Common Problems Ages 1-18 Years

1
Common Problems Ages 1-18 Years
White 2nd ed Christensen 5th ed
Leslie Lehmkuhl, RN 2008
2
Terms

• Acanthois nigricans
• Comedome
• Encopesis
• Epistaxis
• Gowers sign
• Rhinorrhea

3
Upper Respiratory Infections (viral or
bacterial)See Table 57-1
ii

• Nasopharyngitis (common cold) is viral
• 6-9 colds per year
• Tx symptoms (e.g. rhinorrhea, congestion,
  sneezing, fever, muscle aches) and usually self
  resolves in 3 days
• Pharyngitis viral or bacterial
• Most common in 4-6 yo
• Tx symptoms (e.g. sore throat, inflammation, HA)
  and if caused by streptococcal infection teach
  parents to finish all ATBs.
• Note enlarged lymph nodes, tender cervical lymph
  nodes.

• Influenza viral
• Treat symptoms (e.g. chills, fever, mylagia,
  cough, congestion, HA
• Highest among school age children.
• With all three enc. rest, use non-ASA
  antipyretic/analgesics, PO decongestants, nasal
  saline gtts, warm salt water gargle, humidifier,
  fluids, clear or bland liquids, tea and honey.

4
Allergic Rhinitis
0

• Commonly called "hay fever,"
• Irritation of the nose where the inside of the
  nose becomes inflamed after being exposed to an
  allergic trigger.
• It often is associated with asthma and sinusitis.
• Familial predisposition

• Etiology dust, fomites e.g. mop head, feathers,
  animal dander, spores
• Manifestations itchy nose, mouth breathing, dark
  circles under the eyes from congestion, allergic
  salute (transverse crease from pushing nose
  upward and backward in attempt to relieve
  itching).

5
Allergic Rhinitis (continued)

• Management allergy skin testing, CBC with
  elevated eosinophil count
• Immunotherapy includes allergy shots

• Antihistamines, decongestants
• Avoid wool and down blankets, humidifier in home,
  keep pets outside if possible

allergic salute
6
Tonsils

• Tonsil glands are located in the back of the
  throat. They contain immune cells which fight
  infection.
• Tonsils progressively enlarge at 2-10 years old
  and is considered normal.
• By pre-adolescence they reduce in size.

7
Inflamed Tonsils

• Tonsillectomy is advisable when tonsillitis
  attacks are so frequent (5 or more a yr) or
  severe that they affect a child's general health
  or interfere with school, hearing, or breathing.
  However, tonsillectomies are thought to be done
  more often than necessary, so a second opinion
  should be obtained when there is any doubt.

8
Tonsillectomy

• Under general anesthesia, the ear-nose-throat
  (ENT) surgeon holds the mouth open and pulls the
  tongue forward to reveal the tonsils. The tonsils
  are pulled away from the back of the throat and
  then removed by being cut away. Bleeding is
  controlled, and often the cut heals naturally
  without stitches.

9
Tonsillits

• Inflammation of palatine tonsils in throat
  resulting from pharyngitis.
• Etiolgy viral or bacterial
• Note 2-10 years of age tonsil are normally
  enlarged and reduce in size during pre
  adolescence.

• Manifestations sore throat, cough, vomiting,
  muscle ache, difficulty swallowing, tonsils
  enlarged and bright red, mouth breathing, if
  adenoids enlarged May have sleep apnea, hearing
  problems

10
Tonsillitis

• Tests CBC, CS of throat
• Streptococcus is cause of 15 of pharygitis for
  children under 3 years
• Peak age is 4-7 years
• Spread is by droplets
• Antibiotics for management
• Surgery for recurrent infection

• Post surgery monitor for frequent swallowing,
  elevated pulse rate, restlessness not related to
  pain
• No red liquids, popsicles, straws, carbonated
  drinks, citrus, very hot or very cold fluids
• Often vomit from anesthesia, ice collar
• Soft diet when able to swallow

11
Tonsillitis

• Bleeding most common
• Within 24 hours of surgery
• 7-10 days post surgery when the tissue sloughs
  off from the scar site
• Watch for restlessness, anxiety, frequent
  swallowing and rapid pulse.

• Call if temp 101 or above, earache, bleeding,
  avoid crowds for 2 weeks

12
Asthma
13
Bronchial asthma

• Leading cause of absenteeism school and most
  common admitting diagnosis.
• More common in boys until puberty
• S/S dry hacking cough or productive, wheezing
  and difficulty breathing.

• Reactive airway dz that causes narrowing or
  obstruction of the airway.
• Highest incidence in first year of life
• Affects 9 million children under 18 years
• Affects 10 of all school age children

14
Asthma

• Etiology history of allergies in family, smoke,
  stress, exercise, trees, peanutsdo not have to
  have allergies to have asthma
• Assess triggers to prevent future episodes and
  cause no further damage.
• Reversible airway obstruction
• Tests pulmonary function, ABG,CBC,CXR

• Management bronchodialators-albuterol,
  theophylline (narrow therapeutic range, watch for
  irritability, restless, insomnia, HA, V, D)
• Cromolyn sodium-nonsteroid anti-inflammatory-may
  prevent asthma.
• Prednisone a corticosteriods

15
Asthma

• Children's airways are narrower than those of
  adults. This means that triggers that may cause
  only a slight problem in an adult can create more
  serious problems in children. In children, an
  asthma attack can appear suddenly with severe
  symptoms. For this reason, it is important that
  asthma be diagnosed and treated correctly. Some
  children may need to take medicine every day,
  even when they do not have symptoms.

16
Foreign Body Aspiration

• Manifestations sudden violent spasmodic
  coughing, vomiting, gagging, wheezing, may have
  brief episode of apnea, cyanosis, resp distress.
• Management laryngoscopy, bronchoscopy
• Cool mist for 24-48 hours, bronchodilators,
  corticosteroids

• Inhaling any foreign object into respiratory
  tract.
• At risk when playing, running, laughing
• Most frequent age 6 months to 4 years
• Etiology popcorn, peanuts, dry beans, grapes,
  coins, toys, balloons, earrings, hot dog

17
Rheumatic fever
18
Rheumatic Fever

• Multi-system (e.g. heart, joints, lungs, brain)
  autoimmune condition
• From an untreated group B hemolytic
  streptococcus infection (e,g. strp throat,
  scarlet fever).

19
Rheumatic fever

• In connective tissue, heart, joints, brain..
• Manifestations high fever, headache, chills,
  acute
• Tonsillitis, red strawberry tongue by day 4, red
  painless rash, warm erythematous joints,
  inflammation of endocardium, valves, myocardium,
  small nontender lesions on tendon sheaths of
  joints, murmur

20
Rheumatic Fever

• Minor S/S
• Fever
• Listlessness
• Anorexia
• Pallor
• Wt loss
• Muscle
• Joint or abd pain

• Major S/S
• Polyarthritis
• Carditis
• Erythema marginatum (red skin lesions)
• Subcutaneous nodules
• Elevated ASO titer

21

22
Rheumatic Fever
Subcutaneous skin nodules
23
Rheumatic Fever
Skin rash (erythema marginatum)
24
Rheumatic Fever
25
Rheumatic Fever

• Because this disease has different forms, there
  is no specific test that can firmly diagnose it.
  Your doctor will perform a careful exam, which
  includes checking your heart sounds, skin, and
  joints.
• Your doctor may also do an electrocardiogram
  while testing your heart.
• You may have blood samples taken to test for
  recurrent strep infection (such as an ASO test),
  complete blood counts, and sedimentation rate
  (ESR).
• Several major and minor criteria have been
  developed to help standardize rheumatic fever
  diagnosis. Meeting these criteria, as well as
  having evidence of a recent streptococcal
  infection, can help confirm that you have
  rheumatic fever.

26
Rheumatic Fever

• Goal is to treat any existing strep infection
• Rx PCN, Salicilytes for pain, fever reduction
  and inflammation, Corticosteriods for carditis,
  dig and diuretics for CHF

• Low Na diet
• BR to reduce cardiac workload can be weeks even
  months depending on the severity of heart status.
• Heat and cold packs to affected joints

27
Leukemia cells
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Acute lymphoblasticleukemia

• Highest in age 3-5 3,000 new cases a year
• Etiology genetic altered stem cell and cells
  produce the defective cell rapidly forms
  increased number of immature or blast cells
• Blast cells released into circulation
  .Replication continues

29
Leukemia

• Patho bone marrow replaced by malignant blast
  cells, neutropenia, decreased RBCs, platelets
  producing anemia, thrombocytopenia
• All acute leukemia lymphocytic-originates in B
  lymphocytes and T lymphocytes

30
Leukemia

• Manifestations pallor, excessive bruising,
  leg/bone pain, abdominal pain, fever, malaise,
• Hepatosplenomegaly, abnormal elevation of WBC
  (lymphocytes), anemia, neutropenia?? and
  decreased RBCs.
• Complications bleeding, death, sepsis, anemia

31
Leukemia

• Tests CBC, bone marrow aspirate, lumbar puncture
  for mast cells, electrolytes, uric acid level,
  bone scan
• Managementcombination of chemo over 2-3 years,
  prednisone, vincristine over 2-3 years,
• Prognosis is good if remission occurs.

32
Bone Marrow Aspiration
                                                  
                                                  
                    

• A small amount of bone marrow is removed during a
  bone marrow aspiration. The procedure is
  uncomfortable, but can be tolerated by both
  children and adults. The marrow can be studied to
  determine the cause of anemia, the presence of
  leukemia

33
Leukemia

• Daily and weekly doses of medication
• Bone marrow aspirate and spinal puncture in 30
  days after chemo
• Chemo, radiation effects
• Anemia, bleeding, urinary tract infection, hair
  loss, nail loss

34
Idiopathic Thrombocytopenia Purpura (ITP)

• Bleeding disorder characterized by too few
  platelets in the blood. This is because platelets
  are being destroyed by the immune system.
• Blood Platelets under 20,000

• More common in age 2-4 years
• Auto immune disorder often preceded by a viral
  infection
• Child may not feel bad
• Manifestations nose bleed, hematuria, melana,
  hematemesis, subarrachnoid hemorrhage

35
Idiopathic Thrombocytopenia Purpura (ITP)

• The disease occurs when immune system cells,
  called lymphocytes, produce antibodies against
  platelets. Platelets are necessary for normal
  blood clotting. They clump together to plug small
  holes in damaged blood vessels.
• The presence of antibodies on platelets leads to
  their destruction in the spleen. A characteristic
  skin rash, easy bruising, abnormal menstrual
  bleeding, or sudden and severe loss of blood from
  the digestive tract may occur.

• Usually, no other abnormal findings are present.
  In children, the disease sometimes follows a
  viral infection, and usually runs its course
  without treatment (self limiting), with the
  platelet count returning to normal within 6
  months without therapy.

36
Idiopathic thrombocytopenia..

• Tests CBC, platelet count
• Replace blood, blood products, gama globulin
• Spleenectomy if needed to modify disease
• No ASA or ASA products, soft bristle tooth brush

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Hemophilia
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Hemophilia

• Hemophilia refers to a group of bleeding
  disorders in which it takes a long time for the
  blood to clot. This may cause abnormal bleeding.
  In most cases, the disorder is passed down
  through families (inherited) and most often
  affects males.

39
Hemophilia

• Sex linked heredity disorder carried by x
  chromosome
• Male inherits from mother
• Bleeding problems by age 4 yr (however neonatal
  bleeding from the umbilical cord or circumcision
  site may be an early manifestation of severe
  hemophilia).
• Hemophilia A lack of factor viii
• Hemophilia B Christmas disease lack of factor ix

40
Hemophilia

• Bleeding after surgery, trauma or from no
  apparent reason
• Tests PT, ptt, fibrinogen level platelet count,
  factor viii, factor ix, cbc, platelet count,
  coagulation profile

41
Hemophilia

• Medication to stop bleeding desmopressin
  acetate, amicar, cyclokapron
• No asa or asa products factor viii or factor ix
  replacement
• Prognosis good
• No contact sports, ID bracelet

42
Hemophilia

• Care with bicycling, hiking, bowling, golf,
  running, prevent falls
• Watch for intracranial bleed
• Headache, vomiting, disorientation

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Common GI Problems

• Constipation
• Intestinal Parasitic Infections

44
Constipation

• Infrequent or difficult passage of hard dry
  stools d/t to medication, low fiber diet,
  decreased fluid intake
• Manifestations hard dry stool , cramping, pain
  without abd dist, blood in stool, paplpable fecal
  mass inside retum, xray.

• Management increase fluid, fiber, increase fruit
  and vegetables, daily exercise, toilet training,
  allow plenty of time to defecate.
• Impaction use enema
• Stool softners, laxatives, mineral oil may be
  used
• Prognosois is good

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Parasites
46
Giardiasis

• Giardiasis is an intestinal infection caused by a
  protozoan and is spread by contaminated water or
  contact with an infected person. People who are
  travelling or hiking should assume water sources
  are contaminated and either purify drinking water
  or drink bottled water..

47
Parasitic infections

• Giardiasis
• Transmission
• Person to person
• Untreated water
• Contaminated food
• Animals
• Soil
• Feces
• Anal sex with infected person

• Manifestations diarrhea, weight loss, abdominal
  cramping
• Fecal smear

48
Institutional Hygiene

49
Pinworm, Close-up of the Head

• This is the head of a pinworm. Pinworms are most
  common in children. They are easily transmitted
  and sometimes appear in small outbreaks among
  school children.

50
Pinworm Eggs

• Pinworms are a common problem in children and may
  spread to adults (typically the parents or other
  care-givers). The eggs may be easily seen under a
  microscope. To obtain a sample, a piece of
  cellophane tape is pressed against the patient's
  anal opening. The sticky side of the tape picks
  up the pinworm eggs and the tape is then stuck to
  a microscope slide. The eggs can be viewed under
  the microscope, as seen above.

51
Parasitic

• Pinworm is a white threadlike worm
• Transmission
• Person to person
• Ingest or inhale eggs
• Untreated water
• Poor hygiene
• Common in school age children

• Manifestations itching around anus, irritability
• Cellophane tape to capture eggs early am

52
Roundworm

• The adult worms multiply by producing eggs called
  ova or larvae.
• The eggs usually become infectious
• soil
• Intermediate host before humans are infected.
• It is interesting to note that unless the worm
  infection is heavy, many individuals do not show
  signs of infestation.

53
Parasitic

• Roundworm pink worm 9-12 inches
• Transmission eggs passed hand to mouth
• May migrate to liver or lungs

• Manifestations abdominal pain, abdominal
  distention, vomiting, jaundice, pneumonitis
• Fecal smear

54
Parasitic

• Hookworm
• Transmission skin penetration and contact with
  contaminated soil
• May migrate to lungs

• Manifestations anemia, dermatitis, pneumonia,
  malnutrition
• Well balanced diet with increase protein and Fe
  to replace lost nutrients.
• Fecal smear

55
Hookworm

• This is the mouth part of the hookworm
  Ancyclostoma duodenale. The hookworm uses sharp,
  curved cutting plates to attach to the lining of
  the intestine where it sucks blood for nourishment

The oral opening of this species containscutting
"plates" as opposed to "teeth".
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Endocrine
Type 2
Type 1
57
DM
Type 1
Type 2
58
Diabetes Mellitus in Children

• Children often manifest with polyuria,
  polydipsia, polyphagia
• Weight loss, fatigue and blurred vision
• Children may need glucose or snacks after
  exercise
• Toddlers are difficult to control as they can
  refuse to eat

• Type 1 formally called juvenile onset diabetes
  and/or insulin-dependant diabetes
• Most common is type 1 increase of number in type
  2 associated with childhood obesity

59
Diabetes Mellitus in Children

• Most school-age children are able to learn and
  give their own insulin injections.
• Diet and exercise for DM II. However, most may
  need drug therapy eventually.

•  
•  

60
Musculoskeletal D/Os in Childhood

• Scoliosis
• Legg-Calve-Perths
• Duchenne Muscukar Dystrophy
• Juvenile Arthrirtis
• Fractures

61
Scoliosis
62
Signs of Scoliosis

• One shoulder appears to be higher than the other,
  there is a curvature in the spine, or the pelvis
  appears to be tilted. The treatment of scoliosis
  can involve the use of a brace or surgery.
  Treatment is determined by the cause of the
  scoliosis, the size and location of the curve,
  and the stage of bone growth of the patient

63
Scoloisis

• Lateral curvature of the spine more in female
  adolescents
• Manifestations
• Unequal hip and shoulder height, rib asymmetry
• Scapular and rib prominence
• Posterior hump when child bends forward at the
  waist

64
Forward Bend Test

• The forward bend test is a test used most often
  in schools and doctor's offices to screen for
  scoliosis. During the test, the child bends
  forward with the feet together and knees straight
  while dangling the arms. Any imbalances in the
  rib cage or other deformities (e.g. uneven
  shoulder or pelvic heights, posterior rib hump)
  along the back could be a sign of scoliosis.

65
Scoliosis

• Test x-ray
• Management
• curvature under 20 degrees- no treatment
• Orthotic brace boston or thoracolumbosacral
• Surgery-spinal fusion and stabilizing rod as
  harrington rod or l rod

• With brace continuous monitering of curvature.
  Suspect non-compliance if curavture becomes more
  pronounced.
• Post operative log roll q2h, vs, pain level,
  wound care, monitor for bleeding, bowel and
  bladder function, neuro checks with vital signs
  (warmth, color, sensation, movement, pulses,
  swelling, burning)in legs

66

67
Legg-Calve-Perthes Disease

• Etiology decreased blood supply to femoral head
  resulting in epiphyseal necrosis and degeneration
  of femoral head and calcification
• Unknown cause
• Ages 4-8 yr caucasion boys most affected
• S/S include pain, limp, limited rom, worse with
  activity

• Decreased pain with rest
• Tests x-ray
• Management traction, bed rest, cast, brace or
  harness
• Goal to maintain head of femur in acetabulum and
  preserve normal shape as regeneration occurs

68
Blood Supply to Bone

• Bones require their own blood supply which
  travels through the periosteum to the inner bone
  marrow.
• Surgical tx is often treatment of choice as it
  reduces time and eliminates compliance issues.

69
Legg-Calve-Perthes
70
Duchennes Muscular Dystrophy

• Sex-linked (X-link recessive) inherited disease
  with progressive muscle wasting, and weakness
• Ages 2-4.. Onset of disease almost exclusively in
  males.
• Onset subtle and later progresses rapidly
  waddling gait, difficulty running, climbing..

• By 12 years the child may lose the ability to
  walk.
• Genetic Counseling is recommended for parents,
  female siblings and maternal Aunts.

71
Genetic Counseling and Prenatal Diagnosis

72
Muscular dystrophy
73
Juvenile arthritis

• JRA occurs in 50-100 per 100,000 children in the
  United States. It usually occurs before age 16.
• S/S- stiffness, edema, loss of motion, synovial
  thickening, macular rash on trunk, pain, joint
  swelling

• Tests ESR erythrocyte sedimentation rate
• Prognosis is good if caught early

74
Juvenile arthritis

• Drug therapy- nonsteroidal anti-inflammatory
  medication as naprosyn, motirn, aspirin, gold,
  corticosteroids(sparining), cytoxic meds,

• Rest, normal exercise, heat

75
Greenstick Fracture

• Only one side of the bone has been broken. The
  bone usually is "bent" and only broken of the
  outside of the bend. It is mostly seen in
  children because of incomplete ossification, and
  is considered a stable fracture due to the fact
  that the whole bone has not been broken. As long
  as the bone is kept rigid healing is usually
  quick.

76
Fractures

• Common sites long bones, wrist, clavicle,
  fingers, skull
• Can be complete or incomplete fracture

• Nx intervention calm and reassure child, assess
  pain, color, sensation, motion, pulses
• management cast or splint

77
Fracture
78
Immune System/ Communicable Diseases

• Chix pox
• Diptheria
• Fifth disease
• Hep B
• Mesles
• Mono
• Mumps

• Whooping Cough
• Poliomyelytis
• Roseola
• German measles
• Scarlet fever
• tetanus

79
Varicella

• Chicken pox, varicella zoster (Viral)
• Transmission direct contact with resp tract
  secretions
• Manifestations low grade fever, pururtic rash,
  starts as a macule progressing to fluid filled
  papule, vessicles rupture and ooze, crusting
  lesions occurs

• Treat with antihistamines, oatmeal baths and
  lotion to deter itching.
• Vaccine available

80
Varicella-Zoster
Macular rash that progresses to papules to
crusted lesions
81
Diptheria

• corynebacterium dipheriae
• Direct contact (e.g.nasal drainage),or indirect
  through contaminated atrticles.
• Pharyngitis, anorexia, low grade fever, laryngeal
  cough..

• Complications airway obstruction,
  thrombocytopenia
• Treat with antibiotics and analgesics
• Vaccine available

82
Diptheria
Membraneous lesions on tonsils
83
Erythema Infectiosum

• Fifths disease human parovirus b 19
  transmission resp tract secretions, blood
• Manifestaions fever, malaise. Fiery-red cheeks
  (slapped face). Rash red rash on
  facemaculopapular, rash on upper extremities to
  trunk and thighs.

• Lasting 1 week or more
• Treatment supportive measures
• No vaccine available

84
Erythema infantosum
85
Hepatitis B

• Transmissionvia blood and sexual contact
• Flu like symptoms, jaundice
• Hep B vaccine available

86
Rubeola

• Measles paramyxovirus
• Transmission via direct contact from resp
  secretions, blood, urine of infected person
• Manifestations malaise, kopilks
  spots-blue/white spots with a red base in buccal
  mucosa.

• Maculopapular red rash, lasting 7 days
• Rash begins behind the ears or at the hairline
  and spreads downward on body
• Supportive treatment
• Vaccine Available

87
Mononucleosis

• Epstein-barr virus
• Transmission via saliva, blood products
• Manifestations fever, sore throat, enlarged
  lymph nodes, hepatospleenomegaly

• Treatment includes supportive care, antipyretics,
  analgesics
• No vaccine available

88
Mononucleosis
89
Mumps or Paratitis

• Etiology paramyxovirus
• Transmitted by direct contact of respiratory
  secretions
• S/S fever, malaise, headachetenderness of
  parotid gland unilateral or bilateral edema

• Treat w/ supportive care, antipyretics and
  analgesics
• Vaccine available

90
Mumps or Paratitis
Enlarged parotid gland, earache aggravated by
eating ususally accompanied w/fever
91
Pertussis

• AKA Whooping cough.
• Bordetella pertusis
• Respiratory droplets transmission, including
  running nose.
• Manifestations cough, dry, hacking cough
  paroxysms of coughing, followed by prolonged
  inspiratory whoop, sound when child takes a
  breath, lasts 1-2 weeks

• Complications otitis media, atelectasis,
  pneumonia, weight loss, hemorrhage from
  expistaxis
• Management antibiotics, anti-seizure treatment
  for those with seizures, iv therapy, cool mist
• Prevention vaccine

92
Pertussis
Paroxsmal cough, followed by a whoop sound
93
Roseola infantum 6th disease

• Children age 6-24 months
• Sudden onset, high fever last to 4 days child
  seems well
• Rose-pink macular rash on trunk going to rest of
  body
• Lasts 1-2 days

• Complication febrile seizures
• Treat with antpyretics and supportive care

94
6th disease
95
Rubella

• German Measles, 3 day measles
• Airborne, direct contact with droplets,
  transplacental
• S/S fever, HA, malaise, running nose,
  maculopapular rash progressing fro head to
  extremities.

• Supportive care
• Vaccine available

96
Rubella
Maculopapular rash over entire body
97
Rubella
98
Scarlet Fever

• Group A hemolytic strep
• Airborne, resp droplets and contaminated items
• S/S strawberry tounge, abd pain, sore throat,
  skin that peels on hands

99
Scarlet Fever

• Treat with PCN, antipyretics, analgesics

100
Tetanus

• Lockjaw
• Direct contact of skin wound w/contaminated soil
  of a bactyeria spore
• S/S Stiffness of neck and jaw, difficulty
  breathing.

• Supportive care
• Vaccine available

101
Tetanus
102
Integ

• Impetigo
• Cellulitis
• Fungal infections
• Viral infections
• Infestations
• Animal bites
• Spider bites

• Tick bites
• Insect bites
• Contact dermatitis
• Acne
• Burns

103
Impetigo

• Common skin infection, often begins in open skin
• S/S macules that change to papules vesicles that
  rupture with crusty honey colored over red base.

• See 57-11

104
Impetigo
105
Cellulitis

• Cellulitis staph a strep b
• Haemophilus influenzae
• Manifestations pain, redness, edema, lymph node
  enlargement
• Managementantibiotics, moist compresses,
  hydration, bedrest, may elevate affected extremity

106
Tinea capitis, tinea corporis, tinea cruis..

• Fungal infections of the skin
• Tinea capitis-scalp
• Corporis-trunk and extremities
• Cruis-inguinal area
• Pedis- athletes foot
• Treatment antifungal medication, lotritmin,
  monostat, oxistat

• Treatment antifungal medication, lotritmin,
  monostat, oxistat

107
Tinea capitis
108
Herpes Simplex Type 1

• HSV-1 in 30-60 of youth
• Termed cold sore, fever blister
• Virus that remains dormat within nerve cells and
  is reactivated by fever, stress, trauma, sun
  exposure immune suppressed

• Transmitted by direct contact with body fluid

109
Pediculosis

• Head lice , pediculosis capitus
• Causes intense pruritus
• Louse attaches to skin and sucks blood .. lays
  eggs in hair shaft..
• Eggs hatch in 7-10 days
• Treatment kwell, rid, pronto, triple x, repeat
  in 1-2 weeks

• Check head and body
• Lice cannot transmit from hand to hair so the use
  of gloves is unecessary.

110
Pediculosis
111
Parasitic

• Scabies are mites that burrows under the skin
  with feces and eggs left under skin papular
  rash with pruritus
• Transmission by direct contact

• Management kwell/lindane rid, elimite
  retreat in 1 week
• Wash all clothing in hot water

112
Scabes
113
Traumatic injuries

• Human bites
• Insect bites
• Sunburn
• Dogs laceration/avulsion
• Cats puncture
• Bite area face, scalp, upper extremities

114
Dog bite
115
Animal Bites

• Children under 4 years of age are often biten
  most frequently because of their ht and close
  proximity to a dogs face.

• Atb, tetnus

116
Spider Bites

• Black widow red edematous area, dizziness,
  weakness, abd pain, paraylsis, shock, renal
  failure
• Brown reculse bite causes a necrotic ulcer that
  takes months to heal, nausea, vomiting, joint pain

• These spiders are nonaggressive, avoid light
  (e.g. closets, woodpiles) and bite only in self
  defense

117
Black widow
Venom is neurotoxic and may cause dizziness,
weakness Abd, pain, paralysis, seizures, and
possibly death.
118
Black widow bite
119
Brown recluse spider
Venom is necrotoxic, with the bite progressing to
a necrotic Ulcer within 1-2 weeks. This bite
is not fatal, but ulcer may take months to heal.
120
Brown recluse bite
121
Skin

• Impetigostaph aureus infection
• Honey crusting over an ulcerated base
• Mouth and nose
• Manifestations lesions bleed if crusting removed
• Soak off crusts wash with soap and water 3 times
  a day

122
Contact dermatitis

• Inflammatory reaction to allergens soap, wool,
  dyes, citrus, bubble bath
• Manifestations dry, inflamed pruritic skin, may
  have macules or papules

• Tests skin testing for allergen
• Management cool wet dressings of burows
  solution or aveeno bath, ad, desitin,
  antihistamines
• To not use caladryl (benedryl) due to possible
  toxicity calamine recommended for children
• Steroid 1 cream BID

123
Contact Dermatitis
124
Acne Vulgaris

• Inflammatory process common in adolescence
• Involves face, neck, shoulders, back, upper chest
• Management retin-a, tretinoin
• Use sunscreen
• Topical benzoyl peroxide inhibits organism growth

• Management antibiotics for topical use
  clindamycin, erthromycin, metronidazole
• Systemic antibiotics if local do not work
  tetracycline, erythromycin, clidamycin
• Accutane monitor for depression

125
Acne Vulgaris
126
Burns

• Carless adults, children curiosity, increasing
  mobility, failure to adequately supervise
  contribute to high incidence of burns in children.

127
Urinary tract infection

• Infection of kidney, ureters, bladder..
• Bacteria, congenital anomaly manifestations
• Painful urination, flank pain, hematuria,
  vomiting, fever, weight loss, feeding problems

• Tests cs of urine
• Management antibiotics, push fluids, repeat
  urine culture after antibiotics completed
• Complications kidney infection, renal failure

128
Acute glomerulonephritis

• Inflammation of glomeruli of kidney
• Patho strep, pneumococcal, viral, hemolytic
  beta strep, throat infectionstrep fixed to
  glomeruli of kidneyedema occurs.. Filtration
  decreases.. Accumulate sodium and water in blood
  causes edema and circulary congestion..Protein
  escapes in urine

129
Glomerulonephritis

• S/S Hematuria, proteinuria, hypoalbuminemia,
  oliguria, urine brown to tea colored , abd pain,
  pallor, low grade fever, hypertension, heart
  failure

130
Glomerulnephritis

• Tests urinalysis, culture and sensitivity,
  antistreptolisin titer for strep management
• Bed rest, restrict fluid, sodium and potassium

• VS, weight, IO, antibiotic, antihypertensive
  medication..
• Prognosis good, No treatment lab values usually
  self resolve in 6-12 weeks.

131
Glomerulnephritis
132
Nephrosis Nephrotic Syndrome

• Protenuria, edema, hyperlipidemia,
  hypoproteinemia
• Types primary or idiopathic
• Secondary or caused by another disease
• congenital

• Patho autoimmune response
• Allows protein to escape in urine ..Proteinuria
  and low level in blood or hypoproteinemia
• Decreased osmotic pressure allows fluid to leak
  interstitualedema

133
Nephrosis..

• Low fluid volume-retention of sodium and
  water-increases edema
• Manifestations preorbital edema, weight gain,
  anasarca, decreased urine output, pallor

• Tests cbc, urine-fat bodies in urine, bun,
  creatinine, serum protein level..
• Flu and pneumonia vaccinations recommended when
  the child is in remission.

134
Nephrosis

• Management low sodium intake, bed rest,
  prednisone for 7-21 days to initiate remession,
  diuretics, increase protein

• Monitor urine output, elevated glucose,
  abdominal pain, check urine for protein, vs,
  weight

135
Nephrosis
136
Enuresis

• Involuntary urination after control has been
  established
• Etiology urinary tract infection, stress,
  pinworms, diabetes mellitus, sexual abuse, sickle
  cell anemia

• Management ua, cs, fluid restriction after 6pm,
  ditropan

137
Review

• Obestiy
• Anorexia
• Bulemia
• Attention deficit
• Suicide

138
Obesity
139
Obesity

• Obesity is a term used to describe body weight
  that is much greater than what is considered
  healthy. Excessive body fat gt20.

• Factors overeating, lack of parental knowledge
  on nutrition and food preparation, unstructured
  mealtime, genetic predisposition, peer pressure.

140
Anorexia
141
Anorexia and Bulimia

• Eating d/o that is self inflicted starvation
• Binge eating and purging
• Body wt , 15 IBW
• Higher incidence in caucasion girls in higher
  socioeconomic class.

• Antidepressants
• Wt gain at a teady rate 0.1-0.2 kg QD until
  desired wt is achieved

142
Autism

• Autism is a developmental disorder that appears
  in the first 3 years of life, and affects the
  brain's normal development of social and
  communication skills.

• Behavior modification
• Consistent care schedules.
• Prognosis varies good if caught early.
• Many autistic children achieve independence by
  adulthood.

143
Hyperactivity
144
ADHD

• D/O with limited attention spans, overactive,
  easily distracted, excessive talking, difficulty
  following instructions.

• Modifying bx, setting limits, consistant routine,
  reward system, praise
• Ritalin, cylert, dexdrine stimulate concentration

145
Suicide
146
Suicide

• 3rd leading cause of death in adolescents
• Males complete suicide 75 more than females
• Males use lethal methods
• Females drug OD or slit wrists

• No Suicide contracts, chemical restraints-
  benadryl, mellaril, thorazine, ativan.
• Psychotherapy

147
Child
148
Hodgkins

• Treatment radiation therapy chemo surgery
• High success in early diagnosis
• 75 success rate in advanced cases 90 success
  in early diagnosis

149
Patent ductus arteriosus

• Failure of ductus arteriosus to close completely
  after birth
• Abnormal blood flow from aorta to pulmonary
  artery
• Left to right shunt
• Chf, endocarditis, tachypnea, retractions,
  hypoxemia, murmur

150
Patent ductus

• Normallly closes 10-18 hours after birth
• Complications chf, endocarditis, pulmonary
  vascular obstructive disease-later in life,
• Management diuretics, digoxin
• Surgery

151
Ventral septal defect

• Abnormal opening in interventricular septum
  resulting in blood flow from left to right
  ventricle
• Heart failure, holosystolic murmur
• Diuretics for chf, digoxin

152
Ventral septal defect

• Other treatments
• Pulmonary artery banding
• Surgery- repair with a dacron patch

153
Tetrology of fallot

• Pulmonary stenosis, ventral septal defect, right
  ventricular hypertrophy, overriding aorta
• Right to left shunt
• Severe cyanosis, poor growth, syncope, chronic
  hypoxemia, harsh murmur

154
Tetrology

• Monitor for anemia, dehydration
• Blalock-taussing shunt.. Close ventral septal
  defect
• Redirects blood flow back into lungs and allows
  oxygenation
• Crates artificial connection between pulmonary
  artery and aorta

155
Tetrology

• Repair overiding aorta
• Long term complications heart block, ventricular
  arrhythmias, severe right ventricular
  dysfunction, sudden death
• Complications phrenic nerve injury

156
Transportation of the great vessles

• Pulmonary artery arises from left ventricle and
• Aorta rises from right ventricle
• Venous blood returns to right side of heart from
  aorta without being oxygenated

157
Transportation

• Unoxygenated blood returns from the pulmonary
  system and returned to pulmonary artery to lungs
• Management createing an atrial septal defect or
  surgery to correct the vessels to proper position

158
Coarctation of the aorta

• Defect narrowing the lumen of the aorta
• Increased pressure to head and arms
• Lower pressure to body and legs
• Which is reverse of normal

159
Coarctation

• Manifestations bounding pulse in legs, heart
  failure, leg cramps with exertion
• Treat for chf, digoxin, diuretics, baloon
  dilation of aorta - graft replacement if
  narrowing extensive

160
Iron deficiency anemia

• Most common blood disorder in infancy, early
  childhood
• Etiology decreased iron in diet malabsorption
  syndrome, diarrhea
• Decreased rbc production or premature destruction
  of rbc
• Milk without iron

161
Iron deficiency

• Patho bone marrow produces rbcs but hemoglobin
  is decreaed and ineffective to carry o2
• Too little o2 increases work load of heart
• Manifestations pallor, tired, tachycardia,
  irritability
• Iron therapy oral liquid given with straw or
  dropper vit c

162
Iron deficiency

• Medication ferrous sulfate, ferrous gluconate,
  ferrous fumarate, fer-in-sol
• Iron rich foods liver, cream of wheat, dark
  green leafy vegetables, dried fruit, egg yolks
  give with vitamin c foods

163
Sickle cell anemia

• Genetic disorder sickle hemoblobin
• Inherited autosomal recessive disease african
  american, mediterranean, middle east..
• Life long disease
• Each parent has trait50 change of each child
  carrying the trait

164
Sickle cell

• 25 chance of each child without the trait, and
  25 chance of each child having the disease
• Newborn screening cbc,
• Path low oxygen causes shape to sickle and slump
  together

165
Sickle cell

• Lifespan of cell reduced from 120 days to 12 days
• Manifestations
• Pallor, jaundice, delayed growth, renal
  dysfunction crying when joint touched, fever,
  fatigue

166
Sickle cell

• Eye, liver, kidney, lungs, skin affected
• Sickled cells cause occlusion of small vessles
• Usually not diagnosed until 6 months

167
Sickle cell crisis

• Joint pain bone pain, fever, cough swelling of
  hands/feet, seizures tachycardia, pripism, pallor
• Iv fluids, pain management
• Antibiotics due to high infection rate,
  pneumoccal vaccine at 1,2,5 yr h influenza at
  2 mos hepatitis b positive response to bone
  marrow transplant in some

168
Sickle cell crisis

• Complications
• Spleen often removed as it is not functioning
• Septicemia cause of deat from 1-3 year olds
  highest period of mortality to infection
• Child is susceptible to infection

169
Aplastic anemia

• Etiology failure of cell generating ability of
  bone marrow
• All elements of blood are defective, not
  developed or absent
• Related to toxic chemicals, neoplastic disease of
  bone marrow
• Some antibiotics, radiation

170
Aplastic anemia

• Tests bone marrow aspiration
• Manifestations severe anemia, thrombocytopenia,
  leukopenia
• Treatment bone marrow replacement is treatment
  of choice

171
Hodgkins disease

• Malignant lymphoma
• Highest in 15-19 year olds
• Manifestations painless growth of lymph tissue
  in neck, weight loss, fever, night sweats
• Success depends on stage of disease

172
Hiv

• Etiology human immunodeficiency virus
• Transmission breast milk, blood, urine, body
  fluid
• From mother to infant before or during birth via
  placenta
• Infant can be positive at birth and negative at
  18 months

173
Hiv

• Manifestations failure to thrive, viral
  bacterial infection, pneumonia
• Kaposis sarcoma rare in adolescents
• Over 18 months diagnosed by elisa and western
  blot

174
Hiv

• Management
• Antiretroviral meds to prevent reproduction of
  virus
• Combination of medication due to drug resistance
• Monitor cd4 count

175
Respiratory distress syndrome

• Hyaline membrane disease
• Patho lack of surfactant in newborn making
  lungs difficult to inflate
• Alveoli collapse at end of expiration

176
Respiratory distress

• Manifestations nasal flaring, expiratory grunt,
  tachpnea, low body temperature
• Tests abg
• Management oxygen, pulmonary surfactant,
  respiratory support

177
Bronchopulmonary dysplasia

• Patho chronic pulmonary disorders associated
  with meconium aspiration
• Lung becomes thicker and necrosis of alveolar
  walls with o2 impairedalveoli can collapse

178
Bronchopulmonary dysplasia

• Manifestations wheezing, nasal flaring,
  irritability, cyanosis
• Management tpn, feed by lavage when infant able,
  mechanical ventilation, oxygen bronchodilators.

179
Laryngotrachobronchitis

• Croup common 3 mos to 3 yrs
• Patho viral or bacterial as h influenza
• Manifestations hoarsness, inspiratory stridor,
  tachypnea, nasal flaring, barking cough

180
Larygotracheobronchitis

• Tests cbc, cs of tracheal secretions, cs of
  blood
• Management cool mist, oxygen, epinephrine by
  aerosol, npo, iv fluids, antibiotics, fowlers
  position
• Epiglottal edema reduced after 24 hours

181
Acute epiglottitis

• Definition bacterial infection of epiglottis
  in older child cause can beh influenzae
• Manifestations epiglottis cherry red, can
  obstruct airway, drooling, respiratory distress
  treatment
• Cool mist, iv fluids, antibiotics

182
Acute bronchiolitis

• Patho inflammation of bronchioles inflammation
  causing edema often to respiratory synctial virus
• Most in child under 2 yr
• Manifestations tachypnea, rstractions, wheezing,
  fussy,

183
Bronchiolitis

• Eating problems, fever
• Test x-ray
• Treatment high humidity, mist tent, oxygen , iv
  therapy, liquify secretions, corticosteroids
• Lasts 3-10 days
• Prognosis good

184
Respiratory synctial virus

• Associated with bronchiolitis
• Rsv or respiratory synctial virus
• Causes an infection usually
• More infall and peaks in winter
• Tests x-ray shows atelectasis, hyperinflation

185
Respiratory synctial virus

• Nasal secretions positive for elisa and
  immunofluorescent antibody ifa
• Ribavirin has antiviral activity
• Respiratory isolation, good handwashing
• Prognosis good

186
Pulmonary tuberculosis

• Etiology mycobacterium tuberculosis
• Many strains resistant to medication
• Seen in young, old, those with hiv, immune
  suppressed
• Test tb skin test, chest x-ray, cultures

187
Tb

• Some children have no signs of disease
• Success dependent on compliance to therapy and
  parent to give medication for as long as ordered

188
Sudden infant death syndrome

• Etiology unknown
• Child under 1 year peak age 2-4 months
• Most occur in sleep
• More during winter

189
Sids

• Associated with maternal smoking, premature
  birth, respiratory infections, prone position for
  sleep
• Prevention
• Place infant on back or side to sleep

190
Pharyngitis

• Inflammation of the pharynx
• Etiology viral bacterial
• Common age 4-12yr
• Manifestations low grade fever, malaise,
  anorexia, pharyngeal erythema, cough, hoarseness,
  rhinitis..

191
Pharyngitis

• Managementcs of throat, cool liquids, saline
  gargles, warm compress to neck, tylenol
• Viral treated symptomatically
• Strep causes high fever, white exudate on
  posterior pharynx

192
Pneumonia

• Acute inflammation of pulmonary tissue
• Etiology viral bacterial
• Often foreign body aspiration
• Manifestations cough, wheeze, respiratory
  distress, anorexia, irritability

193
Pneumonia

• Tests cbc, cs of blood, urine, and sputum
• Management oxygen, chest physiotherapy, suction
  as needed, fluids, bronchodilator, antipyretic
• Prognosis good

194
Cystic fibrosis

• Inherited disease autosomal recessive traitboth
  parents must have gene for child to be affected
  patho
• Abnormal thick mucus obstructs organs producing
  resp, digestive, integumentary, and reproductive
  dysfunction

195
Cystic fibrosis

• Stasis of secretions-bacterial growth-chronic
  infection-actelectasis and fibrosis-lung
  destruction
• Hypoxia-increased pulmonary resistance-right
  heart failure
• Pancrease ducts blocked-trypsin, amylase, lipase
  not secreted for digestion islets of
  langerhans can be decreasedinsulin dependence

196
Cystic fibrosis

• Sweat glands secrete excess sodium and
  chloridechloride over 60meq/l
• In forearm
• Wheezing, bronchitis pneumonia, copious mucus
  with infections, hypoxia, crackles,steatorrhea
• Growth failure, corpulmonale, chf, clubbing of
  nailbeds

197
Cystic fibrosis

• Tests prenatal testing
• Sweat test, pancreatic enzymes
• Management high calorie, high protein diet,
• High salt in diet
• Breathing exercises, blow bubbles

198
Cystic fibrosis

• Pancreatic enzymes before meals, pulmonary
  therapy, postural drainage, immunization,
  nurtition, prevent exposure to persons with
  respiratory disease, emotional suppport
• Many live into adulthood with antibiotics

199
Cleft lip cleft palate

• Patho failure of medial nasal and maxillary
  process to join
• Unilateral or bilateral
• Feeding problems, gagging, choking, otitis media
• Surgical closure of cleft lip at 1-2 months
  cleft palate repaired before 1 year

200
Cleft lip cleft palate

• Special feeding nipple with head of child
  elevated
• Burp frequently as child swallows air can feed
  by syringe
• Post surgery npo until anesthesia gone.. Rubber
  tip used with syringe to feed and clean mouth..
  No pacifiersclean mouth with water after feeding

201
Gastroesophageal reflux

• Regurgitation of stomach contents into esophagus
• Begin within 1 week of birth
• Occurs immediately after infant lies down
  manifestations
• Spitting up, pneumonia, anemia, hematemesis,
  growth and weight gain problems

202
Gastroesophageal reflux

• Tests barium swallow, bronchoscopy
• Management feed upright, cereal added, antacids,
  head elevated surgery- nissen fundoplication

203
Hypertrophic pyloric stenosis

• Etiology unknown patho congenital
  hypertrophied pyloric muscle that surrounds the
  valve between stomach and duodenum
• Manifestations forceful vomiting projectile
  noted at 4-6 weeks
• Vomiting shortly after eating, hunger, sunken
  fontanel, decreased urine, weight loss..

204
Pyloric stenosis

• Tests ultrasound, barium swallow
• Management ng to empty stomach, iv fluids,
  pyloromyotomy-release obstruction

205
Pyloric stenosis..

• Feed pedialyte in 4-6 hours then ½ strength
  formula or undiluted breast milk, advance
  formula as tol
• Complications dehiscence,
• Obstruction
• Prognosis good

206
Dehydration

• Number one killer of children world wide
• Causes bacterial, viral, parasites, irritable
  bowel syndrome .. patho increased motility,
  loss of water, electrolytes
• Vomiting, diarrhea, pyloric stenosis,
  malabsorption

207
Dehydration

• Fluid loss- isotonic fluid and eletroyte loss
• Etiology burns, fever, diarrhea, malabsorption
  syndrome, cystic fibrosis..
• Manifestations 3-5 loss mild
• 6-9 loss moderate 15 or more severe

208
Dehydration

• Manifestations weight loss, decreased urine
  output, sunken fontanels, no tears, low bp, rapid
  respirations.
• Weigh diapers and count, iv fluid, io,
  electrolytes, daily weight
• Fluids and electrolyte replacement

209
Diarrhea gastroenteritis

• Etiology bacterial, viral, parasites,
  salmonella..
• Loss of water and electrolytes in stool
• Manifestations large volume of stool, light in
  color greasy foul smelling sunken fontanels,
  rapid pulse

210
Diarrhea

• Management
• Npo, iv solution -- in 24 hours begin pedialyte,
  gatorade
• Antibiotics as needed
• brat dietbanana, rice cereal, applesauce, toast
  
• Io, electrolytes, stool for c difficile, cbc,
  ova and parasites

211
Intussecption

• Common cause of intestinal obstruction 3 mos to 6
  yr
• Patho telescoping of one part of the bowel into
  another part of the bowel often at distal ileum
  manifestations
• Vomiting, lethargy, abd pain, currant jelly
  stools..

212
Intussecption

• Tests
• Barium enema, rectal exam
• Barium enema can correct the problem or
• Bowel resection with end to end anstamosis
• Post surgery npo, iv, vs, bowel sounds, oral
  feedings when peristalsis returns

213
Hirschsprungs disease

• Congenital aganglionosis or megacolon
• Absence of ganglion cells in rectum and in colon
• Patho ganglions provide parasympathetic nerve
  action to colon
• Constipation, ribbonlike stool, poor weight gain

214
Hirschsprungs

• Management stool softeners, enema, oral
  antbiotics, colostomy or ileostomy to rest the
  bowel and regain tone
• Later colostomy closure
• Fluid and electrolyte replacement, monitor bowel
  sounds, vs, stools

215
Hernias

• Protrusion of a portion of an organ through a
  structural defect
• Complication circulation to organ impaired
• Incarceratedcannot be reduced
• Strangulatedcirculation impaired

216
Hernias

• Types diaphragmaticprotrusion of stomach
  through part of diaphragm
• Hiatalprotrusion of stomach through esophageal
  opening in diaphragm
• Inguinalprotrusion of organ through inguinal
  ring
• Umbilicalprotrusion of intestine through weak
  abd wall

217
Hernias

• Manifestation buldging sac
• Management most have surgical repair
• Inguinal may have scrotal truss or surgical repair

218
Urinary

• Define
• Hypospadiaurethral opening along ventral surface
  of shaft
• Epispadiaurethralopening along dorsal surface of
  shaft
• Phimosisnarrowing of opening of foreskin

219
Urinary..

• Hydrocelefluid in scrotal sac
• Cryptorchidismfailure of one or both testes to
  descend into scrotum

220
Wilms tumor

• Nephroblastoma
• Most common renal or intrabdominal malignant
  tumor of childhood
• Peak age 2-3 yeaars
• Patho/etiology most common in left kidney both
  hereditary and non hereditary origin

221
WilmS

• Manifestations
• Asymptomatic enlarging abdominal mass, abd pain,
  hematuria, fever, hypertension, weight loss,
  fatigue
• Metastasis liver, lungs, lymph nodes, brain, bone

222
Wilms

• Tests x-ray, abdominal ultrasound, abdominal and
  chest ct, chemistry, biopsy
• Management surgical resection 24-48 hours after
  diagnosis
• Radiation therapy, chemotherapy treatment ranges
  6-15 months

223
WilmS

• Post operative monitor vs, renal output, bowel
  sounds,parents feelings regarding diagnosis,
  avoid contact sports, prompt treatment of
  geniturinary symptoms

224
Hypothyroid

• Hypothyroid to decreased production of thyroid
  hormone
• By thyroid gland
• Patho congenital or acquired
• Insufficient stimulation of gland or systemic
  resistance to hormone

225
Hypothyroid

• Manifestations
• Lethargy, poor appetite, dyspnea, hypothermia,
  delayed growth, dry skin, constipation, mental
  slowness
• Management
• Thyroid hormone replacement

226
Hyperthyroid

• Patho autoimmune, unknown etiology
• Manifestations nervousness, tremors,
  irritability, hypertension, tachycardia,
• Tachpnea, heat intolerance
• Tests tsh, t3, t4, radioactive iodine uptake

227
Hyperthyroid

• Management
• Antithyroid medication propylthioracil,
  tapazole
• Subtotal thyroidectomy
• Post-op monitor breathing, bleeding, calcium
  levels, head elevated, trach tray at bedside

228
Dysplasia of the hip

• Developmental abnormality of the femoral head,
  acetabulum or both associated with other problems
• Associated with first pregnancy, spina bifida,
  breech presentation
• Subluxation or incorrect position of the femoral
  head in acetabulum is the most common in infants

229
Dysplasia of the hip

• Manifestations click when hip moved thigh and
  gluteal folds are not even when infant prone
• Shorter femur on affected side
• Older child can have affected leg shorter or
  waddling gaint or limp

230
Dysplasia of the hip

• Tests sonography, x-ray
• Management varies with severity of deformity
• Pavlik harness-for infants under 6 months to
  maintain hip in abduction and alignment
• Hip spica cast-infants 6-18 months
• Other open reduction, osteotomy, arthroplasty

231
Hip dysplasia

• Nursing maintain position of hip joint, prevent
  complications, provide stimulation, involve
  parents in caring for child, neurovascular
  assessment of extremity, report erythema,
  tenderness, teach cast care smooth edges of cast
  with tape

232
Taipes

• Clubfoot
• Congenital deformity of foot and ankle
  unilateral/bilateral
• Cause unknown
• Noted at birth may be related to environmental
  conditions, intrauterine position, restricted
  movement in uterus

233
Talipes

• Special shoes, short leg cast
• Passive stretching exercises, corrective splints,
  brace
• Corrective shoes
• Management neurovascular check on feet, check
  cast edges for rough edges

234
Septic arthritis

• Infection of a joint
• From bacteria or existing osteomylitis, bit