Pediatrics Exam 2 Flashcards
SIADH treatment
- Use fluid restriction
- Give sodium supplements
- Give diuretics (increase urine output)
HgB A1C
Measures blood glucose over 90 days
Hypoglycemia – symptoms
• Lethargic
• Irritable
Eat something that will convert into sugar or carbs (drink a glass of milk)
• “unresponsive” “not acting right”
• Dizzy, sweaty, pale
• Behavior changes
• Decrease BSHyperglycemia – symptoms
• Increased thirst
• Dry mucous membranes
• Increase urine output
• 3 p’s
Polyuria
Polydipsia
Polyphagia
• Skinny, underweight, weight loss
• Diabetic ketoacidosis
Dehydrated
Mental confusion
Fruity breath odor (classic symptom)Diabetes Insipidus – first sign
Bedwetting after toilet training (Enuresis)
Animism
Giving lifelike qualities to inanimate objects
ex: Toy Story (Andy gives his toys living characteristics)
Role-playing
• Imaginary friends
Encourage parents to accept and use friend name and acknowledge friend
Do not sit on imaginary friend if in chair, etc.
Risk factors for overweight children in US
• High calorie snack foods
• Sedentary activities
-Video games, computer, tv more readily available
• Using food as a reward for desired behavior
Team play
- Great way to socialize children into adult world
* Sports, school, mixing boys & girls
Safety equipment
- Helmets
- Eye protection
- Mouth protection
- Sport safety
Socialization using what type of play
• Team play
-Sports, school, mixing boys & girls
• Peer groups
-Most important aspect of socialization
-Helps gain independence
-Modifying behavior to be accepted
-Peer pressure
Sleeping long hours due to rapid growth
- Difficulty awaking, sleepiness during day
- Difficulty going to sleep & periods of wakefulness during night emerge during adolescent years
- Many teens report chronic or severe sleep disturbances; those reporting sleep disturbances also described themselves in negative terms
- Sick= sleeps more
Risk taking behaviors
• Smoking
• Alcohol
• Drugs
-Peer pressure; teach parents to address this head on and not ignore
Developing self-image
- Concerned with normalcy of their physical status
- Concerned how they appear to others & compare themselves to peers
- Search for “body beautiful”
- Binging and vomiting lead to significant health problems
- Eating major part of socialization process
Parental behaviors of concern
• Using food as a reward
-Contributes to obesity
• Ignoring risk taking behaviors
-Teach parents to address head on
Priority treatment for status epilepticus
• Assess airway FIRST
o Make sure it is open/ getting enough air
Seizures – risk factors
- Febrile episodes
- Low sodium levels
- Hypoglycemia
- (most common pediatric neurologic disorder)
Early signs of increased ICP
- Headache
- Blurred vision
- Nausea/ vomiting
Late signs of increased ICP
- Decrease in consciousness
- Bradycardia
- Decreased motor response
- Decreased response to pain
3 signs related to meningitis – describe each
• Nuchal rigidity
-Stiff neck
-Usually 1st
• Brudzinski’s signs
-Forced neck flexion pull knees up
• Kernig’s signs
-Inability to straighten leg when hip flexed at 90 degrees
-hamstring is stiffBacterial meningitis – vaccine will prevent
Hib vaccine
Near drowning – Primary problem
hypoxia
Glasgow Coma Scale – components
- Eye opening
- Verbal response
- Motor response
Priority treatment for Botulism
Botulism IVIG
- Start without waiting for confirmation
- Start ASAP if botulism is suspected
Cerebral Palsy – developmental milestones
Unable to hold head up by 3 months old
Neural tube defects – Maternal factors, blood test
Anencephaly
- Underdeveloped brain
- 1st 24 weeks of pregnancy, increased AFP
Myelodysplasia- Spina Bifida
- Neural tube fails to close in utero (usually lumbar area)
- Occulta
- Not visible externally, may have a dimple
Meningocele
-Not associated with neuro deficit
Myelomeningocele
- Spina bifida meninges, spinal fluid and nerves
- Maternal AFP
If you have neural tube defects, they usually occur in the first 24 weeks of pregnancy. If alpha feet proteins are elevated, then there are neural tube defects. People with prenatal care take folic acid to prevent them. Today, these are not as common with proper prenatal care
Duchene Muscular Dystrophy – First sign
Difficulty rising from a sitting or supine position
Guillian-Barre – most often associated with what?
-Viral infection/ immune mediated disease
- Ascending paralysis
- Starts at feet and moves up
5 P’s related to cast care and which is most ominous and when should you call physician
• Paralysis
• Paresthesia
• Pain (Increased)
• Pallor
• Pulselessness
If blue and no pulse
1st get cast saw before calling dr.Reasons for traction
• Resist the response of the muscle
• Immobilization
• Alignment
-Realign: pull 1 direction while counter pulling into other direction (manual)
-Prevent contractureOsteogenesis Imperfecta – common findings
- Inherited disease
- Blue sclera
- Indigenous teeth (short in stature)
Bryant’s traction – How does it help?
- Realign bone fragments
* Alleviates pain
Scoliosis – Gold standard treatment
Bracing
Myelomeningocele – Care prior to surgery
- lay prone
- knees/hips flexed
- dressing with NS
Fracture – Most common site in children
Growth Plate
Hemophilia A – treatment
• Factor concentrate
• DDAVP: synthetic vasopressin that increases plasma factor VII and vWF levels
• Physical therapy
• Home infusion
-Treatment without delay
• Aggressive factor replacement: high dose od factor when bleeding occurs
• Bleeding prevention, recognizing s/s of bleeding
Sickle cell disease treatment
o Adequate oxygenation o Hydration o Electrolytes o Transfusions o Antibiotics o PAIN CONTROL
Sickle cell disease genetics
Presence of hemoglobin S
-Replacing some or all of hemoglobin A
-Diagnosis depends on how much Hgb S has replaced Hgb A
-The more Hgb S= more severe course
Hemoglobin electrophoresis to detect types of Hgb in pt. blood to accurately diagnose SCD
Chances of having another child with sickle cell
25% of a SCA baby if both parents have sickle cell trait
Sickle Cell disease: Risk factors leading to vaso-occlusive crisis
o Pain
o Priapism (prolonged erection of penis, usually without sexual arousal)
o Acute chest syndrome
o Stroke
Down Syndrome – clinical characteristics
- Rounded small head with flat occiput
- Inner epicanthal folds
- Small flat nose with depressed nasal bridge
- Small, short ears
- Protruding tongue
- Short, broad neck
- Protruding, lax, and flabby abdominal muscles
- Broad, short fingers
- Transverse palmar crease
- Short stature
Parental behavior that might alert to abuse
• incompatibility with history vs. injury seen
-conduct skeletal x-ray to detect old fractures
• overly charming, extremely cooperative
• tells you what you want to hear
• violent, aggressive behavior
• unrealistic expectations of child
• alienated from family; no family support
• isolation; lack of contacts
• calls child offensive names, chronically ridicules child
• rejects child or obvious preference of one child
• blames child for problems
• leaves child in hostile or dangerous situation
• abuses substances
• pulls child’s hair
Most common fracture associated with abuse
Spinal fracture
What are ACEs?
• Various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood
• Injury (Fractures, burns, shaken baby syndrome, etc) • Mental health (Depression, anxiety, suicide, ptsd) • Disease • Risky behavior (Alcohol and drug abuse, unsafe sex) • Lack of opportunity (poverty, etc.)
Long term effects of childhood trauma
- Flat affect, no stranger danger
- Self-stimulation
- Begging for food (stealing)
- Absent from school
- Vandalism
- Destructive (animals, people)
- Extreme passiveness or aggressiveness
- Lacks emotional intelligence
- Suicide attempts
- Learning disabilities
Tylenol Safe Dosage
- 10-15mL/kg/dose
* Do not administer more than 5 doses in 24 hrs.
