Test 2 - Study Guide Flashcards
1
Q
Cleft Lip & Palate: Patho, Dx, Signs/Sx, Risk Factors, Complications, Treatment
A
Patho:
Failure of soft tissue or bony structures to fuse
Unilateral or bilateral
Dx:
Using gloved finger in baby’s mouth
Signs/Sx:
- Difficulty feeding
- Spilling formula from nose
Risk Factors:
- Decreased folic acid in maternal diet
- Genetic and environmental
Complications:
- Chronic otis media
- Nutrition
- Speech
- Parents may feel guilt, grief, anger or sense of loss, it helps to provide photo of before/after
Treatment:
- Feeding devices
- Elevate after feeding and burp regularly
- Do not feed longer than 20-30 minutes
Surgery typically by 3-5 months of age
- Cleft lip performed at 4 weeks
- Palate surgery before 12 months of age
Post-op Care
- Elbow restraint/immobilizer
- Avoid sucking/crying
- Do not put into prone position
2
Q
Esophageal Atresia: Patho, S/Sx, Complications
A
Surgical emergency!
Assessed during feeding
Patho:
- Congenital malformation occurring at 4-5 weeks gestation where esophagus fails to develop as continuous tube
Signs/Symptoms:
- Excessive drooling or salivation
- 3 Classic Signs: Choking, coughing, Cyanosis
Complications:
- Tracheoesophogeal fistula developed in 90% of cases
3
Q
Tracheoesophogeal Fistula
A
Complication of esophageal atresia where esophagus ends in blind pouch or pouch is connected to trachea by fistula
4
Q
Omphalocele and Gastroschisis: Patho, Management, Treatment goals
A
Omphalocele Patho:
- Congenital defect
- Intra abdominal contents herniate into umbilical cord and fail to return to abdominal cavity during 10 to 12 weeks gestation
- Sealed by peritoneal layered/membranous sac
Gastroschisis Patho
- Congenital defect where bowel protrudes through abdominal wall
- No membrane covering - exposed to air
Management
- Infant placed into bowel bag with warm sterile saline to decrease heat loss and keep organs moist
- Surgery performed immediately and infant will remain in NICU
Treatment Goals:
1) Prevent infection, hypothermia, and injury/trauma to organs
2) Maintain perfusion to organs
5
Q
Imperforate Anus: Patho
A
Patho
- Congenital Defect
- Incomplete development or absence of the anus
- Not able to pass stool
- Rectum ends in blind pouch
6
Q
Inguinal Hernia: Patho
A
Bulge in groin/inguinal area
7
Q
Umbilical Hernia
A
Protrusion in umbilical area
8
Q
Mild Dehydration: Patho, S/Sx, treatment
A
Up to 5% body weight loss, roughly 40-50 ml/kg
S/Sx:
- Normal VS
- Fussy
- Restless
- Alert
- Thirsty
- Normal mucous membranes and skin turgor
-Anterior fontanel and eyes normal - Cap refill < 3 seconds
Treatment:
Oral rehydration
5 to 15 mLs of fluid every 10-15 minutes
Small amounts, frequent intervals
9
Q
Moderate Dehydration: Patho, S/Sx
A
6-10% body weight loss, 60-90 ml/kg
S/Sx:
- Increased heart rate
- Normal to low bp
- lethargic but arousable
- dry mucous membranes
- Decreased skin turgor
- Anterior fontanel sunken and eyes slightly sunken
- Cap refill 3-5 seconds
- Specific gravity 1.020-1.030
- Decreased urine output and darker color
Treatment:
Oral rehydration
5 to 15 mLs of fluid every 10-15 minutes
Small amounts, frequent intervals
10
Q
Severe Dehydration: Patho, S/Sx
A
Greater than 10% body weight loss, 100mL/kg
- Increased HR, weak heart
- Low BP
- Rapid, Deep respirations
- Drowsy to comatose, not arousable
- Parched mucous membranes
- Very poor skin turgor
- Anterior fontanel sunken
- Eyes sunken - no tears
- Cap refill >5 seconds
- Specific gravity > 1.030
- Decreased to absent UOP
11
Q
Vomiting
A
Forceful expulsion of stomach contents
Complications
- Metabolic alkalosis
- Dehydration
Treatment
IV fluids according to maintenance fluid calculation
Always monitor kidney function before adding potassium chloride to primary IV fluids
12
Q
Diarrhea: Patho, Classification, Classification, Treatment
A
Patho
Increased stool frequency or decrease in consistency
Loose watery stools
Classification:
- Acute <14 days
- Chronic >14 days - stool culture needed
Treatment:
- Rehydration therapy - Pedialyte/electrolytes
13
Q
Oral Candidiasis: Patho, Treatment
A
Patho
- Fungal infection of oral mucosa
- Most common in newborns and infants but also kids with immune disorders, corticosteroid inhalants or immune suppression therapy
- May be transmitted between breastfeeding mom and infant
- Does not wipe off with washcloth or swab
Treatment
- Oral antifungal - nystatin or fluconazole
14
Q
Pyloric Stenosis: Patho, S/Sx, Dx, Treatment
A
Patho
- Narrowing between stomach and duodenum
S/Sx:
Projectile vomiting - up to 3ft
Visible peristaltic waves from left to right
Failure to thrive/weight loss
Dx:
- US or upper GI series
Treatment:
- Laparoscopic pyloromyotomy surgery
15
Q
Intussusception: Patho, S/Sx, Treatment, Risk Factors
A
Patho
- Telescoping of one part of bowel into another
S/Sx
- Currant jelly-like stool
- Palpable sausage shaped abdominal mass
Treatment:
- Contrast/air enema
Risk Factors:
- CF
- Henoch-schonlein pupura
- chrons disease
- celiac disease
16
Q
Appendicitis: Patho, S/Sx, Assessment, Treatment
A
1 Periumbillical pain
Most common pediatric condition requiring abdominal surgery
S/Sx:
#2 RLQ pain
Assessment:
- Rebound tenderness
Treatment:
- Surgery
17
Q
Gastroesophageal Reflux (GER): Patho, S/Sx, Dx, Management, Complications
A
Gastric content reflux into lower esophagus causing tissue inflammation, scarring, stricture
S/Sx:
- Infant eats often but not gaining weight
- Chronic vomiting
- Hematemsis
- Failure to thrive
- Abdominal pain
- Irritability
Dx:
- Barrium swallow and Upper GI endoscopy
Management:
- Revise feeding - thickened foods
- Elevate during feeding
- Post feeding prone position with elevated head for 1-2 hours
- Smaller feeding volume, more frequent
- Sometimes surgery for FTT - fundoplication w/ gtube
Complications:
-Aspiration
-Apnea
18
Q
Hirschsprung Disease: Patho, S/Sx, Treatment, Complications
A
Patho:
- Congenital aganglionic megacolon
- Proximal bowel dilates and fecal matter collects due to absence of ganglion cells and lack of peristalsis
S/Sx:
- Failure to pass meconium for 24-48 hours
- Failure to thrive/ inadequate weight gain
- bile stained vomiting
- frequent foul-smelling ribbon-like stools
- Distended abdomen
- Poor feeding
Treatment
- Remove aganglionic portion of intestine
- Temporary colostomy
Complications:
- Enterocolitis - inflammation of small intestine and colon (life threatening)
19
Q
Irritable Bowel Syndrome: Patho, S/Sx, Dx, Treatment
A
Nervous Stomach
Recurrent abdominal pain in children
S/Sx
- Abdominal pain
- Flatus
- Bloating,
- Constipation
- Diarrhea (or both)
Dx: No specific test
Treatment:
- Dietary changes
20
Q
Chron’s Disease: Patho, S/Sx, Dx, Treatment
A
Patho:
-IBD - NO CURE
- Chronic inflammatory process with exacerbation and remission
S/Sx:
- Abdominal pain with cramps
- diarrhea
- weight loss
- anorexia
- fever (may be present)
- Rectal bleeding/perineal discomfort
Dx:
- CBC
- ESR
- C-reactive protein - elevated
- Low protein/albumin, iron, zinc, magnesium, B12
Treatment:
- Pharmacological - antidiarrheal, antiinflammatory, immunosuppressants, analgesics, antibiotics
- Nutrition and vitamins
- Surgery for pallative care
21
Q
Ulcerative Colitis: Patho, S/Sx, Treatment
A
Patho
- Acute or chronic bowel inflammation
S/Sx:
- Recurrent bloody diarrhea
- abdominal pain
- urgency
- tenesmus
Treatment:
- Curable with surgery - illeostomy
22
Q
Necrotizing Enterocolitis: Patho, treatment
A
Life threatening inflammatory disease of intestinal tract
- Common in premature infants
- Manifests during 2nd week of life after enteral feedings begin
Treatment: Needs to be immediate to decrease morbiditiy and mortality
23
Q
Celiac Disease: Patho, S/Sx, Celiac Crisis
A
Patho:
- Inability to digest protein of wheat, barley, rye and oats
- life-long
S/Sx:
Early: diarrhea, vomiting, failure to gain weight, constipation, abdominal pain, fatty stool
Late: behavior change, muscle wasting
Celiac Crisis: electrolyte imbalance, dehydration, severe acidosis
Treatment:
- High calorie and protein diet with simple carbs,
24
Q
Viral Hepatitis: A: Patho, Prevention
A
Patho:
- “Infectious hepatitis”
- Fecal-oral route
Prevention: Vaccine
25
Hepatitis B: Patho, Prevention
Patho:
- Most common
- Transmission through blood and body fluids
- May be transferred from mother to fetus
Prevention: Vaccine before discharge
26
Colic: Patho, Treatment
Patho:
- Feeding disorder with abdominal pain and severe crying, lasting up to 3-hours
- Peeks around 6 weeks and resolves by 3-4 months
Treatment:
- Supportive
- Simethicone drops
- Switching to soy based formula
27
Failure to Thrive: Patho
Patho:
- Infants or young children fail to eat enough nutrients to adequately be nourished
- Most are not organic in nature - immunodeficiency syndrome, metabolism error or neuro disease
28
Overweight and obesity: Patho, S/Sx, Treatment
Common in pediatrics
Children at risk for later health issues
S/Sx:
- >95% (correlate with weight)
Treatment:
- Modify diet
- Add exercise
29
How do we treat lead poisoning? What do we need to carefully monitor?
Chelation therapy
Monitor: Renal Function
30
Why are infants prone to fluid overload?
Immature kidney functioning
31
Bladder Exstrophy: Patho, Assessment, Treatment
Patho:
- Bladder is open and exposed outside of abdomen
- Defect occurring during embryonic period
Assessment:
- Bladder is red and seen on abdomen
- Visible draining urine
Treatment:
- Surgery
32
Vesicoureteral Reflux (VUR): Patho, Dx, Grading, Complication
Patho:
- Congenital abnormality
- Vesicoureteral is a valve between ureter and bladder designed to prevent urine refluxing into ureter
Dx:
- Renal ultrasound
- Voiding Cystourethrogram VCUG
Grading:
I-III - no surgery, prophylactic antibiotic, monitoring for a few months and usually resolves on own
IV, V - surgery to reimplant ureters into bladder, prophylactic antibiotics and antispasmodics; kidney damage will occur if not corrected
UTI Complications Causes:
- Bacteria in urine carried back up ureter causing pyelonphritis and renal damage
- Small reflux leaves residual and breeding ground for bacteria
33
UTI: Patho, Children S/Sx, Infant S/Sx, Treatment
Patho:
- Common cause is E. Coli
- Young girls prone b/c short urethra - no bubble baths
Children S/Sx:
- Fever w/o focus
- Abdominal pain
- Urinary frequency and urgency
- dysuria
- fever
- new onset. enuresis
Infant S/Sx: fever, irritability, dysuria, crying when voiding, change in urine color/odor, poor weight gain, feeding difficulty
Treatment:
- Antibiotics for 7-10 days
- Always test for cure following treatment
34
Pyelonephritis: Patho, S/Sx, Treatment
Patho:
- Untreated UTI
S/Sx:
- Similar to UTI, BUT...
-Back pain
- CAV tenderness
- n/v
- very ill
Treatment:
- IV antibiotics followed by oral therapy
35
Nephrotic Syndrome: Patho, S/Sx, Types, Treatment
Patho
- Autoimmune
- Loss of protein into urine (>3g day)
S/Sx:
Na decrease, fluid shift, edema, decrease UOP
Albumin decrease
Protein decrease (3g/day in urine)
Hyperlipidemia
Renal vein thrombis
Orbital edema
Thromboembolism
Infection
Coagulation
Weight gain, anorexia, fatigue, abdominal pain
Types:
Primary - disorder within glomerulus, common in kids
Secondary - secondary to disease like hep, lupus, cancer, etc.
Treatment:
- Prednisone 2mg/kg/day for 2 or 3 times/day until zero trace of protein in urine for 5-7 days
- Must taper steroids
- NO salt diet
36
Acute Poststreptococcal Glomerulonephritis: Patho, S/Sx, Treatment
Patho
- Follows strep A infection
S/Sx:
- Hematuria/Coca cola urine
- Proteinuria
- Edema
- Renal insufficiency
- Hypertension
Treatment:
- NO antibiotics if strep is neg
- bed rest
- monitor fluid/electroylytes, daily weights
- possible fluid restriction
- Restrict protein, sodium and potassium
***These kids are very sick and need LOTS of support***
37
Hemolytic Uremic Syndrome: Patho, S/Sx, Treatment, Prevention
Patho:
- Most common cause of renal failure in peds
- Consumption of beef w/ e-coli
S/Sx:
- gastroenteritis, bloody diarrhea, URI or UTI precede infection
- HTN
- Pallor
- Bruising
- Oliguria
- Fever
- Vomiting
- Jaundice
- Neuro involvement
Treatment:
- Acute renal failure - fluid restriction, high calorie, high carb, low protein, Na, K
- PD
- Strict I&Os
Prevention
- NO RARE hamburgers, NO PINK
- Wash hands when handling raw beef
38
Cryptorchidism: Patho, Treatment, Risks
Patho:
- Undescended testes
- Usually detected during newborn assessment
Treatment:
- Most testes spontaneously descend by 3-months
- If not, orchiopexy performed at 12-months
Risks:
- Sterility
- Testicular cancer
39
In pediatric bones, where does growth occur? What are differences in pediatric bones?
Epiphyseal plate until adult height reached
Stimulated by pituitary growth hormone
-Bones are more pliable and porus in peds, resulting in bend or buckle
- Soft tissues are more resilient and bone healing is more rapid in children
40
When do cranial sutures finish fusing?
18 months
41
Growth Velocity:
First 6 Months
Second 6 Months
Age 1-7
Age 8-15
First 6 Months: 2.54cm/month
Second 6 Months: 1.27cm/month
Age 1-7: 7.6cm/year
Age 8-15: 5cm/year
42
5 P's of Vascular Impairment
Pain and joint tenderness
Pallor
Pulselessness distal to fracture
Paresthesia distal to fracture site
Paralysis
43
What type of fracture may indicate child abuse?
Spiral
44
Why may fractures in older children be common?
Playing
MVA
45
What are the complications of fracture in epiphyseal plate?
Fractures affecting the growth plate may affect growth in affected limb long-term
46
Compartment Syndrome: Patho & Treatment
Progressive decrease in tissue perfusion due to increased pressure from edema or swelling pressing on tissues and vessels
If not treated immediately, may lead to permanent nerve and vascular damage, possible amputation
Treatment:
- Fasciotomy
47
Casting: Purpose, Care, Type, Signs of Compromise
Purpose:
- Immobilize fracture site and involve joints above/below fracture
Care:
- handle wet cast by palms to prevent indenting cast and creating pressure areas
- NO HOT SPOTS should be felt, nothing inside cast
- Monitor for swelling in first 6-8 hours
- Elevate
- Protect from water/urine
Type:
- Plaster of Paris (drying takes 24-48hrs)
-Synthetic
Signs of Compromise:
- Increased pain, edema
- Pallor or Blue color
- Skin coolness
-Numbness or tingling
- Decreased pulse strength
48
Traction: Purpose, Care
Purpose:
#1 Fatigue involved muscle and reduce spasm so bones can be realigned
#2 Position distal/proximal bone ends in desired position to promote bone healing (reduction)
#3 Immobilize fracture until realignment
Care:
- Weights must hang freely
- If child must be repositioned, someone must hold weights while repositioning child and then gently let go of weights when correct position achieved
49
Manual Traction
Applied to body part by hand and placed distally to fracture site
Performed during cast application
50
Skin Traction
Pull applied directly to skin surface and indirectly into skeletal structure
- Pull attached to skin with adhesive material or bandage
51
Skeletal Traction
Pull applied directly to bone with pin, wire or tongs
Possible source of infection - monitor pin sites, clean and dress as prescribed
52
Spina Bifida: Patho, Types, Treatment, Prevention, Risks
Patho
- posterior vertebral arches fail to fuse
- no herniation or loss of function
- may have dimple or tuft of hair
Types:
- Occulta - tuft of hair
- Meningocele - saclike protrusion w/ menings/CSF
- Myelomeningocele - saclike protrusion w/ CSF, meninges, nerve roots and spinal cord
Treatment:
- Meningocele will have sac repaired in first 48-hours
- If sac located outside of spinal cord - prone posiiton, no rectal temps, keep sac moist
- Straight cath due to neurogenic bladder (except in occulta)
- Bowel management program
Prevention:
- Folic acid during pregnancy
Risks:
- Latex allergy
- Hydrocephalus - measure head, monitor for ICP
53
Three Degrees of Developmental Dysplasia of Hip
Acetabular (or preluxation) - mildest, no subluxation or dislocation
Subluxation - incomplete dislocation of hip
Dislocation - femoral head loses contact w/ acetabulum, hip rests in dislocated position
54
Developmental Dysplasia: Infant S/Sx, Children/Toddler S/Sx, Diagnosis, Treatment
Infant S/Sx:
-Positive Ortolani (assess click) and Barlow (feel for click)
- Shortening of limb on affected side
- Unequal gluteal folds
- Restricted hip abduction on affected side
Toddlers/Older Children:
- waddling gait
- Lordosis when standing
- Affected leg shorter than other leg
- Trendelenburg Sign - weakness in hip abductor muscles (gluteus medius/minimus)
Assessment:
- Dx made during neonatal period
- US (4 months and younger)
- Xray - (4 months and older)
Treatment:
- Initiated before 2-months of age for most success
- Ongoing hip exam until child begins to walk
-Pavlik harness - Corrective device placed during neonatal period to maintain hip flexion/abduction
55
Cerebral Palsy: Patho, Classifications, S/Sx, Complications
Patho:
- nonprogressive motor disorder of CNS resulting in alteration in movement/posture
- Leading cause of anoxia or hypoxia at birth
Classifications:
- Spastic - most common
- Athetoid
- Ataxic
-Mixed
S/Sx:
- Primative reflexes
- Delayed gross motor development
- Lack of progression through developmental milestones
- Uncontrolled movements in extremity
Complications:
- Gait disturbance
- Seizure
ADD
- sensory impairment
- Failure of automatic reactions
- Speech and swallowing impairment
56
How do you prevent aspiration in child with CP?
Place into upright position and support lower jaw when feeding
57
Legg-Calve-Perthes Disease: Patho, S/Sx, Treatment
Patho:
- Avascular necrosis of femoral head
- Femoral head loses spherical shape
- Swelling of soft tissue around hip
- Unknown Cause
S/Sx:
- Limping
- Pain/Stiffness in hip, groin, leg or knee
-Limited ROM
Treatment:
- Revascularization occurs within 18-24 months
- NO CONTACT or HIGH IMPACT sports
- Swimming and biking can maintain ROM
- PT
- Nighttime brace
-Possible hip surgery
58
Scoliosis: Patho, Dx, Treatment
Patho
- lateral curvature in spine >10 degrees
- Occurs anywhere along spine, thoracic region most common
- Idiopathic Scoliosis common in adolescence
Dx:
- Screening: Forward bending test
- Xray of spine - anteroposterior and lateral
Treatment:
- Monitored every 3-12 months if curve <20
- Curve 20-40 degrees - bracing w/ exercise
- Curves >40 - surgery
59
Greenstick Fracture
Most common in under 3
Common in forearm
Break in periosteum on one side and only buckling on other side
60
Complete Fracture
Divides bone fragments
61
Incomplete Fracture
Fragments remain attached
62
Oblique Fracture
Diagonal or slanting break
63
Transverse Fracture
Break at right angles to long axis of bone
64
Comminuted
Very Rare
Bone is splintered into pieces
65
Osteomylitis: Patho, S/Sx, Treatment
Patho:
- Infection of bone
- Common between 5-14, especially boys
- Can occur due to penetrating injury or wound or result from infection elsewhere in body
S/Sx:
- Fever
- Abrupt pain
- Unwillingness to bear weight or move limb
- Irritable
- Possible dehydration/poor appetite
Treatment:
- IV antibiotics for 4-6 weeks
- Bed rest
- Affected limb may be cast or splint
- Surgery
66
Impetigo: Patho, S/Sx, Prevention, Treatment
Patho
- Highly contagious bacterial infection
- Staph or Strep (or both)
S/Sx:
- Leasion start as vesicle or pustule w/ edema and erythema then erupt leaving honey-colored exudate
Prevention:
- Hand washing
- Short nails
Treatment:
- Remove crust from lesion prior to applying topical antibiotic medication
- Severe cases require systemic antibiotic
67
Cellulitis: Patho, S/Sx, Treatment
Patho:
- Bacterial infection entering through opened skin due to derm issue or trauma
- Staph or Strep most common
S/Sx:
- Edematous
- Redness
- Warm, hot to touch
- Pain in affected area
Treatment:
- Mild: home w/ oral antibiotics
-Severe - IV atbx and possible incision/drainage (I&D)
68
How do you apply antigunfal creams?
Start with area outside of affected area and then spread inward to avoid spreading of infection
Cleanse affected area first
69
Diaper Dermatitis: Patho, Complication, Treatment
Common contact dermatitis in infants 9-13 months of age due to urine/feces
Complication: candida albican which requires topical antifungal medication - nystatin
Treatment:
- Diaper Cream
- Allow child to air dry
- Frequent Changes
-Avoid rubber pants, harsh soaps and non-sensitive baby wipes
70
Allergic Dermatitis: S/Sx, treatment
Allergic Contact Dermatitis
S/sx:
- rash limited to area of contact
- symptoms may develop several hours later
Treatment:
- Medium potency topical corticosteroid
- Oral corticosteroids for 7-10 days if >10% body affected followed by tapered dose for 7-10 days
71
Seborrhea: Patho, S/Sx, Treatment
Patho:
-Cradle cap
Treatment:
- Daily shampooing
- Apply emollient to soothe and soften
- remove scales w/ fingertips or toothbrush
72
Atopic Dermatitis: Patho, S/Sx, Treatment
- Eczema
- Chronic skin condition with no known cause
S/Sx:
- Red, painful, itchy rash
- Raised
Treatment:
- Moisturize, moisturize, moisturize
- Avoid harsh soap/lotion
- Topical steroid cream
73
Pediculosis: Patho, S/Sx, Treatment
Patho:
- Headlice
S/Sx:
- Itching is only symptom
Treatment: rid hair of nits
- Application of pediculicides AND manual removal of nits
- Drug of choice: NIX
***Children should stay in school even if NOT ALL NITS are removed***
74
Scabies: Transmission, S/Sx, Treatment
Transmission via close contact w/ infected person
Common in crowded conditions or shared bed
Common in kids < 2 years
S/Sx:
- Red streaked, linear rash
- Papules
- Intense itching
Treatment:
- Elimite cream
- Treat everyone in close contact - clothing, bedding, towels, cloth toys, hair items - warm water and dryer
