Dehydration
Most common result of GI illness in infants/children
Rehydration therapy
Mildly or moderately dehydrated child must receive this to prevent progression to hypovolemic shock
Oral rehydration
Most common form of rehydration therapy
Intravenous therapy
Key rehydration therapy in severe cases
2 seconds
Capillary refill in mild dehydration
2-4 seconds
Capillary refill in moderate dehydration
Greater than 4 seconds; cool limbs
Capillary refill in severe dehydration
Normal
Respiratory rate/pattern in mild dehydration
Increased
Respiratory rate/pattern in moderate dehydration
Increased and hyperpnea
Respiratory rate/pattern in severe dehydration
Normal
Skin turgor in mild dehydration
Slow
Skin turgor in moderate dehydration
Tenting
Skin turgor in severe dehydration
High or Low
Serum sodium in dehydration
Elevated
BUN & creatinine in dehydration due to renal hyperprofusion
High
Lactic acid in dehydration due to poor tissue perfusion
Low
bicarb in dehydration due to high lactic acid
100 ml/kg
First 10 kg
50 ml/kg
Second 10 kg
20 ml/kg
Remaining kg
Maintenance fluid
Add together for total mL needed per 24 hour period; divide total amount by 24 for rate in mL/hr
1st step of physical exam
Assess color, hydration status, abd size & shape, mental status
2nd step of exam
Auscultate bowel sounds
3rd step of exam
Percuss- dullness/flatness found along the right costal margin and 1-3 cm below the costal margin of the liver, and above the symphysis pubis. Remainder of abd should = tympany
4th step of exam
Palpate- light first, then deep. Areas of firmness or masses indicate stool or tumor. Tenderness not nml. Kidneys should only be palpable in neonates.
GERD
Immaturity of lower esophageal sphincter
Physiologic GERD
No underlying conditions (spit up infants w/ immature esophageal sphincter)
Pathologic GERD
Esophagitis, strictures, etc.
S/S of GERD in Infants
Crying/irritability, apnea/bradycardia, poor appetite, ALTE/BRUE, Vomiting, Wheezing
S/S of GERD in children
heartburn, vomiting, unhealthy teeth, commonly associated with asthma
PUD
defects/sores in the gastroduodenal mucosa
PUD symptoms
abdominal pain (worsens after meals), vomiting, GI bleeding
Colic
Syndrome characterized by excessive paroxysmal crying
Colic nursing teaching
Teach parents to rule out hair in eye/hair wrapped around finger, strangulated hernia, torsion, otitis, sepsis
Rotavirus
Most common cause of gastroenteritis
Acute diarrhea
Caused by viruses, bacteria, parasites
Chronic diarrhea
Allergies, intolerances, bowel disease, tumors, constipation with encopresis
Encopresis
Soiling of fecal contents into underwear beyond age of expected toilet training
Necrotizing enterocolitis
Most common GI emergency in neonates under 1500 grams; mortality rate 50%
Symptoms of necrotizing enterocolitis
Feeding difficulties, decreased bowel sounds, abd distension, vomiting, hypotension, apnea, jaundice, abd often shiny, bloody stools, bilious vomitus, shock sx
Necrotizing enterocolitis tx
Stop feeds, need NG tube for decompression and surgery to remove dead bowel
Short bowel syndrome
Results from alteration of intestinal digestion and absorption following extensive bowel resection
Short bowel syndrome leading COD
Central line sepsis and liver failure from long term parenteral nutrition
Duodenum
Iron absorption
Jejunum
Carbs, proteins, fat, vitamin absorption
Ileum
Bile acids, vitamin B-12 absorption
Celiac disease
Autoimmune disorder triggered by gluten and primarily affects the small intestine, leads to flattening of the small intestinal mucosa
Gluten
Present in wheat, rye, barley
S/S of celiac
Chronic diarrhea, anorexia, abd distention, poor weight gain, vomiting
Giardiasis
Endemic in areas of poor sanitation; common in day-care centers/institutions; passed by oral-fecal contamination; highest incidence in western US
S/S of Giardiasis
Sometimes none; diarrhea, abd distension/cramps, flatulence, malodorous/greasy stools
Metronidazole
Tx giardiasis
Prevent giardiasis
Hand washing, chlorination of water, avoid eating uncooked foods grown in contaminated water, do not swim in unchlorinated water where children in diapers are swimming
Pinworms
Eggs ingested or inhaled; hatch in intestine, then migrate out anus and lay eggs; causes intense itching
Dx pinworms
Tape applied to anal area in AM; tape examined under microscope for pinworms
Management of pinworms
Albendazole is most common tx; 1 pill now & one again in 2 weeks; treat everyone in the house
Prevent pinworms
Good handwashing, keep nails short, wash bedding and PJs everyday for 2-3 weeks
Cleft lip/palate
Facial malformation that occurs during embryonic development
Cleft lip/palate immediate needs
Feeding- reduces ability to suck
Cleft lip/palate tx
Surgical with long term scar revisions
Cleft lip/palate nursing assessment
Coughing, choking w/ feeds, monitor hydration status, monitor weight
Cleft lip/palate post op care
Protect surgery site, monitor airway, position supine or side opposite of defect
Esophageal atresia
Condition where proximal and distal portions of the esophagus do not communicate resulting in blind pouch
Tracheoesophageal fistula
Abnormal communication between the trachea and esophagus
Pyloric stenosis
Hypertrophy of the muscular layer of the pylorus, causing an outlet obstruction
60-80% of pyloric stenosis cases
Have a firm, nontender, and mobile hard pylorus described as an olive in the RUQ
Ultrasound
Gold standard of pyloric stenosis dx
Prune Belly Syndrome
Group of birth abnormalities marked by 3 major findings
1st Prune Belly Syndrome finding
lack of development of abd muscles, causing the skin of the belly area to wrinkle like a prune
2nd Prune Belly Syndrome finding
Undescended testicles
3rd Prune Belly Syndrome finding
Urinary tract problems- obstruction, ureter malformations
Tx for Prune Belly Syndrome
Surgical repair of abd wall, repair of GU anomalies; mortality 20%
Gastroschisis
Protrusion of abdominal contents through the abdominal wall
Omphalocele
Protrusion of abdominal contents through the belly button or umbilical cord
Difference between Gastroschisis and Omphalocele
Gastroschisis has no sac and can occur anywhere in abd wall; omphalocele has intact sac
Associated with gastroschisis and omphalocele
Short gut, poor wound healing after surgery, minimal pulmonary reserve resulting in long term trach and ventilator support
Hirschsprung disease
Congenital megacolon
Congenital ganglionosis
Absence of ganglion cells in the distal colon resulting in inadequate motility
When to consider Hirschsprung dx
In any newborn who fails to pass meconium within 24-48 hours of birth
Characteristics of Hirschsprung
Chronic constipation in first month of life; pellet, ribbon-like stools
Hirschsprung disease dx
Barium enema
Hirschsprung disease tx
Diverting colostomy or ileostomy at time of dx; when child weighs more than 10kg, surgical repair; 1% require permanent colostomy; constipation and incontinence may persist after surgery
Imperforate anus
No obvious anal opening
Intussusception
Section of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction
Most common cause of bowel obstruction in kids <2 years
Intussusception
Classic presentation of intussusception
Sudden onset of intermittent, crampy abd pain; severe pain; vomiting/diarrhea; passage of frank or occult blood per rectum; palpable (sausage shaped) abd mass in upper/mid abd; currant jelly stool
Intussusception dx
CT/Ultrasound
Intussuscpetion tx
Barium/ air enema; surgical
Umbilical hernias
Intestinal protrusion through weak abd muscle; painless protrusion when infant cries; usually disappears by age 1; rarely become incarcerated
Inguinal hernia
Results from weakness in abd wall; more common in boys; may be visible only when infant is crying, coughing, or straining during a bowel movement; surgery if hernia becomes bigger after age 2, becomes painful, or is not reducible
Most common cause of emergent abd surgery in children
Appendicitis
4-15
Median age of appendicitis
S/S of appendicitis
Vague abd which localizes to RLQ (McBurney's point); nausea & vomiting; small volume, frequent stools; fever (low grade unless perforation)
Appendicitis dx
CT; leukocytosis
Biliary atresia
Absence of some or all of the major biliary ducts
What does biliary atresia cause
Obstruction of bile flow
Results from biliary atresia
Secondary cirrhosis
S/S of biliary atresia
Jaundice, dark urine, light stools
Failure to thrive
Growth failure d/t inability to obtain or use calories required for growth
Failure to thrive classifications
Inadequate absorption, inadequate caloric intake, increased metabolism, defective utilization
Dx/Tx failure to thrive
Evidence of growth failure, complete health and family hx, treat underlying cause
Failure to thrive nursing care
Positive feeding environment, minimize distractions during feeding, be consistent and persistent
Premature infants nutritional considerations
Have poor muscle tone in lower esophagus (GERD), have higher demand for nutrients (more calories)
Older children nutritional considerations
Nutritional needs dependent on level of activity, amount of gut available for nutritional absorption
Naso/Oral Gastric tubes
cxr is gold standard for checking placement
uses of naso/oral gastric tubes
Enteral feeding, medication administration, gavage feeds
G-tubes long term placement
Placed either surgically, endoscopically, or IR; after about 6 weeks, then can insert G-button or Mickey
J-tubes long term placement
Inserted the same way as G-tube; if becomes dislodged, Foley cath insertion to keep stoma open until physician can replace
Pediatric GU differences
Urethra is shorter (risk of UTIs), blood flow to kidneys (GFR) is slower, newborn bladder capacity is 30 mL, kidney large r/t size of abd
BUN
Comes from breakdown of proteins from food and metabolism
Normal BUN
7-20 mg/dl
Creatinine
Waste product of muscle activity
Normal creatinine
0.5-1.5 mg/dl
GFR
More accurate way to measure how well kidneys filter waste from the blood; can be estimated from serum creatinine using a formula
90
Normal GFR in children
<15 GFR
End stage renal failure in children
Bladder exstrophy
Bladder is outside abd wall; have urethral tube malformation & separation of the pelvic bones
Catheterizing urethral stoma
If bladder tissue is insufficient for repair; allows for urinary continence; urine tends to be mucous-like and often cloudier; teach parents how to catheterize and signs of UTI to report
Hypospadias
on the low side
Epispadias
on top
Vesicoureteral reflux
Retrograde flow of urine from bladder into ureters during bladder contraction when voiding
Primary VUR
Congenital anomaly, runs in families
Secondary VUR
Acquired, UTI, obstruction
VUR Grade I
Minor dilation of proximal ureter
VUR Grade I & II
Typically resolve spontaneously
VUR Grade V
Severe dilation of ureter and kidney pelvis
VUR Grades III, IV, & V
Typically warrant surgical intervention
Obstructive uropathy
May occur at any site in the urinary system
Most common obstructive uropathy
Posterior urethral valves, and ureteropelvic junction
Hydronephrosis
Pelvis and calyces of kidney are dilated
Hydronephrosis complications
Renal insufficiency, HTN, renal failure
UTI
Bacterial invasion of urinary tract from skin flora or GI tract
Enuresis
Child unable to control bladder fx by age expected or after successful completion of bladder control program
Primary enuresis
Onset of wetting occurs after a period of established urinary continence
Secondary enuresis
Onset of wetting occurs after a period of established urinary continence
Nephrotic syndrome
Triad: massive proteinuria, hypoalbuminemia, and edema
Nephrotic syndrome therapeutic management
reduce excretion of urine protein, maintain protein-free urine, reduce edema, prevent infection, and minimize complications
Nephrotic syndrome monitoring
Strict I&O and vital signs, urine for specific gravity and protein, edema
Nephrotic syndrome management
Remission: regular diet w/o added sodium, sodium restricted diet (fluid restriction) in periods of massive edema, corticosteroids upon dx, immunosuppressive therapy to reduce relapse rate, diuretics, instruct parents to test urine and minimize sick contac
Glomerulonephritis
Group of kidney disorders characterized by inflammatory injury to the glomerulus
Causes of glomerulonephritis
post infection, viral infection, systemic disorders
Glomerulonephritis volume overload
Assess airway, wt, VS, dyspnea, rapid pulse, dysrhythmias, distended hand and neck veins, level of edema, amount of urine output
signs of glomerulonephritis
Periorbital edema, loss of appetite, decreased UOP, dark urine, irritability, lethargic, dysuria, HTN, and abd pain
Complications of glomerulonephritis
Kidney failure, hypertensive encephalopathy, pulmonary edema, heart failure, seizures
Hemolytic-Uremic syndrome
Defined by hemolytic anemia, thrombocytopenia, ARF
S/S of hemolytic uremic syndrome
Marked pallor, irritability, lethargy, vomiting, bloody diarrhea, hemorrhagic manifestations, decreased/no UOP, CNS involvment
Labs in hemolytic uremic syndrome
H&H decreased, BUN and creatinine increased
Hemolytic uremic syndrome tx
Early dialysis, strict I&O adequate nutrition, blood transfusions
Polycystic kidney disease
Autosomal recessive and dominant forms, multiple cysts in kidneys, may involve liver and other organs
S/S of polycystic kidney disease
HTN, hematuria, frequent urination, poor growth, UTI, proteinuria
Polycystic kidney disease tx
No cure, good outcomes w supportive care, dialysis, transplant
Renal failure
Inability of the kidneys to excrete waste products, concentrate urine, conserve electrolytes
S/S of renal failure
Oliguria, edema, drowsiness, circulatory congestion, cardiac arrhythmia, seizures, tachypnea
Acute renal failure
Sudden onset, multiple causes, usually reversible; manage HTN, restore fluid/electrolyte balance, educate family
Chronic renal failure
Progression of acute renal failure into ESRD; dialysis and kidney transplant are treatment modalities
Early renal failure
GFR 50-75% normal, decreased renal reserve but normal excretory and regulatory function
Chronic renal insufficiency
GFR 25-50% normal, associated impairment of excretory and regulatory functions
Chronic renal failure
GFR 10-25% normal, increasing clinical manifestations of renal failure
End stage renal disease
GFR 10% or less, renal replacement therapy necessary to sustain life
Osteodystrophy
phosphorus binding agents, supplement calcium and vitamin D, control acidosis
Hemodialysis
Blood is circulated outside the body through an artificial semipermeable membrane permitting diffusion and ultrafiltration
AVF/AVG care
Palpate thrill daily (call if absent), avoid tight clothing or watches on access extremity, avoid sleeping on the arm with the graft, no blood pressures or venipunctures in graft extremity, graft should only be accessed by dialysis staff
Nursing care for hemodialysis
Obtain pre-dialysis wt, T, BP, HR, MAP; prepare access site with betadine, insert needles, connect tubing; check and record BP, HR, and machine pressures q 1hr and prn; set machine for amount of fluid to remove and length of tx; tx any complications appro
Peritoneal dialysis
Abd cavity acts as a semipermeable membrane; Tenckhoff catheter is inserted through the abdominal wall into the peritoneal cavity, Dialysate solution introduced into peritoneum, left to dwell then drained out
Continuous venovenous hemofiltration
Ultrafiltration of blood at a slow rate; may add dialysate; used primarily for critically ill patients
Nursing care plan for child with chronic renal failure
Risk for tissue injury r/t elevated electrolytes and waste products; fluid volume excess r/t renal failure; altered nutrition: less than body requirements r/t restricted diet; body image disturbance r/t chronic illness, impaired growth, and perception of
Pediatric renal transplant criteria
Chronic or end stage renal disease; age and wt to accommodate adult kidney; good nutritional status; absence of active infection, obstructed urinary tract, GI, liver, pancreas, or CV disease, severe mental retardation, serious psychosocial or behavior pro
Hyper acute transplant rejection
Irreversible, immediate, or a few hours after revascularization
Acute transplant rejection
Few days to 6 months after transplant; fever, swelling, and tenderness over graft site; hypertension
Chronic transplant rejection
Slow deterioration of function 6 months or more after transplant; total loss of organ
Labial adhesion/fusion
Partial or complete adherence to labia minora, UTI may result from stasis of urine behind bladder, younger girls have increased risk, administer topical estrogen cream as prescribed
PID
Results from bacterial invasion through vagina, ascending through cervix into uterus and fallopian tubes
Chlamydia trachomatis and gonorrhoeae
Most common causes of PID
S/S of PID
Fever, abd pain, pain with intercourse, dysmenorrhea, abnl uterine bleeding
Complications of PID
Chronic pelvic pain, ectopic pregnancy, infertility r/t scarring
Cryptorchidism
One or both testes fail to descend through inguinal canal into scrotal sac
Hydrocele
Peritoneal fluid in the scrotum; usually resolves spontaneously by 1 year
Phimosis
Foreskin of the penis cannot be retracted; local irritation, balanitis, or UTI can occur
Paraphimosis
Serious disorder caused by retraction of phimotic prepuce, leading to constricting band behind the glans of the penis; incarceration if left untreated
Testicular torsion
A testicle is abnormally attached to the scrotum and twisted
Skin differences in infants
Epidermis thinner, more blood vessels closer to the surface (loses heat more readily through skin surface; substances are more easily absorbed through the skin), skin contains more water (epidermis loosely bound to the dermis, friction more easily results
Macule
<1 cm; flat
Papule
<0.5 cm; elevated and rounded bump
Plaques
Like a papule but >5 cm
Annular
Ring around it
Pruritis
Itching
Pustule
Blister
Morbilliform
Rogue, red, slightly elevated rash usually seen d/t rxn to medication
Causes of integumentary disorders
Exposure to infection microorganisms, hypersensitivity reactions (contact dermatitis), hormonal influences (acne), genetic predisposition (psoriasis), injuries
Bacterial skin infections
Impetigo, folliculitis, cellulitis, MRSA, staphylococcal scalded skin syndrome
Fungal skin infections
Tinea (pedis, corporis, versicolor, capitis, and cruris), candida albicans
Viral skin infections
Viral exanthems (rashes), herpes simplex (cold sore)
Impetigo
bacterial infxn that has a papule with honey colored exudate that ruptures and causes and honey colored crust
Folliculitis
Inflammation of the hair follicles
Cellulitis
Infection usually from site of trauma on skin
MRSA
Looks like a pimple with swelling around it
Staphylococcal scalded skin syndrome
Staph produces a toxin that causes exfoliation, skin redness, and tenderness. Common in infancy and rare after age 5. Tx like a burn
Tinea capitis
Affecting the scalp, eyebrows, or eyelashes
Tinea cruris
Affecting the groin
Tinea pedis
Affecting the feet
Tinea corporis
Affecting the arms or legs
Tinea versicolor
Presents differently; tan or hypopigmented lesions on upper body; occurs on the trunk and extremities
Diaper dermatitis
Inflammatory reaction of the skin in the diaper area to an irritant
Causes of diaper dermatitis
Prolonged exposure to urine and feces, overgrowth of C. albicans
Diaper dermatitis tx
Ointments and cream; vit. A, D, E, and zinc oxide; petrolatum
Diaper dermatitis prevention
Change diapers frequently, avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
Contact dermatitis causes
Antigenic substance exposure; allergy to nickel or cobalt in clothing, hardware, or dyes; exposure to highly allergic plants (poison ivy, oak, and sumac)
Contact dermatitis complications
Secondary bacterial skin infection; lichenification (thickening), or hyperpigmentation
Contact dermatitis management
Topical corticosteroids; control itching (cool compress, antihistamines)
Erythema multiforme
Acute, self-limiting hypersensitivity reactions
Stevens-Johnson syndrome and toxic epidermal necrolysis
Rare reactions to certain medications, skin peels off in sheaths and rots. Often get treated and admitted to burn units
Causes of erythema multiforme
Viral infection, drug (most common), food reaction
Erythema multiforme management
Supportive tx, d/c causing agent, oral hydration, analgesics and antihistamines as prescribed
Urticaria
Hypersensitivity reaction
Urticaria causes
Foods, drugs, animal stings, infections, environmental stimuli, stress
Urticaria management
D/C causing agent; administer antihistamines, corticosteroids, and topical antipruritics as prescribed
Urticaria assessment
Detailed hx of new foods, medications, sx of recent infxns, changes in environment, unusal stress
Atopic dermatitis (eczema) causes
Food or environmental allergies; associated with asthma and allergic rhinitis
Atopic dermatitis complications
Chronic itching can lead to psychological distress, self-image issues, difficulty sleeping, bacterial infection
Atopic dermatitis management
Promote skin hydration, maintain skin integrity, and prevent infection
Atopic dermatitis tx
Topical immunomodulators (moderate to severe), coal tar preparations
Seborrhea
Chronic inflammatory dermatitis, occurs on skin and scalp, commonly known as cradle cap in infants and dandruff in adolescents
Seborrhea nursing management
Wash/shampoo with mild soap, mineral oil for cradle cap
Seborrhea tx
Corticosteroid creams or lotions, antidandruff shampoo
Psoriasis
Chronic inflammatory skin disease with periods of remission and exacerbation; hyperproliferation of the epidermis; rash develops at sites of trauma; genetic predisposition
Psoriasis tx
Emollient creams, coal tar preparations, topical steroids, UV light (sunlight), mineral oil and warm towels to soak and remove thick plaques
Acne neonatorum
maternal androgens or transient androgen production in the newborn; may be present immediately after birth, most often between 2-4 weeks of age
Mild acne
primarily noninflammatory lesions (comedones)
Moderate acne
Comedones plus inflammatory lesions such as papules or pustules (localized to face or back)
Severe acne
Lesions similar to moderate acne, but more widespread, and/or presence of cysts or nodules. Associated more frequently with scarring
Thermal burn
Flame, hot surface, hot liquids, sun
Electrical burn
Outlet hazards/cords, lightening
Chemical burn
Household cleaning agents
Radioactive burn
Medical exposure, UV light
1st step in burn care
Stop the burning process
2nd step in burn care
Assess- primary and secondary survey
3rd step in burn care
Cover the burn with clean dry cloth. Cover the child. Vital for thermoregulation and to prevent water loss
4th step in burn care
Transport to emergency facility
5th step in burn care
Provide reassurance
Management of minor burns
Get tetanus hx, cleanse with mild soap/tepid water, debride, cover with antimicrobial ointment, dress with fine-mesh gauze, mild analgesic, caregiver instructions
Severity of burns
Assessed as a percentage of total body surface area burned
First degree burns
Superficial
Second degree burns
Superficial/deep partial thickness; painful, red, moist, blistered; involves epidermis and some degree of dermis
Third degree burns
Full thickness; entire epidermis, dermis, and hypodermis; red to tan, waxy white, brown, black, dry and leathery; severe pain r/t severity; requires surgical excision/graft
Fourth degree burns
Full thickness; involves muscle, fascia, and bone; appears dull, dry; ligaments, tendons, bone exposure
Zone of hyperemia
Outer layer; peripheral area of burn, limited inflammation, increased blood flow; recovers without intervention
Zones of stasis
Around center; area surrounding zone of coagulation; inflammation, decreased blood flow; requires early resuscitation to survive; may convert to a zone of coagulation if not recovered correctly
Zone of coagulation (necrosis)
Center; area nearest the burn, ruptured cell membranes, clotted blood/thrombosis; tissue is dead and will not return
Minor burn
<10% TBSA partial thickness; treated as outpatient
Specialized burn center
>10% TBSA partial thickness burns; all full thickness burns; face/hands/feet/perineum/major joints; chemical/electrical/inhalation; with a trauma
Cardiovascular response to burns
Immediate postburn period= burn shock (drop in output precedes change in plasma volume); capillary permeability; rapid fluid shift to interstitial spaces; edema rapid first 18 hours post burn, maximum at 48 hours
Renal response to burns
<2 yrs increased risk for dehydration; fluid replacement important; BUN/Cr increased; myoglobin lost in urine
Gastrointestinal response to burns
Decreased blood flow; ischemia results; can lead to ulcers, enterocolitis; portal of sepsis; need for NG tube until motility restored (prevents aspiration); metabolism greatly accelerated
Neuroendocrine response to burns
Increase epinephrine, norepinephrine, aldosterone, antidiuretic hormone
Pulmonary system complications
Inhalation injury; wheezing, secretions, hoarseness, wet rales; aspiration of gastric contents; bacterial pneumonia; pulmonary edema (due to fluid overload or ARDS; pulmonary emboli)
GI complications
Feeding intolerances; mucosal changes (may see within 72 hours of a major burn; leading to ulceration); bleeding; paralytic ileus (due to trauma, sepsis, narcotics, renal failure); enteral feeding (provides nutrition; early feedings may prevent some compl
CNS complications
Burn encephalopathy; symptoms: lethargy, withdrawal, coma; causes: hypoxemia, hyponatremia, hypovolemia, septicemia, meds; usually full neuro recovery
Wound sepsis in burns
Major complication; dead tissue/exudate is bacterial growth medium; occlusion of blood supply impairs delivery of phagocytic cells; granulation tissue forms by third week; good vascular supply affords better immune response
First degree tissue repair
Heals in 3-5 days
Superficial partial thickness tissue repair
Healing in around 14 days without scarring
Deep partial thickness tissue repair
May require several months; scarring common
Full thickness tissue repair
Severe edema, extensive metabolic changes; dead tissue turns to leathery eschar in 48-72 hours; eschar separates in 12-21 days if not excised; high risk of infection; severe scarring
Burn management
Fluid resuscitation; wound care; prevention of infection; restoration of function; goal is to close the wound
Elements of burn wound tx
Primary excision of eschar; hygiene with hydrotherapy; dressings; topical antimicrobials (silver sulfadiazine, sulfamylon, bacitracin)
Temporary skin substitues
Allograft skin from human cadavers; porcine xenograft
Burn wound tx
Synthetic skin coverings; artificial skin to prepare wound for graft, permanent skin coverings, permanent epithelium
Acute burn phase
1st 24-48 hours; tx of burn shock and management of pulmonary status
Management of major burns
Adequate airway, IV fluid administration, nutrition, medication, positioning & splinting, treatment of anemia and hypoproteinemia, psychosocial support, rehabilitation
Congenital heart disease
Structural anomalies present at birth; accounts for the largest percentage of all birth defects; non-cardiac anomalies occur in over 28% of children; commonly associated with chromosomal abnormalities
Acquired heart disease
Disorders that occur after birth; develop from a wide range of causes or may occur as a complication/long term side effect of CHD
Pediatric CV differences
Infants- children <7 years of age: the heart lies more horizontally; apex is higher in the chest, below the 4th intercostal space
Post op cardiac catheterization
Monitor pulses; extremity temperature and color, bp and hr, and dressing for evidence of bleeding
Bleeding dressing
Apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. Should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should main
Hepatomegaly
Sign of right sided heart failure in kids
1/6 murmur
Very faint; not always heard in all positions
2/6 murmur
Quiet but not difficult to hear
3/6 murmur
Moderately loud
4/6 murmur
Loud +/- thrills
5/6 murmur
Very loud +/- thrills; may be heard with stethoscope partly off chest
6/6 murmur
May be heard with stethoscope completely off chest; +/- thrills
Alprostadil
Direct vasodilation of the ductus arteriosus smooth muscle. Indicated for temporary maintenance of ductus arteriosus patency in infants with ductal dependent congenital heart defects
Digoxin
Increases contractility of the heart muscle by decreasing conduction and increasing force. Used for HF, A-fib, a-flutter and SVT
Furosemide
Inhibits reabsorption of Na and Cl. Used to manage edema and in combo with antihypertensives
Indomethacin
Inhibits prostaglandin synthesis in order to close patent ductus arteriosus
Disorders of decreased pulmonary blood flow
Tetralogy of Fallot; Tricuspid atresia
Decreased pulmonary blood flow
The blood has difficulty exiting the right side of the heart via the pulmonary artery, pressure on the rt side increase, exceeding left sided pressure. This allows desaturated blood to shunt right to left, causing desaturation in the left side of the hear
Tetralogy of Fallot
4 congenital heart defects that occur together. 1. ventricular septal defect. 2. overriding aorta 3. pulmonary stenosis 4. right ventricular hypertrophy
Tricuspid atresia
Missing or abnormally developed tricuspid valve. Blocks blood flow from right atrium to right ventricle
Disorders of increased pulmonary blood flow
Patent ductus arteriosus, atrial septal defect, ventricular septal defect
Obstructive disorders
Coarctation of the aorta; aortic stenosis and pulmonary stenosis
Mixed disorders
Transposition of the great vessels, total anomalous pulmonary venous return, truncus arteriosus and hypoplastic left heart