Finals Flashcards
It is a proliferation of abnormal WBCs
Leukemia
The most common leukemia in children is
acute lymphocytic leukemia (ALL)
is a proliferation of blast cells (immature lymphocytes.
Acute Lymphocytic Leukemia
ALL is classified by?
Form, Structure and morphology of the blast cells
Leukemia may be diagnosed at any age but has a peak onset between
3 and 5 years of age
environmental factors of leukemia
chemicals and radiation
genetic diseases have been associated with increase of leukemia?
Down Syndrome, Fanconi anemia and Bloom syndrome.
pathophysiology of leukemia
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.
Clinical manifestations of anemia
– fatigue, pallor, tachycardia
Clinical manifestation of leukemia
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
what are the laboratory findings and diagnostic study findings
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.
Nursing Diagnoses
- Risk for injury
- Risk for infection
- Risk for trauma
- Risk for fluid volume deficit
- Altered nutrition: less than body requirements
- Altered oral mucous membranes
- Pain
- Risk for altered growth
- Risk for altered development
- Altered family processes
- Anticipatory grief
- Assist in ensuring partial or complete remission from the disease by administering ?
administering chemotherapy and by preventing or minimizing, the complications of chemotherapy, radiation, and bone marrow transplant (BMT).
What are the complication of BMT in the GI tract
nausea, vomiting, anorexia, diarrhea, mucositis
What are the complication of BMT in the renal
Hypovolemia, hypoproteinemia, dehydration, septic shock
what are the - Interstitial pneumonia and - Graft rejection or failure complications
fever, infection, decreased blood count
is a malignant neoplasm of the kidney.
Wilm’s tumor
. It is the most common intraabdominal tumor in children
Wilm’s tumor
the most curable solid tumor in children
Wilm’s tumor
The median age at diagnosis is between? (wilm’s tumor)
2 and 3 years old.
Wilm’s tumor is , it is unilateral and occurs with other abnormalities such as an
absent iris or genitourinary problems.
Pathophysiology of wilm’s tumor
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
Five stages of wilms tumor
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
what is the common sign of wilms tumor
Abdominal mass
Laboratory and diagnostic findings of wilm’s tumor
Ultrasound or CT scan reveals a mass
Other studies may be performed if metastasis is suspected.
why we do not palpate the abdomen?
Do not palpate the abdomen – doing so can rupture the encapsulated tumor and cause dissemination of the disease to adjacent and distant sites.
is a chronic, reversible, obstructive airway disease, characterized by wheezing.
Asthma
It is caused by a spasm of the bronchial tubes, or the swelling of the bronchial mucosa, after exposure to various stimuli
Asthma
It is the most common chronic disease in childhood.
ASthma
when Most children experience their first symptoms of asthma?
Most children experience their first symptoms by 5 years of age.
is the strongest predisposing factor for the development of asthma.
Allergen
Common irritant includes?
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
Pathophysiology of asthma
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.
Clinical manifestation of asthma
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
. Laboratory and Diagnostic study findings.
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)
are characterized by inflammation usually of bacterial origin of the urethra (urethritis), bladder (cystitis), ureters (ureteritis), or kidneys (pyelonephritis).
UTI
what is the peak indence of UTI
between 2 and 6 years of age
The recurrence rate in neonates is ______, in older children, it is _____.
25% and 30%
- In the neonate, the urinary tract may be infected via the
Bloodstream
what age? bacteria ascend the urethra, creating an increased incidence in girls
Older children
Contributing factors include: UTI
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
Pathophyisiology of UTI
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
Clinical manifestation of infants with UTI
Infants may exhibit irritability, constant squirming, fever or hypothermia, jaundice, weight loss, FTT, vomiting and diarrhea, diaper rash, and an abnormal urinary stream.
clinical manifestation of with lower UTIs
- foul-smelling urine, hematuria (possibly), dysuria, increased frequency, increased urgency, incontinence, and abdominal pain are seen with lower UTIs
clinical manifestation of with with pyelonephritis.
Fever, costovertebral abdominal (CVA) tenderness, chills, and flank pain are seen with pyelonephritis.
Laboratory and diagnostic study findings of UTI
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
What findings in Urinalysis
hematuria, proteinuria, and pyuria. Urine may have a foul odor and appear cloudy with strands of mucus.
is used to confirm diagnosis through detection of bacteria.
Urine culture
Nursing management of UTI
- Assess urinary status
- Administer prescribed antibiotics
- Prevent infection
- Provide comfort measures
- Provide child and family teaching
is a chronic metabolic disorder that results from either a partial or complete deficiency of insulin
DM
Is characterized by pancreatic beta cells destruction leading to absolute insulin deficiency
Type 1 DM
usually results from insulin resistance
Type 2 DM
is the most common endocrine disease of childhood.
Type 1 DM
Long term complications of DM
nephropathy, retinopathy, and neuropathy. Altered thyroid functioning is frequently noted in children with diabetes.
is an autoimmune disease that develops when a genetically pre-disposed child is exposed to a precipitating factor, such as a viral infection.
Type 1 DM
Pathophysiology of DM
- Insulin is needed to support carbohydrate, protein, and fat metabolism, primarily to facilitate entry of these substances into cells.
- Destruction of 80% to 90% of the pancreatic beta cells results in a clinically significant drop in insulin secretion.
- 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.
- 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.
- A persistent blood glucose concentration above 180 mg/dl results in glycosuria, leading to osmotic diuresis with polyuria and polydipsia.
- 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.
Assessment Findings
1. Clinical Manifestations
of DM
a. Classic symptoms:
- Polydipsia
- Polyuria
- Polyphagia
- Fatigue
b. Other symptoms:
- Weight loss
- dry skin
- Blurred vision
Signs of DKA
- Hyperglycemia
- Acidosis
- Glycosuria
- Ketonuria
d. Early signs of hypoglycemia
- Trembling/tremors
- Tachycardia
- sweating
- anxiety
- hunger
- pallor
- headache
e. Late signs of hypoglycemia
- Loss of coordination
- Personality and mood changes
- Slurred speech
- Sleepiness
- Nightmares
- Decreasing level of consciousness
- Seizure activity
Laboratory and Diagnostic study findings of DM
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.
How many hours should we check for urine if patient X have a DM?
- test urine for ketones every 3 hours
what should we Offer a readily absorbed carbohydrate ?
Orange juice
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.
Rheumatic fever
It is the most common cause of acquired heart disease in children worldwide.
rHEUMATIC FEVER
what infections occurs in the rheumatic fever?
group A beta-hemolytic streptococcal infection.
what age rheumatic fever occurs? and what is the peak age of it?
occurs in children between 5 and 15 years of age, with peak incidence at 8 years of age.
what is the onset of rheumatic fever?
usually occurs 2-6 weeks after an untreated upper respiratory infection with group A beta-hemolytic streptococci
It is believed that a genetic susceptibility to RF is associated
with a state of immune hyperactivity to the streptococcal antigens
Exact etiology is unknown
rheumatic fever
pathophysiology of RF?
- The child becomes infected with group A beta-hemolytic streptococcal bacteria.
- 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.
- 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.
which divides signs and symptoms into major and minor characteristics of the disease, is used when assessing the child with suspected RF.
Jones Criteria
Major characteristics of Carditis when have RH?
– tachycardia, cardiomegaly, murmur, muffled heart sounds, precordial friction rub, precordial pain, and a prolonged PR interval.
carditis can lead to?
Carditis can lead to CHF, pericardial friction rubs, cardiomegaly, and aortic or mitral valve regurgitation
Most serious problems of RF
Carditis
Polyarthritis major characteristics?
swollen, hot, painful joints (usually large joints).
is the most common presenting symptom and it occurs in about 75% of all cases of RF.
Polyarthritis
– 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.
Chorea
– clear-centered, transitory, nonpruritic macules, with defined boarders.
Erythema Marginatum
- Erythema marginatum noted mostly on what part of the body?
trunk and proximal extremities
are non-tender lesions that may persist, then resolve.
- Subcutaneous nodules
. These rarely occur in RF.
Subcutaneous nodules
what body part occurs when having subcutaneous nodules
bony prominence
Minor characteristics of RH
fever, arthralgia, and specific laboratory findings
a. Laboratory findings consistent with the Jones Criteria:
- Erythrocyte Sedimentation Rate (ESR) is elevated
- C-reactive protein (CRP) is elevated
- Acute-phase reactants
may disclose cardiac enlargement what diagnostic laboratory
Chest radiography studies
may reveal a prolonged PR interval.
ECG
what are the laboratory finding of RH
Jones criteria
CBC
Throat culture
ECG
autoimmune inflammatory disorder
Juvenile Rheumatoid Arthritis (JRA)
It is one of the more common chronic diseases in children.
C. Juvenile Rheumatoid Arthritis (JRA)
The outcome is variable and unpredictable in individual children.
Juvenile Rheumatoid Arthritis (JRA)
The cause is unknown, but infectious and genetic origins have been implicated.
Juvenile Rheumatoid Arthritis (JRA)
Pathophysiology of Juvenile Rheumatoid Arthritis (JRA)
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.
Assessment Findings
1. Clinical Manifestations
systemic
- Any joint can be involved
- Extra-articular manifestations include fever, malaise, myalgia, rash, pleuritis, pericarditis, adenomegaly, and hepatosplenomegaly
Assessment Findings
1. Clinical Manifestations
Pauciaticular
joint involvement is usually confined to the lower extremities.
- Extra-articular manifestations include iridocyclitis, sacroiliitis, and eventual ankylosing spondylitis
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.
Iridocyclitis
Inflammation of iris alone is called anterior uvetitis or iritis.
anterior uvetitis or iritis.
is an inflammation of one or both of your sacroiliac joints — situated where your lower spine and pelvis connect.
Sacroiliitis
Sacroiliitis can cause
pain in your buttocks or lower back, and can extend down one or both legs. Prolonged standing or stair climbing can worsen the pain
is a rare type of arthritis that causes pain and stiffness in your spine.
Ankylosing spondylitis
Assessment Findings
1. Clinical Manifestations
Polyarticular
- Any joint can be involved, smaller joints are usually affected.
- Systemic symptoms are mild and may include low-grade fever, fatigue and slowed growth.
Laboratory and Diagnostic Study Finding of systemic
- CBC will reveal leukocytosis and anemia
- ESR will be elevated
- CRP will be elevated
- RF (rheumatoid factor) is negative
- ANA (antinuclear antibody) is negative
Laboratory and Diagnostic Study Finding of pauciarticular
- CBC will reveal mild leukocytosis
- ESR will be elevated
- ANA may be positive
are reserved for children who do not respond to conventional therapy.
- Immunosuppressive agents
is usually spread by close, prolonged skin-to-skin contact (e.g. holding hands), and is common in school-aged children.
Scabies
scabies Treatment should be
be repeated one week after the first treatment. Do not apply the treatment more than twice.
is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis).
Human scabies
mite burrows into the upper layer of the skin where it lives and lays its eggs.
The microscopic scabies mite
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.
Burrow ink test
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;
tetracycline
this method is preferred because ________ is a colorless solution and large areas of skin can be examined.
tetracycline
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
skin scraping
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;
Adhesive tape test
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.
skin rash
s/x of scabies
- skin rash
- pruritus
- scabies rash
- burrow in skin
intense itching, especially at night, is the earliest and most common symptom of scabies.
Pruritus
. A pimple-like (papular) itchy (pruritic) “scabies rash” is also common
Scabies rash
Pharmacologic management of scabies
- The mainstay of scabies treatment is the application of topical scabicidal agents, with repeat application in 7 days.
drug of choice of scabies
permethrin cream
These agents are used to treat secondarily infected lesions.
Topical antibiotics
. These agents may be applied to help control intense pruritus caused by scabies.
Topical corticosteroids
difference between first manifestation and secondary manifestation of scabies?
the first manifestation of the infestation small papules, vesicles, and burrows
2nd manifestation: rubbing and scartching
Nursing diagnosis of scabies
- Risk for infection related to tissue damage.
- Impaired skin integrity related to edema.
- Acute pain related to injury to biological agents.
- Disturbed sleep pattern related to itchiness and pain of lesions.
It is a common childhood condition that can be passed among friends and family.
Pediculosis
the highest prevalence of head lice infestation occurs in children between the ages of
3 and 11
who said Females are at higher risk because they are more likely to share combs, brushes, and hair accessories
(Wiederkehr & Schwartz, 2003).
There are three kinds of lice: SCALP?
(pediculosis capitis
There are three kinds of lice: BODY?
pediculosis corporis
There are three kinds of lice: PUBIC AREA?
pediculosis pubis
is a highly contagious bacterial infection often found on and around the mouth of the child or elsewhere on the face
IMPETIGO
what does the cause of impetigo? and who said that?
Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) or both (Watkins, 2005).
Pathophysiology of impetigo?
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.
is a common reservoir of impetigo?
Nose
The nose is a common reservoir and carriers can be treated with
mupirocin (Bactroban Nasal)
It is a spinal deformity that usually involves lateral curvature of the spine, spinal rotation and thoracic hypokyphosis.
Scoliosis
The most common spinal deformity.
Scoliosis
During adolescence, scoliosis is more common in ______
Girls
Untreated scoliosis may lead to
back pain, fatigue, disability, and heart and lung complications
Pathophysiology of scoliosis?
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.
Laboratory and Diagnostic Study Findings
A. Radiographic examinations reveals the degree and location of the curvature.
B. an MRI scan is used to evaluate the possibility of intraspinal pathology.
Assessment Findings
1. Clinical Manifestations
b. The first signs of scoliosis include:
-Presence of a spinal curve
-asymmetry of scapula and extremities
-unequal distance between the arms and waist.
reveals the degree and location of the curvature.
Radiographic examinations
is used to evaluate the possibility of intraspinal pathology.
MRI scan
caused by poor posture and not by spinal disease
Flexible and easily correctible
- Functional Scoliosis
anatomical change in shape of thorax or vertebrae
Hips and shoulders are uneven
Not easily correctible/ may need medical interventions
It may be congenital
- Structural Scoliosis
result of muscle weakness or imbalance
Neuromuscular scoliosis
Treatment of scoliosis?
- Milwaukee brace
- Boston Brace
- Spinal fusion
- This apparatus exerts pressure on the chin, pelvis and convex (curved) side the spine.
- Milwaukee brace
- Indicated for curves between 20-40 degrees
- Milwaukee brace
- An underarm modification of the brace
Boston brace
- Effective for patients with low curvature
Boston brace
- Indicated for curves more than 40 degrees and for patient with unsuccessful conservative treatment
Spinal fusion
used when there is associated weakness or paralysis of the neck and trunk muscle
Halo traction
It is a primary malignant tumor of the long bones involving rapidly growing bone tissue (mesenchymal matrix-forming cells).
B. Bone Tumor (Osteosarcoma)
Risk factor of bone tumor
Age: 10-15 years old
History of radiation therapy
History of retinoblastoma
Soft tissue injuries usually accompany traumatic fractures in adolescents involved in sports and adventurous activities.
Trauma and injury
- tearing of subcutaneous tissue results in hemorrhage, edema and pain. Hematoma is evident.
Contusion
when ligament is torn or stretched away from the bone at the point of trauma. Swelling, disability, and pain are major signs.
Sprain
microscopic tear of the muscle or tendon occurs over time and results in edema and pain.
Strain
how to reduce edema and bleeding and relieves pain?
- Cold pack and elastic wrap Applied at alternating 30-minutes interval
to ensure adequate tissue perfusion
Neurovascular check
RICE
REST
ICE
COMPRESSION
ELEVATION
- General name given to infections spread through direct sexual activities.
STD
refers to the absence of menses.
AMENORRHEA
Primary amenorrhea AND Seconadray ammenorrhea difference
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.
Causes of amenorrhea
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
- Certain medications can cause amenorrhea, including
chemotherapy and medroxyprogesterone acetate (Depo Provera), which is given as a contraceptive injection.
- primary amenorrhea includes
agenesis (no formation) of the uterus, Turner’s syndrome (genetic disorder with pectus excavatus, heart murmur, and short stature), imperforate hymen, and constitutional delay.
- Primary amenorrhea:
the patient may exhibit abnormalities in body habitus, suggestive of delayed puberty. The Tanner stages of sexual characteristic development may show delays.
Ssecondary amenorrhea
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.
to determine disorders such as Turner’s syndrome.
GEnectic testing
is used to test for pregnancy, ovarian cysts, and other gynecological abnormalities.
b. Pelvic ultrasound or transvaginal (ultrasound wand in the vaginal canal)
Diagnosis of amenorrhea
- Genetic testing
- Pelvic ultrasound
Painful menses, or cramps
Dysmenorrhea
Discomfort in the lower abdomen and may radiate to the lower back or down the legs.
Dysmenorrhea
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
primary in dysmenorrhea and secondary
onset of dysmenorrhea
is shortly after menarche with heavy menstrual flow
Excessive weight in childhood is related to obesity in adulthood
Obesity
Obesity can lead to?
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
what is the bmi of obesity?
BMI- 22-24 in adolescents indicates obesity
purging or withholding
Anorexia Nervosa
binging and purging
Bulimia Nervosa
Is a form of self-starvation seen mostly in adolescent girls
eating disorders
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.
I. Substance and alcohol abuse
physical symptoms of I. Substance and alcohol abuse
slurred speech, unsteady gait, et.al.
psychologic response of substance and alcoholo abuse
depression, hostility, suspiciousness
Assessment Findings of substance and alcohol abuse
- Physical: fatigue, repeated health complaints, red and glazed eyes, and a lasting cough
- Emotional: personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgment, depression, and a general lack of interest
- Family: starting arguments, breaking rules, or withdrawing from the family
- School: decreased interest, negative attitude, drop in grades, many absences, truancy, and discipline problems
- 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
Complication of substance and alcohol abuse?
- Delirium tremens & alcohol syndrome.
- Korsakoff’s psychosis
- Wernicke’s syndrome
- Peripheral neuropathies
- Hepatitis, cirrhosis, pancreatitis
- Anemia
stage 1-4 difference in alcohol and substance abuse
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
It is a deliberate self-injury with the intent to end one’s life.
Suicide
Ranks third as cause of death in the age group of
15-19 years old
