Maternal-Child Final

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mottersh10
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Maternal-Child Final
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2009-12-14 01:35:45
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  1. Cerebral Palsy
    • Most common permanent physical disability of childhood
    • Non-progressive disorder
    • Characterized by:Abnormal muscle tone and coordination, and failure to reach motor milestones. May have perpetual problems, language deficits and intellectual involvemnet
  2. CP: Classification
    • Spastic (most common)
    • Dyskinetic/athetoid
    • Ataxic
    • Mixed
  3. Spastic CP
    • Most common type
    • Decreased tone early, increased tone later
    • Delayed gross motor development
    • May have normal language and personal-social development
  4. CP: Signs/Symptoms
    • Reflex abnormalities: persistant primitive infantile reflexes
    • Abnormal motor performances: poor suck/swallow, feeding problems, facial grimacing, early hand dominance, abnormal crawling, may stand or walk on toes, hips flexed when prone
  5. CP: Interventions
    Mobilizing devices, surgery, medication (relaxants, botox), technical aids, physical, speech and occupational therapy
  6. Pseudohypertrophic (Duchenne) Muscular Dystrophy
    • Most are X-linked inheritance
    • Affects males, mothers carry it
    • Pathophysiology: mutation of the gene that encodes dystrophin
  7. MD: Signs/Symptoms
    • Normal development until onset at age 3-5. Then they may have motor delay, difficulty running...etc.
    • Progressive muscle wasting and weakness
    • Calf muscle hypertrophy from fatty infiltration
    • Waddling gait and frequent falls
    • Lordosis
    • Wheelchair bound by 12
  8. MD: Complications
    • Contractures
    • Atrophy of disuse
    • Infections
    • Obesity
    • Scoliosis
    • Cardiac failure
    • Gowers Sign
    • Related to MD
    • + Sign: rising using hands walking up thighs
  9. Developmental Dysplasia of the Hip
    • Improper alignment of femoral head and acetabulum
    • Hip instability, dislocation, subluxation, dysplasia
    • More common in first-born females
  10. DDH: Predisposing Factors
    • Newborn has lax joints from maternal relaxin
    • Acetabulum is not fully formed
    • Pressure from femoral head stimulates bone growth
  11. Barlow Maneuver
  12. Ortolani's Maneuver
  13. DDH: Signs/ Symptoms
    • Positive Ortolani's and Barlow's maneuver
    • Limited abduction of hips
    • Affected side leg appears shorter
    • Asymmetry of gluteal folds
    • Limp/telescoping
  14. Hip Spica Cast
    • Assess for skin condition
    • Provide for safety
  15. Signs/Symptoms: Congenital Club Foot
    • Present at birth
    • Unable to passively realign the foot with manipulation
    • Involves bone and soft tissue
  16. Management of Club Foot
    • Serial casting or surgery
    • Cast changes every week or two
  17. Fractures
    Clavicle is the most frequently broken bone in children younger than 10
  18. Compound or Open Fractures
    Fractured bone protrudes through skin
  19. Complicated Fracture
    Bone fragments have damaged other organs or tissues
  20. Comminuted Fracture
    Small fragments of bone are broken from the fractured shaft and lie in surrounding tissue
  21. Greenstick Fracture
    Compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture
    • I & II: Break is not through growth plate
    • III & IV: through the growth plate, abnormal/no growth later
    • V: Crushing injury and plate is crushed
  22. Management of Fractures
    • Traction
    • Casting
    • Surgery
  23. Scoliosis
    • S shaped lateral curve of >10 degrees
    • Bracing and Surgery
    • No intervention until >20 degrees, then, braces are used
  24. Reticulocyte
    • Leave the bone marrow and then develop into RBC between 24 and 48 hours later
    • Immature RBC's and make up 1% of RBC's circulating
  25. Anemia
    • A decrease in either total number of circulating RBCs or a decrease in concentration of Hgb or both
    • Usually caused from iron deficiency
    • Management:
    • Reverse the anemia by treating underlying cause
    • Iron supplements
    • Increase bioavaliability with Vitamin C
  26. Anemia: Signs/Symptoms
    • Gradual, vague, nonspecific onset
    • Fatigue, pallor, grayish mucous membranes, irritability, anorexia
  27. Anemia: Management
    • Don't take with milk or tea
    • May cause diarrhea or constipation
    • Prevent accidental overdose
    • Reticulocyte count
  28. Lead Poisoning: Signs/Symptoms
    • Irritability
    • Loss of appetite
    • Weight loss
    • Sluggishness
    • Abdominal pain
    • N/V/C
    • Pallor
  29. Lead Poisoning: Symptoms
    • Affects brain development-irreversible damage possible
    • Nervous system damage
    • Renal impairment
    • Anemia
    • Poor muscle coordination
    • Behavior problems
    • Decreased muscle and bone growth
    • Hearing impairment, blindness
  30. Hemoglobinopathies
    • Sickle cell anemia
    • Thalassemias

    Defect within the cell that shortens the life span of the RBC
  31. Sickle Cell: Etiology
    • Genetic, autosomal recessive
    • Normal is Hgb AA
    • Sickle cell trait is Hgb As
    • Sickle cell anemia Hgb ss
    • Both parents w/trait=?% with each pregnancy
    • Appears to be protective against malaria
  32. Sickle Cell: Signs/Symptoms
    Spleen
    Liver
    Kidney
    Bones
    • Pallor, weakness, fatigue, jaundice
    • Spleen: enlarged from congestion and engorgement->splenic infarction-.replaced by fibrous tissue->functional asplenia
    • Liver: enlarged->eventually fails from impaired hepatic blood flow and capillary obstruction
    • Kidney: capillaries get congested with sickle cells->tissue necrosis->scarring
    • Bones: hyperplasia and congestion of bone marrow->osteoporosis, widening of medullary spaces, thinning of cortices
  33. Sickle Cell Crisis
    • Vaso-occlusive crisis-distal ischemia from vascular occlusion
    • Severe bone pain r/t tissue hypoxia
    • Systemic damage
    • Fever
  34. SCA: Management and Medication
    • Prevent sickling
    • Minimize tissue deoxygenation
    • Promote hydration
    • Minimize crisis: prevent infection
    • Supportive therapies during crisis
    • Medication:
    • Immunization
    • Prophylactic antibiotics
  35. Care During SCA Crisis
    • Bed rest to O2 demand
    • Hydration
    • Replace electrolytes
    • Analgesics
    • Antibiotics
    • Blood replacements
    • Apply heat
  36. Thalassemias
    • Inherited blood disorder: Hgb is not formed correctly
    • Classified according to Hgb chain affected
    • alpha or beta
    • Results from:
    • Defective synthesis of Hgb
    • Structurally impaired RBCs
    • Shortened life of RBCs
    • Chronic Hypoxia:
    • HA, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxsis
  37. Thalassemia: Treatment
    • Blood transfusion every 3 weeks
    • Complications of blood transfusions->hemosiderosis (iron overload)
    • Need desferal-iron chelating agent: gets rid of extra iron in the blood
    • Bone marrow transplantation
  38. Lymphocytosis
    • Caused by:
    • Viral infection
    • Mono
  39. Hemophilia A: Signs/Symptoms and Management
    • X-linked recessive
    • Signs/Symptoms:
    • prolonged bleeding, oozing of blood into soft tissue
    • Management:
    • Replacement of missing factors, transfusion of factor concentrate
    • Preserve joints and manage pain
    • Prevent bleeding and joint degeneration
    • Safety issues: no rough play/contact sports
    • Medications:
    • Steroids
    • Ibuprofen
    • Self-infusion
  40. HIV/AIDS: Signs/Symptoms
    • Infants that acquire disease are asymptomatic until 18-24mos.
    • Signs/Symptoms:
    • Weight loss, failure to thrive
    • Chronic diarrhea
    • Developmental delay, loss of milestones
    • Repeated respiratory infections
    • Fever, night sweats
    • Weakness, fatigue, malaise, myalgia
    • Opportunistic infections
    • Hepatospleenomegaly
  41. Renal Development and Function
    • Children's kidneys can't concentrate urine or deal with extra fluid
    • Increased risk for injury r/t lack of back fat
  42. Urinary Tract Infection
    Infection of bladder, urethra or kidney
    • Vesicoureteral Reflux
    • I&II: can outgrow
    • III: may or may not outgrow
    • IV&V: severe UTI probably need surgery
    • Voiding Cystourethrogram
    • How far up ureter does urine go
    • Surgery may be needed to re-implant ureters higher
  43. UTI: Signs/Symptoms
    • Infant: Non-specific (irritable, fever)
    • Child >2 years: fever, anorexia, vomiting, diarrhea, constipation, abd, flank or back pain, foul smelling urine, dysuria, dibbling, enuresis, hematuria
  44. Lower UTI
    • Cystitis
    • Frequency, dysuria, urgency, enuresis, strong-smelling urine, cloudy urine, hematuria, abd pain, fever
  45. UTI Treatment
    • 5-7 days of antibiotics
    • Encourage oral fluids
    • Analgesic
  46. Upper UTI
    • Pyelonephritis (ureters and kidneys)
    • High fever, chills, abd pain, flank pain, costovertebral angle tenderness, persistant vomiting, moderate to severe dehydration
  47. Upper UTI Treatment
    Rehydration, antipyretics, IV antibiotics initially then orally for 7-10 days
  48. Acute Glomerulonephritis
    Usually follows strep infection

    • Acute inflammation lasts about 2 weeks then a slow return to normal function in
    • weeks to a few months – sometimes there is chronic renal failure
  49. Acute Glomerulonephritis Signs/Symptoms
    • Good health prior to causative infection
    • Puffy face w/periorbital edema in AM
    • Anorexia
    • Oliguria
    • Cola cored urine
    • Irritability, lethargy, generalized discomfort
  50. Acute Glomerulonephritis: Treatment and Complications
    • No specific treatment
    • Antibiotics if infection is still present
    • Bed rest during acute phase
    • Complications:
    • HTN
    • Acute renal failure
    • Hypertensive encephalopathy
    • Seizures
    • Infection/sepsis
    • Not likely to reoccur
  51. Nephrotic Syndrome: Signs/Symptoms
    • Edema
    • Massive proteinuria
    • Hypoalbunemia
    • Hypoproteinemia
    • Hyperlipidemia
    • Altered immunity

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