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Pediatric Conditions Pathophysiology Reactive Airway Disease The site of the problem is obstruction to airflow in the lower airways of the lungs. The obstruction to airflow is due to narrowing of the airways by constriction of muscles around the airways as well as swelling of the lining of the airway and collection of secretions within the lumen of the airway. Wheezing is a reaction that can be triggered by many factors (such as viral upper respiratory infections, inhalant allergies to pollens and molds, cold air, exercise, emotion, cigarette smoke, paint fumes, ozone). Gastroenteritis Femur Fracture Specific Assessment Findings An inflammation of the mucous membranes lining the stomach and intestine resulting from viral or bacterial infections or toxins. Enterotoxins produced by infectious agents or the cytotoxins damage the intestinal lining, producing inflammation. Fluid doss and electrolyte losses result from decreased intake, vomiting , and diarrhea Indirect force or direct force in which bone is subjected to stress beyond what it can endure. Spontaneous fracturing associated with an underlying disease process - increased work of breathing increased respiratory rate retractions frequent and repetitive cough vomiting; decreased oral intake due to fatigue and cough. use of the muscles of the abdomen, neck and nose to assist in breathing inability to lie down due to respiratory distress Cyanosis (a bluish color about the mouth). Laboratory Findings Peak flows Chest xray Severity of dehydration o Sunken eyes o Wgt. Loss o Dry mucous membranes o Decreased urine output Fever Diarrhea Vomiting Abdominal pain and cramping Tenderness at site Limb Limited mobility Swelling Deformity Decreased vascularity UA Gastrocult Treatments / Medications SVN Bronchodilators/ Albuterol, Atrovent Anti-inflammatory agent/ prednisolone, solumedrol Hydration Antiemetics (Phenergan, Compazine, Zofran) Antidiarrheal (Lomotil, Imodium) X ray Bone scan MRI Immobilizing the fractured limb or site Traction Surgery Assess neuro Discharge Teaching for caregivers & patients Teach family to identify and avoid potential triggers Recognizing signs and symptoms of an impending attack Peak flows Review families understanding of medication administration. Good hand washing Pedialyte 5-10ml’s wait 5- 10 mins then repeat Slowly increase as tolerated. Advance diet as tolerated with easily digested foods BRAT diet Cast care Educate on assessment of skin at cast site. Elevate, ice, and rest Adequate nutrition to promote healing Osteogenisis Imperfecta Closed head injury Child abuse Cancer; sarcomas Any injury to the head that does not penetrate skull. Closed head injuries range from mild skull injuries to traumatic brain injuries. Different types include: Concussion Brain contusion Diffused axonal injury Hematoma and neurological function distal from the site Headache Dizziness Nausea Ringing in the ear Slurred speech Vomiting CT scan Neuro Assessment vascular status Pain medication Maintain cardiopulmonary function Monitor neuro signs (protein & vitamins) Primary injuries develop at time of trauma when initial tissue damages takes place. Sickle Cell Anemia Secondary brain trauma develops as a result of body’s response to injury, this can occur from a few hours to a few weeks after the injury. An autosomal recessive condition where normal hemoglobin is partially or completely replaced by sickle shaped abnormal hemoglobin S (Hgb S). When exposed to diminished levels of oxygen, hemoglobin develops a sickle or crescent shape; these cells are rigid and obstruct capillary blood flow, leading to congestion and tissue hypoxia, cyclically, this hypoxia causes additional sickling and extensive infarctions Fatigue Shortness of breath (hypoxia) Pain Dizziness Headache Coldness in the hands and feet Pale skin Chest pain Newborn screening Sickle cell test (sicklidex) Hydroxyurea Antibiotics Blood transfusions Oxygen Pain medication Minor injuries, teach what behaviors to expect from child and symptoms to monitor (mild headache expected, focal deficits are abnormal) Recovery period up to 6 weeks, children may tire easily have memory loss or forgetfulness, are easily distractible, have difficulty concentrating of following directions, irritability or short temper, and need help starting and finishing tasks Folic acid supplements Plenty of water Avoid temperature extremes Reduce stress Exercise regularly Use caution with OTC (decongestant, pseudoephedrine, can constrict blood vessels). May need supplemental oxygen in high altitudes