Pediatric Accidents

PEDIATRIC ACCIDENTS
Ingestions
General information
Emergency care: ABCs
Identify substance, save evidence of poison
Call poison control center for treatment advice
Removal of substance
syrup of ipecac
Emetic
15 cc with 200-300 cc of water
Save emesis
Contraindications
Unconscious
Convulsing
Ingested hydrocarbon, lye, strychnine

Activated charcoal
Gastric lavage
Administer specific antidote
Provide supportive therapy
Educate parents about childproof environment
Provide anticipatory guidance
Infants and toddlers: at risk because everything goes into the mouth
Adolescents: at risk for intentional ingestion

OVERVIEW OF COMMON ACCIDENTAL INGESTION -Counseling if suicide attempt - Liver assessment
Emesis
Mucomyst (antidote)
Liver necrosis in 2-5 days; nausea; vomiting; pain in R upper quadrant; jaundice; coagulation; abnormalities, hepatoxic Acetaminophen (Tylenol) Anticipatory guidance Bleeding precautions Counseling if suicide attempt Emesis Hydration Vitamin K Activated charcoal Tinnitus Hyperpyrexia Seizures Bleeding Hyperventilation Salicylate (Aspirin) INTERVENTIONS NURSING TREATMENT CLINICAL MANIFESTATION INGESTION

Keep warm and inactive
- DO NOT INDUCE EMESIS
Dilute toxin with water
Activated charcoal
-Burning in mouth
White swollen mucous membranes
Violent vomiting
Corrosives (drain or oven cleanser, chlorine bleach, battery acid) If vomiting, reduce aspiration
DO NOT INDUCE EMESIS
Activated charcoal
Gastric lavage
Burning in mouth
choking and gagging
CNS depression
Hydrocarbons (kerosene, turpentine, gasoline)
Neuro assessment
Diet high in calcium, iron
Educate parents to wash chuld’s hands, toys frequently to remove lead dust
Lead abatement
Chelation therapy
EDTA
Bal
Child must be well hydrated
-Developmental regression -Impaired growth (encelophalopathy) -Irritability -Increased clumsiness Lead (paint, also in soil near heavily trafficked roadways, household dust)

BURNS
1. Characteristics of burns in children
Due to the difference in proportions of head, trunk and limbs, burn percentages are rated differently for children
Due to the high percentage of extracellular fluids in the child, fluid loss can quickly leas to hypovolemic shock.

2. Treatment
similar to adult
Children are likely to resist eating enough calories to sustain healing and growth needs. Parenteral or enteral feedings are usually necessary.
3. Rehabilitation
Incorporate play into the PT and OT regimens for improved success.
Consider psychosocial needs of the child
Adjustment and transition back to school may be very difficult for the child who has sustained at disfiguring burn

FRACTURES
1. Characteristics of fractures in children
Due to immaturity of bones and incomplete ossification, greenstick (incomplete) fractures are commonly seen
Fractures to the epiphysis (growth plate) are of greater concern as growth in limb can be stunted depending on the amount of injury
2. Treatment
Similar to adult, although pediatric fractures often have shorter healing times
May use cast (plaster or more commonly, fiberglass) soft splint, traction or bracing

MUSCULOSKELETAL DISORDERS
Scoliosis
Lateral curvature of the spine
Most common form is idiopathic seen (predominately) in adolescent females; unknown etiology
Acquired scoliosis associated with deformity resulting from other neuromuscular disorders
Diagnosis
1) Classic signs: truneal asymmetry; especially noted in hips and shoulders, posture
2) Screening exam in school: child flexes at waist; one scapula more prominent
3) Spinal x-ray

e. Treatment
1) Mild scoliosis (20˚ curvature): observation, encourage physical exercise
2) Moderate scoliosis (20˚-40˚curvature): Milwaukee brace (pelvis to neck), Boston brace (body jacket/TLSO brace)
a) Goal is to prevent worsening of curve
b) NURSING INTERVENTIONS
Risk for noncompliance: difficult for adolescent due to body image concerns; must wear 23 hours a day (one hour off hygiene care); wears T-shirt under brace
Body image disturbance: Boston brace better accepted (can be completely hidden under clothing)

3) Severe scoliosis (40˚ curvature): surgery
a) Spinal fusion with instrumentation
b) Requires prolonged immobilization in cast, brace or body jacket
c) NURSING INTERVENTIONS
(1) High risk for injury related to spinal manipulation: log roll first 24 hours; neurovascular checks; advance activity as ordered; observe for paralytic ileus
(2) Pain: adolescent good candidate for PCA pump

ONCOLOGY DISORDER
A. Leukemia
Most common childhood cancer
Peak incidence: 3-5 years of age
Etiology: unknown, may be related to environmental exposures (example:radiation)
Characterized by proliferation of abnormal white blood cells

Clinical Manifestation
Fever and infection from decreased (normal) WBCs
Anemia, pallor and fatigue from decreased RBCs
Petechiae and epistaxis from decreased platelets
Limb and joint pain
Lymphadenopathy
Central Nervous System (CNS) involvement
Hepatosplenomegaly/bleeding tendencies

Treatments:
Terminology
Induction, remission
CNS prophylaxis, consolidation
Maintenance
Chemotherapy
Purine antagonists: 6-mercaptopurine (Purinethol) (may affect kidneys)
Alkylating agents: cyclophosphamide (Cytoxan) (causes chemical cystitis)
Folic acid antagonists: methotrexate (Folex)
Plan alkaloid: vincristine sulfate (Oncovine) (neuro toxic)
Steroids: prednisone (Prelone)
Enzymes: L-asparaginase (Elspar)

NEPHROBLASTOMA (Wilms Tumor)
Most frequent type of renal cancer
Peak age is 3 years
Most common clinical sign: swelling, mass within the abdomen,
May also see: anemia, hypertension, hematuria
Clinical Manifestations
Arises from embryonal tissue
Encapsulated (do not biopsy, will “seed” tumor further)

Diagnosis
Intravenous pyelogram
Computerized tomography
Bone marrow to rule out metastasis
Treatment
Nephrectomy and adrenalectomy
Radiation and chemotherapy determined by staging

Nursing Management
Preoperative care
Treatment begun quickly; support parents and keep explanations simple
Monitor blood pressure due to excess rennin production
Prevent rupture of encapsulated tumor
post sign on bed: “DO NOT PALPATE ABDOMEN”
Bathe and handle gently

Postoperative care
problems related to radiation, chemotherapy
large surgical incision
Pain management
Gentle handling
Prepare parents
Protect remaining kidney
Monitor blood pressure
Dipstick urine for proteine or blood

NEUROBLASTOMA
Most frequent seen below 2 years of age
Frequently called “silent” tumor because by the time of diagnosis, metastasis has occurred
Clinical signs include: abdominal mass, urinary retention and frequency, lymphadenopathy, generalized weakness, malaise
Primary site is abdomen, most often in flank area

Diagnosis
Computerized tomography
Bone marrow to determine metastasis
Excessive catecholamine production
Treatment
Surgery to remove as much of the tunor as possible, determine staging
Chemotherapy and radiation determined by staging of tumor

HODKIN’S LYMPHOMA
Primarily affects adolescents and young adults
Clinical signs include: painless enlargement of lymph nodes (cervical most common), metastasis related manifestations (persistent cough, abdominal pain), systemic problems (pruritus, night sweats, fever)
Clinical Manifestations
Malignancy originates in lymphoid system
Metastasis may include spleen, liver, bone marrow, lungs

Diagnosis
Computerized axial tomography
Lymph node biopsy, exploratory laparotomy (to stage)
Treatment
Radiation and chemotherapy determined by clinical staging
Surgical laparatomy
Splenectomy

RENAL DISORDERS 2/3 of cases in children under 4-7 years; more common in boys Average age of onset about 2-1/2 years most common in boys Incidence Antigen- antibody reaction secondary to infection elsewhere in the body, usually a Group A beta hemolytic streptococcal infection of the upper respiratory tract Cause unknown; may follow the toxic effects of mercury or Tridione exposure or bee sting Etiology Post-streptococcal glomerulonephritis Childhood nephrosis Other names ACUTE GLOMERULONEPHRITIS NEPHROTIC SYNDROME

Urine – contains RBC and increase specific gravity Urine – shows heavy albuminuria Laboratory findings Varying degrees of HPN maybe present, when BP is increased, cerebral manifestations may occur such as, headache, drowsiness, diplopia, vomiting and convulsions Usually normal, transient elevation may occur early Blood pressure Periorbital edema appears insidiously; tea-colored urine from hematuria, hypertension oliguria Edema appears insidiously; usually first noticed about the eyes and can advance to the legs, arms, back, pentoneal cavity and scrotum; massive protenuria, anorexia; pallor Clinical manifestations Inflammation of the kidneys; damage to the glomeruli allows excretion of red blood cells Increased permeability of the glomerular membrane to protein Pathology

Bed rest if hypertensive
Restrict fluid
Monitor BP
Provide low potassium diet, no added salt
Prevent infection
Control edema
Provide skin care
Prevent infection
Monitor nutrition: low Na, high CHON, high potassium
Monitor urine for proteinuria
Nursing interventions
Antibiotics for strep infection
Antihypertensives and diuretics
Corticosteroids
Prednisone
Furosemide
Salt-poor albumin
Treatments

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Pediatric Accidents

by ALLEICARG DC on Apr 18, 2009

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Pediatric Accidents — Presentation Transcript