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Approaches to Common Pediatric Disease and Injury PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "Approaches to Common Pediatric Disease and Injury", to know about Common Pediatric Disease and Injury with an Emergency Room Perspective.

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Published on : Aug 03, 2021 | Views : 2467 | Downloads : 8

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Slide 1-

Approaches to Common Pediatric Disease and Injury:An Emergency Room Perspective Designed and Presented by: Thea Bachemin MSN Jan Tatum MSN Tina Wood BSN, MRCH ED/ICU Manager
Slide 2-

Recognizing Normals the basics….
Slide 3-

How to do a physical exam………. Infant/toddler/preschooler: parents present. Nursing consideration: Are they good historians? School age: participatory, able to answer basic questions (remember, language they can relate to!) Adolescent: independence and identity, need privacy and decision making in health care issues
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Normal mapped growth and development Growth and development charts
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Health Assessment…… History of present illness/condition….when did it start? Family History Past medical History, Allergies Vital signs Immunizations Denver II screening test (well child) Sleep patterns Nutrition
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Anthropometric Measurements Height Weight Length BMI Childhood Obesity (2015, CDC 17%) Reasons………………………
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More Assessment………………… General behavior….. Skin: rashes HEENT: screenings Neck: swollen glands…what could they be? Chest: Heart sounds/lung sounds Cardiovascular: circulation Gastrointestinal: Peds GU: Common issues A B
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Pediatric Pain Subjective vs. Objective 0-10 scale, when? Wong’s Faces scale: eh NIPS: research and current findings FLACC: key is consolability CHEOPS
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NIPS FLACC The recognition and assessment of acute pain in children: technical ... CHEOPS What is the reason for using one scale over another?
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Developmental perception of pain 0-2 yo: sensory stage, pain without understanding source 2-7 yo: preoperative stage: pain is punishment 7-11 yo: concrete operational: connect pain with injury 11-18 yo: formal operational thought
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Common Primary Diagnosis of Children Cared for at MRCH (2015)
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Common Secondary Diagnosis on Children Cared for at MRCH (2015, by classification)
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Hospitalization, Emergency Treatment and Family Centered Care Caregivers at bedside, why and why not? Therapeutic play Role modeling Guided imagery Age specific language Care giver needs/stressors Procedures: Infants: parental involvement Toddlers: they hate you, accept it… Preschool: choice and reward School age: concrete, time stamped Adolescent: control and explanation
Slide 15-

Common Respiratory Disease
Slide 16-

REVIEW OF SYSTEMS………. Upper respiratory system Sinuses, nasal cavity Pharynx, Larynx Lower respiratory tract Trachea, bronchi, lungs
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RESPIRATORY REVIEW…. < 6 years of age, “belly breathers” At 7 years of age, tonsils done growing From 6 to 8 years of age, sinuses develop Diaphragm expands and contracts, negative pressure created, aveoli expand 4mm to 12 mm FB more likely to lodge in Right bronchus Immature lung tissue, fully developed at about age 12 Surface area of alveoli increase 9 times by 12 years old Alveoli in newborns 25,000,000, increases to 300,000,000 by age 12.
Slide 18-

Respiratory ailments Asthma/RSV/Pertussis The younger the child, the sicker they can become, why? Compensatory mechanisms
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Why are children at greater risk for respiratory ailments? Immature immune systems coupled with rapid decompensation of respiratory system based on anatomy and physiology
Slide 20-

Upper respiratory infections Nasopharyngitis, the common cold Viral in nature Pediatric considerations: fall and spring Emphasis on prevention and support No way to shorten symptoms Pharyngitis, sore throat Strep throat Nursing considerations: highly infectious, antibiotics, throw out your toothbrush (reinfection) Possible severe complications: Scarlet Fever, Pneumonia (PNA), rheumatic fever, acute glomularnephritis
Slide 21-

Influenza…. Viral illness Have you ever had the flu? Supportive treatment, may need hospitalization (weakness and lethargy) Opportunistic bacterial infections Flu shots Obtaining specimen If suspected, droplet precautions! Spreads very aggressively (epidemic) Viruses evolve and adapt prolifically
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Tonsilitis Two lumps of lymph tissue in the throat, part of the immune system Inflammation causes sore throat, difficulty swallowing Can be acute, recurrent, chronic, peritonsillar abcesses (the nose knows…) Surgical removal if indicated Pain management Post op complications: bleeding No red ice pops!
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Pertussis……Bordetella pertussis “whooping cough” Caused by bacterial infection Greater morbidity and mortality in children under 2 years old Can be fatal in infants less that 3 months old Droplet infection, 80 to 90% of those exposed get it Cycle….. Incubates in 6 to 21 days from exposure (can you say prodromal?) Cough can last for 6 to 10 weeks 2 to 4 weeks convalescent period
Slide 24-

Pertussis First vaccine at 2 months Then at 4 months, 6 months Again at 15 months and 18 months Booster at 12 years “Whooping” sound is air intake after paroxysmal coughing Cough can rupture blood vessels in the eye and pleura, can cause rib fractures, vomiting, fainting……..
Slide 25-

Croup….. Effects children 3 months to 36 months Edema in larynx accounts for the sound Causative agents: RSV, Paraflu Nursing considerations Steeple Sign
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Epiglottitis EMERGENCY! Usually caused by Flu B Signs and symptoms: drooling, tripoding Rapid onset, systemic toxicity
Slide 27-

ASTHMA Common chronic respiratory condition Varying degrees of severity Triad of symptoms: bronchiol spasm, inflammation of bronchiol mucosa, production of thick mucus Who is at risk? Minorities Lower socio economic Males versus females Allergies Eczema
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ASTHMA Signs and symptoms Wheezing Cough Exercise intolerance Chest tightness Increased expiratory phase Retractions/nasal flaring allergies
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ASTHMA TRIGGERS…. Allergens Weather Illness Anxiety/emotions Temperature Animals Odors
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ASTHMA SEQUELAE….. Trigger happens: 10 to 20 minutes until attack Allergen specific immunoglobin E (IgE) Activates mast cells/macrophages (remember inflammation lecture?) Inflammatory mediators, histamine/leukotrienes Smooth muscle contracts
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ASTHMA Classified by age/symptoms/medication usage/activity intolerance Emphasis on prevention Peak Flow meter used to measure ability to push air out of lungs (pushing against resistance) The asthma personality Develop an “Asthma Action Plan”
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ASTHMA MEDICATIONS Inhaled steroids Bronchodilators Oral steroids Rescue inhalors IV smooth muscle relaxers
Slide 33-

Lower airway diseases RSV (respiratory syncytial virus) Causes bronchiolitis The smaller the child, the faster the respirations (compensatory mechanism) supportive treatment, especially in infants Pneumonia Primary (disease process) Secondary……name some Defined be geography/anatomy Lobar, interstitial, empyema, aspiration….
Slide 34-

Types of respiratory support…… Blow by oxygen Cool mist Warm mist Nasal canula Simple mask Non rebreather mask CPAP BiPap Ventilator HFOV
Slide 35-

Differences in respiratory distress in children and adults Children: Ancillary muscle usage Seek position of comfort Fall off a cliff Adults: Verbalize Slide down a hill Whoops Un Oh…
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Acute Respiratory Distress Syndrome Increased capillary permeability leads to pulmonary edema Causative agent: disease/trauma Nursing considerations Supportive care: prevention of hypoxemia, serial x-rays, labs, ABGs CPAP/peep
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Tuberculosis….Mycobacterium Tuberculosis Airborne illness Primary (but not exclusively) a lung disease “Latent” infections eventually become active disease Lungs can become sclerosed or necrotic Can also become meningitis Can be glandular, skeletal, miliary (accounts for small percentages of cases)
Slide 38-

CHRONIC OBSTRUCTIVE PULMONARY DISEASE Term for series of diseases Causes chronic airflow limitations (CAL) Hyperinflated lungs with flattened diaphragm Chronic bronchitis Emphysema Lungs with COPD and Pneumonia from a PET Scan
Slide 39-

COPD CONTINUED…… Chronic Bronchitis Caused by irritants (smoking) Bronchus gets irritated Cough, sputum production Alveoli not effected “blue bloaters” Emphysema Caused by inhaled irritants Alveoli effected Loss of elasticity/hyperinflation of lung Dyspnea with increased respiratory rate “pink puffers”
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COR PULMONALE Cardiac failure, right sided due to increased pulmonary resistance Lead to cardiac dysrhythmias (artrial fibrillation) Later stages of COPD
Slide 41-

Infectious Disease Signs and Symptoms… Infections Viral Bacterial Fungal Parasitic Autoimmune Common… Fever Malaise Congestion Cough Mumps virus
Slide 42-

And now some diseases….. Chicken Pox Viral Caused by Varicella Zoster (Herpes) Common childhood illness Exposure/antibodies/ IMMUNITY Fever, malaise, teardrop rash, scabs over Extreme pruritis Vaccine available Diptheria Bacterial Tx: hospitalization for Antibiotic and Antitoxin therapy 50% mortality if untreated Vaccine available Membrane forms
Slide 43-

And more diseases….. Pertussis Bacterial High mortality in infants Tx: supportive, antibiotic therapy Vaccine available Whooping cough…. Sound of a child with whooping cough WITH whooping Sound of a child with whooping cough WITHOUT whooping CLASSICAL whooping cough with lots of whooping Male with whooping cough making loud whooping sound View videos of 2 year old and 6 year old children with whooping cough
Slide 44-

Diseases continued……. German measles Viral illness Similar to measles Red rash Different virus than the one that causes measles Not as infectious as measles Tx: supportive Vaccine available Measles Viral illness Highly contagious Koplik’s sign Rash appears after 3 to 4 days Three Cs, cough, coryza, conjunctivitis Complications: blindness encephalitis, PNA Vaccine available
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And more diseases…. Parotitis Mumps Viral Airborne transmission Tx: supportive Mononucleosis Viral: Epstein Barr Long illness Tx: supportive Complications: Peritonsilar abscess, Hepatomegaly, Splenomegaly, Splenic rupture Notice the assymetic jaw
Slide 47-

Childhood communicable diseases Pediculosis: head lice Parasitic infection Signs and symptoms, itching, especially around ears, bottom back of hair line Eggs are nits, stick to hair shaft Hatch cycle every 7 to 10 days Easily re-infest host Tx: Medicated shampoos, diligence Scabies: mite rash Parasitic infection Highly infectious Itching, lines of reddened bumps (rash) Tx: Permethrin
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Continued…….. Impetigo Bacterial, Strep or Staph Facial sores Highly contagious Tx: oral antibiotics Tinea Capis, Corpis, Pedis: Ringworm Fungal infection Highly infectious Thrives in warm moist climate Tx: Antifungals, topical and oral
Slide 49-

Animals as vectors Cat scratch fever West Nile virus Rabies Influenza pandemics Rocky Mountain Spotted Fever Lyme
Slide 50-

Sexually Transmitted Infections STIs become sexually transmitted diseases when they are chronic Adolescents are a vulnerable population, why? EDUCATION! Condoms, information, monogamy, abstinence, decreased number of sexual partners
Slide 51-

Herpes Incurable viral disease Why disease? Process of exacerbation and remission Signs and Symptoms: Papules on genitals or elsewhere after unprotected sex Caused by Herpes 2 and Herpes 1 Many affected are asymptomatic Outbreaks and severity decrease over time Virus remains dormant in sacral nerve ganglia Pregnant women/girls candidates for cesection Tx: Antivirals
Slide 52-

Common Gastrointestinal Disease
Slide 53-

Appendicitis Symptoms Loss of appetite, with or without vomiting or diarrhea Persistent, unexplained belly pain in the lower right side that lasts more than 24 hours Inability to cough, jump, or go over bumps in the car without pain Difficulty walking and/or staying upright "Rebound pain," so called because when you push gently on your child's belly it hurts more when you let go than when you pressed down
Slide 54-

Most Common Symptoms Abdominal pain: Most common symptom. Nausea: 61-92% of patients. Anorexia: 74-78% of patients. Vomiting: Nearly always follows the onset of pain; vomiting that precedes pain suggests intestinal obstruction. Diarrhea or constipation: As many as 18% of patients.
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What to look for……
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Laboratory Information in Appendicitis CBC with Differentrial: WBC >10,500 cells/µL: 80-85% of adults with appendicitis Neutrophilia >75-78% of patients Less than 4% of patients with appendicitis have a WBC count less than 10,500 cells/µL and neutrophilia less than 75% Note: In infants, a WBC count is especially unreliable because these patients may not mount a normal response to infection. In pregnant women, the physiologic leukocytosis renders the CBC count useless for the diagnosis of appendicitis. Also Check: C-reactive protein (CRP) Liver and pancreatic function tests Urinalysis (for differentiating appendicitis from urinary tract conditions) Urinary beta-hCG (for differentiating appendicitis from early ectopic pregnancy in women of childbearing age) Urinary 5-hydroxyindoleacetic acid (5-HIAA)
Slide 58-

“Action” Trauma Magnets
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Skeletal and Other Traumatic Injury Areas: Upper extremity injury, which includes a broken arm or wrist, collarbone, or ribs Lower extremity injury, which includes a broken ankle, hip, or legs Soft tissue injury, which affects the muscles, tendon, and ligaments The most common causes of pediatric traumatic injuries are: Falls Twisting the ankle Sporting accidents Other types of accident Blows to specific parts of the body
Slide 60-

Swelling Tenderness Bleeding, but only if the break in the bone damages the skin Major bruising Inability to move the affected part without experiencing pain Bone sticking out at an abnormal angle Bone sticking out of the skin Numbness A pins and needles sensation if some nerves are injured Inability to lift or rotate the injured part Inability to put any weight (for leg injuries) Severe pain when breathing in (for broken ribs) Shallow breathing A grinding, cracking, or snapping noise is heard at the time of the fall or accident Assessment, Symptoms of a Broken Limb
Slide 61-

Neurologic Injury and Disease in Children Infections of the brain of spinal cord: Encephalitis (inflammation of the brain) can be caused by many types of infection (usually viral Meningitis is caused by a bacterial or viral infection that inflames the meninges (membranes surrounding the brain and spinal cord).
Slide 62-

More Neurologic Injury and Disease Trauma Traumatic brain injury including Shaken Baby Syndrome Closed head injuries – where no damage is visible; these are common in car accidents. Open wounds – where the brain is exposed and damaged by an object. Crushing injuries– where the head is crushed and brain damage occurs. Spinal cord injuries
Slide 63-

And…More Neurologic Injury and Disease Seizures Neoplasm Toxins: Exposure to environmental chemicals or toxins during childhood can lead to neurologic impairment. Common neurological disorders affecting children: Brain tumor Cerebral palsy Congenital malformations Developmental disorders Encephalopathy, infective Epilepsy Cerebral palsy
Slide 64-

Abuse and neglect
Slide 65-

Grief……. Kubler Ross 5 stages Denial Anger Bargaining Depression Acceptance Miles and Perry Shock Intense grief Reorganization
Slide 66-

Pediatric perceptions of Death Infant: discomfort Toddler: separation and disruption, cues from parents Preschool: comprehension without verbalization ability School age: reasonable understanding, time and permanence Adolescent: understanding with difficulty accepting it
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The end …..and a beginning…to better