proper study guide flashcards based on all the information textbook and her words in videos
The beginning part of this long study guide flashcards will be about anemia
then it’ll go into cerebral dysfunction
then lastly it’ll go into endocrine disorders
please use this study flashcards the most to prepare for the test as it will contain all the information from textbook and from the video based presentation.
What are the anemia types we are going to talk about ? (7)
Anemia
Iron deficiency anemia
Sickle-cell anemia
B-thalssemia
Hemophilia
Von Willebrand Disease
ITP
How long is the life of a red blood cell in a pediatric patient?
100 days
In an adult, it’s usually 120 days
Where is the red blood cell produce typically in pediatrics patients?
Red bone marrow
In adults, typically this is found to be in the spleen
What is the hemoglobin level in an infant?
17-18g
What is hematocrit level in an infant?
45-50%
How much red blood cell is produced at birth of an infant?
5 million
Compared to an adult
That is 1 million more
What are your 3 low hemoglobin level complications?
Kidney disease
Anemia
Liver disease
What are your 3 elevated hemoglobin levels complications?
Chronic lung disease
DeHydration
Heart failure
What does anemia mean?
A reduction in red blood cell mass per volume and or hemoglobin concentration compared with normal values of age and gender
Red blood cell morphology
The following terms below, tell me what they mean?
Normocytes
Microcytes
Macrocytes
Spherocytes
Drepanocytes
Normochromic
Hypochromic
Hyperchromic
Normal cell size
Smaller than normal cell size
Larger than normal cell size
Globular cells
Sickle-shaped cells
Sufficient-normal amount of hemoglobin per RBC
Reduced amount of hemoglobin per RBC
Increase amount of hemoglobin per RBC
What are the 2 main causes of anemia?
Inadequate production of RBC/components for RBC
Increased destruction of RBC/loss through hemorrhage
What are some sighs and symptoms of anemia with decreased red blood cell production?(6)
decreaSed
Pallor
Tachycardia
Fatigue, headache
Muscle weakness
Systolic heart murmur
Frontal bossing
What are some signs and symptoms of anemia that has increased red blood cell destruction (7)
Think of the I in increased and follow that
Icteric sclera, jaundice
Fatigue
Headache
Tachycardia
Dark urine
Spelnomegaly
Hepatomegaly
Low blood pressure (late sign shock)
What are signs and symptoms of anemia with increased red blood cell loss? (7)
Think of L in cooL
Pallor
Fatigue, headache
Muscle weakness
Cool skin
Tachycardia
Decreased peripheral pulses
Low blood pressure ( late sign shock)
What are your diagnostic evaluation for anemia?
Typically look like CBC tests
Bone marrow aspiration
Peripheral smear
History & physical examination
What is the therapeutic management of anemia?
How are we going to treat it?
It really all depends on what type of anemia it may be like
Iron = iron supplements
Blood loss = transfusions
Oxygenation & IV fluids
In the book it mentions that a viral nursing care is to listen to the parents signs and symptoms with the way they talk, so what 2 phrases do you think might indicate to us that something may be wrong and leans towards the idea of anemia?
My child drinks a lot of milk
My teenage is on liquid/vegetarian diet
What are some question we might ask a parent to tell us about the history of a child that could help identify anemia and intervene properly?
Nutrition
Past history of chronic infections
Eating habits
Bowel habits - dark tarry stool - blood
Family history of anemia
It’s very important to assess a child energy level, why you may ask? Because child tend to show a lot in behavior that we as adults usually speak about. What might you think will indicate good anemia behavior and bad anemia behavior?
Child energy level and tolerance to activity’s usually is a great indicator of treatment or illness
Good = good oxygen = better “anemia” = lots of energy
Bad = no oxygen = bad “anemia”
= fatigue and no energy
How are we going to prevent anemia?
It really all depends on the type of anemia
But mainly we are going to provide great hydration and nutrition to our kids
Limit infection by hand washing
Providing good oxygenation
What is iron deficiency anemia ?
Anemia caused by inadequate supply or loss of iron
Is iron deficiency anemia the most common in the world to have?
Yes
What is the cause behind iron deficiency anemia?
Dont over think it
Decrease supply,
impair absorption,
increase body need for iron
What is the biggest cause of anemia in children? (2)
Excessive milk intake
Poor iron intake
It’s very vital to note that iron deficiency can also occur in patients with GI issues like lactose intolerance chronic diarrhea and those who also have a ton of blood loss
What is the pathophysiology behind iron deficiency anemia?
Iron is required for the production of hemoglobin
Iron binds to hemogloblin
We have decreased hemoglobin level and reduced oxygen carrying capacity of the blood
What are some common sources/food of iron patient can get? (5)
Egg
Red meat
Beans
Pomegranate
Sesame seeds
What type of diet is very famous for having been associated with iron deficiency anemia that can be mainly found in teenagers?
Vegetarian diet
What type of food/drink is famous for causing the lack of absorption of iron in patients? (2)
Calcium
Tea
What are your 3 big clinical manifestation behind iron deficiency anemia?
Koilonychia ( concave/spoon nails )
Glossitis
Pallor
- tachycardia fatigue and irritability is also included
What are the diagnostic evaluation of iron deficiency anemia
How does the RBC look like?
CBC test is typically performed
Microcytic
What is the therapeutic management behind iron deficiency anemia?
Primary goal is to achieve optimal nutrition and appropriate iron supplements
What type of food would you think to include in the administration of iron supplements ?
Orange juice ! ( vitamin C )
The reason behind this is that ingested iron is absorbed largely from the duodenum and absorption is facilitated by an acid environment
What interferes with iron metabolism that results in the low iron absorption ?
So think of what we are going to educate patients on to avoid what having iron supplements?
Calcium
( dairy products must be avoided ! )
It’s very important warn patients about two things when on iron supplements ?
This is when they are administration
Think about the liquid version
Think about the excretion
Liquid version = stain teeth
Poops will be dark and tarry !!
Since the patient is given a liquid supplement and we understand it can stain the teeth, what are we going to tell patients?
Use a straw and place it in the back of the mouth to avoid staining the teeth
If stained teeth occurs, decay may be the long term complication with these kids
Sickle cell anemia what is it?
Sickle cell anemia is when patients have an additional hemoglobin, named hemoglobin S, that causes other red blood cells to stick together and cause poor circulation
( Vaso-occlusion )
This is usually hereditary
Sickle cell anemia mainly affects who?
African Americans
Once again to review, sickle cell anemia has what type of extra hemoglobin?
Hemoglobin S
Dr. Rickerby describes sickle cell anemia blood to be what? (2)
Crescent shape- sickling
Sticky!!
What is the Vaso-occlusive crisis clinical manifestions of sickle cell anemia? (8)
Painful swelling hands and feet
( sickle cell dactlysis or hand and foot syndrome )
Severe pain in abdomen
Stroke
Visual disturbances
Pneumonia symptoms
Obstructive jaundice
Hematuria
Priapsism
What is the diagnostic evaluation of sickle cell anemia?
Peripheral blood smear
What is the management of pain of the hands and feet when it comes to sickle cell patients? (2)
Treat with heat
&
Typically administer an opiate
What are the 2 big things we want to want to promote patients to follow when they have sickle cell anemia?
Minimize tissue deoxygenating
Promote hydration
Why would promoting to decrease tissue deoxygenation be the best way to reduce sickle cell anemia?
Because when you don’t have oxygen you’re body is going to constrict, when it constricts these sickle blood cells will cause Vaso-occlusion
What are the 4 ways we are going to minimize tissue deoxygenation? Or in other word avoid hypoxia?
Avoid high altitude
Avoid poorly pressurized airpline
Hypoventilation
Hypothermia - cold
Why would hydration be a very vital thing for sickle cell patients to be doing?
Allows for the blood to dilated and to avoid that occlusion from occurring
Do we use ice with sickle cell anemia?
NO!
We use heat!!
Since sickle cell anemia is a genetic thing, what do you think would we recommend to these patients?
Possible screening and genetic counseling to help diagnose earlier and prevent future complications
What is B thalassemia ?
It’s a genetic disorder that results in severe anemia that is not compatible with life without transfusion support
What are your clinical manifestation of progressive anemia in B-thalassemia? (6)
Think of B for Bone!
Signs of chronic hypoxia
Headache
Precordial & bone pain
Decreased exercise tolerance
Restless
Anorexia
What are the major bone changes, typically in older children with B-thalassemia? (7)
Enlarged head
Prominent frontal & partial bosses
Prominent Malar eminences
Flat or depressed bridge of the nose
Enlarged maxilla
Protrusion of lip
Generalized osteropories
What is the patho behind B-thalassemia?
Anemia results from defective synthesis of HGB, structurally impaired RBCS and shorten life of RBC
What is the diagnostic evaluation of B-thalassemia?
High performance liquid chromatography
What is the therapeutic management of B-thalassemia?
Blood transfusions
What does hemophilia mean?
A bleeding disorder in which patients are usually missing a clotting factor
How is hemophilia transmitted? (2)
X lined recessive disorder
Unaffected male and trait carrier female
What is the most common hemophilia?
Type A
Hemophilia A is missing?
Hemophilia B is missing?
Hemophilia A is missing 8
Hemophilia B is missing 9
Hemophilia B is also known as your?
Christmas disease
The bleeding tendency may vary from severe, moderate and mild
However symptoms do not start showing until the child is usually this age___ and why do you think so?
6 months
Because children are becoming more mobile and they have more ability/access to having accidents
What did hemarthosis mean?
Bleeding into joint spaces knee, ankle and elbow, leading to impaired mobility
Why do you think hemoarthosis occurs in hemophilia?
Because of the fact that patients are missing a clotting factor, typically clotting factor 8.
So instead their body will decide to just bleed, bleeding internally and mainly go into the joints
And result in this big bleeding pool
What are the 3 big clinical manifestation of hemophilia?
Ecchymosis
Epistaxis
Bleeding from procedures
How do you diagnose hemophilia? (3)
Amniocentesis
Genetic testing - seeing that clot factor
CBC
What is the medical management behind hemophilia?
Giving them the factor they are missing through an IV with normal saline
Think of the factor to be like a blood transfusion, so give it with normal saline and administer slow
What are the interventions for patients, like educations wise when it comes to being diagnose with hemophilia?
Dont over think it
Monitor bleeding
Close supervision & safe environment
Dental procedure
Shave only with electric razor
If the patient is having superficial bleeding and has hemophilia what are we going to do to help them? (2)
Apply pressure for 15 minutes
Then use ice to vasoconstrict
To review
Sickle cell we use ___to help ___
Hemophilia we use ___ to help__
Sickle cell we use HEAT
To help VASODILUATE
Hemophilia we use ICE
to help VASOCONSTRICT
What is von willebrand disease?
A hereditary bleeding disorder characterized by the missing of
Von willebrand protein
What are the 5 clinical manifestation of Von willebrand disease?
Easy brusing
Epistaxis
Gingival bleeding
Excessive bleeding with laceration & surgeries
Menorrhagia - long period time
How will we diagnose von willebrand disease?
CBC
Prolonged bleeding
Genetic - not having protein
What is the 2 important treatments for Von willebrand disease?
DDVAP to help treat their low platelet count and help clot because it’s a bleeding disorder
IV administrion of the VW protein
TEST QUESTION!!
It’s important to mention that both hemophilia and Von willebrand disease are both extreme bleeding disorders, what mediation (2) would you think would be contraindicated in these patients?
And why?
Aspirin and NSAIDS
Because they cause patients to bleed more often
Remmeber aspirin is an anti-platelet and these conditions don’t have platelets to begin with
Idiopathic thrombocytopenia purpura
What is it?
Usually results from an infection that results the patient to have a severe reduction in platelets count
Otherwise known as
Acquired hemorrhagic
What are the 3 characterization of IDP?
Thrombocytopenia
Purpura
Normal bone marrow with increased number of immature platelets
TEST QUESTION
Purpura means what?
Petechiae means what?
Large rash
Small rash
What’s the biggest thing to know about IDP rashes?
It will not Blanche, like turn white, when you press on it
What is the therapeutics mangement of ITP?
Often self limited
IVIG and anti-D has been given though
TEST QUESTION
Administration of blood transfusion
What are the 5 biggest inductor to monitor when there is a reaction to blood transfusion?
Sudden chest pain
Shortness of breathe
Fever
Chills
Lowe back pain
Do you just hang blood transfusion by itself? If not, then with what?
No
Normal saline
Usually administer it slow
Let’s say the blood bank delivers you the blood early and the patient is out on a walk, how long do you have with the blood bag?
30mins
How long is the transfusion going to be when you first do it slowly?
15-20mins
What is the longest you can give blood?
4 hours
Test question
If the patient has a reaction to a blood transfusion, what are you going to do?
STOP THE BLOOD.
Ring the emergency bell.
DONT go out of the room, call the emergency bell on the phone
She’ll more than likely going to trick you into reading the slow transfusion, don’t pick that
ITS STOP.
So our patient is having a reaction, you stop the transfusion and called for help, what is the next step?
Then let’s say help arrives, what are you going to do with the now blood bag?
Bolus of IV saline in order to flush out all those toxic blood
Give it to them for them to evaluate what went wrong
Another thing to note
With massive transfusion reaction
You’re more than likely to have renal problems, typically a patient might produce red urine
What is your thing to monitor as a nurse when this is happening in a blood transfusion?
Hyperkalemia
Remember kidneys and heart are best friends
If one is upset, the other will be too!
How do you do vital signs checks with blood transfusions?
Note
This is a dual verificafion.
TWO NURSES ARE NEEDED.
Before administration( vital sign )
Give blood
After giving blood ( vital sign )
Stay in the room 15mins
Do another vital sign check
Then do it every hour
Then stop transfusion at 4 hours
Blood transfusion reaction
What is the tempature
What is the heart rate
What is the respiratory
What is the blood pressure?
High temp
High heart rate, hyperkalemia
Dyspnea, high RR
Low, hypotension
Additional information
DIC
- condition affecting the blood ability to clot and stop bleeding
Clinical manifestations
- thrombotic manfiestions & bleeding
Treatment
- heparin & blood transfuse
Neutropnia
- low white blood cell
- infections & fevers
Diagnostic
- CBC = low WBC
Treatment
- hand washing & Iv antibiotics
- G-CSF administration
The following flashcards are going to be about the cerebral dysfunction
Cerebral dysfunction
What are the 11 topics we are going to talk about regarding children with cerebral dysfunction?
Increased intracranial pressure
Head injury
Shaken baby syndrome
Subversion injury
Meningitis
Encephalitis
Rabies
Reye syndrome
Seizures
Migraine/headaches
Hydrocephalus
At birth, the brain is __% of an adult
By age __the brain is ___of adult size
25%
5 is about 90%
CSF is __ml in a neonate
CSF is __ml in an adult
5ml
150ml
When is myelinization completed by?
Puberty
What does myelinization mean?
It’s a cholesterol coating that protects our nerves and allows impulses to move faster
What section of the spinal cord does it terminate in an infant?
L3
How much percentage does the brain make up infants body weight?
How much percentage does the brain make up in an adults body weight?
12%
2%
Are the peripheral nerves myelinated in an infant??
Are the peripheral nerves myelinated in an adult?
Infant no
Adult yes
When are the primitive reflexes gone in a child?
Can they reappear in an adult and if so how?
6 months of age
They shouldn’t be able too, however with severe neurological damage or disease they can occur
The following are reflexes that she stated she wants us to know and easy test questions ; so tell me for the following reflexes
What it does/how to do it (1)
When it comes (2)
When it disappears (3)
CNS origin (4)
Moto reflex ( startle )
Grasp reflex
Rooting reflex
Trunk incurvation reflex
Placing reflex
Tonic neck reflex (fencing pose!)
Parachute reflex
Motor reflex ( startle )
- extension of all limbs
Appears : birth
Disappears : 4-6 months
Origin : brain stem vestibular nuclei
Grasp reflex
- finger grabs onto something
Appears : birth
Disappears : 4-6 months
Origin : Brain stem vesicular Nuclei
Rooting reflex
- touch the cheek, they will go to you looking for food
Appears : birth
Disappears : 4-6 months
Origin : brain stem trigeminal system
Trunk incurvation
- withdrawal from stroking along the surface of the back ; so little the back will curve when you stroke them
Appears : birth
Disappears : 4-6 months
Origin : spinal cord
Placing reflex
- hold the child up as if they were walking and it stimulates it as a walk
Appears : birth
Disappears : 4-6months
Origin : cerebral cortex
Tonic neck
- fencing pose, so extend their right arm, their left arm should flex
Appears : birth
Disappears : 4-6 months
Origin : brain stem vestibular nuclei
Parachute reflex
- stimulate a falling motion = extend of the limbs to protect itself
Appears : 4-6months
Disappears : never
Origin : brain stem vestibular
How are you going to evaluate the neurologic status in infants and in young children?
Observing for spontaneous and elicited reflex responses
Ex : arm movements, resting state, extension
Great fact
Babies can handle a little bit more intracranial pressure, what 2 things allows for babies to do this?
Their fontanels aren’t closed yet
Anterior fontanel ( diamond shape )
Posterior fontanel ( y shape )
What is an increased intracranial pressure?
Pressure that may accumulate within the enclosure of the brain
How can increased intracranial pressure occur?
Really can be from any head injury
Concussion for an example
What are the 5 mainly associations of clinical manifestation with children who have an increased intracranial pressure?
Projectile vomiting
Loss of consciousnes / deteriorations
Hypertension
Headaches/dizziness
Bulging fontanel
When you’re first seeing an increased intracranial pressure, what are the 3 following vital signs going to be doing?
Blood pressure ?
Pulse?
Respirations?
Blood pressure = up
Pulse = up
Respirations = down
How would you assess an infant and young children for a neurological status?
Remember they can’t talk, so instead we are going to?
Be observing their spontaneous and elicited reflex responses
What type of physical or history exam will be we doing on these children with an increased intracranial pressure?
Physical
- observation of size of head
- spontaneous activity
- posture
History
- pregnancy complications
- delivery
- disorders/ genetic predisposition
What does consciousness mean?
Awareness
- the ability to respond to sensory stimuli and have subjective experiences
What does altered state of consciousness mean?
Refers to varying states of unconsciousness that may be momentary, or may last for hours, days or indefinitely
What does unsciousness mean?
Depressed cerebral function
- inability to respond to sensory stimuli and has subjective experiences
What does coma mean?
State of unconsciousness from which cannot be aroused, even with painful stimuli
What is the scale that we use to assess the mental status or neurologic state to help assess a patient?
Glasgow coma scale
What are the 3 components that Glasgow scale measure?
Eyes
Verbal
Motor/movement
How would you assess the eyes using the Glasgow coma scale ?(4)
4 points = moves eyes spontaneously
3 points = moves eyes to speaking
2 points = moves eyes to pain
0 points = none
How would you assess verbal when using the glascoma scale? (5)
(5) Coos, babble
(4) Irritable, crying
(3) Crying to pain
(2) Moans to pain
(0) None
How would you assess motor when using the glascoma scale ? (6)
(6) Normal movement
(5) Withdrawal from touch
(4) Withdrawal from pain
(3) Abnormal Flexion
(2) Abnormal extension
(0) None
What is the best number score to get when being assed when using the glascoma scale?
What is the number that would indicate a coma?
What is the number that indicates a deep coma or even death?
15
8
3
It’s important to note that GCS in itself is not sufficient to determine what type of children?
Those with an induced coma
Quadriplegic
What is the purpose of a neurologic examination?
To establish an accurate objective baseline of neurological function
Why would assessing the skin be helpful for assessing a neurological function ?
May offer Clues to the cause of why they are unconscious, or have ICP
Ex : bacteria infection
Why is posturing such an important thing for a neurologic examination ?
Because our body even in the deepest of pain, will try its best to protect itself by putting itself in certain positions
What are the 2 posture names that we need to know when assessing patient with neurologic issues?
Decorticate = Flexion
Decerevrate = extension
Out the 2 posturing, what would be the worst to have and why do you think so?
The decervrate because you body is extended and exposed, you’re not long protecting the vital organs
Remember deCORE = protecting the core of your body, Flexion
deCER= E would indicate extension = no longer protecting the body
A sudden appearance of a fixed and dilated pupil would promote us to do what?
Would be a neurological-surgical emergency
What are some diagnostic procedures we will do for patients with neurologic dysfunctions?
Lumbar puncture
EEG
Imaging
Radiography
TEST QUESTION
Dr. Rickerby states in her video that when a doctor is doing a lumbar puncture, what is the nurse vital job to do!?
Have the child in a
KNEE TO CHEST POSITION.
maintain the child calm and non-moving
What is the first thing we are going to do when a child is unconscious ?
Begin CPR
As we’re doing CPR, do you think it’s appropriate to move the child head around ? And if not why not?
No
Because we want to rule out that there isn’t any cervical spine injury, so using we are going to stabilize the spine and place a C-collar around them to protect their head
Pain management is a huge issue with these children, one because their head is going to be hurting with all that increased pressure, what do you think are the main medication we are going to give to these children ?
NSAIDS
In severe cases, opiates may be used to help aid a child with increased intracranial pressure or a potential head injury, however what is so dangerous and vital to note about the usage of opiate?
It will mask the signs of an alerted consciousness and depress respirations
In essence, it can affect our assessment of their neurologic function and impend their risk of respiration depression
Notes to know
Codeine shouldn’t be used under the age of 12 in children
Nalxone,narcan, should be on hand in order to reverse opiate overdose
Acetaminophen and IB are the best
If a patient is on a narcotic, or an opiate, what are the 2 big things we are going to be watching out?
Respiratory depression
Constipation
When a patient is constipated due to using opiates, what might we encouraged them to do ?
Increase fiber and fluid intake
Sometimes we may provide them with a stool softener
Fun fact
Do you think brains work better in a cooler environment or a warmer environment ?
Cooler
In what position do you think we should have our patients who have intracranial pressure
Like sitting up?
Like laying down and why?
Well in her original video she mentioned laying down
- which makes sense to me because it’s too much pressure trying to get fluid to circulate UP to the head
But in her review video she said sitting down?
- I believe I’m gonna go with the laying down though
What type of stimulation would be best for these kids with increased intracranial pressure to be in and why?
A decrease stimulation, so like close the curtains, lower the lights down
Because the minimal stimuli, the brain can relax and try to release all the pressure out
If a patient develops a fever, usually is a common manifestation of increased intracranial pressure, what do you think we’ll give them?
Antipyretics medications
What is the treatment of an increased intracranial pressure?
The usage of osmotic diuretic
Like mannitol
What is a head injury?
A pathologic process involving the scalp; skull; meninges or brain as a result of mechanical force
What are the 3 main causes of head injuries ?
Falls
Being struck by an object
Car accidents
What are your 3 main worries behind a head injury? Usually the common complications we’d see
Concussions
Contusion & lacerations
Fractures
What are the 3 major complications of the head injuries that usually promote us as nurses to intervene more?
Epidural hematoma
Subdural hematoma
Cerebral edema
What is an epidural hematoma?
Hemorrhage into the space between the Dura and the skull
- however the bleeding doesn’t go into the brain, it just kinda floats around it
What is a subdural hematoma?
Hemorrhage between the furs and arachnoid membrane
- bleeding into the brain
What is cerebral edema?
Swelling the head
Out of epidural and subdural hematoma. What is the worser condition to have? And why?
Subdural hematoma
- because you’re literally bleeding into your brain
How would you diagnose a brain injury?
CT
MRI
Signs and symptoms
What are your major symptoms of a head injury? They are similar to those of ICP?
Vomiting
Bulging fontanel
Elevated tempetatre
- same hypertension as well
Nursing alert!
If a child has a head injury, it’s more than likely they are going to bleed out of their nose.
However, if they are bleeding this yellow, watery discharge.
What might that indicate to us ?
Additional, what test will we run to confirm that indication ^?
Cerebral spinal fluid
Glucose test -
Usually will see that halo sign
Nursing care management behind a head injury, how often are we doing neuro exams on these patients?
Every 15mins
What are the 3 important things we want to maintain adequately with these patients with a head injury?
Ventilation
Oxygenation
Circulation
How are we going to prevent head injuries from occurring?
Don’t over think it
Seat belts
Following driving rules
Sleeping on the lower bunk bed
Identify signs of abuse
What is the main treatment that we are going to do for our children with a head injury?
So typically give them mannitol- osmotic diuretic to help alleviate that fluid built up in their head
What is shaken baby syndrome?
Or more so how do you get this to occur?
Shaking the baby vigorously to where the head kinda gets a double concussion; causing the head to kinda just float in the fluid after words
This can cause severe blood vessels and nerves to be detached from that rotational force
What are the major clinical manifestation we can tell that a baby has been shaken vigorously? (3)
Retina detachment
Pale,blue skin
Lethargic eyes
It may include bleeding in the retina, bleeding the brain, bone fractures and bruises
Once the baby has been shaken, the damage is already done, so what are we monitoring afterwards?
Again, the damage has been done to the baby, we simply do supportive care and when the swelling has decreased, we are more than likely going to treat whatever disability to child may have received from the trauma
What is submersion injury?
Otherwise known as near drowning
The process of respiratory impairment from submersion/immersion in liquid
What is the pathology behind submersion injury? (5)
- Accidental submersion
- Loss of normal breathing pattern, typically the last auscultatory gasp
- Panic,struggle & laryngospams
3.5 pulmonary aspiration (wet/90%)
3.5 breath holding/apnea (dry/10%) - Hypoxemia
- Hypoxia, hypercarbia, acidosis
With submersion injury, what is the treatment management to help aid these kids?
CPR
Remember they are literally drowning. They are submersion in water, they are gonna come out unconscious, we need to do CPR
How do we prevention submersion injury from occurring?
Don’t over think it
Life jackets
Supervision of kids
Teach the children how to swim
What are some common examples/causes that we see or may be the identifier of an intracranial infection ? (3)
Bacterial
Viral
TB
What is bacterial meningitis?
Acute inflammation of the meninges and CSF
What are the main clinical manifestation we will see in patients with meningitis? (6)
Photophobia
Phonephobis
Stiff neck
Pin-prick rash
Arching of the back
Cold hands and feet
What is the pathology behind bacterial meningitis?
Usually a bacteria enters through a wound and travels up your spine into your meningitis, causing inflammation
What is the definitive diagnostic test for meningitis ?
What does it usually reveal?
Lumbar puncture test
Results normally are a cloudy CSF
What are the 2 signs that we might do to test if a patient may have mengingitis?
Brudzinski neck sign
Kernig sign
What is the Brudzinski neck sign ?
What is the Kernig sign ?
Brud
- usually when you left the patient neck and the child will curve up their knees to the Chest
Kernig sign
- usually when you lift the child knee/leg up to see if itlll extend, but the child ends up curling up
How would we normally treat bacterial meningitis?
Usually giving them anti microbial agents, typically penicillin
Possible test question
We like to do a ___ test to help rule out the blanching features of the skin when a child has bacterial meningitis.
However most of the time the Blanche test comes out ____
Glass test
- so press the glass on the skin to see blanching
However it’s comes out negative
What type of isolation is bacterial meningitis in?
Droplet precautions
Is there a way we can prevent bacterial meningitis ?
And how?
Vaccination
HIB vaccine
What is non bacterial (aspectic) meningitis?
Onset of meninges symptoms without the bacterial growth
What is encephalitis?
Inflammation process of the CNS
What is the main cause of encephalitis)
Enterovirus
What is the therapeutic management behind encephalitis?
Typically supportive care because it’s a virus
Mainly hydration &! Nutrition
What is rabies?
A viral infection that is transmitted through a bite of an animal
What are the 4 main common animals that carry rabies virus?
Raccoons
Skunks
Bats
Foxes
What is the incubation period of rabies?
1-3 months
What are the big 4 clinical manifestation behind rabies?
Hydrophobia
Hallucinations
Hyperslavations
Flu like symptoms
How do you diagnose rabies?
Typically 2 methods
The hallmark : hydrophobia
Skin biopsy of the bite
What is the first thing you’re going to do when you get bitten by an animal, and worse case scenario a rabies carrying one?
After this of course rush to the hospital, or even do this at the hospital
Wash the site for 15mins with antimicrobial agents
What is the therapy they are going to do for you when you go to the hospital being bitten by a rabies animal?
Vaccines & antibodies
What are the 4 doses of vaccines that are going to be scheduled
Like what are the dates to remember
Day 0
Day 3
Day 7
Day 14
TEST question
Where do we give rabies vaccines?
Where do we NOT give rabies vaccines?
We give it IM
We do NOT give it glutes
What is Reye syndrome?
Typically associated with kids having flu like symptoms or a viral infection and being given aspirin
What is the diagnosis behind Reye syndrome?
Liver biopsy
- reason behind this is because their liver will most likely fail
What is the treatment of Reye syndrome?
I did find this off of google as she didn’t mentioned anything about it andddd I’m too lazy to look into the book right now so
Help with breathing- oxygenation
Fluids- hydration
Really no cure, just aid with it
What is a seizure?
Malfunction of the brain electrical system
What does epilepsy mean?
Two or more unprovoked seizures more than 24 hours apart
What is are some causes behind why children or people in general get seizures?
Usually underlying cause
Being struck up something
Being sick
Etc
What is a focal seizure?
A seizure when you’re aware that you’re having
Remember, this is awareness of it happening, usually patients will see their arm spamsing but they are conscious
What is a generalized seizure?
You will see patients go
UNCONSCIOUS.
They will typically fall over
She mentioned this the video for review of the exam
What is a tonic seizure
What is a clonic seizure
Tonic = extension of the body
Clonic = Flexion/clousness of the body
Possible test question
What is an absence seizure?
When you go unconscious however you’re still kinda looking normal
Kinda like that day dreaming look
What is the most common type of seizures in kids?
Febrile seizure
What’s the big characteristic behind a febrile seizure, mainly how does it occur?
A rapid temperature
What does status epileptic seizures mean?
A seizure that does not stop and we need to intervene if not we can let our patient die
If a seizure last more than 5mins what is that indicting to us ?
That it is status epileptics, and we need to take them to the hospital before brain damage and death
She mentioned this in the review video
The first thing to go is hearing
And usually the first thing to come back as well
Just something to note about seizures
What are the 4 main treatment methods we can use to help treat seizures?
Anti-seizure drugs
Ketogenic diet
Vagus nerve stimulation
Surgery
When would it be indicative to give an antiseizure drug?
She mentioned her in her original video
That you shouldn’t give a antiseizure drug to someone who has just gotten one seizure
Instead you give to those with epilepsy or status epileptics
In the textbook it uses the phenyoin examples as an antiseizure drug remember
PICC LINE & SLOW ADMINISTERING
DILUTE THE MEDICATION
AVOID PURPLE GLOVE SYNDROME
TELL THEM TO BRUSH THEIR TEETH!!
Gingival bleeding
Osteroporiesis
Heptatoxicity & Nephrotoxicity
CV side
- hypotension,bradycardia,V-fib
Teratogenic
What is the ketogenic diet? (3)
A high fat
Low carbohydrate
Adequate protein
Why is ketogenic diet successful for seizures ?
It makes the body use fat instead of glucose of energy
What are the 2 main things to look out for ketogenic diet?
Hypoglycemia
Constipation
How does the vagus nerve stimulation help children with seizures?
Help deliver precise pattern of electrical impulses
Lastly surgery, some basic notes to know, if it’s a tumor causing the patient to have seizures
Just use surgery to remove it
Pretty basic
To review
What is a febrile seizure?
And what age range does it mainly affect?
What is the main treatment?
High rapid in temperature
Age 6 to 60 months
Antipyretic medications, Lower that fever
What are your safety intervention in helping with a seizure?
Seizure pads
Document the time it started and end
Don’t leave the room
Remove any potential hazards
Protect the head
Are we going to restrain our patient in a seizure?
Are we going to put anything in their mouth during a seizure?
NO!!!
What is a primary headache?
Migraine
Tension type headache
What is a secondary headache?
Another condition causes it
What are the 4 things we normally like to ask about a patient who is experiencing a headache?
Are you getting
Good sleep?
Good hydration?
Good eating ?
Good exercise ?
What are the main 4 symptoms of a migraine?
Photophobia
Phonephobis
Nausea & fatigue
Migraine typically are on what?
One side of the head
What is migraine with aura
What is migraine without aura
Aura is usually something that triggers and you’re aware of it,
Example smelling a daisy, and it causes you to have a migraine
Without aura usually is just a persistent headache that grows into a migraine
What is the best medication to give patients with migraines?
Advil- IB (nsaids)
Patient education
The second a migraine is coming do you want to take the medication or delay it?
Take
DONT delay anything
I don’t want to forget it
But aura can also happen with seizures as well, typically patients will start to see fuzzy lines of like be very dizzy
So that’s a great sign to prepare for a seizure
What is hydrocephalus ?
Condition caused by an imbalance in the production and absorption of CSF
What is the two main causes or I guess malformations that can cause hydrocephalus?
Chiari 1 and 2
What are the big 3 clinical manifestation behind hydrocephalus ?
Mainly intracranial pressure symptoms
- vomiting
- frontal bossing
- hypertension
Other important things to note though
Macewen ( cracked pot sound )
- palpitation on the skull
Setting sun sign
- sclera may be vividly about the iris
What is the main treatment to help with hydrocephalus?
A surgical treatment called
Ventriculoperintoneal shunt (VP)
What is the dangerous things that can occur with VP Shunt? (2)
Don’t over think it
Infection and occlusion
What is the biggest clinical manifestation behind VP shun occlusion?
Strabismus ( cross eyed children )
The last following flashcards are going to be about the endocrine dysfunction in children
Endocrine dysfunction
What are the 15 conditions we are going to be talking about when it comes to endocrine dysfunction with children
Endocrine dysfunction
Diabetes type 1 & 2
DKA
Hypopituitarism
Hyperpituitarism
Precocious puberty
Diabetes insipidus
SIADH
Hypothyroid
Hyperthyroid
Hypoparathyroid
Hyperparathyroid
Addision
Cushing syndrome
Hyperaldosteronism
Phenochromocytoma
What does diabetes mean?
Total or partial deficient of the hormone insulin
Diabetes usually peaks around what age for children?
Diabetes usually peaks around what age for adults ?
10-15 years old
45 years old, mainly African Americans
How many types of diabetes are there?
Type 1
Type 2
Technical 3, with diabetes insipidus but that’s another topic
What is type 1 diabetes mean?
Autoimmune condition where the patient is born with literally no insulin, or functioning pancreas
What is type 2 diabetes ?
Chronic condition where patients become insulin resistant
Usually due to having a high increase in their amount of sugar intact
Usually what type of diabetes we see in children?
Type 1
It was also known as juvenile diabetes
What is the pathology behind diabetes?
With a deficiency in insulin, glucose is unable to enter a cell and instead remains free in the blood, otherwise known as HYPERGLYCEMIA.
When serum glucose is too high, the kidneys will end up having to glucose spill out into the urine, dashing a key identification of GLYCOSURIA.
cell breakdown the protein for conversion to glucose by the liver
Known as glucogeneis
Test question!
What are the signs of hyperglycemia ?
Remember the anagram (6)
Feeling tired
Irritability
Blurred vision
Polyruia
Polydipsia
Polyphagia
FIB-PPP
Test question
What are the 9 hypoglycemia side effects?
Think of the anagram
Feeling tried
Irritability
Blurred vision
Dizziness
Increased hunger
Shakiness
Headache
Paleness
Sweatiness
FIB-DISH-PS
What are the long term complication of diabetes ?(2)
Like what type of conditions
Microvascular
Macrovascular issues
What are the 2 microvascular issues with diabetes?
Nephropathy
Retinopathy
What is your major macrovascular complication with diabetes?
Neuropathy
What are some therapeutic management of Diabetes?
Dont over think it
Insulin therapy
Monitor blood sugar - A1C
Urine test for ketones
Nutrition and exercise
Teach patient how to mange
Hypoglycemia
Illness management
What does A1C tell us?
Past 3 months of where your blood sugar averaged
What is the target blood sugar in a 5 year old and typically younger?
What is the target blood sugar in a 6 year old and typically older?
70-200
70-150
How often are you checking blood sugar in these patients?
So give me usually the time we’d check them (5)
Before breakfest
Before lunch
Before dinner
Before bedtime
Exercise
What is the statement we use when talking about hypoglycemia?
Cold and clammy give me some candy!!
What is the treatment for hyperglycemia?
Insulin administration
What are some fast acting sugar examples (5)
These are based off the PowerPoint picture she had up
Glucose tablets (4-5)
Fruit juice (150-200ml)
Honey (1 Tablespoon)
Sugary drink (75-100ML)
Jelly beans (4-5)
Do we give chocolate for hypoglycemia?
No
TEST QUESTION
Usually after the administration of a sugary substance to patients with hypoglycemia reactions, what do we want to follow up with and why?
Carbohydrate
We want the sugar to stay in our body a little longer, not just spike up
We understand that with Hyperglycemia we are going to want to administer insulin.
Name me the 3 rapid type of insulin
Onset
Peak
Duration
Novolog, humalog, apidra
10-15mins
60-90mins
3-4hours
Possible test question
What’s the super important thing to note when administering rapid insulin to a patient?
They must have their food tray right in front of them, if not they only have 10-15mins before they become severely hypoglycemia
What is your long acting insulin, otherwise known as your background basa
Give me the names (3)
Onset
Peak
Duration
Lantus,Levemir, basaglar
Doesn’t really have a peak or onset
But has a duration of 20-24hours
TEST QUESTION
What’s the super important thing to note about long acting, background basal insulin?
We do not mix it another insulin
TEST QUESTION EXAMPLE
a patient is receiving Lantus/letermir/basaglar insulin injection, should we give them a rapid insulin?
No!
We never mix long acting insulin with another insulin
Do you give insulin injections in the same spot?
So what do we do?
And if you do give it in the same spot, what does it mean?
No
Rotate sites
Lipodystrphy, abnormal fat growth and leads to improper absorption
Some other patients education
DM : INSULIN therapy
Nature of the disease
Meal planning
Insulin therapy
Insulin pump therapy
Glucose monitoring
Rotate the sites of injection
Have it on the thigh, the stomach left/right, upper arm
- very important to note is that the stomach has the best absorption site
Just something to note
What do you think is better to have for a patient, for them be hyperglycemia or hypoglycemic? And why?
Hyperglycemia
Because it’s a lot easier to bring someone down with insulin, remember it’s a very slow process but that sugar is still in the brain
For hypoglycemia, it’s the worsen scenario because our body needs sugar and it takes a while for sugar to be absorbed, so it’s a lot more worse
What is diabetic ketoacidosis (DKA)?
When glucose is unavailable for cellular metabolism, the body breaks down alternate sources for energy
Ketones are then release and excess ketones are eliminated in the urine (ketonuria) or by the lungs
(acetone breathe )
Ketones in the blood are strong acids that lower the serum PH
DKA results from what?
Progressive deterioration with
Dehydration
Electrolytes imbalance
Acidosis
Coma
Death
Is DKA a pediatric emergency?
Yes
What are the 3 big clinical manifestations that you will in patients with DKA?
Fruit smelling breath
Kussmal breathing
Very low ph- aciditiy
If the patient were to get a urine dipstick done when they are in DKA what will show?
It’ll be the color pink
Indicting there is ketones
What does kussmual respirations mean?
And why does this happen in DKA?
Fast shallow breathing,
deep labored breathing
In order to get rid of the excess CO2 in the body
What is the only type of insulin that can be given to patients, like DKA?
And why do you think that?
Regular insulin
Because of the method it’s given, IV Drip with normal saline, fastest way of absorption
TEST QUESTION
If a patient is in DKA, or very high blood sugar and you wanna bring that sugar down, what are you going to ?
Regular insulin IV drip
Can you give regular insulin with normal saline?
Yes
This is the protocol typically to use both of them
Something I forgot to note
If you’re patient is hypoglycemia And is unconscious, what are you going to give them!?
- what if it’s in the hospital?
Glucogon
Typically dextrose 50%
Kids carb count when diabetic!
Using the bread example in the picture
5g - top half of the bread
5g - middle half of the bread
5g - end half of the bread
Let’s say a kid has for every 5g he eats, he will need 1 unit of insulin
He eats the top, and middle portion of a singular piece of bread, how much units do you think he needs?
Alright what about a kid is for every 15g and he needs 1 unit, let’s see he eats the entire piece of bread, how much units will he need?
2units
1unit
Just some patient education
We don’t want to say to patients that they can’t eat anything, instead we tell them?
Eat with moderation
What is the function of the endocrine system?
Controls and regulated metabolic process
What is the “big boss” for the entire endocrine system ?
- which helps regular your?
Hypothalamus
Pituitary gland
The pituitary gland has two lobes, which are?
Anterior and posterior
What is the function of the pituitary?
Controls several hormonal glands in the body
What are the 6 hormones anterior pituitary lobe controls ?
GH growth hormone
ACTH - adrenal
TSH - thyroid
FSH/LH - gonads
PRL - prolactin - mammary
MSH - skin
What are the 2 hormones the posterior pituitary controls?
ADH - kidneys
Oxytocin - mammary gland
What are the 3 main endocrine organs we are mainly going to be focusing on during this chapter?
Thyroid
Parathyroid
Adrenal glands
What is hypopituitarism mean?
Growth hormone deficiency
Since within hypopituitarism we don’t have the growth hormone and or lack it, how are kids going to be presenting ?
Like physically wise!
In short stature
How would we diagnose or more so become concern with their growth hormone deficiency in kids, typically with the assessment or observation of what in their chart?
When they deviate by 2 sections away from their normal growth curve
So it’s obvious with hypopituitarism, children are more than like going to need _______ therapy in order to meet the demands of the body.
Growth hormone replacement therapy
Or growth hormone medication
However if growth hormone deficient is caught on later in life, let say teenager years, what’s the very important thing to note about this?
Usually by this time their bone plates are slowly closing away day by day, meaning if we don’t act quickly,
Growth hormone replacement won’t do anything
So again
We need plates to use growth hormone, so we can grow into these plates!!
What is pituitary hyperfunction ?
Otherwise known as your?
Excess amount of growth hormone
Acromegaly
What is the most common cause of pituitary hyperfunction, or Acromegaly is what?
An adenoma or benign tumor on the pituitary gland
Test question
What is the 2 big manifestation we will see with patients with acromegaly?
prominent chin & jaw
Large hands
It may also include
Joint pain
Voice changes
Sweeting
Remmeber for acromegaly, these children are producing a ton of ____so it results then to grow really really tall
But you know, these platelets are going to end up closed eventually, what symptoms will you see out of this?
What is the biggest thing about girls about this though ?
Growth hormone
Again you’d see that prominent jaw and chin
Thyell have a lot of testosterone and eventually it can stop their period!!
What is the treatment for pituitary hyperfunction or acromegaly?
Usually the removal of the adenoma or tumor
What is precocious puberty mean?
ages we use to identify this
Boy
White girl
African American girl
Defined by early sexual development
( reaching puberty too soon )
Boy= 9 years old
White girl = 7 years old
African American girl = 6 years old
What type of scale do we use to help assess the sexual maturity or more so puberty signs on kids?
Tanner scale
So what do you think we’ll see on these kids with precocious puberty?
Dont over think it
Usually pubic hair
Or breast buds for example
At a very very young age
What is the treatment for precocious puberty?
And what is it doing?
Leuprolide acetate (lupron Depot)
Helps slow down prepubertal growth to normal rates
When do you stop giving lupron to children?
When the child reaches an appropriate age for pubertal changes
Typically 11-12 years old
What is diabetes insidious?
Otherwise known as water diabetes
Too little ADH
Meaning they are not able to hold fluid, so they are peeing a lot
What is the main manifestation of diabetes insipidus?
What does it look like?
Diuresis
A very clear white urine
- clearer than clear she says
What type of children do we normally see have diabetes insipidus?
Usually those with some form of brain damage or near death
Possible tests question
What are the 7D’s to remmeber for diabetes insipidus?
Diuresis
Diluted urine (1.005)
Dry inside
Drinking
Dehydration
Decreased blood pressure
Desmopressin
What is the treatment for diabetes insipidus ?
DDVAP (ADH)
Giving this hormone to help stop the diuresis
What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
When you have TOO MUCH ADH
- kidneys hold onto their pee and Edema usually occurs
What are the 3 S causes for SIADH?
Small cell lung cancer
Severe brain tumor
Sepsis infections of the brain
Possible test question
What are the 7s to remember for SIADH?
Stop urination
Sticky & thick urine 1.030 gravity
Soaked inside
Sodium low
Seizures
Severe high blood pressure
Stop all fluids
What is the treatment for SIADH?
Fluid restriction
More than likely a diuretic to help pee it out
TEST QUESTION
Difference of DI and SIADH
Which does it belong to
HIGH ADH - water intoxication
LOW ADH
LOW OU, olugiria
HIGH OU, Polyuria
HIGH SODIUM
LOW SODIUM
High osmolaity - weight loss
Low osmolality - weight gain
Risk : seizures
Risk : Hypovolemic
Treatment : DDVAP (ADH)
Treatment : Fluid restriction
SIADH
DI
SIADH
DI
DI
SIADH
DI
SIADH
SIADH
DI
DI
SIADH
Diabetes insipidus has ___sodium
SIADH has ___sodium
DI = High sodium = Hypernatremia
SIADH = low sodium = hyponatremia
What is the serum gravity of urine for diabetes insipidus?
What is the serum gravity of urine for SIADH?
1.005
1.030
What precautions are we going to patients with SIADH?
Seizure precautions
What is the function of the thyroid hormone?
Regulates the basal metabolic rate (BMR)
Fun fact
Thyroid is the only organ in the body that has the ability to do what?
Store excess amount of hormone for later usage
What is hypothyroidism?
What is the TSH level
What is T3 and T4 level
Little thyroid is being produced
HIGH TSH
Low T3 & T4
What are the 3 main causes behind hypothyroidism?
Congenital
Acquired
Iodine insufficiency
What are the clinical manifestation of hypothyroidism?
Remember low and slow!
Weight gain
Delayed puberty
Lose hair
Constipation
Dry skin
Heat sensitivities
What is the worst case scenario of hypothyroid call? Like the condition ?
Hashimoto disease
What is hashimoto disease?
An autoimmune diseases when you have critically low thyroid that it forms a goiter, so a damage thyroid
What is the treatment for hypothyroidism ?
When do you take?
Full or empty stomach?
How long do you wait for food?
Synthroid, Levothyroxine
Morning pill
Empty stomach
1 hour
With hashimoto disease. We have that goiter, what if it is too bad even with medication, what are we going to do?
Usually remove the entire thyroid & life long thyroid pill
What is hyperthyroidism?
What are the following ranges
TSH?
T3 & T4?
When you have too much thyroid being produced
Low TSH
High T3 & T4
What are you clinical manifestation of hyperthyroidism ?
Think of fast and hyper!
However just 1 big clinical manifestation that is super important to note is)
Tachycardia
Diarrhea
Hungery!
Weight loss
Exophtalamos - big eyes !!!!
What is the severe form of hyperthyroidism that results in a goiter?
Graves disease
What is Graves’ disease?
An autoimmune condition When the body produces way too much thyroid hormone and attacks itself, resulting in a goiter
What is the peak incidence of Graves’ disease?
12-14years old
What is the treatment for hyperthyroidism? (3)
Proplythiouricil (PTU) medication
Thyroidecomty
Radioiodine therapy
What is a goiter?
And what makes it so special ?
Usually a result from a thyroid hormone imbalance, either from hypo or hyper !
How can you diagnose a goiter?
Think about a physical exam?
Enlarged throat
What is thyrotoxicosis?
Otherwise know as
Thyroid crisis or storm
Sudden release of hormone,
too much hormone
What might cause thyrotoxicosis? (3$
Stopping antithyroid therapy
Infection
Surgery
What is the 2 important treatment for thyrotoxicosis?
Antithyroid drugs
Propanolol ( beta blocker )
Additional notes
Hashimoto disease usually ranges what from what age?
6 years and older
What is the function of the parathyroid?
Maintain serum calcium levels
How does the parathyroid hormone maintain serum calcium levels?(3)
Increasing the release of calcium and phosphate from bone demineralization
Increasing the absorption of calcium and excretion of phosphate by the kidney
Promoting calcium absorption in the GI tract
What is hypoparathyrdoism?
When you have too little PTH
What by the the 2 causes of hypoparathyrdoism?
Congenital
Psudohypoparathyrdoism
She mentioned that psydophypoparsyhydoism may be related to patients what?
Having an X-linked dominant trait
What are the big 3 characteristics of hypoparathyroidism?
LOW PTH
Hypocalcemia
Hyperphosphatemia
What are your 5 clinical manifestation of hypocalcemia in your hypoparathyroid patients?
Tetany
Chvostek sign - facial nerve
Trousseau sign - carpal spasm BP
Paraesthestisia - hand and feet
Prolonged QT interval
What is the 4 treatment of hypoparathydoism?
Add foods in rich magnesium
Take OTC vitaimin D
Eat a calcium rich diet
Reduce phosphors intake
Why would we have vitamin D in hypoparathyroid?
Why do we not want phosphorus in hypoparathyroid?
Vitamin D helps increase calcium
Phosphate decreases calcium
Notes
Hyperparathyroid
Too much PTH
Clinical manifestation
GI upset - nausea vomit
CNS - confusion, hallucination
Polyruia
Treatment ; surgically remove
What are the 3 things the adrenal gland helps secrete?
Glucocorticoids ( cortisol, corticosterone)
Mineralocorticoids ( aldosterone )
Sex steroids ( androgens, estrogens, progestins )
What is adrenal crisis caused by?
Hemorrhage into the gland from trauma, fulminating infections, abrupt withdrawal of exogenous cortisone and failure to increase cortisone during times of stress
What is Addison disease?
Chronic adrenocortisol insufficiency
How does Addison disease occur?
Like what is the main cause?
Neoplasm or lesion on the adrenal gland
When do symptoms of Addison disease normally start to show up?
When 90% of the adrenal tissue is nonfunctional
What is your big manifestation to know about Addison disease?
Then 4 more
So 5 in total
Hyperpigmentation - bronze skin
Low blood pressure
Weakness
Weight loss
A lot of GI issues
Vitiligo
TEST QUESTIONS
Patient has bronze sign, what might be the disease?
Addison disease
Addision disease patients have a craving of what?
And do we allow them to eat this craving?
Salt
Yes they need it
What is the treatment for Addison disease?
Steroid replacement
Like cortisol replacement pills
What is Cushing syndrome?
Excessive circulating free cortisol
What is the 2 main cause of Cushing syndrome?
An adrenal tumor
Excessive prolong steroid therapy
What is the 3 biggest clinical finding to know about Cushing syndrome?
Moon shape face
Buffalo hump
Purple straie
What is the treatment for Cushing syndrome?
Surgery to remove that adenoma
What is hyperaldosyeronism ?
And what is it caused by?
Too much aldoserton
Adrenal tumor
Test question
What is the 3 clinical manifestation to know about hyper aldosterone?
Hypertension
Hypokalemia
Polyuria - low ADH
What is the 2 treatment for hyperaldosterone?
Replacement of potassium
Administration of spironolactone
( K+ sparing diuretic )
What is phenochromocytoma ?
Adrenal tumor that secrets catecholamines
- pretty much a tumor that releases so much epinephrine that causes you to have a sympathetic nervous system symptom
What is your major clinical manifestation of phenochromocytoma?
High blood pressure!!
Everything is sympathetic nervous system
What is your treatment for phenochromocytoma?
Surgical removal of the tumor
Adrenalectomy
- usually life long cortisol therapy
