Fluid and Electrolytes Imbalances
What measurement is the greatest predictor of dehydration in infants? Other signs/symptoms?
Weight
You would expect to find this in the urine of a child with acute glomerular nephritis?
What is blood (hematuria) and protein? (But not too much protein). Might also see pink tinged, tea colored, or cola colored urine.
What are the signs/symptoms of intussusception?
Sudden abdominal pain, screaming with drawing knees to chest, sausage shaped abdominal mass, stools mixed with blood and mucus looks like red currant jelly.
The number one goal in congenital hypothyroidism is ____, to prevent impacts on what?
Early detection to prevent impacts on growth and development.
Patients born with spina bifida are at risk of developing this allergy.
Latex (why?)
How do we educate the parents when giving antibiotics?
It is important to give medication until it is gone even if the child is feeling better. Can cause resistance if the full cycle is not completed.
What is normal weight loss in a newborn infant after birth?
Less than or equal to 10% --> this is normal in the newborn and should gain the weight back
Nephrotic Syndrome manifestations
Severe edema, especially around the eyes, ankles, feet. Foamy urine as a result of excessive protein. Weight gain due to fluid retention. (Lots of protein will be found in the urine).
What are the signs/symptoms in appendicitis?
Abdominal pain in right lower quadrant (McBurney's point), rigid abdomen, decreased or absent bowel sounds, tachycardia, fever, HIGH WBC'S
What causes Addison's disease?
What is...Etiology includes idiopathic, infection, tumor, and autoimmune processes. Adrenal gland does not make enough hormones. (Cortisol and Aldosterone)
90% of tissue is already destroyed when symptoms present
What can we do to try to prevent neural tube defects?
Women should start on folic acid prior to getting pregnant and should take during pregnancy.
After cleft lip surgery, how can we help not damage the suture lines?
don't suction or stick anything in the mouth, need very good pain management (crying and open mouth is not good), supervision of children not putting fingers in mouth (might need elbow restraints to help with this part), avoid prone -->position on the unaffected side.
What are some clinical manifestations of severe dehydration?
Weight loss greater than 10%, lethargic, tachycardia, mottled, sunken eyes, sunken fontanelle (infants), may be difficult to awaken, dark concentrated urine (if present).
These diet restrictions should be followed in patients that have peripheral edema with acute glomerulonephritis.
Fluid restriction, diet low in protein, salt, potassium.
This is how a patient with gastroesophageal reflux should be positioned after eating.
What is have the child sit-up after eating?
What are the signs and symptoms of Cushing's Syndrome.
What is too much cortisol. Moon face (facial swelling), excessive hair growth, pendulous abdomen, ecchymosis, weight gain, poor wound healing, short stature.
Excessive circulations of cortisol. Addison insufficient-Cushing too much!
When is the most likely screening for scoliosis?
Girls screened at 10-12 years. Boys at 13-14 years at school.
What is the parent teaching about treatment for club foot
The infant will need serial casting done every week, proper cast care, check for decreased circulation, bonding is important and reassuring the child will be able to walk.
List the Rehydration formulas for both oral and IV.
Mild dehydration - Oral = 50ml/kg over 4-6hrs
Moderated dehydration - Oral = 100ml/kg over 4-6hrs
Ongoing losses = 10ml/kg extra for each loose stool or vomiting episode
Severe dehydration - IV = 20ml/kg over 5-20mins
Can repeat 2-3x if needed
Chronic glomerulonephritis lab abnormalities.
Serum creatine and blood urea nitrogen (BUN) are elevated. Hyperkalemia, hyponatremia, low bicarb.
If diagnosed with appendicitis, what do we not do as part of non-pharmacological pain management?
Do NOT apply heat = can lead to increased inflammation and rupture of appendix
For what reasons would you need to call the provider during a period of illness with diabetes mellitus
Blood glucose great than 240, ketones in urine, tachypnea, vomiting, liquids not tolerated.
What is the education when treating juvenile idiopathic arthritis.
Supportive, diet, exercise, heat or warm packs (not cold), prednisone, rest periods, encourage to attend school, NSAIDS
When a patient has extremely low WBC, what are some infection precautions you would take?
Neutropenic precautions. Don't get live vaccine. Avoid sick people. Don't drink unpasteurized milk.
Wash fruits and vegetables. Good hygiene.
This electrolyte, if too high or low can cause heart arrhythmias, and can be dangerously imbalanced when a child has vomiting or diarrhea.
Potassium (What is the normal range?)
This disorder manifests as facial and other edemas, decreased urinary output with proteinuria, hyperlipidemia and is NOT contagious.
Nephrotic Syndrome
Hirschsprung's disease (and CF) can first be identified in the newborn when this does not happen in 24-48 hours.
Pass meconium stool (first poo in a newborn)
What should a child with DM do before exercise, or exerting himself/herself physically?
Eat a small snack containing 15 - 30 grams of carbohydrates, such as fruit juice, juice, crackers.
How do you take care of a patient who is post-op for a VP shunt?
Observe for increased ICP. Position child on the unoperated side to prevent pressure on the shunt-valve. Teach no contact sports, wear a helmet.
This leukemia is associated w/ high WBC count and risk of tumor lysis syndrome at diagnosis
What is ALL? (acute lymphocytic leukemia)
Tip: In acute leukemias like Acute Lymphocytic Leukemia (ALL), the bone marrow produces a large number of immature, abnormal white blood cells, causing their total count to be high.
Chronic leukemias have an abnormal lymphocytes build up in the bone marrow, crowding out healthy cells, which can lead to a lower count of healthy white blood cells.
What includes insensible fluid loss in a child?
Respiratory loss (water vapor exhaled from lungs), evaporation from skin
Factors that increase insensible fluid loss:
Fever
Increased resp rate
High body surface area (younger kids have a greater BSA compared to the older child)
Higher metabolic rate (kids already have a incr met rate to support cell/tissue growth)
List facts about UTI.
-common problem in children
-e.coli is the most common pathogen
-risk factors include:
females, urinary tract anomalies, indwelling caths, bubble baths, wrong fabrics, sexual activity
A child with celiac disease can't and can have these types of food.
Cannot have wheat, barley, and rye and all food with gluten additives, high probability lactose intolerant. (Can't have oats either)
Can have corn, rice, and millet.
In Grave's Disease, what would be some clinical manifestations?
Irritability, gradual weight loss despite appetite, bulging eyes, hyperactivity, rapid pulse, fine hair.
Labs will show:
TH or T3&T4 will be HIGH -->too much thyroid hormone circulating around
TSH will be LOW
What are the Do's and Don'ts when a patient is seizing?
Do's: Protect from injury/remove objects or add pillows, side-lying, assess airway, prepare 02 and suction, note onset, time, and characteristics.
Don't: restrain the child, do not put anything in child's mouth.
This tumor arises from neural crest cells and may present with periorbital ecchymosis (racoon eyes) and elevated urinary catecholamines.
What is neuroblastoma?
Differences between pitting edema and non-pitting edema.
Pitting = Characterized by swelling that leaves an indentation (pit) when pressure is applied to the affected area.
Common causes:
Congestive heart failure
Kidney disease
Liver disease
Lymphedema
Non-pitting = Does not leave an indentation when pressure is applied to the affected area.
Common Causes:
Allergic reactions
Insect bites
Medications (e.g., corticosteroids)
Chronic venous insufficiency
Acute glomerulonephritis is a complication of what condition?
Group A-Strep infection; not because of the bacteria, but because the immune system starts to attack kidneys.
Hypertrophic Pyloric Stenosis signs/symptoms
Projectile vomiting, infant is hungry, poor weight gain, signs of dehydration, palpable olive-shaped tumor above umbilics, visible gastric peristaltic waves move from left to right across the epigastrium.
These are the sick day rules for patients with type 1 diabetes.
Check blood glucose every 2-4 hrs. Check urine for ketones. Drink fluids 4-8 oz per hour. Take extra insulin as a correction every 2-4 hours as directed.
What is the education regarding antiepileptic medications?
Take medication as directed. Do not skip doses and give at the times stated. Do not take with milk. Add vitamin D and folic acid to avoid deficiency.
Ketogenic diet (why?)
These are cell types are present in Hodgkin's Lymphoma.
Reed Sternberg cells
This hormone is secreted in response to hypovolemia and promotes water reabsorption in the kidneys, potentially worsening hyponatremia.
what is antidiuretic hormone? (ADH)
SIADH = too much secretion ADH
DI = under secretion of ADH
What are the two renal replacement therapies?
Hemodialysis & Peritoneal dialysis.
(What are the differences between the 2?)
Signs of Rupture in appendicitis dx.
Sudden relief in pain
Peritonitis follows = increased diffuse pain
What is "Thyroid storm"?
Sudden release of TH (Thyroid hormone)
can be life threatening
s/s: delirium, severe irritability, coma
Antithyroid Drugs can help decrease the circulating TH = METHIMAZOLE is only drug for children. PTU is not recommended for children.
What is the concern when there is a fracture in the epiphyseal plate?
The bone will not grow correctly
A 2-year-old child presents with a white pupillary reflex. The eye tumor should be high on your differential.
What is retinoblastoma?
A 6-month-old with diarrhea is lethargic, has sunken eyes, dry mucous membranes, and delayed cap refill. This is the estimated severity of dehydration.
What is severe dehydration?
This should NEVER be done on a patient with an abdominal mass and pink-tinged urine
Palpate (Wilms's tumor)
In a newborn with Hirschsprung's Disease (megacolon), these will be the s/s.
Bilious vomiting w/ feeding intolerance
Delay in passing meconium
Distended abdomen
PRIMARY DKA treatment.
Regular insulin, fluids -->because of dehydration
Potassium is part of the treatment but it is not primary.
DKA Diagnosis:
Glucose greater than 200
pH <7.30
BiCarb <15
glycosuria
ketonuria
What are a couple of reasons that an infant may have a bulging fontanelle?
Bacterial meningitis, hydrocephaly, head injury
How do you take care of a patient in Buck's traction?
Sponge baths, redistribution of child's weight q 2 hours
ensure the weights are hanging freely, check that the rope is not frayed, and monitor skin integrity and neurovascular status regularly
A deficiency of this adrenal hormone can lead to hyponatremia, hyperkalemia, and dehydration in neonates.
what is aldosterone? or What is cortisol?
The most common cause of AKI (acute kidney injury) in children.
what is prerenal azotemia (often due to dehydration or hypovolemia)?
why are children NOT given Imodium to treat diarrhea?
Serious side effects:
children have immature liver function
Imodium slows motility and can trap the bacteria or toxin inside and makes things worse
immature physiology
immature blood brain barrier
List differences between Type 1 and 2 DM.
Type 1 = is an autoimmune destruction of pancreatic beta cells --> leading to insulin deficiency
Oral diabetic meds and diet alterations don't work for type 1
DKA is very common for type 1 diabetics
Type 2 = Insulin resistance in which body is failing to use insulin properly
Oral agents and diet alterations are often effective treatment
DKA happens infrequently
What are the signs/symptoms of increased intracranial pressure?
Headache, nausea, forceful vomiting, diplopia/blurred vision, seizures, drowsiness, decline in school performance, lethargy
Late signs: Bradycardia, decrease motor response to command, decreased sensory response to pain, alteration in pupil size and reactivity, decrease consciousness, Cheyne-stokes, coma
This condition is when an infant's neck does not have full range of motion and the head is unable to go to midline.
What is torticollis?