SUR 102 - Peds/Geriatrics

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SUR 102 - Peds/Geriatrics
2012-12-03 21:10:30
Peds Geriatrics

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  1. VACTER syndrome - presence of 3 or more physical congenital anomalies
    • V - vertebral defect
    • A - anal malformation
    • C - cardiac anomaly
    • T - transesophageal fistula
    • E - esophageal atresia
    • R - renal anomaly
    • L - limb defect
  2. CHARGE syndrome
    • C - coloboma (split iris) defect in the eye
    • H - hearing impairment
    • A - atresia choanae
    • R - retardation
    • G - genitourinary defects
    • E - esophageal defects
  3. most common surgically corrected childhood disease
  4. frequency of malignant tumors in infants and children
    minimal frequency when compared with occurrence rates for adults
  5. leading cause of death in children
    accidental injury
  6. chronologic category - not compatible with life
  7. chronologic category - in utero after 3 months' gestation
  8. chronologic category - gestational age more than 24 weeks, birthweight >500 g, capable of sustaining life outside uterus
    potentially viable
  9. chronologic category - gestational age less than 37 weeks, birthweight 2500 g or less
    true preterm
  10. chronologic category - gestational age less than 38 weeks, birthweight more than 2500 g
    large preterm
  11. chronologic category - gestational age 38-40 weeks, birthweight >2500 g
    term neonate
  12. chronologic category - gestational age extended by more than 8 weeks
  13. chronologic category - first 28 days of extrauterine life
  14. chronologic category - 28 days to 18 months
  15. chronologic category - 18-30 months
  16. chronologic category - 2-1/2 to 5 years
    preschool age
  17. chronologic category - 6-12 years
    school age
  18. chronologic category - 13-18 years
  19. when is hypotension apparent in an infant?
    not until 50% of circulating volume is lost
  20. blood volume of neonate
  21. blood volume of age 6 weeks-2 years
  22. blood volume of age 2 years-puberty
  23. newborn heart rate
    • awake - 100-180
    • asleep - 80-160
  24. infant heart rate
    • awake - 110-150
    • asleep - 70-120
  25. toddler heart rate
    • awake - 110-130
    • asleep - 70-100
  26. preschool heart rate
    • awake - 80-120
    • asleep - 60-90
  27. school age heart rate
    • awake - 70-115
    • asleep - 60-90
  28. adolescent heart rate
    • awake - 60-100
    • asleep - 60-90
  29. critical factors in selection of instrumentation, sutures, needles and equipment for peds surgery
    size and weight
  30. instruments used on delicate tissues of children
    small instruments
  31. in peds surgery, what should hemostats have?
    fine points
  32. in peds surgery, what does mosquito hemostat clamp?
    superficial vessel, but not major artery
  33. in peds surgery, what are noncrushing vascular clamps used for?
    occlusion of major vessels as well as can be placed across intestine
  34. in peds surgery, where should instruments not being used be placed?
    • return to Mayo stand or instrument table immediately after use
    • never on patient, especially not on chest
  35. what are frequently used in peds surgery to retract blood vessels and small structures to give greater visibility
    umbilical tape or vessel loops
  36. types of instruments used on adolescents
    adult-size instruments
  37. acute congenital anomaly characterized by esophageal obstruction, accumulation of secretions, gastric reflux, and respiratory complications
    esophageal atresia
  38. what is the goal of esophageal atresia?
    to obtain end-to-end esophageal anastomosis
  39. why is gastrostomy performed for esophageal atresia?
    to establish conduit for feeding newborn less than 1200 g
  40. what type of tube is placed during gastrostomy
    PEG tube
  41. when does anorectal malformation generally occur?
    during 4th to 12th week of fetal development
  42. how is imperforate anus classified?
    as high or low in relation to levator muscles
  43. single opening for urethra, rectum, and vagina
  44. most common cause for abdominal surgical procedure in child aged 5-10 years
  45. how can appendectomy be performed?
    laparoscopy or open laparotomy
  46. how is questionable diagnosis of appendicitis confirmed or ruled out?
  47. undescended testicles
  48. with what condition is cryptorchidism associated?
  49. operation performed for cryptorchidism
    two-stage Torek operation
  50. when is cryptorchidism usually repaired?
    at age 5 or 6 years
  51. treatment for congenital dislocated hip if diagnosed early in infancy
    closed reduction with immobilization
  52. treatment for congenital dislocated hip if diagnosed after child has begun to walk
    open reduction with osteotomy to stabilize the joint
  53. otherwise known as clubfoot
    talipes varus
  54. treatment for talipes varus during infancy
  55. treatment for talipes varus in older, weightbearing child
    wedge cast with turnbuckles
  56. most common chronic condition of childhood
    secretory otitis media
  57. incision in tympanic membrane for drainage
  58. what is commonly performed bilaterally in association with myringotomy?
  59. cleft lip rules of 10
    • 10 weeks of age
    • 10 g hemoglobin
    • 10 lbs body weight
  60. fusion of two or more fingers or toes
  61. most common congenital hand deformity
    webbing between fingers
  62. what does separation of webbed digits almost always necessitate?
    skin grafts
  63. occurs when passages between ventricles are blocked and dilated by accumulated CSF
  64. how is hydrocephalus treated in utero?
    cephalocentesis with insertion of ventriculoamniotic shunt to drain ventricles
  65. how is hydrocephalus treated after birth?
    implantation of shunt for transporting excess fluid from ventricles
  66. funnel-shaped concave depression over lower end of sternum
    pectus excavatum
  67. what can result from extreme pectus excavatum during pubertal growth period?
    cardiopulmonary impairment
  68. procedures for pectus excavatum
    • Nuss procedure - minimally invasive
    • Ravitch repair - open
  69. when is pulmonary ventilation established?
    • during first breath at birth
    • this causes increased left atrial force, which closes foramen ovale
  70. when does ductus arteriosus close after birth?
    • after 15 hours
    • some neonates have delay of 1-3 weeks for complete closure
  71. opening in septum between right and left atria, allowing oxygenated blood to shunt from left to right and return to lungs
    atrial septal defect
  72. 2 ways atrial septal defect can be repaired
    • closed with sutures
    • if cannot be closed with sutures, patch graft is inserted
  73. opening in membranous portion of septum between right and left ventricles
    ventricular septal defect
  74. repair of ventricular septal defect
    • patients with small defects may not necessitate repair - 1/3 small defects close spontaneously by age 2
    • patch graft is used to repair large defects
  75. 4 defects of tetralogy of Fallot
    • large VSD
    • stenosis or atresia of pulmonary valve
    • hypertrophy of right ventricle
    • displacement of aorta to the right
  76. "blue babies"
    infants with tetralogy of Fallot
  77. procedure in which aorta and pulmonary arteries are anatomically switched
    Jantene procedure
  78. why is Jantene procedure done?
    infants with VSD or large PDA
  79. absence of tricuspid valve between right atrium and ventricle, preventing normal blood flow through chambers of the heart
    tricuspid atresia
  80. treatment for tricuspid atresia
    Fontan procedure - performed at 3 or 4 years of age - direct anastomosis of pulmonary artery to right atrium
  81. Rashkind procedure
    a balloon catheter is advancd into the right atrium, through foramen ovale and into left atrium, balloon inflated and pulled back, enlarging foramen ovale
  82. most common cause of cardiac death in first week of life
    hypoplastic left heart syndrome
  83. what happens with hypoplastic left heart syndrome?
    • left ventricle is severely underdeveloped and right ventricle is overloaded
    • patient is in complete heart failure within 28 hours of life
  84. treatment for hypoplastic left heart syndrome
    immediate cardiac transplant
  85. in postop peds care, how often is the patient's recovery evaluated?
    at 5-min to 15-min intervals as patient emerges from anesthesia
  86. who is responsible for the postop pediatric patient in PACU and for release criteria?
    anesthesia provider
  87. theories of aging
    • wear-and-tear theory - body loses ability to keep pace
    • genetic mutation theory - various agents damage DNA code
    • viral theory - viruses use genetic materials to fool immune system
    • environmental theory - environmental elements accelerate aging process
    • physical factor theory - free radicals may cause premature aging
  88. in physical factor theory, hormonal activities affecting organ systems
    • decrease in estrogen production = increased risk for osteoporosis and heart disease
    • decrease in thyroid activity decreases basal metabolic rate and increases weight gain
    • decrease in efficiency of insulin production decreases efficiency of glucose metabolism
    • decrease in testosterone production = decreased libido in men
  89. how many geriatric patients have than one medical diagnosis capable of causing death?
    more than 73%
  90. aging myths
    • older adults are senile
    • older adults do not engage in sexual behavior
    • older adults always decline in health after surgical procedure
  91. hearing defect of an older adult could be mistaken for?
    cognitive impairment
  92. where should hearing aids be during surgical procedure
    if possible, patient should be allowed to wear it to the OR and possibly throughout the procedure
  93. how many geriatric patients experience depression and alteration in self-image?
    • between 10% and 65%
    • physical decline may be rapid if psychological well-being is threatened
  94. assessment of integumentary system
    skin, fingernails and toenails, and all hair patterns of body, face and scalp
  95. normal skin changes
    • skin is often wrinkled as result of changes in connective tissue
    • pigmentation and skin tags can be normal lesions in aging process
    • hair patterns may be thinning or loss
  96. chronic inflammatory disease characterized by fixation or fusion of vertebral joint
    ankylosing spondylosis
  97. increased forward thoracic curvature
  98. when assessing geriatric cardiopulmonary status, what is assessed?
    • BP in sitting and lying positions
    • respiratory efforts
    • temperature
    • hemoglobin and hematocrit levels
  99. multiple vaginal births can cause what?
    uterine and bladder prolapse
  100. at what temp are geriatric patients at risk for hypothermia?
    when temp falls below 96.8 F (36 C)
  101. why is anesthesia induction sometimes prolonged?
    • because of COPD such as emphysema
    • surgical procedures tend to be major and take longer
    • increase in body fat is accompanied with aging process and most anesthetics are fat-soluble