
Purpura (ITP)
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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.
Idiopathic thrombocytopenia..
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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
Hemophilia
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.
Hemophilia
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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
Hemophilia
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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
Hemophilia
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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
Hemophilia
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Care with bicycling, hiking, bowling,
golf, running, prevent falls
Watch for intracranial bleed
Headache, vomiting, disorientation
Common GI Problems
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Constipation
Intestinal Parasitic
Infections
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Constipation
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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.
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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
Parasites
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..
Parasitic infections
Giardiasis
 Transmission
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Person to person
Untreated water
Contaminated food
Animals
Soil
Feces
Anal sex with
infected person
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Manifestations:
diarrhea, weight
loss, abdominal
cramping
Fecal smear
Institutional Hygiene
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.
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
Parasitic
Pinworm is a white
threadlike worm
 Transmission
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Person to person
Ingest or inhale eggs
Untreated water
Poor hygiene
Common in school
age children
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Manifestations:
itching around anus,
irritability
Cellophane tape to
capture eggs early
am
Roundworm
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The adult worms multiply
by producing eggs called
ova or larvae.
The eggs usually become
infectious
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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.
Parasitic
Roundworm pink
worm 9-12 inches
 Transmission eggs
passed hand to
mouth
 May migrate to liver
or lungs
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Manifestations:
abdominal pain,
abdominal
distention, vomiting,
jaundice,
pneumonitis
Fecal smear
Parasitic
Hookworm
 Transmission: skin
penetration and
contact with
contaminated soil
 May migrate to
lungs
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Manifestations:
anemia, dermatitis,
pneumonia,
malnutrition
Well balanced diet
with increase protein
and Fe to replace
lost nutrients.
Fecal smear
Hookworm
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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".
Endocrine
Type 1
Type 2
DM
Type 1
Type 2
Diabetes Mellitus in Children
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Type 1 formally
called “juvenile
onset diabetes”
and/or “insulindependant diabetes”
Most common is
type 1 increase of
number in type 2
associated with
childhood obesity
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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
Diabetes Mellitus in Children
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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.
Musculoskeletal D/O’s in
Childhood
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Scoliosis
Legg-Calve’-Perths
Duchenne Muscukar Dystrophy
Juvenile Arthrirtis
Fractures
Scoliosis
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
Scoloisis
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Lateral curvature of the spine more in
female adolescents
Manifestations
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Unequal hip and shoulder height, rib
asymmetry
Scapular and rib prominence
Posterior hump when child bends forward
at the waist
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.
Scoliosis
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Test: x-ray
Management:
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curvature under 20
degrees- no treatment
Orthotic brace: boston or
thoracolumbosacral
Surgery-spinal fusion
and stabilizing rod as
harrington rod or l rod
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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
Legg-Calve-Perthes Disease
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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
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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
Blood Supply to Bone
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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.
Legg-Calve-Perthes
Duchenne’s Muscular
Dystrophy
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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..
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By 12 years the child
may lose the ability
to walk.
Genetic Counseling
is recommended for
parents, female
siblings and
maternal Aunts.
Genetic Counseling and
Prenatal Diagnosis
Muscular dystrophy
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

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Tests: ESR erythrocyte
sedimentation rate
Prognosis is good if
caught early
Juvenile arthritis

Drug therapynonsteroidal antiinflammatory
medication as
naprosyn, motirn,
aspirin, gold,
corticosteroids(spari
ning), cytoxic meds,

Rest, normal
exercise, heat
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.
Fractures
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Common sites long
bones, wrist,
clavicle, fingers,
skull
Can be complete or
incomplete fracture
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Nx intervention calm
and reassure child,
assess pain, color,
sensation, motion,
pulses
management cast
or splint
Fracture
Immune System/
Communicable Diseases
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Chix pox
Diptheria
Fifth disease
Hep B
Mesles
Mono
Mumps
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Whooping Cough
Poliomyelytis
Roseola
German measles
Scarlet fever
tetanus
Varicella
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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
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
Treat with
antihistamines,
oatmeal baths and
lotion to deter
itching.
Vaccine available
Varicella-Zoster
Macular rash that progresses to papules to crusted lesions
Diptheria
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corynebacterium
dipheriae
Direct contact
(e.g.nasal drainage),or
indirect through
contaminated atrticles.
Pharyngitis, anorexia,
low grade fever,
laryngeal cough..
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Complications:
airway obstruction,
thrombocytopenia
Treat with antibiotics
and analgesics
Vaccine available
Diptheria
Membraneous lesions on tonsils
Erythema Infectiosum


Fifth’s disease human
parovirus b 19
transmission: resp tract
secretions, blood
Manifestaions: fever,
malaise. Fiery-red
cheeks (“slapped face”).
Rash red rash on face—
maculopapular, rash on
upper extremities to
trunk and thighs.
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Lasting 1 week or
more
Treatment
supportive measures
No vaccine available
Erythema infantosum
Hepatitis B
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Transmissionvia
blood and sexual
contact
Flu like symptoms,
jaundice
Hep B vaccine
available
Rubeola
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
Measles
paramyxovirus
Transmission via direct
contact from resp
secretions, blood, urine
of infected person
Manifestations: malaise,
kopilk’s spotsblue/white spots with a
red base in buccal
mucosa….

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Maculopapular red rash,
lasting 7 days
Rash begins behind the
ears or at the hairline
and spreads downward
on body
Supportive treatment
Vaccine Available
Mononucleosis
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

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
Mononucleosis
Mumps or Paratitis



Etiology: paramyxovirus
Transmitted by direct
contact of respiratory
secretions
S/S fever, malaise,
headache…tenderness
of parotid gland
unilateral or bilateral
edema


Treat w/ supportive
care, antipyretics
and analgesics
Vaccine available
Mumps or Paratitis
Enlarged parotid gland, earache aggravated by
eating ususally accompanied w/fever
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
Pertussis
Paroxsmal cough, followed by a whoop sound
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
6th disease
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
Rubella
Maculopapular rash
over entire body
Rubella
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
Scarlet Fever

Treat with PCN,
antipyretics,
analgesics
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
Tetanus
Integ







Impetigo
Cellulitis
Fungal infections
Viral infections
Infestations
Animal bites
Spider bites





Tick bites
Insect bites
Contact dermatitis
Acne
Burns
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
Impetigo
Cellulitis




Cellulitis staph a strep
b
Haemophilus influenzae
Manifestations: pain,
redness, edema, lymph
node enlargement
Management:antibiotics
, moist compresses,
hydration, bedrest, may
elevate affected
extremity
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
Tinea capitis
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
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.
Pediculosis
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
Scabes
Traumatic injuries






Human bites
Insect bites
Sunburn
Dogs: laceration/avulsion
Cats: puncture
Bite area: face, scalp, upper extremities
Dog bite
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
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
Black widow
Venom is neurotoxic and may cause dizziness, weakness
Abd, pain, paralysis, seizures, and possibly death.
Black widow bite
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.
Brown recluse bite
Skin





Impetigo=staph 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
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 burow’s
solution or aveeno bath,
a&d, desitin,
antihistamines
To not use caladryl
(benedryl) due to
possible toxicity
calamine recommended
for children
Steroid 1% cream BID
Contact Dermatitis
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
Acne Vulgaris
Burns

Carless adults,
children curiosity,
increasing mobility,
failure to adequately
supervise contribute
to high incidence of
burns in children.
Urinary tract infection



Infection of kidney,
ureters, bladder..
Bacteria, congenital
anomaly
manifestations:
Painful urination,
flank pain,
hematuria, vomiting,
fever, weight loss,
feeding problems



Tests: c&s of urine
Management:
antibiotics, push
fluids, repeat urine
culture after
antibiotics
completed
Complications:
kidney infection,
renal failure
Acute glomerulonephritis


Inflammation of glomeruli of kidney
Patho: strep, pneumococcal, viral,
hemolytic beta strep, throat infection=strep
fixed to glomeruli of kidney…edema occurs..
Filtration decreases.. Accumulate sodium and
water in blood… causes edema and
circulary congestion..Protein escapes in urine
Glomerulonephritis

S/S: Hematuria,
proteinuria,
hypoalbuminemia,
oliguria, urine brown
to tea colored , abd
pain, pallor, low
grade fever,
hypertension, heart
failure
Glomerulnephritis


Tests: urinalysis, culture
and sensitivity,
antistreptolisin titer for
strep management:
Bed rest, restrict: fluid,
sodium and potassium


VS, weight, I&O,
antibiotic,
antihypertensive
medication..
Prognosis good, No
treatment lab values
usually self resolve in 612 weeks.
Glomerulnephritis
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 interstitual=edema
Nephrosis..


Low fluid volumeretention 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.
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
Nephrosis
Enuresis


Involuntary
urination after
control has been
established
Etiology: urinary
tract infection,
stress, pinworms,
diabetes mellitus,
sexual abuse, sickle
cell anemia

Management: ua,
c&s, fluid restriction
after 6pm, ditropan
Review





Obestiy
Anorexia
Bulemia
Attention deficit
Suicide
Obesity
Obesity

Obesity is a term
used to describe
body weight that is
much greater than
what is considered
healthy. Excessive
body fat >20%.

Factors: overeating,
lack of parental
knowledge on
nutrition and food
preparation,
unstructured
mealtime, genetic
predisposition, peer
pressure.
Anorexia
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
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.
Hyperactivity
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
Suicide
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
Child
Hodgkin’s



Treatment: radiation therapy chemo
surgery
High success in early diagnosis
75% success rate in advanced cases
90% success in early diagnosis
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
Patent ductus




Normallly closes 10-18 hours after birth
Complications: chf, endocarditis,
pulmonary vascular obstructive diseaselater in life,
Management: diuretics, digoxin
Surgery
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
Ventral septal defect



Other treatments:
Pulmonary artery banding
Surgery- repair with a dacron patch
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
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
Tetrology



Repair overiding aorta
Long term complications: heart block,
ventricular arrhythmias, severe right
ventricular dysfunction, sudden death
Complications phrenic nerve injury
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
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
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
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
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
Iron deficiency




Patho: bone marrow produces rbc’s 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
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
Sickle cell anemia




Genetic disorder sickle hemoblobin
Inherited autosomal recessive disease
african american, mediterranean,
middle east..
Life long disease
Each parent has trait=50% change of
each child carrying the trait
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
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
Sickle cell



Eye, liver, kidney, lungs, skin affected
Sickled cells cause occlusion of small
vessles
Usually not diagnosed until 6 months
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…
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
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
Aplastic anemia



Tests: bone marrow aspiration
Manifestations: severe anemia,
thrombocytopenia, leukopenia
Treatment: bone marrow replacement is
treatment of choice
Hodgkin’s 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
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
Hiv



Manifestations: failure to thrive, viral
bacterial infection, pneumonia
Kaposis sarcoma rare in adolescents
Over 18 months diagnosed by elisa and
western blot
Hiv




Management:
Antiretroviral meds to prevent
reproduction of virus
Combination of medication due to drug
resistance
Monitor cd4 count
Respiratory distress syndrome



Hyaline membrane disease
Patho: lack of surfactant in newborn
making lungs difficult to inflate
Alveoli collapse at end of expiration
Respiratory distress



Manifestations: nasal flaring, expiratory
grunt, tachpnea, low body temperature
Tests: abg
Management: oxygen, pulmonary
surfactant, respiratory support
Bronchopulmonary dysplasia


Patho: chronic pulmonary disorders
associated with meconium aspiration
Lung becomes thicker and necrosis of
alveolar walls with o2 impaired…alveoli
can collapse
Bronchopulmonary dysplasia


Manifestations: wheezing, nasal flaring,
irritability, cyanosis
Management: tpn, feed by lavage when
infant able, mechanical ventilation,
oxygen bronchodilators….
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
Larygotracheo
bronchitis



Tests: cbc, c&s of tracheal secretions,
c&s of blood
Management: cool mist, oxygen,
epinephrine by aerosol, npo, iv fluids,
antibiotics, fowlers position
Epiglottal edema reduced after 24 hours
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
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,
Bronchiolitis





Eating problems, fever
Test: x-ray
Treatment: high humidity, mist tent,
oxygen , iv therapy, liquify secretions,
corticosteroids
Lasts 3-10 days
Prognosis good
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
Respiratory synctial virus




Nasal secretions positive for elisa and
immunofluorescent antibody ifa
Ribavirin has antiviral activity
Respiratory isolation, good
handwashing
Prognosis good
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
Tb


Some children have no signs of disease
Success dependent on: compliance to
therapy and parent to give medication
for as long as ordered
Sudden infant death syndrome




Etiology: unknown
Child under 1 year peak age 2-4 months
Most occur in sleep
More during winter
Sids



Associated with: maternal smoking,
premature birth, respiratory infections,
prone position for sleep
Prevention:
Place infant on back or side to sleep
Pharyngitis




Inflammation of the pharynx
Etiology: viral bacterial
Common age 4-12yr
Manifestations: low grade fever,
malaise, anorexia, pharyngeal
erythema, cough, hoarseness, rhinitis..
Pharyngitis



Management:c&s of throat, cool liquids,
saline gargles, warm compress to neck,
tylenol
Viral treated symptomatically
Strep causes high fever, white exudate
on posterior pharynx…
Pneumonia




Acute inflammation of pulmonary tissue
Etiology: viral bacterial
Often foreign body aspiration
Manifestations: cough, wheeze,
respiratory distress, anorexia, irritability
Pneumonia



Tests: cbc, c&s of blood, urine, and
sputum
Management: oxygen, chest
physiotherapy, suction as needed,
fluids, bronchodilator, antipyretic
Prognosis good
Cystic fibrosis


Inherited disease autosomal recessive
trait—both parents must have gene for
child to be affected
patho:
Abnormal thick mucus obstructs organs
producing resp, digestive,
integumentary, and reproductive
dysfunction
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 decreased=insulin
dependence
Cystic fibrosis




Sweat glands secrete excess sodium
and chloride=chloride over 60meq/l
In forearm
Wheezing, bronchitis pneumonia,
copious mucus with infections, hypoxia,
crackles,steatorrhea
Growth failure, corpulmonale, chf,
clubbing of nailbeds
Cystic fibrosis





Tests: prenatal testing
Sweat test, pancreatic enzymes
Management: high calorie, high protein
diet,
High salt in diet
Breathing exercises, blow bubbles
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
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
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 pacifiers…clean mouth with
water after feeding
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
Gastroesophageal reflux


Tests: barium swallow, bronchoscopy
Management: feed upright, cereal
added, antacids, head elevated
surgery- nissen fundoplication
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..
Pyloric stenosis


Tests: ultrasound, barium swallow
Management: ng to empty stomach, iv
fluids, pyloromyotomy-release
obstruction
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
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
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
Dehydration



Manifestations: weight loss, decreased
urine output, sunken fontanels, no
tears, low bp, rapid respirations….
Weigh diapers and count, iv fluid, i&o,
electrolytes, daily weight
Fluids and electrolyte replacement
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
Diarrhea





Management:
Npo, iv solution -- in 24 hours begin
pedialyte, gatorade
Antibiotics as needed
brat diet=banana, rice cereal,
applesauce, toast
I&o, electrolytes, stool for c difficile,
cbc, ova and parasites
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..
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
Hirschsprung’s 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
Hirschsprung’s



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…
Hernias




Protrusion of a portion of an organ
through a structural defect
Complication: circulation to organ
impaired
Incarcerated=cannot be reduced
Strangulated=circulation impaired
Hernias




Types: diaphragmatic=protrusion of
stomach through part of diaphragm
Hiatal=protrusion of stomach through
esophageal opening in diaphragm
Inguinal=protrusion of organ through
inguinal ring
Umbilical=protrusion of intestine
through weak abd wall
Hernias



Manifestation: buldging sac
Management: most have surgical repair
Inguinal may have scrotal truss or
surgical repair
Urinary




Define:
Hypospadia=urethral opening along
ventral surface of shaft
Epispadia=urethralopening along dorsal
surface of shaft
Phimosis=narrowing of opening of
foreskin
Urinary..


Hydrocele=fluid in scrotal sac
Cryptorchidism=failure of one or both
testes to descend into scrotum
Wilm’s 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
Wilm;S



Manifestations:
Asymptomatic enlarging abdominal
mass, abd pain, hematuria, fever,
hypertension, weight loss, fatigue
Metastasis: liver, lungs, lymph nodes,
brain, bone
Wilm’s



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
Wilm;S

Post operative : monitor vs, renal
output, bowel sounds,parents feelings
regarding diagnosis, avoid contact
sports, prompt treatment of
geniturinary symptoms
Hypothyroid




Hypothyroid to decreased production of
thyroid hormone
By thyroid gland
Patho: congenital or acquired
Insufficient stimulation of gland or
systemic resistance to hormone
Hypothyroid




Manifestations:
Lethargy, poor appetite, dyspnea,
hypothermia, delayed growth, dry skin,
constipation, mental slowness
Management:
Thyroid hormone replacement
Hyperthyroid




Patho: autoimmune, unknown etiology
Manifestations: nervousness, tremors,
irritability, hypertension, tachycardia,
Tachpnea, heat intolerance
Tests: tsh, t3, t4, radioactive iodine
uptake
Hyperthyroid




Management:
Antithyroid medication: propylthioracil,
tapazole…
Subtotal thyroidectomy…
Post-op: monitor breathing, bleeding,
calcium levels, head elevated, trach tray
at bedside
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
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
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
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
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
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…
Septic arthritis



Infection of a joint
From bacteria or existing osteomylitis,
bites from human, cat, dog, rat, tick..
Infection causes damage to synovial
membrane, synovial fluid increases, pus
breaks down cartilage=permanent
damage
Septic arthritis




Infants= found in both girls and boys
Adolescent=more in males
Joints=hip, knee, shoulder, wrist, ankle
Organisms: b streptococcus, gram
negative enterics h influenza, staph
aureus..
Septic arthritis



Manifestations: pain, warmth, edema,
redness of joint
Fever, occurs rapidly and is an
emergency
Tests: x-ray, aspiration of joint, c&s of
fluid, blood culture, cbc, elevated esr
Septic arthritis


Management: surgical aspiration and
drainage of joint, iv therapy, iv
antibiotics for 10-14 days, then oral
antibiotics for 4 weeks
Long term disability can develop
Meningitis



Definition: infection of meninges
Most cases in children under 5 years
Etiology: bacterial, viral, fungus,
haemophilis influenza
Meningitis


Inflammation of meninges causes
inflammation and thick exudate and
wbc accumulation…cfs becomes
occluded and brain becomes edematous
Manifestations: fever, vomiting,
photophobia, stiffness in neck when
flexed
Meningitis





High pitched cry, kernig sign, brudzinski sign,
poor feeding..
Cs fluid… cloudy
Tests: c&s of spinal fluid, lumbar tap
management:
Iv fluid, antibiotics for 10 days, isolation, rest,
vs, i&o, decrease stimuli
Monitor for: seizure, pupil reaction, change in
loc
Encephalitis



Definition: inflammation of brain and
spinal cord
Etiology: bacteria, viral, fungi, protozoa,
spirochetes…
Manifestations: malaise, fever,
headache, dizziness, nuchal rigidity,
nause, vomiting, ataxia, tremors,
seizures, coma..
Encephalitis


Tests: serology, csf culture
Management: hospitalization, hydration,
nutrition, vs, medication, i&o,
neurological status
Hydrocephalus



Excess fluid in the cranial vault
subarachnoid space or both
Can obstruct the ventricle system
Congenital or acquired—related to
meningitis, tumor, hemorrhage
Hydrocephalus


Cfs fluid accumulates in cranium and
brain is compressed creating increased
intracranial pressure
When hydrocephalus occurs before the
fusion of cranial sutures, the skull
becomes enlarged
Hydrocephalus

Manifestations: increased head
circumference, bulging fontanel, poor
feeding,sluggish, high pitched cry,
depressed eyes with sun sign (sclera
seen above iris) lethargy, slow pupil
response to light
Hydrocephalus




Tests: head crcumfrance, mri, ct
Management: reduce accumulation of fluid
Ventriculoperitoneal shunt =from ventricle to
peritoneal cavity to drain fluid from ventricle
and place into body fliud
Post op care: place on nonoperatiave side,
small feedings…
Hydrocephalus



Place on side after feeding
Observe for intracranial pressure,
sheepskin under head
Monitor vs, vomiting, swelling along
shunt tract, dressing for glucose..
Cerebralspinal fluid makes a halo on
gauze when glucose is present…
Cerebral palsy



Most common permanent disability in
childhood
Affects visual, intellectual, language,
neurological, motor dysfunction
etiology:
Infection, maternal drug use, birth
trauma, anoxia, anesthesia during labor,
head trauma..
Cerebral palsy


Manifestations:
Delayed motor development, arching of
back, hearing and/or vision impairment,
poor feeding/sucking, hypertonic
muscles, developmental disabilities…
Cerebral palsy



Management: botox for spacticity,
baclofen..
Corrective orthotic equipment, braces,
casts, wheelchair, protective headgear,
wheeled scooters, walkers,
Stretching exercises, special classes,
encourage independence
Seizures




Definition: sudden, disorderly discharge
of electrical impulses from neurons
No known cause-idiopathic
Some from trauma, tumors, toxins,
poisons, fever
Child most prone from birth to 2 years
Seizures



Management: prevent from injury,
airway , id
Reduce fever, eeg, medication as:
dilantin, tegretol, depakote, cerebryx,
phenobarbital
Others: neurontin, lamicatal, felbatol
Meyelomenigocele



Spina bifida failure of neural tube to
close
Etiology: folic acid deficiency during
pregnancy, malnutrition
Manifestations: absence of sensory and
motor function beyond the defect
flaccid paralysis, bowel and bladder
incontinence, clubfoot, subluxated hip..
Meyelomenigocele




Tests: alpha-fetoprotein afp, ct
Management: surgery to replace neural
contents in the sac ..
Vp shunt for hydrocephalus, surgery for
hip and extremity deformities
Preop: position on abd, cover sac with
saline soaked gauze..
Meyelomenigocele



Protect sac from feces/urine
Post op: position on abd for 10-14 days,
monitor vs, watch for bleeding or
infection
Long term concerns: motor movement,
bladder and bowel control, urinary tract
infection, pulmonary infections
Neonatal abstinence syndrome



Opiod withdrawl of infant
Manifestations: irritability, feeding problems,
sleep problems, tremors, seizures…can
persist for 3-4 months
Management: urine tested for substance,
tightly swaddled, decrease light and
stimuli,i&o, vs, pacifier referred to
intervention program due to potential
neurological deficits
Neuroblastoma




Malignant tumor of the cells that give
rise to sympathetic ganglia
Most in children under 2 years
70% have metastasis at diagnosis
Manifestations: palpable, firm mass at
midline of abdomen
Neuroblastoma


Anorexia, bowlel and bladder alteration,
if in chest=dyspnea, dificulty
swallowing,neck and face edema
Tests: ct, bone scan, mri, abd
ultrasound, bone marrow aspiration,
biopsy, urine for catecholamines
Neuroblastoma


Management: surgery, radiation,
chemotherapy
The younger the diagnosis the bettter
the survival rates
Lead poisoning



Most common preventable problem in
children in us
Lead poisoning=blood level over
10mg/dl
Etiology: inhaled, ingested, lead-based
paint, caulking chips, lead contaminated
soil or dust
Lead poisoning


Manifestations: anemia, anorexia,
learning disability, decreased attention
span, hearing deficits, growth and
development failure, pica
Tests: x-ray of abdomen, x-ray of long
bones, ua for proteinuria, keytonuria,
glycosuria to kidney damage
Lead poisoning




Management: chelation therapy
Prevent future exposure to lead
High levels: lead encephalopathy
Cognitive impairment, behavior changes
seizures..
Diaper dermatitis


Contact dermatitis often due to
prolonged exposure to feces, urine,
inadequate cleaning of diaper area
Manifestations: erythematous papular
lesion on buttock, labia, scrotum, inner
thighs
Diaper dermatitis


Management: keep area clean and dry
desitin, a&d ointment zinc oxide
Expose area to air several times a day
Atopic dermatitis




Eczema
Pruritic allergic response or allergy
Family history of allergy, asthma,
allergic rhinitis
Cause unknown
Atopic dermatitis



Manifestations: erythema, vesicles,
papules that ooze and crust on cheeks,
scalp, trunk..
Affected skin dry and pruritis intense
Tests: skin testing, history of allergy
Atopic dermatitis


Management: hydration of skin,
decrease inflammation, prevent
infection
Tepid bath, lotion, topical steroid cream,
oral antihistamines,burow’s solution,
corstarch added to bath, neutrogena
soap..
Seborrheic dermatitis




Cradle cap
Chronic inflammatory reaction of skin in
infancy
etiology: unknown
Manifestation: scalp thick, white,
yellow, crusty, scaly patches, mild
pruritis
Seborrheic dermatitis


Management: patches removed by
mineral oil and shampoo daily
Hair brush with soft brush
antiseborrheic shampoo or topical
corticosteroids can be used
Psoriasis




Proliferation os skin disorder
Manifestations: thick, scaly patches and
inflammation
Remission and exacerbations
Humifiers help in winter
Candidiasis





Thrush etiology: candidia albicans
Etiology: contaminated nipples,
pacifiers, hands
Manifestations: white or whitish yellow
lesions in infected area..Mouth, gi
tract..
Management: nystatin oral or cream
Fluconazole….
Otitis media



Common in age 2-6 year after upper
resp infection
Manifectations: fever, rhinitis, irritability,
pulling rubbing affected ear..
Management: antibiotics for 10 days
..Tympanostomy tubes can be in place
6 months before being spontaneously
rejected
Refractory errors




Light rays bent and fall infront or
behind retina
Myopia-nearsighted
Hyperopia-farsighted
Management: corrective lenses and
screening
Strabismus



Lack of coordination in extraocular
muscle results in cross eyed appearance
Congenital or paralysis of muscle
Manifestations: squinting, tilt head to
block out image, closing one eye
Strabismus



Management: patching the stronger eye
a few hours a day
Surgical correction
If untreated: amblyopia can develop if
untreated
Preorbital cellulitis



Inflammation of eyelid and periorbital
area
Manifestations: pain, tendrness, fever,
erythema, headache, purulent nasal
drainage
Management: iv antibiotics,
antipyretics, analgesics