Peds Part 2 #10 Flashcards
1
Q
is it normal to see abdominal distention after a NB eats
A
yes, due to intestinal muscles being weak
2
Q
stomach capacity of NB
A
@90 ml (at birth is 15-20 ml)
3
Q
rate of gastric emptying
A
2-4 hours
4
Q
if a NB hasn’t pooped in 24 hours what do we suspect
A
obstruction suspected
5
Q
when are bowel sounds present after birth
A
1 hour
6
Q
mucus stools
A
milk allergy
7
Q
clay/gray stools
A
obstruction of bile ducts (hepatic problem)
8
Q
black/tarry stools
A
intestinal obstruction
9
Q
what can turn stools green, very odorous
A
nutramigen
10
Q
stricture of the anus
A
imperforated anus
11
Q
what does a imperforated anus usually accompany
A
spinal cord defects
12
Q
when does a imperforated anus usually occur
A
7th week of intrauterine life (same as spinal cord)
13
Q
S/Sx of imperforated anus
A
absence of anus, membrane filled with black mec protruding from rectum, no stools passed within 24 hours, meconium in urine or vaginal opening
14
Q
Tx for imperforated anus
A
surgery within 24 hours!
want to keep them on their backs after surgery, keep area clean
15
Q
protrusion of abdominal contents through the abdominal wall at the point of the junction of the umbilical cord and abdomen
A
omphalocele
16
Q
when does a omphalocele usually occur
A
6-8 weeks intrauterine
17
Q
Tx of omphalocele
A
delivery via C/S, topical application of warmed saline soaked pads and plastic drape, prophylactic Abx, surgery (delayed to allow NB to grow
18
Q
what do you need to watch for when doing surgery for a omphalocele
A
respiratory issues when organs are placed back in body
19
Q
congenital absence of one or more layers of abdominal musculature
A
prune belly syndrome
20
Q
same as omphalocele but has no sac, occurs with other defects are rare, usually to side of umbilicus
A
gastroschisis
21
Q
failure of esophagus to develop as a continuous passage
A
esophageal atresia (EA)
22
Q
failure of trachea and esophagus to separate into distinct structures
A
tracheoesopaheal fistula (TEF)
23
Q
when does EA & TEF usually occur
A
4-8 weeks gestation
24
Q
esophagus ends in blind pouch, fistula between trachea and stomach
A
Proximal (EA wth TEF)
25
esophagus ends in blind pouch, no connection to trachea
Pure EA
26
fistula is present between otherwise normal esophagus and trachea
H type
27
what needs to be a concern with EA or TEF babies
aspiration
28
Dx of EA and TEF
xray, barium swallow
29
Tx for EA and TEF
emergency surgery
30
post op for EA and TEF babies
NPO 1-10 days after surgery, chest tube care, skin care
31
primary palate
anterior portion of mouth (lip, mouth, teeth)
32
secondary palate
posterior portion of mouth
33
embryology of...
1. lip
2. maxillary
3. palatal processes
1. 5-6 weeks
2. week 7
3. week 13
34
repair of palate
palatoplasty
35
what is extremely important in cleft palate
oral hygiene
36
menstruation from decrease of estrogen from mother
pseudomenstration
37
excessive secretion of androgens by the adrenal cortex, AKA ambiguous genitalia
decrease of cortisol, decrease aldosterone, increase of androgen
congenital adrenal hyperplasia
38
what kind of recessive disorder is congenital adrenal hyperplasia
autosomal recessive disorder
39
what is the patho of congenital adrenal hyperplasia
interference in biosynthesis of cortisol during fetal life resulting in increase production of ACTH (which stimulates cortisol production) and has an excessive production of androgens
40
S/Sx of congenital adrenal hyperplasia
ambiguous genitalia
female: clitoris enlarged, fusion of labia
male: enlargement of genitals
41
emergency situation caused by a lack of cortisol so body cant respond to stress, when have stressful situation have dizziness, weakness, N/V, sweting and LOC
acute adrenal crisis
42
Tx for adrenal crisis
glutocoticods, lean S & Sx and must keep solu-cortef
43
if adrenal hyperplasia is left untreated
early development of axilliary, pubic and facial hair,
| early closure of growth plate (short stature)
44
Tx for adrenal hyperplasia
cortisone, may need reconstructive surgery
| if salt losing type: supplement with salt (aldosterone & cortisone)
45
IgG
passive acquired immunity, transferred to fetus in utero, fetus does not produce, protects against bacterial toxins
46
IgM
active immunity, fetus is able to produce by 20 weeks, stimulated by all infectious agents
47
IgA
does not cross placenta, not produced by fetus, secretory surfaces (resp., GI, eyes)
48
Secretory IgA
passive immunity, transferred through colostrum and breast milk
49
when is passive immunity of the NB gone by
3 months
50
HIV
retrovirus, contact with body fluids
51
when do you test NB for HIV
2-3 weeks, 1-2 months, 4-6 months
52
fetal effects of HIV
AIDS dysmorphia syndrome, resembles FAS
53
Tx for NB HIV
avoid PROM, C/S, forceps, episiotomy, administer IV Zidovutine
54
Dx of NB HIV
2 positive results
55
gonorrhea
contacted with infected birth canal,
56
fetal effects of gonorrhea
blindness
57
Tx of gonorrhea in NB
erythromycin, if active infection also PCN
58
Toxoplasmosis
systemic protozoal, transplacental, undercooked meat, contact with cat feces
59
fetal effects of toxoplasmosis
jaundice, premature, hepatomegaly, IUGR
60
Tx for toxoplasmosis
patient education, Daraprien (antimaleria)
61
syphilis
direct contact with exudates, transplacental
62
fetal effects with syphilis
asymptomatic at birth, rashes, lesions, FTT, SGA
63
Rubella
german measles, virus, droplet, contact, transplacental
64
fetal effects on rubella
heart & eye, (blind deaf, fetal death)
65
Dx of rubella in NB
TORCH titer
66
Tx for tubella in NB
isolation, screen
67
CMV
most prevalent of TORCH group, transplacental, NO BREAST FEEDING
68
fetal effects with CMV
IUGR, petechiae, severe CNS issues
69
Dx of CMV
TORCH titer
70
Tx of CMV
isolation, no tx available
71
Herpes
virus, contact with birth canal
72
fetal effects with herpes
vesicular lesions, hepatitis, neuro involvement
73
Dx of herpes
TORCH titer, culture lesions
74
Tx of herpes
universal standards, C/S if active lesions, IV acycclovir
75
monilia (yeast)
candida albicans, direct contact with birth canal
76
fetal effects of monilia
thrush
77
Dx of monilia
wet mount slide
78
tx of monilia
nystain
79
chlamydia
direct contact
80
fetal effect of chlamydia
NB conjunctivitis, pneumonia, otitis media
81
Dx of chlamydia
culture
82
Tx of chlamydia
erythromycin, isolation
83
group B strep
direct contact
84
fetal effects of group B strep
hypothermia, apnea, poor feeding, resp. distress, if S/Sx in 1st 24 hours high mortality
85
Dx of GBS
S&S blood cultures, chest x ray
86
tx of GBS
ampicillin, or PCN and gentamycin IV
87
E Coli
direct contact
88
effects on NB with E Coli
neonatal meningitis, and sepsis
89
Dx of E Coli
culture
90
Tx of E Coli
IV Abx
91
TB
placental or droplet
92
fetal effect with TB
poor feeder, febrile, lethargy, hepatosleenomegaly
93
Dx of TB
maternal Hx and S& Sx
94
Tx of TB
INH
95
SSSS (staphococcal scalded skin syndrome)
direct contact
96
fetal effects of SSSS
severe bullous eruption, looks like scald marks
97
Dx of SSSS
cultures
98
Tx of SSSS
IV Abx, thermoregulation
99
invasion of infectious agents resulting in a disease process
sepsis
100
presence in blood of bacterial toxins
septicemia
101
S & Sx of
resp distress, lethargy, full fontanels, N/V, unstable temperature, increase of bands, hyperbili, bradycardia, tachycardia (early sign)
102
Tx of sepsis
Abx immediately after cultures, thermoregulation
103
urinary output 1st day of NB
15 ml, void 6-10 times a day
104
is tan colored urine for 1st few days normal
yes, uric acid crystals
105
excess of CSF in the ventricles and subarachnoid spaces of the brain
hydrocephalus
106
Pathophysiology of hydrocephalus
CSF flows from the lateral ventricles to 3rd to 4th ventricle and is absorbed within the subarachnoid space
107
opening, passage of fluid between ventricles and spinal fluid
communicating hydrocephalus
108
obstruction, block flow of fluid, fluid accumulates and dilates the system above the point of obstruction
non communicating hydrocephalus
109
S & Sx
increase head circumference, bulging fontanels, eyes rotated downward (sun setting)
110
Tx of hydrocephalus
surgical, shunting
111
post op for hydrocephalus
position flat so fluid doesn't drain too quickly
112
what prevents neural tube defects
folic acid
113
absence of cerebral hemisphere, brain stem only NO brain
anencephaly
114
no brain, fluid in place of where brain should be
hydranencephaly
115
refers to any malformation of the spinal canal and cord
myodysplasia
116
midline defects involving failure of the osseous (bony)spine to close
spina bifida
117
occurs when the posterior laminae of vertebrae fail to fuse
spina bifida occulta
118
S/Sx of spina bifida occulta
dimpling, tuffs of hair, soft subcutaneous lipoma, may be asymptomatic
119
Tx of spina bifida occulta
nothing, may have deteratio nof vertebre later in life then may need ortho
120
spina bifida cystica
visible defect with external sac protrusion
| 2 major forms: meningocele, myelomeningocele
121
contains meninges and spinal fluid but no neural elements, meninges herniate through the vertebrae
meningocele
122
contains meninges, spinal fluid and nerves, spinal cord and meninges and nerves protrude through the vertebrae
myelomeningocele
123
what is usually effected with myelomeningocele
bowel and bladder
124
dolls eye phenomenon
eye lag behind when head is turned (lack of integratio nof head-eye coordination)
125
pseudostrabismus
irises do not appear centered
126
epsteins pears
small white dots on oral mucosa (calcium deposites) that disappear in 2-3 months
127
rooting
stroke side of cheek, lips or mouth with finger or nipple
128
moro
startle, extends and abducts arms accompainied by extensio nof fingers
129
tonic neck reflex
place infant on back, turn head to one side, the infants opposite arm and leg will flex towards that side
130
babinski
fanning and extensio nof all toes when one side of sole is stroked
131
failure of urachus to close between bladder and umbilicus
patent urachus
132
Dx of patent urachus
U/S, sonogram, clear odorless fluid draining from base of umbilical cord (test pH)
133
Tx patent urachus
surgical correctio immediatly bc of infection and sepsis risk
134
deficiency in the deveolpment of the anterior abdominal wall, symphysis pubis, bladder and urethra
exstrophy of the bladder
135
Dx of exstrophy of bladder
bladder lies open and exposed on the abdomen
136
Tx of exstrophy of bladder
surgery (2 stage) repair abd wall, bladder neck tightening procedure
pre op: protect from injury, cover with sterile dressing, wrap baby legs together to protect symphysis pubis
post op: clean of feces, cath care, urine will be bloody after procedure
137
urethral defect where the urethral opening is not at the end of the penis but is on the ventral (lower) aspect of the penis
hypospadius
138
opening is on the dorsal surface of penis
epispadius
139
TX for both hypospadius or epispadius
NO circumcision, surgical correction
140
large fluid filled cysts form in place of normal kidney tissue
```
polycystic kidneys
(autosomal resessive disorder)
```
141
Dx of polycystic kidneys
large kidneys, soft and spongy, anuria if bilateral, oliguria if unilateral
142
Tx for polycystic kidneys
unilateral-remove diseased kidney
| bilateral-transplant
143
collection of fluid within the processus vaginalis (scrotal sac)
hydrocele
144
upper portion of the processue vaginalis is obliterated but the porition within the scrotum remains open
non communicating (fluid stays)
145
processus vaginalis remians open from scrotum to abdominal cavity
communicating (fluid goes back and forth)
146
Tx for hydrocele
fluid will reabsorb over time, if hasnt fotten better by 3 months good indicatio nof hernia=repair of hernia
147
why at birth does the blood glucose level fall rapidly
bc of trauma of birth
148
decreased ability to conjugate bilirubin
hyperbilirubinemia
149
decreased ability to regulate BS concentrations
hypoglycemia
150
deficient productio nof prothrombin and other coagulatin factors dependent upon Vit. K for synthesis
NB predisposed to hemorrhage
151
function of liver
glycogen storage, depot for iron, carbohydrate metabolism, conjugatio nof bilirubin, coagulation
152
conjugate
break down bilirubin to an excretable form
153
orange bile pigment produced by the breakdown of heme (RBC) and excreted by the cells
bilirubin
154
conjugated bilirubin
has been broken down my liver, cross the BBB but is not dangerous to the brain
155
unconjugated bilirubin
not been broken down by liver, fat soluble, unbound is dangerous becuase if can deposit on brain=encephalopathy
156
pathological jaundice occurs when
within first 24 hours of birth
157
Rh incompatibility
if you have a Rh - mom with a Rh baby (1st pregnancy) with birth Rh + blood from placenta enters maternal blood stream, mom produces Rh+ antibodies, if 2nd pregnancy baby is Rh - than no affect on fetus, if 2nd pregnancy baby is Rh + then Rh + antibodies from mom attack fetal blood = erythroblastosis fetalis (fetal death)
158
if abortion occurs is mother given Rhogam?
yes because unknown status of fetus
159
why is Rhogam given
prevents body from creating antibodies so cant attack fetus, has to be given within 72 hours
160
ABO incompatibility
occurs if there the antigens of fetus differ from mother, antibodies cross placenta and attack fetal RBC's causing hemolysis
*not as severe as Rh incompatibility (not fatal)
161
jaundice that occurs after 24 hours of age, due to high bilirubin production bc of increase in # of RBC, shorter RBC living rime, bilirubin levels build up bc reabsorbed
physiologic jaundice
162
progressive indirect hyperbilirubinemia beyond 1st week of life, occurs after breast milk is in and lasts longer (enzyme that inhibits conjugation)
breast milk jaundice
163
Dx of jaundice
transcutaneous bilirubinometry (TcB) bilirubin blood measurements
164
normal unconjugated measurement
0.2-1.4 mg/dl
165
coombs test
tests if there are antibodies on NB RBC
| positive test= bad
166
Tx of jaundice
early feeds, phototherapy
167
what does phototherapy do
breaks dowm to a water soluble form
| watch for SE: hypotherma, loose stools, water loss
168
free unconjugated bilirubin taken up by fatty tissues, crosses the BBB, bilirubin over 20 is considered toxic (dont want over 12)
kernicterus
169
Tx for kernicterus
exchange transfusion
| watch for calcium levels
170
S/Sx of encephalopathy
sleepy, lack tone, poor feeding
171
congential absence or closure of ducts that drain bile from the liver
biliary atresia
| *can take 2-3 weeks to see
172
S/Sx of biliary atresia
jaundice, dark urine, gray/tan stools, ascitesk prutiris
173
Dx of biliary atresia
increased bilirubin, increase alk. phosphatase, increase cholesterol
liver biopsy is definitive test
174
Tx of biliary atresia
surgery, Kasai procedure-anastomose the jejunium to a hepatic duct (NOT A CURE)
transplant=cure
175
where foot twisted out of normal position or shape
congenital clubfoot
176
varus
inversion
177
valgus
eversion
178
talipes equinus
plantar flexion, toes lower than heel
179
talipes calcaneous
dorsal flexion, toes higher than heel
180
congenital clubfoot
true clubfoot, babies are normal other than clubfoot
181
Tx for clubfoot
catsing in stages to turn feet back to normal position, or dennis browne splints
182
AKA congenital dislocated hip, improper formatio nand function of hip socket
developmental dysplasia of hip
183
etiology of DDH
hormones in pregnancy, breech, LGA genetic
184
one knee lower than another
galeazzi
185
audible click heard on exit or entry of femur out of or into the acetabulum
barlows test
186
Tx for DDH
frejka splint, pavlik harness, cast, surgery if severe
187
underdevelopement of skeletal elements of the extremities
skeletal limb deficiency
188
2 types of skeletal limb deficiency
amelia-absence of entire extremity
| phocomelia-seal like extremity
189
Tx for skeletal limb deficiency
prosthetic device
190
why does skeletal limb deficiency occur
issue around 7th week gestation
191
generalized dysfunction of exocrine glands
cystic fibrosis
192
S/Sx of cystic fibrosis
thicked pooled bronchial secretions, dry non productive cough, secondary infections
193
1st S/Sx of cystic fibrosis
thich meconium blocks bowel
194
Dx for cystic fibrosis
sweat test
195
Tx for cystic fibrosis
Abx, moist O2, lung transplant, NO COUGH SUPPRESANTS, high caloric , high protein, moderate fat diet, pancreatic enzyme b4 each meal, Extra Na in hot months
196
NB endocrine functioning must regulate what
calcium phosphorus balance, and regulatio nof blood glucose concentration
197
the NB is dependent on what for a normal glucose supply
constant circulating supply of glucose to the tissues and especially to the central nervous system
198
during pregnancy how is the glucose transferred to the fetus
across the placenta from mother to fetus
199
when to glycose stores build up
3rd trimester (so preterm NB doesnt have same stores as term NB)
200
the brain is dependent on what
a constant circulating supply of glucose, brain cant store or make glucose
201
Dx of hypoglycemia
fullterm in 1st 3 days less than 45 mg/dl
preterm in 1st 3 days less than 50 mg/dl
all infants after 1st 3 days less than 50 mg/dl
202
S/Sx of hypoglycemia
tremors, cyanosis, convulsions, apnea, irreg. resp. apathy, lethargy, inability to regulate temperature
203
if you have tactile touh and the tremors continue this is a sign of what
hypoglycemia
204
when will a IDM have Sx of hypoglycemia
1-4 hours of age
205
when will perinatal stress NB have Sx of hypoglycemia
onset within 6 hours
206
when will IUGR/SGA infants show Sx of hypoglycemia
24-72 hours
207
when will premature infants and postmature infants show Sx of hypoglycemia
depends on age
208
when will LGA infants show Sx of hypoglycemia
within 4 hours
209
Tx of hypoglycemia
prevention, early po, parental glucose (d50 or D10w)
210
acute hypoglycemia
less than 20-25 mg/dl
211
what do you give for acute hypoglycemia
10% glucose 2ml/kg slow IV taper to stop to prevent rebound hypoglycemia
212
what is often found in NB experienceing hypoglycemia
hypocalcemia
213
Calcium review
decreae neuromuscle irritability, promotes contractility of muscle, transmissio nof nerve impulses, and essential for blood clotting and building of bones and teeth
214
Tx for hypocalcemia
calcium gluconate, give IV slow (watch cardiac)give with Vit D
215
classifies severity of pregnant DM mothers, may see change in each pregnancy
whites classification
216
problems with IDM
macrosomia, fetal hyperinsulinism, birth injuries bc LGA, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, RDS
217
polycythemia due to IDM
ruddy in color, too many RBC=increase viscosity of blood, cause R heart failure, start IV to thin out blood
218
RDS due to IDM
delayed maturation of surfactnant, related to preterm delivery
219
infection and inflammation of throat
pharyngitis, can be bacterial or viral
| need throat cultures, Tx is PCN
220
infection and inflammation of tonsils
tonsillitis, Sx hard to swallow, fever, lethargy
| if bacterial = Abx, if viral = nothing
221
acute epiglottitis
sudden onset, tripod, dysphagia, enlarged epigoltis, Tx: airway protection
MEDICAL EMERGENCY
222
acute laryngotracheobronchitis
slow, stridor (like seal), cool mist, steriods, racemic epinephirine
223
acute spasmotic laryngitis
sudden at night, croupy cough, Sx decrease during day, better with cool air
224
acute tracheitis
moderate, Hx or recent URI, high fever, no response to LTB Tx (cool mist, steroids) need Abx
225
inflammation of bronchioles
bronchiolitis (RSV)
226
is RSV contagious
YES, direct contact with secretions
227
Dx of RSV
nasal swab, C xray
228
Tx for RSV
fluids, broncodilators, corticosteroids, cough supressant, Ribavirin
IgIV (RespiGam)
229
inflammation and edema of mucous membranes, accumulation of secretions, spasms of smooth muscleof bronchi
asthma
230
measures maxium flow of air that can be forecefullly exhaled in 1 second
PEFR
231
PFT
pulmonary function test, presence and degree of lung disease
232
why would you want to avoid cool liquids in asthma
may induce bronchospasm
233
when giving Rx what do you want to give first for asthma
bronchodilator then steriod
234
severe life threatening asthma exacerbation that is refractory (wont respond) to Tx
status asthmaticus
235
caused by a inadequate supply of dietary iron, most preventable nutrional disorder in US
iron deficiency anemia
236
when is the most iron transferred to fetus
3rd trimester
237
S/Sx of iron deficiency anemia
pallor, weakness, fatigue
238
Lab work for iron deficiency anemia
dreased: hem, Hct, MCV, MCH, MCHC, serum iron concentration
increased: TIBC (total iron binding capacity
Normal: retic count
can have occult blood
239
Tx for iron deficiency anemia
dietary, addition of iron rich foods, NO COWS MILK
240
when will you need a transfusion
less than 4 mg/ml
241
Hgb is partially or completely replaced by abnormal sickle Hgb
sickle cell anemia
242
etiology of sickle cell
RBC gets distorted and spleen sees it as abnormal and removes it, autosomal recessive
243
trail of sickle cell
increase of RBC destruction = tangle of cells = blockage = vasoocclusion = decrease blood flow = hypoxia = pain = death
244
spleen is enlarged working hard to remove abnormal RBCs and blood pools in spleen
sequestration crisis
| get hypovolemic shock
245
bone marrow is tired, cant produce more RBC
aplastic crisis
246
destruction is happening quicker than production
hyperhemolytic crisis
247
painful episode, have distal ischemia and pain
vasocclusive crisis
248
can sickle cell cause CVA
yes, block major blood vessels in brain
249
hand foot syndrome
painful swollen hands and feet
250
Dx of sickle cell
sickledex (finger stick), if reticulocytes are 15 % = crisis
251
Tx of sickle cell crisis
prevention
pain control, bedrest, hydration, O2
splenectomy - help stop getting rid of cells
252
what can you do for someone in a sickle cell crisis
adequate hydration, heat to painful areas (vasodilate) PCN, support
253
rheumatic fever
caused by untx strep, after initial infection has subsided, 2-6 weeks later it will appear if not treated
254
2 major manifestations of rhematic fever
carditis, polyarthritis, erythema marginatum, chorea, sub q nodules
255
Dx of rheumatic fever
ESR elevated, positive strep, elevated strep antibody titer
256
Tx for rheumatic fever
PCN, bedrest, oral salicylates (asa, ibuprofen, advil, motrin), give steroids if asa doesnt work
257
what must pts with past hx of rheumatic fever do
prophylaxis for dental work, infections, invasive procedures to protect heart valves
258
kawasaki diease
difficult to Tx, fever lasting longer than 5 days plus: conjunctiva, mucous membrane changes, rash, lower extremity changes, enlarged lymph
259
when do you consider kawasaki disease
on any child with rash and fever of unknown origin
260
S/Sx
abd pain, N/V, restlessness, pallor, shock
| increase of : platelets, EST, sed rate, WBC, liver enzymes, EKG changes
261
Tx for KD
gamma globulin IV, ASA
262
Mononucleosis
aka kissing disesase, epstein barr virus, CONTAGIOUS
| no contact sports bc enlarged spleen
263
triad of mono
sore throat, fever, enlarged lymphnodes
264
Tx for mono
no specific tx, PCN, bedrest, acyclovir, increase fluids
265
acute lymphocytic leukemia
most common childhood cancer, bone marrow
266
B cells
make immunoglobin
267
T cells
helper cell
268
Dx of ALL
increase # of cells with increase # of lymphoblasts, lumbar puncture
269
Tx of ALL
chemo, radiaton, bone marrow transplant
270
lead poisoning test
erythrocyte protorphyrin (EP)
271
lead poisoning effects what
proximal tubles, neurological system
272
Tx for lead
remove source
273
lead encephalopathy
permanent brain damage
