Peds Exam One

Aug 26th Lecture

Giving Meds to children. If you have an order for 20 mg of valium

and the available med comes in 2, 5 and 10 mg tabs. Give 2 tabs of
10mg. Crush into one spoon of applesauce. Not a whole cup. You will
have no idea how much of the med they have taken if they decide
after a couple bites from a cup that they don’t want anymore.

Safety.
No-No’s- arm covers to prevent elbow from bending.

For restraints. Do not tie to moving bed parts-rails. Only to bed

frame.
Watch skin for breakdown due to friction and moisture.

Trust vs. Mistrust Growth & Development Erikson

Understand what they are capable of at certain ages. Also, understand
their disorder. Consider Hazards to them.

Book
Erikson pg. 87-88

-Birth( Infant)- 1 yr old is trust vs. mistrust. Need consistent

care. Result is Faith and Optimism.
-1-3 yr (Toddler) is autonomy vs. shame & doubt. Need to due
things that they are capable of. Not be shamed. Result is self control
and will power.
-3-6 yr (preschool) is initiative vs. guilt. Children develop
conscious at this time. Should establish sense of right and wrong as it
relates to behaviour that can affect others. Result is direction and
purpose.
- 6-12 (Schoolage) Industry vs. Inferiority. If sense of industry
accomplished results in ego quality of competence.
-12-18 (adolescent) Identity vs. role confusion. Result is fidelity
and devotion to others and values and ideologies.

Injury prevention

-Birth- 4 months babies have involuntary reflexes. Could roll

over, fall back/forward or body may jerk. Aspiration and poisoning not
a big risk for this age group.
-4-7 months. Can roll over, sit momentarily, grasp objects. At
risk for aspiration, suffocation, falls and poisoning.
-8-12 months. Can crawl, creep, stand, walk, climb and pull objects.
Risk of all kinds of injury.

Leading cause of injury to infants: Falls, ingestion and burns.

FB aspiration and mechanical suffocation leading cause of

death in children under 1. By Fatal injury.
Motor vehicle accidents leading cause of accidental death in
children over one.

Safety

Name bands critical

Infants unable to respond to names.
Toddlers will respond to anything or nick-names only.
Older kids may exchange names and/or bands or just not respond as a
joke.

Car seats-children <1 yr and weighing less than 20 lbs. Can not be
placed in a rear facing car seat in front passenger seat w and air bag.

Object smaller than tip of elbow should not go in ear canal.

Guns- Should be in locked cabinets with ammunition kept locked in

separate location. Guns should never be loaded.

Free smoke detector programs through fire departments. Carbon

monoxide detectors and fire extinguishers should also be in homes.

Food items- hot dogs, candy, nuts and grapes. Most dangerous
foods.

Pacifiers- should be one piece.

Syringe caps can be hazardous.
Baby powder is not recommended for use. Corn starch better choice.
Apply with hands.

Latex balloons- leading cause of choking death.

Wedging between bed/mattress and wall as well as plastic bags are

leading cause of suffocations.

Falls-Gates should be placed at bottom and top of stairs.

Poisoning- plants, button-size batteries, vapors, drugs, mis-labeling of
containers urd to store drugs, cleaning solutions etc.

Burns- set tap water tank to 120 F.

Medication Poisoning

Too much of anything like water can be harmful; water intoxication.

Pica- abnormal ingestion of non-food items.

Household items-meds.

Around 2 yr old have good eyesight. How to keep safe: Locked

cabinets. Watch for mislabeled stuff.

Assessment- treat child first not the poison. Deal with airway, bleeding
whatever first.

Poison Control Center. Call before doing any interventions.

Do not want to throw up anything that was caustic. Can damage/re-
damage mucosa. Best to dilute with water or milk. No more than 120
ml or 4 oz.

If a drug, may make throw up with ipecac.

Ipecac abused by bulimics, easy to hide and fast acting.

Acteylsalicylic acid poisoning (ASA or Aspirin)- can lower blood

sugar, cause gastric problems.
Treat with emesis, lavage, activated charcoal or cathartic. Activated
charcoal important early.
300-500 mg/kg is toxic to children.

Acetaminophen- causes liver toxicity. Antedote is mucomist.

Antidote is N-acetylcysteine (NAC) Mucomyst. Given orally in juice or
soda due to nasty odor. Give loading dose and usually 17
maintenance doses in different amounts.
Toxic dose 150mg/kg for children.

Lead poisoning- from soil, paint, gas, sinkers, home remodels.

Poorly absorbed and slowly excreted.
Chelating agents bind to lead and it is urinated out. Brain damage and
death is possible without treatment. EDTA and BAL are the agents
used. Deep IM injections q4 ATC for 5 days = 60 injections.
Can only be diagnosed w/ a blood sample. 10 ug/dl is positive.
Primary prevention- prevent initial exposure.
Secondary prevention- screening for elevated blood levels.
Universal screening recommended at age 1 & 2.
Major concern- affects developing brain and nervous system.
At cellular level competes with calcium and interferes with its
regulating actions.
Also interferes with binding of iron on hem molecule creating picture of
anemia though child may not be iron deficient.
Treatment is chelation therapy. BAL is never used alone. Only with
EDTA if lead levels are higher than 70 ug/dl.
Leading source of lead is from and around older homes due to
deteriorating paint. Dust to hand to mouth.
Child often has no symptoms, even at levels that require chelation
therapy (>45 ug/dl).
Primary nursing goal: prevent exposure.

Neglect
Assessment 1st before conclusions are drawn. Emergency numbers
should always be available.
Most common form of maltreatment. Ignorance of childs needs and
lack of resources are large contributing factors. Most serious deficit is
ignorance of emotional nurturing needs of a child.

Food
Vomiting and diarrhea leads to dehydration faster in children. E. coli,
botulism, salmonella-transferred in feces.

Plants
Can be toxic. Know names of plants if you need to call poison control.

Lecture September 2

Physical Assessment in Peds

Hot dogs one of biggest choking hazards. Childs throat is

diameter of a nickel. At fair, hot dog on stick is bigger hazard.
Hot dogs should be cut up into irregular shapes-not kept round.

Balloons deadly- latex.

If you must have, when done with celebration, explode and dispose of
promptly. Milar are OK. No latex permitted in hospital.
 Disease Issues

Immunizations: Hepatitus B, Diptheria, Tetanus, Pertussis

(DtaP), Haemophilus influenza Type B (Hib), Inactivated Polio
(IPV), Measles, Mumps and Rubella (MMR), Varicella,
Pneumococcal, Influenza.

Age, immunity suppression, household members immunity, religious

reasons, can all vary immunization schedule.

Purpose of immunization is to protect public at large. If individual has

adverse reaction=collateral damage. Unfortunate but acceptable.

Autism risk-associated with DtaP. Insure that formula does not have
mercury in it-used as preservative.

Children may run low grade temp after some immunizations. May give
up to 4 shots at a time. May be necessary if you think the child may
not be getting regular health care.
Give profalactive Tylenol. Most likely will have some reaction.

Book does not mention association between autism and DtaP but does
mention a study that was done re: MMR that showed no link.

Book recommends using 1’ needle to get deep in muscle and minimize

pain. Deltoid can be used after 18 mos.

Diptheria- Bacteria. Respiratory infection. Bacteria feeds on tissue

and forms membrane causing breathing difficulty-mechanical
obstruction. Shick test to indicate exposure.

Tetanus- Bacteria. Must have injury or break in skin for bacteria to get
in. Naturally occurring organism. Aneorobic and spore forming.
Various forms of tetanus. Locked jaw, fixed muscle. Recommended
immunization schedule is q 7-10 years.
Most significant place to get tetanus exposure=pig farms.

Pertussis- Bacteria. Whooping cough. Bacteria in respiratory tract.

Causes inspirational whoop. Robitussin does not work. In younger
children it is worse. No cure. Runs its course.
Coughing can lead to vomiting which can lead to fluid volume deficit.
Dispersed by droplets in air. Hospital, IV therapy, supportive care, runs
course.

Fluid replacement in hospital will include running primary IV and

secondary IV for fluid loss by vomiting or whatever.
Hib influenzae- Bacteria. leading cause of of bacterial infections like
pneumonia.
Also causes bacterial meningitis, epiglottitis, septic arthritis and sepsis.

Polio (IPV)- Virus. Polio caused by a virus. Vaccine was once oral
given in sugar cubes. Was associated with iron lung and paralyis. Now
it is injected polio vaccine (IPV). Recommended in 4 doses( 2, 4, 6 and
18 mos.)

MMR
Measles (Rubeola)- Virus. Involves respiratory tract. Transmitted by
droplets. S&S : fever, malaise, coughing, conjunctivitis, sensitivity to
light. Koplik spots appear on inner cheeks or lips 24 hours before
measles rash outbreak.

Mumps- Throat swelling. Virus. Swelling in parotid glands; painful

swallowing. Can affect the breasts in women, or the testicles in men
(causes breasts or testes to swell with mumps, and can cause men to
be sterile). Very painful. Amount of swelling not indicative of amount
of immunity that will be gained. Most contagious just before and just after
swelling begins.

Rubella (German Measles)- Virus. Nasopharangeal. Respiratory.

Develops rash. Can vary in intensity and location. Most harmful to
unborn. Can acquire deafness and or blindness or neurological
complications.

Varicella (chicen pox)- virus. Respiratory droplet transmission.

Most communicable 24 hours before rash erupts. There are 3 types of
rashes; macule, papule and vesicles (forms crust). Symptoms: fever,
malaise, itching, scarring. Goal: To prevent secondary infections
primarily from scratching. To minimize or prevent scratching use
creams, oatmeal baths, careful when combining oral and topical
solutions for OD. Keep nails trimmed, socks over hands, cool baths,
pat dry. No soap. No rubbing. Benadryl at bedtime.

Shingles-Can appear later in life. Attack nerves. Very painful.

Happen when immunity is lowered.

Pneumonia vaccine (PCV) –pneumococcal.

Scarlet Fever- Strep infection gone wild. Transmission,; contact,
droplet, ingestion. Sandpaper rash on skin. Like fine grit sand paper.
Red ‘Strawberry’ tongue. DICK Test. Antibiotics for treatment. Kidney
or cardiac problems possible. GABHS infection.

Fifth Disease- Human parvo virus. Respiratory. Lighter skin around

mouth (circumoral pallor).

Encephalitis (swelling of brain)- can be caused by meningitis (viral

or bacterial).

September 2 lec cont.

Diagnosis-By spinal tap. Put EMLA cream over puncture site 30-35
minutes before to numb area. Can spray on. Brain damage or death
possible.

Small pox- virus. considered eradicated. Large and small blisters.

Can kill you.

Tuberculosis- Very contagious. Lung disease but can affect other

organs. Maybury park was a TB respite. Once exposes always
positive. X-rays confirm. Manitox test. 3-drug therapy.

Hepatitis A- Vaccine for select states and groups. Transmitted mostly

through contaminated food and water.

Hepatitis B- Vaccine recommended for all babies. 3-shots.

Hepatitis C- There is no vaccine.

Typhoid Fever- fever and hallucinations. Contracted by ingesting

food and water contaminated with feces. Cipro antibiotic of choice.
STD’s-Children usually have more than one at a time. Encourage
condom use.

Rabies- Contracted from animals. Brain should not be frozen. Can

destroy tissue necessary for analysis and confirmation of disease in the
animal.

Impetigo- Skin infection. (Staph/Strep) . Face and genitlia common

sites. Causes lesions. Highly contagious. Topical bacterial ointment.
Oral or parenteral antibiotic (penicillin) may be necessary in more
severe cases.

Ringworm- Fungus. Ringed/circle shaped rash on skin. Very resistant

to treatment. Can cause hair to fall out. Can use Tenactin for athletes
foot on it. Oral Gristafubulin is good for it. Can have it for up to a year.

Scabies- Bug under skin. Leaves tracks as it travels. Very itchy.

Prevent scratching to minimize secondary infection.

Conjunctivitis/pink eye- Bacteria infection. Highly contagious.

Sealed eyes in AM from exudates. Warm compress to open. Wash
hands well after. Drops administered carefully. Ointment applied at
night to avoid blurred vision. Gentamycin

Peticulosis- Lice. Body or hair lice. Red dots or track marks on top
of skin. Key is intense scratching. May draw blood. Particularly at base
of neck. Rid or Quell and fine tooth comb to remove. 1 week to 10
days later must repeat. Wash all linens, clothes etc. in hot sudsy
water. Repeat in 1 week to 10 days. May have respiratory sensitivity
to treatment. Dries hair and can break off.

Lyme disease- From ticks. Burrow head in skin. Must be tweezed

out. Leaves bullseye rash. Tetracycline is treatment med of choice.
Neuro complications possible. Prevention: long sleeve, socks over
pants. Use spray as needed-camping for example. Organism
Spirochete

Snakebite-antivenin

Rye Syndrome: don’t give aspirin. This disease is associated with use
during chickenpox, or flu-like symptoms.
Leaches are used to suck out hematomas. Maggots are used to
remove necrotic tissue-hospital windows should not be open due to
flies laying eggs in undesirable locations like trachs and wounds.

Obesity: Diabetes, and heart disease. Food intake and activity level.

Pinworms- characterized by itchy bottoms. Eggs ingested or inhaled

(eggs float in air! ) Eggs survive GI tract and female comes out to lay
eggs. Diagnosed doing tape test. Treatment of choice is
memendazole (Vermox). Everyone in household should take.

MRSA- methicillin resistant staph aureous.

September 2 lecture cont.

Burns

Secondary infection concern. Prevention important first. Promote

safety: smoke detectors, age appropriate behaviour protection.
Growth and development.

Seasonal accidents. Change in weather; accessory heat. Holiday

lights. Fourth of July, labor day and memorial day celebrations.

Degrees of Burn:

1st degree=superficial

2nd degree=partial thickness

3rd degree=full thickness burns.

September 9 Lecture

Local fire department good source for brochures and demonstration

equipment on safety. Want to give children something to take home.
Wanting teaching material to be age/developmentally appropriate.

SKIN

Razors- disposable razors after use and kept in moist environment can harbor
bacteria. Small cut on skin can allow bacteria to get in. Armpit loss story.
 Graft

Best graft is your own.

Burn

Shock and fluid loss first concerns.

Assessment: Body Surface area affected. Depth of burn/classification and

location. Rule of nines Burkau method.

Toes & fingers have less skin and hence are at greater risk for bone infection.

Loss of fluid can have impact on kidneys.

Other injuries/illnesses must be considered for attention: car accident can

have internal bleeding, broken bones, ailments like chicken pox or diabetes.

Obesity-compromises a child’s chances of survival.

Extent of Injury= Total body surface area. Rule of Nines. Charts are
contructed for different ages. Weight is more important than age though-
Gafford.

Degrees of Burn=Depth of injury

1st degree- short contact/duration with hot object. If large body surface area
involved and/or involving a young child, could prevent from eating and
drinking and can be serious.

2nd degree- partial thickness burn. Liquid, chemical, flame, electrical (has
entrance and exit points).

3rd degree- deep dermal burn. Entire thickness of skin. Tough leathery or
charred looking. Doesn’t blanch well under pressure. Pain at edges (usually
no pain with full burn due to destruction of nerves). Result of longer
exposure. Lost fluid. First 12 hours will give lots of fluid.

Severity of Injury- Major, moderate or minor burns. If major, should go to

specialized burn center.

In hospital IV’s calculated by graph.

Intentional burns-punishment. Submersion in hot water.

Never microwave bottles or containers of food for baby. Uneven heating.

Heat from inside out.

Severity of burn- depends on amt of area affected.

< 2yr old have higher mortality rate with burns of similar magnitude in those
who are older.

Shock & pain

Fluid guide 22mg/kg/hr going in.

First 48-72 hours most critical to stabilize.

Infection risk with loss of tissue and central lines. Wash hands.

Gastric issues-stress ulcers arise.

Rehab phase can be long phase. Compression dressings used.

Child falls in fire pit? Stop Burn. Throw in lake if you have to-if showers not
available.

Diet for rehab must be high in calories and protein. Hard to achieve when
you have a lack of appetite for protein. Increased metabolic needs and to
stop protein breakdown.

Icky burn- clean, scrub,silvadene, bandage and your on your way.

If worse. Hospitalize. Dip in hubbard tank, debride, cut away, silvadene,

bandage.

Need pain control. Painful process.

Contracture can develop as child grows because scar tissue does not grow
with them. Have to repeatedly cut.

Blisters-do not break. Source of infection. Some are thin, others are thick.

Major complication: Airway compromise and Shock r/t fluid loss and infection
both local and systemic.

Carbon Monoxide-byproduct of combustion- has a greater affeinity for

hemoglobin than oxygen and results in oxygen deprivation. Must give 100%
O2 to correct. Note: When monitoring O2 sat w/Dinemap that it can NOT
differentiate between CO3 and O2. As a result cannot monitor .

First thing to do in emergency: stop the burning process. Smother flame.

Get horizontal.

Second: assess and address ABC’s

Cover burn and transport.

Prophalactic antibiotic use is usually not done systemically because
mediction can’t get to burn sights. Surveillance cultures are performed and
then treated as necessary.

Morphine is drug of choice for treatment of burns.

Phases of burn treatment:

Acute phase- first 24-48 hours. Burn shock and pulmonary management. IV
infusion goal is to get urine output of 1-2 mg/kg/hour.

Management phase- infection control, wound closure, and managing

complications.

Rehab phase- Starts once wound is closed. Rehap portion can last a long
time.

Respiratory

Babies are nose breathers. Nasal flaring a sign of respiratory distress.

Depress nasal bulbs before insertion to suck out boogies. Use saline drops to
soften crusty ones.

O2 if given needs to be humidified. Hood or tent is best. Mask if you have to

but nasal cannula is not best choice. Child may get damp under tent and get
cold which is bad-burns lots of calories. Child may need to be changed
periodically to keep warm and dry.

Note that a child with asthma can also have pneumonia.

Acute streptococcal pharyngitis-Strep throat- Soar throat. Mild to

severe pain. Exudate on tonsils. Repeat infections causes pitting. Food
particles can get in and get stinky.

Treat to prevent rheumtic fever complication. Swab for culture. 2 kinds of

swabs. Treatment of choice: Penicillin. Erythromycin for those allergic to
penicillin. Amoxicillin usually prescribed because its cheap.

Can have abdominal pain and diarrhea due to antibiotics. 10 day course.

Zythromax good choice but expensive.

Tonsillitis- Can be viral or bacterial. Palentine tonsils enlarge. Can enlarge
to midline becoming ‘kissing’ tonsils. Can block airway!

Exudate present. Adenoids enlarge and effect hearing.

T & A- tonselectomy (if airway occluded) and adenoidectomy (for

obstruction of nasal breathing). Is not a routine procedure. Can bleed to
death or not wake up from anesthesia. A lot of pain. Assess for bleeding.
Hard to get to look in mouth. Watch for a lot of swallowing. Sign of bleeding.
If they swallow to much blood they will vomit. Call surgeon.

About 1 week later, watch for bleeding again. Scabbing can break off and
bleed.

Tylenol w/codeine hurts to swallow. Taken for a while can cause vomiting
which hurts.

Ice compress over neck helps w/swelling and pain.

Cool fluids, watch spicy foods. No aspirin due to bleeding risk. Ice cream not
good due to thickness. Give Popsicles with cup or in cup so a little slushy.

If bleed occurs needs to be cauterized.

Ear ache (Otitis Media)- Anything smaller than elbow should not go in ear.
Cecum can build up. Otitis Media- half of children can be affected. They have
short estuchian tubes. Ear drops are put in depending on developmental age
of child

Temps can be high. Child may pull at ears.

Ear drum may rupture. May see fluid on pillow. Organisms involved include:
Streptoccocus pneumoniae, H. influenzae and Moraxella catarrhalis.

Middle ear is affected. Amoxicillin is treatment of choice. Pink bubblegum

medication tolerated OK. Give full course. Usually 10-14 days.

Sulpha drugs and augmentin are second line drugs.

Otititis w/ effusion- Tubes put in ears. No swimming under water, laying in

tub etc. Protect ears.
Earrings, long standing holes, can cause an infection. Tongue piercings
affect the taste buds, and can cause infection; the tongue swells to the
size of a cow. If severely swollen, the tongue may have to be
amputated. There is no prosthesis for the tongue.

External Ear Infection/Swimmers ear: causes excruciating pain. Pt.

seeks pain relief. Neomycin and steroids helps.

Croup- can affect larynx, trachea & bronchi but usually larynx.
Syndromes are described based on the anatomical area affected.
Characteristics include: hoarseness, barking or brassy cough,
inspiratory stridor and respiratory distress.

Acute Epiglottitis- croup illness. Bacteria. Usually involves H.

influenzae bacteria. Affects children 2-5 year old . Progresses quickly.
Is an emergency situation. THROAT INSPECTION SHOULD NOT BE
ATTEMPTED UNLESS YOU ARE READY TO INTUBATE.
Children go to bed fine and wake up later with soar throat, fever and
sick. NO cough. Drooling and agitation key features.
Child will insist on sitting in tripod position, leaning over to facilitate
breathing.
If making frog-like croaking sounds and drooling (due to pain and
difficulty swallowing) will probably need to be intubated (endotracheal
tube) or have a tracheostomy.
Monitor arterial blood gases. Give antipyretics, antibiotics, O2 and
humidity.
Weird sounds indicate respiratory distress. Can just put air tubing near
baby mouth/nose to help get O2 up.

CPT/cupping done before eating/sleeping. Clear airway.

Bronchodialators, steroids, O2 and antibiotics.

Restlessness is early sign of distress. S is late sign.

Carotid is easiest place to get a pulse on a child.

Epinephrine and theophylline are emergency drugs.

LTB (laryngotracheaobroncitis)- croup illness. Viral. Slower

progressing. Have cough. Cool mist vaporizers helpful for soothing
upper respiratory tract. Does nothing for lower. Watch respiratory
status.
Emphysema
People can get air anxious. Reduce anxiety w/parent presence,
blanket or toy. May have to use medication to decrease anxiety.
Steroids may be used. May dilate airways w/ meds. If edema in throat
and need to get culture could increase anxiety.

Bronchitis- Inflammation of large airways. Dry hacky cough.

Sometimes confused with whooping cough.

RSV (Respiratory Synctial Virus)/causing Bronchiolitis- Viral infection.

Affects children up to 2 years old and accounts for 80% of cases during
epidemic periods. Late fall through early spring. Treated symptomatically.
High humidity, fluids and rest.

SIDS- Babies should be kept on back. There can be exceptions.

Mononucleosis- Herpes like Epstein Barr. Affects people in groups like

Dorms. Affects liver.

Carbon Monoxide Poisoning- Turn cherry red. Watch indoor combustions

sources.

Allergies- Benadryl, Claritin and other histamine blockers dry you out.
Anticholingergic affects cause problems with contacts and constipation.
Monitor I & O.

Smoke inhalation- Give O2 first by mask. May have hoarse cough.

Headache, visual disturbance.

Aspiration Pneumonia- HR increases, Respirations go up, nasal flaring

with children, and very restless. This can be deadly. Thickeners can be
used to thicken fluids. Pneumonia causes scaring if repetitive.

Sinuses- can fill and get infected. Painful. Can kill U. Full craniotomy
in 18 year old.

Pneumonia- Viral, bacterial, walking, bilateral.. All types. Viral must

common in children. Inflammation of the pulmonary parenchyma (functional
parts such as alveoli) Person needs rest. If viral not too much can do but
support. If bacterial will give antibiotics. Immobility can lead to pneumonia.
Must get up, have positions changed. Small amount of food. People still die
from this.

Asthma- chronic inflammatory disorder that causes narrowing of airways by

secretions and trapping of air. Can be triggered by allergens, stress, illness,
food, cold air, exercise…widespread narrowing of the bronchia’s,
hyperinflation of the lungs. It can be caused by allergies, infections,
weather. Can affect adult and children alike, and it can kill you.
Heightened airway activity; airway reacts to something; spasms occur,
mucus builds up, airway resistance (lungs aren’t inflating properly),
inspiration and expiration needs to be assisted. Medications to give are
usually epinephrine or Theophylline. Theophylline can be toxic; signs
are nausea. Bronchodilators and steroids are used (prednisone). Have
to wean the child off steroids. Long-term use can cause steroid induced
diabetes. Steroid use over a long period causes immune compromise.
Albuterol, Atrovent, and Advair (not for acute, used for continuous).
Want the Pt to exhale and get air out before they inhale the inhaler.
Things that interfere with or cause induced asthma: swimming,
allergies, etc. Want the children to go home as soon as possible,
because the longer they stay the greater the risk for anxiety and
infection.

Cystic Fibrosis- Gunky tube disease. Like asthma, they can do

pulmonary function test (how much air goes in and out during
respiratory cycle). Pt can wheeze, because this is a restrictive disease.
It is an autosomal disease. “They Gunk Up and can’t get enough air.”
Thick and tenacious secretions develop. It is a genetic issue. The
bearer holds responsibility. Multiple organs are involved. Early sign of
this is Myconium Ileus. Not 100%, but is an indicator to check. Salty
tasting skin is another sign, especially if the child has not participated
in an activity that would cause excessive sweating. ‘Kiss your baby’
disease. Increased sweat electrolytes is what causes the salty skin. Get
cystic pockets in their lungs, they can’t digest, so they get steatorrhea.
Might be diagnosed as having Asthma; often failure to thrive is another
diagnosis because they have muscle wasting. Clubbing occurs and
doesn’t usually go away. Chronicity in respiratory systems, keeps the
children from developing because of hyper-metabolic syndromes, so
the child requires more calories to achieve development. Child might
receive an NG tube so they can be given supplemental calories. After
repeated hospitalizations, they catch Pneumonia. These Pt’s are likely
to get MRSA and Cepaca. Have high dose ABX r/t ABX resistance. If
they can’t get out their pancreatic enzymes needed for digestion, they
have steatorrhea, and they have to receive enzymes. For infants, open
the enzyme capsule and mix with applesauce to give to the baby. They
need to receive enzymes with every feed in order to digest the food.
With steatorrhea, the pt holds no nutrition, everything taken in comes
out. Will need supplements of A, D, E and K. Most pts with this disease
appear anorexic due to malnutrition. Pts usually have a G-tube placed
when digestion has failed. Enzymes are given WHEN THE FOOD IS
PRESENT WITH THE FOOD. Need high calorie diet and
supplementation. Nutrition is very important. The preferred diet is High
calorie, High Protein Diet. They like salty foods, like Pickles, because
they sweat out all their electrolytes. Clean their respiratory tract before
they sleep or attempt to eat using CPT. Respiratory is the terminal
event. Boys are usually sterile. Girls have to have fat in order to
ovulate, so they usually won’t have a period so they won’t ovulate r/t
malnutrition. Children from parents with this will be a carrier if they
don’t actively have it.