Peds Ati Takeaways 4e1k6k

1. A child with hemophilia scraps his knee  RICE (Rest, Ice, Compression, Elevation) 2. Two parents test positive for sickle cell trait  each pregnancy has 25% chance of being affected with sickle cell disease (autosomal recessive). 3. Kawasaki’s disease  place child in quiet environment to decrease workload on heart 4. Child with Hirschsprung’s disease has explosive, watery diarrhea  enterocolitis (lifethreatening, notify physician immediately) 5. Newborn failure to meconium in first 24 hrs  Hirschsprung’s disease or Congenital Aganglionic Megacolon (or imperforate anus but  should be noticed immediately, so check for the hole!). 6. Jelly-like stools containing blood and mucus are an indication of intussusception. Acute, episodic abdominal pain is characteristics of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant, (most always occurs at ileocecal valve). 7. Hallmark sign of GER in infants  back arching 8. Esophageal atresia 3 C’s (cyanosis, choking, coughing) AND maternal polyhydraminosis. 9. Big reason for varicella vaccine eye lesions =blindness 10. Meckel’s diverticulitis. 11. Hemorrhage is the most common complication of Meckel’s diverticulitis in children; therefore, this condition should be considered in any child with abdominal pain of unclear etiology associated with GI hemorrhage. Intestinal obstruction is another possible diagnosis but is more common in adults. The diagnosis of Meckel’s diverticulitis can be confirmed by 99mTc-pertechnetate scan, which detects heterotopic gastric mucosa or pancreatic tissue within the diverticulum. Meckel’s diverticula are usually completely asymptomatic, but resection is necessary when complications develop. Colonic arteriovenous malformations can cause GI hemorrhage in children but are much less common than Meckel’s diverticula. SXS: blood with bowel movement 12. TORCH infections in utero  deafness (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex virus) 13. Signs of CHF: irritable, sweating with feeds, frequent respiratory infections 14. Strawberry tongue kawasaki’s disease 15. Vomiting green  bile, = GI obstruction! 16. After Tonsillectomy and Adenoidectomy (T&A) avoid red drinks, citrus drinks or scratchy foods until throat is healed (10-14 days?) 17. TET spell knees to chest for relief 18. Arthritis associated with rheumatic fever can be severe even weight of bed linens can cause pain use bed cradle 19. Children with congenital heart disease are more prone to respiratory infections. 20. Sucking ability compromised in cleft lip 21. Postoperatively children with cleft palate repair only should be placed on their abdomens to facilitate drainage. If cleft lip  only supine to prevent tears or injury to suture line. 22. GER thickened feedings to stop vomiting 23. Because the incidence of testicular cancer is increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination monthly. 24. 12 month old infant with hypospadias and chordee repair  prevent the child from disrupting the catheter by using soft restraints.

25. The child will glomerulonephritis experiences a problem with renal function that ultimately affects fluid balance. Because weight is the best indicator of fluid balance, obtaining daily weight is the highest priority. 26. The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. 27. Positioning the neonate with an unrepaired myelomeningocele  infant is kept in the prone position to decrease tension on the sac. This allows for optimal positioning of the hips, knees, and feet because orthopedic problems are common. 28. For at least the first 24 hours after insertion of a ventriculoperitoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid decrease in CSF pressure. A rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative site is to be avoided because it places pressure on the shunt valve, possibly blocking desired drainage of CSF. With continued increased I, the child would be positioned with the head of bed elevated to allow gravity to aid drainage. 29. A toxic effect of valproic acid (Depakene) is livertoxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as possible. 30. The Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin. (Hip dysplasia is a condition in which the head of the femur is improperly rested in the acetabulum, or hip socket of the pelvis. The characteristic manifestations are as follows: asymmetry of the gluteal and thigh folds; limited hip abduction in the affected hip; apparent shortening of the femur on the affected side (Galeazzi sign and Allis sign); weight bearing causes titling of the pelvis downward on the unaffected side (Trendelenberg sign); Ortolani click (in infant under 4 weeks of age) 31. Muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50%chance of being carriers. It is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9-11 years. There is no effective treatment for the disease. A characteristic manifestation is Gower's sign -- the child walks the hands up the legs in an attempt to rise from sitting to standing position. 32. Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. 33. Half-strength hydrogen peroxide is recommended for cleansing the suture line after cleft lip repair. The bubbling action of the hydrogen peroxide is effective for removing debris. Normal saline may also be used. Mouthwashes frequently contain alcohol which can be irritating. Povidone-iodine solution is not used because iodine contained in the solution can be absorbed through the skin, leading to toxicity. A mild antiseptic solution has some antibacterial properties but is ineffective in removing suture-line debris. 34. Because the blind pouch associated with TEF fills quickly with fluids  the child is at risk for aspiration. Children with TEF usually develop aspiration pneumonia.

35. After surgical repair for an imperforate anus, the infant should be positioned either supine with the legs suspended at 90-degree angle or on either side with the hips elevated to prevent pressure on the perineum.  Try to limit pressure on perineum. 36. Eating with dirty hands, especially after playing outside, can lead to lead poisoning because lead is often present in soil surrounding homes. When blood levels of lead reaches 15-19 mg/dL.., an investigation of the child's environment will be initiated. Oral chelation therapy is started when blood lead levels reached 45 mg/dL. When they reach 70 mg/dL, the child usually is hospitalized for intravenous chelation therapy. 37. A negative urinalysis rules out UTI in children < 2 years of age. In children younger than 2-years-old, a negative urinalysis does not rule out a urinary tract infection. Up to 50% of children with UTIs can have a false negative urinalysis. Nitrite and leukocyte esterase presence in urine dipstick have the highest combined sensitivity for UTI. In addition, if both are positive, the false positive rate is less than 4%. Most consider young girls to be at the highest risk for UTI. This is in fact true except for the neonatal period, when neonatal boys actually have a higher risk than girls. Children with UTIs are managed differently based on the age of the child. The very young are treated conservatively, and those under 3 months of age are generally itted to the hospital for IV antibiotics. Pyelonephritis used to be commonly managed as an in-patient, but in well appearing children, this infection can be treated as an outpatient with oral antibiotics. 38. After tonsillectomy (sleepy from anesthesia) Side-lying -most effective to facilitate drainage of secretions from the mouth and pharynx; reduces possibility of airway obstruction. 39. Excessive exercise, consumption of very small amounts of food and food rituals, amenorrhea, and excessive weight loss or weight is below normal, lanugo, dry skin, bradycardia, are signs of anorexia nervosa. 40. Laryngotracheobronchitis  Because croup causes upper airway obstruction, inspiratory stridor is predominant symptom. 41. Discharged with slow CSF leak  most CSF leaks resolve spontaneously. The child should be maintained on bed rest until CSF leak stops. NSAID's may be used. The child may assume position of comfort. There are no dietary restrictions. 42. During feto-placental circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is established, the pressure will shift from the R to the L side, and will facilitate the closure of Foramen Ovale. (Note: that is why you should position the NB in R side lying position to increase pressure in the L side of the heart.) 43. Slipped capital femoral epiphysis typically presents in girls aged 11 to 13 years and boys aged 13 to 15 years who are obese. It is most common in blacks. Although a slipped capital femoral epiphysis can produce pain localized to the groin area, it often presents as knee pain, especially on the board examination. Internal rotation is difficult. If you were to suggest an x-ray, antero-posterior and frog lateral x-rays of the pelvis would be the way to go. 44. Shortness of breath and perspiration during feeding can also indicate left-sided heart failure. 45. The triad of cystic fibrosis is COPD, pancreatic enzyme deficiency, and a high concentration of sweat electrolytes. 46. Because of the structural defect, children with cleft palate may have ineffective functioning of their Eustachian tubes creating frequent bouts of otitis media. Most

children with cleft palate remain well-nourished and maintain adequate nutrition through the use of proper feeding techniques. Food particles do not through the cleft and into the Eustachian tubes. 47. Projectile vomiting is a key symptom of pyloricstenosis. 48. Currant jelly stool intussusception 49. Burping babies throughout the feeding will help prevent gastric distention that contributes to esophageal reflux. 50. The least restrictive restraint for infant with acleft lip and cleft palate repair is elbow restraint. 51. Lanoxin slows and strengthens (inotropic effect) the contractions of the heart. An increase in urinary output shows that the medication is having a desired effect. 52. The primary reason for placing the child with croupunder a mist tent is to liquefy secretions andrelieve laryngeal spasm. 53. Digoxin  treatment for tetralogy of fallot 54. Flexion of the hip and knees with ive flexionof the neck. A positive Brudzinski’s sign —flexionof hip and knees with ive flexion of the neck;a positive Kernig’s sign— inability to extend theknee to more than 135 degrees, without painbehind the knee, while the hip is flexed usuallyestablishes the diagnosis of meningitis. 55. Clothing has become tight around the waist of a 2 years old Parents often recognize the increasing abdominal girth first. This is an early sign of Wilm''s tumor, a malignant tumor of the kidney. 56. The recommended age for switching from formula to whole milk is 12 months. Switching to cow's milk before the age of 1 can predispose an infant to allergies and lactose intolerance. 57. Acute glomerulonephritis  HTN is a key assessment, note patterns of blood pressure. 58. Nephrotic syndrome  low albumin in blood (going through urine = frothy urine), high lipids in serum, 59. Measure head circumference In meningitis, assessment of neurological signs should be done frequently. Head circumference is measured because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis. The client will be on airborne precautions and crib top applied to bed on ission to the unit. 60. Retinal hemorrhage in infants is always R/O NAT 61. EpiglottitisDROOLING (do not open mouth to look at throat) 62. Post tonsillectomy observe for frequent swallowing or clearing throat 63. ATI: Nystatin Troche: Head Injuries: The hospitalized child: Congenital hip dysplasia: Pavlik Harness 9 kg patient who consumed 40 oz of 22cal/oz formula (how many cal did she consume?) Nephrotic syndrome: