Peds Flashcards
Define the two parts of the prenatal period
When do the most critical stages of development occur
What are TORCH infections
Embryonic: through 8wks EGA
Fetal: 9wks EGA +
First trimester
Toxoplasmosis Rubella CMV HSV
Rh incompatibility can lead to ? OB complication
Define APGAR
Why are the timings of this score different
Hydrops fetalis
Appearance Pulse Grimace Activity Respiration:
0-10pts w/ 5 features, done at 1min and 5min-
Rpt q5min if score <8
1min: tolerance of birthing process
5min: tolerance to life
What are the APGAR scores made
Appearance:
0- cyanotic 1- Acrocyanosis/blue extremities 2- all pink
Pulse:
0- none 1- <100bpm 2- >100bpm
Grimace w/ bulb suction to nares:
0- none 1- grimace/cry w/ stimulation 2- sneeze/cough/withdrawal w/ stimulation
Activity:
0- limp/none 1- some flexion 2- active
Respiration:
0- none 1- weak/slow/irregular 2- strong cry
Newborn respiratory rate
Newborn HR
What are the next steps taken for abnormal HR ranges
30-60/min w/ inc number if premature
120-160
> 100: routine care
60-99: ventilation support
<60: ventilation w/ compressions
Neonatal Resuscitation Protocol flow chart
Compressions at 120bpm w/ two thumbs > two fingers
3 compression : 1 respiration
BVM sniffing position (neck w/ slight extension) w/ 40-60 bpm
How do premature/neonates respond to hypoxia
What fluids are used during NRP
What is the next step for asystole/bradycardia unresponsive to O2
Apnea rather than tachypnea
10mL/kg NS for hypo-volemia/tension
IV Epinephrine
Rules for Narcan usage in newborns
? care is routine for all infants and w/ ? goal
What are the two categories of this care and what is done during each
Yes- opiates used during labor
No- maternal addict/methadone d/t withdrawal seizures
Nursing- prevent illness/complications w/ high level of morbidity/mortality
A) Shortly after:
Erythromycin ointment- prevent G/C conjunctivitis
Vit K injection- prevents Hemorrhagic Dz of Newborn
HBV- only vaccine given at birth
B) 24hr Routine Care: Bilirubin screen Congenital heart screening Genetic/Metabolic screen (AKA- newborn screen) Hearing
Infants receive Vit K injections into their thigh at birth to prevent HDzoN which is more common in ? population and will present as ?
? genetic/metabolic tests are included in the Newborn Screen
Infant length is done in ? position until ? time frame and when are inaccurate measurements most likely to occur
MC in breast fed infants in first few weeks of life;
Generalized ecchymosis
GI bleeds
Umbilical/Circumcision bleeding
CF CAH PKU Sickle TSH
Laying down until 2yrs old;
First week d/t positioning
Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how
Spo2 95% or higher w/ 3% or less difference between right hand/foot= negative screening, plan for d/c
SpO2 90-94% in right hand/foot or 3% difference= repeat in one hour; same results- repeat again in one hour; 3 readings in same range= echo
SpO2 <90% in right hand/foot= +screen- order Echo
? is the number one cause of LBW
Criteria for Low/Very Low birth weights
What are the RFs for LBW
Prematurity
Low: <2500gm; Very: <1500gm
Previous LBW baby Age <16, >35 Socioeconomic status Tobacco/ETOH/Drugs Poor weight gain during pregnancy Education Antenatal care
Normal sutures and two abnormal findings possibly seen in newborn HEENT exam
Define Caput Seccedaneum
Define Cephalohematoma
Normal: open/flat sutures
Anterior suture >5cm suggests hypothyroidism
Closed sutures: craniosynostosis
Boggy, edematous swelling crossing lines, self resolves
RBC breakdown/jaundice causing swelling w/out crossing suture lines
? head malformation is associated w/ vacuum deliveries and how is it Tx
Define Hydrocephalus, the two types, and Tx
Subgleal hemorrhage- swelling crosses suture lines pushing ears anteriorly;
Tx: Compression w/ resuscitation PRN
Inc CSF volume- macrocephaly, bulging fontanelle, ‘setting sun’ gaze;
Communicating w/ subarachnoid
Non-Communicating= obstructed
Tx: ventriculoperitoneal shunt
What can cause an abnormal red reflex on newborn eye exam
What optic abnormality can be normal until 4mon old
How is normal ear positioning verified
Leukocoria: cataract, tumor, retinopathy of prematurity
Disconjugate gaze: eyes fail to move in same direction; alignment achieved at 4mon old
1/3 of ear above canthus/occipital protuberance line
20* from anterior of lobe to superior helix
Define Epstein Pearls and Bohn Nodules
What parent education goes w/ Dx
When conducting new born exams, how do neck bulge locations hint at Dx
EP: Keratin cysts on gums/palate
BN: Keratin cysts on salivary tissues
Harmless, resolve in first week of life
Anterior midline: thyroid d/o
Anterior to SCM: brachial cleft cyst
Posterior to SCM: cystic hygroma
What do each of the following suggest for cardiac d/o/dz
Weak pulse
Bounding pulse
Single second sound
Holosystolic, continuous, harsh
Grade 3/>
Diastolic murmur
Hempatomegaly
Weak: poor CO/AS
Bounding: high CO, PDA
Second sound: cyanotic dz- truncus/hypoplastic heart
Holosystolic, continuous, harsh- pathologic
Grade 3/>: pathologic
Diastolic: pathologic
Hempatomegaly: left sided HF
How are lower extremity pulses assessed during newborn exam
? abdomen shape suggests diaphragmatic hernia
? umbilical finding suggests need for detailed exam
Brachial and femoral together:
Pulse pressure >40mm= r/o PDA
LE < UE pulse= r/o coarctation
Scaphoid
Two vessels: 1 artery, 1 vein instead of normal 2A/1V
Umbilical cord stump remaining longer than ? needs further work up
? DDxs need to be r/o
1mon
Umbilical polp: sticky surface
Patent Urachas: urinary d/c
Meckels: proximal end of vitelline duct
Vitelline duct: odorous d/c
What is the main concern w/ hip exam
Since all infants are born w/ limited laxity, what are the three concerns if this persists
RFs for Congenital Hip Dysplasia
Congenital Hip Dysplasia- spontaneous dislocation and reduction of femoral heads; L > R
Flat acetabulum
Muscle contraction limiting ROM
Capsule tightening
Female First FamHx
Breech
Oligohydramnios
Postnatal swaddling position
What are the two maneuvers done for hip stability during newborn exam
If ‘clunk’ is heard, ? is the next step
What populations should received this next step
Barlow
Ortolani- clunk from hip relocating anteriorly
Hip US at 4-6wks to avoid confusion w/ normal laxity
Clunk or persistant click x 2wks of age
+ RFs- US after 4-6wks old
Congenital Hip Dysplasia referred to Peds Ortho will be placed in ? device for ? age groups
? is the MC foot d/o in infants
Infants w/ this MC are at risk for developing ? later in life
Pavlik harness- up to 6mon old
Metatarsus adductus- medial deviation of mid and forefoot
Developmental hip dysplasia
How is Metatarsus Adductus Dx
How are these Tx
Define Talipes Equinovarus
What is the next step after Dx Talipes Equinovarus
Mid-heel bisector line- should go between toes 2-3
V-finger- should not gap at base of 5th MT (styloid)
Most self-resolve
If not w/in 2yrs= Ortho referral cast/brace/surgery
Clubfoot- entire leg involved d/t hypoplastic tarsals and limb muscles
MC affected- talus, causes foot shortening/calf atrophy
Refer to Ortho: casting/tenotomy to correct deformity, preserve mobility
? testi/female genitalia abnormalities can be seen on newborn exam
Define Spina Bifida
When/How is this normally identified during pregnancy
Testi: retractile
Female: hypertrophy d/t maternal estrogen
Cleft Spine; Lumbosacral tube defect d/t incomplete brain/cord/meninge development
2nd-Tri Quad screen- maternal A-fetoprotein/US
Define Rachischisis and ? risk needs to be r/o
Spina Bifida Occulta- hair tuft/minor defect w/out neuro S/Sxs; r/o connecting sinus d/t inc risk for meningitis
What are the categories of Spina Bifida
How is this Tx and avoided
Meningocele- meninges herniates through neural arch
Meningomyelocele- meninges and cord herniate through neural arch
Myeloschisis- open skin w/ cord exposed
Neurosurgery;
Folate prior to tube closure at 4-6wks EGA