PEDIATRIC ACCIDENTSPEDIATRIC ACCIDENTS IngestionsIngestions
General informationGeneral information Emergency care: ABCsEmergency care: ABCs Identify substance, save evidence of poisonIdentify substance, save evidence of poison Call poison control center for treatment advice Call poison control center for treatment advice Removal of substanceRemoval of substance
syrup of ipecacsyrup of ipecac EmeticEmetic 15 cc with 200-300 cc of water15 cc with 200-300 cc of water Save emesisSave emesis ContraindicationsContraindications
UnconsciousUnconscious Convulsing Convulsing Ingested hydrocarbon, lye, strychnineIngested hydrocarbon, lye, strychnine
Activated charcoalActivated charcoal Gastric lavageGastric lavage Administer specific antidoteAdminister specific antidote Provide supportive therapyProvide supportive therapy Educate parents about childproof Educate parents about childproof
environmentenvironment Provide anticipatory guidanceProvide anticipatory guidance Infants and toddlers: at risk because Infants and toddlers: at risk because
everything goes into the moutheverything goes into the mouth Adolescents: at risk for intentional ingestion Adolescents: at risk for intentional ingestion
OVERVIEW OF COMMON OVERVIEW OF COMMON ACCIDENTAL INGESTIONACCIDENTAL INGESTION
INGESTION INGESTION CLINICAL CLINICAL MANIFESTATIMANIFESTATION ON
NURSING NURSING TREATMENT TREATMENT
INTERVENTIONS INTERVENTIONS
Salicylate Salicylate
(Aspirin)(Aspirin) TinnitusTinnitus
HyperpyrexiaHyperpyrexia
SeizuresSeizures
BleedingBleeding
HyperventilationHyperventilation
EmesisEmesis
HydrationHydration
Vitamin KVitamin K
Activated Activated
charcoalcharcoal
Anticipatory Anticipatory guidanceguidance
Bleeding Bleeding precautionsprecautions
Counseling if Counseling if
suicide attemptsuicide attempt AcetaminophenAcetaminophen
(Tylenol)(Tylenol)Liver necrosis in Liver necrosis in 2-5 days; nausea; 2-5 days; nausea; vomiting; pain in vomiting; pain in R upper quadrant; R upper quadrant; jaundice; jaundice; coagulation; coagulation; abnormalities, abnormalities, hepatoxichepatoxic
-EmesisEmesis
Mucomyst Mucomyst (antidote)(antidote)
-Counseling if -Counseling if suicide attemptsuicide attempt
- Liver - Liver assessmentassessment
Lead (paint, also Lead (paint, also in soil near in soil near heavily trafficked heavily trafficked roadways, roadways, household dust)household dust)
-Developmental -Developmental regressionregression
-Impaired growth -Impaired growth (encelophalopath(encelophalopathy)y)
-Irritability-Irritability
-Increased -Increased clumsinessclumsiness
-Chelation therapyChelation therapy-EDTAEDTA-BalBal-Child must be Child must be well hydratedwell hydrated
-Neuro Neuro assessmentassessment-Diet high in Diet high in calcium, ironcalcium, iron-Educate parents Educate parents to wash chuld’s to wash chuld’s hands, toys hands, toys frequently to frequently to remove lead dustremove lead dust-Lead abatementLead abatement
Hydrocarbons Hydrocarbons (kerosene, (kerosene, turpentine, turpentine, gasoline)gasoline)
-Burning in mouthBurning in mouth- choking and choking and gagginggagging-CNS depressionCNS depression
-DO NOT INDUCE DO NOT INDUCE EMESISEMESIS-Activated Activated charcoalcharcoal-Gastric lavageGastric lavage
If vomiting, If vomiting, reduce aspirationreduce aspiration
Corrosives (drain Corrosives (drain or oven cleanser, or oven cleanser, chlorine bleach, chlorine bleach, battery acid)battery acid)
-Burning in mouth-Burning in mouth-White swollen White swollen mucous mucous membranesmembranes-Violent vomitingViolent vomiting
- DO NOT INDUCE - DO NOT INDUCE EMESISEMESIS-Dilute toxin with Dilute toxin with waterwater-Activated Activated charcoalcharcoal
Keep warm and Keep warm and inactiveinactive
BURNSBURNS
1. Characteristics of burns in children1. Characteristics of burns in childrenDue to the difference in proportions Due to the difference in proportions
of head, trunk and limbs, burn of head, trunk and limbs, burn percentages are rated differently for percentages are rated differently for childrenchildren
Due to the high percentage of Due to the high percentage of extracellular fluids in the child, fluid extracellular fluids in the child, fluid loss can quickly leas to hypovolemic loss can quickly leas to hypovolemic shock. shock.
2. Treatment2. Treatment similar to adult similar to adult Children are likely to resist eating enough Children are likely to resist eating enough
calories to sustain healing and growth calories to sustain healing and growth needs. Parenteral or enteral feedings are needs. Parenteral or enteral feedings are usually necessary.usually necessary.
3. Rehabilitation3. Rehabilitation Incorporate play into the PT and OT Incorporate play into the PT and OT
regimens for improved success.regimens for improved success. Consider psychosocial needs of the child Consider psychosocial needs of the child Adjustment and transition back to school Adjustment and transition back to school
may be very difficult for the child who has may be very difficult for the child who has sustained at disfiguring burnsustained at disfiguring burn
FRACTURESFRACTURES
1. Characteristics of fractures in children1. Characteristics of fractures in children Due to immaturity of bones and incomplete Due to immaturity of bones and incomplete
ossification, greenstick (incomplete) fractures are ossification, greenstick (incomplete) fractures are commonly seencommonly seen
Fractures to the epiphysis (growth plate) are of Fractures to the epiphysis (growth plate) are of greater concern as growth in limb can be stunted greater concern as growth in limb can be stunted depending on the amount of injurydepending on the amount of injury
2. Treatment2. Treatment Similar to adult, although pediatric fractures often Similar to adult, although pediatric fractures often
have shorter healing timeshave shorter healing times May use cast (plaster or more commonly, May use cast (plaster or more commonly,
fiberglass) soft splint, traction or bracingfiberglass) soft splint, traction or bracing
MUSCULOSKELETAL MUSCULOSKELETAL DISORDERSDISORDERS
ScoliosisScoliosis Lateral curvature of the spineLateral curvature of the spine Most common form is idiopathic seen Most common form is idiopathic seen
(predominately) in adolescent females; unknown (predominately) in adolescent females; unknown etiologyetiology
Acquired scoliosis associated with deformity Acquired scoliosis associated with deformity resulting from other neuromuscular disordersresulting from other neuromuscular disorders
DiagnosisDiagnosis 1) Classic signs: truneal asymmetry; especially 1) Classic signs: truneal asymmetry; especially
noted in hips and shoulders, posturenoted in hips and shoulders, posture 2) Screening exam in school: child flexes at waist; 2) Screening exam in school: child flexes at waist;
one scapula more prominentone scapula more prominent 3) Spinal x-ray3) Spinal x-ray
e. Treatmente. Treatment 1) Mild scoliosis (20˚ curvature): 1) Mild scoliosis (20˚ curvature):
observation, encourage physical exercise observation, encourage physical exercise 2) Moderate scoliosis (20˚-40˚curvature): 2) Moderate scoliosis (20˚-40˚curvature):
Milwaukee brace (pelvis to neck), Milwaukee brace (pelvis to neck), Boston brace (body jacket/TLSO brace) Boston brace (body jacket/TLSO brace)
a) Goal is to prevent worsening of curvea) Goal is to prevent worsening of curve b) NURSING INTERVENTIONSb) NURSING INTERVENTIONS
Risk for noncompliance: difficult for adolescent Risk for noncompliance: difficult for adolescent due to body image concerns; must wear 23 due to body image concerns; must wear 23 hours a day (one hour off hygiene care); wears T-hours a day (one hour off hygiene care); wears T-shirt under brace shirt under brace
Body image disturbance: Boston brace better Body image disturbance: Boston brace better accepted (can be completely hidden under accepted (can be completely hidden under clothing)clothing)
3) Severe scoliosis (40˚ curvature): surgery 3) Severe scoliosis (40˚ curvature): surgery a) Spinal fusion with instrumentationa) Spinal fusion with instrumentation b) Requires prolonged immobilization b) Requires prolonged immobilization
in cast, brace or body jacketin cast, brace or body jacket c) NURSING INTERVENTIONSc) NURSING INTERVENTIONS (1) High risk for injury related to spinal (1) High risk for injury related to spinal
manipulation: log roll first 24 hours; manipulation: log roll first 24 hours; neurovascular checks; advance activity as neurovascular checks; advance activity as ordered; observe for paralytic ileusordered; observe for paralytic ileus
(2) Pain: adolescent good candidate for PCA (2) Pain: adolescent good candidate for PCA pumppump
ONCOLOGY DISORDERONCOLOGY DISORDER
A. LeukemiaA. LeukemiaMost common childhood cancerMost common childhood cancerPeak incidence: 3-5 years of agePeak incidence: 3-5 years of ageEtiology: unknown, may be related to Etiology: unknown, may be related to
environmental exposures environmental exposures (example:radiation)(example:radiation)
Characterized by proliferation of Characterized by proliferation of abnormal white blood cellsabnormal white blood cells
Clinical ManifestationClinical ManifestationFever and infection from decreased Fever and infection from decreased
(normal) WBCs(normal) WBCsAnemia, pallor and fatigue from Anemia, pallor and fatigue from
decreased RBCsdecreased RBCsPetechiae and epistaxis from decreased Petechiae and epistaxis from decreased
plateletsplateletsLimb and joint painLimb and joint painLymphadenopathyLymphadenopathyCentral Nervous System (CNS) Central Nervous System (CNS)
involvementinvolvementHepatosplenomegaly/bleeding tendenciesHepatosplenomegaly/bleeding tendencies
Treatments: Treatments: TerminologyTerminology
Induction, remissionInduction, remission CNS prophylaxis, consolidationCNS prophylaxis, consolidation MaintenanceMaintenance
ChemotherapyChemotherapy Purine antagonists: 6-mercaptopurine (Purinethol) Purine antagonists: 6-mercaptopurine (Purinethol)
(may affect kidneys)(may affect kidneys) Alkylating agents: cyclophosphamide (Cytoxan) Alkylating agents: cyclophosphamide (Cytoxan)
(causes chemical cystitis)(causes chemical cystitis) Folic acid antagonists: methotrexate (Folex)Folic acid antagonists: methotrexate (Folex) Plan alkaloid: vincristine sulfate (Oncovine) (neuro Plan alkaloid: vincristine sulfate (Oncovine) (neuro
toxic)toxic) Steroids: prednisone (Prelone)Steroids: prednisone (Prelone) Enzymes: L-asparaginase (Elspar)Enzymes: L-asparaginase (Elspar)
NEPHROBLASTOMA (Wilms NEPHROBLASTOMA (Wilms Tumor)Tumor)
Most frequent type of renal cancerMost frequent type of renal cancer Peak age is 3 yearsPeak age is 3 years Most common clinical sign: swelling, mass Most common clinical sign: swelling, mass
within the abdomen, within the abdomen, May also see: anemia, hypertension, May also see: anemia, hypertension,
hematuriahematuria Clinical ManifestationsClinical Manifestations
Arises from embryonal tissueArises from embryonal tissueEncapsulated (do not biopsy, will “seed” tumor Encapsulated (do not biopsy, will “seed” tumor
further)further)
DiagnosisDiagnosis Intravenous pyelogramIntravenous pyelogramComputerized tomographyComputerized tomographyBone marrow to rule out metastasisBone marrow to rule out metastasisTreatmentTreatmentNephrectomy and adrenalectomyNephrectomy and adrenalectomyRadiation and chemotherapy Radiation and chemotherapy
determined by stagingdetermined by staging
Nursing ManagementNursing ManagementPreoperative carePreoperative care
Treatment begun quickly; support Treatment begun quickly; support parents and keep explanations simpleparents and keep explanations simple
Monitor blood pressure due to excess Monitor blood pressure due to excess rennin productionrennin production
Prevent rupture of encapsulated tumorPrevent rupture of encapsulated tumorpost sign on bed: “DO NOT PALPATE post sign on bed: “DO NOT PALPATE
ABDOMEN”ABDOMEN”Bathe and handle gentlyBathe and handle gently
Postoperative carePostoperative care problems related to radiation, problems related to radiation,
chemotherapy chemotherapy large surgical incisionlarge surgical incision
Pain managementPain management Gentle handlingGentle handling Prepare parentsPrepare parents
Protect remaining kidneyProtect remaining kidney Monitor blood pressureMonitor blood pressure Dipstick urine for proteine or bloodDipstick urine for proteine or blood
NEUROBLASTOMANEUROBLASTOMA
Most frequent seen below 2 years of ageMost frequent seen below 2 years of age Frequently called “silent” tumor because Frequently called “silent” tumor because
by the time of diagnosis, metastasis has by the time of diagnosis, metastasis has occurredoccurred
Clinical signs include: abdominal mass, Clinical signs include: abdominal mass, urinary retention and frequency, urinary retention and frequency, lymphadenopathy, generalized weakness, lymphadenopathy, generalized weakness, malaisemalaise
Primary site is abdomen, most often in Primary site is abdomen, most often in flank areaflank area
DiagnosisDiagnosis Computerized tomographyComputerized tomography Bone marrow to determine metastasisBone marrow to determine metastasis Excessive catecholamine production Excessive catecholamine production TreatmentTreatment Surgery to remove as much of the tunor as Surgery to remove as much of the tunor as
possible, determine stagingpossible, determine staging Chemotherapy and radiation determined Chemotherapy and radiation determined
by staging of tumorby staging of tumor
HODKIN’S LYMPHOMAHODKIN’S LYMPHOMA
Primarily affects adolescents and young Primarily affects adolescents and young adults adults
Clinical signs include: painless enlargement Clinical signs include: painless enlargement of lymph nodes (cervical most common), of lymph nodes (cervical most common), metastasis related manifestations metastasis related manifestations (persistent cough, abdominal pain), systemic (persistent cough, abdominal pain), systemic problems (pruritus, night sweats, fever)problems (pruritus, night sweats, fever)
Clinical ManifestationsClinical Manifestations Malignancy originates in lymphoid systemMalignancy originates in lymphoid system Metastasis may include spleen, liver, bone Metastasis may include spleen, liver, bone
marrow, lungsmarrow, lungs
DiagnosisDiagnosisComputerized axial tomographyComputerized axial tomographyLymph node biopsy, exploratory Lymph node biopsy, exploratory
laparotomy (to stage)laparotomy (to stage)TreatmentTreatmentRadiation and chemotherapy Radiation and chemotherapy
determined by clinical stagingdetermined by clinical stagingSurgical laparatomySurgical laparatomySplenectomySplenectomy
RENAL DISORDERSRENAL DISORDERSNEPHROTIC NEPHROTIC SYNDROMESYNDROME
ACUTE ACUTE GLOMERULONEPHRITIGLOMERULONEPHRITISS
Other namesOther names Childhood nephrosisChildhood nephrosis Post-streptococcal Post-streptococcal glomerulonephritisglomerulonephritis
EtiologyEtiology Cause unknown; may Cause unknown; may follow the toxic effects of follow the toxic effects of mercury or Tridione mercury or Tridione exposure or bee stingexposure or bee sting
Antigen- antibody Antigen- antibody reaction secondary to reaction secondary to infection elsewhere in infection elsewhere in the body, usually a the body, usually a Group A beta hemolytic Group A beta hemolytic streptococcal infection streptococcal infection of the upper respiratory of the upper respiratory tracttract
IncidenceIncidence Average age of onset Average age of onset about 2-1/2 years most about 2-1/2 years most common in boyscommon in boys
2/3 of cases in children 2/3 of cases in children under 4-7 years; more under 4-7 years; more common in boyscommon in boys
PathologyPathology Increased permeability Increased permeability of the glomerular of the glomerular membrane to proteinmembrane to protein
Inflammation of the Inflammation of the kidneys; damage to the kidneys; damage to the glomeruli allows glomeruli allows excretion of red blood excretion of red blood cellscells
Clinical manifestationsClinical manifestations Edema appears Edema appears insidiously; usually first insidiously; usually first noticed about the eyes noticed about the eyes and can advance to the and can advance to the legs, arms, back, legs, arms, back, pentoneal cavity and pentoneal cavity and scrotum; massive scrotum; massive protenuria, anorexia; protenuria, anorexia; pallorpallor
Periorbital edema Periorbital edema appears insidiously; tea-appears insidiously; tea-colored urine from colored urine from hematuria, hypertension hematuria, hypertension oliguriaoliguria
Blood pressureBlood pressure Usually normal, transient Usually normal, transient elevation may occur elevation may occur earlyearly
Varying degrees of HPN Varying degrees of HPN maybe present, when BP maybe present, when BP is increased, cerebral is increased, cerebral manifestations may manifestations may occur such as, occur such as, headache, drowsiness, headache, drowsiness, diplopia, vomiting and diplopia, vomiting and convulsionsconvulsions
Laboratory findingsLaboratory findings Urine – shows heavy Urine – shows heavy albuminuriaalbuminuria
Urine – contains RBC and Urine – contains RBC and increase specific gravityincrease specific gravity
TreatmentsTreatments 1.1. PrednisonePrednisone
2.2. FurosemideFurosemide
3.3. Salt-poor albuminSalt-poor albumin
1.1. Antibiotics for strep Antibiotics for strep infectioninfection
2.2. Antihypertensives Antihypertensives and diureticsand diuretics
3.3. CorticosteroidsCorticosteroids
Nursing interventionsNursing interventions 1.1. Control edemaControl edema
2.2. Provide skin careProvide skin care
3.3. Prevent infectionPrevent infection
4.4. Monitor nutrition: Monitor nutrition: low Na, high CHON, low Na, high CHON, high potassiumhigh potassium
5.5. Monitor urine for Monitor urine for proteinuriaproteinuria
1.1. Bed rest if Bed rest if hypertensivehypertensive
2.2. Restrict fluidRestrict fluid
3.3. Monitor BPMonitor BP
4.4. Provide low Provide low potassium diet, no potassium diet, no added saltadded salt
5.5. Prevent infectionPrevent infection