pediatric test 2

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pediatric test 2
2012-03-07 14:41:08
pediatric test

pediatric test 2
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  1. Disorders in newborns-
    usually have 3 birth defects present when they are born, most do not have just 1
  2. 250,000 are affected by birth defects, areas-
    • skeletal system, metabolism enzymes missing, organs defects, inborn errors of metabolism- systic fibrosis, PKU: phenylketonuria, blood disorders, preemies,
    • Measles, type c drugs, moms stay away
    • Moms take folic acid
  3. Hydrocephalus-
    water on the brain, imbalance between absorption and produce of cerebral spinal fluid, acquired- disease, trauma; or unknown cause, it is sex linked- bound on Xchromosome
  4. Congenital hydrocephalus develops from defects-
    • oArnold-chiari malformation: manijo micelle,
    • oDanny walker syndrome- back flow of fluid caused
    • by obstruction,
    • oArachnoids cyst
    • o Ampuleductal stenosis or tumors
  5. From meningitis, or hemorrhaging in the brain, infection can cause hydrocephalus., prenatal hemorrhaging, TORCH
  6. Acquired hydrocephalus- Older children something happened
  7. Characteristics of hydrocephalus- increased of c.s.f., enlarged head, high pitched cry, gaps between cranial sutures, eyes squinted- fore head enlarged, veins in their head, not a lot of hair on the head, rapid enlarged head – first big sign, baby wont be able to hold up head, anterior fontanel bulges out- elevate head of the bed, if suck in fontanels, keep bed flat
    • ·
    • head enlarged, seen at birth and could show up months later,
    • ·
    • Can cause mental impairment, will have other defects, may have brain damage
    • ·
    • Setting sun – eyes covered by forehead,
    • ·
    • Signs and symptoms- irritability, restless, projectile vomiting, failure to thrive, ataxia, ha, loc change, sluggish pupils, seizures, temperature- blood pressure increase, baby pulse goes down,
    • ·
    • 6 babies out of 1000 will be born with hydrocephalus
  8. Spinabifida (divided spine) – comes along with hydrocephalus
    • 3-4 out 1000 have both diseases together
    • ·
    • Obstructive or non-communicating of hydrocephalus are the ones we see the most of , 99% of all babies with hydrocephalus have it
    • ·
    • Types of hydrocephalus:
    • oCommunicating- defect in absorption of cerebral spinal fluid, produced but not absorbed properly, seen in meningitis or hemorrhaging babies, subarachnoid hemorrhaging- no obstructions, no place for fluid to go, issue between ventricles and the spine; causes sub arachnoids pace
    • affected, affects brain, brain stem, spinal colomn

    • oNon-communicating- has obstruction, congenital, due to tumor, stenosis, can see at birth or weeks later,
    • ·
    • Measure head daily, MRI, ventriculograms, light test, ventricular tap, can grow fast or slow
    • ·
    • Treatment- surgical procedure, get baseline info, sooner the better, bypass or shunt, can use the heart to reabsorb fluid
    • unless heart defect,·
    • Shunt “radiopax”, has a valve, ventriculoperitoneal shunt- cathter fenestrated, under subcutaneous tissue- behind ear to abdomen?, usually left ventricle
    • ·
    • Ventriculoatrial shunt- goes to right atrium of the heart,
    • ·
    • Biggest problem infection, or moving,
    • ·
    • Nursing care after surgery- unable to left head on their own, ears or scalp get cupidsis/ skin break down, lay head on opposite side of shunt, and sideways r/t vomiting, get them moving/ cry to expand their lungs, no increase in head circumferenceat all, some damage to brain, lack of
    • appetite, record I&O, type of vomiting, irritability, always look at vital signs, should see improvement over time, any signs of infection needs to be reported immediately
  9. Spinabifida or myelodysplasia- divided spine, it did not close properly
    • usually unknown cause, congential neural tube defect happens between 24-28 week of pregnancy,
    • ·
    • Two forms: occulta, cystica
    • o Occulta- patch of hair, dimple on spine or hole
    • there, very minimal does not cause many issues, happens in L5 or S1, no outward protrusion of spinal , port wine stain in sacral area, no treatment unless neurological issues occur

    • o Cystica- incomplete closure of spine, cyst in
    • middle of spine, two types:

    Meningocle-spinal protrudes out forms a sac, in nerve root in the sac, rupture of sac before repair, put them on their stomach and cover with sterile-moist dressing, cardiac monitors, watch for infection, cosmetic surgery- close it up

    • Myelomeningocele or meningomyocele- sac with nerve endings protruding out, will have paralysis below the lesion, affects vary
    • ·
    • T12- no muscle tone in lower extremities, decrease in sensation, lack of bowel and bladder control, club foot,
    • ·
    • L1-L3- hip flexion, club foot
    • L2-L4- hip adduction,
    • L3-S2- hip adduction, hip extension, “knee flexion”, everything wrong with hip
    • S3 and below- plantar flexion,
    • Sacral root-
    • ·
    • Diagnosis- increased alpha fetal protein test happens between 13 and 15 weeks, and ultrasound; newborn based on exam, mri, ct scaning, screen for hydrocephalus, club foot,
    • ·
    • Treatment is surgery- prevent damage and infection, do hubilation , may use walker or wheelchair
    • ·
    • Nursing care- prevent infection or damage to sac, put in “isolate” box- to protect them, monitor ICP, see if they pass
    • myconium- babies first stool, keep baby pretty still, neurological assessment, fontanel assessment,

    ·Complication- pneumonia, meningitis, UTI, skin care- no diapers, feeding-tube or delayed feeding- takes two people to feed baby
  10. Cleft lip– fissure or opening of upper lip
    happens at 8 week of pregnancy, mostly in boys,
  11. Cleft palate- happens 7-12 weeks of pregnancy, surgery to fix,
    • ·
    • Fix lip first, so baby can suck,
    • ·
    • Feeding devices used- haverman feeder has longer nipple, feed them on side that is not affected, post op feeding- medicine dropper or haverman or feeding tube, hardest thing to do is keep them from crying, prevent sucking, don’t place on stomach, logan bar or bow protects incision (wire covers mouth),
    • ·
    • Cleft palate- more common in females, affects speech, post op- no cold or hot foods, progress diet, clear liquids, 2nd
    • week soft diet, rubber tip spoon sideways, good oral hygiene, remove every 2 hours restraints, keep kids distracted
  12. Gastroesophagealreflux-
    • different types of GERD: functional, physiological, pathological
    • ·
    • Mainly happens to boys, 3-5 % of babies with GERD have esophageal scaring,
    • ·
    • Signs and symptoms- vomiting or spitting up after eating, have Otis media, get hiccups a lot, weight loss, irritable,
    • restlessness, failure to thrive, abdomen pain,

    • ·Pathological symptoms gone by 3months some go to 18 months,
    • ·
    • Sevre GERD- hemotenisis- spit up blood, anemia, malina- blood in stool, get respiratory infection, rule out other diseases,

    • ·Test: barium swallow, endoscopy, scans, ph
    • studies,
    • ·
    • Look at diet, elevate baby, medication, or surgery

    ·Functional- try to do medicine, surgery is last option,

    • ·Medications- H2 receptor antagonist- block histamines
    • ·
    • Can have acute bleeding, needs tx immediately, “niesal fundal flitation”- wrap stomach around esophagus, close the opening up a little bit,

    • ·Keep abdominal distension down, watch for dumping syndrome- can get tachycardia,
    • ·
    • Get good history on kid, failure to thrive- weight loss, feeding type, vomiting type, respiratory distress, can have
    • coughing, choking, cyanotic, the three Cs, pain with feeding turn head to one side,
    • ·
    • Rice cereal 1-3 teaspoons added, water after meals, prone position, 6 weeks of age or until symptoms are gone, don’t hold baby a lot after meals, older infants, upright or standing for a meal, pacifiers are ok, surgery is last resort
  13. Musculoskeletalsystem:
    • club foot-types congenital or acquired- position in uterus,
    • o Congenital- born with it, talipes aquinovirus(textbook),
    • affects lower leg, ankle, and foot; multi factoral – many reasons for why it happened, high risk myomeningo.., males more likely,

    Acquired or position- foot manipulated, foot rigid, reposition foot manually with long term therapy, treatment when born, bandaging, casting changed weekly, no correction- surgery will be done, splint- Dennis brown plate in center of foot for children under 2, foot ½ size smaller than the other
  14. Look at page- legg calf herthes. 380?
  15. Congenitalhip dysplasia-
    • head of femur pops out, legs are up towards abdomen, 1 knee higher than the other, creases on thigh- buttock, developmental happens after birth; environment, heredity, hip malformation, wont stay in place, happens in birech babies- born butt first,
    • ·
    • Walking, will cause it to show up more,

    • Signs and symptoms- touching can cause it, checking for “ortolonic” clicks- barlows test, first month of life
    • ·
    • Limitation of abduction of leg, affected leg lower, skin folds deepened, prone position one hip high than the other, xray
    • and ultrasound, ·
    • Tx: immediately, 8 weeks for form splint hip in flexion and abduction- by double and triple diapering, harness- pavloc 1-6months, wear constantly, traction, or surgery if severe, cast- spika cast- opening at genital area 5-9 months, change
    • every 6 weeks,

    Don’t be afraid to touch them, parents need to hold them, long socks , shirts on, cast care- sponge bath, check extremities, post op care- board under mattress, no pillows with spika cast
  16. Chromosomalabnormalities- down syndrome
    • - 1 in every 800 live births, affects 21chromosome, higher in mothers over 35, some have issue with 15 chromosome,
    • mental status ranges,
    • ·
    • Signs and symptoms at birth- “FLK” J, eyes are close together, heads smaller, rounded, protruding tongue, problem sucking, mouth breathers, hands short and thicker, ears low set, amniocentesis- line goes all the way across hand, wider space between toe spaces, heart defects, most
    • parents are encouraged to have defects corrected, high risk for leukemia
  17. Congenital heart defects-
    • dx in 1 month of life, baby have ducts that act as shunts, ductusartriosis- design to bypass blood away from the lungs, ductusvenosis- blood bypasses the liver, “foramenovalley”- opening from one side of the heart to the other
    • ·
    • Causes- alcoholism, “teriatrogens”, type 1 DM, measles, bipolar moms- lithium, ·
    • Defect in one or more of thr larger vessels,
    • ·
    • 2 types cyanotic, acynotic defects, some do both,
    • ·
    • Cyanotic- no oxygen in blood, when ductusartioosis starts to close, give PGE
    • ·
    • Give PGE-prostaglandin gel : helps to keep it open,
    • ·
    • Acyanotic- no symptoms at birth, may not show it as a child, Left and right shunting, should go left to right blood, blood
    • sometimes mixes together
    • o Non-obstructive-most common, left to right shunting of blood, PDA, ASD, VSD,AVC
    • o Obstructive- blocks out flow of blood to heart,” monic stenosis, aortic stenosis, coartion of aorta”
    • o Signs and symptoms- non-o: murmur, fluid overload, CHF, pressure overload, hypertropherys, O- closing of tube closing, pulmonary blood flow, right to left shunting, no oxygen available, cyanotic, most common defects- transitation of great vessels, heredity plays a role,

    • o Increase pulmonary blood flow defect- no cyanosis-left to right shunting, PDA- patent ductus arteriosis,10 % have PDA, increase in baby born before 37 weeks of pregnancy, to much blood in system, respiratory distress symptoms- grunting, sub sternal –sucks chest in, nasal flaring, pda more in girls, s/s- dizzy, dsypnea, fainting, pulses bounding, wide range between systolic and dystolic, nose bleed, enlarged heart; dx- 2-d echocardiogram, antiinflammitory closes
    • defect, analgesics, antipyuretics, excellent cure rate

    o obstructive- not enough blood comes out, defect,

    o decreased pulmonary blood flow defect- not enough oxygen, blood mixes some;

    o mixed defects-

    • o atrial septal defect(ASD)- 4-5% seen with down’s syndrome, 10% of all defects in babies, have abnormal opening between right and left ventricle, shunting from left to right , oxygenated blood
    • § Ostium secundum-most common, upper portion of
    • septum, seen 7x more in females, no cyanosis unless comes from right side of heart, from heart failure, dx: cardiac catheter, ekg, chest xray, no symptoms, systolic heart murmur, increase respiratory infection, decrease in activity,
    • failure to thrive, delayed growth, enlarged heart, close defect- use umbrella .., cut into heart, antibiotics, cardiac
    • dsyrrthimia, mitral valve prolapsed,

    § Ostium priman-

    • oVentral septal defect (VSD) – 25% of all cardiac defects, most common intracardiac defect, abnormal opening between right and left ventricle, blood goes left to right, loud heart murmur, increased pressure in the heart, most defect closes at age 2,if small; if large defect- symptoms of CHF-tachycardia, feeding problems, increase respiration, mild cyanosis, slowing of physical growth, irritable, 20-60% closes on its own, palletive care, band pulmonary artery- wrap it; complications- CHF, dsyrrthmias, heart block- nodes don’t fire, good survival rate,
    • o Obstructive defects- coarctation of aorta, remove block then end to end “enastimosis”, near ductus artierosis, low blood flow restricted to lower body, improper development,

    o s/s infant-CHF, failure to thrive,

    o s/s newborn- CHF, lower body perfusion, metabolic acidosis,

    o s/s older child- systolic murmur, hypertension, HA, nose bleeds, HBP, leg fatigue,

    o tx: 3-5 years, end to end …
  18. pulmonarystenosis-
    • not enough blood flow to lung, right ventricle enlarged effects,
    • ·
    • s/s - heart murmur, cardiomeglie, severe stenosis- cyanosis, right ventricle will fail,
    • ·
    • tx: open heart surgery, none surgical – balloon angioplasty,
    • ·
    • decreased pulmonary blood flow- cyanosis, blood comes from right to left shunt,

    • ·tetrology of fallout: 4 defects; ventral septal defect, over riding aorta, stenosis of pulmonary artery, hypertrophy right
    • ventricle

    o s/s cyanosis, poor growth, systolic murmur, hypoxic spells, polycitemia, activity entolerance, tet spells- squat down, clubbing of fingers and toes, failure to thrive, high risk for respiratory infection, can have strokes, iron deficiency anemia, irritable, blackout, seizure,

    • o tx: stabilize them first, open heart surgery at 8 months to 3 years of age, keep shunts open, harder survival rate,
    • ·
    • mixed defects- severe cyanosis, pulmonary congestion, transposition great vessels, blood from both ventricles enters system at same time, two separate circularotary system, no mixing, they don’t work together, bounding pulses, clubbing,

    ·tx: iv, keep ductus open, create opening, balloon septotomia- oxygenates blood
  19. CHF-
    acquired defect- due to complications, heart enlarges and fails, most outstanding symptoms bulging of neck vein, edema, more fluid, - right sided failure, weight gain, 1 pint=1 lb.

    • Left sided failure- pacipnea, dsypnea, rails or crackles, orthopenia, fatigue, very restless,
    • ·
    • Assessment- pallor, rapid respirations, feeding difficulty, not gaining weight, a lot of respiratory infection, first sign of
    • pulmonary edema is rapid respirations, respiratory rate over 60, hr over 150, tired, weak cry, poor weight gain, sudden weight gain heart failure, see edema first in head at eyes, sacrum, and testicles, watch for edema, risk for infection, maintain good nutrition, decrease anxiety, similac 16/40, or
    • breastmilk, lavage feeding,

    • ·Medication- lanoxin or digoxin- slows and strengths heartbeat, don’t give if apical hr is under 100beats/min, child if hr is 70, n/v, irregular heart rate and rhythm, adverse effect- severe bradycardia?,
    • ·
    • Give diuretics- not-potassium sparing, lasix, teach parent about potassium loss, usually iv, know I&O, weigh diapers, weigh daily at same time before they eat, morphine helps, a lot more rbc, blood clots, polycythemia, dehydration, can get pneumonia fast, chest tubes, on vents when out of surgery
  20. Otismedia-
    • common in boys, fluid in ear, allergies, start with upper
    • respiratory infection, pulls at ear, turn head side to side, high fever, most common illnesses, propping bottles, thin them and increase fluid
    • ·
    • Acute- inner ear, secondary to other illnesses,
    • ·
    • Otis media with effusion- bubbles behind tempanic membrane, fluid behind the ear, follows behind acute sometimes, goes away In a couple of weeks, if not check for hearing loss, normaling peaks between ages of 6 months and 2 years, majority are under age 3, influenza and strep can cause that, pain in the ear- temp peaks in the evening, drainage smells, tx: antibiotics, 3-5 days- kids, 10-14 days- under 3, give amoxicillin, takes 3 days to clear, septra, etc …., throat culture, analgesics from pain- motrin, Tylenol, oral antihistamine, can increase heart rate, nose drops, ear
    • drops, heat sometimes helps, surgical tx last resort, abcess- drainage and hearing loss, can lead to mastoiditis, and meningitis
  21. Bronchiolitis-
    • inflammation small airways, RSV, extremely contagious, usually less than 1 year of age- pick up from someone else, can live 0ne hour on paper, six hours on cribs, hand washing very important, RSV during winter months and early spring,
    • s/s- wheezing, nasal drainage, temperature low grade several days, acute respiratory distress, rhonci- cough and clear it up, crackles, nasal flaring, accessory muscles to breath, sucking in effect, grunting sound, subcoastal retraction, with or without nasal flaring, ·
    • Test- c&S- viral rapid test, blood test- elisa, TX: inhalation of biaroin or …., strict isolation, croup tent, super saturate the room- allergies affect you in the room, ammunioglobulin,
    • “revsgain”,
    • ·Airway , assess s/s, position kid head up 30-40 degrees, keep close to nurses station, oxygen mist, parent support, watch for apnea
  22. FEdeficiency anemia-
    • most common in US, look at what they eat, may not produce enough blood cells, or it can’t bind, drinking too much milk, common age- 9 months and 24 months, prevention is best tool, take prenatal vitamins, foods-
    • hardboiled egg, green leafy vegetable, baby cereal rice, cream of wheat, liver,

    • ·s/s- pale, fatigue, irritable, anorexia, not moving much, may have an enlarged spleen or heart murmur, heart muscle will
    • weaken,
    • ·
    • monitor labs, teaching, H&H, hemoglobin below 11, hematocrit-33 or below

    • ·higher chance in infancy and adolescent due to food they eat,
    • ·
    • drinking too much milk can cause anemia

    · mom take prenatal care with iron

    • · farris sulfate – iron supplement, liquid iron- check teeth- drink through a straw, they need to take all of it,
    • ·
    • stools dark and tarry from iron
  23. sicklecell anemia/ disease-
    • heredity, group of disorders, they don’t carry enough oxygen, hemoglobin S- type to look for, hemoglobin A is normal,
    • colisanemia- sickle beta cell?
    • ·Started from malaria, tropical disease, African, meditterians, Indians
    • ·Stress, too much exercise, lack of oxygen, illness, hydration, exposure to cold, high altitude
    • ·Test – sickle dex-increase reticulocyte count, rbc life decreased , plasma electrophoresis- looks at one cell , will have increase in

    • ·causes infracts to brain, lungs, …
    • many get addicted to drugs
    • east Africa have 45%
    • both parents have to be carriers
    • bone marrow function- newborns should be at 2.5-6.5%,
    • infants-.5-3.5%, child .5-2%

    • if some has the trait, they will not develop the disease
    • ·
    • 25% chance or 1 out 4 babies
    • ·
    • Clump up in small capillaries, picks it up at 4-6 months of age, effects most organ system , delayed puberty, growth; normal growth happens at age 20, jaundice, fatigue, swelling finger and toes, high risk for stroke, pvd
    • ·
    • 3 types of crisis: look up
    • o Vaso-occlusive- most common
    • o Acute spleenic sequestion- spleen engorged
    • o Aplastic crisis, spleenectomy

    • ·Hyper-hemolysis : look up
    • ·Report any abnormal eye movement, pain in the neck, gallstone, usually die from infection or severe anemia, babies can not go to full term- in pregnancy,
    • ·
    • Tx: take folic acid, dosing 0.8 mg a day; surgery after age 2 on babies, benzalpenacillin, then regular pen. Til age 5,
    • can get resistant, get vaccines
  24. Beta-thalassemia-
    abnormal rate of production, pale, growth slow, delayed puberty, enlarged head, over bite, skin bronze color, look for hemoglobin F?, charcoal helps to get rid of iron, blood transfusion
  25. Hernia-
    inguinal hernia, common in boys, Types: Reducible, Irreducible or Incarcerated, Strangulated. Symptoms, Diagnosis, Treatment, Herniorrhaphy. Umbilical Hernia, S/S, Treatment
  26. Pyloricstenosis-
    • starts 2-4 weeks of age, projectile vomiting, always hungry, they don’t gain weight, dehydration, poor skin tugor, mass upper right mass, surgery as soon as possible, pylorimyotomy - procedure, use liquid dressing- colloidal
    • dressing, use thickened formula, burp freq, put on right side after eating to increase drainage
  27. Intussusceptions-
    • intestine fall inside self or telescoping, swelling, bowels incarcerated, usually in males before age 5, 6-18 months of age-most common age, adno virus causes, treatment within 24 hours – good prognosis, severe pain right upper quad.,
    • kicking a lot, vomit green yellowish fluid, stool gets jelly, looks like current jelly stools- seen within 12 hours, will vomit feces after, high fever 106, shock, sweating, hard abdomen, sausage shaped mass RUQ, before surgery give barium enema, can recur
  28. Vomiting-
    Common Symptom, Persistent Vomiting, Can Result In Metabolic Alkalosis
  29. Fluid balance-
    • equal amounts come in and out, loss from extracellular usually, harder to treat intracellular loss, infant-intracellular- 35%, extracellular-40 %,
    • ·
    • Sodium, mg, potassium, calcium: loss massive amount in 2-3 hours, greater metabolic turn over, 75-80% is body weight, severe of weight loss can happen in 1 hour, loss over 10% of body weight in severe diarrhea,
    • ·
    • Types of dehydration:
    • oHypotonic- loss to much sodium, replace fluid over 24 hour, first 8 hours
    • o Hypertonic- too much sodium , fluid replaced over 48 hours
    • o Isotonic- loss equal amounts of fluid, hypovolemic shock biggest risk
    • ·
    • Normal sodium level- infant 134-150 mEq/L, child 136-145 mEq/L, newborn 134-144 mEq/L,
    • ·
    • Premies high risk
    • ·
    • Tx: correct fluid balance, oral best route, pedilyte, 1 tsp every minute to rehydrate or 120ml per hour for 4-6 hours, 5ml more can kill them
  30. Overhydration:
    N/V, abd cramp, dizzy, lethargic, seizure, coma, edema,
  31. Cystic Fibrosis-
    • Affects Exocrine Glands, Inherited Autosomal Disorder, Located On 7th Pair Chromosomes, Cause, 1 in 4,000 Live Births, 1 in 20 Caucasians, Three Main Areas Involved
    • ·
    • Wheezing, Dry Cough - Early Pulmonary SX., Obstructive Emphysema, Onset Cystic Fibrosis, General Physical Changes, Pancreatic involvement, Bowels, Skin, Reproductive System, Sweat Glands, Labs & Diagnostic Tests, Pancreatic Enzyme Test, A-Trypson Test, Treatment Pancreatic, Complications Cystic Fibrosis, Treatment, Nursing Care and Diet, Home Care, Emotional Support