Pedia Notes POISONING- common in toddlers. (falls- common to infant) 1. determine substance taken, assess LOC 2.

unless poison is corrosive, caustic (strong alkali such as lye) or a hydrocarbon, vomiting is the most effective way to remove poison.

Give syrup 1 pecac to induce vomiting

1. 1 pecac – oral emetic
• •

15 ml – adolescent, school age & pre school 10 ml to infant

1. 2. 3. 4.

UNIVERSAL ANTIDOTE- charcoal, milk of magnesia & burned toast Never adm charcoal before 1 pecac antidote for acetaminophen poisoning – acetylsysterine ( mucomyst) caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit prepare tracheostomy set 5. Gas- mineral oil will coat intestine Lead poisoning Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning Accumulation of anemia = Encepalopathy Sx: 1. beginning sx of lethargy 2. impulsiveness, learning difficulties 3. as lead increases, severe encepalopathy with seizure and permanent mental retardation Dx: 1. Blood smear 2. abd x ray 3. long bones Mgt: 1. remove child from source 2. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney

=nephrotoxic Amogenital Female: Pseudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood – rape/ child abuse
Rape- Report within 48 h Shape pubic hair in inverted triangle ( female) Male: Undescended testes – cyrptorchidism -common to preterm surgery – orchidopexy assess scrotum- warm room & hands baby – pee within 24 h -check for arch of urination Epispadias- urinary meatus located dorsal or above glans penis Hypospadias- urinary meauts loc ventral or below glans penis Hypospadias with chordee- fibrous band causing penis to curb downward Mgt: Surgery Phimosis- tight foreskin Balanitis-infection of glands penis – due smegma Mgt: Circusicion Hydroseal – fld filled scrotum Tst of Dx: Transillumination with use of flashlight - glowing sign

Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)

Renal Disorder NEPHROTIC SYNDROME

Cause infectious

Sx 1. 2. 3. 4. 5. 6. 7. Anasarcagen edema massive protenuria microscopic or no hematuria serum CHON decreased serum lipid increased fatigue normal or decreased BP (PPP) primary peripheral periobital edema moderate protenuria gross hematuria ( smokey urine) serum K increased fatigue increase BP

Tx Prednisone Diuretic

NSG CARE Focus of care: monitor edema • weigh daily

Diet: Increase CHON Increase K- OJ, beef broth, banana Decrease Na

AGN ( acute Glomerulo Nephritis) 3A’s; AGN, autoimmune, Grp A

Autoimmune Grp A beta hemolytic streptococcus

1.

1. anti HPN drug hydralazine or apresoline 2. iron

1. weigh daily 2. monitor BP & neurologiuc status 3. Diet: decrease K, decrease Na

2. 3.

4. 5. 6. Complication : 1.

hypersensive encephalopathy anemia

2. BACK- check for flatness & symmetry

Open Neural Tube Defect- decreased Folic Acid intake SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to fuse

Sx: dimpling of back , Abnormal tufts of hair SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac Types: 1. Meningocele – protrusion of CSF & Meninges 2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most dangerous) 3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele or myelomeningocele Most common problem • • • rupture of sac prone pos sterile wet dressing

Most common complication - infection Myelomeningocele – genitourinary complication- urinary & fecal incontinence Nsg care: always check diaper Orthopedic complication – paralysis of lower extremities Surgery to prevent infection Post op – prone position SCOLIOSIS- lateral curvature of the spine 2 types: 1. structural – rye neck 2. postural – improper posture

Dx: 1. 2. uneven hemline bend forward- 1 hip higher 1 shoulder blade more prominent Nsg care:

1. conservative – avoid obesity, exercise 2. preventive – Milwaukee brace - worn 23 h a day 3. corrective surgery – insert Harrington rod post op- how to move log rolling- move client as 1 unit EXTREMITIES: check # of digits = 20 1. 2. 3. 4. 5. syndactyly – webbing of digits polydactyly – extra digits olidactyly – lack of digits Amelia – total absence of digits pocoamelia- absence of distal part of extremities

ErQ duchennes – paralysis- brachial plexus injury or brachial palsy • Sx: 1. 2. Mgt: 1. abduct arm from shoulders with elbow flex. unable to abduct arms from shoulders, rotate arm externally or supinate forearm absence or asymetrical moro reflex birth injury caused by lateral & excessive traction during a breech injury

CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum Types; 1. 2. Sx: 1. 2. 3. 4. 5. shortening of affected leg asymmetrical gluteal fold limited movement – earliest sx (+) ortolanis sign – abnormal clicking sound when able to walk – child limps – late sx- trendelenburg sign subluxated – most common type dislocated

Goal of Mgt: Facilitate abduction

Mgt. 1. 2. 3. 4. 5. triple diaper carry baby astride Frejka splint Pavlik harness Hip Spica Cast

TALIPES – "clubfoot" a. b. c. d. Equinos – plantar flexion – horsefoot Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior leg Varus- foot turns in Valgus- foot turns out

Equino varus- most common Assessment: 1. Straighten legs & flexing them at midline pos

Mgt: 1. Corrective shoe- Dennis brown shoe, spica cast Fx: of cast – - to immobilize • • bone alignment prevent muscle spasm

lead pencil – mark area to be amputated cold H20 – hasten setting process hot H20- slow setting process After cast application – how to move pt: - use open palm not fingers- fingers will cause indention • • dry cast – natural air not blower priority check : neurovascular check

C- circulation M- motion S- sensation

Cast – with bleeding - mask with ball pen edge of blood to know if bleeding is on going sign cast is dry = resonant sound, cast cold to touch do petaline – making rough surface of cast smooth CRUTCHES Fx: To maintain balance • To support weakened leg

Principles in crutches • • • wt of body on palm! Brachial pulsing – if wt of body in axila Do palm exercise- squeeze ball

Different crutch Gaits: 1. 2. • 1. Swing Through Swing to no weight bearing are allowed into lower ext Three point Gait - wt bearing is allowed in 1 ext 2. 3. Four point gait Two point Gait - wt bearing allowed in 2 lower ext

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