PEDIATRICS REVIEW SHEET
Hospitalization and Illness pg 51, Cardiovascular pg 113, Hematologic pg 125
General
0.5 ml for infant one month or younger
1 ml for small child 1-12 months
20 to 25 gauge
5/8 to 1-inch length
Site of choice
Vital Signs
Clark’s Rule: Uses weight (always pounds!), divide by 150, multiply by adult dose and the answer is the child dose
Young’s Rule: Uses age, child’s age plus 12, then divide by the +12 number, multiplied by the adult dosage
Safe Dosage: States safe dose based on mg/kg per day
Registered Nurse RN: Safe Dose Video https://www.youtube.com/watch?v=QRdIVGaQf7Q
Heart
In this disorder, the pulmonary artery arises out of the left ventricle; aorta arises from right ventricle
Usually fatal without treatment or without PDA, ASD or VSD to mix blood
Venous blood exits out of right side of heart via aorta back into circulation without ever being oxygenated
Oxygenated blood returning from the pulmonary system keeps circulating back to the lungs
PDA Treatment
Indomethacin: Prostaglandin inhibitor effective in closing PDA especially in premature infants, if meds do no close, surgery may be required
Occasionally requires surgery: Ligation of PDA, or clip placed; small incision between ribs or through catheter in groin
Transcatheter device placed in blood vessel then small metal coil passed into site of PDA to block it off so blood can’t pass
50% close spontaneously during first 2 years of life
Others may require surgery with patch
Palliative procedure performed in infants with profound cyanosis, temporary procedure to shunt blood back to lungs for oxygenation
Later surgery to correct all defects
May need pulmonary valve replacement
Initially, palliative procedures to provide mixing by creating ASD
O2 therapy may be harmful: May enhance closure of PDA which may be only source of mixing of blood
Decrease stress factors for infant to decrease cardiac workload
Prostaglandin E to maintain PDA: maintain the mixing of blood (prostaglandins keep PDA patent
Enlarge an already existing defect (cardiac cath with atrial balloon)
Complete correction occurs with switching vessels to proper place; usually done in first week called Atrial Switch, but has good outcomes
End to End Anastomosis for small sections (cut out narrow part)
Graft for larger sections
May do balloon angioplasty to stretch and widen, but higher rate of failure
Treat underlying strep with penicillin or erythromycin, must take entire course
Prevent cardiac damage: corticosteroids for carditis (observe for early signs)
Comfort measures for S/S
Prevention of recurrent strep with penicillin prophylaxis: daily doses or monthly IM injections after acute phase; treatment for 5 years or until 21 whichever is longer
Bedrest to reduce heart workload for patients with active carditis
Narrowing of lumen of aorta resulting in increased pressure proximal to defect and decreased pressure distal to defect
Think squeezing a garden hose, the water pressure will be higher behind kink
Impedes blood flow to lower portion of body
Signs and Symptoms
Increased BP in arms vs. legs (>20mmHg different)
Pulses in upper extremities are bounding
Pulses in lower extremities are weak or absent
Older children complain of leg cramping, fatigue, nosebleeds
Severe cyanosis at birth
TET spells (blue spells): acute episodes of severe cyanosis and hypoxia; sudden restlessness, gasping respirations, increasing cyanosis
Can lead to loss of consciousness, convulsions; especially after exertion like feeding or crying—child’s skin, lips, tongue bluish tint
Murmur
Clubbing of nails
Dyspnea, squatting (knee-chest position decreases venous return by occluding femoral veins thus lessening workload of right side of heart)
Failure to thrive/growth problems
Syncope
Increased RBCs in effort to compensate for lack of oxygen (Increased HCT)
Signs and Symptoms
Slow onset, child listless, anorexic, pale
Low-grade afternoon fever
Lose weight
Complain of vague muscle pain, migratory joint pain, inflammation
Skin rash on trunk, upper extremities
Leads to cough, chest pain, dyspnea
May develop chorea (rapid, jerky movements)
Strep releases toxin that cause antibody formation; antibodies react with tissue antigens and cause damage in different tissues leading to autoimmune reaction
Autoimmune complexes attach heart with bulk of scarring/damage to mitral and aortic valves; can lead to heart failure, pericarditis, endocarditis, myocarditis
Treatment
Treat underlying strep with penicillin or erythromycin, must take entire course
Prevent cardiac damage: corticosteroids for carditis (observe for early signs)
Comfort measures for S/S
Prevention of recurrent strep with penicillin prophylaxis: daily doses or monthly IM injections after acute phase; treatment for 5 years or until 21 whichever is longer
Bedrest to reduce heart workload for patients with active carditis
Hematologic
Labs:
Normal prothrombin time, INR, bleeding time, platelet count
Abnormal Prolonged partial thromboplastin time (PTT)
Abnormal clotting factors 8/9 low
Acute Lymphoblastic Leukemia (ALL): Uncontrollable proliferation of blast cells (immature WBCs) that accumulate in bone marrow
Crowds and depressed other healthy cells
More blast cells means decreased WBCs, decreased RBCs, decreased platelets
Signs and Symptoms
Pallor, fever, infection (decreased WBCs—leukopenia)
Tiredness (decreased RBCs—anemia)
Bleeding, petechiae, bruising (decreased platelets—thrombocytopenia)
Bone pain, joint pain
Enlarged lymph nodes, glands, hepatosplenomegaly (liver/spleen)
Vaso-occlusive: Small vessels blocked in hands/feet which leads to pain, edema, impaired ROM from tissue hypoxia
Sequestration: Blood pools in liver and spleen, can progress to cardiovascular collapse, death
Aplastic: Premature destruction of RBCs because of sickle shape and results in profound anemia, causes bone marrow to stop producing RBCs
Diagnosis:
Sickledex used for screening, adds deoxidating agent to blood and if 25% of Hgb sickles, test is positive.
Hgb Electrophoresis uses electrical charge to separate normal and abnormal to determine trait or disease and uses umbilical blood to screen newborns in nursery
Treatment
IV fluids to maintain hydration
Oxygen to correct hypoxia
Pain management: analgesics (mild: ibuprofen/acetaminophen; severe: morphine, hydromorphone—Dilaudid); meperidine (Demerol) contraindicated due to increased risk for seizures
Supplement with folic acid: needed to produce RBCs
PRBCs, BR
Always use heat—cold aggravates condition
Prophylactic antibiotics—prevents infections
Hydroxyurea: severe cases; reduces frequency of crises; stimulates production of HgbF
Bone marrow transplant
Splenectomy: for enlargement; more prone to infection afterward
Acute Form: Follows viral infection, self-limiting, last 6 months or less; kids affected
Chronic form: Periods of remission; mostly adults affected
Signs and Symptoms
Child appears healthy but has bleeding problems
Platelet count decreased: below 20,000
Bruising and pinpoint petechiae first S/S over bony prominences
Can have bleeding anywhere: gums, nosebleeds, intracranial, hematuria
Acute Treatment
Let illness run course; most recover in 3 months, platelet count will return to normal in 6-12 months
Corticosteroids: suppress immune attack on platelets
IV gamma globulins: concentrated antibodies; help to block destruction of platelets
Platelets and blood as needed if there is a life-threatening problem
Chronic Treatment
Splenectomy: Eliminates site of antibody formation, removes risk of hemorrhage
Blood and vitamin K to correct anemia and coagulation defects
Teaching: Protect from injury; no aspirin, ibuprofen (thin blood); call immediately with head injury
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