PEDIATRICS UNIT 2

1. PEDIATRICS UNIT 2 Revised 2012

2. Hematologic Disorders Anemia (Iron Deficiency) Sickle Cell Anemia Hemophilia ALL ( Acute Lymphobalstic Leukemia)

3. Iron Deficiency Anemia • Insufficient dietary iron • Maternal stored depleted at 6 mo. • Inadequate iron intake

4. Clinical Manifestations • Hgb 6-10 • Irritability, weakness, decreased play activity • Fatique • Hgb <5 • Anorexia • Pale • tachycardic

5. Treatment • Iron replacement – ferrous sulfate • Give with straw or syringe • ^ citrus fruits or juices

6. Nursing Interventions • Dietary instruction • Teaching of long term complications of anemia • Dark, tarry stools

7. Sickle Cell Anemia • Inherited • African-American / Mediteranian • No cure

8. Sickling: • Clumping of abnormal shaped cells • Results in obstruction w/ severe tissue hypoxia

9. Sickle shaped cell in center of picture Severe sickling can lead to sickle cell crisis, an acutely painful period that occurs intermittent throughout life.

10. Factors that precipitate a crisis • Infection • Dehydration • Cold • Emotional stress

11. Nursing Interventions • Hydration • Analgesics • O2 • Warm baths, local heat • Avoid precipitating factors

12. Coagulation Disorder • Hemophilia • Inherited – X linked • Lack clotting factors: • Factor VIII or Factor IX

13. Clinical Manifestations: • Bleeding, bruising • Hemarthrosis • Bone deformities, contractures • Hematomas • Diag test: PTT

14. Medical Management: Replace clotting factors

15. CRITICAL THINKING Q’S • What are your nrsg interventions? • What is RICE? • What are s/s of intracranial bleed?

16. Neoplastic Disorder • Acute Lymphoblastic Leukemia • Most commom malignancy in children, ^ males • Increased blast cells • Decreased rbc’s and platelets • Internal organs enlarge

18. Medical Management: • Chemo & steroids • Intrathecal drugs • Goal is remission

19. Clinical Manifestations • Pallor, fatigue • Fever, ^ infections • Bleeding, bone pain • Limping • s/s of ICP

20. Nursing Interventions: • Monitor s/s infection & reduce risk • Oral care • Enc. Nutrition

21. Immune Disorders • AIDS • RHEUMATOID ARTHRITIS

22. HIV/AIDS • Chronic, usually fatal • Perinatal infection, 91% • Blood & bodily fluids • Sexual abuse • Adolescents have ^ risk d/t risky behaviors

23. Medical Managment • Keep viral load low • Prev. infections • Restore normal G & D • Improve quality of life • Box 31-2 drugs

24. Nursing Interventions • Prevent infection • Nutrition / meds • Family support

25. Juvenile Rheumatoid Arthritis • Chronic inflammatory autoimmune connective tissue disease • Destroys cartilage, affects joints & tissues • Occuring bet. 1-3 & 8-10 yrs old

26. Clinical Manifestations • Stiffness, edema • Loss of motion • Warm to touch • Increase temp • Macula rash

27. Diagnostic Tests • Clinical findings • No specific tests • ESR • X-rays

28. Medical Management • Preserve joint function • NSAIDS – SAARDS • Moist heat - PT

29. Nursing Interventions • Manage pain, educate • Support groups to express fears & concerns • Balance rest/exercise

30. Respiratory Disorders • Acute respiratory infections are common in infancts & children. They range from minor to life threatening illnesses.

31. Respiratory Distress Syndrome • Lack surfactant to keep lungs expanded • Gestational age at birth influences severity • #1 s/s  respiratory distress

32. Treatment Exogenous Surfactant O2 therapy Parenteral therapy

33. Pneumonia • Inflammation of lung tissue • Common cause RSV • Viral more common than bacterial

34. Clinical Manifestations See Box 31-3 Dx x-ray Tx O2, fluids, nebulizers, antx if bacterial cause

35. Nursing Interventions • Resp & CV assessmt • Infection control • Hydration, IV fluids • O2 & antx as ordered

36. Sudden Infant Death Syndrome • No cause • Occurs during sleep • 3rd leading cau of death betw. 2-4 mos. • Diagnosed on autopsy

37. Nursing Inteventions • Family grief support • Allay feelings of guilt and blame • Teach “back to sleep”

38. Acute Pharyngitis • “sore throat” • 80% viral • 20% strep • H-influenza in children , 3 yrs • s/s: • Fever • Sore throat • White exudate

39. Tonsillitis • S/S same as pharyngitis Treatment : 1)Same as pharyngitis 2) Tonsillectomy

40. Nursing Care • Pre-op Notify MD of temp • Post-op Monitor for bleeding, no straws, analgesics

41. Croup Acute viral disease marked by resonant barking cough, difficult breathing & laryngeal spasm.

42. Laryngeotracheobronchitis • LTB = most common form of Croup • Follows an URI • s/s: barking cough, tachypnea • retractions

43. Epiglottitis • Cause: H influenzae bacteria • Life threatening airway obstruction

44. Signs & Symptoms Drooling High Fever Resp distress Muffled voice Progressive resp. distress Anxiety Fear

45. Nursing Assessment • Check for the 4 “D’s” 1) Drooling 2) Dyspnea 3) Dysphonia 4) Dysphagia

46. Treatment • Maintain airway • Cool mist • NPO – IV fluids • Epinephrine, Antx

47. Nursing Interventions ^ HOB Assess resp. status Freq. VS Trach tray @ bedside

48. Bronchitis • Usually viral • s/s: same as with URI + cough • Common during winter months • Children < 4 y.o.

49. Cystic Fibrosis • Inherited, defective gene • No cure • Excessive thick mucus produced • Obstructs lungs & GI system