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Pedia Notes

POISONING- common in toddlers. (falls- common to infant)

1. determine substance taken, assess LOC


2. unless poison is corrosive, caustic (strong alkali such as lye) or a hydrocarbon,
vomiting is the most effective way to remove poison.

• Give syrup 1 pecac to induce vomiting

1. 1 pecac – oral emetic

• 15 ml – adolescent, school age & pre school


• 10 ml to infant

1. UNIVERSAL ANTIDOTE- charcoal, milk of magnesia & burned toast


2. Never adm charcoal before 1 pecac
3. antidote for acetaminophen poisoning – acetylsysterine ( mucomyst)
4. caustic poisoning ( muriatic acid ) neutralize acid by giving vinegar . Don’t vomit
prepare tracheostomy set
5. Gas- mineral oil will coat intestine

Lead poisoning

Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney


functioning

Accumulation of anemia = Encepalopathy

Sx:

1. beginning sx of lethargy
2. impulsiveness, learning difficulties
3. as lead increases, severe encepalopathy with seizure and permanent mental
retardation

Dx:

1. Blood smear
2. abd x ray
3. long bones

Mgt:

1. remove child from source


2. if > 20 ug/dL – need chelation therapy = binds with led & excreted by kidney
=nephrotoxic

Amogenital

Female:

Pseudomenstration slight bleeding on vagina related to hormonal changes

Tearing of fourchette with blood – rape/ child abuse

Rape- Report within 48 h

Shape pubic hair in inverted triangle ( female)

Male:

Undescended testes – cyrptorchidism -common to preterm

surgery – orchidopexy

assess scrotum- warm room & hands

baby – pee within 24 h

-check for arch of urination

Epispadias- urinary meatus located dorsal or above glans penis

Hypospadias- urinary meauts loc ventral or below glans penis

Hypospadias with chordee- fibrous band causing penis to curb downward

Mgt:

Surgery

Phimosis- tight foreskin

Balanitis-infection of glands penis – due smegma

Mgt:

Circusicion

Hydroseal – fld filled scrotum

Tst of Dx:

Transillumination with use of flashlight - glowing sign


Varicoseal – enlarged vein of epididimis ( girls- vulvular varicosities)

Renal Disorder Cause Sx Tx NSG CARE

NEPHROTIC infectious 1. Anasarca- Prednisone Focus of care:


gen edema monitor edema
SYNDROME 2. massive Diuretic
protenuria • weigh
3. microscopic daily
or no
hematuria
Diet:
4. serum
CHON
decreased Increase CHON
5. serum lipid
increased Increase K- OJ,
6. fatigue beef broth, banana

7. normal or Decrease Na
decreased
BP

AGN ( acute Autoimmune 1. (PPP) 1. anti HPN 1. weigh daily


Glomerulo primary drug
Nephritis) Grp A beta peripheral 2. monitor BP &
hemolytic periobital - neurologiuc status
3A’s; streptococcus edema hydralazine
2. moderate or apresoline 3. Diet: decrease
AGN, protenuria K, decrease Na
3. gross 2. iron
hematuria
autoimmune, ( smokey
urine)
Grp A 4. serum K
increased
5. fatigue
6. increase BP

Complication :

1. hypersensive
encephalopathy

2. anemia

BACK- check for flatness & symmetry

Open Neural Tube Defect- decreased Folic Acid intake

SPINA BIFIDA OCCULTA- failure of post laminae of vertebrae to fuse


Sx: dimpling of back , Abnormal tufts of hair

SPINA BIFIDA CYSTICA- failure of post laminae of vertebrae to fuse with a sac

Types:

1. Meningocele – protrusion of CSF & Meninges

2. Myelomeningocele – protrusion of CSF & Meninges & spinal cord ( most


dangerous)

3. Encephalocele ( CNS complication – hydrocephalus) – cranial meningocele


or myelomeningocele

Most common problem

• rupture of sac
• prone pos
• sterile wet dressing

Most common complication - infection

Myelomeningocele – genitourinary complication- urinary & fecal incontinence

Nsg care: always check diaper

Orthopedic complication – paralysis of lower extremities

Surgery to prevent infection

Post op – prone position

SCOLIOSIS- lateral curvature of the spine

2 types:

1. structural – rye neck

2. postural – improper posture

Dx:

1. uneven hemline
2. bend forward- 1 hip higher

1 shoulder blade more prominent

Nsg care:
1. conservative – avoid obesity, exercise

2. preventive – Milwaukee brace - worn 23 h a day

3. corrective surgery – insert Harrington rod

post op- how to move

log rolling- move client as 1 unit

EXTREMITIES:

check # of digits = 20

1. syndactyly – webbing of digits


2. polydactyly – extra digits
3. olidactyly – lack of digits
4. Amelia – total absence of digits
5. pocoamelia- absence of distal part of extremities

ErQ duchennes – paralysis- brachial plexus injury or brachial palsy

• birth injury caused by lateral & excessive traction during a breech injury

Sx:

1. unable to abduct arms from shoulders, rotate arm externally or supinate forearm
2. absence or asymetrical moro reflex

Mgt:

1. abduct arm from shoulders with elbow flex.

CONGENITAL HIP DISLOCATION – head of femur is outside acetabulum

Types;

1. subluxated – most common type


2. dislocated

Sx:

1. shortening of affected leg


2. asymmetrical gluteal fold
3. limited movement – earliest sx
4. (+) ortolanis sign – abnormal clicking sound
5. when able to walk – child limps – late sx- trendelenburg sign

Goal of Mgt:

Facilitate abduction
Mgt.

1. triple diaper
2. carry baby astride
3. Frejka splint
4. Pavlik harness
5. Hip Spica Cast

TALIPES – "clubfoot"

a. Equinos – plantar flexion – horsefoot


b. Calcaneous – dorsiflexion – heal lower that foot anterior posterior of foot flexed towards anterior
leg
c. Varus- foot turns in
d. Valgus- foot turns out

Equino varus- most common

Assessment:

1. Straighten legs & flexing them at midline pos

Mgt:

1. Corrective shoe- Dennis brown shoe, spica cast

Fx: of cast –

- to immobilize

• bone alignment
• prevent muscle spasm

lead pencil – mark area to be amputated

cold H20 – hasten setting process

hot H20- slow setting process

After cast application – how to move pt:

- use open palm not fingers- fingers will cause indention

• dry cast – natural air not blower


• priority check : neurovascular check

C- circulation

M- motion S- sensation
Cast – with bleeding

- mask with ball pen edge of blood to know if bleeding is on going

sign cast is dry = resonant sound, cast cold to touch

do petaline – making rough surface of cast smooth

CRUTCHES

Fx: To maintain balance

• To support weakened leg

Principles in crutches

• wt of body on palm!
• Brachial pulsing – if wt of body in axila
• Do palm exercise- squeeze ball

Different crutch Gaits:

1. Swing Through
2. Swing to

• no weight bearing are allowed into lower ext

1. Three point Gait

- wt bearing is allowed in 1 ext

2. Four point gait


3. Two point Gait

- wt bearing allowed in 2 lower ext

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