PEDIATRIC NOTES

MANAGEMENT:
NEUROLGIC DISORDERS OF THE PEDIA a) Position: Semi fowler’s
1. Increased ICP (intracranial pressure) (dec. ICP = gravity)
NV: 5-15mmHg b) Coughing and sneezing is
-Cushing’s Triad: (hepertension, avoided
c) Limit fluid intake: (1,200-
bradycardia, bradypnea)
1500ml/day)
(heper,brady,brady)
1)Na= water fallows
-Widened pulse pressure
2)Inc. fluid =
120/80 (minus) =40 inc.pressure
Normal PR: 30-40 d) Pharmacotherapy:
1)Diuretics:
S/SX: -Lasix (loop
-Bulging fontanels: aggravated by crying diuretic > loop
(2: infants) of henle)
+anterior (diamond in shape: function:
BIG) 12-18 mos before it closed localized
+posterior (triangular: 2-3 mons -Mannitol
before it closed) (osmosis>pullin
g pressure)
-high pitched cry: early sign of increase function:
ICP generalized
NOTE: Ealy S/sx of ICP 2)Decadron
a) Infant: high pitched cry (Dexamethasone):
b)Child: irritability/agitation cerebral edema
c)Adult: restlessness
d)Geria: confusion 3)Anti-convulsants:
prevent seizures
-increased head circumference
NOTE: should have in bedside 4) Antacids
+tape measure (a)Magnesium:
diarrhea (Mg TAE)
-headache: initial sign (b)Aluminum:
constipation
-projectile vomiting: compress medulla (AL ANG TAE)
>CTZ (chemoreceptor trigger zone:
vomiting center) >cerebral edema 5)Anticoagulants:
prevent blood clumping
-diplopia (double vision): inc. ICP= inc (a)heparin – IV/subQ
IOP resulting to optic nerve edema > (partial
blurring of vision > blindness thromboplastine time)
(b)warfarin – Oral (pro
-pupillary changes: PERLLA (pupil thrombine time)
equally round and reactive to light and
accommodation) NOTE: Remember: Opiates and sedatives are C/I
(3) pupillary in inc. ICP (respiratory and cardiac depression)
a) anisocoria – uneven pupils >
brain damage 2. Seizure Disorder/ Epilepsy
b) dilated - shock -erratic transmission
c) constricted – narcotic
overdose Types of Seizures
1)Grand Mal (Generalized)
-sunset eyes a)Tonic (mild) Clonic (severe) –
“during” – dyspnea, salivation,
-anorexia, nausea, weight loss urination (flat/supine>protect
the head)
-seizures: 2reason b)Post ictal (exhaustion) –
a) inc neuronal impulses > “after” (side lying/recovery)
erratic transmission> seizures
b)vomiting >dec fluid levels 2)Petite Mal/Absent
>DHN >inc temp. >convulsions +blank facial expression,
(seizures) automatisms, lip smacking
3)Jacksonian
 -tonic clonic of a group muscle a)Antibiotics > finish the duration, =
> grand mal presence resistance (any antibiotics)
4)Psychomotor
-mental clouding/intoxication
5)Febrile
4. Head Trauma
-under 5yr/old
-hyperpyrexia>38.5>39>40C 1)Concussion = jarring of head, forceful
6)Status Epilepticus contact in a rigid skull > transient loss of
-30 mins will last consciousness.
-brain damage>emergency
2)Contusion = Bruising: structural
MANAGEMENT: alteration > extravasation of blood
(a)Hydantoin: Phenytoin
WOF (watch our for): MANAGEMENT
gingival hyperplasia (use soft bristled a)Safety = bike helmets, seatbelts, safe
toothbrush/meticulous oral care),
driving, proper usage of infant
pinkish red urine (inform SO)
car seat.
(b)benzodiazepines: pam/lam
>minimizes seizure episodes > 3y/o: rear facing (adequate
(c)iminostilbines: carbamazepine support to the spine)
(refractory seizures to prevent seizure
reoccurence) >3y/o: front facing booster seat
(d)valproates: valproic acid (last resort)
-hepatotoxicity b)Assess cerebral functioning: GCS,
-never given in pregnancy: PERRLA
Nural tube defect (NTD) *LOC: most important prognostic
(e)Surgery
indicator
-Neurectomy: surgical resection
of the cranial nerve involve in c)Assess for cervical injury
the seizure
(+)immobilize: prevent further
3. Bacterial Meningitis damage
-inflammation of the meninges
(-)HOBE (head of the bed
(supports and nourishes the brain)
elevated) >dec. ICP =
DIAGNOSTICS: gravity
(a)lumbar puncture: L3-4-5
Position: C-shape
Fetal
Knee-chest: genupectoral
CSF sample:
Normal (CLEAR)
CSF analysis: meningitis
-cloudy
-elevated WBC
-elevated CHON-protein (by
product)
S/SX

a) Kernig/s: K (nee) > Flex > pain in the

hamstring, back neck = (+)

b) Brudzinski: B (atok)/nape > pain in the neck

back = (+)

c) Nuchal regidity: stiff neck

d) Seizure

e) Opisthotunus - arching of the back

Position: side lying

MANAGEMENT
PEDIATRIC CARDIOVASCULAR DISORDERS 2. Septal Defect

Layers of the Heart A. ASD (Atrial Septal Defect)

-endocardium: innermost layer -10% CHD

B. VSD (Ventricular Septal Defect)
-myocardium: muscle>contract>cardiac
output (tse perfusion) -20% CHD

-pericardium: S/SX

*Visceral: inner a) poor feeding > fatigue

-pericardial b) Dyspnea on exertion >activity intolerance

c) Failure to thrive (delayed milestones)

space>pericardial fluid
(prevent fluid) d) S/sx of heart failure
*Parietal:outer MANAGEMENT
Chamber of the Heart -Dacron Patch (bypass)
-4 chamber of the heart *tissue: dec. Rejection rate

*plastic: inc. Rejection rate

3. Coarctation of Aorta

-narrowing of the aorta (descending)

-inc. Pressure. Dec. Output

S/SX
2 Pediatric Cardiovascular Disorders

(1)Acyanotic: absent of cyanosis, 1

problem only

(2)Cyanotic: present of cyanosis, 2 or

more problems

Acyanotic Congenital Heart Defect

1. Patent Ductus Arteriosus (PDA) *Ribnotching - older chidren (bad sig,

the aorta will be high)
-acyanotic
MANAGEMENT

a)Balloon Angioplasty With Coronary

S/SX Stenting
a)machinery like murmur -staffold>support>mesh
(pathognomic/hallmark)
Cyanotic Congenital Heart Defect
b)s/sx of heart failure
1) Tetralogy of Fallot
c)poor feeding>fatigue

d)weight loss

-6mos: double birth weight

-12mos: triple birth weight

d)irritablity: cerebra; hypoxia

MANAGEMENT

DOC: indomethacin: facilitates closures

of PDA
Heart failure