ill child

Question 1

glomerulonephritis

Answer 1

“Did your child recently complain of a sore throat?”

Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in options 1, 2, and 4 are unrelated to a diagnosis of glomerulonephritis.

Question 2

increased intracranial pressure (ICP)

Answer 2

early sign of increased ICP:
Nausea

Nausea is an early sign of increased ICP. Late signs of increased ICP include a significant decrease in level of consciousness, Cushing’s triad (increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respirations), and fixed and dilated pupils. Other late signs include decreased motor response to command, decreased sensory response to painful stimuli, posturing, Cheyne-Stokes respirations, and papilledema.

Question 3

leukemia

Answer 3

thrombocytopenic
thrombocytopenic =< 20,000 mm3

Question 4

A temperature of 103F for the past 3 days
Conjunctivitis without discharge
Cracked lips
Enlarged reddened papilla on the tongue
Inflamed oropharyngeal membranes
Enlarged montender lymph nodes

Answer 4

Kawasaki’s disease
Aneurysm and thrombi development

Question 5

Croup syndromes

Answer 5

General term given to respiratory conditions with a cardinal symptom of** “seal-like” cough**, or “barking” cough

May result in stridor

Concern of airway obstruction, acute respiratory failure, and hypoxia

May be benign or acute

Most common is acute LTB (laryngotracheobronchitis)

Question 6

Acute “Croup”- Laryngotracheobronchitis “LTB”

Answer 6

3 S’s
Stridor
Subglottic swelling
Seal-bark cough

Question 7

Epiglottitis
- Cough is absent
- No tongue blade

Answer 7

S/sx:
tachycardia,
sore throat,
high fever,
anxious/agitated,
difficulty speaking,
nasal flaring,
stridor,
chest retractions

Question 8

Acute croup vs. Epiglottitis

Answer 8

Question 9

RSV

Answer 9

Respiratory Syncytial Virus

Question 10

Bronchiolitis

RSV

contact precaution

Answer 10

Viral infection of small airways
Infants and children (6 months to 2 years)
URI with mild fever and serous nasal discharge
Develops into wheezing cough and respiratory distress
Obstruction of airway leads to atelectasis
Increased respiratory rate
Can lead to irritability and dehydration
Apnea leads to hospitalization
RSV primary cause in 50% of cases
Treatment:
symptoms and place in semi-Fowler’s position
IV fluids
Strict I & O
Bronchodilators and high-humidity tents
VS and O2 sat

Question 11

Tonsillitis and Adenoiditis

Answer 11

Difficulty swallowing and breathing
Provide cool mist vaporizer, salt-water gargles, throat lozenges (if age-appropriate), cool liquid diet, acetaminophen
Removal of tonsils and adenoids not recommended if under 3 years of age
Tonsillectomy done only if persistent airway obstruction or difficulty breathing occurs

Question 12

Tonsillectomy

Answer 12

Post op care
Fluids when child awake (sips of H2O or ice chips)
Popsicles
Avoid red liquids (confuse with bleeding), no diery - milk
Ice collars
Pain control- Tylenol
Discourage clearing of throat, blowing nose or coughing
Position to facilitate drainage

**Repeated swallowing **while child is asleep is an early sign of bleeding after tonsillectomy

Question 13

Allergic Rhinitis

Answer 13

Characteristic signs
nasal congestion
clear, watery nasal discharge
sneezing
itching of the eyes
allergic salute and allergic shiners

Question 14

Cystic Fibrosis

Answer 14

Inherited recessive trait
Both parents carry the gene for this disease
Defect in chromosome 7 (CFTR gene)
A protective response against cholera?

Question 15

Sudden Infant Death Syndrome (SIDS)

Question 16

CPR
infant

Question 18

Rationale:
Kernig’s sign is pain that occurs with extension of the leg and knee. Brudzinski’s sign occurs when flexion of the head causes flexion of the hips and knees. Chvostek’s sign, seen in tetany, is a spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland. Trousseau’s sign is a sign for tetany in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally.

Question 19

Reye’s syndrome

Answer 19

Reye’s syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. A definitive diagnosis is made by liver biopsy. In Reye’s syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses. Hearing loss and urine output are not affected. Changing the body position every 2 hours would not affect the cerebral edema directly. The child should be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid.

Question 20

Scoliosis

Answer 20

Scoliosis is a three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. A complication after surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child’s abdominal contents, resulting from lengthening of the child’s body. The disorder results in a syndrome of emesis and abdominal distention similar to that which occurs with intestinal obstruction or paralytic ileus.