PEDs Test #2 Flashcards
skeletal growth is stimulated by
pituitary growth hormone
growth of the long boned occurs at the
epiphysis
clubfoot deformities
can have one or a combination of four: plantar flexion, dorsiflexion, varus deviation, valgus deviation
varus deviation
foot turns in
valgus deviation
foot turns out
what causes clubfoot
bone deformity and malposition with soft tissue contraction
the affected foot ic clubfoot is usually
smaller and shorter, with an empty heel pad and transverse plantar crease
management of clubfoot
serial manipulation and casting, and if correction not achieved within 3-6 months surgery will be performed
developmental dysplasia of the hip
dislocation of the hip - femoral head and acetabulum are improperly aligned
clinical manifestation in an infant with dysplasia of the hip
asymmetry of the gluteal folds, short femur, limited range of motion on affected hip
clinical manifestation in a child with dysplasia of the hip
same as manifestations of infant plus positive trendelenburg gait
trendelenburg gait
abnormal tilting of pelvis on unaffected side when bearing weight on the affected side
diagnostics for dysplasia of the hip
screening at birth with ortolans’s and Barlow’s maneuvers, ultrasound, radiography
most important management of dysplasia of hip
early intervention
management for dysplasia of hip for newborns
pavlik harness
management for dysplasia of hip at 6-18 months
dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (Spica cast)
management for dysplasia of hip in older child
operative reduction, difficult after 4 years
nursing care for pavlik harness
teaching parents to keep harness on continuously, follow up appts, teach and reinforce skin care
nursing care for spica cast
frequent neurovascular checks, range of motion, skin integrity, evaluate hydration status, assess elimination status daily
bone healing and remodeling in neonatal period
2-3 weeks
bone healing and remodeling in early childhood
4 weeks
bone healing and remodeling in later childhood
6-8 weeks
bone healing and remodeling in adolescence
8-12 weeks
osteogenesis imperfecta
also known as brittle bone disease
osteogenesis imperfecta results from
a defect in the synthesis of collagen
most common type of osteogenesis imperfecta
autosomal-dominant inheritance pattern
clinical manifestations of osteogenesis imperfecta
osteoporosis, excessive bone fragility, blue sclera, discolored teeth, conductive hearing loss by age 20-30, skin may appear translucent
scoliosis
lateral curvature of the spine
muscular dystrophy clinical manifestations
waddling gait, lordosis, difficulty climbing stairs, development of gower’s sign, scoliosis of the spine
muscular dystrophy clinical manifestations appear when?
after walking is achieved (3-7 years)
muscular dystrophy diagnostics
positive family history, elevated serum creatine kinase, electromyography, muscle biopsy
therapeutic management of muscular dystrophy
maintenance of ambulation and independence, surgery, bracing, physical therapy
muscular dystrophy nursing considerations
Child should be immobilized for as short a period as possible to help prevent disuse atrophy- try to ambulate 3 hours a day
Frequent rest periods in a recumbent position are helpful to help reduce the incidence of scoliosis
muscular dystrophy diet
low calorie, high protein, high fiber and high fluid
Duchenne muscular dystrophy
most common hereditary neuromuscular disease
Duchenne muscular dystrophy is linked to
X linked recessive disorder
Duchenne muscular dystrophy s/s
progressive weakness with no loss of sensation
Duchenne muscular dystrophy usually diagnosed
3-7 yrs of age
treatment of Duchenne muscular dystrophy
aimed to control symptoms and improve quality of life and steroids can slow strength
Duchenne muscular dystrophy death occurs usually by
age 25
stroke volume in neonates
they cannot increase stoke volume as effectively as older children
heart and great vessels develop during
first 3-8 wks gestation
congenital heart disease (CHD)
anatomic- abnormal function present at birth
acquires heart disease
occurs due to disease process such as infection, autoimmune response, environmental factors, familial tendencies
assessment of cardiovascular dysfunction
nutrition status, color, chest deformities, clubbing
diagnostic evaluation of cardiovascular dysfunction
electrocardiography, echocardiography, cardiac catheterization, electrophysiology
major cause of death in first year of life after prematurity
congenital heart disease
most common anomaly of congenital heart disease
ventricular septal defect
survival of congenital heart disease depends on
how severe the defect is, when its diagnosed, and how its treated
what is acyanotic heart defect
blood is shunted (flows) from the left side of the heart to the right side of the heart due to a structural defect (hole) in the interventricular septum
what is cyanotic heart defect
result in a low blood oxygen level
bloods flows
from area of high pressure to one of low pressure and takes the path of least resistance
what happens with acyanotic heart defect
increase pulmonary blood flow and obstruction of blood flow from ventricles
what happens with cyanotic heart defect
decrease pulmonary blood flow and mixed blood flow
ductus arteriosus
in utero normally shunts blood from the main pulmonary artery to the descending aorta bypassing the non aerated lungs
normally ductus arteriosus closes
functionally within 48 hours and anatomically around 2 weeks
patent ductus arteriosus
medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has a higher pressure, to the pulmonary artery.
patent ductus arteriosus manifestations
varies from asymptomatic to s/s of CHF and machinery like murmur
patent ductus arteriosus manifestations is dependent on
the amount of left to right shunting
what should be administered for patent ductus arteriosus
indomethacin
management for patent ductus arteriosus
surgical division of ligation of the patent vessel, coils, and indomethacin
ventricular septal defect
an opening in the ventricular septum in which blood flows through the defect back into the pulmonary artery
most common form of congestive heart disease
ventricular septal defect accounts for 20% of all cases
increased pulmonary resistance in VSD causes
RV hypertrophy and if RV cannot accommodate workload than the RA may also enlarge
VSD manifestations
s/s of failure to thrive and/or respiration infection with s/s of CHF. holosystolic murmur
VSD s/s based on
the size of the defect and amount of pulmonary over circulation
holosystolic murmur heard best at
LSB
VSD can ultimately lead to
pulmonary hypertension
VSD management
complete repair with sutures or patch
coarctation of the aorta
narrowing of the aorta typically near the insertion of the ductus arteriosus
coarctation of the aorta results in
increased pressure proximal to the defect and decreased pressure distal to the obstruction
coarctation of the aorta manifestations
high blood pressure and bounding pulses in the arms and absent femoral pulses with cool lower extremities. some may show signs of CHF
coarctation of the aorta management
resection of the coarcted portion with an end to end anastomosis or balloon angioplasty or stents
tetralogy of fallot includes what defects
VSD
Pulmonic stenosis: narrowing at the entrance of the pulmonary arteries
Overriding aorta
RV hypertrophy
the degree cyanosis of tetralogy of fallot is directly related to
severity of the Pulmonic stenosis
tetralogy of fallot manifestations
systolic murmur, tet spells, acutely cyanotic at birth others may have progressive cyanosis as PS worsens
tet spells
anoxic spells when O2 requirement exceed blood supply
tetralogy of fallot management
complete repair during 1st year of life and blalock trussing shunt
complete repair of tetralogy of fallot
closure of the VSD, resection, and patch of PS which requires open thoracotomy/sternotomy and bypass
blalock-taussig shunt
provides blood flow to the pulmonary arteries via a tube graft (palliative tetralogy of fallot)
hypoplastic left heart syndrome
underdevelopment of the left side of the heart
hypoplastic left heart syndrome manifestations
mild cyanosis until PDA closes the rapid progressive deterioration
decreased cardiac output during hypo plastic left heart syndrome leads to
cardiovascular collapse
hypo plastic left heart syndrome management
transplantation, prostaglandin infusion, multiple stage procedure
prostaglandin infusion
helps maintain ductal latency until surgical intervention
heart failure
inability of the heart to pump an adequate amount of blood to the systemic circulation
in children heart failure occurs
most frequently secondary to structural abnormalities
right sided heart failure
RV is unable to pump blood into the pulmonary artery which increases RA pressure =, systemic venous hypertension
left sided heart failure
LV is unable to pump blood into the systemic circulation which increase LA pressure and pulmonary venous pressure
management of heart failure
improve cardiac function, remove accumulated fluid and sodium, decrease cardiac demands, improve tissue oxygenation
evaluation of heart failure
CXR, ECG, and echo
CXR
shows for cardiomegaly and increased pulmonary blood flow
ECG shows for
ventricular hypertrophy
echo helps
determine the cause of heart failure
digoxin toxicity manifests with
slow pulse, vomiting, and arrhythmia
what can increase risk of digoxin
hypokalemia and hypomagnesemia
what med is effective for heart failure
digoxin
bradydysrhythmias can be attributed to
hyper vagal tone and response to hypoxia and hypotension from the influence of the autonomic nervous system
meds for CHF
diuretics, furosemide, spironolactone (potassium sparing diuretic)
tachydysrhythmia can be from
fever, anxiety, pain, anemia, dehydration
supraventricular tachycardia beats per minute
HR 200-300+ beats per min
supraventricular tachycardia
sudden onset, variable duration, and may end abruptly and convert back to normal without intervention
supraventricular tachycardia s/s
poor feeding, extreme irritability, pallor, dizziness, chest pain, palpitations
treatment of supraventricular tachycardia
vagal maneuvers, adenosine, synchronized cardioversion, and long term management with digoxin, propranolol, amiodarone, or ablation
adenosine
impairs AV conduction
Kawasaki disease
acute systemic vasculitis of unknown cause
75% of Kawasaki disease occurs in
children with a peak incidence in toddlers
increased incidence of Kawasaki disease in
late winter and early spring
treatment of Kawasaki disease
acute disease is self limiting
20% of children with Kawasaki disease develop
coronary artery dilation or aneurysm without treatment
what is Kawasaki disease
extensive inflammation of arterioles, venues, and capillaries
Kawasaki disease manifestation
fever for more than 5 days with changes in extremities, bilateral conjunctival injection, changes in oral mucous membranes, polymorphous rash, and cervical lymphadenopathy (must have 4 of the five)