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Thursday, October 20, 2011

Pediatric Notes III


RESPIRATORY DISORDERS  


BRONCHIOLITIS
Mani:
Rhinorrhea & ß fever
Lethargy
Poor feeding
Irritablity
Tachypnea
Dyspnea
Nasal flaring
Wheezing
Diminished breath sounds

Mgt: Ribavirin (Virazole)

PNEUMONIA

Types:
Viral : Whitish sputum
Bacterial: non productive hacking cough
Primary Atypical: Non productive – productive- blood streak sputum


NURSING CARE


  • Administer O2, Mist tent
  •  Suction PRN
  •  Chest physiotherapy
  •  Bed rest
  •  Lie on the affected side     
  •  Isolation precaution
  •  Anti-tussives, antimicrobial therapy, antipyretics
  •  Thoracenthesis

ASTHMA

ü   Wheezing
ü   Dyspnea
ü   Chest tightness
ü   Exacerbations
    - air is trapped behind occluded or narrow airways    
      and hypoxemia can occur


STATUS ASTHMATICUS

  - child displays respiratory distress despite vigorous 
    treatment
  - may result in respiratory failure & death if untreated


HOME CARE MEASURES

            - Allergens control
            - Avoid extremes of temperature
            - Avoid exposure to viral respiratory infection
            - Recognize early symptoms
            - Instruct the child in the administration of  medications as Rx
            - Adequate rest, sleep, and a well-balanced diet
            - Adequate fluid intake
            - Exercise as tolerated



SUDDEN INFANT ‘s DEATH SYNDROME

MATERNAL RISK FACTORS
Maternal smoking
Substance abuse
Younger mothers



APPEARANCE WHEN FOUND

Apneic &  blue
Frothy blood-tinged fluid in the nose & mouth
Typically found in a disheveled bed, with blankets over the head,
Diaper is wet & full of stool



GUT

Cryptorchidism

       Whether or not to treat is still controversial.
     - If the testes remains in the abdomen, damage to the testes (sterility) is possible because of  increased body temperature.
       If not descended by age 8-9 mos, chorionic gonadotropin can be given.


 Orchipexy
    - surgical procedure to retrieve and secure testes placement
    - preformed between ages 1-3 years


NURSING CARE

       Advise parents of absence of testes and provide nformation about treatment options.
       Support parents if surgery is to performed.


Post-op
       Avoid disturbing the tension mechanism.
    - will be in place for about 1 week.
       Avoid contamination of incision.



GIT DISORDERS

Celiac’s dse aka Gluten Enteropathy

- Increase in amino acid glutamine
Monitor gluten free diet
Provide supplement fat-soluble vitamins
Provide client teaching and discharge planning concerning:
             a. Gluten-free diet
             b. avoidance of infection.
             c. importance of adhering to diet      
             d. importance of long term ff-up management.



IMPERFORATED ANUS

         Surgery to reconstruct the anus and perform a colon pull-through or sigmoid colostomy with anastomosis and pull-through 1 year later

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