N7 Pediatrics

#separator:tab #html:true Cephalocaudal developmentGrowth from the head downward through the body toward the feet Proximodistal developmentGrowth that proceeds from the center of the body outward toward the extremities Anticipatory guidancePrediction of upcoming developmental tasks or needs of a child Oral stage[Birth to 1 year] Pleasure derives from mouth Anal stage[1 to 3 years] Pleasure from anal area Phallic stage[3-6 years] Sexual energy centered in genitalia as child works out relationships with parents/opposite sex Latency stage[6-12 years] Sexual energy at rest Genital stage[12 years to adulthood] Mature sexuality is achieved as physical growth completed Trust vs Mistrust[0-1 years] Establishing trust in the people providing care Autonomy vs Shame and Doubt[1 and 3 years] Autonomy develops, sense of shame develops if criticized for expressions of autonomy --> self-doubt Initiative vs Guilt[3 to 6 years] Initiates new activities and plans; if criticized, develops guilt and lack of purpose Industry vs Inferiority[6 to 12 years] Involvement in activities--otherwise, inferiority develop Identity vs Role Confusion[12-18 years] Sense of identity established, otherwise role confusion AssimilationChild incorporates new experiences Sensorimotor stageBirth to 2 years old. Child experiences world through fundamental senses Acquisition: object permanence Preoperational stage2 to 7 years. Acquire ability to internally represent world through language and mental imagery Acquisition: theory of mind Concrete operational7 to 11 years. Children begin to think logically Attainment: Conservation Formal operational stage11 years old. Can reason abstractly Attainment: abstract logic Preconventional stage4 to 7 years. Decisions based on desire to please others and avoid trouble Conventional stage7 to 12 years. Conscience develops; rules are important and are followed to please people. Postconventional12 years and older. Internalized ethics, has social responsibility Onlooker playWatch but don't participate Solitary playPlay alone but with different toys Parallel playPlay with similar toys as other children but neither is influenced Associate playPlay together but with no organization Cooperative playCoordinated play in a group When is object permanence developed4-8 months "When do children typically say ""mama/dada"""10 months "Children say about [...] at 12 months""Children say about five words at 12 months " Average birth weight7.5 lbs (3.4 kg) "Weight [...] by 6 months (4-7 months)""Weight doubles by 6 months (4-7 months) " "Weight [...] by 1 year""Weight triples by 1 year " Average birth heigh is19-21 inches (48-53 cm) "Growth of [...] a month for first six months, then 0.5 inches a month afterward""Growth of 1 inch a month for first six months, then 0.5 inches a month afterward " "Growth of 1 inch a month for first six months, then [...] a month afterward""Growth of 1 inch a month for first six months, then 0.5 inches a month afterward " "Cephalocaudal development responsible for [...] motor skills""Cephalocaudal development responsible for gross motor skills " "Proximodistal development responsible for [...] motor skills""Proximodistal development responsible for fine motor skills " Conservation (Piaget)Knowledge that matter is not changed when its formed is altered When do teeth begin to erupt6 to 8 months "Infants have shorter [...]""Infants have shorter loops of Henle " Vitamin D in infancy preventsRicketts Begin solid foods (tongue extrusion reflex) at4 to 6 months Toddler reaches half of their adult height by 2nd year Myelinization of brain and spinal cord complete by24 months How many words can kids say at 18 months50 How many words can kids say at 24 months400 words, use 2-3 word phrases Nutrients for toddlersCalcium and iron Sources of calciumBroccoli, orange, dry beans, legumes Wean off of the bottle by15 months How many hours should preschoolers sleep at night10-12 hours Order of examination for younger childrenToe-to-head Normal locations for bruisesKnees, lower legs, forearms, forehead What is petechiae associated with in young children?Meningicococcemia Measure head circumference if child is2 years or younger What might limited ROM in infant neck indicateTorticollis (neck muscle contracture) Posterior fontanelle closes between2 and 3 months Anterior fontanelle and sutures close by18 months Palebral slantDirection of slant from outer corner of eye to inner Cover-uncover testCover one eye and watch for movement of other eye. If other eye moves, weakness is present. Then remove cover. If it doesn't fixate on picture, then there is also weakness. How to pull pinna if >3 years oldBack and up How to pull pinna for <3 years oldDown and back Normal tonsil sizes+1 and +2 Direct pupil reactionPupil constriction in same eye Consensual pupil reactionPupil constriction in opposite eye Pectus excavatumSunken/funnel chest Pectus carinatumPigeon chest (sternum protrudes) """Silent chest"" may be an indication of"An asthma attack "Older children use [...] when breathing""Older children use accessory muscles when breathing " "Sinus arrythmias are [...] in children""Sinus arrythmias are normal in children " "How many children (6-9 years old) have ""innocent"" heart murmurs"50% Liver palpable in infants at1-2 cm below right costal margin Enlarged liver frequently a sign ofFluid overload Rebound tendernessTenderness elicited when hand removed Flank pain usually indicatesUTI or kidney infection Epigastric pain may indicatePancreatitis Urinary output in infants is2-3 mL/kg/hr Urinary output in children is1-2 mL/kg/hr Urinary output in adolescents is0.5-1 mL/kg/hr Definition of neonate0-28 days from birth When do children take first steps12-15 months Separation anxiety intensifies at16-18, 24-30 months Fat intake should be30-35% Only vaccine given at birthHepatitis B Which pain medication is given first in childrenAcetaminophen Toxoid vaccineContains toxin or chemical produced by the bacteria Conjugate vaccineLinks antigen with a carrier protein to enhance immune response CocooningProtecting those who are too young to get immunized Cannot give MMR virus to children under1 year old Standard quadrivalent dose of flu vaccine is what type of vaccineLive virus Transmission radius of flu virus from infected person is6 feet Flu is contagious for7-9 days Prevnar-13/PCV13 vaccinates againstpneumococcal bacteria When to give MMR12 months and 4 years of age When should children get HPV vaccine and how many doses11 or 12 years old, two doses (0, 6-12 months) When should children get menactra vaccine11 or 12 years old, booster at 16 Parent education regarding feverOnly give one pyretic and ensure correct dose Mortality rate of diptheria in children younger than 51 out of 5 Fifth disease (Erythema infectiosum)"Mild rash caused by parvovirus b19 (""slapped cheek""), bright red" Another name for measlesRubeola Diptheria S/SSore throat, mild fever, chills, then coating in the back of the nose or throat Measles S/S (three C's(Prodrome of high fever, malaise, Koplik spots, maculopapular rash Three C's: <ul><li>Cough</li><li>Coryza (catarrhal inflammation of the mucous membranes in the nose)</li><li>Conjunctivitis</li></ul> Koplik spotsWhite dots in the inner mouth from measles infection Meningococcal S/SCaused by N. meningitidis <ul><li>Fever</li><li>Stiff neck</li><li>Headache</li><li>Confusion </li><li>Light sensitivity</li><li>N/V</li></ul> Mononucleosis S/SEpstein-Barr virus (most common human virus) <ul><li>Extreme fatigue</li><li>Fever</li><li>Sore throat</li><li>Head and body aches</li><li>Swollen lymph nodes in neck and armpits</li><li>Swollen liver and/or spleen</li><li>Rash</li></ul> Mumps S/S<ul><li>Fever</li><li>Headache</li><li>Muscle aches</li><li>Fatigue</li><li>Loss of appetite</li><li>Swollen salivary glands </li></ul> Roseola"Exanthema subitum, ""sixth disease"" Caused by a type of herpes virus High fever, then rash No vaccine" Rubella (3)<ul><li>Mild fever</li><li>Sore throat</li><li>Rash starting on face going to the rest of the body</li></ul> When should children get vaccinated for diptheria2/4/6 months, 15 months, 11 years as part of combination vaccine DiptheriaCauses grey coating pseudomembrane, kills respiratory system tissue When should children receive TdapDTaP (young children): <ul><li>2, 4, and 6 months</li><li>15-18 months</li><li>4 to 6 years</li></ul><div>Tdap (adolescents):</div><div><ul><li>11-12 years</li></ul><div>Td or Tdap (adults):</div></div><div><ul><li>Every 10 years</li></ul></div> Vaccinations given at 2 monthsB DR HIP <ul><li>Hep B </li><li>DTaP</li><li>Rotavirus</li><li>Haemophilus influenzae</li><li>Inactivated polio vaccine</li><li>Pneumococcal</li></ul> Vaccinations given at 4 monthsDR HIP  <ul><li>DTaP</li><li>Rotavirus</li><li>Haemophillus influenzae</li><li>Inactivated polio virus</li><li>Pneumococcal</li></ul> Vaccinations given at 6 monthsB DR HIP + FLU <ul><li>Hep B </li><li>DTaP</li><li>Rotovirus</li><li>Haemophillus influenzae</li><li>Inactivated polio virus</li><li>Pneumococcal</li><li>Flu vaccine</li></ul> Vaccines given at 12-18 monthsMAD HPV <ul><li>MMR </li><li>Hep A</li><li>DTaP</li><li>Haemophillus influenzae</li><li>Pneumococcal</li><li>Varicella</li></ul> Vaccines given at 4-6 years oldVery DIM <ul><li>Varicella</li><li>DTaP</li><li>Inactivated polio vaccine</li><li>MMR</li></ul> Vaccines given at 11-12 yearsMITH <ul><li>Meningococcal </li><li>Influenza</li><li>TdaP</li><li>HPV</li></ul> How do most accidental deaths of <1 year olds occur?Drowning in bathtub Usual age of first cigarrette9-14 years old Premature birth weight is a risk factor forPhysical abuse Symptoms of foreign object swallowedDrooling, dysphagia, coughing, wheezing Treatment for lead poisoningChelation therapy Infant caloric requirement100-115 kcal/kg/day How much of infant diet consists of fat50% When are infants ready to eat solid food6 months Appropriate first food, according to the bookRice cereal What should infants eat after rice cereal<ul><li>Fruits and vegetables</li><li>Meats and proteins</li><li>Finger foods</li></ul> Cleft lip post op care<ul><li>Choking </li><li>Lie on back </li><li>Evaluate airway </li><li>Feed slowly</li><li>Teaching</li></ul><ul><li>Larger nipple opening </li><li>Incidence greater in males</li><li>Prevent crust formation </li></ul> Size of stomach on first day of life5-7mL GI enzymes deficient until4-6 months What does projectile vomiting indicate?Pyloric stenosis Feeding techniques for cleft lip<ul><li>Upright positioning</li><li>Special nipples</li></ul> Surgery to correct cleft lip/palate usually done around3-4 months Esophageal atresiaFailure of esophagus to establish passageway to stomach at 4-5 weeks gestation Esophageal atresia s/sExcessive salivation and drooling Three C's: <ul><li>Cyanosis</li><li>Choking</li><li>Coughing</li></ul> Nursing interventions for esophageal atresia<ul><li>Gastric pouch decompression with suction</li><li>NPO</li><li>Upright position</li></ul> Hypertrophic pyloric stenosisObstruction in pyloric lumen secondary to muscular hypertrophy Etiology of HPSUnknown HPS S/S (3)"<ul><li>Forceful projectile vomiting after feeds</li><li>Dehydration (visible peristalsis)</li><li>""Olive-like"" mass in right epigastrum</li></ul>" Medical treatment of HPSPyloromyotomy Nursing interventions for HPSResume feedings slowly post-op Nissen fundoplicationFundus of stomach wrapped entirely around distal esophagus to create a valve mechanism to prevent GER Hernial incarcerationHernia can't be easily reduced Hernial strangulationBlood supply to herniated organ is impaired (surgical emergency) Most common hernia in childrenInguinal (abdominal), most common in boys OmphaloceleAbdominal contents herniate through the umbilical cord GastroschisisProtrusion of bowel through defect in the abdominal wall to the side of the umbilicus Leading cause of illness in children <5 yearsDiarrhea Most common cause of infectious diarrheaRotavirus Management of diarrheaOral rehydration first choice for mild/moderate EncopresisInappropriate passage of feces, often with soiling Hirschsprung diseaseAKA congenital anganglionic megacolon Absence of ganglion cells in rectum and colon --> megacolon Hirschsprung S/S"<ul><li>Accumulation of stool</li><li>""Ribbon-like"" stool</li><li>May develop into enterocolitis (explosive diarrhea, fever)</li></ul>" Hirschsprung method of diagnosisDiagnosed by X-ray and barium enema or anorectal manometric examination, confirmed with rectal biopsy Hirschprung medical treatment<ul><li>Correct F&E imbalances</li><li>Surgery</li></ul><div>Prognosis very good if diagnosed early</div> Hirschsprung surgical management<ul><li>Colostomy</li><li>Pull-through (definitive correction when >10kg)</li></ul> Most common emergency abdominal surgery in childrenAppendicitis Appendicitis S/S<ul><li>Pain at McBurney's point (RLQ)</li><li>Fever</li><li>Increased WBC</li></ul> Perforation rate in appendicitis for children <2 years old80-100% Peak incidence of appendicitis10-12 years Most common cause of acute intestinal obstruction in children younger than 5Intussusception Intussuseption S/S"<ul><li>Sudden acute abdominal pain</li><li>Red ""current-jelly"" stools </li><li>Tender, distended abdomen</li><li>Vomiting</li><li>Lethargy</li></ul>" Intussusception diagnosis/treatmentAir contrast enema Imperforate anus diagnosis<ul><li>Fluoroscopy</li><li>Ultrasound</li><li>Cystogram</li></ul> Imperforate anus possible treatmentsDepends on type <ul><li>Manual dilation</li><li>Anoplasty</li><li>Colostomy (usually temporary)</li><li>Corrective surgery</li></ul> Preemies are what percent water90% Infant weight is what percent water75-80% ECF percent in infants40-45% Kidneys cannot fully conserve fluid until they are2 years old Body water distribution reaches adult levels atSchool age What proportions of water is lost by children through insensible fluid loss2/3rds via skin and 1/3 respiratory Mild dehydration<50mL/kg, 5% Moderate dehydration50-90mL/kg, 6-9% Severe dehydration>100mL/kg, 10% Water intoxication interventions<ul><li>Infants: Pedialyte every 4-6 hours</li><li>Older children: ORS</li></ul><div> </div><ul><li>Initial: 50mL/kg of ORS</li></ul> What fluid should never be used alone in dehydration/resuscitation?D5W --> glycosuria, hyponatremia, cerebral edema Daily maintenance fluid requirement calculation<ul><li>100 mL/kg for first 10 kg</li><li>50 mL/kg for second 20 kg</li><li>20 mL/kg for further weight</li></ul> Most UTIs in children casued byE. coli Bladder control achieved at2 years of age Frequency of childhood voiding5-6 times a day How to collect a clean catch<ul><li>U-bag</li><li>Cotton balls in diaper if no cultures needed</li></ul> How to collect a sterile sample<ul><li>Suprapubic aspiration in infants</li><li>Straight cath</li></ul> When does enuresis typically cease6-8 years 90% of uncircumcized men should be able to retract foreskin by 3 years old Most common incidence of testicular torsion10-19 years old Tissue death from torsion begins within2-12 hours EpispadiasCongenital absence of upper wall of urethra Epispadias is more common inMen "Urethral opening of men with epispadias is on the [...] side of the penis""Urethral opening of men with epispadias is on the dorsal side of the penis " HypospadiasUrethral opening not located in normal position Turner syndromeFemales have a missing or partial absence of one X chromosome (XO) Klinefelter syndromeExtra X chromosome (80% 47 XXY type) Nephrotic syndromeGlomerular membrane becomes permeable to proteins Nephrotic syndrome S/S (4)<ul><li>Proteinuria</li><li>Edema</li><li>Hypoalbuminia</li><li>Ascites</li></ul> Onset of nephrotic syndrome usually2-7 years old Nephrotic syndrome is more common inmales Minimal change nephrotic syndrome (MCNS)Primary disease in 85% of cases, responds well to steroids Urine in nephrotic syndromeqDecreased volume, frothy Management of nephrotic syndrome<ul><li>Low to moderate protein diet</li><li>Steroids</li><li>Diuretics or 25% albumin</li></ul> Acute glomerulonephritis symptoms (3)<ul><li>Generalized edema (beginning in periorbital area)</li><li>Acute hypertension</li><li>Oliguria</li></ul> Weight gain for toddlers rate3-5 lbs/year Acute glomerulonephritis S/S<ol><li>Edema (begins periorbital)</li><li>Acute HTN</li><li>Oliguria</li><li>Hematuria</li><li>Proteinuria</li></ol> Acute glomerulonephritis diagnosisKidney biopsy Acute Postreptococcal Glomerulonephritis (APSGN)Autoimmune response 7-21 days post-infection APSGN is most common among6-7 year olds, boys Nursing management of APSGN (4)<ul><li>Daily weights and I/O</li><li>Abdominal girth</li><li>BP monitoring</li><li>Low sodium diet</li></ul> Wilms tumorAKA nephroblastoma Malignant renal, intra-abdominal tumor of childhood Wilms tumors are 3x more common inAfrican American children Most common cause of renal failure in childrenTransient renal failure secondary to dehydration or shock Complications of ARF<ul><li>Hyperkalemia</li><li>HTN</li><li>Anemia</li><li>Seizures</li><li>Hypervolemia</li><li>Pulmonary edema -> cardiac failure</li></ul> "Chronic renal failure indicates [...] of functional capacity is destroyed""Chronic renal failure indicates 50% of functional capacity is destroyed " Preferred method of dialysis for childrenPeritoneal CystitisLower UTI Pyelonephritis syndromeUpper UTI Voiding cystourethrogram (VCUG) is used to diagnoseReflux of urine into bladder, causing UTI Diet for renal failure childrenLow sodium, low phosphorous, low potassium When to start offering child a cup8-9 months Adolescent male caloric need3000 calories Adolescent female caloric need2000 Breastfeeding infants at risk forIron deficiency Adolescents at risk for anemia due toHeavy periods KwashiorkorWater retention and abdominal swelling from severe protein deficiency MarasmusTotal nutritional deficiency causing emaciation and decreased energy level ColicParyoxysmal abdominal pain and severe crying HydronephrosisAccumulation of urine in the renal pelvis --> renal scarring When do Wilms tumors most commonly affect childrenBefore 5 years old Uremic syndrone (renal failure) signs and symptoms<ul><li>N/V</li><li>Progressive anemia</li><li>Dyspnea</li><li>Malaise</li><li>Uremic frost</li><li>Halitosis</li><li>Progressive confusion</li><li>Tremors</li><li>Pulmonary edema</li><li>CHF</li></ul> High potassium foods <ul><li>citrus fruits</li><li>apricots</li><li>bananas</li><li>celery</li><li>dried beans</li><li>potatoes</li><li>whole grains</li><li>peanuts</li><li>dairy products</li></ul> "Surgical closure of cleft [...] done prior to [...]""Surgical closure of cleft lip done prior to palate " Most common esophageal disorder in childrenGER S/S of GERD in children<ul><li>Regurgitation</li><li>Irritability, crying</li><li>Hunger</li><li>Dehydration</li><li>Arching of back </li></ul> When does intussusception most frequently occur?6 months to 3 years old When is Hepatitis A given12 and 18 months First sign of rubella is typicallyRash HPV administered as two doses if initiated between9-14 years old HPV administered as three doses if initiatedOlder than 15 What size needle to use for vaccinations22-25 g, 1 inch Methods for giving vaccinations to children<ul><li>Coach parent to hold and talk to child</li><li>Infants up to 4 months: sucrose pacifier</li><li>Apply pressure to site before injection</li><li>Topical anesthetic (vapo-coolant)</li><li>Simultaneous injections</li><li>Stingning injections last</li></ul> Which vaccines sting<ul><li>PCV 13</li><li>MMR</li><li>HPV</li></ul> Keep what nearby when administering vaccinesEpinephrine Aspirin never given to children due to risk ofReyes' syndrome Criteria for Hep A diagnosis<ul><li>Immunoglobulin M antibody to Hep A (anti-HAV)</li><li>PCR</li></ul> Initial dose of ORS50ml/kg How often to give ORSEvery 4-6 hours What percentage of US children live in poverty20% Transductive reasoningMaking connections between two unrelated events (2-7 years old) Denver Developmental Screening tests forGross motor, fine motor, language, and personal (social) skills Average head circumference at birth (in inches)13-14 inches Infants grow in height at a rate of1 inch per month, then slows to 0.5 inches a month Do not give enemas to kids withAppendicitis How much milk should toddlers drink a day16-24 oz/day How much juice should toddlers drink a day4-6 oz/day What is the incidence of congenital heart disease5 to 8 per 1000 live births Major cause of death in first year of life after prematurityCHD Most common CHD anomalyVentricular septal defect CHD caused by genetic inheritance in10-12% of cases CHD caused by environmental or maternal health habits in1-2% of cases What percentage of FAS infants have CHD50% Rubella increases risk of CHD by50% What other infections can cause CHDCMV, toxoplasmosis Maternal diabetes increases risk of CHD by10% CHD is multifactorial in 85% of cases Symptoms of CHD (6)<ol><li>Tachycardia</li><li>Tachypnea</li><li>Stunted growth</li><li>Dyspnea/orthopnea</li><li>Fatigue</li><li>URI</li></ol> When do symptoms of CHD appear4 to 12 weeks after birth Which medications may stimulate closure of ductus arteriosusIV ibuprofen or indomethacin What are the clinical manifestations of a PDA<ul><li>Dyspnea</li><li>Tachypnea</li><li>Full bounding pulses</li><li>Widened pulse pressure</li><li>Hypotension if CO is low</li><li>May be asymptomatic</li></ul> What are the symptoms of a large PDA<ul><li>CHF</li><li>Intercostal retractions</li><li>Hepatomegaly</li><li>Poor growth</li></ul> What heart sounds do PDAs make"Continuous ""machinery"" murmur during both systole and diastole and with a thrill in the pulmonic area" What EKG abnormality is present when there is a PDALVH Treatment of PDA<ul><li>Obstructive device via transcatheter is standard therapy </li><li>Video-assisted thoracoscopic (VAT) surgery with clip ligation also performed</li><li>IV ibuprofen/indomethacin may close PDA in preterm infants if no CHF present</li><li>Small PDAs don't need to be closed</li></ul> Prognosis for PDANo long-term sequelae if treated before pulmonary hypertension or pulmonary vascular obstructive disease occurs Symptoms of ASDs<ul><li>Small or moderate: no symptoms</li><li>Large: CHF, easy tiring, poor growth </li></ul> What do ASDs sound like<ul><li>Soft systolic ejection murmur in pulmonic area</li><li>Fixed, wide splitting of S2 through all respiratory phases</li></ul> What do echocardiograms of ASDs revealDilated right ventricle from blood volume overload Prognosis of ASDs<ul><li>Stroke in middle age</li><li>CHF, atrial arrythmias, pulmonary artery HTN in untreated adults</li></ul> What is the most common CHDVentricular septal defect (VSD) Symptoms of VSDsInfants and children may have no symptoms Moderate to large: CHF, poor growth, decreased activity tolerance, increased number of pulmonary infections, pulmonary hypertension What do VSDs sound likeSystolic murmur auscultated at the third or fourth intercostal space at the sternal border. Thrill may be present Diagnosis of VSDs<ul><li>Radiograph: large VSDs show cardiomegaly and pulmonary vascular markings</li><li>EKG: both LVH and RVH</li><li>Echocardiograms can identify size and location of defect</li></ul> Treatment of VSDs<ul><li>Small VSDs close spontaneously within 6 months</li><li>VSD closure performed after 6 months unless CHF is unmanaged</li><li>Device closure if not too close to valves</li></ul> Prognosis and potential complications of VSDs<ul><li>Children respond well to surgery</li><li>Arrythmias</li><li>right bundle branch block, and complete heart block are possible complications</li><li>May need pacemaker</li></ul> What percentage of children with AV canal defects have Down syndrome70% What is a classic sign of decreased pulmonary bloodflow CHD?Cyanosis that is not relieved by oxygen Which type of defect makes toddlers squatDecreased bloodflow CHD What are the symptoms of PSNo symptoms if mild Moderate: dyspnea, fatigue on exertion Severe: CHF and CP Diagnostic results of PSRadiograph: enlarged pulmonary artery EKG: atrial enlargement, RVH Echo: thickness and size of valve Treatment of PS<ul><li>Balloon dilation</li><li>Surgical valvotomy if dilation unsuccessful</li></ul> What is the mortality rate for infants with severe PS?10% Tetralogy of Fallot<div> </div><ol><li>PS</li><li>RVH</li><li>VSD</li><li>Overriding of aorta</li></ol> TOF accounts for what percentage of CHD10-20% Heart sounds of PS<ul><li>Loud systolic murmur</li><li>Widely split S2</li><li>Thrill</li></ul> Heart sounds of TOFSystolic murmur in pulmonic transmitted to suprasternal notch  Blalock-Taussig shuntCreation of pathway between right subclavian and pulmonary artery for single ventricle defects Treatment to keep ductus arteriosus openProstaglandin E Clinical manifestations of Transposition of the Great ArteriesCyanosis progressing to hypoxemia and acidosis after birth How many valves are present in a heart with atrioventricular septal defectOne single valve Heart sounds of AVC<ul><li>S1 accentuated</li><li>S2 split</li><li>Holosystolic murmur, loudest at left lower sternal border</li><li>Possible thrill</li></ul> Treatment for AV canalAt 2-4 months: <ul><li>Patches placed over septal defects</li><li>New valves made from valve tissue</li><li>Endocarditis prophylaxis for 6 months</li></ul> Prognosis for AV canalPost-surgery, at risk for: <ul><li>Arrythmias</li><li>Mitral valve regurgitation</li><li>Residual defect</li><li>Subaortic stenosis</li></ul> What is an overriding aortaWhen the aorta is placed over a septal defect such that unoxygenated blood goes into systemic circulation Treatmemt of TOFCorrective surgery by 1-2 years, 3-4 months if symptomatic (hypercyanotic spells) Palliative surgery before corrective is BT shunt Prognosis for TOF<ul><li>Surgery is not curative</li><li>May develop right bundle branch block</li><li>Pulmonary regurgitation may --> valve replacement in 10-20 years</li><li>Ventricular arrythmias</li></ul> Signs and symptoms of aortic stenosis<ul><li>Hypotension and tachycardia due to decreased CO</li><li>Weak pulses</li><li>Characteristic murmur</li></ul> Coarctation of the aortaNarrowing of descending aorta (Often near DA or left subclavian artery) Signs and symptoms of COACyanosis and weak pulses in lower extremities, bounding pulses in upper extremities Diagnostic indications of COA<ul><li>CXR: cardiomegaly, pulmonary venous congestion, indentation of the descending aorta</li><li>EKG: LVH, RVH</li><li>MRI preferred to echocardiogram</li></ul> Treatment for COA<ul><li>PGE1 in symptomatic newborns</li><li>CHF prevention with inotropic meds, diuretics, oxygen</li><li>Surgical resection preferred to balloon dilation due to risk of recoarctation</li></ul> Prognosis for COASurgery is palliative, as recoarctation may still occur Life-long follow-up required May cause persistent HTN What is rheumatic feverInflammatory disease occuring after group A beta-hemolytic streptococcal pharyngitis What is the most common complication of rheumatic feverRheumatic heart disease (damage to valves) Which valve does rheumatic heart disease typically affectLeft-sided heart valves What are the Joness criteria<div>PECCS </div><ul><li>Polyarthritis</li><li>Erythema marginatum</li><li>Carditis</li><li>Chorea</li><li>Subcutaneous nodules</li></ul><div>Two major or one major and two minor manifestations required to diagnose rheumatic fever</div> What percentage of children with KD are under 575% Clinical manifestations and time frame of Kawasaki disease in the acute phase<div>Acute phase:</div><div>HERHI</div><ul><li>High fever</li><li>Irritability</li><li>Red throat, hands, feet, eyes</li><li>Hepatic dysfunction </li><li>Englargment of cervical lymph nodes</li><li>Rash on trunk</li></ul> Treatment of Kawasaki disease<ul><li>IV immunoglobulin</li><li>Aspirin 80 to 100 mg/kg/day for fever (then antiplatelet dose after fever is gone)</li><li>Steroids if IVIG doesn't work</li></ul> Health understanding of toddlers/pre-school age children<ul><li>Separation anxiety from parents</li><li>May see illness as punishment</li><li>Has vague notions about germs and some body parts</li></ul> Health understanding of school-age children<ul><li>Knows cause and effect of illness</li><li>Require support</li><li>Stressful procedures --> regression</li><li>Sense of industry</li></ul> Health understanding of adolescents<ul><li>Concerned with body image</li><li>Need for privacy</li><li>Partner with family and adolescent in care</li></ul> Stages of separation<ul><li>Protest</li><li>Despair</li><li>Denial</li></ul> Maternal antibodies provide infants protection for3 months Symptoms of mild respiratory distress<div>(attempting to compensate)</div><ul><li>Restlessness</li><li>Tachypnea</li><li>Tachycardia</li><li>Diaphoresis</li></ul> Signs and symptoms of moderate respiratory distress(early decompensation) <ul><li>Nasal flaring</li><li>Retractions</li><li>Grunting, wheezing</li><li>Anxiety, irritability, mood swings, confusion</li><li>Hypertension</li></ul> Symptoms of severe respiratory distress (respiratory failure/arrest)<ul><li>Dyspnea</li><li>Bradycardia</li><li>Cyanosis</li><li>Stupor, coma</li></ul> Signs and symptoms of epiglottitisAIR RAID <ul><li>Airway inflammation </li><li>Increased pulse</li><li>Restlessness</li><li>Retractions</li><li>Anxiety increased</li><li>Inspiratory stridor</li><li>Drooling</li></ul> What does IGF-1 and IGFBP-3 test forGrowth hormone deficiency What do karyotypes detect in girlsTurner syndrome What do antigliadin antibodies test forCeliac disease Which hand is used to detect bone age with x-rayLeft AcromegalyIncreased secretion of GH after normal growth has stopped --> bone thickens, organs and other structures grow larger GigantismExcessive secretion of GH in children before normal growth has stopped --> overgrowth in long bones, muscles, organs Precocious pubertyPuberty before 8 in girls and 9 in boys Gonadotropin-dependent precocious puberty AKA central precocious puberty Early secretions of LH and FSH Gonadotropin-independent precocious pubertyCaused by early secretion of sex hormones Hyperpituitarism and precocious puberty may indicate apituitary tumor Treatment of precocious pubertyGoal is to stop the onset Synthetic gonadotropin-releasing hormone Treatment for central DIDesmopressin What additional symptoms does nephrogenic DI entailHypernatremia in neonatal period, mental status changes Treatment for nephrogenic DI<ul><li>Diuretics</li><li>High fluid intake</li><li>Salt- and protien-restricted diets</li></ul> One serving of carbs is15 grams of carbs Holosystolic murmursBegins with S1 and end at or continue through S2 Treatment for GH excess<ul><li>Surgical reduction or removal of pituitary tumor (most common)</li><li>Radiation</li></ul> Treatment of AV canal<ul><li>Performed between 2-4 months</li><li>Patches placed over septal defects</li><li>Valve tissue used to form functional valves</li><li>Endocarditis prophylaxis for 6 months after</li></ul> Prognosis of AV canalComplications: <ul><li>Arrythmias</li><li>Mitral valve regurgitation</li><li>Residual septal defect</li><li>Subaortic stenosis</li></ul> Surgical procedures for TOF<ol><li>Norwood procedure</li><li>Glenn procedure</li><li>Fontan procedure</li></ol> Norwood procedure<ul><li>BT shunt temporarily placed --> blood to lungs</li><li>Aorta rerouted to right ventricle</li><li>Aorta is widened</li></ul><div>Failed shunt --> respiratory distress</div> Diagnostic results of TOFCXR: boot-shaped heart (enlarged right ventricle), decreased pulmonary vascular markings, prominent aorta EKG: RVH Echo: shows everything, often prior to birth Labs: elevated H&H. increased clotting time Glenn procedureSVC connected to PA Fontan procedureIVC connected to pulmonary artery via conduit --> increase pulmonary blood flow, bypass right side of heart Total Anomalous Pulmonary Venous ReturnPulmonary veins empty into right atrium or veins instead of left atrium Which CHD is found in 30% of those with Turner syndromeCoarctation of the aorta Treatment for HLHSPE1 Which is the most common form of croupAcute Laryngotracheobronchitis S/S of croup<ul><li>Barking cough</li><li>Inspiratory stridor</li><li>Retractions</li><li>Respiratory distress (in varying degrees)</li></ul> What age group does LTB primarily affect5 or younger Treatment of LTB<ul><li>Airway management</li><li>Hydration</li><li>High humidity with cool mist</li><li>Nebulized epinephrine and steroids</li></ul> Additional S/S of epiglottitis<ul><li>Sore throat</li><li>Tripoding</li><li>Mild hypoxia</li></ul> Which vaccine prevents epiglottitisHib Which virus primarily causes bronchiolitisRSV "RSV causes copious amounts of [...]""RSV causes copious amounts of thick secretions " Medications for asthma<ul><li>Bronchodilators: albuterol, metaproterenol, terbutaline, salmeterol</li><li>Theophylline (if you monitor labs)</li><li>Leukotriene modifiers: montelukast</li><li>Cromolyn sodium</li><li>Corticosteroids</li></ul> Which disease does CF cause in the lungsBronchiectasis What percent of white people have CF trait3% Most reliable diagnostic procedure for CFSweat test What systems/organs does CF affect<ul><li>Lungs</li><li>GI (small intestine)</li><li>Pancreas</li><li>Liver</li></ul> How does CF affect small intestineInspissated meconium --> obstruction in newborn How does CF affect pancreasPrevents release of enzymes, causes secondary pancreatic degeneration How does CF affect the liverBlocks bile ducts --> portal HTN Clinical manifestations of CF<ul><li>Pancreatic enzyme deficiency</li><li>COPD</li><li>Sweat gland dysfunction</li><li>FTT</li><li>Respiratory deterioration</li></ul> S/S of CF<ul><li>Wheezing</li><li>Nasal polyps</li><li>Patchy atelectasis</li><li>Cyanosis</li><li>Clubbing</li><li>Bouts of bronchitis and PNA</li></ul> How does CF affect the GI system<ul><li>Meconium ileus</li><li>Rectal prolapse</li><li>Distal intestinal obstruction syndrome</li><li>Undigested food in stool (bulky, frothy, foul-smelling)</li><li>Tissue wasting</li><li>Steatorrhea and azotorrhea</li></ul> "CF causes delayed puberty in females and [...] in females""CF causes delayed puberty in females and infertility in females " "CF causes [...] in females and infertility in females""CF causes delayed puberty in females and infertility in females " What lab abnormalities are associated with CF<ul><li>Hyponatremic/hypochloremic alkalosis</li><li>Hypoalbuminemia</li></ul> GI management of CF<ul><li>Pancreatic enzyme replacement</li><li>High protein and calorie diet (150% RDA)</li><li>Salt supplementation</li><li>Fat-soluble vitamins</li></ul> Survival rate of lung transplantation90% Management of asthmaASTHMA <ul><li>Adrenergics (Beta 2 agonists) </li><li>Steroids</li><li>Theophylline</li><li>Hydration</li><li>Mask O2</li><li>Anticholinergics</li></ul><div> </div> Binocularity is developed at4 months Infants should start babbling by7 months Visual acuity in newborns is20/100 - 20/400 Visual acuity of toddlers20/50 Eustachian tube in infants/young children isShorter, wider, and more horizontal "Brushfield spots are [...] associated with [...]""Brushfield spots are white spots on the iris associated with down syndrome " "<div>No cloze 2 found on card. Please either add a cloze deletion, or use the Empty Cards tool. <a href='https://anki.tenderapp.com/kb/problems/no-cloze-found-on-card'>More information</a></div>""<div>No cloze 2 found on card. Please either add a cloze deletion, or use the Empty Cards tool. <a href='https://anki.tenderapp.com/kb/problems/no-cloze-found-on-card'>More information</a></div>" Serious complications associated with Down's syndrome (3)Diabetes, congenital heart defects, leukemia Facial characteristics of Fragile X syndrome<ol><li>Long face</li><li>Prominent jaw</li><li>Large ears</li><li>Epicanthal eye folds</li><li>Strabismus</li></ol> Down syndrome is caused by defects in chromosome21 "Down syndrome can be diagnosed with genetic testing within [...] of conception.""Down syndrome can be diagnosed with genetic testing within nine weeks of conception. " Congenital defects associated with Down syndrome (6)<div>THISHH </div><ol><li>Thyroid disease </li><li>Hirschprung and tracheoesophageal fistula</li><li>Immune dysfunction (--> leukemia)</li><li>Skeletal defects (Atlantoaxial instability)</li><li>Heart defects (40-50%)</li><li>Hearing/vision problems (70%)</li></ol> Permanent teeth begin to erupt at6 years of age White reflex in the eye indicatescancer S/S of acute otitis media"<ul><li>Tugging on ear</li><li>Infant not responsive to voice/child not responding to request (""uncooperativeness"")</li><li>Bulging red tympanic membrane</li></ul>" Risk factor for otitis mediaLiving in smoking household Children with conjunctivitis should not return to school until24 hours after initiation of antibiotic Treatment of strabismus may prevent amblyopia if begun before24 months Tympanostomy tubes are used to <ul><li>Relieve middle ear pressure</li><li>Drain middle ear infection</li></ul> "Bend [...] in a nosebleed""Bend forward in a nosebleed " Treatment for acute otitis media<ul><li>Verify that tympanic membrane is intact</li><li>Anesthetic ear drops or systemic ibuprofen/Tylenol</li><li>Abx if nonsevere bilateral or severe bilateral</li><li>If <2 years, consult with parents about abx vs observation</li><li>If >2 years, observe 48-72 hours for improvement before abx</li></ul><div></div> S/S of tonsillitis<ul><li>Tonsils inflammed and covered with exudate</li><li>Lymph nodes may be enlarged</li><li>May be accompanied by high fever</li></ul> "Make sure to [...] after throat infection""Make sure to change out toothbrush after throat infection " When do children begin to have memories of pain6 months Pain scale for newborns/infantsNeonatal Infant Pain Scale Pain scales for toddler<ul><li>FLACC</li><li>Oucher Scale</li><li>FACES Pain Relating Scale</li></ul> FLACC<ul><li>Faces</li><li>Legs</li><li>Activity</li><li>Cry</li><li>Consolability</li></ul> Pain scales for preschoolers<ul><li>Oucher Scale</li><li>Faces Pain Relating Scale</li><li>FLACC</li></ul> Do not use ibuprofen for infants younger than6 months Long-bone growth continues until20 years old "Ligaments are [...] than bones until puberty""Ligaments are stronger than bones until puberty " Metatarsus adductusIntoeing Talipes equinovarusClubfoot Treatment of talipes equinovarus<ul><li>Series of casts (long-term)</li><li>Possible surgery</li></ul> Unilateral dilated and reactive pupil associated withintracranial mass Fixed and dilated pupil may indicateimpending brainstem rupture Bilateral fixed and dilated pupils associated withbrainstem herniation from increased ICP Febrile seizures occur in children3 months to 5 years Status epilepticus lasts for over 30 minutes Monitor these parameters during status epilepticus (5)Monitor: <ol><li>Electrolytes</li><li>Glucose</li><li>Blood gases</li><li>Tempterature</li><li>BP</li></ol> How to hold infant for LPChin to chest, chest to knees CSF proteins >200 in Bacterial and fungal meningitis CSF glucose <40 inbacterial meningitis Elevated CSF pressure inBacterial, sometimes fungal meningitis Opsithontonic positionNeck and head hyperextended EncephalitisInflammation of brain Reye syndrome is a form ofacute encephalopathy Toxic salicylate dosage for 30 lb child48 baby aspirin (3888 mg) -> 0.23 mg/kg/dose Guillain--Barre SyndromeAcute inflammatory peripheral neuropathy Treatment of status epilepticusEmergency: <ul><li>Patent airway</li><li>Supplemental O2</li><li>VS and cardiac monitoring</li><li>Neuro checks q 5-10 mins</li></ul><div>Ongoing (urgent) treatment:</div><div><ul><li>Assess BG</li><li>NG tube</li><li>Protect from injury</li><li>Thermoregulation</li></ul><div>Medications:</div></div><div><ul><li>Benzo</li><li>Fosphenytoin (Dilantin), levetiracetam (Keppra), phenobarbital</li><li>Prepare for intubation due to meds</li><li> </li></ul></div> "GB syndrome begins in [...] and moves [...]""GB syndrome begins in lower extremities and moves up the body " S/S of GB (3)<ol><li>Weakness</li><li>Ataxia</li><li>Bilaterial parasthesia --> paralysis</li></ol> Most common age for GBS is4 to 8 years old HydrocephalusImbalance of production and absorption of CSF --> increased ICP Treatment of hydrocephalusVentroperitoneal shunt Nursing management of hydrocephalus<ul><li>Compare HC to parents</li><li>Monitor of S/S of ICP</li><li>Preop care</li></ul> S/S of spinal bifida<ul><li>Impaired mobility</li><li>Impaired urinary elimination</li></ul> Nursing management for SB<ol><li>Transfer to specialty unit/hospital</li><li>Monitor sac for leakage</li><li>Assess extremities for deformities</li></ol> Prevention of SB0.4 mg/day supplement for all women of child bearing age Risk factors of SB<ul><li>More common in boys</li><li>Drugs, chemicals, radiation exposure</li><li>Low maternal vitamine B12</li><li>Maternal hyperthermia</li><li>AED use in pregnancy</li></ul> Treatment of SBAntenatal surgical intervention Nursing management of SB<ol><li>Daily HC measurement</li><li>Side-lying position while sleeping</li><li>Keep diaper away from incision site</li><li>Assess motor deficits, infection, and bladder and bowel involvement</li><li>Urinary catherization</li><li>ROM ASAP</li></ol> How is the face shaped in people with Fragile X syndrome?Long Describe the jaw of those with Fragile X syndromeProminent What size are the ears of those with Fragile X syndromeLarge Which diseases are associated with epicathnal folds?Down syndrome, Fragile X syndrome, FAS What eye movement disorder is associated with Fragile X?Strabismus Clinical manifestations and time frame of Kawasaki disease in the subacute phase2 weeks JC-CPT <ul><li>Joint pain</li><li>Cardiac disease</li><li>Cracking lips</li><li>Peeling fingers and toes</li><li>Thrombocytosis</li></ul> Clinical manifestations and time frame of Kawasaki disease in the convalescent phase6-8 weeks Normal, but lingering inflammation Skin color of dehydrated child by degreeMild: pale Moderate: gray Severe: mottled Skin elasticity for dehydrated childrenMild: decreased Moderate: poor Severe: very poor Mucous membranes for dehydrated childrenMild: dry Moderate: very dry Severe: parched Urine output for dehydrated childrenMild: decreased Moderate: oliguria Severe: marked oliguria Heart rate for dehydrated childrenMild: normal Moderate: increased Severe: rapid Blood pressure for children with dehydrationMild: normal Moderate: normal or lowered Severe: lowered Nursing Management of Kawasaki Disease<ul><li>Temperature q4h</li><li>Passive ROM</li><li>Educate parents on temperature log, follow-up for cardiovascular complications</li></ul> Antibiotic for rheumatic feverPenicllin Cardiac complications of Kawasaki diseaseCoronary artery disease and aneurysms Etiology of talipus equinovarus<ul><li>Isolated deformity</li><li>Chromosomal defect</li><li>Spina bifida</li><li>Cerebral palsy</li></ul> CXR findings in AV canalCardiomegaly, pulmonary vascular markings EKG findings in AV canalProlonged PR interval, enlarged ventricles Simple febrile seizure<15 minutes Complex febrile seizures>15 minutes "BMR rises during [...] increasing demand for [...]""BMR rises during status epilepticus increasing demand for glucose and oxygen " S/S of simple focal seizureTwitching, change in sensation S/S of comples focal seizuresConfusion Ketogenic diet may causekidney stones "Guillan-Barre syndrome is the most common cause of [...] in childhood""Guillan-Barre syndrome is the most common cause of acute flaccid paralysis in childhood " GBS most commonly affects4-8 year olds Spina bifida patients at risk for latex allergies "Assess spina bifida children for [...] beginning at birth""Assess spina bifida children for scoliosis beginning at birth " Nursing management for spina bifida<ol><li>Measure HC</li><li>Side-lying sleep</li><li>Diaper away from incision</li><li>Catheterize regularly if needed</li><li>ROM ASAP</li></ol> Education for parents with children with spina bifida<ul><li>Immunizations may cause seizures if disorder exists</li><li>Screen for scoliosis</li></ul>

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