Peds exam 3 Flashcards
Outpouching of lower small intestine, Symptoms appear at age 1-2 years (i.e., painless rectal bleeding)
meckel diverticulum
Internal organs eviscerate through sac in umbilical cord, Dress with saline soaked gauze and impermeable dressing at delivery, Protect the sac, prevent hypothermia and infection, and provide comfort measures and nutritional support.
omphalocele
Intestines are outside the body through a hole in the abdominal wall near umbilicus; no sac covering organs, may have resp distress
gastroschisis
Tissues in lip and/or palate do not fuse, Feeding, ontological, dental, and speech complications.
cleft lip and palate
t/f: An infant with an omphalocele has evisceration of the intestines and other abdominal contents
through a sac in the umbilical cord.
true
Communication between thoracic and abdominal cavities, Severe respiratory distress; auscultatory changes
Congenital diaphragmatic hernia
Stenosis, prolapse, or atresia; Dilation or surgical intervention are commonly used, May have temporary colostomy to allow for healing, Avoid placing anything in the rectum.
Anorectal malformations
Upper and lower portions of esophagus are
disconnected.
Esophageal atresia
Connection between trachea and esophagus.
Tracheoesophageal fistula:
Pediatric patients are more vulnerable to this, Can be isotonic, hypotonic, or hypertonic
dehydration
nausea, retching, and expulsion of stomach contents.
vomiting
Acute diarrhea, Infection, food sensitivity, or environmental.
gastroenteritis
Elongation and thickening of the pylorus muscle, Projectile and forceful vomiting without nausea, Typically presents 3 to 6 weeks after birth, Signs of malnutrition and dehydration.
Hypertrophic pyloric stenosis
Mucosal and transmural necrosis in the intestine, most lethal, Air in the abdominal wall present on x-ray
Necrotizing enterocolitis (NEC):
One portion of the intestine prolapses and telescopes, Currant jelly (red) stools and nausea and vomiting, enema to reduce defect
Intussusception
A 4-week-old infant presents to the emergency
room with nonbilious projectile vomiting
immediately after eating. What conditions does the infant most likely have?
Hypertrophic pyloric stenosis
Inflammation of the appendix, Obstruction of appendiceal lumen.
appendicitis
Presents with cramping around the umbilicus, pain
at McBurney point, rebound tenderness, fever,
vomiting, guarding, and rigidity.
appendicitis
Erosion of mucosal tissue in the stomach, esophagus, or duodenum, Proton pump inhibitors and antibiotics used for treatment.
peptic ulcer disease
If failure to gain weight or respiratory symptoms present, may have
gastroesophageal reflux disease (GERD) .
Infrequent bowel movements, hard or large stools
constipation
Voluntary or involuntary passage of stool, Usually associated with constipation (retentive), toilet training/high fiber diet
Encopresis
Absence of ganglion cells and peristalsis, Also known as congenital megacolon, Distended abdomen; failure to pass meconium.
Hirschsprung disease
Occurs after bowel removal, Severe diarrhea, signs of electrolyte imbalances, and dehydration.
short bowel syndrome
Causes wall thickening, Involves small and large bowel (intermittent normal bowel segments).
crohns disease
Causes wall thinning, Involves large bowel only
Ulcerative colitis
Gluten-sensitive enteropathy, autoimmune reaction to gluten such as Intestinal inflammation, Villous atrophy, Malabsorption
celiac disease
Chronic, irreversible disease with impaired fat absorption (steatorrhea)
celiac disease
Yellow discoloration of skin, sclera, and mucous membrane, Establish regular feeding patterns to prevent jaundice, treat with phototherapy with blue light.
Hyperbilirubinemia (jaundice):
Progressive obstruction of the extrahepatic bile ducts, Presents with jaundice 2 to 3 weeks after birth, abdominal distension, bruising, bleeding, itching, and clay-colored stools
biliary atresia
Inflammation of the liver, viral cause, Presents with jaundice, fever, fatigue, and abdominal pain.
hepatitis
Scarring of the liver, Chronic cholestasis, inborn errors of metabolism, and chronic hepatitis are common causes.
cirrhosis
Which hepatobiliary disorder is treated with the
Kasai procedure?
Biliary atresia
t/f: Caregivers should manage all aspects of disease management until the adolescent stage.
false
Hormones: growth, thyroid-stimulating, adrenocorticotropic, prolactin, follicle-stimulating, and luteinizing
Anterior pituitary
Hormones: Antidiuretic and oxytocin
posterior pituitary
Hormones: Thyroxine, triiodothyronine, and calcitonin
thyroid
Hormones: Epinephrine and norepinephrine
adrenal medulla
Hormones: Cortisol and aldosterone
adrenal cortex
Hormones: Insulin and glucagon
pancreas
Hormones: Testosterone
testes
Hormones: Estrogens and progesterone
ovaries
Hormones: Thymosin
thymus
Hormones: Melatonin
pineal
(hypopituitarism) Results in children being smaller than other children of the same age and gender, Normal height and weight at birth, but percentiles decrease with age; puberty is delayed.
Growth Hormone Deficiency (anterior pituitary)
Excess of growth hormone, also known as
hyperpituitarism
Growth Hormone Excess Excess (anterior pituitary)
Puberty before age 9 in boys and 8 in girls, CNS abnormality (too early! must be treated)
precocious (early puberty)
Puberty does not occur by age 12 in girls or 14 in boys
delayed puberty
diabetes indipidus: Kidneys cannot concentrate urine because of decreased or lack of the hormone ______ (antidiuretic hormone [ADH]).
vasopressin
manifestations of diabetes insipidus
polyuria, dehydration, polydipsia
treatment for diabetes insipidus
intranasal or oral desmopressin; low sodium and protein diet
t/f: Healthcare providers should encourage a child
with diabetes insipidus to increase their fluid
intake.
true
inability to suppress antidiuretic hormone (ADH,
vasopressin), resulting in its excessive secretion
Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) (posterior pituitary)
Deficient production of thyroid hormones, congenital, autosomal recessive
Congenital Hypothyroidism (thyroid)
Can occur because of an autoimmune disorder, late-onset thyroid dysfunction, drugs*, iodine deficiency, and/or isolated thyroid stimulating hormone (TSH) deficiency.
acquired hypothyroidism
Also known as thyrotoxicosis (too much thyroid
hormone).
hyperthyroidism
Adrenal insufficiency resulting in a deficiency of
cortisol and aldosterone.
addison disease
Autosomal recessive disorder (genetic), Insufficient enzymes for synthesis of cortisol and
aldosterone, adrenal glands become hyperplastic due to continued adrenocorticotropic hormone (ACTH) secretion.
Congenital Adrenal Hyperplasia (adrenal cortex)
Overproduction of cortisol by the adrenal cortex, Caused by small ACTH-secreting pituitary tumor or prolonged exposure to corticosteroid therapy.
Cushing syndrome
what is not a clinical
manifestation of Cushing syndrome?
excessive hair loss
Autoimmune condition resulting in pancreatic damage and lack of insulin.
Type 1 Diabetes Mellitus (pancreas)
May occur in teenage and school-aged children
due to the increase in childhood obesity.
- Pancreas produces insulin, but it is unable to
be used by the body (insulin resistance).
Type 2 Diabetes Mellitus (pancreas)
Deficient secretion of parathyroid hormone (PTH), Usually caused by the accidental removal of the
parathyroid glands during surgery.
hypoparathyroidism (parathyroid)
Excess secretion of parathyroid hormone (PTH), Most commonly caused by parathyroid
adenoma or chronic renal failure.
Hyperparathyroidism
Newborns enter the world with the brain and its
structures intact but ______, and brain development
really begins to take hold after birth.
immature
Significant adversity can impair cognitive, language,
and emotional development in the first __ years of life.
3
________ defects of the neurological system include
defects in which brain, cerebral spinal fluid tracts,
spinal cord, or skull are malformed, incompletely
developed, or, in some cases, absent.
structural
_______ defects involve the skull bones and cranial
sutures and can range from major defects that are
incompatible with life, to defects that are insignificant
and do not require intervention.
cranial
Cranial defects can be caused by _____ _____ of
the cranial sutures, a skull that grows too quickly in
relation to how fast the brain is growing, or absence
of the bones that make up the skull.
premature closure
Premature fusion of one or more of the cranial sutures, at or before birth, increased ICP and head malformations
Craniosynostosis
Asymmetry and flattening of head from external forces (mattress), Skull deformation; affects right occiput more than left occiput
Deformational plagiocephaly (DP)
An abnormally small head
microcephaly
Primary, due to a genetic, chromosomal, or hereditary cause; or secondary, as a result of exposure to irradiation, maternal infection with toxoplasmosis, rubella, Zika
virus, or cytomegalovirus; or maternal use of alcohol or tobacco. cognitive and motor development delays from birth
microcephaly
Buildup of cerebrospinal fluid (CSF) in the brain, Increased CSF production, decreased CSF absorption, or flow
obstruction – the effect is increased intracranial pressure (ICP)
hydrocephalus
Dilated scalp veins, bulging fontanel, apnea, irritability,
headaches, sunset eyes, and vomiting, Lethargy, irritability, a decline in school performance, and gait disturbances
hydrocephalus
A tangle of arteries and veins in the brain that disrupt the normal flow of blood; blood travels directly from the arteries to the veins instead of moving through the capillaries first
Intracranial Arteriovenous Malformation (AVM)
Infection of the meninges (membranes protecting the
brain); cause may be viral, or bacterial (septic)
meningitis
Infection of meninges with cerebral edema, similar to viral
(aseptic) meningitis
Encephalitis
Typically viral, but can occur from toxins, fungi, bacteria, or
parasites; Usually associated with vector-borne viruses
(mosquitoes); Increased risk for seizures, flaccid paralysis, headaches, photophobia, lethargy, and stiff neck
encephalitis
Rapid progression of multiorgan failure with poor outcomes
reye syndrome
often misdiagnosed as meningitis or encephalitis; associated with aspirin during viral illness
reye syndrome
May involve one hemisphere (focal) or
both hemispheres (generalized)
seizures
seizure that may have impaired awareness or be unconscious; with or without motor activity
focal
seizure; unconscious; with or
without motor activity
generalized
Recurrent, unprovoked seizures; Two unprovoked seizures more than 24 hours apart, Or one, with high probability of repetition over the next 10 years (abnormal EEG)
epilepsy
Prolonged seizure or series of seizures without
recovery in between (more than 5 minutes), EMERGENCY, Convulsive or nonconvulsive based on movement activities
Status Epilepticus
Use IV fluids, oxygen, and IV medications to stop
seizure, Medically-induced coma to stop seizures if necessary
status epilepticus
Acute seizures triggered by high fever in children
younger than 7 years of age (above 101.2)
Febrile Seizures
occurs after a blow or jolt to the head, Classified as primary (skull fracture, bleeding) or secondary (cerebral edema, tissue ischemia)
TBI
Infants and toddlers are at greatest risk
due to ____ _____; adolescents are at
risk for their ________
large head, recklessness
Occurs when an infant or a small child has been
shaken or beaten, #1 cause of brain
damage in infants and the most common form of
non-accidental head trauma in infants in the U.S.
shaken baby syndrome (abusive head trauma)
Pain in the nerves, blood vessels, and muscles that cover the head and neck
headache
Unequal refractory curvatures
Astigmatism
Abnormal movement of eyes
nystagmus
“Cross eye”, treat with occlusion therapy
strabismus
Increase in intraocular pressure
infantile glaucoma
Cloudiness over corneal lens
congenital cataracts
Obstruction of tear duct and excessive tearing, Failure of canalization of the opening between the nose
and nasolacrimal duct, red/swollen eyelids (looks like conjunctivits
Nasolacrimal Duct Obstruction
Infection of eyelid and orbital tissues surrounding the eye, distinct swelling of eyelid, decreased
vision, elevated intraocular pressures
Periorbital Cellulitis
An inflammation of the conjunctiva of the eye - the membrane that lines the inside of the eyelids and covers the eyeball
conjunctivitis
Suspect hearing loss if startle reflex is absent, or no turn to voice or noise, or babbling at __ to __ months
6-7
“State of well-being in which every individual
realizes his or her own potential, can cope with the
normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his
or her community”
- Disorders result from genetics, physiological
changes, and environmental exposures
mental health
“The process of thought and knowing that is
acquired through experiences and maturation”
cognition
a form of psychotherapy that encourages
children to express feelings and emotions through play, for 3-12yo
play therapy
a technique employed by child life specialists for hospitalized children.
therapeutic play
incorporates creativity in healing and expressing childhood emotions (all ages).
art therapy
Difficulties in receiving and processing information and
generating appropriate responses.
learning disabilities
is a disorder of receptive language that creates difficulty using letters to decode written language
dyslexia
A continuum of neurobiological symptoms that result in
difficulty with communication, behavior, and social
interaction that are usually present by age 3.
Autism Spectrum Disorder (ASD)
is Autism Spectrum Disorder (ASD) increased in boys or girls
boys
Manifestations of ________ include : stereotypy (repetitive movements), obsessive behavior, difficulty with sensory integration, echolalia (repetition of words without meaning), and avoidance of eye contact.
autism spectrum disorder
Neurobehavioral disorder characterized by
inattentiveness with or without hyperactivity and
impulsivity; short attention span, impulsivity, movement difficulties
Attention Deficit Hyperactivity Disorder (ADHD)
Worry, fear, and anxiety extend past normal adaptive
coping mechanisms and cause stress and significant
impairment.
anxiety disorders
Eating disorder characterized by fear of gaining weight or
becoming overweight
Anorexia Nervosa
Eating disorder characterized by periods of binge
eating followed by periods of purging; self induced vomiting, diuretics or laxatives
Nervosa Bulimia
Use a forensic medical team to
collect evidence of _____ abuse
and a Sexual Assault Nurse
Examiner to collect evidence of
_____ abuse.
physical, sexual
Misinterpretation or presentation of exaggerated or
absent symptoms in a child to gain entry into the medical
setting, imposer often is mother
Factitious disorder imposed on another (FDIA),
(formerly Munchausen syndrome by proxy (MSP))
uncontrolled proliferation of (malignant) cells
growth rate
malignant cells: Exhibit Independent Behavior
anaplasia
malignant cells compressing all normal
functioning cells in the area and competing
for oxygen, nutrients
expansion
malignant cells taking over and occupying/replacing normal cells
invasion
long term effects of radiation:
skeletal, neurological, secondary malignancies
_____ effects of radiation:
- dental
- skin (radiation dermatitis)
- salivary glands
- alopecia
local
All __________ drugs are immunosuppressive – they
interfere with function of normal as well as
malignant cells – especially the white blood
cells.
chemotherapy
decreased production of all normal blood cells (RBCs, WBCs, PLTs)
myelosuppression
normal RBC level:
4.5 – 5.5 million/mm3
normal Hgb level:
12-14
normal Hct level:
36-40%
normal WBC level:
5,000 – 10,000
normal PLT count:
150,000 – 400,000
decreased RBC (myelosuppression)
-(activity intolerance)
anemia
decreased WBC (myelosuppression)
-(prone to infection)
neutropenia
decreased PLT (myelosuppression)
(protect from injury)
thrombocytopenia
Chemo SE
N/V, anorexia (altered nutrition), mucosal irritations (impaired tissue integrity), alopecia (self-concept, body-image disturbance), tumor lysis syndrome, anaphylaxis
SE of chemo drug vincristine
Peripheral Neuropathy
SE of chemo drug Cytoxan
Hemorrhagic cystitis
An uncontrolled production of abnormal
WBCs called lymphoblasts, “liquid tumor”
Acute Lymphoblastic Leukemia
most common malignancy and type of leukymia in children
Acute Lymphoblastic Leukemia
infection, often respiratory; pale d/t anemia, may complain of belly pain (due to inflamed bowel wall from
decreased WBCs), bone/joint pain, Lymphadenopathy/hepatosplenomegaly, Headaches, irritability, nerve palsies, hypermetabolism
Acute lymphoblastic leukemia
ALL can infiltrate into:
testicles, ovaries, lungs, CNS
ALL lab studies:
Complete Blood Count, Bone Marrow Aspiration, Lumbar Puncture
Excess number of immature nonfunctioning
myeloid cells (Myeloblasts), not as responsive to treatments as ALL
acute myelogenous leukemia
types of stem cell transplants: autologus
from self
types of stem cell transplants: allogenic
from someone else
types of stem cell transplants: Syngeneic
from identical twin
Approximately __-__% of all pediatric
patients have some type of GVHD [Graft vs.
Host Disease]
40-70
Typical history for ______: headache, visual problems,
nausea, and early morning vomiting, Balance problems/clumsiness (if cerebellum
involved)
brain tumor
Obstructed CSF flow (4th ventricle blocked)
brain tumor
(too much ADH) –decreased urine
output, decreased serum sodium, increased
urine specific gravity
SIADH
(suppression of ADH) – increased urine output, increased serum sodium, decreased urine specific gravity
diabetes insipidus
Develops in cells of fetus called the “neural crest” –
these become the adrenal glands and sympathetic
ganglion (head- pelvis)
neuroblastoma
Common sites/related symptoms of ________ : weight loss, feeding problems, FTT, diarrhea, tumor may secrete
catecholamines (HTN, sweating, flushing, diarrhea)
neuroblastoma
Multimodal Treatment because it’s so aggressive;
surgery to excise tumor and stage, irradiation and
chemo
neuroblastoma treatment
cure rate for neuroblastoma : diagnosed under 1 year – ___% survival
75%
cure rate for neuroblastoma: diagnosed over 1 year – __% survival
12%
Most common malignancy affecting the renal
system (can be bilateral or unilateral), often genetic, child with painless mass
Wilm’s tumor (Nephroblastoma)
do NOT palpate ____ tumor
Wilm’s
If unilateral – nephrectomy; If bilateral –
nephrectomy on worse affected kidney and
partial nephrectomy on the other kidney
Wilm’s tumor
Malignant tumor of the retina, diagnosed by 17 months, Cat’s eye reflex (leukokoria),
retinoblastoma
cancers of the lymph system
lymphoma
Reed-Sternberg cells, painless, swollen
lymph nodes, fever, night sweats
- RX: chemo/radiation
Hodgkin Lymphoma
Uncontrolled proliferation of abnormal lymphocytes, fever, wt loss, night sweats, tumors outside of lymph system,
RX: chemo
- common 15-19 (adolescents)
Non-Hodgkin Lymphoma
Occurs near growth plates (metaphyses) of long bones, peak during adol growth spurt
- Pain, soft tissue edema, limp
RX: chemo/ tumor removal (amputate vs limb salvage)
osteosarcoma
Occurs in diaphysis of long bones, peak adolescents, small round blue cells on stain
-Pain, soft tissue edema, wt loss, fever, fatigue
RX: chemo, before and after surgery; avoid wt bearing until all Rx complete
Ewing Sarcoma
Tumors arising from muscle tissue, peak under 6yo, common places: head and neck, GU
tracts, extremities, and orbits
Rhabdomyosarcoma
Kills malignant cells and normal (squamous) cells surrounding the radiation site, assess skin for redness, scales, breakdown, Avoid fragranced soap or moisturizers, skin is more photosensitive
radiation therapy
SE of radiation
N/V, fatigue, appetite changes
Metabolic abnormalities from release of intracellular contents after malignant cells are destroyed, IV fluids before chemo, Treat with allopurinol
Tumor lysis syndrome
Progression of infection in children with neutropenia, Absolute neutrophil count less than 500 are at higher risk; prevention is key, confirm with positive blood cultures, fluid admin, abx, ventilatory support
sepsis
Compression of superior vena cava from mediastinal
mass, Dyspnea, cough, headache, pleural effusion, and edema in neck and upper extremities, confirm with chest x-ray/ CT, Treat tumor to reduce pressure; may require intubation.
superior vena cava syndrome
From primary tumor, metastases, or surgical procedures, – vomiting, vision changes, altered mental
status, headaches, and behavior changes.
- May result in herniation of brainstem without prompt
intervention.
increased ICP
chemo treatment phase 1: Induction phase (4 weeks)
induce remission
chemo treatment phase 2: Consolidation phase
strengthen remission and CNS prophylaxis with intrathecal chemotherapy
chemo treatment phase 3: maintenance phase (2-3 years)
eliminate residual cancer cells with intermittent chemotherapy.
Arise from embryonal cells of peripheral nervous system, SNS but common in medulla and adrenal gland,
