ࡱ> pro%` 5)bjbj"x"x 4`@@5!D%D%D%D% P%Fh(&(&(&(&(&'''TFVFVFVFVFVFVF$=HhJzFR(''R(R(zF(&(&F***R((&(&TF*R(TF**A8C(&& 0ܤoID%@)4BxCF0FJBAKV)6AK,8CAK8C@'03'"*U'q''''zFzF* '''FR(R(R(R(| `| ` Chapter 19 Evaluation and Care of the Pediatric Patient Common Pediatric Diseases and Disorders There are many diseases and disorders seen in a pediatric practice. The following table lists some of the more common ones along with their symptoms and usual treatment. DiseaseDescriptionSigns and SymptomsUsual TreatmentAsthmaLung disease in which the airways become inflamed and obstructed as a response to various stimuli, including allergensAirway obstruction, wheezing, coughing, inability to speak, fatigue and cyanosis, which may result in severe distressBronchodilators Beta agonists Corticosteroids Theophylline Diaper dermatitisA rash anywhere in the groin region or gluteal folds of the buttocks which may become infected with bacteria or yeastPatches of reddened skin that may contain fluid and pustulesFrequent diaper changes Application of protective barrier ointmentsEczemaSkin inflammation resulting from allergies and irritatantsVesicles, redness, oozing, crusting, scaling and itchingRemoval of offending agent, astringents, antihistamines, corticosteroidsGastroenteritisA syndrome of vomiting and diarrhea that may cause dehydration and electrolyte imbalanceDiarrhea, vomiting, dehydration, lethargy, anorexia, weight loss, fever and decreased urinationGive fluids Antibiotics if caused by a bacterial infectionImpetigoSuperficial skin infection characterized by vesicles and pustulesLesions on the skin, exudate, crusting, and itchingSystemic and topical antibioticsOtitis mediaBacterial or viral infection of the middle earSevere earache, fever, nausea and vomiting, and diarrheaAntibiotic therapyPinworms (Enterobius vermicularis)Small worms that infest the large intestineIrritation of the anal region, allergic skin reaction, intense itching, and secondary infectionOral medication for the entire family, thorough cleansing of the house, bedding, and sleepware, topical medication for irritation ScabiesContagious skin infestation caused by the itch miteSevere itchy rash characterized by fine wavy dark lines. Lesions may occur between the fingers, at the wrist or elbow, in the axilla, and on the trunk or extremities5% permethrin creamStrep throatSevere throat infection caused by the Streptococcus genus of bacteriaRed, sore throat, pustules, and high feverAntibioticsUrinary tract infectionAn infection of the kidneys, ureters, or bladder caused by microorganismsPainful and frequent urination, foul-smelling urine, and hematuriaAntibiotics Other Pediatric Conditions In todays society, we hear a lot about issues that can have a profound effect on the pediatric patients learning abilities and social interactions. Conditions such as ADHD, autism, Downs syndrome, cerebral palsy and childhood obesity are more prevalent now and need to be dealt with in a professional but helpful manner. Attention-Deficit Hyperactivity Disorder (ADHD) Although first described in 1845, this condition appears to be on the increase in current years. It may first be apparent in preschool, while others cases are diagnosed in late adolescence and even adulthood. The most classic symptoms of ADHD are: Being overly impulsive Unable to maintain attention during important tasks Hyperactivity Usually the child is viewed as one who is disruptive and highly active. Another child with ADHD might be a day dreamer. Poor concentration is a term often used to describe the patient. This condition is difficult to diagnose as these symptoms may also be an indication of other physical or emotional problems. If diagnosed, the patient can be treated with medication and support by the health care team. Autism Autism is a brain disorder that hinders a persons ability to communicate or relate to others. It is thought to be a genetic disorder, as it often runs in families. This disorder can also affect how a child understands and processes information that is sensory in nature. Autism is usually diagnosed by the time a child reaches the age of three; however, some cases are not diagnosed until later. Typically parents are the first to notice the signs and seek the advice of their pediatrician. There are diagnostic guidelines that have been established by the American Academy of Child and Adolescent Psychiatry (AACAP) which the clinician will use to determine if the child has the core symptoms of autism. Signs and symptoms may include: Toddlers who do not begin to talk or do not interact like other children do Little or no eye contact with others Plays alone Delayed language development Repetitive patterns of behavior such as, rocking, keeping to a certain routine or ritual, and resistance to any change There is no mold that all persons with autism fit into. Some need help with the simplest aspects of daily living, while others are able to function at a level high enough that permits them to attend school in a regular class and participate in sports and other activities. Treatment methods include: behavioral, speech, and occupational therapy, parent education, and sometimes medications. Since each child with autism is different, treatment methods are usually individualized. Collectively, most children with autism need to be in a structured and specialized educational program in order to achieve their highest potential. Down Syndrome Down syndrome is a common birth defect that occurs in approximately one in every 800 to 1,000 newborns. This syndrome includes mild to moderate mental retardation and other health problems such as cardiac valvular disease, along with specific physical characteristics which include a sloping forehead, low-set ears, and short, broad hands. The most common form of Down syndrome, trisomy 21, is caused by the presence of an extra 21st chromosome. The cause of the occurrence of this extra chromosome is unknown but appears to be related to the age of the mother and usually occurs in women over the age of 40. Cerebral Palsy Cerebral palsy is a term that is used to describe a range of disorders that impairs control of movement due to damage to the brain during its developmental stage. It is one of the most common causes of disability in children. While CP is not a progressive disease, symptoms may get better for a time only to worsen later on. The exact cause of CP is unknown but is thought to be related to the oxygen levels in the brain before, during, and after birth, infections, and injuries occurring during the birth process. Children with CP not only have physical disabilities, but may also have some level of retardation, learning disabilities, and vision, speech, hearing, and language problems. Patient Tutor Parents, especially first-time parents, and caregivers may need to be provided with educational information on infant and child safety issues, including car seats, cribs, animals/pets, etc. Brochures and pamphlets are useful tools along with information about community resources available to assist the parent with these issues. Pediatric Disorders Related to Abnormal Vital Signs and Measurements The following table identifies some possible medical conditions related to abnormal measurements. The medical assistant should be familiar with pathology related to pediatric patients. Familiarity with common diseases and disorders helps to increase communication opportunities with patients and family members, thus enabling better patient education and patient compliance. Abnormal Vital SignPossible Pediatric PathologyLow Weight (less than 5th percentile)GI disease, neurological disorder, environmental influences, failure to thriveLow Height, Short StatureEndocrine disorder, growth hormone deficiency, Inflammatory bowel disease, renal disease, celiac disease (disorder of the immune system that damages lining of the small intestine if foods are consumed that contain gluten)Small Head CircumferencePremature suture closure, chromosomal abnormalities, infection, maternal metabolic disorderLarge Head CircumferenceHydrocephalus, subdural hematoma, brain tumor, benign brain growthElevated Blood PressureRenal artery disease, coarctation (stricture) of the aorta, primary hypertension, drugsHigh Pulse Rate (Tachycardia)Supraventricular tachycardia Low Pulse Rate (Bradycardia)Hypoxia, intracranial disorders, heart block, drug ingestion, anorexiaRapid, Shallow RespirationsCardiac disease, metabolic acidosis, bronchiolitis, pneumoniaFeverInfections, anxiety, dressing the infant too warmly 8 B s u ~  C D H I rs=>mnRSfg /0 ! !'"X#Y###%G%4)5)ӽ h{~hnDh{~h_ut5 h{~h{~ h{~h_ut h{~h,h06 *h{~h06h{~h065 h{~h06h{~?8`   2 B $x$Ifa$gd{~xgd{~xgd{~xgd{~5)B C J + x$Ifgd{~kd$$Ifl\xI$]    t(̙̙̙̙0644 lap(̙̙̙̙yt{~  ( 8 H V f s t x$Ifgd{~ & Fx$Ifgd{~ t u : R ~ [PPAAA & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~~  C [PPAA & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~C D T  H [PPAAA & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~H I R [PPAA & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~ &_r[PPAA & Fx$Ifgd{~ x$Ifgd{~kd6$$Ifl\xI$]   t0644 layt{~rs|"[PPPAAP & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~[PPAAA & Fx$Ifgd{~ x$Ifgd{~kdX$$Ifl\xI$]   t0644 layt{~([PPAA & Fx$Ifgd{~ x$Ifgd{~kd$$Ifl\xI$]   t0644 layt{~()A[PPAA & Fx$Ifgd{~ x$Ifgd{~kdz$$Ifl\xI$]   t0644 layt{~=>nf[TTOTJJTgd{~gd{~xgd{~kd $$Ifl\xI$]   t0644 layt{~f}UV]m@QRf/=>M!! & Fxgd{~gd{~xgd{~ & Fxgd{~! 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