Test Plan Flashcards
Postpartum Hemorrhage
-Leading cause of maternal death worldwide
-PPH defined as 500mL of blood after vaginal birth. 1000mL after C-section
-Life threatening with little warning
-Often unrecognized until profound symptoms
Postpartum Hemorrhage Nursing interventions
-Remain w/ patient
-Assess uterine tone- fundal massage
-Assess bladder- straight cath/void
-Administer uterine stimulants as ordered
-Weigh pads to estimate blood loss
-Monitor vitals
-Watch for signs of shock
-Replace fluids and administer blood products as ordered
Postpartum Hemorrhage Etiology and Risk Factors
-Uterine atony
-Lacerations of genital tract
-Hematomas
-Retained placenta
-Inversion of uterus (turning inside out)
-Subinvolution of uterus (retained placental fragments and pelvic infection
Postpartum Hemorrhage Care Management
-Early recognition
-First evaluate the contractility of the uterus
-Massage fundus
-Increase contractility and minimize blood loss
Mastitis Interventions
-Well fitting, supportive bra for 24 hours
-Adequate nutrition, hydration, rest and sleep
-Good hand hygiene
-Educate/reinforce proper breastfeeding techniques
-Antibiotics, analgesics, and antipyretics as ordered
Medications for Postpartum Hemorrhage
-Oxytocin
-Misoprostol (cytotec) Rectally
-Hemabate (Avoid with asthma or hypertension)
Chlamydia Effects
Maternal Effects
-PROM
-Preterm labor
- Postpartum endometritis
Fetal Effects
-LBW
-Opthalmia neonatorum
S/S: vulvar itching, and postcoital bleeding, white watery vaginal discharge
Mastitis
Infection of the breast connective tissue primarily in women who are lactating
(traumatized, cracked nipple, breast engorgement, poor hygiene)
Nursing Care of the Postpartum Woman
-Assist mother with rest and recovery after birth
-Assessment of physiologic and psychological adaptation
-Prevention of complications
-Education regarding self-management and infant care
-Support of mother and her partner during transition to parenthood
Postpartum Mom/Baby Care
-Attachment, bonding, and acquaintance
Postpartum Discharge Teachings
-Self-management and signs of complications
-Sexual activity/contraception
-Routine mother and baby checkups
-Prescribed medications
-ADL’s at home
-Follow up after discharge
Postpartum (puerperal) Infection
Puerperal sepsis: any infection of genital tract within 28 days after miscarriage, induces abortion, or birth.
Teratogens
An agent that disturbs the development of an embryo or fetus. May cause birth defects or end the pregnancy.
-Drugs, infections, exposure to radiation, certain maternal conditions (diabetes and PKU)
Have greatest effect during embryonic period (day 15- 8 weeks)
Gonorrhea Effects
Maternal Effects
-Miscarriage
-Preterm labor
-PROM
-Amniotic infection syndrome
-Chorioamnionitis
-Postpartum sepsis or endometritis
Fetal Effects
-Preterm birth
-IUGR
-Opthalmia neonatorum
S/S: Urethral discharge. Yellowish-green vaginal discharge, reddened vulva and vaginal walls. Untreated can cause PID
Prevention of STI’s
-Know your partner
-Reduce number of partners
-Practice low risk sex
-Avoid exchange of bodily fluids
-Vaccination
-Correct use of condoms
GTPAL
G- Gravidity (including current and death)
T- Term (>38 weeks)
P- Preterm (<36 weeks)
A- Abortions (planned, miscarriage, loss)
L- Living (living now)
Nancy is pregnant. THe first pregnancy resulted in a birth at 36 weeks of gestation and a second pregnancy resulted in the birth of a baby at 42 weeks of gestation. What is the GTPAL?
G3-1102
G- 3 gestations
T- 1 term
P- 1 preterm
A- 0 aborted
L- 2 that are currently living
A woman’s LMP began on September 10, 2016, and ended on September 15th, 2016. What is the EDB?
June 17, 2017
Oxytocin (Pitocin)
Augmentation of labor- the stimulation of uterine contractions after labor has spontaneously started but progress is unsatisfactory
1st option used for PPH, crunches uterus by stimulating contractions
Calculating “Estimated date of birth” from last menstrual period
1) Determine first day of LMP
2) Subtract 3 months
3) Add 7 days and 1 year
True Labor
Contractions:
-May being irregularly but become regular in frequency.
-Get stronger, last longer and are more frequent.
-Felt in lower back, radiating to abdomen.
-Continue despite comfort measures
Cervix (assessed by vaginal exam):
-Progressive change in dilation and effacement
-Moves to anterior position
-Bloody show
Fetus:
-Presenting part engages
Nonstress Test
-Electronic fetal monitoring that determines fetal activity
-FHR is monitored, tracing is observed for signs of fetal activity and a concurrent acceleration in FHR
-20-30 minutes
-Reactive: 2 accels in 20 minutes each lasting 15 secs and 15 beats/min above baseline (15x15) GOOD!!!
-Nonreactive: Does not meet relative criteria BAD!!!
False Labor
Contractions:
-Painless, irregular frequency and intermittent (Braxton Hicks)
-Decrease in frequency, duration and intensity with walking or position changing
-Felt in lower back or abdomen above umbilicus
-Often stopped with sleep or comfort measures (oral hydration, voiding)
Cervix (assessed by vaginal exam):
-No significant change in dilation or effacement
-Often remains in posterior position
-No significant bloody show
Fetus:
-Presenting part is not engaged in pelvis
Fentanyl
Use: synthetic opioid for moderate-severe pain relief
Pregestational Diabetes
-Occurs in women who have pre-existing disease
-Complicated by vascular disease, retinopathy, or nephropathy
-Almost all of these patients are insulin dependent during pregnancy
*Usually, insulin needs decrease in first trimester, and increase in second and third trimester
Does glucose cross the placenta???
YES
Glucose crosses the placenta, insulin does not
Gestational Hypertension
> 140/>90 BP
Onset of hypertension w/o proteinuria after the 20th week of pregnancy
Sometimes progresses to preeclampsia
Requires more frequent monitoring
Gestational Diabetes
Occurs during the 24-28th week, risk for stillbirth, miscarriage, and macrosomia
Preeclampsia
HTN develops after 20 weeks of gestation in previously normotensive women PLUS presence of proteinuria
A vasospastic systemic disorder categorized as mild to severe (>160/>110 BP)
Preeclampsia Treatment
Treat w/ Magnesium Sulfate
Therapeutic level is 4-7mEq/L
Preeclampsia S/S
HA, visual disturbances, epigastric pain, hyper reflexive, clonus.
HELLP syndrome
Severe preeclampsia involves hepatic dysfunction characterized by:
-H: Hemolysis of RBC
-EL: Elevated liver enzymes (ALT/AST)
-LP: Low platelets
Preeclampsia Risk Factors
Family hx, multifetal pregnancy, black, obese, <19/>40
Hyperemesis
Excessive vomiting accompanied by dehydration, electrolyte imbalance, and ketosis
Avoid empty stomach, eat frequently small snacks, separate liquids from solids, high protein snack at night, dry, bland food, dairy might go well.
Placenta Previa
Placenta implants in lower uterine segment near or over internal cervical OS (Complete, marginal, or low-lying)
Hemorrhage-MAIN CONCERN
C-section
Placenta Previa Clinical Manifestations
Painless, bright red vaginal bleeding during second of third trimester
Soft relaxed non-tender uterus
Hemorrhage-MAIN CONCERN
Placental Abruption Risk Factors
HTN, cocaine, trauma, smoking
Placental Abruption Clinical Manifestations
PAIN!
-Sudden onset of intense high frequency uterine contractions
-w/ or w/o bleeding
-Rigid, tender abdomen
Placental Abruption
Premature separation of placenta
Vaginal birth is preferred
Newborn’s First hour of Life
Airway maintenance/oxygenation
Maintaining body temp (cold stress)
Promoting parent-infant interaction
Medication (eye prophylaxis (protection against gonorrhea or chlamydia), Vit. K prophylaxis (promotes formation of clotting factors))
LGA/SGA
Pathologic Jaundice
Happens inside the uterus before birth
Shows up within first 24 hours of birth
Goes higher and farther than physiologic jaundice and causes more problems.
Pathologic Jaundice Treatment
phototherapy (protect eyes), blood exchange transfusions
Pathologic Jaundice Risk Factors
Risk Factors: premature birth, significant bruising during birth, blood type, breastfeeding (less poop = less bilirubin excreted)
Can lead to Kernicterus- irreversible toxicity that causes brain damage
Physiologic Jaundice Treatment
phototherapy (protect eyes), blood exchange transfusions
Physiologic Jaundice
Not present at birth, the liver wasn’t ready to handle all the RBCs, we want them to poop a lot. Shows up 24 hours after birth
Physiologic Jaundice Risk Factors
premature birth, significant bruising during birth, blood type, breastfeeding (less poop = less bilirubin excreted)
Can lead to Kernicterus- irreversible toxicity that causes brain damage
Newborn Hypoglycemia
-Treatment is warranted at levels less than 40-45 mg/dL
-Heel stick
-Feed in first hour of life, test 30 minutes after feeding.
Newborn Hypoglycemia S/S
S/S: Jitteriness, respiratory distress, poor thermoregulation
Newborn Hypoglycemia Risk Factors
Risk Factors: large for gestational age/SGA, mother is diabetic, late preterm, or low birth weight
Breastfeeding
-Should be done for the first 6 months and up to 12 months, complementary foods can be introduced at 6 months
-Baby should have their whole mouth around the nipple, should hear audible swallowing, their whole face should be in the breast.
-Baby should have 6-8 dirty diapers a day
-Very beneficial for the mother and nutritious for baby
-Makes the baby poop less than formula (quality over quantity)
Amniotomy (AROM)
-Performed to rupture the membranes of a pregnant women
-After the procedure, the nurse should monitor the FHR due to the risk for cord compression, variable decelerations indicative it and the provide should be immediately informed.
-Tachycardia is normal afterwards and doesn’t require action
-Greatest concern is infection, indicted by maternal chills and foul-smelling vaginal discharge
Weight Gain in First Year of Life
Double birth weight by 5-6 months
Triple birth weight by 1 year
Pediatric Vitals
Pulse: taken apically, count for full minute
RR: watch abdomen, count for full minute
Temp: taken rectally only when absolutely neccesary
To get the correct BP cuff size: cuff bladder width should be 40% of arm circumference, the length 80%-100% of circumference, measured at heart level
Use play!
Toddler Development
-Walk alone (12-13 months)
-Throw ball w/o falling down (18 months)
-Attempt to run (18 months)
-Anterior fontanels closes (18 months)
-Birth weight is tripled by one year
Infant Safe Sleep
Do not co-sleep with baby. Do not put any toys in the crib. Keep the baby supine while sleeping. No blankets or pillows in the crib. Have a tight fitted sheet as the cover. Make sure the baby cannot slip through or climb over guard rails
Pregnancy Nutrition
-Additional 340 calories/day during second trimester.
-Additional 452 calories/day during third trimester.
-Consume more protein, iron, calcium, and fluids
-Consume folic acid to prevent neural tube defects
-2.2-4.4 lbs in 1st trimester, then 1 lb per week after.
-Underweight 28-40 lb total, normal 25-35 lbs, overweight 15-25 lbs
Infant Development in First Year of Life
-By one year old, attempts to build tower of two blocks but fail
-By end of first year, recognize distinct from parents
-Posterior fontanels closes (6-8 weeks/2 months)
-Birth weight doubles by 6 months
-Object permanence (9 months)
Asthma
Chronic inflammatory disorder of airways
Limited airflow or obstruction that reverses spontaneously or w/ treatment
Asthma Manifestations
Coughing, wheezing, dyspnea
Betamethasone
Glucocorticoid given in 2 doses to promote fetal lung maturity when a preterm birth is going to occur
The most significant benefits occur within the first 24 hours
Asthma Therapeutic Management
Goal: to maintain normal activities levels
Prevention of exacerbations
Allergen control
Relieve bronchospasm
Terbutaline
Used to stop premature labor
Causes relaxation of uterine smooth muscle
Magnesium Sulfate Use
Prevent/treat convulsions via relaxing uterine smooth muscle.
Indicated in severe gestational HTN & severe preeclampsia
Also prevents contractions in preterm labor
Magnesium Sulfate Dosage
4-6 g loading dose/bolus over 20-30 min. Then 2-3 g/hr maintenance dose
Magnesium Sulfate Therapeutic Level
4-7 mEq/L
Magnesium Sulfate Toxicity
-Presents with absent DTRs, resp below 12, pulse ox below 95% even with O2, decreased LOC.
-Give calcium gluconate as the antidote but stop IV flow first
Magnesium Sulfate Interventions
Pad siderails, dim lights, lower activity (seizure precautions); vital signs every 15 mins; excreted through urine so I&Os important (minimum 30 mL/hr)
Methergine
Med given for postpartum hemorrhage, not the 1st choice
Has hypertensive side effecrs, don’t give with HTN, preeclampsia, or cardiac disease
Albuterol Therapeutic Use
Quick relief of asthma (relaxes airway smooth muscle)
Albuterol Adverse Effects
Minimal at therapeutic doses, at higher doses will activate beta 1 (increasing HR/tachycardia), tremors
Warfarin
Anticoagulant therapy prevents clots.
Crosses the placenta and is not safe during pregnancy
Heparin
-Anticoagulant therapy, prevents clots.
Does NOT cross the placenta and is thought to be safe in pregnancy
Propranolol
Beta blocker used to reverse intolerable CV effects of terbutaline
Oral Medication Administration
Cannot be done with vomiting, intubation, or feeding tubes
Crush it if possible, for those with difficulty swallowing.
Offer something to drink
With syringe give it into the cheek, don’t mix with food
Pain Control During Labor
Everyone perceives pain differently, offer nonpharm pain relief right away.
Give pharm pain relief before the pain becomes severe
Demerol is used for moderate-severe pain here. Don’t give in delivery is expected within 4 hours
Epidurals are also used, lowers oxygen consumption
Growth Hormone
Hormone responsible for causing growth, mostly occurs at night
Given as a drug for children with hypopituitarism
Epidural
Use: pain relief of vaginal birth labor and sometimes for C section. Lowers oxygen consumption
A catheter is used to insert the needle into the epidural space
Cystic Fibrosis Patho
Less water and chloride in mucus causes it to dry up and allow foreign agents to collect in the airways
Cystic Fibrosis Growth/Development
Food goes undigested and stools are more abundant and noxious.
Pancreatic enzymes can’t reach duodenum causing nutrient absorption of fat/protein to be impaired.
Eventual pancreatic fibrosis can cause diabetes mellitus.
Respiratory infections are common; the lung muscles are weaker.
Chronic hypoxemia causes contraction/hypertrophy of pulmonary artery muscle fibers.
1st symptom is meconium ileus
Cystic Fibrosis Health Promotion
Recommend physical exercise, aggressive treatment of infections, postural drainage, and chest physiotherapy (give bronchodilators beforehand).
They need extra vitamin A, D, E, K, high protein, high calorie
Puberty in girls is delayed, and boys are sterile.
Failure to thrive in infants, increased weight loss despite appetite
Epiglottitis
Medical Emergency
Inflammation of epiglottis
Sore throat, pain, tripod position, inspiratory stridor, drooling, difficulty swallowing
Epiglottitis Therapeutic Management
Prevention of progressive respiratory obstruction, protect airway
Prepare for intubation or tracheostomy
Humidified oxygen, continuous pulse ox
Nothing in mouth, no throat culture or tongue blade
Asthma Triggers
Animal hair/dander
Food allergies
Allergens
Exercise and activity
Cold air or weather changes
Tabacco smoke
Infections/colds
Coarctation of the Aorta
Obstructive Defect
-Anatomic narrowing (stenosis) of blood vessel exiting the heart
-Pressure in ventricle and artery before the narrowing is increased
-Pressure beyond the obstruction is decreased
-Location if stenosis is usually near the valve
-Increased pressure to head and upper extremities
-Decrease pressure to lower extremities
Cardiac Catheterization Postop Care
Strict bed rest for 6 hours with a quiet environment, check vitals, cap refill, swelling. Give pressure dressings, give more dressings if bleeding present, don’t take off.
Patient will lose a lot of fluid so monitor I/Os, blood glucose.
Make sure affected limb is extended and flat
Cardiac Catheterization
Invasive procedure looks at oxygen/pressure levels in each chamber and their structure, can also blow a balloon to expand a heart chamber.
Risk for bleeding, pulse lost in cathed extremity
Coarctation of the Aorta Treatment
Get BP readings on both extremities, cardiac catherization balloon
Coarctation of the Aorta S/S
Upper body BP can be 20 mmHg higher, upper body pulse is stronger than lower, vertigo, headache, dizziness, nosebleed, cool feet, exercise intolerance
What Can Rheumatic Fever Lead To?
Rheumatic heart disease- permanent valve damage
Rheumatic Fever
-Inflammatory disease occurs after group A B-hemolytic streptococcal pharyngitis
(UNTREATED STREP)
-Affects joints, skin, brain, serous surfaces, and heart (mitral valve)
Rheumatic Fever Goal
Eradicate infection, prevent permanent damage, prevent recurrences.
Salicylates (prednisone) control inflammation, then bedrest, aspirin, and penicillin are prescribed
Dehydration
Occurs whenever total output of fluids exceeds intake
Dehydration Causes
-Insensible fluid loss
-Increased renal excretion
-GI tract dysfunction (vomiting, diarrhea), ketoacidosis
-Burns
Hirschsprung Disease
Rare congenital anomaly where the absence of ganglions in the colon causes the internal anal sphincter to be unable to relax, and subsequent stool accumulation
Dehydration Management
Goal is to correct the fluid loss or deficit while treating underlying cause
-Oral rehydration is initiated for mild cases, if tolerated (not vomiting)
-Parenteral fluid if oral rehydration does not meet needs.
Hirschsprung Disease
Newborn- no meconium stool, constipation, reluctant to eat, abdominal distention. Infant- failure to thrive, constipation, abdominal distention, vomiting, diarrhea. Foul smelling ribbon like stools”.
Toddlers/Children- foul smelling stool, abdominal distention, visible peristalsis, palpable fecal mass, malnourishment, signs of anemia/hypoproteinemia
Hirschsprung Disease Diagnosis
X-ray, barium enema study, anorectal exam, rectal biopsy.
These are performed when the S/S point to this
Hirschsprung Disease Management
Surgical removal of aganglionic portion of bowel to restore motility. 1st stage is a temporary ostomy, 2nd stage is a “pull-through” procedure
Appendicitis Cause
Obstructed appendix lumen, usually from hardened fecal matter, or from swollen lymphoid tissue
Appendicitis Patho
Obstruction compresses blood vessels, causing ischemia.
Can progress to necrosis then perforation
Appendicitis Diagnosis
Abdominal ultrasounds and CT scans, evaluation for several hours
Appendicitis S/S
Early S/S: periumbilical cramps, abdominal tenderness, anorexia, nausea, and fever
Late S/S: guarding, rigidity, N/V, rebound tenderness in RLQ
Appendicitis Management
Immediate surgical removal, treat ruptured appendix.
Postop give liquid diet and move gradually to solids, use stool softeners and pain management
Reye’s Syndrome
A disorder defined as toxic encephalopathy associated with other characteristic organ involvement
-Fever, profoundly impaired consciousness and disordered hepatic function
-Association between aspirin therapy for fever and development of Reye’s
-Liver biopsy
-Early diagnosis and aggressive therapy
Increasing ICP
Cause: injury or fluid buildup in brain
S/S: Infant- irritability, poor feeding, difficult to soothe, fontanels bulging, scalp veins distended. Child- headache, N/V, seizures, lethargy, can’t follow commands. Fixed dilated pupils,
Cushing Triad: widening BP, bradycardia, irregular respirations
Management: 30 degrees, maintain head midline, don’t cough or blow nose, minimize noise
Hydrocephalus
Patho: impaired CSF absorption in subarachnoid space or ventricular obstruction
Causes: developmental defects, neoplasms, infection, trauma, myelomeningocele.
Management: ventriculoperitoneal shunt to drain fluid. treat complications, infection S/S is an emergency
Hemophilia Cause
Cause: hereditary X recessive bleeding disorder.
Type A (classic): factor VIII deficiency
Type B (Christmas disease): factor IX deficiency
Von Willebrand: von Willebrand factor and factor VIII deficiency
Hemophilia Diagnosis
History of bleeding episodes, low factor VIII/IX, prolonged prothrombin time, low platelets
Hemophilia Care Management
-Prevent bleeding: safe environment, and dental hygiene
-Recognize and control bleeding: RICE
-Prevent the crippling effects of bleeding
-Support the family and home care: genetic counseling
Hemophilia Treatment
Infuse missing factors
Desmopressin Acetate for extreme situations
Aminocaproic acid prevents clot dissolution.
Corticosteroids may cause hematuria/arthritis, no NSAIDs
Precocious Puberty
-Children begin their physical and sexual development much earlier than normal
-Cause is usually unknown: possibly related to obesity, heredity, stress, environment, adrenal or CNS tumors or tumors on the gonads
-Early signs of puberty, including the appearance of secondary sex characteristics
-Treatment: Leuprolide acetate
Aplastic Anemia
-Bone marrow failure: formed elements all simultaneously depressed
-Can be congenital or acquired
-Diagnostics: anemia, leukemia, and thrombocytopenia/decreased platelet count. Bone marrow biopsy
-Treatment: immunosuppressive therapy, bone marrow transplant
Type 1 DM
Autoimmune destruction of pancreatic beta cells
Greater risk to fetus since it is active in 1st trimester birth defects
Give baby fluids before insulin
Almost all of these patients are insulin-dependent during pregnancy
Glucose monitoring and insulin administration
Type 1 DM Clinical Manifestations
Polydipsia
Polyuria
Weight loss
Fatigue
Headaches
Diaper Dermatitis Causes
Diaper Rash!
-Usually caused by irritation from urine and feces
-Detergents inadequately rinsed from clothing
-Chemical irritation (especially from diaper wipes)
Atopic Dermatitis
Eczema
-A type of pruritic that begins during infancy
-Hereditary tendency
-Often associated with hx of food allergies, allergic rhinitis and asthma.
-3 forms: infantile (2-6m), childhood (2-3y), and preadolescent and adolescent (12 years of age)
Atopic Dermatitis Management
-Hydrate the skin (tepid baths and emollient)
-Relieve pruritus (antihistamines and topical corticosteroids)
-Reduce inflammation (NSAIDs)
-Prevent/control secondary infections (trim/clean nails)
-Cotton clothing
-Avoid bubble baths, soaps, perfumes, fabric softeners
-Mild laundry detergents
-Avoid overheating bedrooms during winter months (dry out skin)
Diaper Dermatitis Management
-Keep skin dry
-Apply skin protectants (zinc oxide), do not wash off with diaper change
-Avoid over washing
Diaper Dermatitis Manifestations
Candidiasis (fungal yeast infection (dark place)) of diaper area
Redness, painful, baby irritated
Burn Causes
Hot water, flames, chemicals, electricity
Patho: causes loss of plasma, proteins, fluid, and electrolytes
Burns depth of injury
1st degree: superficial
2nd degree: partial thickness
3rd degree: full thickness
4th degree: full thickness and underlying tissue
Burn S/S
edema 8-12 hours after injury, hypovolemia, anemia
Burn Complications
Airway compromise, shock, infection, pulmonary embolus, aspiration
Burn Management
Maintain airway, remove clothes/jewelry in burn, apply cool soaked gauze or lukewarm water with mild soap, cover the burn.
Fluid replacement therapy for severe burns, debridement, skin grafts
ABCs!!!
Immobilization Muscular system
Decreased muscle strength and mass
Atrophy
Loss of joint mobility
(after 3-5 weeks of bedrest, almost half the normal strength of a muscle is lost)
Immobilization Skeletal system
Bone demineralization: bone mineral density of the vertebral column decreases by about 1% per week of bedrest, nearly 50 times that of normal age-related bone loss
Negative calcium balance: diphosphonates
RICE
R- rest the injured part
I- ice immediately (max 30 min)
C- compression with elastic bandage
E- elevation of the extremity
Fracture
-Common injury in children
-Methods of treatment are different in children than in adults
-Rare in infants, warrants investigation
-Distal forearm: the most frequently broken bone in childhood
-School-age: bike-related, sports injuries
Cast Care
Elevate extremity above heart with pillow, assess injury and distal circulation. Keep cast clean and dry with no powders or lotions. Ensure child doesn’t itch or put things into the cast
6 P’s
Pain and point of tenderness
Pallor
Pulselessness
Paresthesia: sensation of fracture site
Paralysis: movement of fracture site
Pressure
Diagnosis of Fractures
Radiographs, suspicion in child refusing to walk
Fracture Goals
Reduction & immobilization, restore function, prevent deformity
3 Degrees of Hip Dysplasia (DDH)
Acetabular
Subluxation
Dislocation
Acetabular hip dysplasia
Mildest form; osseous hypoplasia of acetabular roof
Femoral head remains in the acetabulum
DDH Clinical Manifestations
Infant
-Hip joint laxity
-Shortened limp on affected side
-Restricted motion
-Unequal gluteal folds when prone
-Positive Ortolani test (hip reduced by abduction)
-Positive Barlow test (hip dislocated by adduction)
Older Children
-Affected leg shorter than the other
-Telescoping or piston mobility of the affected leg
-Hx of delay in walking
-Limp and toe walking
Dislocation hip dysplasia
Femoral head loses contact with acetabulum and is displaced posteriorly and superiorly, ligaments are elongated and taut.
Management of DDH
Pavlik harness from birth - 6 months (must start before 2 months)
Place diaper under harness and avoid lotions/powders
Assess every 1-2 weeks.
Older children receive surgery (very difficult after 4 years)
Subluxation Hip dysplasia
Most common
Incomplete dislocation of the hip
Scoliosis Patho and Causes
Most common spinal deformity
Lateral curvature, spinal rotation, and thoracic hypokyphosis most often occurring during puberty growth spurts
Causes: cerebral palsy, muscular dystrophy, myelomeningocele
Scoliosis S/S and Diagnosis
“ill fitting” clothes, unequal shoulders, waist angles, scapula prominences, rib prominences, chest asymmetry
Radiograph- at least 10 degrees, less than 25 agrees is a mild case
Scoliosis Management
Bracing- assess skin
Exercise
Surgical intervention for severe curvature
Meningocele
Spinal fluid and meninges protrude through abnormal opening in vertebrae (may or may not be covered)
Myelomeningocele
Spinal cord exposed through opening in spine resulting in partial or complete paralysis of parts of body below the spinal opening
Can lead to scoliosis
*Most severe form)
Duchenne Muscular Dystrophy
Most severe and most common of muscular dystrophies in childhood
X-linked inheritance pattern; one third of cases result from fresh mutations
Incidence: 1 per 3600 male births
Duchenne Muscular Dystrophy Goals
Maintain function as long as possible with activity.
No effective treatment established
ROM exercises
Genetic counseling for family
Duchenne Muscular Dystrophy S/S
Progressive muscle weakness, wasting, and contractures.
Enlarged thigh and upper arm muscles.
Waddling gait, frequent falls, lordosis, obesity.
Leads to death from respiratory/cardiac failure
Vaso-occlusive Crisis S/S
Hgb decreased, WBC count increased, bilirubin and reticulocyte levels elevated
Vaso-occlusive Crisis Cause
Sickle cell disease
Sickled blood red cells clump together and block blood vessel. Painful and can cause hypoxia
Vaso-occlusive Crisis Management
Rest, oxygen, oral/IV fluids, electrolytes/hydration, analgesia for pain, blood transfusion, prophylactic antibiotics.
Hypercyanotic Spell
Tet/Blue spell
Acute episodes of cyanosis and hypoxia when they cry, defecate, or feed (stressful situation).
Hypercyanotic Spell Interventions
1) calm down the kid
2) knees to chest
3) give O2
(they often hold their breath, risk for neuro damage, requires prompt intervention)
Can give Digoxin
Iron Deficiency Anemia Management
H&H and RBC/reticulocyte count
Diet- meat, peanut butter, legumes, beans, leafy greens.
Iron supplements
Iron Deficiency Anemia Cause
Inadequate dietary intake, milk babies (12-36 months with too much cow’s milk)
Iron Deficiency Anemia Complications
HF and developmental delays
Iron Deficiency Anemia Education
Limit milk to 32 oz/day, vitamin C helps iron absorption, give supplements 1 hour before/2 hours after eating. Eat iron cereals by 4-6 months
Congenital Hypothyroidism
Hypoplastic thyroid gland at birth
Congenital Hypothyroidism S/S
Mental decline, constipation, sleepiness; dark skin, sparse hair, puffy eyes
Congenital Hypothyroidism Management
Oral thyroid hormone levothyroxine is required promptly for brain growth.
May administer progressively larger amounts over 4-8 weeks to avoid symptoms of hyperthyroidism.
Give in the morning
Myelosuppression
Suppressing cell production due to chemotherapy
Will have infection risk because it reduces all blood cell production
Can cause anemia and following fatigue. Risk for bleeding, internal injuries - rest, ice, compress, elevate
Fever of > 100.4 is an emergency
Hemabate
Drug for postpartum hemorrhage
Avoid giving with asthma or hypertension
Side effect of watery diarrhea, risk for infection
