Acute Peds Flashcards
large for gestational age
birth weight > 90th percentile
small for gestational age
birth weight < 10th percentile
intrauterine growth restriction (IUGR)
pathological birth weight < 10th percentile
selective fetal growth restriction (sFGR)
< 10th percentile and discordance >25%
low birth weight (LBW)
<2500 grams
very low birth weight (VLBW)
<1500 grams
T or F: babies with IUGR automatically qualify for early intervention
T
gravida 3 para0020. what does this mean?
3 pregnancies
0 babies
0 preemies
2 miscarriages
0 living children
APGAR
appearance (color)
pulse
grimace (reflexes)
activity (tone)
respiration
range of scores for APGAR… is higher or lower better?
1-10
higher is better
gestational age =
last menstrual cycle to birth
chronological age =
birth date to current age
weeks early =
40 weeks - gestational age
corrected age =
chronological age - weeks of prematurity
how long do you account for prematurity
until age 2
T or F: almost every preemie has osteopenia
T
retinopathy of prematurity (ROP)
disruption of normal progression of retinal vascular development in preterm infant
how many stages of ROP
5
at what stage of ROP do you need to start intervention
stage 3 - some get better without treatment but some need intervention
plus disease
- a sign that ROP is getting worse but treatment can prevent retinal detachment
- blood vessels on retina get large and twisted (stage 3 ROP)
stage 4 ROP vs stage 5 ROP
stage 4 = partially detached retina
stage 5 = completely detached retina
**both need treatment
what can ROP cause later in life
nearsightedness
bronchopulmonary dysplasia (BPD)
- stiff lung tissue leads to difficult delivery of oxygen
- usually occurs in alveoli
what can BPD lead to later in life
asthma
decreased immune system
if a baby still needs O2 after ______ weeks they will be diagnosed with BPD
36
SiPap
- similar to Cpap and Bipap
- almost like a ventilator through the nose
helps infant breath for theirself
with babies on SiPap they alternate between a mask and prongs. why?
to prevent skin breakdown
ECMO
extracorporeal membrane oxygenation
*gives heart/lungs a rest
two types of ECMO
venovenous = just for lungs
venoarterial = heart and lungs
can babies stay on venovenous or venoarterial ecmo longer
venovenous
- for venoarterial they don’t like to keep them on it for more than a week
ECMO cannot be used on babies less than ______ weeks. Why?
34
equipment not small enough
how many grades of intraventricular hemorrhage
4
grade 1 intraventricular hemorrhage
hemorrhage in germinal matrix
grade 2 intraventricular hemorrhage
IVH <50% and not distending
grade 3 intraventricular hemorrhage
IVH>50% and distending
grade 4 intraventricular hemorrhage
grade 3 IVH with periventricular hemorrhagic infarction
T or F: all infants have a germinal matric
F: only preemies
T or F: babies with grades 1 and 2 IVH typically do not have long term problems
T
what could babies with grade 3 and 4 IVH develop
hydrocephalus
what do they do for a baby with grade 4 IVH?
MRI
neurosurgery consult
monitor head circumference
periventricular leukomalacia
damage to deep periventricular white matter due to softening of brain tissue
*white matter is patchy like swiss cheese
kids with periventricular leukomalacia often have…
microcephaly
*high risk for CP
indants at highest risk of periventricular leukomalacia are those less than ____ weeks gestational age
32
T or F: preemies have lots of spontaneous movements
F: minimal spontaneous movements
what does prolonged mechanical ventilation put preemies at increased risk for?
- neck hyperextension
- scapular elevation/retraction
- arching of trunk
- ant/post pelvic tilt
name some psychological stress cues for infants
- yawning
- spitting up
- hiccups
- HR
- color change
- RR
- sneezing
name some motor stress cues for infants
- tremor
- startle
- sitting on air?
- splaying
- saluting
T or F: you should document state of arousal every time you see an infant
T
Brazelton Neonatal Behavioral Assessment Scale (NBAS)
state 1 - deep sleep, no movement
state 2 - light sleep, closed eyes, some movement
state 3 - sleepy, eyes opening and closing
state 4 - awake, open eyes, min movement
state 5 - completely awake, strongmovement
stage 6 - cry
what does supine positioning encourage
- midline symmetric flexion
- shoulders protracted
- hands near face or mouth
- hips neutral rotation
- hips/knees flexes
what does sidelying positioning encourage?
- midline symmetry
- tucked chin
- flexion of trunk/hips/knees
what does prone positioning encourage
- flexion/protraction of UE
- neutral head position
- flexion of hips/knees
what position do you want to avoid with infants and why
extension because this uses increased calories
what can you use to assess pain in babies/kids
FLACC scale
FLACC scale
face, legs, activity, cry, consolability
how will a newborn with a brachial plexus injury present
-absent shoulder abduction, ER, elbow flexion, and supination (more mild, recovery 4-6 months)
-flail shoulder, absent elbow flexion, flexed wrist, closed fist (slow recovery, 15 months)
-flail extremity, limited finger movement (poor recovery)
if a newborn with a brachial plexus injury doesn’t have active biceps by 6 months what should you do
refer them to neurosurgery because that is a good indicator they are not goingt o get return without surgery
what is the leading cause of death from disease in children in the US
cancer
what is the most common peds cancer
leukemia
peds cancer is considered birth to age ______
14
what are chemotherapy side effects
- nausea
- neurotoxicity
- pulmonary toxicity
- cardiotoxicity
- muscle weakness
- osteonecrosis
does chemotherapy induced peripheral neuropathy usually start in the lower or upper extremities
lower
what does vincristine do
- disrups microtubules
- degeneration of axion cytoskeleton
- inhibits axonal transport
**increased risk of neuropathy
