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Peds > Test 2 - Study Guide > Flashcards

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
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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
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3
Q

Tracheoesophogeal Fistula

A

Complication of esophageal atresia where esophagus ends in blind pouch or pouch is connected to trachea by fistula

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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

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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
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6
Q

Inguinal Hernia: Patho

A

Bulge in groin/inguinal area

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7
Q

Umbilical Hernia

A

Protrusion in umbilical area

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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

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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

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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
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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

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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
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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
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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
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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
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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
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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

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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)
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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

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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
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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

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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

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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,
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24
Q

Viral Hepatitis: A: Patho, Prevention

A

Patho:

  • “Infectious hepatitis”
  • Fecal-oral route

Prevention: Vaccine

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25
Q

Hepatitis B: Patho, Prevention

A

Patho:

  • Most common
  • Transmission through blood and body fluids
  • May be transferred from mother to fetus

Prevention: Vaccine before discharge

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26
Q

Colic: Patho, Treatment

A

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
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27
Q

Failure to Thrive: Patho

A

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
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28
Q

Overweight and obesity: Patho, S/Sx, Treatment

A

Common in pediatrics
Children at risk for later health issues

S/Sx:
- >95% (correlate with weight)

Treatment:

  • Modify diet
  • Add exercise
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29
Q

How do we treat lead poisoning? What do we need to carefully monitor?

A

Chelation therapy
Monitor: Renal Function

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30
Q

Why are infants prone to fluid overload?

A

Immature kidney functioning

31
Q

Bladder Exstrophy: Patho, Assessment, Treatment

A

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
Q

Vesicoureteral Reflux (VUR): Patho, Dx, Grading, Complication

A

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
Q

UTI: Patho, Children S/Sx, Infant S/Sx, Treatment

A

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
Q

Pyelonephritis: Patho, S/Sx, Treatment

A

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
Q

Nephrotic Syndrome: Patho, S/Sx, Types, Treatment

A

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
Q

Acute Poststreptococcal Glomerulonephritis: Patho, S/Sx, Treatment

A

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
Q

Hemolytic Uremic Syndrome: Patho, S/Sx, Treatment, Prevention

A

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
Q

Cryptorchidism: Patho, Treatment, Risks

A

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
Q

In pediatric bones, where does growth occur? What are differences in pediatric bones?

A

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
Q

When do cranial sutures finish fusing?

A

18 months

41
Q

Growth Velocity:

First 6 Months
Second 6 Months
Age 1-7
Age 8-15

A

First 6 Months: 2.54cm/month
Second 6 Months: 1.27cm/month
Age 1-7: 7.6cm/year
Age 8-15: 5cm/year

42
Q

5 P’s of Vascular Impairment

A

Pain and joint tenderness
Pallor
Pulselessness distal to fracture
Paresthesia distal to fracture site
Paralysis

43
Q

What type of fracture may indicate child abuse?

A

Spiral

44
Q

Why may fractures in older children be common?

A

Playing
MVA

45
Q

What are the complications of fracture in epiphyseal plate?

A

Fractures affecting the growth plate may affect growth in affected limb long-term

46
Q

Compartment Syndrome: Patho & Treatment

A

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
Q

Casting: Purpose, Care, Type, Signs of Compromise

A

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
Q

Traction: Purpose, Care

A

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
Q

Manual Traction

A

Applied to body part by hand and placed distally to fracture site

Performed during cast application

50
Q

Skin Traction

A

Pull applied directly to skin surface and indirectly into skeletal structure
- Pull attached to skin with adhesive material or bandage

51
Q

Skeletal Traction

A

Pull applied directly to bone with pin, wire or tongs
Possible source of infection - monitor pin sites, clean and dress as prescribed

52
Q

Spina Bifida: Patho, Types, Treatment, Prevention, Risks

A

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
Q

Three Degrees of Developmental Dysplasia of Hip

A

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
Q

Developmental Dysplasia: Infant S/Sx, Children/Toddler S/Sx, Diagnosis, Treatment

A

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
Q

Cerebral Palsy: Patho, Classifications, S/Sx, Complications

A

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
Q

How do you prevent aspiration in child with CP?

A

Place into upright position and support lower jaw when feeding

57
Q

Legg-Calve-Perthes Disease: Patho, S/Sx, Treatment

A

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
Q

Scoliosis: Patho, Dx, Treatment

A

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
Q

Greenstick Fracture

A

Most common in under 3

Common in forearm

Break in periosteum on one side and only buckling on other side

60
Q

Complete Fracture

A

Divides bone fragments

61
Q

Incomplete Fracture

A

Fragments remain attached

62
Q

Oblique Fracture

A

Diagonal or slanting break

63
Q

Transverse Fracture

A

Break at right angles to long axis of bone

64
Q

Comminuted

A

Very Rare

Bone is splintered into pieces

65
Q

Osteomylitis: Patho, S/Sx, Treatment

A

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
Q

Impetigo: Patho, S/Sx, Prevention, Treatment

A

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
Q

Cellulitis: Patho, S/Sx, Treatment

A

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
Q

How do you apply antigunfal creams?

A

Start with area outside of affected area and then spread inward to avoid spreading of infection

Cleanse affected area first

69
Q

Diaper Dermatitis: Patho, Complication, Treatment

A

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
Q

Allergic Dermatitis: S/Sx, treatment

A

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
Q

Seborrhea: Patho, S/Sx, Treatment

A

Patho:
-Cradle cap

Treatment:
- Daily shampooing
- Apply emollient to soothe and soften
- remove scales w/ fingertips or toothbrush

72
Q

Atopic Dermatitis: Patho, S/Sx, Treatment

A
  • 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
Q

Pediculosis: Patho, S/Sx, Treatment

A

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
Q

Scabies: Transmission, S/Sx, Treatment

A

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

Peds (3 decks)

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