Test 2 - Study Guide Flashcards
Cleft Lip & Palate: Patho, Dx, Signs/Sx, Risk Factors, Complications, Treatment
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
Esophageal Atresia: Patho, S/Sx, Complications
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
Tracheoesophogeal Fistula
Complication of esophageal atresia where esophagus ends in blind pouch or pouch is connected to trachea by fistula
Omphalocele and Gastroschisis: Patho, Management, Treatment goals
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
Imperforate Anus: Patho
Patho
- Congenital Defect
- Incomplete development or absence of the anus
- Not able to pass stool
- Rectum ends in blind pouch
Inguinal Hernia: Patho
Bulge in groin/inguinal area
Umbilical Hernia
Protrusion in umbilical area
Mild Dehydration: Patho, S/Sx, treatment
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
Moderate Dehydration: Patho, S/Sx
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
Severe Dehydration: Patho, S/Sx
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
Vomiting
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
Diarrhea: Patho, Classification, Classification, Treatment
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
Oral Candidiasis: Patho, Treatment
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
Pyloric Stenosis: Patho, S/Sx, Dx, Treatment
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
Intussusception: Patho, S/Sx, Treatment, Risk Factors
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
Appendicitis: Patho, S/Sx, Assessment, Treatment
1 Periumbillical pain
Most common pediatric condition requiring abdominal surgery
S/Sx:
#2 RLQ pain
Assessment:
- Rebound tenderness
Treatment:
- Surgery
Gastroesophageal Reflux (GER): Patho, S/Sx, Dx, Management, Complications
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
Hirschsprung Disease: Patho, S/Sx, Treatment, Complications
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)
Irritable Bowel Syndrome: Patho, S/Sx, Dx, Treatment
Nervous Stomach
Recurrent abdominal pain in children
S/Sx
- Abdominal pain
- Flatus
- Bloating,
- Constipation
- Diarrhea (or both)
Dx: No specific test
Treatment:
- Dietary changes
Chron’s Disease: Patho, S/Sx, Dx, Treatment
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
Ulcerative Colitis: Patho, S/Sx, Treatment
Patho
- Acute or chronic bowel inflammation
S/Sx:
- Recurrent bloody diarrhea
- abdominal pain
- urgency
- tenesmus
Treatment:
- Curable with surgery - illeostomy
Necrotizing Enterocolitis: Patho, treatment
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
Celiac Disease: Patho, S/Sx, Celiac Crisis
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,
Viral Hepatitis: A: Patho, Prevention
Patho:
- “Infectious hepatitis”
- Fecal-oral route
Prevention: Vaccine
Hepatitis B: Patho, Prevention
Patho:
- Most common
- Transmission through blood and body fluids
- May be transferred from mother to fetus
Prevention: Vaccine before discharge
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
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
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
How do we treat lead poisoning? What do we need to carefully monitor?
Chelation therapy
Monitor: Renal Function
