PNP roles and interventions with children with special needs and their families.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.     

Gastroschisis with extracorporeal liver and stomach associated with sacrococcygeal teratoma and limb abnormalities

Gastroschisis is the herniation of abdominal viscera through a paramedian abdominal wall fusion defect without involvement of the umbilical cord. Evisceration usually contains intestinal loops and has no surrounding membrane. Rarely, herniation of other major viscera such as stomach and liver occurs, which makes the prognosis worse. Gastroschisis is usually not associated with sacrococcygeal teratoma. In the present report, a very rare case of gastroschisis associated with sacrococcygeal teratoma is described. The gastroschisis had complete evisceration of the stomach, bowel and extracorporeal liver. A large sacrococcygeal mass was located on the posteroinferior part of the trunk and gluteal region, and was completely external. The fetus also showed a malrotated lower limb and talipes equinovarus.     

Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess

Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case–control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n?=?21) and group B was classified as non-KD (n?=?18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p?=?0.0170) and neck pain (17 patients vs. 12 patients; p?=?0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p?<?0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p?<?0.0003). Conclusion: Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.     

Infants with myocarditis presenting with severe respiratory distress and shock

The characteristics of four infants with myocarditis who presented to the emergency department with acute onset of severe respiratory distress and shock are presented. Although history and physical findings were not supportive of hypovolemic shock or bronchospasm, three of the four infants received an intravenous fluid bolus, and two were given bronchodilator therapy. All patients had metabolic acidosis, and three had cardiomegaly on chest x-ray. Two patients survived. Initial recognition and stabilization of the pediatric patient with cardiogenic shock secondary to myocarditis is reviewed.     

视物不清伴发热和昏迷

1 病历摘要 患儿,女,9岁,以"发作性视物不清,间断发热、昏迷18?d"为主诉入院.18?d前患儿无明显诱因出现一过性双眼视物模糊,夜间自觉眼球疼痛,晨起后又间断有黑朦发作,之后逐渐出现烦躁不安、肢体无力,于傍晚时分患儿突发抽搐,表现为意识丧失,头后仰,右侧肢体屈曲,持续时间不详.抽后呕吐1次,呈喷射性,为胃内容物,随即进入昏迷状态.昏迷后患儿呈现姿势异常,表现为双眼直视,双上肢屈曲,双下肢伸直.     

咳嗽气促伴面色苍白

1 病历摘要 患儿,女,81 d,因"咳嗽1周,气促伴面色苍白1 d"至急诊室就诊.1周前与感冒的父亲接触后开始出现流涕、咳嗽,入院前1 d发现患儿咳嗽加重,气促明显,伴低热,来院急诊.患儿面色苍白,查血常规WBC 17.0×109/L,N15.7%,L 66.7%,PLT91×109/L,Hb 58g/L,以"肺炎、贫血待查"收住我院.病程中患儿无呕吐、腹泻、皮疹.