Test #4 Flashcards
results from the failure of a fetal duct in the intestine to fuse normally in utero
Meckel’s diverticulum
baseline tests to get before scoliosis surgery
x-rays, PFTs, ABGs
complications of chronic vaso-occlusive crisis
increased r/f URI osteomyelitis retinal detachment liver and renal failure
Duchenne MD
mutation in gene for dystrophin protein that maintains muscle fibers; muscle wasting that begins in pelvis and hips
antidote for iron OD
Deferoxamine
Failure to Thrive diagnosed when weight is
below the 3rd percentile
first 24-48h after a burn injury
Emergent (Resuscitative) Phase Fast fluid resus
s/s Vaso-occlusive crisis
**pain; swollen joints; hematuria; fever
complications of infant GER
can injure esophageal mucosa, lead to FTT, bleeding, dysphagia; can trigger RAD; stricures; aspiration PNA; esophagitis
Post op care for Hirschprung’s correction
ng tube, NPO to decompress ostomy care monitor abd girth
aplastic crisis
worsening of baseline anemia in SCA; viral trigger
s/s child abuse
inconsistency between injuries and story; chip/spiral Fx; child withdraws or is fearful of parents; behavior changes, sleep disturbances
s/s TEF
excessive drooling; 3Cs after feeding: coughing, choking, and cyanosis
Meckel’s diverticulum s/s
Painless bloody stools with bright red mucus
tylenol antidote
large dose Mucomyst
congenital aganglionic megacolon
Hirschprung’s disease–missing nerves at the end of the colon, obstruction results from inadequate motility
treatment for imperforate anus or fistula
surgical reconstruction and temporary colostomy
complications of Hirschprung’s disease
Enterocolitis (fever and explosive diarrhea) that can lead to sepsis, peritonitis, or shock of bowel perfs; anal stricture/incontinence; fussy eating/manipulation with meals
Meckel’s diverticulum Dx
radionucleotide scan
surgery to fix pyloric stenosis
pyloromyotomy
non-surgical treatment for intussusception
enema or air inflation; successful if brown stool passes but can often recur
noninvasive, keeps hips abducted and in socket in a child with DDH
Pavlik harness (6 mos)
with hemophilia its important to monitor for
brain bleed: HA, slurred speech, decreased LOC
Pre op most babies with TEF have
aspiration pneumonia
cleft palate repair
palatoplasty; performed between 12-18 mos; only cup liquids and soft foods 4-6 weeks postop
three zones of burns
Zone of Coagulation (non-viable); Zone of Stasis (tissue can be salvaged by fluid resus and reducing edema); Zone of Hyperemia (usually heals spontaneously)
severe GER causing FTT or tracheomalacia treat with
Nissan fundoplication: stomach wrapped around esophagus to increase LES tone
sickle cell anemia s/s
pain; SOB/fatigue/tachycardia; pallor or jaundice; nail bed deformities; Hand Foot syndrome=symmetric painful swelling; low fever; FTT
sickle cell pts need this test yearly to monitor for CVA from ages 2-16
transcranial doppler
screening tool for sickle cell anemia
SickleDex
RFs for sickle cell crisis
hypoxemia; infection; dehydration; fever
s/s hemophilia
bleeding episodes; joint pain and stiffness (hemoarthrosis), can lead to deformities; activity intolerance, prolonged PTT
inheritance pattern of Duchenne MD
X-linked recessive
Complications of cleft lip/palate
Aspiration, sinus infections; ear infections, hearing loss; speech delay; dental delay; feeding aversions
pinworm dx
Tape test
TEF diagnosis
X-ray with ng/og tube and air injection to show pouch
s/s tylenol OD
n/v; jaundice; RUQ pain; bleeding; coma
Leukemia Dx
Bone marrow biopsy showing immature leukemic blast cells
s/s tracheomalacia
barky cough and intermittent stridor; may outgrow or need trach temporarily
post op for scoliosis surgery
ICU; ng tube, foley, blood transfusions (autologous if possible), log rolling
s/s narcotic OD
decreased LOC, pinpoint pupils
risk factors for leukemia
family history; Down’s syndrome; chemical exposure; maternal smoking
often first sign of Duchenne MD
difficulty climbing stairs, riding a bike
RFs for DDH
Family history; uterine position, especially breech presentation
position to avoid GER
feed upright; prone HOB elevated 30 deg after feeding; thicken feeding, avoid overfeeding
s/s Hirschprung’s disease
bilious vomiting, refusal to feed; no meconium 48h after birth, abd distention; Child: ribbon-like stool, visible peristalsis
group of genetic diseases with progressive weakness and degeneration of skeletal muscles.
Muscular Dystrophy
best way to prevent sickle cell crisis
adequate hydration
most common childhood cancer
leukemia; 60% ALL, 38% AML
s/s intussusception
sudden colicky abd pain, knees to chest; currant jelly-like stools; palpable sausage-shape in RUQ; vomiting, abd distention
s/s rotavirus
mild/mod fever and vomiting for 2 days, followed by frequent watery foul-smelling stools for 5-7 days
frostbite treatment (white waxy areas)
water bath 38-41 deg; pain meds, Td
leukemia: Early s/s
low grade fever; recurrent infections; pallor; bruising; enlarged lymph nodes; joint pain
RFs for cleft lip/palate
heredity; maternal intake of dilantin, alcohol, smoking; maternal infection; Vitamin B/folate deficiency
cyanide antidote
amyl nitrate or IV sodium nitrate
goal of fluid admin in emergent phase of burn
good urine output (30-50 mL/hr)
an infant may have an imperforate anus or fistula if they haven’t passed stool in the first
24 hours of birth
MD Dx
muscle biopsy
purpose of traction in DDH treatment
stretch soft tissues to allow femoral head to return to socket
inheritance pattern of sickle cell anemia
autosomal recessive (both parents must be carriers)
this applied after closed reduction for DDH
spica cast for 3-6 mos, then a brace
s/s infant GER
excessive non-bilious vomiting; wt loss, FTT; chronic cough;
post op position for pyloromyotomy
head up and on side to aid stomach emptying
sickle cell anemia usually dosn’t present until 4-6 months of age because
before that babies have fetal hemoglobin from mother
after leukemia there is high risk for
secondary malignancy
thickened pyloric sphincter; surgical emergency
Pyloric stenosis
s/s DDH
“click” in hips; asymmetrical gluteal/thigh folds; shorter leg on affected side, turned outward
hypothermia s/s
pinworm treatment
Vermox or Pyrantel; treat family; stool precautions–wash linen in hot water, T/L hygeine
abnormal, uncontrolled and destructive proliferation of one type of white blood cell and its precursors.
Leukemia
hemophilia severity depends on
% of clotting factor missing
inheritance pattern of hemophilia
X-linked recessive
definitive diagnosis for sickle cell anemia
Hgb electrophoresis
complications to watch for after TEF repair
Pleural effusion, pneumothorax; Feeding aversions (may need Gtube); Strictures (may need future eso dilations)
Hirschprung’s Dx
rectal biopsy to see aganglionic cells
burn extends into dermis, painful scalds, blisters can form; edema, pain, and moistness
second degree: superficial or deep partial thickness
acute painful splenomegaly due to trapped sickled rbcs; decreased Hgb, can lead to shock; medical emergency
splenic sequestration
cleft lip repair
cheiloplasty; performed at 6-12 weeks, use staggered sutures to prevent scar
s/s acute chest syndrome
pulmonary infiltrates, dyspnea, tachypnea, congested cough
palmar surface rule for burn estimation
the patient’s palmar surface is equal to 1% of their BSA
RFs for esophageal atresia/ TEF
maternal: Vit A, riboflavin deficiency, polyhydramnios
treatment for ethylene glycol poisoning
activated charcoal and gastric lavage
MD complications
contractures; disuse atrophy; infections; obesity; CP problems
Dx of infant GER
esophagus pH monitoring
s/s pyloric stenosis
Projectile vomiting, especially 30-60 min after eating, non-bilious; constant hunger with FTT and dehydration; Olive-shaped mass in epigastric area
pre op for intussusception monitor for this complication
peritonitis
rotavirus transmission
fecal-oral
edema in a burn can convert partial thickness burns into full thickness burns because of
decreased perfusion to the area–therefore, decrease edema and admin fluids quickly
s/s smoke inhalation damage
singed nasal hairs and brows, sooty sputum, hoarseness, wheezing and increased secretions; can be delayed 24-48h
third degree burn=full thickness burn
dry, non-edematous, and painless; no residual epidermal cells so no healing possible; tissue is called eschar; may be waxy white or black; elasticity is lost so escharotomy may be necessary to restore blood flow
s/s Heat Stroke
HoTN, tachypnea, tachycardia, anxiety and confusion/AMS, weakness, thirst, leading to seizures and coma
painful burn, pink to red skin; only epidermis affected, skin function intact; no systemic response
superficial (first degree)
leukemia: Late s/s
Pain; hematuria; mouth ulcerations; enlarged kidneys and testicles; IICP
eye disorder associated with DM
cataracts
Rett disorder
mostly in females; initially normal development, then around 18 mos: deceleration of head growth, loss of speech and hand control, eventual dementia
very rare dev. disorder, regression in multiple areas on function after 2 years of normal development
Child Disintegrative Disorder
social disorder with increased verbal and cognitive ability and social interaction compared with other forms of social disorder, especially concerning the child’s current obsessive preoccupation
Aperger’s disorder
to diagnose autism, s/s must present by
3 years of age
hallmark of autism
impaired social interaction–nonverbals, attention, and social reciprocity. Impairments in socialization, communication, and behavior
loss of lens elasticity with age
presbyopia
light rays focus on two differrnt points on retina due to vurvature abnormality of cornea or lens
astigmatism
blunt trauma causes bloor in anterior chamber of eye; red color on lower iris as blood pools
hyphema
Tx for chemicals in eye
rinse with cool tap water 20 minutes
with eye impalement, cover both eyes initially to
stop movement of the affected eye–eyes move together
treatment for corneal abrasion or tearing
steriod eye drops`
RFs for retinal tear/detachment
Age; Cataract surgery; DM
s/s retinal tear/detachment
light flashes, floaters; ring in field of vision
edema of optic disc
papilledema; can be caused by severe HTN
normal IOP
10-21 mmHg
Increased pressure in eye causes atrophy of optic disc and retinal cells, with loss of peripheral vision first, then central if untreated; also visual halos and blurred vision
glaucoma
normally aqueous humor flows
from posterior chamber to anterior chamber and is absorbed by the veins of the trabecular network
aqueous humor cannot drain well from anterior chamber through trabecular meshwork; insidious development
open angle glaucoma; chronic glaucoma
;IOP 22-32
iris bows forward and completely blocks fluid access to trabecular meshwork, causing pressure buildup, leading to more bowing and pressure; emergency with severe eye pain and fast vision loss
closed angle glaucoma; acute glaucoma; IOP>50
treatment for open angle glaucoma
laser trabeculoplasty–holes made in meshwork to accomodate fluid movement; meds: BBs, cholinergics, miotics to decreased IOP
clouding of eye lens resulting in nighttime glare, reduced color perception, and image distortion
cataracts
most common cause of vision loss >55 yrs
age related macular degeneration
Tx for closed angle glaucoma
laser iridectomy
eye drops to treat cataracts before surgery
mydriatics-cycloplegic agents to temporarily paralyze IO muscles
light sensing cells are damaged in the macula–area in the retina specialized for high acuity vision
macular degeneration
RFs for macular degeneration
aging; smoking; alcohol; UV exposure; heredity
macular degeneration is diagnosed when this is observed with the opthalmoscope
drusen: yellow exudate of extracellular debris
two forms of macular degeneration
Dry (atrophic)–drused accumulates between choroid and retina, can cause detachment; gradual vision loss;
Wet (exudative)–rapid progression, BVs grow between choroid and retina; distinctly darkened or blurred vision
sensorineural hearing loss involves
cranial nerve 8–vestibulocochlear nerve
vertigo and nystagmus caused by calcium carbonate accumulation
benign paroxysmal positional vertigo (BPPV)
endolymph buildup in inner ear causes fullness, tinnitus, and vertigo that can last 30-60 minutes and be accompanied by nystagmus
Meniere’s disease
Meniere’s disease
Head trauma, URI, chronic aspirin use, smoking and alcohol use
meniere’s disease lifestyle treatment
los sodium diet to prevent fluid retention; diuretics, avoid caffeine and nicotine
