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NCM 109 > Finals > Flashcards

Finals Flashcards

1
Q

 It is a proliferation of abnormal WBCs

A

Leukemia

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2
Q

 The most common leukemia in children is

A

acute lymphocytic leukemia (ALL)

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3
Q

is a proliferation of blast cells (immature lymphocytes.

A

Acute Lymphocytic Leukemia

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4
Q

ALL is classified by?

A

Form, Structure and morphology of the blast cells

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5
Q

 Leukemia may be diagnosed at any age but has a peak onset between

A

3 and 5 years of age

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6
Q

environmental factors of leukemia

A

chemicals and radiation

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7
Q

genetic diseases have been associated with increase of leukemia?

A

Down Syndrome, Fanconi anemia and Bloom syndrome.

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8
Q

pathophysiology of leukemia

A

 Malignant leukemia cells arise from precursor cells in blood-forming elements.
 These cells can accumulate and crowd our normal bone marrow elements, spill peripheral blood, and eventually invade all body organs and tissues.
 Replacement of normal hematopoietic elements by leukemic cells results in bone marrow suppression, which is marked by a decreased production of RBCs, normal WBCs, and platelets.
 Bone marrow suppression results in anemia from decreased RBC production, predisposition to infection due to neutropenia, and bleeding tendencies due to thrombocytopenia. These put the child at risk of death from infection or hemorrhage.
 Infiltration of reticuloendothelial organs (spleen, liver, and lymph glands) causes marked enlargement, and eventually, fibrosis.
 Leukemic infiltration of the CNS results in increased intracranial pressure (ICP) and other effects, depending on the specific areas involved.
 Other possible sites of long-term infiltration include the kidneys, testes, prostate, ovaries, GI tract, and lungs.
 The hypermetabolic leukemic cells eventually deprive all body cells of nutrients necessary for survival. Uncontrolled growth of leukemic cells can result in metabolic starvation.

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9
Q

Clinical manifestations of anemia

A

– fatigue, pallor, tachycardia

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10
Q

Clinical manifestation of leukemia

A

a. Anemia – fatigue, pallor, tachycardia
b. Bleeding which includes petechiae, purpura, hematuria, epistaxis, and tarry stools
c. Immunosuppression – fever, infection, poor wound healing
d. Hepatosplenomegaly, bone pain, and lymphadenopathy
e. CNS symptoms (if there is CNS metastasis) – headache, meningeal irritation, and signs of increased ICP.
f. General symptoms: weight loss, anorexia, vomiting

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11
Q

what are the laboratory findings and diagnostic study findings

A

a. CBC may reveal normal, decreased, or increased WBC count with immature cells (blasts), decreased RBCs, and decreased platelets.
b. Bone marrow aspiration confirms the diagnosis by revealing extensive replacement of normal bone marrow elements by leukemic cells.
c. Lumbar puncture assesses abnormal cell migration to the CNS.

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12
Q

Nursing Diagnoses

A
  1. Risk for injury
  2. Risk for infection
  3. Risk for trauma
  4. Risk for fluid volume deficit
  5. Altered nutrition: less than body requirements
  6. Altered oral mucous membranes
  7. Pain
  8. Risk for altered growth
  9. Risk for altered development
  10. Altered family processes
  11. Anticipatory grief
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13
Q
  1. Assist in ensuring partial or complete remission from the disease by administering ?
A

administering chemotherapy and by preventing or minimizing, the complications of chemotherapy, radiation, and bone marrow transplant (BMT).

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14
Q

What are the complication of BMT in the GI tract

A

nausea, vomiting, anorexia, diarrhea, mucositis

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15
Q

What are the complication of BMT in the renal

A

Hypovolemia, hypoproteinemia, dehydration, septic shock

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16
Q

what are the - Interstitial pneumonia and - Graft rejection or failure complications

A

fever, infection, decreased blood count

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17
Q

is a malignant neoplasm of the kidney.

A

 Wilm’s tumor

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18
Q

. It is the most common intraabdominal tumor in children

A

Wilm’s tumor

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19
Q

the most curable solid tumor in children

A

Wilm’s tumor

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20
Q

The median age at diagnosis is between? (wilm’s tumor)

A

2 and 3 years old.

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21
Q

Wilm’s tumor is , it is unilateral and occurs with other abnormalities such as an

A

absent iris or genitourinary problems.

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22
Q

Pathophysiology of wilm’s tumor

A

 The tumor originates from immature renoblast cells located in the renal parenchyma.
 It is well encapsulated in early stages but may later extend into lymph nodes and the renal vein or vena cava and metastasize to the lungs and other sites

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23
Q

Five stages of wilms tumor

A

a. Stage I: tumor is confined in one kidney
b. Stage II: the tumor extends beyond kidney but can be resected
c. Stage III: the tumor has residual nonhematogenous tumor cells confined to the abdomen.
d. Stage IV: The tumor is characterized by distant metastases involving lung, liver. Bone, or brain.
e. Stage V: the tumor involves both kidneys

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24
Q

what is the common sign of wilms tumor

A

 Abdominal mass

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25
Q

Laboratory and diagnostic findings of wilm’s tumor

A

 Ultrasound or CT scan reveals a mass
 Other studies may be performed if metastasis is suspected.

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26
Q

why we do not palpate the abdomen?

A

Do not palpate the abdomen – doing so can rupture the encapsulated tumor and cause dissemination of the disease to adjacent and distant sites.

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27
Q

is a chronic, reversible, obstructive airway disease, characterized by wheezing.

A

Asthma

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28
Q

 It is caused by a spasm of the bronchial tubes, or the swelling of the bronchial mucosa, after exposure to various stimuli

A

Asthma

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29
Q

 It is the most common chronic disease in childhood.

A

ASthma

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30
Q

when Most children experience their first symptoms of asthma?

A

Most children experience their first symptoms by 5 years of age.

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31
Q

is the strongest predisposing factor for the development of asthma.

A

Allergen

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32
Q

Common irritant includes?

A

a. Allergen exposure
- dust mites
- molds
- animal danders
b. Viral infections
c. Irritants which include:
- air pollution
- smoke
- perfumes
- laundry detergents
d. certain foods (food additives)
e. Rapid changes in environmental temperatures
f. Exercise
g. psychological stress

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33
Q

Pathophysiology of asthma

A

the following manner.
a. There is an initial release of inflammatory mediators from bronchial mast cells, epithelial cells, and macrophages, followed by activation of other inflammatory cells.
b. Alterations of autonomic neural control of airway tone and epithelial integrity occur and the increased responsiveness in airway smooth muscle results in clinical manifestations (wheezing and dyspnea).
2. Three events contribute to clinical manifestations.
a. Bronchial spasm
b. Inflammation and edema of the mucosa
c. Production of thick mucus, which results in increased airway resistance, premature closure of airways, hyperinflation, increased work of breathing, and impaired gas exchange.
3. If not treated promptly, status asthmaticus – an acute, severe, prolonged asthma attack that is unresponsive to the usual treatment – may occur, requiring hospitalization.

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34
Q

Clinical manifestation of asthma

A

a. Increased RR
b. Wheezing
c. productive cough
d. Use of accessory muscles in breathing
e. Distant breath sounds
f. fatigue
g. Moist skin
h. Anxiety and apprehension
g. Dyspnea

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35
Q

. Laboratory and Diagnostic study findings.

A

Spirometry will detect:
a. Decreased forced expiratory volume (FEV)
b. Decreased peak expiratory flow rate (PEFR)
c. Diminished forced vital capacity (FVC)
d. Diminished inspiratory capacity (IC)

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36
Q

are characterized by inflammation usually of bacterial origin of the urethra (urethritis), bladder (cystitis), ureters (ureteritis), or kidneys (pyelonephritis).

A

UTI

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37
Q

what is the peak indence of UTI

A

between 2 and 6 years of age

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38
Q

 The recurrence rate in neonates is ______, in older children, it is _____.

A

25% and 30%

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39
Q
  1. In the neonate, the urinary tract may be infected via the
A

Bloodstream

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40
Q

what age? bacteria ascend the urethra, creating an increased incidence in girls

A

Older children

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41
Q

Contributing factors include: UTI

A

a. Urinary stasis
b. Urinary reflux
c. Inadequate fluid intake
d. Poor perineal hygiene
e. Constipation
f. Pregnancy
g. Noncircumcision
h. Indwelling catheter placement
i. Antimicrobial agents that alter normal urinary tract flora
j. Tight clothes or diapers
k. Local inflammation
l. Bubble bath

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42
Q

Pathophyisiology of UTI

A

Pathophysiology
1. In an uncomplicated UTI, inflammation usually is confined to the lower urinary tract. Recurrent cystitis, however, may produce anatomic changes in the ureter that lead to vesicoureteral valve incompetence and resultant urine reflux. This provides organisms with access to the upper urinary tract.
2. Pyelonephritis usually results from an ascending infection from the lower urinary tract. It can lead to acute and chronic inflammatory changes in the pelvis and medulla, with scarring and loss of renal tissue.
3. Recurrent or chronic infection results in increased fibrotic tissue and kidney contraction

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43
Q

Clinical manifestation of infants with UTI

A

Infants may exhibit irritability, constant squirming, fever or hypothermia, jaundice, weight loss, FTT, vomiting and diarrhea, diaper rash, and an abnormal urinary stream.

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44
Q

clinical manifestation of with lower UTIs

A
  • foul-smelling urine, hematuria (possibly), dysuria, increased frequency, increased urgency, incontinence, and abdominal pain are seen with lower UTIs
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45
Q

clinical manifestation of with with pyelonephritis.

A

Fever, costovertebral abdominal (CVA) tenderness, chills, and flank pain are seen with pyelonephritis.

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46
Q

Laboratory and diagnostic study findings of UTI

A

Urinalysis: hematuria, proteinuria, and pyuria. Urine may have a foul odor and appear cloudy with strands of mucus.
b. Urine culture is used to confirm diagnosis through detection of bacteria.
c. Ureteral catheterization, bladder washout procedures, and radioisotope renography may be needed to localize the infection.
d. Renal ultrasound

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47
Q

What findings in Urinalysis

A

hematuria, proteinuria, and pyuria. Urine may have a foul odor and appear cloudy with strands of mucus.

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48
Q

is used to confirm diagnosis through detection of bacteria.

A

Urine culture

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49
Q

Nursing management of UTI

A
  1. Assess urinary status
  2. Administer prescribed antibiotics
  3. Prevent infection
  4. Provide comfort measures
  5. Provide child and family teaching
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50
Q

is a chronic metabolic disorder that results from either a partial or complete deficiency of insulin

A

DM

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51
Q

Is characterized by pancreatic beta cells destruction leading to absolute insulin deficiency

A

Type 1 DM

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52
Q

usually results from insulin resistance

A

Type 2 DM

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53
Q

is the most common endocrine disease of childhood.

A

Type 1 DM

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54
Q

 Long term complications of DM

A

nephropathy, retinopathy, and neuropathy. Altered thyroid functioning is frequently noted in children with diabetes.

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55
Q

is an autoimmune disease that develops when a genetically pre-disposed child is exposed to a precipitating factor, such as a viral infection.

A

Type 1 DM

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56
Q

Pathophysiology of DM

A
  1. Insulin is needed to support carbohydrate, protein, and fat metabolism, primarily to facilitate entry of these substances into cells.
  2. Destruction of 80% to 90% of the pancreatic beta cells results in a clinically significant drop in insulin secretion.
  3. This loss of insulin, the major anabolic hormone, leads to a catabolic state characterized by decreased glucose used, increased glucose production, and inability to store glycogen, eventually resulting in hyperglycemia.
  4. In a state of insulin deficiency, glucagon, epinephrine, GH, and cortisol levels increase, secondary to fat breakdown, stimulating lipolysis, fatty acid release, and ketone production.
  5. A persistent blood glucose concentration above 180 mg/dl results in glycosuria, leading to osmotic diuresis with polyuria and polydipsia.
  6. Excessive ketone production can cause diabetic ketoacidosis (DKA), an acutely life-threatening condition characterized by marked hyperglycemia, metabolic acidosis, dehydration, and altered level of consciousness ranging from lethargy to coma.
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57
Q

Assessment Findings
1. Clinical Manifestations
of DM

A

a. Classic symptoms:
- Polydipsia
- Polyuria
- Polyphagia
- Fatigue
b. Other symptoms:
- Weight loss
- dry skin
- Blurred vision

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58
Q

Signs of DKA

A
  • Hyperglycemia
  • Acidosis
  • Glycosuria
  • Ketonuria
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59
Q

d. Early signs of hypoglycemia

A
  • Trembling/tremors
  • Tachycardia
  • sweating
  • anxiety
  • hunger
  • pallor
  • headache
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60
Q

e. Late signs of hypoglycemia

A
  • Loss of coordination
  • Personality and mood changes
  • Slurred speech
  • Sleepiness
  • Nightmares
  • Decreasing level of consciousness
  • Seizure activity
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61
Q

Laboratory and Diagnostic study findings of DM

A

a. Fasting blood sugar (FBS) will reveal a level above 120 mg/dl accompanied by a random blood glucose level above 200 mg/dl
b. Oral glucose tolerance test (OGTT) will reveal blood glucose levels of 200 mg/dl or higher in a 2-hour sample.

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62
Q

How many hours should we check for urine if patient X have a DM?

A
  • test urine for ketones every 3 hours
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63
Q

what should we Offer a readily absorbed carbohydrate ?

A

Orange juice

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64
Q

is a systemic inflammatory disease that occurs as a result of naturally acquired immunity to group A beta-hemolytic streptococcal infection. There is cardiac involvement in about 50% of cases.

A

Rheumatic fever

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65
Q

 It is the most common cause of acquired heart disease in children worldwide.

A

rHEUMATIC FEVER

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66
Q

what infections occurs in the rheumatic fever?

A

group A beta-hemolytic streptococcal infection.

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67
Q

what age rheumatic fever occurs? and what is the peak age of it?

A

occurs in children between 5 and 15 years of age, with peak incidence at 8 years of age.

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68
Q

what is the onset of rheumatic fever?

A

usually occurs 2-6 weeks after an untreated upper respiratory infection with group A beta-hemolytic streptococci

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69
Q

 It is believed that a genetic susceptibility to RF is associated

A

with a state of immune hyperactivity to the streptococcal antigens

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70
Q

 Exact etiology is unknown

A

rheumatic fever

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71
Q

pathophysiology of RF?

A
  1. The child becomes infected with group A beta-hemolytic streptococcal bacteria.
  2. Antibodies formed against these bacteria begin to attack the connective tissue of the body, producing inflammation, which affects the heart, joints, central nervous system and subcutaneous tissue.
  3. Cardiac involvement is characterized by carditis.
    a. A type of lesion, called an Aschoff body (a proliferating, fibrin-like plaque), forms on the heart valve causing edema and inflammation.
    b. When the healed area becomes fibrous and scarred, the valve leaflets fuse (stenosis), causing inefficiency and leakage.
    c. The mitral and aortic valves are affected most often.
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72
Q

which divides signs and symptoms into major and minor characteristics of the disease, is used when assessing the child with suspected RF.

A

Jones Criteria

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73
Q

Major characteristics of Carditis when have RH?

A

– tachycardia, cardiomegaly, murmur, muffled heart sounds, precordial friction rub, precordial pain, and a prolonged PR interval.

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74
Q

carditis can lead to?

A

Carditis can lead to CHF, pericardial friction rubs, cardiomegaly, and aortic or mitral valve regurgitation

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75
Q

Most serious problems of RF

A

Carditis

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76
Q

Polyarthritis major characteristics?

A

swollen, hot, painful joints (usually large joints).

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77
Q

is the most common presenting symptom and it occurs in about 75% of all cases of RF.

A

Polyarthritis

78
Q

– sudden aimless, irregular movements of the extremities; involuntary facial grimaces; speech disturbances; emotional lability; muscle weakness; and movements that increase with stress and decreased with rest.

A

Chorea

79
Q

– clear-centered, transitory, nonpruritic macules, with defined boarders.

A

Erythema Marginatum

80
Q
  • Erythema marginatum noted mostly on what part of the body?
A

trunk and proximal extremities

81
Q

are non-tender lesions that may persist, then resolve.

A
  • Subcutaneous nodules
82
Q

. These rarely occur in RF.

A

Subcutaneous nodules

83
Q

what body part occurs when having subcutaneous nodules

A

bony prominence

84
Q

Minor characteristics of RH

A

fever, arthralgia, and specific laboratory findings

85
Q

a. Laboratory findings consistent with the Jones Criteria:

A
  • Erythrocyte Sedimentation Rate (ESR) is elevated
  • C-reactive protein (CRP) is elevated
  • Acute-phase reactants
86
Q

may disclose cardiac enlargement what diagnostic laboratory

A

Chest radiography studies

87
Q

may reveal a prolonged PR interval.

A

ECG

88
Q

what are the laboratory finding of RH

A

Jones criteria
CBC
Throat culture
ECG

89
Q

autoimmune inflammatory disorder

A

Juvenile Rheumatoid Arthritis (JRA)

90
Q

 It is one of the more common chronic diseases in children.

A

C. Juvenile Rheumatoid Arthritis (JRA)

91
Q

 The outcome is variable and unpredictable in individual children.

A

Juvenile Rheumatoid Arthritis (JRA)

92
Q

 The cause is unknown, but infectious and genetic origins have been implicated.

A

Juvenile Rheumatoid Arthritis (JRA)

93
Q

Pathophysiology of Juvenile Rheumatoid Arthritis (JRA)

A

 The synovial joints are primarily involved.
 Immune complexes initiate the inflammatory response by activating plasma protein complement.
 Kinin and prostaglandin are released, increasing blood vessel permeability, and attracting leukocytes and lymphocytes to the synovial membrane.
 Neutrophils and macrophages ingest immune complexes, releasing enzymes and damaging joints.
 The synovial becomes inflamed, excessive fluid is produced, and thickened villi and nodules are produced into the joint cavity.

94
Q

Assessment Findings
1. Clinical Manifestations
systemic

A
  • Any joint can be involved
  • Extra-articular manifestations include fever, malaise, myalgia, rash, pleuritis, pericarditis, adenomegaly, and hepatosplenomegaly
95
Q

Assessment Findings
1. Clinical Manifestations
Pauciaticular

A

joint involvement is usually confined to the lower extremities.
- Extra-articular manifestations include iridocyclitis, sacroiliitis, and eventual ankylosing spondylitis

96
Q

is an inflammation of the iris (the colored part of the eye) and of the ciliary body (muscles and tissue involved in focusing the eye). Inflammation of iris alone is called anterior uvetitis or iritis.

A

Iridocyclitis

97
Q

Inflammation of iris alone is called anterior uvetitis or iritis.

A

anterior uvetitis or iritis.

98
Q

is an inflammation of one or both of your sacroiliac joints — situated where your lower spine and pelvis connect.

A

Sacroiliitis

99
Q

Sacroiliitis can cause

A

pain in your buttocks or lower back, and can extend down one or both legs. Prolonged standing or stair climbing can worsen the pain

100
Q

is a rare type of arthritis that causes pain and stiffness in your spine.

A

Ankylosing spondylitis

101
Q

Assessment Findings
1. Clinical Manifestations
Polyarticular

A
  • Any joint can be involved, smaller joints are usually affected.
  • Systemic symptoms are mild and may include low-grade fever, fatigue and slowed growth.
102
Q

Laboratory and Diagnostic Study Finding of systemic

A
  • CBC will reveal leukocytosis and anemia
  • ESR will be elevated
  • CRP will be elevated
  • RF (rheumatoid factor) is negative
  • ANA (antinuclear antibody) is negative
102
Q

Laboratory and Diagnostic Study Finding of pauciarticular

A
  • CBC will reveal mild leukocytosis
  • ESR will be elevated
  • ANA may be positive
103
Q

are reserved for children who do not respond to conventional therapy.

A
  • Immunosuppressive agents
104
Q

is usually spread by close, prolonged skin-to-skin contact (e.g. holding hands), and is common in school-aged children.

A

Scabies

105
Q

scabies  Treatment should be

A

be repeated one week after the first treatment. Do not apply the treatment more than twice.

106
Q

is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis).

A

Human scabies

107
Q

mite burrows into the upper layer of the skin where it lives and lays its eggs.

A

The microscopic scabies mite

108
Q

can be located by rubbing a washable felt-tip marker across the suspected site and removing the ink with an alcohol wipe; when a burrow is present, the ink penetrates the stratum corneum and delineates the site; this technique is particularly useful in children and in individuals with very few burrows.

A

Burrow ink test

109
Q

is an alternative to the burrow ink test; after application and removal of the excess tetracycline solution with alcohol, the burrow is examined under a Wood light; the remaining tetracycline within the burrow fluoresces a greenish color;

A

tetracycline

110
Q

this method is preferred because ________ is a colorless solution and large areas of skin can be examined.

A

tetracycline

111
Q

Definitive testing relies on the identification of mites or their eggs, eggshell fragments, or scybala; this is best undertaken by placing a drop of mineral oil directly over the burrow on the skin and then superficially scraping longitudinally and laterally across the skin with a scalpel blade

A

skin scraping

112
Q

Strips of tape are applied to areas suspected of being burrows and then rapidly pulled off; these are then applied to microscope slides and examined;

A

Adhesive tape test

113
Q

the most common symptoms of scabies, itching and a skin rash, are caused by sensitization (a type of “allergic” reaction) to the proteins and feces of the parasite.

A

skin rash

114
Q

s/x of scabies

A
  1. skin rash
  2. pruritus
  3. scabies rash
  4. burrow in skin
115
Q

intense itching, especially at night, is the earliest and most common symptom of scabies.

A

Pruritus

116
Q

. A pimple-like (papular) itchy (pruritic) “scabies rash” is also common

A

Scabies rash

117
Q

Pharmacologic management of scabies

A
  • The mainstay of scabies treatment is the application of topical scabicidal agents, with repeat application in 7 days.
118
Q

drug of choice of scabies

A

permethrin cream

119
Q

These agents are used to treat secondarily infected lesions.

A

 Topical antibiotics

120
Q

. These agents may be applied to help control intense pruritus caused by scabies.

A

 Topical corticosteroids

121
Q

difference between first manifestation and secondary manifestation of scabies?

A

the first manifestation of the infestation small papules, vesicles, and burrows

2nd manifestation: rubbing and scartching

122
Q

Nursing diagnosis of scabies

A
  1. Risk for infection related to tissue damage.
  2. Impaired skin integrity related to edema.
  3. Acute pain related to injury to biological agents.
  4. Disturbed sleep pattern related to itchiness and pain of lesions.
123
Q

 It is a common childhood condition that can be passed among friends and family.

A

Pediculosis

124
Q

 the highest prevalence of head lice infestation occurs in children between the ages of

A

3 and 11

125
Q

who said Females are at higher risk because they are more likely to share combs, brushes, and hair accessories

A

(Wiederkehr & Schwartz, 2003).

126
Q

There are three kinds of lice: SCALP?

A

(pediculosis capitis

127
Q

There are three kinds of lice: BODY?

A

pediculosis corporis

128
Q

There are three kinds of lice: PUBIC AREA?

A

pediculosis pubis

129
Q

is a highly contagious bacterial infection often found on and around the mouth of the child or elsewhere on the face

A

IMPETIGO

130
Q

what does the cause of impetigo? and who said that?

A

Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) or both (Watkins, 2005).

131
Q

Pathophysiology of impetigo?

A

 The child is predisposed to the infection via dry or cracked skin where bacteria may invade.
 On rare occasions, other bacteria may be responsible for the skin infection. Infants and children who have a less developed immune system are more prone to this condition as well as children who are in close contact with other children through daycare and school associations.

132
Q

is a common reservoir of impetigo?

A

Nose

133
Q

The nose is a common reservoir and carriers can be treated with

A

mupirocin (Bactroban Nasal)

134
Q

 It is a spinal deformity that usually involves lateral curvature of the spine, spinal rotation and thoracic hypokyphosis.

A

Scoliosis

135
Q

 The most common spinal deformity.

A

Scoliosis

136
Q

 During adolescence, scoliosis is more common in ______

A

Girls

137
Q

 Untreated scoliosis may lead to

A

back pain, fatigue, disability, and heart and lung complications

138
Q

Pathophysiology of scoliosis?

A

growth ceases.
2. As the spine grows and the lateral curve develops, the vertebrae rotate, causing the ribs and spine to rotate toward the convex part of the spine. Spinous processes rotate toward the concavity of the curve.
3. The child attempts to maintain an erect posture, resulting in a compensatory curve.
4. Vertebrae becomes wedge shaped and vertebral disks undergo degenerative changes.
5. Muscles and ligaments either shorten and thicken or lengthen and atrophy depending on the concavity or convexity of the curve. A hump forms from the ribs rotating backward on the convex side of the curve.
6. The thoracic cavity becomes asymmetrical, leading to severe ventilatory compensation.
7. If significant scoliosis goes uncorrected, respiratory function is compromised and vital capacity is reduced; eventually, pulmonary hypertension, cor pulmonale and respiratory acidosis may develop.

139
Q

Laboratory and Diagnostic Study Findings

A

A. Radiographic examinations reveals the degree and location of the curvature.
B. an MRI scan is used to evaluate the possibility of intraspinal pathology.

139
Q

Assessment Findings
1. Clinical Manifestations
b. The first signs of scoliosis include:

A

-Presence of a spinal curve
-asymmetry of scapula and extremities
-unequal distance between the arms and waist.

140
Q

reveals the degree and location of the curvature.

A

Radiographic examinations

141
Q

is used to evaluate the possibility of intraspinal pathology.

A

MRI scan

142
Q

caused by poor posture and not by spinal disease
Flexible and easily correctible

A
  1. Functional Scoliosis
143
Q

anatomical change in shape of thorax or vertebrae
Hips and shoulders are uneven
Not easily correctible/ may need medical interventions
It may be congenital

A
  1. Structural Scoliosis
144
Q

result of muscle weakness or imbalance

A

Neuromuscular scoliosis

145
Q

Treatment of scoliosis?

A
  1. Milwaukee brace
  2. Boston Brace
  3. Spinal fusion
146
Q
  • This apparatus exerts pressure on the chin, pelvis and convex (curved) side the spine.
A
  1. Milwaukee brace
147
Q
  • Indicated for curves between 20-40 degrees
A
  1. Milwaukee brace
148
Q
  • An underarm modification of the brace
A

Boston brace

149
Q
  • Effective for patients with low curvature
A

Boston brace

150
Q
  • Indicated for curves more than 40 degrees and for patient with unsuccessful conservative treatment
A

Spinal fusion

151
Q

used when there is associated weakness or paralysis of the neck and trunk muscle

A

Halo traction

152
Q

 It is a primary malignant tumor of the long bones involving rapidly growing bone tissue (mesenchymal matrix-forming cells).

A

B. Bone Tumor (Osteosarcoma)

153
Q

Risk factor of bone tumor

A

 Age: 10-15 years old
 History of radiation therapy
 History of retinoblastoma

154
Q

 Soft tissue injuries usually accompany traumatic fractures in adolescents involved in sports and adventurous activities.

A

Trauma and injury

155
Q
  • tearing of subcutaneous tissue results in hemorrhage, edema and pain. Hematoma is evident.
A

Contusion

156
Q

when ligament is torn or stretched away from the bone at the point of trauma. Swelling, disability, and pain are major signs.

A

Sprain

157
Q

microscopic tear of the muscle or tendon occurs over time and results in edema and pain.

A

Strain

158
Q

how to reduce edema and bleeding and relieves pain?

A
  • Cold pack and elastic wrap  Applied at alternating 30-minutes interval
159
Q

to ensure adequate tissue perfusion

A

Neurovascular check

160
Q

RICE

A

REST
ICE
COMPRESSION
ELEVATION

161
Q
  • General name given to infections spread through direct sexual activities.
A

STD

162
Q

refers to the absence of menses.

A

AMENORRHEA

163
Q

 Primary amenorrhea AND Seconadray ammenorrhea difference

A

 Primary amenorrhea is when no menses occur by the age of 17.
 Secondary amenorrhea implies that menses have been established, but have ceased for a minimum of 3 months.

164
Q

Causes of amenorrhea

A

Causes:
* corpus luteum cyst
* lactation
* menopause (premature or normal)
* hypothyroidism or hyperthyroidism
* chemotherapy
* polycystic ovarian syndrome (PCOS)
* diabetes mellitus
* stress
* excessive exercise
* weight loss
* pregnancy
- Pregnancy must always be considered as a cause of secondary amenorrhea, even if the patient denies sexual contact

165
Q
  • Certain medications can cause amenorrhea, including
A

chemotherapy and medroxyprogesterone acetate (Depo Provera), which is given as a contraceptive injection.

166
Q
  • primary amenorrhea includes
A

agenesis (no formation) of the uterus, Turner’s syndrome (genetic disorder with pectus excavatus, heart murmur, and short stature), imperforate hymen, and constitutional delay.

167
Q
  1. Primary amenorrhea:
A

the patient may exhibit abnormalities in body habitus, suggestive of delayed puberty. The Tanner stages of sexual characteristic development may show delays.

168
Q

Ssecondary amenorrhea

A

a. Signs and symptoms of pregnancy include mastalgia (breast tenderness); breast enlargement; nausea and possibly vomiting, especially in the early morning; gastrointestinal upset; and urinary frequency. On examination, the uterus may be enlarged and Chadwick’s sign (blue or violaceous cervix) may be present, a probable sign of pregnancy that becomes evident about the fourth week of gestation.
b. hypothyroidism, the patient may have dry skin, dry hair, fatigue, hoarseness, constipation, and an enlarged thyroid gland. In hyperthyroidism, the patient may exhibit oily skin and hair, diaphoresis, tachycardia, diarrhea, and a goiter (enlarged thyroid gland).
c. Patients with polycystic ovarian syndrome may have hirsutism (excessive facial and bodily hair) and obesity. Corpus luteum cysts tend to cause pain in the lower quadrants that may be intermittent in nature, as some cysts resolve spontaneously. Other cysts grow and may rupture, causing significant lower quadrant abdominal pain and even peritoneal signs of rebound, guarding, and rigidity.

169
Q

to determine disorders such as Turner’s syndrome.

A

GEnectic testing

170
Q

is used to test for pregnancy, ovarian cysts, and other gynecological abnormalities.

A

b. Pelvic ultrasound or transvaginal (ultrasound wand in the vaginal canal)

171
Q

Diagnosis of amenorrhea

A
  1. Genetic testing
  2. Pelvic ultrasound
172
Q

Painful menses, or cramps

A

Dysmenorrhea

173
Q

 Discomfort in the lower abdomen and may radiate to the lower back or down the legs.

A

Dysmenorrhea

174
Q

there is no evidence of pelvic abnormality; affects 50 % of menstruating females and is the leading cause of short-term recurrent school absenteeism in adolescent girls

pathologic condition is identified

A

primary in dysmenorrhea and secondary

175
Q

onset of dysmenorrhea

A

is shortly after menarche with heavy menstrual flow

176
Q

 Excessive weight in childhood is related to obesity in adulthood

A

Obesity

177
Q

Obesity can lead to?

A

 Can lead to increase cholesterol, orthopedic problems, sleep apnea, high blood pressure and diabetes
 It can lead to social isolation which may lead to depression

178
Q

what is the bmi of obesity?

A

 BMI- 22-24 in adolescents indicates obesity

179
Q

purging or withholding

A

 Anorexia Nervosa

180
Q

binging and purging

A

 Bulimia Nervosa

181
Q

 Is a form of self-starvation seen mostly in adolescent girls

A

eating disorders

182
Q

 It is known that 80% of deaths in adolescents involve accidents, homicides, and suicides and in many of these cases drugs and alcohol are involved.

A

I. Substance and alcohol abuse

183
Q

physical symptoms of I. Substance and alcohol abuse

A

slurred speech, unsteady gait, et.al.

184
Q

psychologic response of substance and alcoholo abuse

A

depression, hostility, suspiciousness

185
Q

Assessment Findings of substance and alcohol abuse

A
  1. Physical: fatigue, repeated health complaints, red and glazed eyes, and a lasting cough
  2. Emotional: personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgment, depression, and a general lack of interest
  3. Family: starting arguments, breaking rules, or withdrawing from the family
  4. School: decreased interest, negative attitude, drop in grades, many absences, truancy, and discipline problems
  5. Social problems: new friends who are less interested in standard home and school activities, problems with the law, and changes to less conventional styles of dress and music
186
Q

Complication of substance and alcohol abuse?

A
  1. Delirium tremens & alcohol syndrome.
  2. Korsakoff’s psychosis
  3. Wernicke’s syndrome
  4. Peripheral neuropathies
  5. Hepatitis, cirrhosis, pancreatitis
  6. Anemia
187
Q

stage 1-4 difference in alcohol and substance abuse

A

Stage 1:
* Anxiety, anorexia, insomnia, mild tremors, hyper alertness, internal shaking, n/v, headache,  pulse & BP.
Stage 2:
* Profound confusion, gross tremors, nervousness, disorientation, illusions, auditory & visual hallucinations, nightmares.
Stage 3:
* Severe hallucinations
Stage 4:
* Delirium, uncontrolled tachycardia, visual & tactile hallucinations, fever, severe psychomotor activity, agitation, restlessness

188
Q

 It is a deliberate self-injury with the intent to end one’s life.

A

Suicide

189
Q

 Ranks third as cause of death in the age group of

A

15-19 years old

NCM 109 (2 decks)

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