OB Unit 3 Review: 37,38,39,42

Question 1

Mode of action and benefits of antipyretic medication

Answer 1

Acetominophen and ibuprofen
They help decrease fluid requirements
Decrease temperature set point by inhibiting production of prostaglandins, leading to heat loss thru vasodilation and sweating. NEVER give aspirin to reduce fever under the age of 19 years old d/t risk of Reyes syndrome. Ibprophen proven to last longer than acetaminophen. Do not give ibuprofen if a bleeding disorder.
a. Ibprophen-no more than 5 doses in a 24 hour period. No more than q6-8 hours. 5-10 mg/kg/dose. >6months old
b. Acetaminophen-10-15 mg/kg/dose no more than q4 hours

Question 2

S&S of Lyme disease

Answer 2

most common vector-borne disease in U.S. caused by Borrelia burgdorferi. Transmitted to humans via bite of infected black-legged (deer) tick. Mainly in northeast and upper Midwest and between June & august.

a. Treatment- antibiotics Doxycycline for children older 8. Children under 8 amoxicillin. If allergic erythromycin or cefuroxime
b. S/S:
1. Early localized- rash 7-14 days after tick bite(can appear 3-32 days after)
2. Early Disseminated-rash begins 3-5 weeks after tick bite. ~fever ~malaise ~mild neck stiffness ~headache ~fatigue ~myalgia ~arthralgia (joint pain), cranial nerve palsies #7, conjunctivitis, meningeal irri
3. Late Disease-recurrent arthritis of large joints beginning weeks to months after tick bites ~erythema migrans (ring like rash). May or may not have history of earlier stage signs

Question 3

‘Tick removal

Answer 3

c. Tick removal-fine tipped tweezers, gloves, grasp tick as close to skin as possible & pull upward w steady even pressure, Do NOT twist or jerk. Clean site w soap & water. Save tick for identification in sealable plastic bag in freezer. Write date of bite on bag.

Question 4

S&S of sepsis

Answer 4

systemic over response to infection from bacteria, fungi, viruses, or parasites. Can lead to septic shock which results in hypotension, low blood flow, & multiorgan failure.
a. Labs- ↑WBC or if sever ↓WBC; ↑C-reactive protein, blood culture, urine culture, CSF fluid, stool culture, xray chest
b. Systematic inflammatory response syndrome (sirs) d/t infection. Results from the effects of circulating bacterial products of toxins.
c. Can lead to widespread inflammation, blood clotting, and organ failure. And shock.
S&S: not look or act right, crying, inconsolable, fever, hypothermia, lethargy, irritable, poor feed and suck, rash, dyspnea, nasal congestion, diarrhea, vomitting, decreased urine output, hypotonia, change mental status, seizures, tachycardia,

Question 5

S&S Cat scratch fever

Answer 5

cats carry bacteria in saliva (Bartonella benselae). Transmitted cat-cat via cat flea. Incubation period 7-12 days. Lymphadenopathy appears in 5-50 days. Self-limiting & resolves on its own between 2-4 months. Papule or pustule may occur at site of bite/scratch. Antibiotics may be required.
Headache, fever, anorexia, fatigue, enlarged lymph nodes, skin papule at bite or scratch area,

Question 6

Chicken pox cycle

Answer 6

Caused by varicella zoster virus, human herpes virus 3. Transmitted by direct contact or via air born spread, and mother to fetus. Incubation period 10-21 days. Communicable 1-2 days before onset of rash until all vesicles have crusted over. (About 3-7 days AFTER onset of rash. May return to school once lesions have crusted.

Question 7

Complications premature babies face

Answer 7

anything

Question 8

S&S Reye Syndrome

Answer 8

• reaction triggered by use of salicylate or salicylate- containing products to treat a viral infection. (aspirin) alkaseltzer, pepto
  a. Effects children <15 years old who are recovering from a viral illness. Exact cause in unknown.
  b. S/S ~sever & continual vomiting
  c. Changes in mental status
  d. Lethargy
  e. Irritability
  f. Confusion hyperreflexia (twitching, spastic behavior)

Question 9

Infantile Spams

Answer 9

 Uncommon
 Generalized seizure seen in epilepsy syndrome of infancy and childhood
 3-12 months of age
 Peak incidence 4-8 months, stops by age 2
 Presents as jerk and sudden stiffening
 Head flexed, arms extended, and legs drawn up (jackknife seizures)
 Majority of infants have some type of brain disorder before this begins
 Infant stops developing and loses any skills learned
 Tx: steroid therapy, anticonvulsants

Question 10

Absence seizures

Answer 10

Petit mal More frequent in girls than boys
 Uncommon before age 5  Sudden cessation of motor activity or speech, with blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids
 Complex absence seizure consists of myoclonic movements of the face, fingers, or extremities and possible loss of body tone.
 Lasts 30 sec
 Countless seizures in a day
 Not associated with a postictal (after seizure state)
 May go unrecognized or mistaken for inattentiveness b/c of subtle change in child’s behavior

Question 11

Tonic-clonic seizures

Answer 11

grand mal
 Extremely common
 Most dramatic type  Associated with an aura
 LOC and maybe a piercing cry
 Entire body experiences tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups
 Cyanosis occurs from apnea
 Saliva collects from inability to swallow
 Child may bite tongue
 Loss of sphincter control (bladder more common)
 Postictal phase: child will be semi-comatose or in a deep sleep for 30 min – 2 hrs; usually replies to painful stimuli.
 Has no memory of seizure, complains of headache and fatigue. Safety is a concern

Question 12

Myoclonic seizures

Answer 12

 Involves motor cortex of the brain.
 May occur along with other seizure forms  Sudden, brief, massive muscle jerks, that may involve the whole body or only one part
 Child may or may not lose LOC

Question 13

Atonic seizures

Answer 13

 Drop attacks
 Seen in children with Lennox-Gastaut syndrome  Loss of muscle tone. In children maybe only a sudden drop of the head
 Child will regain consciousness within a few sec to a min
 Can result in injury related to a violent fall

Question 14

Simple partial seizures

Answer 14

 Occurs in part of the brain
 The symptoms depend on which area of the brain is affected  Clonic or tonic movements involving the face, neck and the extremities
 Numbness, tingling, paresthesia, or pain
 10-20 sec
 Child is conscious and may verbalize during seizure
 No postictal state

Question 15

Complex partial seizure

Answer 15

 Common type of partial seizure
 May begin with a simple partial seizure then progress  May or may not have a preceding aura
 LOC is impaired
 Automatisms and complex purposeful movements are common features in infants and children
 Infants: lip smacking, chewing, swallowing, and excessive salivation, can be difficult to distinguish from normal infants behavior
 Older children: picking or pulling at bed sheets or clothing, rubbing objects, or running or walking in a nondirective and repetitive fashion
 Can be difficult to control

Question 16

Status Epilepticus

Answer 16

 Common neurologic emergency in children
 Can occur with any seizure activity
 Febrile seizures most common type
 It commonly occurs early in the course of epilepsy
 Can be life threatening  Prolonged or clustered seizures where consciousness does not return between seizures
 Age, cause of seizures, and duration influence prognosis.
 Prompt medical attention to reduce morbidity and mortality
 Tx: Basic life support, admin of anticonvulsants ( lorazepam, diazepam, fosphentyoin), blood glucose levels

Question 17

Febrile seizures

Answer 17

Febrile seizure are the most common type seen during childhood, affects children younger than 5. More common in boys, increased risk if family hx, may be a sign of dangerous underlying infection.Generalized seizure lasting less than 15 minutes, and occurs once in 24 hours, fever with no infection present.

Question 18

Neonatal seizures

Answer 18

immature brain is prone to seizure activity and metabolic, infectious, structural, and toxic diseases are more present at this age. They occur within the first 4 weeks of life and are most common in the first 10 days. .Underlying causes include hypoxic ischemia, metabolic disorders hypocalcemia and hypoglycemia, neonatal infection, intracranial hemorrhage, may effect development. Phenobarbital may be used in higher doses because the neonate metabolizes it faster.

Question 19

Care and Treatment for hydrocephalus

Answer 19

results from underlying brain disorder.
Tx: Goal is to relieve hydrocephalus and decrease complication of G&D. Endoscopic third ventriculostomy alternative to shunt placement. Ventriculoperitoneal shunt catheter, shunt diverts flow of CFS.
Care: Preventing and recognizing shunt infection and malfunction, Educate the family.
S&S irritable, lethargy, poor feeding, vomiting, headache, Decreased LOC, Pay close attention to skull size, motor function, LOC, visual disturbances,
Maintain cerebral perfusion, minimize neuro complications, maintain nutrition, promote G&D, support the family
Shunt infection: ^vitals, poor feeding, vomitting, decreased responsiveness seizures, local inflamation along shunt. Malfunction include vomitting, drowsy, headache.

Question 20

Neural tube defect and prevention

Answer 20

Common birth defect contributing to infant mortality and disability. Serious birth defect of the spine and the brain including: spina bifida occulta, myelomeningocele, menigocele, ancephaly, and encephalocele.
Cause is unknown but factors are: drugs, malnutrition, chemicals, and genetics.
Folic acid decreases incidence (0.4 mg of folic acid daily )

Question 21

linear skull fx

Answer 21

Simple fx, straight line

Most common, from head injury, not usually serious unless injury to brain

Question 22

Depressed skull fx

Answer 22

Broken and pushed inward causing pressure.

Forceful impact with small blunt object; surgery to elevate bone and inspect brain

Question 23

Diastatic skull fx

Answer 23

fx through sutures, most often lamboid suture. Usually only needs observation

Question 24

Compound skull fx

Answer 24

laceration of the skin and splintering of the bone. FX can be linear or depressed. Usual from blunt force, medical intervention and surgery needed

Question 25

Basilar skull fx

Answer 25

fx bones that form the base of the skull. Severe head trauma with significant force. Serious cuz close to brain stem. CSF rhinorrhea, and otorrhea, bleeding from ear, orbital and postauricular ecchymosis, ^ risk for infection,

Question 26

Concussion

Answer 26

mild brain injury from jarring,or shaking that disrupts the electrical activities of the brain. Most common head injury. Confusion, amnesia, possible loss of consciousness, distractable, difficulty concentrating. TX: rest, monitor neuro changes such as sleepiness, worsening headache, vomitting, confusion, difficulty waking, talking, seizures

Question 27

Contusion

Answer 27

Bruising of cerebral tissue. From shaken baby, fall, injury. May cause changes in vision, strength, sensation. Mild weakness-prolonged unconsciousness-paralysis. Close monitoring.

Question 28

Subdural hematoma

Answer 28

blood between dura and cerebrum. Most common under 2, Venous bleeding, symptoms appear within 3 days, late as 20. Vomitting, failure to thrive, LOC, seizures, retinal hemorrhage. May need surgery, monitor closely

Question 29

Epidural hematoma

Answer 29

collection of blood located outside dura but within skull. Uncommon. From fx. Severe head trauma. Arterial bleed, rapid brain compression,resulting in impairment of brain stem and respiratory and cardiovascular function. Vomit, headache, lethargy. Trt depends. May include evacuationa nd cauderization of the artery

Question 30

ischemic stroke risk factors

Answer 30

o Risk factors and causes in children- cardiac disorders and intracardiac defects (congenital such as ventricular septal defect, atrial septal defect, and aortic stenosis, or acquired such as rheumatic heart dz) Coagulation abnormalities lading to thrombosis, Sickle cell dz, Infection (meningitis), arterial dissection, genetic disorders

Question 31

hemorrhagic stroke risk factors

Answer 31

Vascular informalities such as intracranial arteriovenous malformation (AVM) , aneurysms, warfarin therapy, cavernous malformations, malignancy, trauma, coagulation disorders such as hemophilia, liver failure, leukemia, intracranial tumors: medulloblastomas.

Question 32

Stroke/Cerebral vascular disorders

Answer 32

sudden disruption in blood supply to the brain. Affects movement and speech. Ischemic and hemorrhagic. ischemic is more common. The cause is often unknown in children. Children often develop neurologic or cognitive deficit. S&S include one sided weakness, facial droop, slurred speech, speech deficits

Question 33

Early ICP

Answer 33

o	Headache
o	Vomiting possibly projectile
o	Blurred vision, double vision (diplopia)
o	Dizziness
o	Decreased P and R
o	Increased B/P or Pulse pressure
o	Pupil reaction time decreased and unequal
o	Sunset eyes
o	Changes in LOC, irritability
o	Seizure activity
o	In infants will also see
	Bulging, tense fontanel
	Wide sutures and increased head circumference
	Dilated scalp vein
	High pitched cry

Question 34

Late ICP

Answer 34

o	Lowered LOC
o	Decreased motor and sensory responses
o	Bradycardia
o	Irregular respirations
o	Cheyne-Stokes respirations (is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing)
o	Decerebrate or decorticate posturing
o	Fixed and dilates pupils

Question 35

decorticate posturing

Answer 35

damage of the cerebral cortex. Adduction of arms, flex elbows and arms on chest, flex wrists and fists, lower extremities are adducted and extended.

Question 36

decerebrate posturing

Answer 36

level of damage at the brain stem. damage to the midbrain and includes extension and pronation of arms and legs.

Question 37

ketogenic diet

Answer 37

• high fats, adequate protein, low carbs, child kept in mild dehydration
  -For children with difficult to control seizures
  -butter, heavy cream, oils
  Monitor I&O, seizures, growth and nutrition,

Question 38

communication with visual impaired

Answer 38

• call child’s name to get attention
  
  • identify yourself and what you are going to do
  • explain what others around are doing
  • make directions specific and simple
  • encourage exploration through touch
  • use child’s body for reference points of equipment
  • describe unfamiliar environments and provide reference points
  • use sight-guided technique when walking

Question 39

conjunctivitis

Answer 39

• inflammation of the bulbar or palpebral conjunctiva
  -3 types: bacterial, viral, allergic
  -bacterial- purulent discharge, mild pain
• treat with antibiotic drops or ointment, warm compresses can be used to loosen the crust
  -viral- watery discharge, lymphadenopathy, photophobia, tearing, eyelid edema
  -treat by relieving symptoms, use antiherpetic agent if cause is herpes
  -allergic- watery or stringy discharge, itching, eyelid edema
  -treat with antihistamines or mast cell stabilizer drops, cold compresses can be used for itching, wash child’s face and hands when coming in from outdoors, shower child before bedtime
  Teaching for conjunctivitis
  -wash hands after caring for child
  
  • do not share washcloths
  • encourage child not to rub eyes
  • rinse child’s eyelid periodically with cool water and washcloth

Question 40

nasolacriminal duct obstruction

Answer 40

• s/s: chronic tearing, mucopurulent drainage, redness of lower lid
  
  • treatment: wait and see until 12 months, doctor may probe duct to relieve obstruction
• teaching: clean eye frequently with moist washcloth, massage by gently pushing in and up then back down the side of the nose

Question 41

Periorbital cellulitis

Answer 41

• bacterial infection of eyelids and tissue surrounding the eye
  
  • s/s: edema of eyelid, pain, restricted movement of the eye, purple or red eyelid
  • treatment: IV antibiotics followed by oral antibiotics
• teaching: apply warm compresses for 20min q2-4 hours, call physician if child does not improve, is unable to move the eye, visual acuity changes, proptosis occurs

Question 42

Hordeolum

Answer 42

• stye, bacterial infection of the sebaceous gland of the eyelid follicle
  s/s: eyelid edema, redness, pain, purulent drainage
  -treatment: antibiotic ointment

Question 43

Chalazion

Answer 43

• infection of the meibomian gland, resolves spontaneously

- s/s: small nodule on the lid margin

Question 44

blepharitis

Answer 44

chronic scaling and discharge along the eyelid margin

- s/s: eyelid edema, redness
- treatment: antibiotic ointment

Question 45

refractive error

Answer 45

myopia (nearsightedness), hyperopia (farsightedness)

- s/s: blurred vision, eye fatigue, difficulty concentrating, headache
- treatment: eyeglass and contact use, frequent vision checks

Question 46

Astigmatism

Answer 46

• uneven curvature of the cornea
  
  • s/s: blurred vision, eye fatigue, headache, may tilt their head to the side to focus
  • treatment: eyeglass and contact use

Question 47

strabismus

Answer 47

misalignment of the eyes
2 types:
Exotropia- eyes turn outward
Esotropia- eyes turn inward
-s/s: diplopia (double vision), blurred vision, eye fatigue, tilting of the head to focus, history of bumping into objects, asymmetrical corneal light reflex
-treatment: eye patching of the stronger eye and eyeglass use

Question 48

Amblyopia

Answer 48

• poor visual development in structurally correct eye, “lazy eye”
  
  • s/s: one eye has greater visual acuity than the other
• treatment: strengthen the weaker eye by patching and eyeglass use, atropine drops reduce vision in the stronger eye

Question 49

Nystagmus

Answer 49

rapid irregular eye movement, “bouncing” of the eyes

- s/s: poor visual development
- treatment: refer to ophthalmologist and possibly neurologist

Question 50

Infantile glaucoma

Answer 50

• autosomal recessive disorder that occurs in interrelated marriages or genetic disorders
• s/s: large prominent eyes due to obstruction of aqueous humor flow, increased intraocular pressure, photophobia, clouding of the eye, tearing, conjunctivitis, child may keep eyes closed or rub them often
• treatment: surgery goniotomy-removal of the obstruction

Question 51

Congenital cataract

Answer 51

• opacity of the lens of the eye
  
  • s/s: visual development delay, absence of red reflex upon visual exam
  • treatment: surgery to remove the lens and contact use

Question 52

Retinopathy of prematurity

Answer 52

rapid growth of retinal blood vessels in the premature infant
-treatment: frequent visual exams, laser surgery

Question 53

S&S of hearing impairments

Answer 53

INFANTS: Wakes only to touch, not environmental noises, does not startle to loud noises, does not turn to sound by 4 months of age, does not babble at 6 months of age, does not progress with speech development.
Young Child: Does not speak by 2 yrs of age, communicates need through gestures, does not speak distinctly, as appropriate for their age, displays developmental (cognitive) delays , prefers solitary play, displays immature emotional behavior, does not respond to ringing of the phone or doorbell, focuses on facial expressions when communicating.
Older Child: often ask for statements to be repeated, is inattentive or daydreams, performs poorly at school, displays monotone or other abnormal speech, gives inappropriate answer to questions except when able to view face of speaker.
Any Age; Speaks loudly, sits very close to the TV or radio or turns volume up too loud, Responds only to moderate or loud voices.

Question 54

Conductive hearing loss

Answer 54

results when transmission of sound through the middle ear is disrupted. Causes include OME.

Question 55

sensorineural hearing loss

Answer 55

• is caused by damage to the hair cells in the cochlea or along the auditory pathway. May results from:
   Kernicterus
   Ototoxic medication
   Intrauterine infection with cytomegalovirus or Rubella
   Neonatal or postnatal infection such as meningitis
   Severe neonatal respiratory depression
   Exposure to excess noise

Question 56

mixed hearing loss

Answer 56

• occurs when the cause may be attributed to both conductive and sensorineural problems.
  Diagnostic tests for hearing loss:
  Whisper test, Weber and Rhine test

Question 57

AOM acute otitis media

Answer 57

: is a bacterial or viral infection of fluid in the middle ear.

• Partly explained by the short length and horizontal positioning of the Eustachian tubes, limit exposure to antigens and lack of previous exposure to common pathogens.
• Most significant factor for OM are Eustachian tube dysfunction and susceptibility to recurrent Upper Respiratory infections.

Question 58

Otitis media with effusion

Answer 58

• refers to the presence of fluid within the middle ear space without signs or symptoms of infection.
  
  • may occur independent of AOM, risk factors of OME include passive smoking absence of breastfeeding, frequent viral upper respiratory infections, allergy, young age, male sex, adenoid hypertrophy ET dysfunction and certain congenital disorders.
• complications of OME include, AOM, hearing loss and deafness.

Question 59

Otitis externa

Answer 59

: is defined as the infection and inflammation of the skin of the external ear canal.

• Caused by pseudomonas, staphylococcus aureus. Moisture in the ear canal contributes to pathogen growth. Commonly known as “swimmers ear”
• Ear pain, ear itching, ear drainage, or feeling fullness in the ear canal, possible difficulty hearing.

Question 60

Difference in eyes of children

Answer 60

The eyeball of infants and young children occupy a much larger space within the orbit than the adults does. More susceptible to injury. Visual accuity develops the first few years of life. 20-20 should be reached by 6-7 years old

Question 61

difference in the ears of children

Answer 61

Hearing is intact at birth. Infant have relatively short, wide, and horizontally placed Eustachian tubes. Increased risk for ear infections. As child matures, tubes become more slanted.

Question 62

conjunctivitis

Answer 62

a. Conjunctivitis is inflammation of the bulbar or palpebral conjunctiva. Most common cause is staph aureus. In the newborn it is usually chlamydia or gonorrhea. Common S&S include redness, edema, tearing, discharge, pain, and itching if allergies.
b. BACTERIAL: conjunctivae is inflamed; discharge is purulent, mucoid; mild pain; occasional eyelid edema; treated with antibiotic drops or ointment
c. VIRAL: conjunctivae is inflamed; discharge is watery, mucoid; lymphadenopathy, photophobia, tearing; eyelid edema is usually present; treated with symptomatic relief; if it is herpes, treat it with an antiherpetic agent
d. ALLERGIC: conjunctivae is inflamed; discharge is watery or stringy; itching; eyelid edema usually present; Treat with antihistamine and/or mast cell stabilizer drops.

Question 63

S&S of IBS

Answer 63

a. It doesn’t really talk about IBS all by itself, but includes Crohns and ulcerative colitis.
b. Abdominal cramping
c. Nighttime symptoms including waking due to abdominal pain or urge to defecate
d. Fever
e. Weight loss
f. Poor growth
g. Delayed sexual development
h. Skin tags or fissures in the perianal area indicates Crohns.

ROME criteria: 12 weeks or more of abdominal pain relieved by defecation, onset pain with change in frequency or form of stool, no structural or metabolic explanation.

Question 64

Cranial nerve tests

Answer 64

I: sense of smell
II optic
III oculomotor
IV trochlear
VI abducens have child follow object, pupil reaction, visual acuity
V trigeminal strength of suck or bite
VII facial symmetry of expressions, taste
VIII acoustic whisper test
IX glossophayngeal
X vagus gag reflex and swallow
XI accessory symetry of head position, shrug shoulders
XII hypoglossal tongue movements

Question 65

Cerebral angiography

Answer 65

x-ray of cerebral blood vessels with contrast and fluoroscope. .Increase fluids after

Question 66

S&S of bacterial meningitis

Answer 66

Meningitis is an infection of the meninges, the lining that surrounds the brain and spinal cord. It can lead to brain damage, nerve dmage, deafness, stroke, and death.
i. S&S: sudden onset, preceding sore throat or respiratory illness, fever & chills, headache, vomiting, photophobia, stiff neck, rash, irritability, drowsiness, lethargy, muscle rigidity, seizures. In infants they may have poor sucking and feeding, weak cry, lethargy, vomiting. They rest in the opisthotonic position.

Question 67

S&S of Aseptic meningitis

Answer 67

Meningitis is the most common type, usually a virus.
i. S&S: fever, general malaise, headache, photophobia, poor feeding, nausea, vomiting, irritability, lethargy, neck pain, positive Kernig and Brudzinski signs. Onset abrupt or gradual.

Question 68

Cleft lip

Answer 68

It is often associated with heart defects, ear malformations, skeletal deformities, and genitourinary abnormality. Complications include feeding difficulties, altered dentition, delayed or altered speech development, otitis media. If speech is not clear by 4, additional surgery may be needed. Cleft lip is usually repaired around 2 to 3 months. Cleft palate from 9 to 18 months.

risk factors include maternal smoking, prenatal infection, advanced maternal age, use of anticonvulsants, steroids, and other medications during pregnancy.

The infant needs to remain in the supine or sideline position and may need arm restraints. Prevent crying. Breast-feeding may allow a better seal. Pay extra attention to burping.

Question 69

Anorectal malformations

Answer 69

imperforated anus May require an ostomy while the bowel is repaired. The stoma can eventually be closed. Once reconnected the perineal skin is at risk for breakdown. Use a barrier cream and clean it once daily. Wipe liquid stool off with mineral oil and cotton balls. Avoid using baby wipes and frequent soap and water

Question 70

Meckel Diverticulum

Answer 70

fibrous band connects the small intestine to the umbilicus. Most common congenital anomaly of GI tract. Signs and symptoms include, anemia, severe colicky abdominal pain with intestinal obstruction. Administer your blood if severe anemia to stabilize the child before surgery. Maintaining NPO status before surgery.

Question 71

Inguinal Hernia

Answer 71

Abdomianl or pelvic viscera to travel to the inguinal region into the inguinal canal. More often in boys and contains bowel. In girls it contains fallopian tubes or ovaries. Surgical correction is performed when the infant is several weeks old and thriving. There will be a bulging mass in the lower abdomen or groin area. May be able to be reduced-pushed back through. It is only temporary. They must be surgically repaired. Teach family how to reduce it until surgery. Call if it becomes hard, discomfort, or painful.

Question 72

Umbilical hernia

Answer 72

Most often in preterm infants and more frequent in Africans. An incomplete closure of the umbilical ring allows intestinal contents to herniate through the opening. It will usually close on its own by five years of age. Teach the family how to reduce it. Do not try home remedies such as a quarter or a belly band to cover it.

Question 73

Dehydration

Answer 73

Risk factors include diarrhea, vomiting, decreased intake, high fever, diabetic ketoacidosis, extensive burns. Dehydrated children can deteriorate very quickly and experience shock. Evaluate mental status, fontanelles, sunken eyes, oral mucosa, skin turgor, heart rate tachycardia at first progressing the bradycardia, blood-pressure possible hypotension, extremities, urine output. For severe dehydration, IV fluids of 20mL/kg of NS or lactated ringers. Reasses and possible have maintenance IV fluids. 100ml-kg for first 10kg, 50ml for next 10, 20 ml for remaining. Add together, divide by 24hrs.

Question 74

Oral rehydration

Answer 74

Sodium chloride and glucose solutions such as Pedialyte Infalyte. Tapwater milk fruit juice soup and broth are not appropriate. Children with mild to moderate dehydration need 50 to 100 mL per kilogram of oral rehydration over four hours. regular diet once rehydrated.

Question 75

Vomiting

Answer 75

Prodromal period: nausea
Retching
Vomiting
Projectile could by pyloric stenosis
Effortless with GERD
Several hours after eating - delayed gastric emptying
middle of night - intracranial lesion or tumor
diarrhea food poison
epigastric pain-peptic ulcer, pancreatitis, cholecystis

Oral feeding is delayed 1-2 hrs after emesis. infant .5-2oz every 15 minutes.
Homemade 1q water, 8 t sugar, 1 t salt
ginger reduces nausea.

Question 76

Diarrhea

Answer 76

acute infectious-gastroenteritis is leading cause of death worldwide.
Most common from virus, but also bacteria, parasite, enteropathogens. Can be from antibiotics. chronic > 2 wks

Supplement with probiotics. Avoid prolonged use of clear liquids because of starvation stools. Avoid fluid high in glucose such as juice, gelatin, and soda which can worsen diarrhea.

Question 77

Oral Candidiasis - Thrush

Answer 77

fungal infection of oral mucosa. Risk immune disorder, steroid inhaler, immunesuppresive therapy, antibiotics.

Mycostatin(nystatin) qid following feeding.
Fluconazole po qd but is hepatotoxic. Give it with food to prevent N&V
Treat mom if infected.
Thick white patches on the tongue, mucosa, pallet, that resemble curdled milk. They do not wipe off easily. Assess for diaper rash which would be beefy red with satellite lesions.

Question 78

Hypertrophic Pyloric Stenosis

Answer 78

circular muscle of the pylorus hypertrophies, thickening, creates gastric outlet obstruction, causes vomiting between 2-4 wks life. More frequent and projectile vomiting. hungry after vomit. wt loss, dehydration, lethargy, possible family history. RUQ olive mass
Surgery: pyloromyotomy
Oral feedings resume in 1-2 days post op

Question 79

Intussusception

Answer 79

bowel telescopes into a more distal segment. Edema, vascular compromise, bowel obstruction. Most often males under 1. may be from a lead point such as polyp or diverticulum. Barium enema may reduce it. Possible surgical reduction or resection.
Signs and symptoms include crampy abdominal pain, severe pain where children draw up their knees and scream, vomitting, diarrhea, jelly stools, blood in stool, lethargy. It made reduce on its own and then recur. Sausage shaped mass in upper midabdomen.

Question 80

Symptoms of GERD

Answer 80

Recurrent vomiting, weight loss or poor weight gain, irritability, chronic cough, wheezing, Strido, Asthma, apnea, sore throat, hematemesis, halitosis, heart burn, abdominal pain, abnormal neck posturing, sinusitis, otitis media, dysphasia, poor dentition. In a baby it often causes bradycardia, arched back after feeding, and grimacing. Frequent burp, elevate head, do not place in swings

Funduplucation and possible gastrostomy tube if conservative measures don’t work.

Question 81

Peptic ulcer disease

Answer 81

Epigastric or periumbilical, dull, vague pain. GI bleed, vomiting. Pain worsens after meals, wakes at night. Adolescents at increased risk if use tobacco, alcohol, and caffeine.

H pylori

Question 82

encopresis

Answer 82

soiling of underwear past 4-5 years. Often from chronic constipation and withholding of stool.

Usually requires behavior modification

Question 83

Hirschsprung disease

Answer 83

inadequate motility in part of the intestine because of lack of ganglion cells. This section needs to be removed. Possible ostomy while it is. Do not pass a meconium stool in first 48 hours, or pass a meconium plug. Barium enema or rectal suction biopsy to evaluate ganglion cells.

Question 84

Celiac disease

Answer 84

gluten free for life

Diarrhea, steatorrhea (fatty stools), constipation, failure to thrive, wt loss, distention or bloating, poor muscle tone, irritable, listlessness, dental disorders, anemia, delayed puberty, nutritional deficiencies,

Question 85

Pancreatitis

Answer 85

Acute causes: Abdominal trauma, drugs and alcohol, multisymptom disease such as IBS & lupus, infections, congenital anomaly, obstruction, metabolic disorders

Chronic: based on structural and functional permanent changes

If suspected, immediate NPO status, NG suction, amylase levels. IV fluids,

S&S: Acute onset of persistent mid epigastric and periumbilical abdominal pain radiates to the back or chest. Vomiting after meals. fever.

Question 86

Biliary Atresia

Answer 86

absence of some or all major biliary ducts, obstructing bile flow>fibrosis, liver cirhosis. Kasai procedure-hepatoportoenterostomy to connect bowel to bile lumen. Usually at 10 wks old. If this isn’t caught early enough, they may need liver transplant.

Persistent recurring jaundice. Stools will lack bile, be white and chalky, enlarged liver and spleen.

Give fat soluble vitamins such as ADEK, special formula,

Question 87

Hepatitis

Answer 87

inflammation of liver.
Acute treated with rest, hydration, nutrition, control of bleeding
Chronic usually requires liver transplant
S&S: jaundice, fever, fatigue, abdominal pain