NURS 330 (Peds) Midterm Flashcards
Autosomal Dominant Inheritance
Each child has 50% chance of getting this
Ex) Huntington’s, Bracas breast cancer gene
Autosomal Recessive Inheritance
Each child has 50% chance of carrying disease and 25% chance of showing disease
Ex) Cystic Fibrosis
X-Linked Recessive Disorders
Males are at risk - each male has 50% chance of inheriting
Ex) Color blindness, hemophilia a, duchenne muscular dystrophy
Numerical chromosome abnormality
Entire single chromosome added or missing
Structural chromosome abnormality
Part of chromosome missing or added OR abnormal rearrangement of material within chromosome (translocation)
Trisomy
When each body cell contains an extra copy of one chromosome (47)
Trisomy 21
Down syndrome - each cell has three copies of chromosome 21
Trisomy 13
Less common and more severe, often die in infancy
Monosomy
Each body cell has a missing chromosome (45)
Turner’s Syndrome
Only monosomy that is compatible with life, only in females, single X chromosome
Klinefelter Syndrome
Occurs in boys who have an extra X chromosome - delay in language development and auditory processing
Duchenne Muscular Dystrophy
X-linked recessive disorder in boys - 30-50% affected children have no family hx
Symptoms within first 3-4 years of life
Loss of endurance/strength in legs and pelvis
Bowlby’s Attachment Thoery
Motivational-behavioral system
Infants need one special relationship for internal development
Birth - social
quiet when fed and comforted, makes eye contact
Birth - self help
interested in sights and sounds, alert
Birth - Gross motor
Wiggles and kicks, thrusts arms and legs in play
Birth - fine motor
Looks at objects or faces
Birth - language
Cries, makes small throaty sounds
1 month - Social
Social smile
1 month - Gross motor
Lifts head and chest when lying on stomach
1 month - fine motor
Follows moving objects with eyes
1 month - language
cries in special way when hungry
2 months - Social
Recognizes mother
2 months - self help
reacts to sight of bottle or breast
2 months - gross motor
Holds head steady when held sitting
2 months - fine motor
Holds object in hand
2 months - language
Makes sounds - ah, eh, ugh
3 months - social
Recognizes other familiar adults
3 months self help
increases activity when shown a toy
3 months - gross motor
makes crawling movements
3 months - fine motor
holds hand up and looks at it
3 months - langauge
laughs out loud, squeals
4 months - social
interested in his/her image in the mirror, smiles, playful
4 months - self help
reaches for obects
4 months - gross motor
pivots around when lying on stomach
4 months - fine motor
puts toys or other objects in mouth
4 months - language
ah-goo
5 months - social
reacts differently to strangers
5 months - gross motor
rolls over from stomach to back
5 months - fine motor
picks up objects with one hand
5 months - language
responds to voice: turns head toward a voice
6 months - social
reaches for familiar persons
6 months - self help
looks for object after it disappears from sigh
6 months - gross motor
rolls over from back to stomach
6 months - fine motor
transfers objects from one hand to the other
6 months - language
babbles, responds to his/her name (turns and looks)
7 months - social
Gets upset and cries if left alone
7 months - self help
feeds self cracker or cookie
7 months - gross motor
sits alone, steady
7 months - fine motor
holds two objects, one in each hand at the same time. brings two objects together
7 months - language
makes sounds like da, ba, ga, ka, ma
8 months - social
plays “peek-a-boo”
8 months - gross motor
moves forward somehow while on stomach
8 months - fine motor
uses forefinger to poke, push or roll small objects
8 months - language
makes sounds like mama, dada, baba (no meaning)
9 months - social
waves bye-bye
9 months self-help
resists having a toy taken away
9 months gross motor
crawls on hands and knees, pulls self to standing position
9 months - fine motor
picks up small objects using thumb and finger grasp
9 months - language
imitates sounds that you make
10 months - social
plays “patty-cake”
10 months - self help
picks up spoon by handle
10 months - gross motor
walks around playpen or furniture while holding on
11 months - gross motor
stands alone briefly
11 months - fine motor
puts small objects in cup or other container
11 months - language
understands phrases like “No” and “all gone”
12 months - social
Imitates simple acts such as hugging a doll
12 months - self help
helps a little when being dressed
12 months - gross motor
Stands alone, steady
12 months - fine motor
turns pages of books
12 months - language
says “mama” or “dada” for parent
13 months - social
Plays with other children
13 months - self help
lifts cup to mouth and drinks
13 months - gross motor
walks without help
13 months - fine motor
builds tower of 2 or more blocks
13 months - language
shakes head to express “no”, hands object when asked
14 months - social
gives kisses
14 months - self help
insists on feeding self
14 months - gross motor
climbs up on chairs or other furniture
14 months - fine motor
marks with pencil or crayons
14 months - language
asks for food or drink with sounds or words
15 months - social
greets people with “hi”
15 months - self help
Feeds self with a spoon
15 months - gross motor
runs
15 month - fine motor
scribbles with pencil or crayon
15 month - language
says 2 words besides mama or dada, makes sounds in sequences that sounds like sentences
18 months - social
sometimes says “no” when interfered with
18 months - self help
eats with a fork
18 months - gross motor
kicks a ball forward, good coordination and balance
18 months - fine motor
builds tower of 4 or more blocks
Erikson’s Theory
Pychosocial
Freuds Theory
Psychosexual
Piaget’s Theory
Cognitive
Kohlberg’s
Moral
Active Immunization
Vaccines
Passive Immunization
Protection from exposure to infections through antibodies from other humans or animals
Immune Globulin (human)
Ex) measles and hepatitis
Obtained from pooled human plasma and contains mainly IgG with small amounts of IgA and IgM
Differences in Pediatric Respiratory System
- lack of bony structures (increased retractions)
- abdominal breathers (rely on diaphragm)
- appear barrel chested
- obligatory nose breathers until 3 months
- smaller airways
- short trachea, angle @ bronchus acute, smallest at cricoid until 8 y/o
- smaller lung capacity, fewer alveoli, underdeveloped IC muscles
- large tongue, large tonsils
Respiratory Syncytial Virus (RSV)
most common cause of lower resp tract infections in children, leading cause of pneumonia and brochiolitis in infants
RSV Symptoms
Coughing, rhinorrhea, wheezing, irritability and restlessness, low grade fever, nasal flaring and retractions, liver and spleen palpable
RSV Diagnosis
using nasopharyngeal secretions containing epithelial cells - swab
RSV management
Relieve symptoms - airway = #1 priority
Position, oxygen, suction
Meds: ventolin, ribovarin
Symptoms of COVID in kids
Fever, malaise, cough, nasal congestion/runny nose, abdominal pain, diarrhea, new loss of taste or smell, sore throat, headache
COVID vaccine for kids
Available for chilren 6months-18y/o.
Influenza/Parainfluenza
Common viruses that can cause upper and lower resp infections (bronchitis, croup, pneumonia)
Clinical signs: fever, cough, runny nose, sore thoat, SOB, wheezing, fatigue)
Treatment: symptom mgmt, prevent with vaccine
Croup-Laryngothracheobronchits
VIRAL cause (usually)
Infection causes swelling in the trachea and larynx, most common in kids 3 months - 4y/o
Signs: tachypnea, stridor, seal-like barking cough
Treatment: oxygen, medications (racemic epi, corticosteroids
Pertussis-Whooping Cough
Highly contagious BACTERIAL disease
signs: severe coughing followed by high-pitched whoop/crowing sounds and/or grasp for air
VOMITING after a cough spell is a big indicator
Prevention: immunization-acellular pertussis vaccine
Growth and Development of GI system
STRUCTURALLY complete at birth, but immature
Sucking=reflex until 6wks
Stomach capacity increases
Intestinal motility is increased in newborns (increased stools)
Enzyme secretion increases (pancreatic start at 4 months)
Excretory control by age 2-3
Necrotizing Enterocolitis (NEC)
Most common and most serious acquired GI disorder among hospitalized pre-term neonates
Caused by: intestinal ischemia, bacterial or viral infection
Predisposing factor = immature intestine
NEC symptoms
Vomiting, blood diarrhea, abdominal distention, feeding intolerance, irritability OR lethargy
Diagnosis and Treatment of NEC
Diagnostic: Physical assessment, abdominal x-ray
Treatment: PROMPT, NPO, CVC/IV fluids and antibiotics, surgical resection
Long term complications of NEC
Malabsorption, short bowel, scarring/narrowing of bowel, scarring in the abdomen, problems with TPN
Complications with Prematurity
Intraventricular hemorrhage (IVH)
Retinopathy of Prematurity (ROP)
Feeding and nutrition problems
Anemia
Resp distress syndrome
5 Types of CVC
Short term (percutaneous)
Tunneled
PICC
Implanted
Hemodialysis
Why might we insert a CVC?
Limited peripheral venous access, resuscitation, hemodialysis, long term therapy, admin of IV fluid/PN/blood products/medications/chemotherapy.
Complications of CVC
Air embolism, occlusion (common), infection (common), malposition or external catheter damage, extravasation
Acute GI disorder-dehydration/vomiting
Causes: infection, structural anomalies, neurologic, endocrine, food poisoning
Viral (rotovirus, adenovirus, norwalk, cytomegalovirus)
Bacterial (salmonellla, e coli, shigella, c-diff)
Treatment of dehydration
NS bolus, and then switch to D5NS because of sodium and glucose
Cleft Lip & Palate
“split” or “separation” of lip or palate, develop in early pregnancy (lip in 5-6wk gest and palate in 7-9wk gest), happens in 1/700 babies
Management of cleft lip & palate
Cleft lip: Surgery after 2-3 months
Cleft palate: Surgery around 6-18 months
Complications of cleft lip
Cannot suck properly with deformed lip/palate, (there are special bottles for cleft lip/palate babies), susceptible to colds, hearing loss, speech defects, dental cavities, otitis media.
Hirschsprung (Congenital aganglionic megacolon)
Absence of autonomic parasympathetic ganglion cells of the colon that prevents peristalsis - obstruction. Presentation = constipation
Signs: gradual onset of vomiting, ABD distention, constipation, failure to pass meconium
Treatment of Hirschsprung
Staged surgical repair - remove dysfunctional part of bowel and re-attach (sometimes involve temporary ileostomy)
Tracheosophageal Fistula (TEF)
Represents an abnormal opening between the trachea and esophagus
- excess amniotic fluid
- excess saliva
- feeds get vomited right back up (EA with distal TEF = most common)
TEF diagnosis
Catheter into esophagus to check for resistance
Barium Swallow test to diagnoses problems
TEF treatment
surgery to close the fistula and anastomosing the esophageal segments
Imperforated Anus
Passage of fecal material is obstructed by a structural anomaly of the anus and rectum
Imperforated anus diagnosis
Inspection of the perineum (fistula)
Rectal atresia (absence of anal opening)
ABD distention, vomiting, failure to pass meconium
US and Lower GI studies confirm diagnosis
Imperforated anus treatment
oral feeds STOPPED
surgery to close fistula and create an anal opening
Surgical site - thoroughly monitored for infection
Intussesception
one portion of the bowel slides/invaginates into the next
Signs: Vomiting, “currant” jelly, gelatinous stools, pain
Treated with barium enema to move bowel back into correct space
Pyloric Stenosis
Hypertrophy of the circular pylorus muscle results in stenosis of the passage between the stomach and the duodenum, partially obstructing the lumen of the stomach
Pyloric Stenosis Symptoms
evident at 2-8 weeks
Easy to diagnose
PROJECTILE VOMITING, irritability, failure to gain weight, signs of dehydration, child hunger
Nissen Fundoplication
For kids that have severe acid reflux - last resort is to wrap stomach around itself to tighten it.
Diagnosis of diabetes in children
- plasma glucose level of 11.1mmol/l or higher
- fasting plasma glucose (FPG) > 7.0mmol/l
- oral glucose tolerance test (OGTT) > 11mmol/l
- random PG > 11.1mmol/l
Type 1 Diabetes
Autoimmune destruction of insulin producing cells (beta-cells) resulting in complete insulin deficiency
Type 2 Diabetes incidence in children
minimum incidence of type 2 diabetes in children and adolescents < 18 years old of 1.54 per 100 000 children per year
Indigenous youth with diabetes
Experience higher long-term risks for end stage renal disease and death than non-first nation kids
Most important risk factor of type 2 diabetes
obesity (95% of children with T2DM were obese)
Risk factors for type 2 diabetes
family history
hypertension
asian, indigenous and african decent
lower PHC
Complications of type 2 diabetes
kidney disease
retinopathy
neuropathy
dyslipidemia
hypertension
Hemoglobin A1C
Objective measurement of glycemic control
Glycosylated (or glycated) hemoglobin
form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time
