Karteikarten
5 - Recognising and managing the seriously ill child
Karten in diesem Stapel (84)
- 1Asthma - pathophysiologycommon - cause unknown
classic features of acute asthma-
- cough, wheeze, breathlessness, breathing probelms
- bronchioles surrounded by smooth muscle, contract to triggers: colds (virus), exercise, weather, smoke, dust, stress
- inflammation, oedema, broncho-constriction result in narrowing of small airways, irritate lining of lungs
- excessive mucus generated - constriction/blockage of airways
- allergen perceived as foreign bodies inflammatory response and broncho-constriction - 2Spacer use in young childrenMDI
requires cooperation and coordination
spacers double the amount of medication getting into lungs
above 5 years can use a spacer
masks easier for young children
nebs require 8-10 minutes - cannot cooperate this long - 3Convulsioins/seizures (epilepsy)- paroxysmal, time-limited change in motor activity/sensory/perception/behaviour that results from abnormal electrical activity in brain
-common in child under 5
50% outgrow seizures as they mature - 4Causes of epilepsyNOT causes by fever or new brain injury
Causes -
idiopathic, CNS, electrolyte abnormalities, drug, toxic ingestion, CNS vascular abnormality - 5Pathophysiology of epilepsyuncontrolled, interrupted neuronal messengers to brain, triggers electrical activity in brain
hyperexcitability of neurones
group of neurones - 6Classifications of epilepsypartial - short, subtle lapse of awareness, simple (focal) - starts in one area of brain (staring, confusion)
Complex (psychomotor) - lip smacking, part twitching
generalised (grand mal) - crosses both hemispheres, myoclonic, tonic clonic muscle movement - 7Unclassified seizuresInfantile spasms (drop attacks)
- onset 6-8 months, fall forward, poor prognosis
pseudo seizure
- looks like seizure but is not
* may be mix of classified and unclassified - 8Epilepsy diagnosisdifficult in some children
- need detailed history
- detailed description of seizure
EEG
MRI
CT scan - 9Effects and management of epilepsyeffects: low self esteem, poor discipline, learning difficulties, behavioural probelms, developmental delay, dental probelms (side effects of medications)
management: medication, only if frequent, type of medication varies, lethargy side effects - 10Cont management of a seizureABCD
* for seizures lasting more than 5 minutes
- midazolam
IV/IM 0.15mg/kg
Buccal 0.5mg/kg
Intranasal 0.2mg/kg *max 5 mg)
if cont for further 5 min - repeat and look for resp depression
if cont for another 5 min: phenobarbitone 20mg/kg (max 600mg)
phenytoin 20mg/kg (max 1.5kg)
*should be cardiac monitored - 11Status epilepticusany tonic/clonic seizure convulsion lasting more than 30 minutes
- 12Management of epilepsy longer termencourafe normal life and routines
medications as ordered
supervison when swimming, and needed etc - 13Cystic Fibrosis (Mucoviscocoidosis) diagnosis:inherited autosomal recessive disorder of exocrine glands
need 2 carriers to be affected
diagnosis: via NNST in infancy, malaabsorption in ileus and failure to thrive, positive sweat test, genetic testing - 14Pathophysiology of CFgene mutation affects specific protein CFTR, which regulates sweat, dgestive juices, mucus
this protein controls movement of chloride and sodium in and out of cells
in CF, the CTFR does not function properly, and thick mucus blocks narrow passgaes of affected organs, e.g. lungs, pancreas, bowel - 15Manifestations of CFabnormal accumulation of viscous, dehydrated mucus result in:
inflammation of lungs, chest infections, SOB, blockage of pancreatic duct, malnourished due to poor absorption, sterility in male no vans deferans forms, muscle cramps, lethargy, poor appetite - 16Management of CFRespiratory therapy to promote lung function, gastro tract therapy, nutrition, to promote essential nutrient balance for health and growth
- 17Resp function and management in CFchest physio 2-3 times daily with bronchodilators to open airways
usually admitted with signs and symptoms
central venous line inserted - 18Promoting optimum nutritionpancreatic enzymes
supplemented calories and vitamins (water soluble) and minerals
enteral feeding - 19Diabetesmajor of children have type 1
onset is usually 8 years
cause unknown - 20Pathophysiology of diabetes 1autoimmune disease - beta cells destroyed by body's immune system in genetically susceptible individuals
triggered by diabetogenic infection trigger
dont make enough insulin for body requirements
glucose remains in blood stream - 21Pathophysiology of type 2 diabetesmore mature onset
overweight and inactive individuals at risk
cant be prevented
cells don't respond to insulin
insulin resistance results
glucose remains in blood stream and body compensates by burning fats for energy - produces ketones and glycouria
excess glucose stored in liver or converted to fat in body tissues - 22Symptoms of diabetespolydipsia, polyuria, weight loss (1), weight gain (2), fatigue, visual disturbances, itchy skin, nausea and vomiting, coma, dizy, sweating, LOC
- 23Diagnosis of diabetesfasting BGL more than 7mmol
2 hours pc more than 11.1 mmol
and glycated HB more than 6.5%
glycated HB - form of HB to identify plasma glucose concentration
also indicator of long term (2-3 months) - 24If untreated or undiagnosedbuilds up ketones in blood stream and dehydration -FATAL
kidney function impaired - nephron damage
increase in infections
eye damage - retina, blindness
poor circulation in feet and legs (gangrene)
nerve damage in feet
heart disease - 25BGL monitoring in children hypoglycaemiaHypoglycaemia in paediatric diabetic patients
less than 2.3 - 2.8mmol (newborns -neonates)
less than 4mmol (paediatric patients)
*neonate heel prick rather than finger
height, weight, BMI monitoring in children - 26Age appropriate Glycaemic aims in diabetic childreninfant: day 5-12, bed 7-12
toddler 1-3: day 5-12, bed, 7-12
school 5-7: day 4-10, bed, 7-12
school 7-11: day4-12, bed 7-12 adolescent: day 4-8, bed 7-12 - 27Ideal BGL groups in childrenToddlers - 5-12 mmol/L
school age children - 7-12 mmol/L
adolescents 4-8mmol/L night 7-12mmol/L - 28Tonsilitis/ adenoiditistonsils and adenoids located in pharynx,
composed of lymph tissue, part of body's defense system, mainly cause by virus, may be acute/chronic - 29Pathophysiology of tonsilitistoxins released from microorganism
cause inflammation and infection on tonsils
causes hypertrophy of tissue
lymph nose involvement, infiltrate the epithelial germ layers - 30Clinical manisfestations of tonsilitisfrequent throat infections - can recur
breathing and swallowing diffculties
dry mucus membranes, N& V, loss of energy, pain, excessive clearing of throat
chronic - bacteria lodge in tonsillar bed - 31Diagnosis and treatment of tonsilitisvisual inspection and symptoms
tonsils lagre and inflamed on observation
enlarged adenoids seen on x-ray
conservation management - rest, fluids, analgesia, abx, - 32Nursing management of tonsilitisairway management
left lateral until breathing established after surgery
if bleeding sit up and support chin anad neck
haemorrhage, pain, infection
frequent swallowing (cardinal sign of bleeding) difficulty in swallowing
pallor, restlessness, vomiting, decreasing BP, increasing temp and pulse
regular panadol, vital signs - 33Discharge planning tonsilitisrest few days, eat food to make swallow and avoid scar tissue, protect against infection, other children, adults, panadol, follow up apt
- 34Otitis media - and risk factors causesinflammation or infection of middle ear
cold, usually precedes
risk factors: boys, dummy use, smoke, child care
causes: viral, strep, influenzae
serous: non-suppurative, purulent, suppurative - 35Pathophysiology of otitis mediaeustachian tube of child - shorter/angled than adults
infection moves from throast via tuse into middle ear
tissue surrounding tube swell, and block tube
negative pressure creates vacuum in middle ear
fluid (serous) moves in
increased pressure - pain intense - 36Clinical manisfestation of otitis mediahistory, cold, fever, ear pain, anorexia, vomiting, lethargy, loss of hearing long term
- 37Examination of otitis mediatympanic membrane dull, opaque, bulging (pressure), cough, sneezing, runny nose, febrile, crying
- 38Complications of otitis mediaperforation of TM, febrile convulsions,
supparative - meningitis
facial nerve palsy - 39Serous otitis mediaas a result of a cold, persists of 7 weeks/months, fluid does not move, conductive hearing loss, cognitive development
may insert grommter - 40Nursing management of otitis mediaAbx
analgesia
topical lignocaine
encourage drinking and eating
ear drops PRN
quiet actvitities, no swimming, report purulent discharge - 41Foreign bodiesInhaled - depend on where in body
main bronchus - sudden catastrophic
coughing, chocking, possible vomiting
total obstruction - unconscious, cardiac arrest
open airway - check for FB
PP ventilation to force FB down L or R main bronchus - 42Choking in FB- assess severityeffective cough - mild airway obstruction, encourage coughing, continue to monitor
ineffective cough - conscious - call ambo, 5 back blows, 5 chest thrust, 5 back blows
unconscious - begin CPR - 43Foreign Body in lower main bronchus6 months to 4 years are at greatest risk
symptoms include: wheese, cough, dyspoes, asymmetrical chest movement, lobal collapse, chest x- ray for dx
total oesophageal obstruction- needs anaesthetic for removal
partial obstruction - observe, may pass in stomach
if drooling, chest pain , unable to eat, abdo pain, vomiting, melaena, then remove - 44Bronchiolitisacute viral resp tract infection
effects children under 2 years
RSV main cause
transmitted through direct contact via resp secretions
incubation period 2-8 days
acute illness - lasts 3-7 days
1-2 weeks recovery period - 45Pathophysiology of bronchiolitisinflammation of bronchioles, virus infects epithelial cells, necrosis of epithelial cells and cilated lining
oedema and increase in production of mucous plugs
resp distress - acute - 46Signs and symptoms of bronchiolititsinitial illness - pharyngitis, conjunctivitis, otitis media, low grade fever, lethergy, irritability, dyspoea, difficulty feeding, coughing, sneezing, audible wheeze, crackle on auscultation
- 47Progression of illness - bronchiolitistachypnoea, tachycardia, increased coughing, audible wheeze, crackles on auscultation, prolonged expiratory phase, nasal flaring, poor oral intake, increased lethargy
- 48Severe illness in bronchiolitistachypoea in increase in 70 breaths per min
accessory muscle use
air hunger, grunting, apnoea, cyanosis, marked lethargy, inability to suck - 49Admission criteria for bronchiolitisall infants with:
accessory muscles withspo2 less than 94%
underlying medical conditions
apnoea, poor oral intake, signs of physical exhaustion - 50Treatment of bronchiolitistreat symptomatically
oxygen to maintain saturation levels above 93%, monitor res status, vitals, hydration, additional precautions, minimal handling
brochodilator therapy - salbutamol over 6 months with past history of wheeze
vital signs and auscultation must be undertaken 30 minutes after each dose of salbutamol
*steroids are not effective - 51Nasopharyngeal suctioninfant obligatory nose breather
clear nasal pharyngeal airway
size of catheter
correct measurement to nose to ear - 52Nasal bleeding - think about and complications with suctioningtrauma to mucous membranes
complications with suctioning:
bronchospasm, bradycardia, laryngospasm, MI - 53Croup (Laryngotracheobronchitis)most common in children 3 months - 3 years
uncommon in children over 6 yeats
usually viral - may be bacterial
common cause is stridor - 54Pathophysiology of croupvirus/bacteria enters throat
infiltration of white cells
leads to swelling of larynx, trachea, bronchi
narrowed airways, noisy movement of air (stridor) over narrowed airways - 55Clinical presentation of croupbarking cough, inspiratory stridor, hoarse voice, dyspnoea, sittin gup and forward to get breath, resp distress, anxious, agitated
- 56Treatment of Crouphumidified oxygen, adrenalin, dex 0.6mg/kg/IM not to exceed 10mg
- 57Gastroenteritis - viralrotavirus major cause
effect children under 4 years
severe dehydration - 58gastroenteritis - bacterialrarely cause dehydration, stools often bloody
- 59Pathophysiology of gastroenteritisinflammation stomach, bowels, caused by infection, decreases SA for absorption of nutrients and water
alters parasympathetic innervations, increased bowel motility - 60Clinical manifestations of gastroenteritispoor feeding, vomiting, frequent, large watery stools - viral, small bloody stools with cramps - bacterial
- 61Fractures in childrenbones softer than adults
thicker periosteum
highyl vascularised
long bones not ossified
ligaments stronger
fractures heal faster, risk of compression fractures - 62Pathophysiology of fracturesforce bone greater than tensile or compression strength of bone
disruption of periosteum, bv, cortex, bone marrow, soft tissue
bleeding from damaged tissues, vasodilation, osteoblasts remodel bone, - 63Clinical presentation of fracturespain over fracture area, swelling, warmth, bruising, deformity, dysfunction
- 64Influences on healinggeneral health, nutrition status, anaemia, infections, compliance
- 65Prevention of complicationsassess circulatoin, skin integrity, plaster care, pain, hygiene, modify clothing, prepare for d/c
- 66Tractionexplanations +++
ensure analgesia
hygiene, privace, neurovas obs, watch for swinging in traction, ensure weights are free - 67Febrile convulsionsassociated with fever more than 38 debress not associated with infection
common in 6 months - 6 years
rapid temperature rises cause the convulsion not the degree of fever - 68Signs and symptoms of febrile convulsionssimple seizures, LOC, twitching, facial jerking, resp muscles, legs, arms, dyspoea, foaming at mouth, drowsiness
keep them safe** - 69Head injury in a childleading cause of trauma and death in young children
mostly preventable - 70Types of head injuriesexternal force (mechanical)
- shaking, strong head rotation - brain structure tear
concussion - BV stretch on impact and damage to cranial nerves
contusion - impact results in bleeding results damage/pressure
penetration - object penetrate skull - breach of dura mater
coup - contrecoup - impact on one side and damage on opposite side (contusion, bleed, clot) - 71Types of head injuries contuedclosed or penetrating mild, mod, sev
acquired after birth - infection, bleeding - 72Trauma associated examples of head injuriesskull fractures, cerebral lacerations, cerebral contusions, sheering injury
- 73Examples of acquired injuries haemorrhagesub dural, extra- dural, intra-cerebral
- 74Pathophysiology of head injuriesbrain structure tear or are compressed
reduced blood flow -
nerve tissues disturbed or damaged
bleeding - increases ICP
breach of dura mater
loss of function - temp or permanent - 75Injury may be..primary - mechanical. direct result of injury, haemotoma, contusion
secondary - hours later, increase ICP, cerebral ischaemia - 76Assessment in head injuriessymptoms - dizziness, ringing in ears, headache, nausea
signs - slurred speech, convulsions, seizure, confusion, blurred vision
primary survey
secondary survey - neck , spine prec, head (swelling + lacerations), eyes - pupils, dental, facial fractures - 77Diagnosis of head injuriesxray, CT, MRI, ICP, EEG
- 78Management of head injuries aimsaims: optimal pressure in brain, recognise
secondary damage, prevent secondary damage - 79Severity of head injuriesmild - no LOC, normal VS, GCS 14/15
mod - brief LOC, headache, normal VS, GCS 9-13
sev - LOC, seizure, CSF leak, GCS 3-8 - 80Treatment and management of head injuriesadmission if: airway at risk, LOC, vital signs compromised
Home if: no LOC, no transient symptoms, dizziness, headache, vomiting - 81Effects of head injuriesdifficulty concentrating and memory
lethargy, sleep disorders, visual and hearing loss
rehab - physio, speech, OT, care of parents - 82Paediatric setting patterns of injury and causes of tarumasigniticant reduction of disease due to better housing, hygiene, immunisations
common injuries: falls, fractures, MVAs, drownings, burns, FB inhalation - 83Accidental injuriesMVA, drowning, burns
- 84Culturally competentawareness, knowledge, skill, encounters, desire
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- Der Nutzer hat seine Fachbereichs-Information gelöscht. Karteikarten am 5 - Recognising and managing the seriously ill child , erstellt von Gelöschter Nutzer am 15/06/2018.
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- Gelöschter Nutzer · Jun 2018
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- Erstellt von Elizabeth Then · 15 Jun 2018
- Kopiert von Elizabeth Then · 15 Jun 2018
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