Peds Exam 2 Flashcards
GI function, newborn capacity, 1 year old capacity
ingests, absorbs, eliminates waste
10 - 20 mL
210 - 360 mL
Pediatric Differences in GI (6)
Poor swallowing ↑ Peristalsis ↓ metabolic functions (enzyme levels, bili conjugaiton, gluconeogenesis, etc.) ↑ metabolic rate, ↑ surface area ↑ sensitivity
6 Types of GI Disorders
Structural Motility Feeding Inflammation Parasitic Hepatic
5 Structural GI Disorders
Cleft Lip/Palate Esophageal Atresia Tracheoesophageal Fistula Pyloric Stenosis GER
Cleft Lip/Palate WT
hole in lip/soft palate
immobilization and steristrip incision
Esophageal Atresia/Tracheoesophageal Fistula WT
underdeveloped esophagus and/or hole between eso and trach
maintain airway with suction, surgery needed.
Pyloric Stenosis WSDT
hypertrophy of pyloric channel r/in regurgitation/projectile vomit ↑ 3 feet from infant.
Dx with blood test/ultrasound
Tx with fluid/electrolyte balance and surgery
GER WST
gastric contents into esophagus b/c relaxation of lower sphincter r/in regurgitation, vomiting, irritability, weight loss.
Tx with thickened feeds and surgical placement of valve
6 Motility GI Disorders
Diarrhea Vomiting GER Gastroenteritis Constipation Encopresis (involuntary pooping r/t stress)
2 Types and 5 Feeding GI Disorders
Retention - colic (crying)/rumination (regurgitation)
Malabsorption - celiac, lactose intolerance, short bowel syndrome
Short Bowel Syndrone SBS W2S
Occurs when surgical removal of small intestines due to other dz r/in it being too short!
Newborns - necrotizing enterocolitis
Adults - Intussusception
5 Inflammatory GI Disorders
Appendicitis Necrotizing Enterocolotis Mekel's Diverticulus (omphalomescenteric duct to yolk sac) Crohns Dz Ulcers
Parasitic GI Disorders Tx
preventative education (hand washing) and medication
4 Hepatic GI Disorders
Hyperbilirubinemia
Biliary Atresia (duct closure)
Viral Hepatitis
Cirrhosis (CT buildup in liver)
Omphalocele/Gastroschisis W2T
herniation of food through umbilical cord or protrusion of whole intestine through abdominal wall
protect organs, correct defect
Intussusception W2T
when intestine invaginates self b/c inflammation/upper respiratory infection
Tx with fluid/electrolyte balance and nasogastric tube to decompress
Vollvulus and Hirschsprung Disease WS
malrotation of intestine during 7 - 12 trimester r/in poor blood flow to bowel. MEDICAL EMERGENCY
absence of aganglionic cell, r/in obstruction, diarrhea, constipation
Anorectal Malformations causes VACTERL and Tx
Vertebral anomaly Anal artresia Congenital ♥ Dz Tracheoesophageal Fistula Renal anomaly Limb Defects
Ostomy w/ education
Hernia W3T
protrusion of organ through abdominal wall
Keep infant calm, VS q30min, elevate head from abdomen
Appendicitis, McBurney’s Point W4ST
inflammation of appendix r/in periumbilical cramps, pain @ point, N/V, fever.
Tx with post-op formula
Necrotizing Enterocolitis WS3T
Inflammatory dz in intestinal track which ↑ r/o SEPSIS
Assess for hypo/erthermia, jaundice, respiratory distress
Most UTI’s are from what bacteria?
E. Coli
Neurogenic Bladder
Vesicoureteral Reflex
Hydronephrosis
poor nerve supply in bladder = poor sense
backflow if urine into ureters = ↑ r/o UTI
accumulation of urine in renal pelvis b/c obstruction
UTI 3 S/S and 4 Tx
ill appearance, fever, poor feeding
Assess VS, abdomen
Tx with antibiotics/pyretics and encourage fluid intake
Azotemia
Oliguria
Anuria
Uremia
Nitrogen in P
less urine
no urine
TOO MUCH URINE!!!
UTI 4 Lab ▲ and 2 pharmacological Tx
↓ filtration = ↑ BUN, Creatinine, WBC, and fever
Tx with diuretics (Lasix/furosemide) and antibiotics if UTI present
Acute Glomerulonephritis W
inflammation of kidneys
Acute Renal Failure WS(acute v. chronic and 3 labs)
acute kidney injury r/in poor filtration
Acute = dark urine, fatigue, crackles
Chronic = fatigue, N/V, failure to thrive
↑ K ↓ Na, Ca
Bladder exstrophy Hypo/Epispadias Tight Chordee Cryptorchidism Testicular Torsion
bladder is showing
penis hole too low/high
low penis hole r/in in curvature to cut at 6 - 9 months
undescending testicles, tx with hormones/surgery
rotating balls r/in twisting, surgery or DIE
Hemodialysis
machine filtration of blood to remove excess for ppl w/ Ø kidney fx
Consciousness…
Alertness
Cognitive Power
ability to react to stimuli
ability to process and respond to data
Confusion Delirium Lethargy Stupor Coma
disorientation to time, place, person
fear, irritability, agitation
profound slumber (mod stimulation wakes but will fall asleep easily)
deep sleep (vigorous stim wakes but will sleep when stopped)
no wakey even w/ stim
Glasgow Coma assesses 3 things, score, purpose
Eyes, Verbal, Motor (5/5) = 15/15
Level of Consciousness
Posturing…
Decorticate
Decerebrate
rigid flexion of arms, clenched fists, extended legs
rigid arms/legs straight out, toes downwards
Pediatric Neurologic Differences (2)
Top heavy, poor neck muscles = prone to injury
Excessive spinal mobility, cartilaginous vertebral bodies = ↑r/o C1 - C2 compression fracture
Example of…
Congenital
Aquired
Infectious Neuro Dz
Cerebral palsy
Head Injury
Meningitis
Pathologic process of neurologic Dz
processes ↑ ICP. Brain needs ↓ Cerebral perfusion pressure to oxygenate
3 Early, 3 Late, and 3 Infant S/S of Neuro Dz’s
headache, diplopia, sunsetting
LoC, ↑ BP, respiratory ▲
bulging fontanels, wide sutures, high-pitched cat cry
Seizures WHAT and 3 CAUSES
uncontrolled neuronal discharge r/t CNS defects caused by infections, toxins, tumors
2 Partial Seizures
Simple - 1 hemisphere (▲ motor/autonomic)
Complex - 1 to both (LoC and lip smacks)
6 Generalized Seizures
Abscence (petit mal) - ok posture, lip smacks
Myoclonic - involuntary muscle group movement
Clonic - opposing muscle group rhythmic contractions
Tonic - continuous contracted state
Tonic/Clonic - tonic 20 - 40 sec followed by clonic postictal/seizure
Atonic - DROP/FALL BACK HELMET PLZ
Status Epilepticus
Febrile
Intractable Seizures
> 5 minutes, intermittent for >15, MEDICAL EMERGENCY
Fever + seizures, sepsis eval, dx with lumbar puncture
reqs. > 2 antiepileptic drugs
Seizure Tx 5 and 3 Dx
calm, airway, Øinjury, keep warm, support, document
EEG, electrolytes, MRI unless Febrile
Meningitis WHAT and 2 Types
inflammation of meninges of brain
Viral b/c mumps, measles - CSF clear
Bacterial b/c upper respiratory infx, injury - CSF cloudy w/ WBC, protein, ↓ glucose
Meningitis S/S in…
Newborn (3)
2 mo - 2 yr (4)
2 yr - adolescent (+2)
poor tone, weak cry, bulging fontanels = late
seizures, fevers, cat cry, nuchal rigidity
All previous + Brudzinski and Kernig sign
Brudzinski and Kernig
Head forward, knees up
Can’t straighten leg @ 90º angle
Meningitis Nursing Management (5)
Seizure precautions Isolation for 24 hrs VS and neurochecks Fluid monitoring Head circumference
Meningitis Medicaitons (4)
IV antibiotics - bacteria
Corticosteroids - inflammation
Anticonvulsants - seizures
Analgesics - pain
Meningitis 2 key/fatal S/S
retinal hemorrhages and slow bleeds
Meningitis 3 Post-Infection Syndromes
Reye’s - acute encephalopathy b/c tylenol OD/influenza
N/V, ▲ mentality, ↓ responsiveness
Gullaine-Barre - acute inflammatory demyelination of spinal roots r/in muscle weakness, areflexia
Encephalitis - inflammation of brain b/c virus (ie. West nile)
Hydrocephalus WST and associated w/ what Dz?
↑ CSF in space of brain b/c obstruction flow/absorption in arachnoid space, r/in…
Bulging ANTERIOR fontanel
Sun sign
Glowy skull
Tx w/ shunt draining CSF to other part of body (red = shunt ineffective)
Associated w/ myelomeningocele
Myelomeningocele/Myelodysplasia/Spina Bifida W3ST
Neural tube defect when vertebral laminae Ø close, Spinal cord protrudes back and r/in…
SAC IN BACK, latex allergies, developmental delays
Sterile moist dressing to prep for surgery
3 Levels of Spina Bifida
Thoracic - leg paralysis/trunk weakness
Lumbar 1 -2 - hip control, Ø knee movement
Lumbar 3 - can flex hips/knees
LOWER THE BETTER
Cerebral Palsy WT
Non-progressive impairment of MS development/function
Work with community to accomodate child
Bachy/Plagio/Scaphocephaly
wide, flat back
asymmetrical
long
Concussions r/in… 2 (+concept), important assessments 3!
May LoC, headache, BRICK HEAD
Assess…
Neuro, VS, report ↓ oxygenation IMMEDIATELY
Near Drowning (3 longers, !location, and tx)
longer = worse prognosis
longer time w/out BLS (10 min)/pulse (25 min) = worse prognosis
↑% with infants is in bathtub
educate on safety precautions
Mental Health
Sense of personal well-being, health, and psychologic stability. #2 reason for hospitalization of 10 - 21 yr olds.
Cognition
▲ in thought, intelligence, and language as life progresses
7 Mental Health Treatment Modalities
Evidence-Based - studies show Individual - child to therapist Family - relationships Group - relatable people Therapeutic Strats - (see card) Imagery - imagination Hypnosis - tx phys. S/S, easier with kids!
Psychodrama and Cognitive Therapy
role playing to ↑ understanding
recognize/counter negative thinking
Play, Art, Cognitive Behavioral Therapy
dolls/fantasy to relieve stress
drawing provides objective image
promote + thinking patterns (structured environments and educate adults)
Generalized Anxiety Separation Anxiety Panic Obsessive Compulsive Conversion Reaction PTSD School/Social Phobia
uncertainty/helplessness uneasy w/ new things > 2 weeks unexpected attack of fear/discomfort 1 hr rituals w/ obsessive thoughts (+fx serotonin in basal ganglia) ↓ physial fx r/t neurologic/somatic dz reliving event > 1 month post-event fear of social interaction
4 External forces which insult Brain Development and OVERALL FX on child
Drugs/alcohol
Poor nutrition
Traumatic Brain injury
Lack of emotional nurturing
Fx child’s ability to COPE
Autism
ADD/ADHD
Depression
Bipolar/Mania
4 Nursing Managements
neurodevelopmental (aspergers, Rett’s, Child Disintegrative Disorder)
ADD = CNS + behavior, ADHD = hyperactivity, impulsivity
psychologic distress
extreme ▲ in affect
Evaluate risk, survey, social support, refer to resources if needed.
2 Cognitive Alternations…
Learning Disability
Intellectual Disability
poor processing w/ developmental delays (NOT LOW IQ)
retarded - ↓ IQ, intellect, ↓Syndrome, and Fetal Alcohol Syndrome
Anorexia vs. Bulimia
Ø eat b/c = fat
eat but PURGE b/c Ø PURGE = fat
Munchausen by Proxy
when parent abuses/seeks unneeded medical attention of child r/t personality disorders
# bones in body, 2 examples of... long, short, flat, irregulat
tibula, fibula
wrist, ankle,
skull, sternum
vertebrae, pelvic
3 Types of Muscles example
Skeletal/striated bicep - voluntary Smooth/short-fibered stomach - involuntary Cardiac/striated w/ special fx ♥ - contract/relaxation
Pediatric Bone differences (3)
↑ porous, ↑ pliable = flexible
Grow from Epiphyseal plate which -> Line
Ligaments/Tendons stronger than bone until puberty
Infant Skull skull growth time and fontanel closing time
Growth complete @ 2 years
Fontanels close @ 18 months
4 Disorders of the Feet and Legs
Club foot (talipes equinovarus) Metatarsus Adductus - congenital inward turning of forefoot @ tarsometatarsal joints Genu Valgum (knock-knees) Genu Varum (bowlegs)
Varus vs. Valgus
Inward/towards midline bending vs.
Outwar/away from midline bending
Club foot (talipes equinovarus) W4S2T
foot is twisted out of normal position
Short Achilles, atrophied lower leg muscles, leg length NORMAL, Ø SOLVE WITH EXERCISE
Serial casting (▲ q1-2wks for 8-12wks)
Surgery (@ 3-12 months w/ casting for 6-12wks following)
Club foot 3 Types of Deformity
Equinus - midfoot downward
Varus - hindfoot inward
Adduction - forefoot curls toward heels
Club food post-surgical care (4) Tx
neuro check q2hrs
ice bags w/ elevation
pain meds q4-8hrs
popliteal/epidural blocks ok
Genu Valgum (knock-knees) WT
knees close together with lower legs valgus’d
Tx with braces DAY and NIGHT
anime school girl
Genu Varum (bowlegs) WT
knees widely separated w/ ankles close b/c legs varus’d
Tx with braces @ NIGHT
Genus Valgum/Varum expectation, optional Tx, 2 common causes (with WS), and diagnoses
Normal until > 4-5 yrs old
Tx with osteotomy
Blount Dz - ↑ growth medial prximal tibia r/t ↓ VitD and being black
Rickets - ↓ mineralization r/t ↓ Ca and VitD (aquired but CAN be congenital via X-linked autosomal dom/reces.
Diagnose w/ radiology (MRI/CT)
3 Disorders of the Hips
Developmental Dysplasia of the Hip (DDH)
Leg-Calve Perthes Dz
Slipped Capital Femoral Epiphysis
4 Reason for DDH
Hip instability
Dislocation
Subluxation - partial dislocation
Dysplasia - abnormal cellular/structural development
Primary cause DDH, gestation occurrence, and alternative cause
Primarily genetic
12 - 18 weeks gestation
Mild cases caused by mechanical force (breech)
DDH 3S4T
↓abduction of hip, asymmetry of folds, limp
60 - 80% resolve by 2 mo. old
↓ 3 months = Palvik Hardness
↑ 6 months = Closed surgery w/ spica cast
↑ 18 months = Open/Closed surgery w/ casting + bracing
Slipped Capital Femoral Epiphysis W2S2T and ages for ♂/♀
Fracture of physis r/in top of femur slipping through growth plate posteriorly
pain, asymmetry
No sitting, surgery w/ casting
♂ 10 - 16
♀ 10 - 14
4 Disorders of the Spine W2S2T
Scoliosis - S or C > 10º
Torticollis - head tilt r/t cervical/visual insult
Kyphosis - hunchback
Lordosis - U shape
Unequal back, pain not normal.
Masses should be investigated, Tx with braces
2 Disorders of the Muscles WS (with age onsets)
Duchennes - mutations in DMD gene r/in progressive muscle weakness ( 3 - 7 yrs old)
Muscular Dystrophy - inherited degeneration of muscles ( onset 3 y/o, immobile by 9 - 11, dead by 20 b/c respiratory failure)
5 Disorders of the Bones/Joints WT
Skeletal TB - spasms, atrophy, swelling @ joints
Tx with antibiotics
Septic Arthritis - paint w/ local inflammation
Tx with antibiotics/drainage
Achondroplasia (Dwarfism) - ugly and short
Tx with self-esteem and short adaptation
Marfan Syndrome - CT manifesations r/t autosomal dominant gene (▲ cardiac, skeletal, ocular, and respiratory)
Tx Ø
Osteogenesis Imperfecta - (see card)
Osteogenesis Imperfecta (W and 4 Types)
Brittle bone disease, hits both ♂♀ equally
- most common, fragile, blue sclerae
- rib involved, likely to die in utero
- numerous fractures, kyphoscoliosis
- all above + bowlegs, structural deformities that improve @ puberty
Sprain
Fracture
Traction (2)
tearing of ligaments
partial/complete break in bone
Skin and Skeletal (sterile, check q4hrs)
Cast and Brace Tx
Cast - 2 days to dry, elevate, check cap refil/neuro q2hr
Brace - snug, but Ø cut circulation, do as above.
Types of Fractures
Complete Transverse Spiral Open Closed Green-stick - compression Comminuted - shatter!
Leg-Calve Perthes Disease W3S4T
Self limiting avascular necrosis of femoral head r/t injury, ↑ thyroid, ↓ Somatomedin C.
Tx with traction, surgery, anti-inflammatories, and PT
5 Stages of Leg-Calve Perthes
Prenecrosis - ↓ blood supply @ femoral head
Necrosis - 3 - 6 months, graphs normal, asymptomatic
Revascularization - 1 - 4 years, +graphs, pain w/ move
Bone Healing - re-ossification, pain
Remodeling - Dz over, Ø pain, ↑ joint fx
Salter-Harris Classification (5)
Type 1 - plate undisturbed
Type 2 - most common, disturbance rare
Type 3 - less common, serious threat to growth
Type 4 - serious threat to growth
Type 5 - rare, crush injury arrests growth/length, deformities may result
