Exam 4 Flashcards

(170 cards)

1
Q

Etiology and Pathophysiology of UTI

A

Mostly caused by E. coli

Urinary stasis can contribute to development

Stasis may be caused by abnormal anatomical structures or abnormal function (e.g. neurogenic bladder)

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2
Q

Clinical Manifestations of UTI

A

Many are asymptomatic and discovered accidentally on routine examination

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3
Q

Bladder Exstrophy

A

Rare congenital defect in which the posterior bladder wall extrudes through the lower abdominal wall

Corrected with surgical reconstruction

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4
Q

Obstructive Uropathy

A

Structural or functional abnormalities of the urinary system that interfere with urine flow and result in urine backflow into the kidneys

Often causes hydronephrosis

Early diagnosis and treatment prevents kidney damage and deterioration of kidney function

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5
Q

Vesicoureteral Reflux

A

Retrograde flow of urine from the bladder into the ureters

Creates a reservoir for bacterial growth

Recurrent infection within 1-2 months

Culture and sensitivity every 2-3 months

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6
Q

Prune Belly Syndrome

A

Congenital defect characterized by failure of the abdominal musculature to develop

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7
Q

Primary Enuresis

A

Child has never had a dry night; attributed to maturational delay and small functional bladder

Not associated with stress or psychiatric cause

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8
Q

Secondary Enuresis

A

Child who has been reliably dry for at least 6 months begins bed-wetting

Associated with stress, infections, and sleep disorders

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9
Q

Milestones in the Development of Bladder Control

A

1.5 years: child passes urine at regular intervals

2 years: child announces when voiding is taking place

2.5 years: child makes known the need to void; can hold urine

3 years: child goes to the bathroom alone; holds urge if preoccupied with play

2.5-3.5 years: child achieves nighttime control

4 years: child shows great interest in going to bathrooms when away from home

5 years: child voids approximately 5-6 times per day; prefers privacy; is able to initiate emptying of bladder at any degree of fullness

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10
Q

Nephrotic Syndrome

A

Alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein

Characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity

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11
Q

Acute Postinfectious Glomerulonephritis

A

Most common inflammation of the glomeruli of the kidneys

Many children are asymptomatic

Onset usually abrupt with flank or midabdominal pain, irritability, malaise, and fever

Treatment focuses on relief of symptoms and supportive therapy

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12
Q

Acute Renal Failure

A

Sudden loss of adequate renal function in which the kidneys are unable to clear metabolic wastes and to regulate extracellular fluid volume, sodium balance, and acid-base homeostasis

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13
Q

Causes of Acute Renal Failure

A

Hemolytic-uremic syndrome, acute glomerulonephritis, sepsis, poisoning, nephrotoxic medications, hypovolemia, obstructive uropathy, and complication of cardiac surgery

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14
Q

Clinical Manifestations and Treatment of Acute Renal Failure

A

Dark urine or gross hematuria, headache, edema, fatigue, crackles, gallop heart rhythm, hypertension, hematuria, lethargy, nausea and vomiting, oliguria

Treatment depends on the underlying cause of the renal failure

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15
Q

Chronic Renal Failure

A

Progressive, irreversible reduction in kidney function

Usually results from developmental abnormalities of the kidney or urinary tract, obstructed urine flow and reflux, hereditary diseases such as polycystic kidney disease, infections such as hemolytic-uremic syndrome, and glomerulonephritis

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16
Q

Clinical Manifestations and Treatment of Chronic Renal Failure

A

Fatigue, malaise, poor appetite, nausea and vomiting, failure to thrive, short stature, oliguria/polyuria, headache, decreased mental alertness/ability to concentrate, chronic anemia, hypertension, edema, fractures with minimal trauma, rickets, valgus deformity

Treatment is dialysis and eventually a kidney replacement

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17
Q

Hemolytic-Uremic Syndrome

A

Most common cause of acute renal failure in young children

Triad of signs includes hemolytic anemia, thrombocytopenia, and acute renal failure

Treatment focuses on the complications of ARF and includes fluid restrictions and a high-calorie, high-carbohydrate diet that is low in protein, sodium, potassium, and phosphorus

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18
Q

Polycystic Kidney Disease

A

Genetic disorder that has autosomal recessive and dominant forms

Liver abnormalities are associated with both forms of the disease

Low-set ears, small jaw, and flattened nose

Treatment is supportive

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19
Q

Cryptorchidism

A

Undescended testes

Congenital defect of the gonads

Surgery may be necessary for correction

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20
Q

Pelvic Inflammatory Disease

A

Serious infection of the upper genital tract caused by the ascending spread of organisms in the cervix and vagina

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21
Q

Clinical Manifestations and Treatment of Pelvic Inflammatory Disease

A

Fever, mild/dull bilateral lower abdominal pain, dysmenorrhea, dysuria, vaginal discharge, prolonged or increased menstrual bleeding

Antibiotics used for treatment

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22
Q

Normal BUN

A

5-18

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23
Q

Normal CRE

A
  1. 2-0.4 in infants

0. 3-0.7 in children

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24
Q

Confusion

A

Disorientation to time, place, or person; loss of clear thinking. Answers to simple questions may be correct, but responses to complex ones may be inaccurate

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25
Delirium
State characterized by disorientation, fear, irritability or agitation, and mental or motor excitement
26
Lethargy
Profound slumber in which speech and movement are limited. The child is aroused with moderate stimulation, but falls asleep easily once stimulation is removed
27
Stupor
Deep sleep or unresponsiveness; the child is aroused only with repeated vigorous stimulation, but returns to the unresponsive state when the stimulus is removed
28
Coma
Unconsciousness; cannot be aroused even by painful stimuli Caused by pathologic processes (meningitis, trauma, hypoxia, poisoning, seizures, alcohol/substance abuse, endocrine/metabolic disorders, etc.) that cause increased intracranial pressure
29
Early Signs of Increased Intracranial Pressure
Headache, visual disturbances, diplopia, nausea/vomiting, dizziness/vertigo, slight change in vital signs, pupils not as equal or reactive, sunsetting eyes, slight change in level of consciousness
30
Late Signs of Increased Intracranial Pressure
Significant decrease in level of consciousness, seizures, fixed and dilated pupils, papilledema Cushing Triad (increased systolic blood pressure and widened pulse pressure, bradycardia, irregular respirations)
31
Focal/Partial Seizures
Caused by abnormal electrical activity in one brain hemisphere or a specific area of the cerebral cortex
32
Generalized Seizures
Result of diffuse electrical activity that begins in both brain hemispheres simultaneously
33
Febrile Seizures
Occur in susceptible infants and children in connection with a rise in temperature to 102.2
34
Bacterial Meningitis
Secondary to other infections such as otitis media, sinusitis, pharyngitis, cellulitis, pneumonia, or septic arthritis; brain trauma; or a neurosurgical procedure Brain becomes inflamed and edematous, leading to cerebral edema
35
Clinical Manifestations of Bacterial Meningitis
Febrile, altered consciousness, vomiting, complaints of muscle/joint pain, headache, photophobia, esotropia, nuchal rigidity
36
Viral Meningitis
Inflammatory response of the meninges characterized by an increased number of blood cells and protein in the CSF
37
Clinical Manifestations of Viral Meningitis
Abrupt onset of fever, headache, photophobia, stiff neck, back pain, myalgia, irritability, lethargy
38
Encephalitis
Acute inflammation of the brain often caused by an arbovirus that is transmitted by a mosquito
39
Clinical Manifestations of Encephalitis
Fever, irritability, severe headache, bulging fontanelle, altered mental status Flaccid or spastic paralysis At risk for seizures, respiratory failure, and increased ICP and receives supportive treatment in the ICU
40
Reye Syndrome
Acute encephalopathy caused by drug toxic to the liver or other toxin, metal, or metabolite and results in a poorly functioning organ
41
Guillain-Barre Syndrome
Acute inflammatory peripheral neuropathy with an acute onset of rapidly developing symmetric motor weakness that progresses in an ascending pattern Postinfectious disorder that affects motor, sensory, and autonomic neurons
42
Clinical Manifestations of Reye Syndrome
Cerebral edema, hypoglycemia, and an enlarged liver
43
Clinical Manifestations of Guillain-Barre Syndrome
Hypotonia, respiratory distress, irritability, feeding difficulties in infants, pain, numbness, paresthesia
44
Migraine Headaches
May be triggered by stress; foods containing nitrates, glutamate, caffeine, tyramine, and salt; menses; fatigue; and hunger
45
Tension Headaches
Associated with stress related to school, anxiety, demanding schedules, fasting, and inadequate sleep
46
Medication Overuse/Rebound Headaches
Associated with the frequent use of medications for headaches
47
Microcephaly
Small brain with a head circumference below the third percentile on growth curves May be caused by genetic disorder or destructive insult during infancy such as an infection, metabolic disorder, or hypoxia-ischemia Intellectual disability is common
48
Hydrocephalus
Body’s response to an imbalance between the volume of CSF produced and absorbed May be congenital or acquired as a result of intraventricular hemorrhage, meningitis, traumatic brain injury, or brain tumor
49
Clinical Manifestations of Hydrocephalus
Increased head circumference, irritability, vomiting, poor appetite, disordered sleep, fever
50
Anencephaly
No development of the brain above the brainstem, which is ultimately fatal
51
Encephalocoele
Protrusion of meningeal tissue or meninges-covered brain through a defect in the skull
52
Spina Bifida Occulta
A vertebral defect in which the posterior vertebral arches fail to fuse, but the spinal cord and meninges are contained in the vertebral canal
53
Spina Bifida Cystica
A posterior vertebral arch defect with protrusion of meninges through the bony spine
54
Meningocoele
Protrusion of a meningeal sac filled with CSF through a vertebral defect, associated with no abnormalities of the spinal cord
55
Myelodysplasia
Protrusion of a meningeal sac that contains CSF, a portion of the spinal cord, and nerves through a vertebral defect
56
Etiology of Myelodysplasia/Spina Bifida
Chemicals, medications, genetic factors, and maternal health conditions
57
Clinical Manifestations of Myelodysplasia
Thoracic Level: paralysis of the legs, weakness and sensory loss in the trunk and lower body region Lumbar 1-2 Level: some hip flexion and adduction, cannot extend knees Lumbar 3 Level: can flex hips and extend the knees; paralyzed ankles and toes Lumbar 4-5 Level: can flex hips and extend the knees; weak or absent ankle extension, toe flexion, and hip extension Sacral Level: mild weakness in the ankles and toes Bowel and bladder incontinence occurs with all except sacral Mobility problems, intellectual disability, and visual impairment
58
Craniosynostosis
Premature closure of cranial sutures in utero or during the first 18 months of life
59
Positional Plagiocephaly
An asymmetric flattening of the skull, associated with sleep position to prevent SIDS
60
Neonatal Abstinence Syndrome
Caused by opioids, CNS stimulants, CNS depressants, antidepressants, and benzodiazepines Initial signs include irritability, jitteriness, tremors, excessive crying Other signs include yawning, diarrhea, vomiting, seizures, inconsolable high-pitched crying, difficulty sleeping, hypertonia, and ANS signs
61
Neurofibromatosis
Autosomal dominant genetic disorder in which tumors grow along nerves Characterized by six or more cafe au lait spots Pain, vision deficits, precocious puberty, delayed puberty, thinning/bowing of the tibia, fractures that do not heal properly, and scoliosis are all possible signs
62
Cerebral Palsy
Common syndrome of movement and posture development disorders caused by a nonprogressive lesion abnormality in the fetal or infant brain that results in activity limitations Associated hearing, vision, communication, perceptual, cognitive, and behavioral problems
63
Etiology of Cerebral Palsy
Risk factors include low birth weight, placental abnormalities, birth defects, meconium aspiration, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycemia and neonatal infections
64
Clinical Manifestations of Cerebral Palsy
Diplegia: both legs are affected Hemiplegia: only one side of the body is involved, the arm is usually more severely affected than the leg Quadriplegia: all four extremities are affected Motor impairment, spasticity, delayed developmental milestones
65
Metatarsus Adductus
Most common congenital foot deformity characterized by an inward turning of the forefoot at the tarsometatarsal joints Treatment depends on the degree of foot flexibility Braces, casting, orthopedic shoes
66
Clubfoot
Congenital abnormality in which the foot is twisted out of its normal position Exact cause is unknown, however some believe neuromuscular or vascular problems Midfoot is directed downward (equinus), the hindfoot turns inward (varus) and the forefoot curls toward the heel (adduction) Foot is small with a shortened Achilles tendon; muscles in the lower leg are atrophied, but leg lengths are generally normal Early treatment is essential
67
Genu Varum
Bowlegs; deformity in which the knees are widely separated while the ankles are close together and the lower legs are turned inward (varus) Braces, osteotomies, casting
68
Developmental Dysplasia of the Hip
Refers to a variety of conditions in which the femoral head and the acetabulum are improperly aligned Conditions include dislocation, hip instability, subluxation, and acetabular dysplasia Genetic factors appear to play a role Common signs and symptoms include limited abduction of the affected hip, asymmetry of the gluteal and thigh skinfolds, and telescoping or pistoning of the thigh 60-80% of hip abnormalities resolve by 2 months of age Pavlik harness, casting
69
Legg-Calve-Perthes Disease
Self-limiting condition in which there is avascular necrosis of the femoral head Results from an interruption of the blood supply to the femoral epiphysis Early symptoms include a mild pain in the hip or anterior thigh and a limp Later symptoms include limited range of motion and weakness and muscle wasting Surgery, braces
70
Slipped Capital Femoral Epiphysis
Occurs when the femoral head is displaced from the femoral neck Seen often in adolescents following a growth spurt Predisposing factors include obesity, a recent growth spurt, and endocrine disorders Symptoms include a limp knee; thigh, hip, or groin pain; and loss of hip motion
71
Scoliosis
Lateral S- or C-shaped curvature of the spine that is often associated with a rotational deformity of the spine and ribs May be congenital, idiopathic, or acquired Classic signs include truncal asymmetry, uneven shoulder and hip height, a one-sided rib hump, and a prominent scapula Does not usually cause pain or discomfort
72
Torticollis
Tilt of the head caused by rotation of the cervical spine Generally an injury sustained to the sternocleidomastoid muscle at the time of birth or to a cervical spine abnormality Stretching exercises or surgical lengthening of the sternocleidomastoid are usual treatments
73
Osteoporosis
A condition in which there is decreased density and mass of bone, promotes the risk of fractures and is commonly associated with aging Preceded by osteopenia or low bone mass, which is between 1.0 and 2.5 standard deviations below the norm
74
Osteomyelitis
Infection of the bone, most often of the long bones of the lower extremity May be acute or chronic and may spread into surrounding tissues Caused by a microorganism, often from URIs, trauma to bone, and surgery Symptoms include pain and tenderness with swelling, decreased mobility of the affected joint, and fever
75
Skeletal Tuberculosis
A rare microbacterial infection that can be very destructive; spine is the most frequent site of infection Clinical Manifestations: depending on the site, pain, limp, severe muscle spasms, kyphosis, muscle atrophy, “doughy” swelling of the joints, decreased joint motion, changes in reflexes, low-grade fever Diagnostic Tests: TB skin test, CBC, synovial fluid analysis, radiographs Clinical Therapy: antibiotic therapy
76
Septic Arthritis
A joint infection of the synovial space; most common site is the knee, followed by the hip, ankle, and elbow Clinical Manifestations: fever, pain, local inflammation, joint tenderness, swelling, loss of spontaneous movement Diagnostic Tests: CBC with differential, ESR, blood cultures Clinical Therapy: joint aspiration, open drainage and irrigation, followed by antibiotic therapy
77
Achondroplasia
Dwarfism is a genetic condition usually resulting in an adult height of 58 inches or less
78
Marfan Syndrome
Most common problems are mitral valve prolapse, aortic regurgitation, abnormal aortic root dimensions, pectus excavatum, long arms and digits, scoliosis, elongated head, high arched palate, lens subluxation, and pneumothorax No treatment for this syndrome
79
Osteogenesis Imperfecta
Brittle bone disease; connective tissue disorder that primarily affects the bones Biochemical defect in the production of collagen Clinical manifestations include multiple and frequent fractures, blue sclerae, thin soft skin, altered joint flexibility, short stature, enlargement of the anterior fontanelle, weak muscles, and brittle bones
80
Pseudohypertrophy
Enlargement of the muscles as a result of their infiltration with fatty tissue
81
Duchenne Muscular Dystrophy
X-linked recessive disorder seen in boys Clinical Manifestations: delayed walking, frequent falls, easily tired when moving, toe walking, hypertrophied calves, waddling gait, lordosis, positive Gowers maneuver, intellectual disability frequently seen Clinical Therapy: supportive care (physical therapy and braces)
82
Becker Muscular Dystrophy
X-linked recessive disorder Clinical Manifestations: similar to Duchenne but more milder and delayed Supportive care
83
Facioscapulohumeral Muscular Dystrophy
Autosomal dominant disorder Clinical Manifestations: face, shoulder girdle, lower limbs affected, unable to raise arms over head, lordosis, cannot close eyes or whistle or smile, facial weakness Physical therapy
84
Emery-Dreifuss Muscular Dystrophy
X-linked recessive disorder Clinical Manifestations: early onset of contractures followed by weakness; achilles tendon elbow and spine affected, cardiac conduction defect may occur Physical therapy, surgery, pacemaker insertion
85
Congenital Muscular Dystrophies
Autosomal recessive group of disorders Clinical Manifestations: muscle weaknesses present at birth; motor development delay; contractures and joint deformities; hypotonia Correction of skeletal deformity (orthosis or surgery), usually nonprogressive
86
Fractures
A break in the bone that occurs when more stress is placed on a bone than a bone can withstand Reduction and immobilization indicated
87
Strain
Stretching or tearing of either a muscle or a tendon, usually from overuse
88
Sprain
Stretching or tearing of a ligament, usually caused by falls, sports injuries, or motor vehicle crashes
89
Skin Traction
Pull is applied to the skin surface, which puts traction directly on the bones and muscles
90
Dunlop Traction (Skeletal or Skin)
Used for fracture of the humerus Arm is suspended horizontally with straps placed on both the upper and lower portions for pull from both sides
91
Bryant Traction
Used specifically for the child under 3 years of age who has developmental dysplasia of the hip or a fractured femur
92
Buck Traction
Used for knee immobilization, to correct contractures or deformities, or for short-term immobilization of a fracture
93
90-90 Traction
Used for fractures of the femur or tibia
94
Skeletal Traction
Pull is applied directly to the bone by pins, wires, tongs, or other apparatus that have been placed surgically
95
Skeletal Cervical Traction
Used for cervical spine injuries to reduce fractures and dislocations
96
Halo Traction
Used to immobilize the head and neck after cervical injury or dislocation
97
Russell Traction
Used for fractures of the femur and lower leg
98
External Fixators
Attached to the extremity by percutaneous transfixing of pins or wires to the bone
99
Spontaneous Reflexes
Pupil dilation, swallowing, gag reflexes, withdrawing from pain, tonic neck reflex, stepping reflex, sucking reflex
100
Elicited Reflexes
DTRs (want them to be 2+), Babinski, rooting reflex, Moro reflex
101
Decorticate Posturing
Flexion
102
Decerebrate Posturing
Extended and outward Indicative of worsening neurological status
103
Eye Assessment
Fixed and dilated pupils are emergent
104
Early Signs of Increased Intracranial Pressure
Challenging to catch early due to vague symptoms Irritability, increased head circumference in infants, not feeling normal, decreased appetite, fatigue, mild confusion, nausea
105
Middle Signs of Increased Intracranial Pressure
Slower to arouse, changing pupil size/reaction time, nausea and vomiting, generalized weakness, seizures, more severe headache, tense or bulging fontanelles, suture separation
106
Later Signs of Increased Intracranial Pressure
Decreasing LOC, decreased motor response on command, decreased sensory response due to pain, pupil size and reactivity worsens, posturing, Cheyne-Stokes respirations, setting-sun eyes, bulging fontanelles
107
Full LOC
Responsive, alert and oriented x3, demonstrating perfectly developmentally appropriate behavior
108
Confusion LOC
Impaired decision-making
109
Disorientation LOC
Disorientation to time/place
110
Lethargy LOC
Drowsy, limited spontaneous movement
111
Obtunded LOC
Aroused only with stimulation
112
Stupor LOC
Responds only to vigorous and repeated stimulation
113
Coma
Unable to arouse
114
Persistent Vegetative State
No brain activity, only reflexive movement
115
Glasgow Coma Scale
``` 15 points total 13-14 is mild impairment 9-12 is moderate impairment Less than or equal to 8 is comatose Less than 3 is persistent vegetative state ```
116
Lab Tests for Neurological Injury
Glucose, CBC, electrolytes, blood culture, evaluate for toxic substances, liver function tests
117
Imaging for Neurological Injury
CT, MRI, PET scan, echoencephalography, ultrasound, nuclear brain scans
118
Lumbar Puncture
Used when meningitis/encephalitis is suspected
119
EEG
Used to diagnose seizure activity, LOC
120
ABCs for Brain Injury
Need to guard against cerebral hypoxia (permanent damage after 4 minutes) Risk of aspiration Minimize invasiveness, maximize oxygenation
121
Safety Considerations with Brain Injury
Positioning: avoid venous neck compression, keep head supported, turn from side to side Avoid activities that increase intracranial pressure (Valsalva, crying/tantrums, stress)
122
Pain Considerations with Brain Injury
Look for behavior changes Analgesics, opioids, anti-seizure medications, sedatives Rest is necessary for the brain to heal
123
Concussion
Transient and reversible by definitiion Instantaneous loss of awareness, often amnesia or confusion May or may not lose consciousness Standard is asymptomatic for 24 hours
124
Post-Concussion Syndrome
Dementia, seizure disorders, chronic headaches, behavior changes
125
Pathophysiology of Spina Bifida
Vertebral defect that allows the spinal cord to protrude Can occur anywhere along the spinal cord--vast majority are lumbar or sacral
126
Risk Factors for Spina Bifida
Chemical exposures in utero, medications (anti-epileptic), diet (lack of folic acid), genetics, gestational diabetes, maternal obesity
127
Clinical Presentation of Spina Bifida
Paralysis, weakness, sensory loss, sac-like protrusion, bowel and bladder incontinence, neurogenic bladder, hydrocephaly if above the sacral region, intellectual deficit, visual impairment, spinal curvature, musculoskeletal/joint pain, skin sores, pressure ulcers, precocious puberty, sexual dysfunction
128
Diagnosis of Spina Bifida
Early fetal ultrasound Maternal alpha-fetoprotein CT, MRI, X-ray
129
Medical Management of Spina Bifida
Fetal corrective surgery if identified before 26 weeks gestation Permanent catheter required with bladder incontinence Laxatives used with chronic constipation Braces and assistive devices to match degree of function patient needs Diet includes lots of calcium and vitamin D, weight-bearing exercise is necessary
130
Spina Bifida Initial Nursing Interventions
Cover the protrusion with moist sterile dressing Prone position with legs flexed and abducted Assess for other congenital deformities Prevent sac from leaking Give small bottle feedings in the prone position Surgical preparation Support parent-child bonding
131
Spina Bifida Post-Operative Nursing Interventions
Prone or side-lying position for healing Assess site routinely for signs/symptoms of infection and/or CSF leakage Pain management Intake and output Daily head circumference Bowel/bladder assessment and motor deficit assessment Gentle ROM Parental support
132
Hemiplegia
Arm and leg on one side Arm bent; hand spastic or floppy, often of little use Walks on tiptoe or outside of foot on affected side Unaffected side is completely or almost normal
133
Paraplegia
Both legs only Upper body usually normal or with very minor signs Child may develop contractures of the ankles and feet
134
Quadriplegia
Both arms and both legs When walking, head arms, and mouth may twist strangely Often have severe brain damage and never are able to walk Knees pressed together Legs and feet are turned inwards
135
Pathophysiology of Cerebral Palsy
Underlying cause is a nonprogressive brain lesion
136
Clinical Presentation of Cerebral Palsy
Activity limitations, abnormal muscle tone and lack of coordination, hemiplegia, diplegia, quadriplegia, some degree of motor impairment and muscle spasticity, muscle weakness, delayed development, delayed speech and language, seizures, feeding difficulties related to decrease in oral muscle tone
137
Diagnosis of Cerebral Palsy
Assessment and symptoms CT, MRI Genetic/metabolic testing Functional Mobility Scale in newborns and infants
138
Medical Management of Cerebral Palsy
Aimed at developing maximal independence and ability to perform ADLs Braces, splints, serial casting, positional devices, therapeutic medications Special Education services Orthopedic surgery--tendon lengthening, muscle release
139
Cerebral Palsy Mobility Nursing Implications
Anything to help maintain proper body alignment Support their head, especially when younger Range of motion to prevent contractures Massage, therapeutic touch, riding therapy Adaptive device referrals, parent teaching
140
Cerebral Palsy Nutrition Nursing Implications
Supplement for a higher calorie diet Avoid aspiration Adaptive utensils G-tube Bowel program may be indicated
141
Congenital Muscular Dystrophy
Present at birth, usually nonprogressive, nonterminal, more rare
142
Duchenne Muscular Dystrophy
Onset is around 3-4 years of age, life expectancy is somewhere around adolescence, most common Wheelchair users by 12 years of age Cardiovascular/respiratory failure is typically cause of death Pseudohypertrophic Responsible gene is absent or deleted
143
Becker Muscular Dystrophy
Appears after age 5, life span is around 30-40 years of age
144
Pathophysiology of Muscular Dystrophy
Inherited disorder Muscle fiber degeneration and muscle wasting Onset can be early or later in life
145
Clinical Manifestations of Muscular Dystrophy
Generalized muscle weakness Gower’s Sign: using hands to push on legs to stand
146
Diagnosis of Muscular Dystrophy
Confirmed by muscle biopsy Initially by clinical signs and pattern of muscle
147
Medical Management of Muscular Dystrophy
No effective treatment Steroids can preserve muscle treatment and walking for a longer amount of time Rehabilitation/physical therapy Mental/emotional support Dietary enhancement Massage Aggressive treatment of respiratory infections
148
Growth Hormone Deficiency
Inhibits somatic growth throughout the body Proportional decrease in growth, no dwarfism Growth hormone injections given until growth plates close
149
Primary Pituitary Hyperfunction
Increased production of growth hormones before the growth plates close Delayed closure of fontanelles, increasing head circumference are early indicators Vertical growth followed by rapid increase in muscle development Weight proportional to height
150
Acromegaly
Occurs after growth plate closure No increase in vertical growth; increased size of head, nose, tongue, jaw, lips, malocclusion of teeth, thick creased skin
151
Treatment of Acromegaly
Hormone replacement therapy Tumor removal/radiation
152
Precocious Puberty
Sexual development before the age of 9 in boys and before the age of 7 in Caucasian girls and 6 in African American girls Treated by Leuprolide until normal onset of puberty
153
Diabetes Insipidus
Undersecretion of ADH leads to uncontrolled diuresis, polyuria, polydipsia Biggest risk is dehydration Treatment is Vasopressin
154
SIADH
Hypersecretion of ADH leads to inability to void or lacking the urge to void Concern is fluid overload Fluid retention, hypotonicity of muscles, anorexia, nausea, vomiting, irritability, behavioral changes ADH antagonists used to treat
155
Hyperparathyroidism
Hypercalcemia occurs Rare in children
156
Cushing's Syndrome
Excessive circulating free cortisol Side effect of prolonged steroid treatment Moon face, red cheeks, weight gain, pendulous abdomen, red striae, ecchymosis, hyperglycemia
157
Diagnostics for Type I Diabetes
Fasting blood glucose under 126 is normal HbA1C Urine ketone testing
158
REEDAR
``` Redness Edema Ecchymosis Drainage Approximation Raised ```
159
Acne
Multifactorial (hygiene, genetics) Use a mild moisturizing soap, products with salicylic acid or benzoil peroxide
160
Penicillin Allergy
Extremely urticaric Appears on day 3-5 of treatment Stop the medication
161
Eczema
Atopic dermatitis Inflamed, irritated, overly dry skin Treatment is hydration and moisturize with lipid-soluble creams and lotions Lichenification common
162
Candida Albicans
Yeast infection Centralized area of erythema surrounded by satellite lesions Antifungal medications required (nystatin, diflucan)
163
Fifths Disease
"Slapped cheek" appearance Caused by human parvovirus B19 Facial erythema with maculopapular rash that moves proximodistal Contagious--emergent in kids with sickle cell disease Symptomatic support
164
Hand Foot and Mouth Disease
Coxsackie virus Presents as 5-10 mucocutaneous lesions that are very painful and hundreds of cutaneous lesions that are painless
165
Warts
Human papillomavirus is responsible Treat with chemicals, laser treatments, cryotherapy, surgery Prevention using HPV vaccine
166
Moloscum Contagiosum
Viral infection Flesh-colored papules with an umbilicated center Passed skin-to-skin Self-resolving
167
Contact Dermatitis
Not an allergic reaction, just an inflammatory process Need to wash poison off as soon as possible Only be concerned with there is a secondary complication such as periorbital edema
168
Scarlet Fever Rash
Strep rash Will resolve as strep throat resolves
169
Tinea
Fungal infection that is contagious Treatment is over the counter azole medications Need to treat several times a day for at least 2-3 weeks
170
Herpes Simplex Virus
Vesicles that form on the mucocutaneous borders Tingling on the skin before lesion appears Contagious when there are active lesions