Pediatric Accidents


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Pediatric Accidents

  1. 1. PEDIATRIC ACCIDENTS <ul><li>Ingestions </li></ul><ul><ul><li>General information </li></ul></ul><ul><ul><ul><li>Emergency care: ABCs </li></ul></ul></ul><ul><ul><ul><li>Identify substance, save evidence of poison </li></ul></ul></ul><ul><ul><ul><li>Call poison control center for treatment advice </li></ul></ul></ul><ul><ul><ul><li>Removal of substance </li></ul></ul></ul><ul><li>syrup of ipecac </li></ul><ul><li>Emetic </li></ul><ul><li>15 cc with 200-300 cc of water </li></ul><ul><li>Save emesis </li></ul><ul><li>Contraindications </li></ul><ul><ul><li>Unconscious </li></ul></ul><ul><ul><li>Convulsing </li></ul></ul><ul><ul><li>Ingested hydrocarbon, lye, strychnine </li></ul></ul>
  2. 2. <ul><li>Activated charcoal </li></ul><ul><li>Gastric lavage </li></ul><ul><li>Administer specific antidote </li></ul><ul><li>Provide supportive therapy </li></ul><ul><li>Educate parents about childproof environment </li></ul><ul><li>Provide anticipatory guidance </li></ul><ul><li>Infants and toddlers: at risk because everything goes into the mouth </li></ul><ul><li>Adolescents: at risk for intentional ingestion </li></ul>
  3. 3. OVERVIEW OF COMMON ACCIDENTAL INGESTION -Counseling if suicide attempt - Liver assessment <ul><li>Emesis </li></ul><ul><li>Mucomyst (antidote) </li></ul>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
  4. 4. Keep warm and inactive <ul><li>- DO NOT INDUCE EMESIS </li></ul><ul><li>Dilute toxin with water </li></ul><ul><li>Activated charcoal </li></ul><ul><li>-Burning in mouth </li></ul><ul><li>White swollen mucous membranes </li></ul><ul><li>Violent vomiting </li></ul>Corrosives (drain or oven cleanser, chlorine bleach, battery acid) If vomiting, reduce aspiration <ul><li>DO NOT INDUCE EMESIS </li></ul><ul><li>Activated charcoal </li></ul><ul><li>Gastric lavage </li></ul><ul><li>Burning in mouth </li></ul><ul><li>choking and gagging </li></ul><ul><li>CNS depression </li></ul>Hydrocarbons (kerosene, turpentine, gasoline) <ul><li>Neuro assessment </li></ul><ul><li>Diet high in calcium, iron </li></ul><ul><li>Educate parents to wash chuld’s hands, toys frequently to remove lead dust </li></ul><ul><li>Lead abatement </li></ul><ul><li>Chelation therapy </li></ul><ul><li>EDTA </li></ul><ul><li>Bal </li></ul><ul><li>Child must be well hydrated </li></ul>-Developmental regression -Impaired growth (encelophalopathy) -Irritability -Increased clumsiness Lead (paint, also in soil near heavily trafficked roadways, household dust)
  5. 5. BURNS <ul><li>1. Characteristics of burns in children </li></ul><ul><li>Due to the difference in proportions of head, trunk and limbs, burn percentages are rated differently for children </li></ul><ul><li>Due to the high percentage of extracellular fluids in the child, fluid loss can quickly leas to hypovolemic shock. </li></ul>
  6. 6. <ul><li>2. Treatment </li></ul><ul><li>similar to adult </li></ul><ul><li>Children are likely to resist eating enough calories to sustain healing and growth needs. Parenteral or enteral feedings are usually necessary. </li></ul><ul><li>3. Rehabilitation </li></ul><ul><li>Incorporate play into the PT and OT regimens for improved success. </li></ul><ul><li>Consider psychosocial needs of the child </li></ul><ul><li>Adjustment and transition back to school may be very difficult for the child who has sustained at disfiguring burn </li></ul>
  7. 7. FRACTURES <ul><li>1. Characteristics of fractures in children </li></ul><ul><li>Due to immaturity of bones and incomplete ossification, greenstick (incomplete) fractures are commonly seen </li></ul><ul><li>Fractures to the epiphysis (growth plate) are of greater concern as growth in limb can be stunted depending on the amount of injury </li></ul><ul><li>2. Treatment </li></ul><ul><li>Similar to adult, although pediatric fractures often have shorter healing times </li></ul><ul><li>May use cast (plaster or more commonly, fiberglass) soft splint, traction or bracing </li></ul>
  8. 8. MUSCULOSKELETAL DISORDERS <ul><li>Scoliosis </li></ul><ul><li>Lateral curvature of the spine </li></ul><ul><li>Most common form is idiopathic seen (predominately) in adolescent females; unknown etiology </li></ul><ul><li>Acquired scoliosis associated with deformity resulting from other neuromuscular disorders </li></ul><ul><li>Diagnosis </li></ul><ul><li>1) Classic signs: truneal asymmetry; especially noted in hips and shoulders, posture </li></ul><ul><li>2) Screening exam in school: child flexes at waist; one scapula more prominent </li></ul><ul><li>3) Spinal x-ray </li></ul>
  9. 9. <ul><li>e. Treatment </li></ul><ul><li>1) Mild scoliosis (20˚ curvature): observation, encourage physical exercise </li></ul><ul><li>2) Moderate scoliosis (20˚-40˚curvature): Milwaukee brace (pelvis to neck), Boston brace (body jacket/TLSO brace) </li></ul><ul><li>a) Goal is to prevent worsening of curve </li></ul><ul><li>b) NURSING INTERVENTIONS </li></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>Body image disturbance: Boston brace better accepted (can be completely hidden under clothing) </li></ul></ul>
  10. 10. <ul><li>3) Severe scoliosis (40˚ curvature): surgery </li></ul><ul><li>a) Spinal fusion with instrumentation </li></ul><ul><li>b) Requires prolonged immobilization in cast, brace or body jacket </li></ul><ul><li>c) NURSING INTERVENTIONS </li></ul><ul><li>(1) High risk for injury related to spinal manipulation: log roll first 24 hours; neurovascular checks; advance activity as ordered; observe for paralytic ileus </li></ul><ul><li>(2) Pain: adolescent good candidate for PCA pump </li></ul>
  11. 11. ONCOLOGY DISORDER <ul><li>A. Leukemia </li></ul><ul><li>Most common childhood cancer </li></ul><ul><li>Peak incidence: 3-5 years of age </li></ul><ul><li>Etiology: unknown, may be related to environmental exposures (example:radiation) </li></ul><ul><li>Characterized by proliferation of abnormal white blood cells </li></ul>
  12. 12. <ul><li>Clinical Manifestation </li></ul><ul><ul><ul><ul><li>Fever and infection from decreased (normal) WBCs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Anemia, pallor and fatigue from decreased RBCs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Petechiae and epistaxis from decreased platelets </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Limb and joint pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lymphadenopathy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Central Nervous System (CNS) involvement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hepatosplenomegaly/bleeding tendencies </li></ul></ul></ul></ul>
  13. 13. <ul><li>Treatments: </li></ul><ul><ul><li>Terminology </li></ul></ul><ul><ul><ul><li>Induction, remission </li></ul></ul></ul><ul><ul><ul><li>CNS prophylaxis, consolidation </li></ul></ul></ul><ul><ul><ul><li>Maintenance </li></ul></ul></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><ul><li>Purine antagonists: 6-mercaptopurine (Purinethol) (may affect kidneys) </li></ul></ul></ul><ul><ul><ul><li>Alkylating agents: cyclophosphamide (Cytoxan) (causes chemical cystitis) </li></ul></ul></ul><ul><ul><ul><li>Folic acid antagonists: methotrexate (Folex) </li></ul></ul></ul><ul><ul><ul><li>Plan alkaloid: vincristine sulfate (Oncovine) (neuro toxic) </li></ul></ul></ul><ul><ul><ul><li>Steroids: prednisone (Prelone) </li></ul></ul></ul><ul><ul><ul><li>Enzymes: L-asparaginase (Elspar) </li></ul></ul></ul>
  14. 14. NEPHROBLASTOMA (Wilms Tumor) <ul><li>Most frequent type of renal cancer </li></ul><ul><li>Peak age is 3 years </li></ul><ul><li>Most common clinical sign: swelling, mass within the abdomen, </li></ul><ul><li>May also see: anemia, hypertension, hematuria </li></ul><ul><li>Clinical Manifestations </li></ul><ul><ul><ul><li>Arises from embryonal tissue </li></ul></ul></ul><ul><ul><ul><li>Encapsulated (do not biopsy, will “seed” tumor further) </li></ul></ul></ul>
  15. 15. <ul><li>Diagnosis </li></ul><ul><li>Intravenous pyelogram </li></ul><ul><li>Computerized tomography </li></ul><ul><li>Bone marrow to rule out metastasis </li></ul><ul><li>Treatment </li></ul><ul><li>Nephrectomy and adrenalectomy </li></ul><ul><li>Radiation and chemotherapy determined by staging </li></ul>
  16. 16. <ul><li>Nursing Management </li></ul><ul><li>Preoperative care </li></ul><ul><ul><li>Treatment begun quickly; support parents and keep explanations simple </li></ul></ul><ul><ul><li>Monitor blood pressure due to excess rennin production </li></ul></ul><ul><ul><li>Prevent rupture of encapsulated tumor </li></ul></ul><ul><ul><ul><li>post sign on bed: “DO NOT PALPATE ABDOMEN” </li></ul></ul></ul><ul><ul><ul><li>Bathe and handle gently </li></ul></ul></ul>
  17. 17. <ul><li>Postoperative care </li></ul><ul><ul><li>problems related to radiation, chemotherapy </li></ul></ul><ul><ul><li>large surgical incision </li></ul></ul><ul><ul><ul><li>Pain management </li></ul></ul></ul><ul><ul><ul><li>Gentle handling </li></ul></ul></ul><ul><ul><ul><li>Prepare parents </li></ul></ul></ul><ul><ul><li>Protect remaining kidney </li></ul></ul><ul><ul><ul><li>Monitor blood pressure </li></ul></ul></ul><ul><ul><ul><li>Dipstick urine for proteine or blood </li></ul></ul></ul>
  18. 18. NEUROBLASTOMA <ul><li>Most frequent seen below 2 years of age </li></ul><ul><li>Frequently called “silent” tumor because by the time of diagnosis, metastasis has occurred </li></ul><ul><li>Clinical signs include: abdominal mass, urinary retention and frequency, lymphadenopathy, generalized weakness, malaise </li></ul><ul><li>Primary site is abdomen, most often in flank area </li></ul>
  19. 19. <ul><li>Diagnosis </li></ul><ul><li>Computerized tomography </li></ul><ul><li>Bone marrow to determine metastasis </li></ul><ul><li>Excessive catecholamine production </li></ul><ul><li>Treatment </li></ul><ul><li>Surgery to remove as much of the tunor as possible, determine staging </li></ul><ul><li>Chemotherapy and radiation determined by staging of tumor </li></ul>
  20. 20. HODKIN’S LYMPHOMA <ul><li>Primarily affects adolescents and young adults </li></ul><ul><li>Clinical signs include: painless enlargement of lymph nodes (cervical most common), metastasis related manifestations (persistent cough, abdominal pain), systemic problems (pruritus, night sweats, fever) </li></ul><ul><li>Clinical Manifestations </li></ul><ul><li>Malignancy originates in lymphoid system </li></ul><ul><li>Metastasis may include spleen, liver, bone marrow, lungs </li></ul>
  21. 21. <ul><li>Diagnosis </li></ul><ul><li>Computerized axial tomography </li></ul><ul><li>Lymph node biopsy, exploratory laparotomy (to stage) </li></ul><ul><li>Treatment </li></ul><ul><li>Radiation and chemotherapy determined by clinical staging </li></ul><ul><li>Surgical laparatomy </li></ul><ul><li>Splenectomy </li></ul>
  22. 22. 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
  23. 23. 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
  24. 24. <ul><li>Bed rest if hypertensive </li></ul><ul><li>Restrict fluid </li></ul><ul><li>Monitor BP </li></ul><ul><li>Provide low potassium diet, no added salt </li></ul><ul><li>Prevent infection </li></ul><ul><li>Control edema </li></ul><ul><li>Provide skin care </li></ul><ul><li>Prevent infection </li></ul><ul><li>Monitor nutrition: low Na, high CHON, high potassium </li></ul><ul><li>Monitor urine for proteinuria </li></ul>Nursing interventions <ul><li>Antibiotics for strep infection </li></ul><ul><li>Antihypertensives and diuretics </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Prednisone </li></ul><ul><li>Furosemide </li></ul><ul><li>Salt-poor albumin </li></ul>Treatments