1. STREPTOCOCCAL -GAHBS -Inflammation of Throat -swab and culture A. Meds: PHARYNGITIS -Pain on swallowing throat -Antibiotics (Amox or Pen G) -> Toothbrush (STREP THROAT) -High grade Fever should be replaced after starting antibiotics -Headache -Antipiretics -Swollen lymph nodes B. Diet: Fluids, Soft diet, Avoid Spicy food and -swollen red tonsils w/ pus acid juices. Gargle with warm water 2. TONSILITIS -viral/bacterial - Inflammation of Palatine A. Meds: TONSILS -Antibiotics (Amox or Pen G) -> Toothbrush -Difficulty swallowing should be replaced after starting antibiotics -Fever, lethargy -Antipiretics -Mouth breathing B. Surgery -Halitosis -TONSILECTOMY -Sleep Apnea -Post Op: WOF BLEEDING (FREQUENT SwaLLOWing or Clearing of THROAT) 3. FOREIGN BODY ASPIRATION -Inhalation of -CHOCKING, Coughing, -Xray REMOVE OBJECT foreign objects dyspnea, hoarseness, stridor -Bronchoscopy -HEIMLICH MANNEUVER (>1y.o) -CYANOSIS, infection-> -Fluoroscopy -5 Back blows/slaps & 5 chest thrusts (<1y.o) Death 4. EPIGLOTITIS -H.Influenzae -Dysphagia, Dysphonia -CBC (Leukocytosis) A. Meds: type B -Drooling, Distressed respi -Elevated c reactive -Antibiotics (Chloramphenicol, co- (Pneumococci, effort CHON amoxiclav,cefotoxime, cefuroxime) streptococci, -High fever -Culture of epiglottis, -Steroids (DEXAmetahSONE) staphylococci) -Sore throat -Neck Xray B. EMERGENCY Tx: INTUBATION & preparation -Inspiratory Stridor of poss tracheostomy -TRIPOD POSITION C. Nsg Care: -Moist Air- O2 humidified -Hydration -NO VISUAL INSPECTION, INVASIVE POCEDURE, ANXIETY-PROVOKING activity
5. LARYNGOTRACHEO- -Infectious -Inflammation & Narrowing -CBC A. Meds:
BRONCHITIS CROUP of Larynx, tranchea & -Neck Xray -Oral Steroids (DEXAmethaSONE) -Parainfluenza bronchi -Epinephrine (via Neb) -RSV (VIRUS) -Hacking/Barking cough- B. Nsg Care: -0-5 y.o worse at Night -Monitor V/S, avoid anxiety-> may ET insertion -1-2 y.o-peak -Hoarse voice, sore throat -STEAM INHALATION (cool mist humidifier or -fever, n/v, poor appetite hot water steam 6. ASTHMA -Hypersensitivity -Dyspnea, wheezing, -Identify Allergy A. Peak Flow Rate Response frightened Exhausted -Pulse Oximeter -Green Zone (80-100%): No asthma sx -Genetics -Peak Flow Meter -YELLOW Zone (50-80%)- contact AP -RED ZONE (<50%)-> MEDS-> Contact AP B. Meds: 1. Reliever-> Bronchodilator-> Ventolin/ Albuterole, Theophylline, Comolyn Na) 2. Anti-Inflamatory-> Glucocorticoids ( *Inhalation- Budesonide, fluticasone *Oral/IV- Hydrocortisone, Dexamethasone 3. Combi Drugs C. Nsg Care: -ORTHOPNEIC position 7. STATUS ASTHMATICUS -Progression of -INC HR & RR A. Meds: attack-> -DEC BREATH SOUNDS -Continue Reliver meds Unresponsive to (SILENT CHEST) -IV steroids therapy -Cyanosis B. Emergency Care: ET -Allergens C. Nsg Care: Asist ET 8. SUDDEN INFANT DEATH -CRIB DEATH -Sudden Death A. Prevention SYNDROME (SIDS) -1mos-1y.o. -M. Risk Factors-> poor -SUPINE Position -2-4mos- peaks lifestyle -Avoid exposure to smoke -Sleeping on -NB Risk Factors: cyanosis, -Own Sleeping environments- NO quilts, PRONE position tachycardia, resp d/o, blankets, pillows hypothermia, poor feeding B. Psychological assistance to parents 9. RESPIRATORY DISTRESS -PRETERM at Risk -INC RR, CHEST -ABG A. Surfactant Replacement (ET Tube) SYNDROME (RDS) RETRACTIONS, EXPIRATORY -XRAY -O2 ventilation GRUNT -< Lecithin/- -supportive care -cyanosis, hypothermia Sphingomyelin ratio (Normal- 2:1) CARDIOVASCULAR DISORDERS
ACYANOTIC Disorder Cause S/Sx Management
1. ATRIAL SEPTAL -Opening between ATRIA -dyspnea, fatigue, failure to thrive A. Surgery (closure) – 1-3y.o. DEFECT (ASD) -FO did not close -SPLIT S2 (2nd intercostal space LSB- pulmonic -Dacron Patch -FEMALES valve) -Open Heart surgery B. Nsg. Care -Complications: Left untreated-> endocarditis-> leads to HEART FAILURE -Post-OP: -Monitor ARRYTHMIA, Administer Antibiotics 2. VENTRICULAR -Ventricular septum -dyspnea, fatigue, failure to thrive, respi infxn -SAME with ASD SEPTAL DEFECT (VSD) opening -PANSYSTOLIC MURMUR (L; 2nd ICS) -MOST COMMON 3. PATENT DUCTUS -Descending Aorta to -CLUBBING, dyspnea, -SAME with ASD ARTERIOSUS (PDA) pulmo artery -LOUD “MACHINERY MURMUR” (-2nd-3rd ICS) -Premature -Maternal rubella -FEMALES CYANOTIC Disorder Cause S/Sx Management 1. TETRALOGY OF PROV -dyspnea, fatigue, failure to thrive, systolic murmur A. Surgery (closure) – 1-2y.o. FALLOT (TOF) -Pulmonary stenosis -Polycythemia, Tet spells- CYANOTIC SPELLS-> -Blalock-Taussig Shunt- Anastomose subclavian -Right Vent hypertrophy cyanosis during stressful or painful procedures art and pulmo while waiting for reparative -Overriding Aorta surgery -Ventricular Septal Defect **Post-op -Monitor Arrythmia, Avoid BP and Venipuncture in Rt ARM B. Nsg Care -Complications: Left untreated-> leads to THROMBOEMBOLISM, CVA -O2-> KNEE-CHEST POSITION, SQUATTING 2. TRANSPOSITION OF -Transposed Aorta -Cyanosis, murmurs A. Surgery -1wk-3mos GREAT VESSELS (TOG) -Transposed pulmo artery -Baloon catheter to create artificial ASD -MALE or Large babies (9- -(Arterial Switch Procedure- JATENE Procedure) 10lbs) 3. TOTAL ANOMALOUS -Pulmonary v. drain -Cyanosis, Fatigue A. Surgery PULMONARY VENOUS to SVC or R atrium PGE, surgery (re-implant pulmoveins to L RETURN (TPV) -PDA or foramen atrium) ovale essential 4. COARCTATION OF Constriction of -asymptomatic HPN, irritability, headache, A. Surgery- 2y.o AORTA (COA) descending epistaxis, dyspnea, leg claudication, higher BP in -Angiography and surgery aorta upper extremities, dec femoral and distal pulses -Post-op- Monitor ABD PAIN, INC BP -MALE B. Nsg Care -Complications: Left untreated-> leads to chronic HPN, CVA OTHER Disorder Cause S/Sx Management 1. KAWASAKI DSE/ -Rare childhood disease -Spiking fever x 5 days, A. Diagnostic- clinical only as it can’t be seen in MUCOCUTANEOS that affects the -bilateral conjunctivitis, reddened pharynx, blood and urine LYMPH NODE blood vessels -dry lips, strawberry tongue, B. Complications- May lead to ANEURYSM and SYNDROME (inflammation) -cervical lymphadenopathy, peripheral edema, MI -before puberty, peaks erythema and desquamation, truncal rash B. Meds: Salicylates(Aspirin) and IV 4y.o. Immunoglobulins C. Nsg Care: -Monitor for HF-> dec urine output, tachy, dob -LIVE VACCINES (Varicella, MMR)- >should be delayed up to 11mos after IV Immunoglobulins administration 2. RHEUMATIC FEVER -Autoimmune-> GABHS DIAGNOSTIC S/SX: A. Meds: (1-3wks after untreated -Salicylate infxn) 5 MAJOR CRITERIA (JONES CRITERIA) -Corticosteroid -6-15 y.o. peaks 8 y.o 1. J-oints- POLYARTHRITIS -Antibiotics (Benzathine, penicillin) 2. H-eart()-CARDITIS -Ibuprofen 3. N-odules- subcutaneous nodule -Digoxin 4. E- rytHema marginatum -Phenobarbital 5. S- Sydenham’s chorea (St. Vitu’s Dance) -Diazepam B. Nsg Care 6 MINOR CRITERIA -Prevent further Infection 1. Fever 2. Polyarthralgia 3. History of RF 4. INC ESR 5. Antecedent STREP infection 6. Prolonged PR interval (1st degree Heartblock)