Pediatrics Flashcards
the most common condition found in premature newborns; it can lead to heart failure and inadequate oxygenation of the brain
patent ductus ateriosus
opening in the septum between the right and left atrium; results in ‘wet lungs’ (blood) and may lead to respiratory infection; right ventricle works hard and may lead to heart failure; poor exercise tolerance and small for chronological age
atrial septal deficits
one or more openings in the muscular or membranous portions of the ventricular septum; 50% self-correct by age 5; may result in Eisenmenger’s complex, pulmonary vascular obstruction, increased blood flow. and high pressure; feeding difficulty, SOB, increased perspiration, increased respiratory infections, fatigue with activity, delayed growth
ventricular septal deficits
pressure in the pulmonary arteries becomes so high that it causes oxygen-poor (blue) blood to flow from the right to left ventricle and then to the body, causing cyanosis. The high pressure also causes the wall of your heart’s right ventricle to thicken (hypertrophy)
Eisenmengers syndrome
decreased pulmonary blood flow characterized by pulmonary valve or artery stenosis, ventricular septal deficits, right ventricle hypertrophy, and override of ventricular septum; central cyanosis, coagulation defects, finger/toe clubbing, feeding difficulty, failure to thrive, dyspnea
Tetralogy of Fallot
mixed pulmonary blood flow characterized by no communication between systemic and pulmonary circulations; result of coexisting congenital transposition of ventricles; cyanosis, CHF, respiratory distress
transposition of great arteries
abnormally slow heart rate (<60 bpm); typically atrioventricular block; may require a pace maker
bradydysrhythmia
abnormally fast heart rate for a child (>200-300 bpm); can lead to CHF; irritability, poor eating habits, palor
tachydysrhythmia
compromised oxygen absorption and carbon monoxide elimination caused by a deficiency of surfactant (produced 34-36 weeks gestation); many recover after a few days and some develop chronic lung conditions
respiratory distress syndrome
airway thickening, formation of excess mucus, and restricted alveolar growth as a result of prolonged use of mechanical ventilation and other traumatic interventions to treat acute respiratory problems; at greater risk for respiratory infections
bronchopulmonary dysplasia
bronchial smooth muscle hyperreactivity that causes airway constriction in the lower respiratory tract, difficulty breathing, and wheezing
asthma
degenerative condition (chromosome 7); muscle-producing glands malfunctioning and producing secretions that are thick, viscous, and lacking in water and block the pancreatic duct, bronchial tree, and digestive tract; abdominal distension, salty-tasting skin, excess sodium levels, greasy/foul stools; can lead to chronic pulmonary disease and enlarged R heart (heart failure)
cystic fibrosis
hematological disorder characterized by too many red blood cells and elevated white blood cells; experienced by 1 in every 150 children with down syndrome
eryhtocytosis or transient leukemia
blood disorder commonly affecting males; characterized by the absence or reduction of one of the clotting blood proteins; longer bleeding time, bleeding episodes, excessive bruising, nosebleeds
hemophilia
severe hemophilia is differentiated because of it’s effect on
joints and muscles
an iron deficiency in the blood treated through diet; may be symptom of lead poisoning, vitamin deficiency, leukemia, and sickle-cell disease
anemia
abnormally shaped red blood cells; common in African-Americans; decreased energy for daily tasks, at risk for organ damage, painful
sickle cell anemia
brittle bones with minor trauma able to cause a fracture; decreased bone deposition from inability to form type I collagen; transmitted by autosomal dominant; range from mild to severe (indicated by age of onset); handling and monitored weight bearing important
osteogenesis imperfecta (OI)
excessive growth at epiphyseal plates; long slender fingers, skull asymmetry, tall stature (joint/eye/heart differences); lax/hypermobile joints and poorly developed striated muscles; walking delayed but otherwise meets developmental milestones
Marfans syndrome (arachondactyly)
‘that MF is tall’
stunting of epiphyseal plate growth and cartilage formation; 4 feet tall or less; short limbs, prominent forehead, small nose and jaw, trunk normal; lumbar lordosis, coxa vara cubitus varas, back/leg pain
achondroplasia (chondrodystrophia/dwarfism)
hip deformity
coxa vara
part of limb deviates to midline of body
cubitus varas
reduced anterior horn cells in the SC; incomplete contracture (fibrous ankylosis) of many joints; thick/spindly extremities, thickened knee/elbow joints; muscles underdeveloped/paralysis; increase ROM and adaptive equipment
arthrogryposis multiplex congenital
fibrous connective tissue process which results in decreased range of motion.
Fibrous ankylosis
unilateral or bilateral forefoot adduction and supination, heel varus (midline), equinus of the ankle (tightness), and medial deviation of the foot; underdeveloped LE musculature; passive treatment
congenital club foot (talipes equinovarus)
bilateral hip laxity causing increased uterine pressure and poor presenting positions (hereditary or in utero); sudden passive extension with legs extended/adducted when caused in utero; breech presentation; if not treated early with splinting, trendelenburg sign can result and may need surgery
developmental dysplasia of the hip (congenital hip dislocation)
assess for dysplasia by examining whether clicking is present when the leg is abducted and pressure placed on the medial thick
barlow test
hip drop to the opposite side of dislocation and trunk shift toward the dislocated hip when standing on one foot
Trendelenburg’s sign
physical anomaly in which a person has an excess of finger or toes (relatively common); amputation or reconstruction in childhood
polydactyly
condition in which webbing occurs between the fingers or toes; frequent in the UE’s of boys; splinting and scar reduction
syndactyly
overly small digits (plastic surgery may be performed)
microdactyly
absence of a limb or distal segment of a limb
amelia
fully or partially formed distal extremity and absence of one of more proximal segments
phocomelia
proximal segments of the limb are correctly develoed but either the medial or lateral side of the rest of the limb is missing
paraxial deficiencies
amputation of a limb segment across the central area; common for bilateral or hemilateral presentations
transverse hemimelia
muscle injury caused by too strong an effort or excessive use of a particular body part; trauma to the muscle or muscle-tendon insertion
strain
ligament injury caused by trauma to a joint characterized by rapid swelling, heat, and impaired function
sprain
childhood arthritis occurring between 2 and 4; characterized by persistent arthritis in one or more joints for >6 weeks; joint inflammation, joint stiffness, joint contractures; splint, AROM/PROM, prevent deformity, energy conservation, adaptive equipment, joint protection
juvenile rheumatoid arthritis (JRA)
JRA involving fewer than 5 joints
pauciarticular
JRA involving more than 5 joints
polyarticular
polyarticular JRA with organ involvement; high fever, rash, anorexia, elevated WBC, enlarged liver and spleen
systemic JRA (Still’s disease)
fracture where the bone is broken into many splintered pieces
comminuted
fracture where broken bone leads to external wound at side and bone often protrudes through the skin
compound
fracture occurs between the shaft of the bone and epiphysis; only occurs in pediatric clients
epiphyseal
fracture where bone is partially broken and partially bent; only occurs in children and frequently with Rickets
greenstick fracture
anteroposterior curvature directed posteriorly (hollow back) as a result of anterior pelvic tilt in the lumbar region (common); secondary to obesity, hip flexion contractures, and muscular dystrophy; treat underlying cause
lordosis
posterior convexity (round back) primarily in upper back; result of faulty posture (skeletal growth outpaces muscular growth); common in spina bifida cystica and arthritis; postural training, strengthening, Milwaukee brace, spinal release/spinal fusion
kyphosis
brace that runs from pelvis to base of skull; useful for kyphosis
Milwaukee brace
lateral curvature, spinal rotation, and thoracic hypokyphosis; treat if lateral curvature > 10 degrees; < 20: mild; > 40 permanent deformity; 65-80 reduced cardiopulmonary function; Boston brace (children), TLSO; strengthening, ADL adaptations
scoliosis
scoliosis caused by poor postural tone, hip contractures, leg length discrepancy, pain; spine flexible
functional scoliosis
scoliosis that is usually structural, caused by abnormal spinal or spinal cord structure or disease of the nervous system
congenital scoliosis
non progressive condition the includes neurologic, motor, and postural deficits; common comorbidities include language, cognitive, sensory, and psychosocial deficits; feeding and seizure disorders common; difficulty maintaining normal muscle postures because of a lack of muscle co-activation and development of abnormal compensatory movement patterns
cerebral palsy
congenital CP is most commonly the result of ________ and infants are at risk __________ weeks gestations
prematurity; 26-32 weeks
retention of primitive reflexes, abnormal/variable tone, hyperresponsive tendon reflexes, asymmetrical extremity use, clonus, poor feeding/tongue control, and involuntary movement may indicate
cerebral palsy
quadriplegia with mild UE involvement and significant LE involvement
diplegia
fluctuation of tone from low to normal with little spasticity
athetosis
constant fluctuation from low to high tone without co-contractions; appear as jerky movements
choreoathetosis
tone within normal range but involving LE flexion patterns
ataxia
2 functional classification systems for CP
manual ability classification system
gross motor function classification system
eye alignment deviation (CP)
strabismus
reflexive back and forth movement of the eyes when the head moves (CP)
nystagmus
difficulty pronouncing or articulating words (CP)
dysarthria
associated with poor language development; looks as though person has difficulty comprehending the meaning of certain words (CP)
aphasia
seizure that involves the entire cerebral cortex
generalized seizure
most frequent type of generalized seizure; person experiences a sensation that seizure is about to begin; followed by LOC and rhythmic clonic contractions; may last as long as 5 minutes; incontinence common; may be drowsy and sleep 1-2 hours
tonic clonic seizures
generalized seizure with a brief lapse or loss of awareness along with absence of motor activity (including eye blinking); lasts 30 seconds or more; mistaken as day dreaming
absence seizures
generalized seizure with contractions of single muscles or muscle groups
myclonic seizures
generalized seizure with loss of muscle tone for more than 30 minutes
akinetic seizure
seizure that begins in a single location and then spreads or remains limited to one area of the cortex
partial seizure
partial seizure that originates in the temporal lobe and appears as lip smacking, chewing, or buttoning and unbuttoning clothing; similar to absence seizures
complex partial seizure
partial seizure that originates in the motor cortex and results in clonic activity of the face/extremities; may experience visual/auditory hallucinations or olfactory sensations
simple partial seizure
experiencing both generalized and partial seizures
mixed seizure disorder
spasms that begin between 6 and 24 months; development stops or slows considerable; some skills lost
infantile spasms
condition that results in progressive degeneration and weakness of a variety of muscle groups and could lead to death; result of biochemical and structural changes of the surface and internal membranes of muscle cells; hereditary link
muscular dystrophy
muscular dystrophy that affects the proximal muscles of the pelvis and shoulder girdle; occurs within first 30 years of life; slow progression
limb girdle muscular dystrophy
muscular dystrophy that affects the face, upper arms, and scapular region; onset in adolescence; slope shoulders and limited ability to raise arms over head; ‘masklike’ appearance of face
Facioscapulohumeral muscular dystrophy
most common form of muscular dystrophy affecting only boys; deficiency in production of dystrophin causing muscles to degenerate; develops after birth with signs between 2-6; enlarged muscles and positive Gower’s sign; difficulty going up/down stairs and getting up from lying-down; die in 20’s as result of respiratory/cardiovascular complications
Duchenne’s muscular dystrophy
when asked to get up from sitting on the floor, the child will move the hands on the legs as though crawling up to the thighs and then assume a standing position
Gower’s sign
muscular dystrophy characterized by brain involvement, neuromuscular functioning, hypotonia, generalized muscle weakness, and contractures; clubfoot, torticollis, diaphragm involvement, heart/spinal defects
congenital muscular dystrophy (CMD)
CMD that does not involve intellectual functioning
CMD I
CMD that does involve muscle and brain abnormalities
CMD II
CMD that involves muscle, brain, and eye abnormalities
CMD III and IV
protrusion in the occipital region of the brain; associated with severe cognitive impairments, hydrocephalus, motor impairment, and seizures
encephalocele
neural development above the level of the brain stem lacking; do not survive infancy
anencephaly
congenital defect of the vertebral arches and spinal column
spina bifida
mild spina bifida with 1 or 2 affected vertebrae and no SC involvement; may have no symptoms
spina bifida occulta
extensive spinal opening with an exposed pouch of CSF and meninges
meningocele (spina bifida)
excessive spinal opening with an exposed pouch of CSF and meninges with nerve roots exposed; severe; sensorimotor problems, LE paralysis, hip/spine/foot deformities; complications include hydrocephalus and arnold-chiari syndrome
myclomeningocele (spina bifida)
is a condition in which brain tissue extends into your spinal canal. It occurs when part of your skull is abnormally small or misshapen, pressing on your brain and forcing it downward.
arnold-chiari syndrome
caused by an injury to the upper brachial plexus (C5/C6) such as extreme shoulder flexion (with arm overhead); breech deliveries; weakness or wasting of small hand muscles and sensory discrimination in hand/arm; unilateral; UE paralysis affecting more shoulder musculature; recovery depends on extend and occurs 3-24 months
Erb-Duchenne palsy
characteristic arm position for Erb-Duchenne palsy
should adduction/internal rotation, elbow extension, forearm pronation, wrist flexion (waiters tip position)
injury resulting from compression or traction of the lower brachial plexus (C8/T1); paralysis of hand and wrist muscles (claw hand deformity); severe can result in full paralysis of entire UE
Klumpke’s palsy
class I peripheral nerve injury with some degree of paralysis but no peripheral degeneration
neurapraxia
class II peripheral nerve injury with the endometrium intact but the axon degenerated distal to the lesion
axonotmesis
class III peripheral nerve injury where the axon and endometrium are severed
neurotmesis
when is a child considered to have an intellectual disability (3 factors)
(1) scores on psycho educational assessment > 2 SD below normative range for child’s age (2) before age 18 (3) impairment in adaptive abilities
IQ between 55 and 70; able to learn academic skills at 3rd to 7th grade level; work with minimal support
mild intellectual disability
IQ between 40 and 55; able to learn academic skills at 2nd grade level; perform unskilled and some skilled work tasks
moderate intellectual disability
IQ between 25 and 40; able to communication and perform basic ADLs and health habits; requires support to complete routines
severe intellectual disability
IQ below 25; requires caregiver assistance for basic tasks; neuromuscular, orthopedic, or behavioral deficits
profound intellectual disability
neurologic soft signs indicative of intellectual disabilities (4)
(1) poor balance, (2) motor asymmetry, (3) decreased perceptual-motor skills, (4) decreased fine motor skills
assesses sensory processing in the home and school environment
sensory processing measure
difficulty taking others’ perspectives and hypothesizing about what they might do next; common for individuals with ASD
theory of mind
acute sense for detail almost to the point of missing the bigger picture; common for individuals with ASD
weak central coherence
poor motor planning ability; common for individuals with ASD
dyspraxia
using variation in pitch, emphasis or rhythm of speech; difficult for individuals with ASD
prosody
use of language in social situations; difficult for individuals with ASD
pragmatics
progressive neurological disorder caused by a genetic mutation found in girls; development appears normal for 6 months; head growth then slows, hand skills lost, and poor trunk/gait coordination; initial loss of social skills with re-emergence; handwringing and hyperventilation common; non-ambulatory and non-verbal by late childhood
Rett’s syndrome
what area of the brain is diminished in ADHD and what does this brain area control
parietal lobe; inhibition and attentional control
difficulty with reading
dyslexia
difficulty with writing
dysgraphia
difficulty with math
dyscalculia
involuntary swearing (Tourette’s)
coprolalia
precautions for children with atlantoaxial instability (down syndrome)
clearance for sports, avoid neck hyper flexion, do not perform front rolls
chromosomal disorder with short stature, small head, low-set ears, flat nose, slack jaw, short extremities and phallanges, simian hand; cardiovascular abnormalities, obesity, respiratory infection, and poor visual acuity common; atlantoaxial instability (AAI)
Trisomy 21/Down syndrome
chromosomal disorder with multiple anomalies affection the eyes, ears, nose, lip, palate, and digits; microcephaly and neural tube differences; 20% survival rate
Trisomy 13/Patau’s syndrome
chromosomal disorder with neck webbing, congenital edema of the extremities, and cardiac problems; short/obesity/lack sexual characteristics; no intellectual disabilities but visual perception deficits
Turner’s syndrome
chromosomal disorder with weak and ‘cat like’ cry in infancy, microcephaly, down-slanting eyes, cardiac abnormalities, failure to thrive, intellectual disability, hypotonia, feeding/respiratory problems
Cri du char syndrome
condition where the head circumference is smaller than normal
microcephaly
boys with extra C chromosome; learning disabilities, emotional/behavioral problems, tall/slim, small genitalia, unable to father children
Klinefelter’s syndrome