PEDS ATI Part II

Meningitis
Inflammation of CSF and meninges, which are the CTs that cover the brain and
spinal cord
Types:
o Viral (aseptic) meningitis
Usually only requires supportive care
o Bacterial (septic)
Contagious infection
Prognosis depends on how quickly care initiatied
Risk factors:
Infections caused by bacterial agents:
o Neisseria meningtitidis (meningococcal),
streptococcus pneumoniae (pnemococcal),
haemophlus influenzae type B (Hib), E. coli)
o Injuries with direct access to CSF (skull fracture,
penetrating head wound)
o Crowded living conditions
o Subjective: photophobia, nausea, irritability, headache
o Newborns
Poor muscle tone, weak cry, poor suck, refuses feeding,
vomiting or diarrhea, possible fever or hypothermia
Neck supple without rigidity
Bulging fontanels late sign
o 3 mos-2 years
seizures with high pithched cry
fever and irritability
bulging fontanels
possible nuchal rigidity
poor feeding
vom
brudzinski and kernigs signs not reliable for dx
o 2 years through adolescence
seizures (often initial sign)
nuchal rigidity
+ brudzinskis sign (flexion of extremities occurring with
deliberate flexion of childs neck)
+ Kernigs sign (resistance to extension of childs leg from flexed
position
fever and chills
H/A
V
Irritablility and restlessness that may progress to drowsiness,
delirium stupor and coma
Petechai and purpuris type rash
Involvement of joins
Chronic draining ear
o Labs
Bacterial
Cloudy color
Elevated WBC
Elevated protein
Decreased glucose
+ gram stain
Viral
Clear
Slightly elevated WBC
Normal or slightly high protein
Normal glucose content
- gram stain
o Droplet precautions
Lumbar puncture
o Measures spinal fluid pressures and collects CSF
o Empty bladder
o Topic anesthetic may be applied over area 45 min to one hour
o Side lying position with head flex and knees drawn up toward chest
o Remain in bed 4-8 hours flat post op to prevent leakage and resulting
headache

Reye Syndrome
Life threatening disorder that involves acute encephalopathy and fatty changes
of the liver

Patient with head injury
S/S of increased ICP
o Infants: bulging fontanel, separation of cranial sutures, irritability,
increased sleeping, high pitched cry, poor feeding, sun setting sign
o Children: nausea, HA, vomiting, blurred vision, increased sleeping,
inability to follow simple commands, seizures
o Late signs: alteration in papillary response, posturing (decorticate and
decerebrae), bradycardia, decreased motor response, decreased
sensory response, cheyne-stokes respirations, coma
o Expected reference range 10-15 mmhG
o Implement to decreased ICP:
Keep HOB 30, promotes venous drainage
Avoid extreme flexion, extension, or rotation of head and
maintain in midline neutral position
Keep body in alignment, avoid hip flexion/extension
Minimize suctioning
Instruct to avoid coughing and blowing nose, because this
increases ICP
Promote fluids

How to use inhaler
Remove cap
Shake five to six times
Attach spacer
Hold mouthpiece at bottom
Hold inhaler with thumb near mouthpiece and index and middle finger at top
Instruct on MDI technique
o Opening mouth method: hold approx 2-4 cm away from front of mout
o Closed: placebetween lips and instruct to form seal around MDI
Take deep breath then exhale
Tild head back slightly and press inhaler. While pessing begin a slow, deep
breath that lasts for 3-5 seconds to facilitate delivery to air passages
Hold breath for approx 10 seconds to let med deposit in airways
Take inhaler out of mouth and slowly exhale through nose

Digoxin (Lanoxin)
Improves myocardial contractility
Monitor pulse and withhold medication as ordered
Generally if infants pulse is less than 90/min the med should be withheld
In children, med held If pulse less than 70/min
Monitor for toxicity: bradycardia, dysrhythmias, N/V, or anoerxis
Monitor serum dig levels

Furosemide (Lasix)
Potassium wasting diuretics rid body of excess fluid and sodium
Encourage diet high in K (bran cereals, potatoes, tomatoes, bananas, melons,
oranges, organge juice)
Monitor I and O
Monitor for adverse affects hypokalema, N/V, dizziness
Weight daily

HDL- good
LDL- bad

Iron deficiency anemia
Most common type in US
Ages 12-1 at risk due to consuming diet high in cows milk without adequate
intake of iron
Nursing actions
o Provide iron supplements for preterm and LBW infants by age 2
months
o Provide iron supplements to infants exclusively breastfed by age of 4
months
o Recommended iron fortified formula for infants who are not breastfed
o Modify infants diet to include high iron, vit C and protein content
o Monitor milk intake
Limit to 32 o (950 mL) per day
Delay giving milk til after meal
Do not let carry bottles or cups of milk
o Iron supplements
Give one hour before or two hour after milk or antacid to
prevent decreased absoption
GI upset normal at start of therapy
Administer on empty stomach
Give with vit C
Use straw to avoid staining teth
Z track; dont massage after
Tarry green stool normal
Sickle cell anemia
Group of diseases in which abnormal sickle hemoglobin S replaces normal adult
hemoglobin (Hgb A)
SCA- Homozygous & most common form; autosomal recessive; African
Americans
Vaso-occlusive
o Painful episode
o Usually lasts 4-6 days
o Manifestations
Acute
Severe pain in bones, joints and abdomen
Swollen joints, hands and feet
Anorexia, vomiting, fever
Hematuria
Obstructive jaundice
Visual disturbances
Chronic
Increased risk of resp infections and osteomyelitis
Retinal detachment and blindness
Systolic murmurs
Renal failure and enuresis
Liver cirrhosis; hepatomegaly
Seizures
Skeletal deformities; should or hip avascular necrosis
Dehydration: fatigue, malaise, change in behavior, change in stool pattern, poor
appetite, weight loss, pain
Isotonic
o Water and sodium lost in equal amounts
o Major loss of fluid from ECF leads to a reduced volume of circulating
fluid
o Hypovolemic shock may result
o Serum sodium WNL (130-150)
Hypotonic
o Electrolyte loss greater than water loss
o Water changes from extracellular fluid to intracellular
o Physical manifestations more severe with smaller fluid loss
o Shock likely
o Serum sodium less than 130
Hypertonic
o Water loss greater tan electrolyte loss
o Fluid shifts from intra to extra
o Shock is les likely
o Neuro changes may occur
o Serm sodium greater than 150

Tape test
Performed to check for enterobius vermicularis
Education
o Tell parents to place transparent tape over childs anus at night
o Remove tape following morning prior to child toileting or bathing
o If possible, have parents apply take after child has gone to bed and
remove before wakens
o Bring specimen to lab

Cleft lip & Palate
Lip
o Done between 2-3 months
o Infants should be at least 10 weeks old, weigh 10 ilbs and Hgb 10g/dl
o Revisions usually required in severe defects
o Postop
Position infant upright, on back, or on her side to maintain
integrity of repair
Elbow restains
Saline on sterile seab to clean
Gently aspirate secretions of mouth and nasopharynx to
prevent respiratory complications
Palate
o Between 6-12 months
o Majority require second surgery
o Post op
Change position frequently to facilitate breathing. May be
placed on abdomen immediate post op period
Maintain IV fluids until infant able to eat and drink
Monitor packing, usually removed 2-3 days
Avoid objects in mouth
Elbow restraints may be used to prevent infant from injuring
repair

Expected findings with renal disorders
Throat culture to ID streptococcus infection (usually by time of diagnosis)
Urinalysis- proteinuria, smoky or tea colored uring, hematuria
Renal function- elevated BUN and creatinine
ASO titer- positive indicator for presence of strep antibodies
AHase ADnase- B step enzymes may be present
Serum complement (C3) decreased initially, increases as recover takes place
normal 8-10 weeks

Compartment syndrome
Compression of nerves, blood vessels, and muscle inside confined place
If untreated tissue necrosis can result
Findings:
o Increased pain not relieved with elevation or analgesics
o Intense pain when passively moved
o Paresthesia or numbness
o Pulselessess or numbness
o Pulselessness distal to fracture
o Inability to move digits
o Warm digits with skin tight and shiny
o Pallor

Clubfoot
Positional clubfoot( occurs from intrauterine crowding), syndromic (in
associaion with other syndromes) and congenital (idiopathic)
Talipes varus- inversion (being inward)
Talipes valgue- eversion (bending outward)
Talpes calcaneaus- dorsiflexsion (toes higher than heels)
Talipes equinus- plantar flexion (toes lower than heels)
Talipes eqinovarus- toes facing inward and lower than heel

Duchenne Muscular Dystrophy (DMD)
Genetic hx
S/S
o Fatigue
o Muscle weakness beginning in lower extremities
o Unsteady gait, with waddle
o Lordosis
o Delayed motor skill development
o Falling
o Hard to get out of bed
o Learning difficulties
o Mild cognitive delays
o Progressive diff walking by 12
o Progressive muscle atrophy
o Resp and cardiac probs by age 20
Tinea coporis- round erythematous scaling path; speards peripherally and clears
centrally

Head lice pediculosis capitus
Shampps containing 1% permethrin as prescribed
Remove nits with nit comb repeat in 7 days after shampoo tx
Wash clothes and bedding in hot water with detergent
Difficult cases: use malathion 0.5% in isopropanol

Diaper rah contact dermatitis
Diaper rash may be caused by detergents, soaps, chemicals that come into
contact with genital area
May be result of candida albicans
Contant derm-Red bumbs that may form moist, weeping blisters, skin
warm and tender to touch, presence of oozing, drainage, or crusts, skin
becomes scaly, raw, or thickened
Diaper derm- bright red rash that extends gradually, fiery red and scaly
areas on scrotum and penis or labia, pimples blisters ulcers large bumps
or pus illed sores, smaller red pathches that blednd together
Nursing care diaper:
o Remove wet diaper
o Clean urine off periineal area with nonirritating cleanser.
Cleanse perineal area of feces with warm water and milk doap
o Wash skil folds and genital area frequently with water
o Expose affected area to air
o Superabsorbent disposable dispers to reduce skin exposure
o Aply skin barrier such as zinc oxide. DO NOT wash off with
each diaper change
o Use cornstarch to reduce friction bet diaper and skin
Diabetes
Hypo <60
Hyper >250: thirst, poly uria, oliguia, N/V, Abd pn, skin that is warm, dry and
flushed with poor turgor, dry MM, confusion, weakness, lethary, weak pulse,
diminished reflexes, rapid deep resirations with acetone/fruity odor due to
ketones (Kussmaul respirations)
Diagnostic Criteria
An 8 hour fasting blod glucose level of 126 or more
A random blood glucose of 200 or more with classic signs of diabetes
An orgal glucose tolerance test of 200 or more in 2 hours sample
TYPE TRADE NAME ONSET PEAK DURATION
Rapid acting Insulin lispro
(humalog)
Less than 15
min
0.5-1 hr 3-4 hr
Short acting Regular insulin
(humulin R)
0.5-1 hr 2-4 hr 5-7hr
Intermediate
actig
NPH (humulin
N)
1-2 hr 4-12 hr 18-24 hr
Long acting Insulin
glargine
(lantus)
3-4 hr None 10/4-24 hr