TEST 2 Flashcards
Neuro disorder - Ch 38
At birth, cranial bones are not well developed or fused this increases risk for
Fracture
Neuro disorder - Ch 38
At birth, the brain is highly vascular which increases a risk for
hemorrhage
Neuro disorder - Ch 38
What history findings are related to neurologic disease in children?
Prematurity
Difficult birth
Infection during preg
Falls
Recent trauma
Neuro disorder - Ch 38
5 states of consciousness
Full
Confusion
Obtunded
Stupor
Coma
Full -Awake and alert, oriented X4
Confusion - Alert but responds inapproprately
Obtunded - Limited responses to environment and falls asleep unless stimulation
Stupor - Only responds to vigorous stimulation
Coma - Cannot be aroused, even with painful stimuli
Neuro disorder - Ch 38
Early signs of ICP
Headache
Vomit (projectile)
Visual changes
Dizziness
Decreasing HR and RR
Changes in pupil reactions
Sunset eyes
Changes in LOC
Seizures
Bulging fontanel and increasing head circumference in infants
Neuro disorder - Ch 38
Late signs of ICP
Decreased LOC
Depressed motor, sensory responses
irregular respirations
Cheyne-stokes respirations
Decerebrate/decorticate postures
Fixed and dilated pupils
Neuro disorder - Ch 38
Intracranial regulation
Ability of cranial contents to maintain normal intracranial pressure, equilibrium and neurologic function
Neuro disorder - Ch 38
When do brain and spinal cord develop?
first 3-4 weeks gestation
What is the earliest indicator of improvment or deterioration of neuro status?
LOC
Neuro disorder - Ch 38
Pediatric Glasgow Coma Scale - define
The lower the score =
used to standardize degree of
consciousness.
The lower the score, the less responsive the child.
Neuro disorder - Ch 38
Always measure head circumference in children younger than
3
Neuro disorder - Ch 38
Cranial nerves
Trigeminal V-
Hypoglossal (XII)-
Trigeminal V- responsible for sucking
Hypoglossal (XII)-observed through spontaneous tongue movements
Neuro disorder - Ch 38
Cranial nerves
Dolls eyes (III, IV, VI)
Facial (VII)
Dolls eyes (III, IV, VI) -turn head in 1 direction and assess if eyes move symmetrically in other direction. Doll eyes do not move, they just look straight
Facial (VII)- Asymmetry when crying, smiling
Neuro disorder - Ch 38
Cranial Nerves
Oculomotor (III) -
Sunsetting indicates?
Invol rapid eye mvmt indicates?
Olfactory -
**Oculomotor (III) **- Observe for sunsetting eyes which indicates increased ICP. Involuntary rapid rhythmic eye movements which indicates brain stem
Olfactory - No evaluated in infants and young children
Neuro disorder - Ch 38
Cranial Nerves
Optic (II)
Optic (II) - Fixed dilated pupils report immediatly
Neuro disorder - Ch 38
Motor function
Decorticate -
Decerebrate -
Decorticate - Arms adducted wtih extremities flexed and held across chest, occurs with cerebral cortex damage
Decerebrate - Extension adn pronation of arms and legs, occurs wtih brain stem damage
Neuro disorder - Ch 38
Glasgow Coma Scale
1.Scores are based on what 3 responses?
2. Perfect score?
3. The lower the score = ?
4. Severe head injury = ?
5. Moderate head injury?
6. Mild head injury?
- based on eye opening, motor response and verbal response.
- The perfect score is 15.
- The lower the score the more severe the injury and prognosis.
- Severe head injury = 8 or less.
- Moderate head injury = 9-12 points.
- Mild head injury= 13 and 15.
Neuro disorder - Ch 38
Lumbar puncture (LP)
Define
How to position NB
How to position older infant
Postive Brudzinski
Postive Kernig
Withdrawl of cerebal spinal fluid from subarachnoid space for analysis
Position newborn upright with head flexed forward.
Position older infant/child on their side with head and knees flexed.
–Keep child flat for 1 hour after procedure.
–Apply EMLA cream to puncture site 30-60 min beforehand.
Positive Brudzinski = pain when flexing head forward.
** Positive Kernig** = pain when flexing knee to abdomen.
Neuro disorder - Ch 38
Electroencephalogram (EEG)
Define
to detect seizure activity and determine brain death
Neuro disorder - Ch 38
Ultrasound
used to assess intracranial hemorrhage in newborns
Neuro disorder - Ch 38
ICP Monitoring catheter
ventricular catheter that measures ICP and
drains CSF to reduce ICP.
Keep HOB elevated 15-30 degrees.
Neuro disorder - Ch 38
MRI
Prep procedure
No metal. All jewerly and clothing removed
IV contrast may be used. IV needs to be in good working order
If sedated, child will need to be on heart monitor and oxygen
Latex allergy is not contraindication for gadolinium (the contrast used in testing)
Neuro disorder - Ch 38
Ventriculoperitoneal Shunt
to drain CSF and decrease ICP. Drains to
peritoneal cavity and is absorbed by the body
Neuro disorder - Ch 38
Hyperventilation
decreases PaCO2 which causes vasoconstriction
and decreases ICP.
Monitor ABGs.
Neuro disorder - Ch 38
Ventricular tap
to drain CSF
Neuro disorder - Ch 38
Vagal Nerve stimulator
For short and long term seizure mgmt
Neuro disorder - Ch 38
Keto diet
high fat, very low carbs, adequate protein, and mild
dehydration to control seizures through diet
Neuro disorder - Ch 38
Antibiotics
to treat bacterial meningitis and shunt infections
Neuro disorder - Ch 38
Anticonvulsants
control seizures, decrease hyperexcitability of
nerves, do not stop abruptly,
ie Levetiracetam, Phenytoin,Fosphenytoin, Phenobarbital
Neuro disorder - Ch 38
Benzodiazepines
ie Diazepam/Lorazepam,
slows down CNS so must monitor LOC, useful for home treatment of seizures
Neuro disorder - Ch 38
Analgesics
pain to help avoid increase in ICP with interventions
that cause pain or stress.
Neuro disorder - Ch 38
Diuretics
Mannitol, monitor electrolytes and I&O
Neuro disorder - Ch 38
Levetiracetam (Keppra)
Used for
Side effects
–Used in children to help control seizures.
–Major side effects: difficulty with gait or coordination and
development of
psychiatric symptoms.
–Does not have a therapeutic level so there is no need for
routine lab
tests.
Neuro disorder - Ch 38
**Phenytoin **
Route?
IF IV, fluids need to be?
Can be administered through?
Treatment of?
–Can be administered PO or IV.
–If it is to be administered IV, the fluids need to be normal
saline solution.
(Any other type of fluid will cause the drug to precipitate in
the IV tubing.)
There is no need to start an additional peripheral IV. The
drug can be administered via a secondary set through the IV pump.
–Treatment of the seizure is the priority.
Neuro disorder - Ch 38
Fosphenytoin
another form of phenytoin, may be tolerated better,
and it can be administered through all IV fluids without
precipitation
Neuro disorder - Ch 38
5 major types of seizures
subtle, tonic, focal clonic, multifocal clonic, and myoclonic
Neuro disorder - Ch 38
Myoclonic rarely occur in —period
Subtle seizures affect?
Tonic primarly occur in?
Focal clonic and multifocal clonic are more common in ?
myoclonic seizures rarely occur during the neonatal period.
Subtle seizures affect preterm and full-term neonates.
Tonic seizures primarily occur in preterm neonates. **Focal clonic and multifocal clonic **are more common in full-term neonates.
Neuro disorder - Ch 38
Neural tube defects
spina bifida, meningocele, anencephaly
folic acid supplements before pregnancy can reduce incidence by 50%.
Neuro disorder - Ch 38
Microcephaly
small head, large face, expect developmental delays
Neuro disorder - Ch 38
Arnold-Chiari malformation
Type 1
Type 2
** Type 1** = benign, c/o neck pain, H/A,
frequent urination, and lower extremity spasticity.
Type 2 = associated with hydrocephalus and myelomeningocele
Neuro disorder - Ch 38
Hydrocephalus
define
children with this are at increased risk for
CFS accumulates within the ventricles and causes
the ventricles to enlarge and ICP increases. Children with
hydrocephalus are at an increased risk for developmental disabilities.
Neuro disorder - Ch 38
Intracranial arteriovenous malformation
Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous
malformation.
Neuro disorder - Ch 38
Craniosynostosis
premature closure of the cranial sutures
Neuro disorder - Ch 38
Positional plagiocephaly
increased incidence since “back to sleep”,
asymmetry in the head without fused sutures, flattening of the back of the head from early closure of the lambdoid suture.
Neuro disorder - Ch 38
Hydocephalus
Symptoms
Parents need to know
Risk for infection most common during
spasticity of lower extremities, bulging
fontanels, brisk reflexes, and skull asymmetry.
-Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows.
- The risk for infection is ever present, but is most common **1 to 2 months after shunt placement. **
Neuro disorder - Ch 38
**Bacterial meningitis **
Do what immediatly
Symptoms
Medical emergency
Start IV antibiotics immediatly
Symptoms - preceding respiratory illness or sore throat, fever, headache, stiff neck, photophobia, vomiting, positive Brudzinski and Kernig signs. In infant, poor feeding, lethargy, weak cry, vomiting, hypothermia
Neuro disorder - Ch 38
With bacterial meningitis, infant may rest in what position?
opisthotonic position (back bend)
Neuro disorder - Ch 38
Encephalitis -
Caused by
caused by polio, HSV 1 and 2, vector-borne viruses
Reye syndrome
Symptoms
Avoid what?
characterized by brain swelling, liver failure, and
death in hours if treatment is not initiated.
Avoid aspirin in children.
Therefore, increased intracranial pressure could occur. Liver enzyme levels and ammonia levels typically increase.
Neuro disorder - Ch 38
Concussion
define
Treatment
-most common head injury. confusion, amnesia, may or may not lose consciousness
-Rest, wake every 2 hours for neuro changes. Bring to ER if constant headache that gets worse, vomit more than 2 times, slurred speech, oozing blood or watery fluid from ears or nose
Neuro disorder - Ch 38
Linear skull fracture
most common skull fracture, can result from
minor head
injuries
Classic signs of SBS
Retinol hemorrhages
In children what is more common? Ischemic or hemorrhagic strokes?
Ischemic
Ischemic =
Hemorrhagic =
Ischemic = a blood vessel supplying the brain becomes blocked
Hemorrhagic = a blood vessel bursts leaking blood into the brain
Ch 39
When is eye color determined?
6-12 mo
Ch 39
When is optic nerve fully myelinated?
3 months
Ch 39
What is vision acuity (Sharpness of vision) at birth?
5 months?
Birth - 20/400
5 months - 20/20
Ch 39
When is binocular vision achieved?
3-7 months
Ch 39
Ptosis?
Failure of eyelids to open fully and equally
Ch 39
How to do visual acuity testing in children 3 and under or nonverbal?
eval childs ability to fixate on and trace an object. Use black and white patterns
Ch 39
How to do visual acuity testing for children 3-5 years old?
Use tumbling E chart. Will be able to indicate direction of arms of E
Ch 39
What is the whisper test ?
4 years and older
one ear occulated, examiner stands behind and whispers a word. Child must repeat word correctly
Ch 39
Weber test?
6 years old and older.
Place a vibrating fork in middle of top of head and ask if child can hear in one or both ears.
Should hear in both
Ch 39
Tympanometry
must be over 7 months
Measures tympanic membrane mobility and determines middle ear pressure
Ch 39
Bacterial conjunctivitis
symptoms
treatment
Purulent drainage, mild pain, occasional eyelid edmea
Required antibiotic ointment/drops
infectious
Ch 39
Viral conjunctivitis
Symptoms
Tearing, photophobia, lumphadenopathy
Ch 39
Allergic conjunctivitis
Symptoms
treatment
Itching, stringy or watery discharge,
Antihistamines
Ch. 39
Treaments for
Conjunctivitis
Astigmatism, hyperopia, myopia
Amblyopia
Conjunctivitis - warm compress
Astigmatism, hyperopia, myopia - corrective lens
Amblyopia- patching
Ch 39
Treatment for:
Strabismus
Chronic ottis media with effusion
Hearing impairment
Strabismus: Eye muscle surgery
Chronic ottis media with effusion: Pressure equalizing tubes
Hearing impairment; Hearing aid or cochlear implant
Ch 39
Hordeolum (Stye)
Symptoms
Treatment
Localized infection of sebaceous gland of eyelid follicle
Painful purulent drainage
Antibiotic
Ch 39
Chalazion
Chronic painless infection of meibomian gland
Ch 39
Blepharitis
Symptoms
Treatment
Chronic scaling, dryness and discahrge along eyelid. redness, edema, no pain
Needs antibiotic ointment
Ch 39
Nasolacrimal duct stenosis
Blocked tear duct. Self resolved with massage, not infectious
Ch 39
Periorbital cellulitis
define
symptoms
Acute bacterial infection of eyelid or skin around eye, can also result from sinusitis
-Eyelid edema, purplish eyelid color, clear conjunctivae, no drainage, normal acuity
Ch 39
What are refractive errors
OIccurs when the light that enters the lens does not bend appropriately to allow it to fall directly on the retina
Ch 39
Hyperopia
Farsighted, blurriness at close range, child had mild hyperopia until about 5 years old
Ch 39
Myopia
Nearsighted, see well at close range but cant see blackboard
Ch39
Astigmatism
Cornea or lens not perfectly spherical
Ch 39
Strabismus
unequal alignment of eyes, crosseyed. may result in diplopia(double vision) and amblyopia.
Treatment - eye muscle surgery, patch and corrective lens
Ch 39
Amblyopia
Lazy eye
Patch on good eye
Ch 39
Nystagmus
Rapid, irregular eye movmnts,
Most common cause is a neuro problem
Ch 39
Glaucoma
Increased ICP resulting in large prominent eyes
Vision loss may occur as a result of corneal scarring, optic nerve damage, or amblyopia
Surgery is required
Ch 39
Cataracts
Opacity of the lens present at birth
leading cause of visual impairment and legal blindness in children
Best outcome is when cataracts is removed before 3 months
symptoms: lack of visual awareness, cloudly cornea, no red reflex
Ch 39
Retinopathy of prematurity
Rapid growth of nonvascularized rential blood vessels
results in retinal detachment, blindness
Ch 39
What heritage is a risk factor for visual impairment
African american
Ch 39
acute otitis media
- Define
- Risk factors
- Pain mgmt
Infected fluid in middle ear,
Risk - occurs in winter, eustachian tube dysfunction, upper respiratory infections
Mgmt - Observation for natural resolution. Give antibiotics if persists with pain mgmt
Ch 39
Otitis media with effusion
Define
Adverse effects
Treatment
presences of fluid in middle ear with or without infection
May delay speech and language development
Pressure equalizing tubes, wear earplugs while swimming
Ch 39
Otitis externa
Infection and inflammation of external ear canal
Swimmers ear
Signigicantly painful
Ch 39
What decible is
Mild hearing loss?
Moderate?
Severe?
Profound?
Mild - 20-40dB
Moderate 40-60db
Severe - 60-80db
Profound greater than 80db
Ch 40
What illnesses are more commonly seen in spring?
Allergen-related respiratory illness
Ch 40
What illnesses are more commonly seen in winter
Flu, RSV, pneumonia
Ch. 40
What is the most common illness and hospitalization for children
Respiratory illness
Ch 40
Nose assessment
Obligate nose breathers until?
Obstructed nares leads to
Small nasal passages leads to?
Sinuses do not develop until
Nb are obligate nose breathers until 4 weeks of age, breath through mouth only when crying
Obstructed nares leads to feeding difficulties
Small passages can lead to obstruction if excess mucous
Sinuses develop at 6-8 years so less apt for sinus infection
Ch 40
Throat assessment
Larger tounges in relation to oropharynx, which can cause?
Children have larger tonsillar and adenoidal tissue which can?
Posterior displacment of tounge can cause severe airway obstruction
Larger tonsillar and adenodial tissue can cause airway obstruction
Ch. 40
Larynx assessment
Why is larynx funnel shaped in children 10 and younger?
What shape is larynx in teens and adults>
Laryngomalacia ?
10 and younger, cricoid cartilage is underdeveloped and results in larynx narrowing creating a funnel shape
Teens and adults, **larynx is cylindrical and uniform
Laryngomalacia = larynx is weak and collapses with inspiration, stridor, improves with time (around1 year old)**
Ch 40
When intubated, if you hear breathe sounds louder on the right, what does that mean?
EET is too deep and needs to be pulled back
Ch 40
How many alveoli does a term baby have?
3-8 year olds?
Term baby = 150 million
3-8 year olds = 300 million
What does having fewer alveoli put the child at risk for?
hypoxemia and carbon dioxide retention
Ch 40.
What is the 1st sign of respiratory illnesS?
Tachypnea
Ch 40
What does slow, irregular breathing with listlessness indicate for a respiratory illness?
Worsening condition
Ch 40
What does pallor indicate for a child with respiratory illness?
Peripheral vasoconstriction to conserve oxygen for vital functions
What does cyanosis indicate for a child with respiratory illness?
hypoxia (oxygen deficiency)
What does circumorla cyanosis look like
blue around the mouth
What does central cyanosis look like
involving midline
Why does grunting occur?
Occurs with expiration from alveolar collapse of loss of lung volume such as with atelectasis, pneumonia and pulmonary edema
What is stridor?
High pitched easily heard inspiratory noise that is sign of upper airway obstruction
What is involved in respiratory effort?
Depth, quality, labored, tachypnea, nasal flaring, retractions
What are retractions
Where?
INward pulling.
Note whether** intercostal (between ribs), subcoastl (around diaphragm), substernal, supraclavicular, suprasternal **
Paradoxical breathing
Chest falls on inspiration and rises on expiration
What do the following interventions help with?
Oxygen =
High humidity =
Suctioning =
Chest PT =
Saline gargles =
Chest tubes =
Bronchoscopy =
Oxygen = respiratory distress, hypoxemia
High humidity = keeps airway/secretions moist to prevent damage
Suctioning = done as needed and carefully especially via ETT or trach
Chest PT = promotes mucus loosening and drainage
Saline gargles = for sore throat in older children
Chest tubes = drainage tube placed in pleural cavity to remove air/fluid (pneumothorax,
empyema)
Bronchoscopy = to diagnose and cleanse the bronchial tre
Croup
Bark like cough often at night with inspriatory stridor and suprasternal retractions
RSV
Peaks?
Begins as a ?
Define?
Symptoms?
Peaks in winter
Starts as a respiratory infection
Allows adequate inspiration but prevents full expiration, leading to hyperinflation and atlelctasis, hypoxemia and carbon dioxide retention
Symptoms - copious amounts of secretions, increased work of breathing, hoarseness, sore throat, fever, coughing wheezing, poor feeding, irritable
What is treatment for RSV?
Position HOB elevated
Supplemental oxygen with continuous pulse ox
Frquent assessment, can deteriote quickly
Droplet precautions
Synagis vaccine - given during RSV months
What are symptoms for TB
Malaise, weight loss, anorexia, chest tightness, COUGH, hemoptysis (coughing up blood)
What is pneumothorax?
how to diagnose?
Symptoms?
Treatment
Collection of air in pleural space
dx - decreased or absent lung sounds on affected side
Chest pain, tachypnea, retractions, grunting, cyanosis, tachycardia
Treatment - chest tube placement
Allergic Rhinitis
Mediated by what immunoglobulin?
Triggered by
Symptoms?
IgE
triggered by dust, pet dander, pollens
Symptoms = Thin watery runny nose, nasal congestion, sneezing
Chronic lung disease (Bronchopulmonary dysplasi)
Primarly seen with what age infant?
Highest risk
symptoms
Primarly with premature infants
Low birth weight and white males are at risk
Tachypnea and increased work of breathing
Cystic fibrosis
What kind of recessive disorder?
Median age of survival?
Autosomal recessive disorder
Median age 39.3years
ASTHMA
When examining a child with asthma nurse would not do what?
What is hallmark sign of airway obstruction?
Priority treatment?
Nurse wouldnt palpation
Wheezing is hallmark sign
Bronchodialtions - admin inhaled short term bronchodilator, start oxygen after, then IV steriods
ALbuterol
Salmeterol
Ipratropium
Albuterol - short acting b2 adrenerfic agonists - treat acute bronchospasn
Salmeterol - long acting b2 adrenergic - long term control of excecise-induced asthma
Ipratropium - anticholinerfic used in adjunt to b2 agonist for treatment of bronchospasm without systemic effects
Montelukast
Cromolyn
Theophylline
Montelukast - decreased inflammatory response by antagonising effects of leukotrienes
Cromolyn - a mast cell stabilizer used prophylactucally to prevent release of histamine but not to relieve bronchospasm
Theophylline - provides continuous airway relaxation
In a patient with Cystic Fibrosis
What will their respiratory tract look like?
Thick tenacious mucus lining the airways causing decreased resistance to infection adn air trapping
Difficultly clearing secretions, repiratory distress, chronic cough, barrel shaped chest, clubbinh, recurrent pneumonia, cor pulmonale (Right sided heart failure)
In a patient with Cystic Fibrosis
What will their GI tract look like?
Dehydration of intestinal material, insufficient pancreatic enzymes, pancreas secreate thick mucus, hypersecretion of gastric acids
-Retention of fecal matter (vomit, abdominal distention, cramping, anorexia) fecal impaction, bowel obstruction, obstructive cirrhosis, gallstones, inability to absorb nutrients, failure to thrive, diabetes
What is a diet for patinets with Cystic Fibrosis
High calories, high protein, low fat
Supplement wtih fat soluable vitamins (A, D, E, K) and pancreatic enzymes to be ingested with every meal (increase with a meal with high fat)
Epiglottis
Symptoms
Treatment
high fever, dysphagia,
NEVER VISUALIZE the Throat can cause REFLEX LARYNGOSPASM
Treatment: 100% oxygen in least invasive manner, tracheostomy tray prepared
A simple mask is used to deliver a flow rate of –/min
8L/min
A venturi mask woudl be used to deliver..
A specific % of oxygen from 24-50%
A oxygen hood requires a liter flow of
10-15 L/min
Perfusion
The flow of blood to cells and tissues
Ductus arteriosus
define
purpose
Closes?
-a fetal vessel that connects pulmonary artery to aorta
-Allows oxygenated blood from mom to bypass pulm circulation and flow directly into systemic circulation
-Closes within 1-2 days after birht
Patent Ductus Arteriosus
Symptoms?
Vessel stays open
Widening pulse pressure, poor eating, failure to thrive, increased RR, Respiratory distress, sweating with crying or eating, murmur, pulmonary HTN
Treatment for PDA
Meds - indomethacin, ibuprofen
Surgery - PDA ligation
Pulse pressure
define
avg?
Widened?
narrow?
Difference between systolic and diastolic
avg 40mmHG
Widened - 100mmHg or over, sign of aortic valve regurgitation
Narrow - 25% or less of SBP; sign of aortic stenosis
Heart rate
Infant
Toddler/preschool
School age/adolescent
Infant - 90-160bpm
Toddler - 80-115bpm
School age/adolescent - 60-100bpm
Blood pressure
Infant -
Toddler -
School age -
Adolescent-
Infant - 80-55
Toddler - 90/55 to 100/75
School age - 100/60 to 120/75
Adolescent- 100/70 to 120/80
What are the 2 categories of cardiovascular disorder in children?
**Congenital heart disease **- anomalies present at birth
Acquired heart disease - disorders that occur after birth
Orthopena
Infant more comfortable sitting up or over moms shoulder rather than lying flat
Signs of dyspnea
Grunting, tachypnea, retractions
Cyanosis in a nb that does not improve with oxygen suspect?
CHD
WIdened pulse pressure is associated with
PDA, Aortic insufficicney, fever, anemia and complete heart block
All murmurs should be evaluated on what 5 characteristics
- Location
- Relation to heart cycle and duration
- Intensity grade
- Quality of sound, muffles, distant, distinct
- Variation while sitting, lying or standing
Congenital Heart Disease
Which age has highest incidence
Common chromosomal defect assoc
Screening done when? Passing criteria?
Premature highest incidence
Trisomy 21 and Turner syndrome
within 1st 24 hours, must be greater than 95% and 3% or less different between reading on hand and foot
Decreased pulmonary blood flow
-define
-2 diagnosed defects
obstruction of blood flow to the lungs, pressure increases to the right side of the heart which then shunts to the left side through a structural defect, and oxygenated blood mixes with deoxygenated blood which is pumped through the body.
Tetralogy of Fallot
Tricuspid atresia
Increased pulmonary blood flow
Define
3 diagnosed defects
efects shunt blood from the higher pressure left side to the lower pressure right side. Increased blood in the right side leads to heart failure early in life and right ventricular hypertrophy.
Patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Obstructive disorders
define
3 types of diagnosed
some type of narrowing of a major vessel, interfering with the ability of the blood to flow freely
Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis
Mixed defects
-Define
4 diagnosed defects
involve a mixing of well-oxygenated blood with poorly oxygenated blood, resulting in systemic blood flow containing a lower oxygen content.
Transposition of the great vessels
Total anomalous pulmonary venous return
Truncus arteriosus
Hypoplastic left heart syndrome
Tetralogy of Fallot
Define
Signs
4 heart defects (pulmonary stenosis, VSD, enlarged aortic valve, right ventricular hypertrophy).
Hypercyanosis with activity ie feeding, crying where color change occurs suddenly and child may assume a specific position to improve pulmonary blood flow (squatting, bending at the knees, fetal position).
Transposition of great vessels
Define
Treatment
Artery and aorta are transposed
Prostaglandin to keep ductus arteriosus open until surgery
Electrocardiogram
= evaluates the pattern or rhythm of the heart’s beating using electrodes attached to the chest
child must lie still for 5 minutes
Holter monitor
is an ambulatory ECG that monitors the heart’s electrical patterns for 24 hours during normal daily activity
Echocardiogram
= noninvasive ultrasound using a gel-coated wand to visualize chambers, heart wall thickness, value motion, hemodynamics of the great vessels, and structural defects
Arteriogram/cardiac cath
= visualize arteries and veins using radiopaque contrast;
consent must be signed; NPO before procedure; maintain bedrest after procedure (can’t get up to the bathroom during specified bedrest timeframe); monitor puncture site for bleeding; monitor pulse distal to puncture site; assess VS frequently (Q15min-1hour).
Digoxin
Effect
Monitor for
hold if
Signs of toxicity
-to reach maximum cardiac effect by increasing contractility. -monitor ECG for prolonged PR interval and decreased ventricular rate. Count apical pulse rate for 1 full minute. -Hold digoxin if HR <60 bpm in adolescent or <90 bpm in an infant.
-S/S toxicity = N/V, lethargy, bradycardia.
Infective endocarditis
-define
-Treatment
-Signs
Bacterial infection of the endothelial surfaces of the heart such as the valves, chambers, septum
-heparin or another thrombolytic to prevent clots
Must be on antibiotics or antifungal meds for 4-6 weeks
🡪 intermittent unexplained low fever, fatigue, weight loss, flu-like symptoms, petechiae on the palpebral conjunctiva, microscopic hematuria, anemia with leukocytosis, dysrhythmias such as prolonged PR interval, adventitious lung sounds, signs of extracardiac emboli such as Roth spots (splinter hemorrhages with pale centers), Janeway lesions, black lines, and Osler nodes.
Acute Rheumatic Fever
-Preceded by
-Cheif complaint
-Classic rash
-Movment disorder
-Mgmt
Usually preceded by strep throat
Chief complaint is typically fever with joint pain 2-3 weeks after sore throat or strep throat
Erythema marginatum is a classic rash
Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever
Management 🡪 manage inflammation and fever, eradicate bacteria, prevent permanent heart damage, and prevent recurrences
Cholesterol levels
Desirable
Borderline
high
Cholesterol < 170 = desirable
Cholesterol 170-199 = borderline
Cholesterol > 200 = high
Kawasaki Disease
Occurs in what age
Leading cause of
Mgmt
-Occurs mostly in children 6-months to 5-years old
-Leading cause of acquired heart disease among children
-Management focuses on reducing inflammation in the walls of the coronary arteries and preventing coronary thrombosis
high-dose aspirin in four divided doses daily and one single infusion of IVIG (immunoglobulin), acetaminophen for fever
Avoid nonsteroidal anti-inflammatories (ie ibuprofen) while on aspirin
Apply petroleum to dry fissured lips
Strawberry tongue is distinctive
Dysphagia
Difficult or painful swallowing
INTESTINES
Small intestine mature at birth?
full term infant —Cm sm bowel?
adults —cm sm bowel?
Sm intestine not mature at birth
Infant 250cm
Adult 600cm
Insensible fluid loss occurs in children in what 3 ways?
- With fever
- Through skin
- higher metabolic rate needed to support growth
ORal candidiasis (Thrush)
-define
-Treatment
Fungal infection of mouth
also w/ beefy red diaper rash
Treat: nystatin or fluconazole
Hypertonic pyloric stenosis
Define
Signs
Treatments
Pyloric valve between stomach and sm intestine thickens and causes obstruction
Projectile vomit immediately after feeding, olive shaped mas in uppper right quad
Requires surgery
Intussesception
Define
Signs
Bowel segment telescopes into a more distal segment, causing edema, impaired circulation and obstruction
Sausage shaped mass in upper mid abdomen, severe ab pain, vomit, diarrhea, jelly stools (blood),
Intestine abnormally attached and mesentery narrows, twisting itself
bilious vomiting, ab distention, bloody stools, usually in 1st week of life
Appendicitis
Define
Signs
Obstrcution due to fecal matter which causes inflammatory fluid anc bacteria to leak into peritoneal cavity
tender lower right quad - Mcburney point
Peptic Ulcer Disease
Define
Signes
Diagnostic test
Variety of disorders involving upper GI / mucosal inflammation caused by Hpylor, excess acid production, stress and meds
Mostly epigastric or umbilical pain worsening after meals
Urea breath test / hold proton pump inhibitors 5 days prior to test
Stages of dehydration
Mild
Moderate
Severe
Mild - Output slightly decreased
Moderate - sunken fontanels, delayed cap refill, urine 1 ml/kg/hr
Severe - dusky cool extremities, dry mucous membranes, no tears, skn tenting, output less than 1ml/kg/hr, hypotension
Cleft lip and palate
Freq occur w/
Complications?
repair time?
Major risk factor?
frq occur w/ other anomalies, heart defects, ear, skeletal and gu abnormalities
complications: feeding diff, altered dentation, speech, otitis media
Lip 2-3months repair, palate 6-9months
Materal smoking - risk factors
Hernias
Inguinal-
Umbilical-
Inguinal - ab or pelvic viscera goes through internal inguinal ring into inguinal canal (males - hernia contains bowel, females - ovaries/fallopian tubes / buldging mass in lower ab groin
Umbilical - common in preterm & african american. Incomplete closure of umbilical ring allowing intestines to herniate; spontaneous closure by 4 years old
GERD
Signs
Mgmt
Irritability, arching with feed, wet burp, vomit
HOB up or hold child up for 30 mins after feed
Smaller more frq meals, meds,
Constipation & encopresis
Define
Constipation - less than 3 bowel weekly, hard, painful stool
Encopresis - fecal in underwear of older children. Withheld stool stretches rectal muscle and liquid leaks around mass into underwear
Hirschsprung Disease
Define
Trtment
Disorder of motility of intestinal track resulting in obstrcution, failure to pass stool within 1st 24 hours of life, lack of ganglion cells in intestine
Surgical resection and reanastomosis of bowel with ostomy that is closed at later date once bowel heals
Short Bowel Syndrome
-Define
Trtment
Massive small intestine loss, results in nutrient malabsoprtion, excessive fluid and electrolyte loss
May require long term TPN (damages liver)
Inflammatory bowel disease
Chrons Disease
Ulcerative colitis
Sgns
trtmnet
Chrons - 10-20years old onset, cobblestone bowel wall appearance, low iron, perianal skin tags, abdominal tenderness
Ulcerative colitis - 10-20yrs onset, involves total colon, elevated WBCs
signs - ab cramping, blood stool, fever, weight loss, poor growth
Trtment - high protein & carb, avoid lactose, take vitamins and iron supplements, antibiotics
Celiac disease
Define
Signs
Foods to avoid
Foods allowed
-Gluten causes damage to sm intestine
S/S - fatty, greasy stool, diarrhea, constipation, weight loss
Avoid - wheat, flavored yogurt, rye, creamed veggies
Allowed - Peanut butter, carbonated drinks, shellfish, jelly, fruit juice
Pancreatitis
Define
Trtment
Acute onset of mid-epigastric pain that radiate to the back or check with vomit and fever
-Serum amylase and lipase levels are elevated at 3 times the normal value, CRP is elevated
-Place on immediate NPO and NGT for stomach decompression, IVFs
Gall bladder disease
Signs
Gall stones assoc w/
**S/S **- R upper quad pain, pain increase after eating greasy fatty food
Assoc w/ - high cholesterol, obesity, pregnancy, female and entering puberity
Biliary Atresia
Define
Signs
Trtment
Absence of biliary ducts resulting in obstrcution of bile flow = choestasis - jaundice and cirrhosis of liver
S/s- clay stools, jaundice, hard enlarged liver
Trtment- surgery (most successful in infants up to 45 days of life)
Hepatitis
Define
S/S
A
B
C
inflammation of the liver caused by viral infections, bacterial invasion, metabolic disorders, chemical toxicity, trauma
** –s/s** 🡪 jaundice, abnormal liver/spleen size and tenderness, elevated liver enzymes
Hepatitis A = oral-fecal route, poor sanitation
Hepatitis B = sex, IV drug use, blood transfusion, prenatally from mom to infant
Hepatitis C = blood transfusion, IV drug use
Cirrhosis / Portal htn
-Cirrhosis
-Causes
-Major complication
-Cure
-Portal HTN
-Cirrhosis = liver damage
-Causes - biliary disorder, chronic hep, prolonged TPN
-Major complication - portal HTN
-Cure - liver transplant
-Portal HTN - blood flow to, through and from liver meets resistance. Pressure rises = GI bleed
GFR measures?
Glomerular filtration rate (GFR) 🡪 the blood flow through the kidneys
BUN measures
BUN 🡪 indirect measure of renal function; may be elevated with high protein diet or dehydration; may be low if overhydrated or malnourished
Creatinine measures
🡪 direct measure of renal function; best indicator of renal function
Total protein measures?
Albumin measures?
Total protein 🡪 to monitor chronic renal failure
Albumin 🡪 low levels contribute to extent of edema
