Pathophysiology 1.1

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Rx2013
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35861
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Pathophysiology 1.1
Updated:
2010-09-19 20:54:26
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Concepts altered health children
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Concepts of altered health in children
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  1. Neonate
    1st month
  2. infant
    2 months - 2 years
  3. child
    2 - 12 years
  4. adolescent
    13-18 years
  5. Toddler
    1 - 3 years
  6. Preschool
    3-5 years
  7. Early Childhood
    2-5 years
  8. Middle to late childhood
    6-12 years
  9. Gestational Age
    Number of weeks from the onset of the mother's last period until birth
  10. Term Neonate
    38-42 weeks
  11. Near Term
    34-38 weeks
  12. Preterm
    < 34 weeks
  13. Post-Term
    > 43 weeks
  14. 23~24 weeks
    • usually survive
    • immature kidney's
    • electrolyte problems with immature skin
  15. Growth
    Physical changes in the body
  16. Development
    changes in body function and psychosocial behaviors
  17. infancy growth
    linear
  18. childhood growth
    growth spurts
  19. Growth Charts
    Measure height, weight and head circumference
  20. Growth charts show all stats below expected for chronologic age
    suggest possibility of intrauterine insult or genetic abnormality
  21. Growth chart shows sparing head circumference relative to wt and ht
    • characteristic of growth delay and genetic short stature
    • structural dystrophies
    • endocrine causes of growth failure
  22. Growth chart shows low wt. with normal head circ. and ht
    • caloric insufficiency
    • hyper-metabolic state
  23. Average birth wieght
    3-4 kg
  24. Birth weight doubles in
    4-5 months
  25. birth weight tripples in
    12 months
  26. birth weight quadruples by
    24 months
  27. Girls growth spurt
    • begins 10-14 years
    • completed by 16-17 years
    • gain 20 cm and 25 kg
  28. Boy's growth spurt
    • begins later
    • completed 18-20
    • gain 30 cm and 30 kg
  29. Low Birth weight
    < 2.5 kg
  30. Very low birth weight
    < 1.5 kg
  31. Extremely low birth weight
    < 1 kg
  32. Large for Gestational Age
    • LGA
    • Subject to injuries during birth
    • usually a sign of uncontrolled diabetes in the mother (increased glucose makes big baby)
    • Easily hypoglycemic due to high insulin production
  33. Birth Injuries
    • Cranial Injuries
    • Fractures
    • Peripheral nerve injuries
  34. Cranial Injuries
    • Caput succedaneum
    • cephalhematoma
    • subdural/subarachnoid hemorrhage
  35. Caput succedaneum
    • scalp edema that may cross suture lines
    • petechiae, purpura, echymosis
    • resolves over the first week of life
    • sub q tissue dmg from pressure on head
  36. Cephalhematoma
    • subperiosteal collection of blood from ruptured blood vessels
    • does not cross suture lines
    • not apparent in the first 24-48 hours
    • skull fracture may be present
    • 2 week to 3 mo resolution
  37. Subdural / subarachnoid hemorrhage
    • closer to skull
    • neurosurgery
    • life threatening
    • below skull may not show visible signs
  38. Skull fractures
    • uncommon
    • usually from forceps delivery
    • usually linear = no treatment
    • depressed = palpable indentation; surgery required
  39. Clavicle Fractures
    • most frequent fractured bone
    • crepitus (bone creek)
    • immobilize the arm and shoulder
  40. Peripheral Nerve Injury: Brachial Plexus
    • C5 to T1 nerves there is a tear
    • Paralysis of upper extremity
    • immobilize for recovery in 3 to 6 months
  41. Erb Palsy
    paralysis of the upper arm
  42. Klumpke palsy
    paralysis of the lower arm
  43. Intrauterine Growth depends on:
    • efficient placental function
    • adequate energy
    • adequate growth substrates
    • hormonal environment
    • room in the uterus
  44. Risk Factors for Intra-uterine growth retardation
    • adolescent mothers
    • low economic status
    • short time between pregnancies
    • diet restrictions
    • heavy physical work
    • Pre-pregnancy hypertension
    • diabetes
    • chonic infection or illness
    • drugs
    • environmental hazards
  45. Craniosynostosis
    • skull bones completely connected at birth
    • causes problems for brain growth
  46. Fontanels
    spaces of unossified tissue at suture junctions
  47. Anterior fontanel
    palpable until 2 years
  48. Primitive reflexes used to evaluate CNS development
    • Moro = startle
    • Rooting = sucking
    • Stepping = placing
  49. Milestones of CNS maturation
    • spinal cord completely myelinated by 2 years
    • myelination complete by 7 years
  50. CNS Development
    • primitive reflex disappears before voluntary movements appear
    • trunk coordination before extremities
    • use of upper extremities before lower
  51. Overall assesment of the CNS should evaluate
    • alertness
    • responsiveness
    • persistence
    • concentration
  52. Speech and language development
    • best predictors of cognitive performance
    • hearing impairments may impede
  53. Respiratory Disorders: Middle Ear infections (Otitis media)
    • eustachian tube short and straight
    • remains common until age 5
    • keep baby upright while feeding
  54. Transient tachypnea of the newborn (TTN)
    • causes hypoxia
    • Usually in term infants
  55. Respiratory Distress Syndrome (RDS)
    • Surfactant deficiency
    • 32-34 weeks
    • Give mom steriods @ 28 weeks
  56. Bronchopulmonary dysplasia
    • chronic lung disease
    • COPD
    • trama to lung tissue
  57. Apnea
    CO2 levels are not registering in the brainstem due to immaturity
  58. Non-Pulmonary causes of Respiratory Distress in newborns
    • cardiac
    • infectious
    • metabolic
    • CNS
  59. Pulmonary Causes of respiratory distress in newborns
    • parechymal conditions
    • developmental abnormalities
    • airway abnormalities
    • mechanical abnormalities
  60. Major signs of respiratory distress
    • Tachypnea > 60 breaths per minute
    • Cyanosis
    • Retractions or nasal flaring
  61. TTN (Transient Tachypnea of the Newborn)
    • Term or near term
    • immediate onset improvement w/in 12-24 hours
    • clinical cours < 72 hours
    • Primary cause: delayed reabsorption of fetal lung fluid
    • Due to poor transitioning
  62. RDS (Respiratory Distress Syndrome)
    • Primarily preterm
    • Onset w/in 1st 6 hours
    • starts improving after 72 hours
    • primary cause is surfactant deficiency
  63. Sudden infant death syndrome
    • death of infant < 1 year that is unexplained
    • usually between 2-3 months
    • brainstem abnormalities
  64. Risk factors for SIDS
    • positioning during sleep (must be on back on firm matress)
    • prematurity/LBW
    • exposure to cigarette smoke
    • young mother
    • inadequate prenatal care
  65. Apnea
    • Cessation of breathing for at least 20 seconds
    • Caused by immaturity of the respiratory center in the medulla oblongota
    • failed recognition of increasing CO2 by the CO2 receptors.
  66. Periodic Breathing
    intermittent failure to breath for 10-15 seconds
  67. Causes of Apnea
    • Prematurity
    • Thermal instability
    • Infection
    • Drugs
    • Impaired Oxygenation
    • Metabolic disorders
    • GI Reflux
    • Intracranial pathology
  68. Treatment of Apnea or Periodic Breathing
    • supplemental oxygen
    • gentle tactile stimulation
    • env. temperature control
    • oscillation water beds
    • positive airway pressure
    • Methylxanthines (stimulate brain stem neurons)
  69. Meconium
    • newborn's first stool
    • amniotic fluid
    • intestinal secretions
    • mucosal cells
    • sometimes blood
  70. Delayed passage of meconium
    • underlying illness
    • cystic fibrosis
    • hirschprung's disease
  71. AAP recommends breast feeding until ____, why?
    • 12 months
    • easy digestion
    • sufficient nutrients and calories
    • some immune protection
  72. Hypoglycemia Diagnosis
    Levels < 40-45 mg/dL
  73. Signs of Hypoglycemia
    • cyanosis
    • apnea
    • hypothermia
    • hypotonia
    • poor feeding
    • lethargy
    • seizures
  74. Risk Factors for Hypoglycemia
    • Infants of diabetic mothers
    • SGA babies
    • premature babies
  75. Jaundice
    excessive circulating levels of unconjugated lipid soluble bilirubin that accumulates in the skin
  76. Causes of Jaundice
    new born RBC life span is shorter = higher turnover rate and higher bilirubin from breakdown of hemoglobin
  77. Treatment of Jaundice
    • hydration
    • phototherapy (change to conjugated form which increases H2O solubility)
    • blood transfusion > 25-30 mg/dL
  78. Kernicterus / Bilirubin Encephalopathy
    Neurologic syndrome from deposition of unconjugated bilirubin in the basal ganglia and brain stem
  79. Iron
    • Deplete iron stores around 6 months
    • Introduce iron fortified cereals at this time
  80. Irritable Infant syndrome / colic
    • Most common < 3 months
    • Abdominal pain or cramping
    • Crying
    • Drawing legs to abdomen
    • extreme irritablity
  81. Rule of 3
    • crying for more than 3 hours a day
    • crying for more than 3 days a week
    • crying for more than 3 weeks
  82. Failure to thrive
    • Inadequate growth due to inability to obtain or use essential nutrients
    • Metabolic genetic defects
    • parental neglect
  83. BMI
    weight in kg divided by height in meters squared
  84. Obesity
    BMI at or above the 95th percentile
  85. Risk Factors for Infections
    • Prematurity (maternal transfer of IgG in later weeks)
    • Rupture of membranes
    • Foul smelling amniotic fluid
    • Maternal fever
    • GBS colonization
    • Maternal UTI
  86. Pathogenesis effect
    • immature immune system
    • bacterial endotoxins
    • central vasodilation
    • peripheral vasoconstriction
    • systemic hypovolemia
  87. Middle to Late childhood diagnosis
    • asthma
    • epilepsy
    • cancer
    • developmental/learning disabilities
  88. Adolescents
    • endocrine system changes
    • lifestyle choices
    • motor vehicle accidents 1st cause
    • cancer = 2nd cause
    • Thicker skin
    • Acne
    • Hair growth
  89. Acne Causes
    • Sebaceous and sweat gland activity increases
    • Andrenal androgens stimulate the sebaceous gland

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