Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for the ‘Semester III’ Category

Classifications of Defects in Pediatrics

Posted by Laura on November 20, 2010

Acyanotic (Traditional)

Defects increasing pulmonary blood flow:

  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Patent Ductus Arteriosus
  • Atrioventricular Canal

Obstructive Defects:

  • Aortic Stenosis
  • Pulmonary Stenosis
  • Coarction of Aorta

Cyanotic (Traditional)

Defects decreasing pulmonary blood flow:

  • Tetralogy of Fallot
  • Tricuspid Atresia

Mixed Blood Flow:

  • Transposition of the Great Vessels
  • Total Anomalous Pulmonary Venous Return
  • Truncus Arteriosus
  • Hypoplastic Left Heart Syndrome

 

Hemodynamic Characteristics Classification ♥

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Weekly Reading

Posted by Laura on November 19, 2010

Week 6 Reading 231


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Seasonal URIs

Posted by Laura on November 16, 2010

Seasonal variation of selected upper respiratory tract infection pathogens. PIV is parainfluenza virus, RSV is respiratory syncytial virus, MPV is metapneumovirus, and Group A Strept is group A streptococcal disease.

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OM

Posted by Laura on November 15, 2010

OM – Otitis Media: inflammation of middle ear w/o reference to etiology or pathogenesis

AOM – Acute Otitis Media: above w/ rapid onset of s/s: fever, ear pain

Otalgia – ear pain

OME – Otitis Media with Effusion: fluid in middle ear space w/o symptoms of acute infection

COME – Chronic Otitis Media with Effusion: middle ear effusion persisting > 3 months

Otorrhea – purulent discharge

1st line medication: PO amoxicillin

2nd line medicaiton: amoxicillin-clavulanate; azithoromycin and cephalosporins: cefdinir, cefuroxime, and cefpodoxime.

3rd line medication: ceftriaxone – painful at IM site

Antihistamines & decongestants are not recommended.

Antibiotic ear drops have no value in Tx AOM

(Wong’s Essentials of Pediatric Nursing)

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Asthma Drug Therapy

Posted by Laura on November 15, 2010

Asthma – Drug Therapy

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From Tabers: Why shouldn’t you give Aspirin to a child who has viral symptoms?

Posted by Laura on November 15, 2010

Reye’s syndrome

[R. D. K. Reye, Australian pathologist, 1912–1977]
A syndrome marked by acute encephalopathy and fatty infiltration of the liver and often of the pancreas, heart, kidney, spleen, and lymph nodes.
It is seen primarily in children under age 18, after an acute viral infection such as chickenpox or influenza. The mortality rate depends on the severity of the central nervous system involvement but may be as high as 80%. Fortunately, the disease occurs rarely. The cause of the disease is unknown, but association with increased use of aspirin and other salicylates is evident from epidemiological studies.
See: Nursing Diagnoses Appendix

SYMPTOMS
The patient experiences a viral infection with a brief recovery period, followed in about 1 to 3 days by severe nausea and vomiting, a change in mental status (disorientation, agitation, coma, seizures), and hepatomegaly without jaundice in 40% of cases. The disease should be suspected in any child with acute onset of encephalopathy, nausea and vomiting, or altered liver function, esp. after a recent illness. The severity of the syndrome depends on how badly the brain swells during the illness, reflected in increased intracranial pressure (ICP).

Aspirin and other salicylates should not be used for any reason in treating children under age 18 with viral infections.

TREATMENT
Supportive care includes intravenous administration of fluids and electrolytes, administration of corticosteroids, and ventilatory assistance. Electrolytes should be controlled carefully, along with serum glucose and ammonia levels, and neurological status.

PATIENT CARE
Increased ICP resulting from increased cerebral blood volume results in intracranial hypertension. To decrease intracranial pressure and cerebral edema, fluids are provided at 2/3 maintenance level and an osmotic diuretic or furosemide is prescribed. The head of the bed is kept at a 30-degree angle. Fluid intake should maintain urine output at 1.0 ml/kg/hour, plasma osmolality at 290 mOsm (normal to high), and blood glucose at 150 mg/ml (high), while preventing fluid overload. Proteins are restricted to keep ammonia levels low. Hypoprothrombinemia (resulting from liver injury) is treated with vitamin K, or fresh frozen plasma if needed. Temperature is monitored, and prescribed measures to alleviate hyperthermia are instituted. Seizure precautions are also instituted. Intake and output are monitored carefully. The patient is observed for evidence of impaired hepatic function, such as signs of bleeding or encephalopathy. All treatments are explained to parents and support is provided to them. The National Reye’s Syndrome Foundation provides information and support.

 

All material is from Tabers at: http://www.tabers.com/tabersonline/ub/view/Tabers/143910/24/Reye%27s_syndrome

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Formal Operations

Posted by Laura on November 15, 2010

Adolescent

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7 Toddler Tasks

Posted by Laura on November 14, 2010

click here for an .pdf

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Weekly Reading

Posted by Laura on November 10, 2010

Week 5 Reading 231

updated 111210

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Oxygen Therapy

Posted by Laura on November 9, 2010

Oxygen Therapy

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Pediatric Med Cards

Posted by Laura on November 3, 2010

These medications cards are for Pediatrics and some are specific by route. Information on them is gathered from Davis Drug Guide, Harriet Lane, and the Pediatric Injectable Drugs – Teddy Bear Book. This is just the grouping of my readings, and is not an official drug use guide. If you have any questions, please ask your Nurse, teacher, doctor….. If you see an error – please let me know!

Pediatric Drug Cards

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Weekly Reading

Posted by Laura on November 3, 2010

Week 4 Reading 231

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Holliday-Segar

Posted by Laura on November 2, 2010

If a baby is at 9kg, what is the fluid maintenance requirement needed in a day, and what would you set the rate on the pump to be?

100mL/kg for first 10 kg  = 900mL

50mL/kg for 2nd 20 kg = 0

20mL/kg for remainder of wt in kg = 0

Total for this example = 900mL in a day

1000mL divided by 24 hrs = 37.5 mL/hr

(A shorter way to see this: For the first 10 kg of weight, give 100 mL/kg fluid.  For 11-20 kg, give 1000 mL + 50 mL/kg for each kg over 10 kg. For a child over 20kg, give 1500mL + 20mL/kg for each kg over 20 kg)

Maintenance requirements for water of individuals is determined by their caloric expenditure.

Problem: The infant on the floor is currently producing 1 diarrheal stool q 3 h and refusing to drink. Clinical findings of dry mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia with normal BP and capillary refill suggest 10% fluid deficit. Rectal temperature is 37° C; serum Na, 136 mEq/L; K, 4 mEq/L; Cl, 104 mEq/L; and HCO3, 20 mEq/L. The doctor has ordered fluid volume replacement for this 25kg child. What would the IVF maintenance rate be set at?

Posted in Math, NS 231 - Peds, Resources, Semester III | 2 Comments »

DTaP Vaccine

Posted by Laura on November 1, 2010

DTaP

DTaP Vaccine

Diptheria=

  • A rare toxin-mediated bacterial infectious disease marked by the formation of a patchy grayish-green membrane over tonsils, uvula, soft palate, pharynx.
  • Precautions – Droplet Includes 3ft or less through air. Direct or indirect contact with freshly contaminated articles.
Tetanus = (Lockjaw or Trismus)

  • an acute life-threatening illness caused by a toxin produced in infected wounds by a bacillus.
  • Bacterium: Clostridium tetani
  • Precautions – Direct

 

Pertussis= (Whooping Cough)

  • An acute contagious disease characterized by paroxysmal coughing, vomiting that follows the cough and whooping inspiration.
  • Bacterium: Bordetella pertussis
  • Precautions – Droplet Includes 3ft or less through air. Direct or indirect contact with freshly contaminated articles.

Signs and Symptoms

Signs and Symptoms

Early stages – mistaken for a bad sore throat; low-grade fever and swollen neck glands.

Can lead to a thick coating in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing. The formation of this coating (or membrane) in the nose, throat, or airway makes a diphtheria infection different from other more common infections (such as strep throat) that cause sore throat.

As the infection progresses, the person may:

  • have difficulty breathing or swallowing
  • complain of double vision
  • have slurred speech
  • even show signs of going into shock (skin that’s pale and cold, rapid heartbeat, sweating, and an anxious appearance)

 

Signs and Symptoms

Tetanus often begins with muscle spasms in the jaw and face (risus sardonicus), together with difficulty swallowing and stiffness or pain in muscles in the neck, shoulder, or back. The muscle spasms can be severe and can quickly spread to muscles of the abdomen, upper arms, and thighs.

The symptoms of tetanus usually appear anywhere from 3 to 14 days after the person has become infected.

 

Signs and Symptoms

The first symptoms of whooping cough are similar to those of a common cold:

  • runny nose
  • sneezing
  • mild cough
  • low-grade fever

after 1-2 wks: coughing spells lasting more than 1 minute, child turning red or purple.

Pertussis
Diphtheria
Tetnus

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Hepatitis

Posted by Laura on October 31, 2010

Hepatitis

Hepatitis

Hepatitis A Virus: HAV is spread by the fecal-oral route & from person-person by ingestion of contaminated food or water and rarely by blood transfusion. Most common form of hepatitis in children. (infected stool can be present on doorknobs or diapers) Can be so mild, many are unaware they have the illness. Typically a short lived virus and does NOT cause chronic liver disease. 

 

Hepatitis B Virus: HBV is spread by blood or body fluids. Also called serum hepatitis. Important because HBV infections that occur in childhood can lead to fatal consequences. 

  • Up to 90% of infants infected prenatally from HBV-infected mothers.
  • 25-50% infected children before age 5 yrs old.
  • Vaccine should be given in the “vastus lateralis” muscle (infants) deltoid (toddlers & children)

 

Hepatitis C Virus: HCV is spread by direct contact with infected person’s blood. Can lead to chronic liver disease and is leading reason for liver transplant in US. 

  • Blood transfusions
  • From mother to newborn.

 

Signs and Symptoms

Hepatitis, in its early stages, may cause flu-like symptoms, including: 

  • malaise (a general ill feeling)
  • fever
  • muscle aches
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • jaundice (a yellowing of the skin and whites of the eyes)

 

If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes: 

  • jaundice
  • foul breath
  • a bitter taste in the mouth
  • dark or “tea-colored” urine
  • white, light, or “clay-colored” stools

 

There can also be abdominal pain, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

Vaccines

A hepatitis A vaccine is available to kids 12 months and older. In the past, the vaccine was only recommended to those at high risk for the disease (such as those who lived in or traveled to locations with high rates of HAV), but now the vaccine is available to anyone who desires immunity to hepatitis A. There’s also a hepatitis B vaccine, which should be given to both children and adults as part of routine immunization. Unfortunately, there’s no vaccine for hepatitis C — animal studies indicate that it may not be possible because the virus doesn’t cause the kind of response that would be needed for a vaccine to be successful.

more can be found at: Kidshealth.org

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Medication Administration

Posted by Laura on October 29, 2010

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Week 3 Reading

Posted by Laura on October 27, 2010

Week 3 Reading 231

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Recommended Immunizations

Posted by Laura on October 26, 2010

More can be found at the CDC link. Since we are currently on Birth to Toddler, I thought I would post this one. This one is cute for parents. Get the pdf here

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Week 2 Reading

Posted by Laura on October 22, 2010

Week 2 Reading 231

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Pain Scale in English and Spanish

Posted by Laura on October 19, 2010

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