d 3 Flashcards
Pyloric stenosis
what and s/s
- A narrowing of the outlet from the stomach to the small intestine (called the pylorus) that occurs in infants, usually 2 – 8 weeks of age
s/s
- Forceful vomiting – projectile (Non-bloody and non-bilious)
- Hungry after emesis and feed vigorously
- Decreased urine output
- Weight loss despite ++feeding
pyloric stenosis
diagnosis, managment
Diagnosis
- Electrolyte imbalance and metabolic alkalosis
- Visible gastric peristalsis left to right following feeding
- Diminished or absent bowel sounds
- Curdled milk appearance in emesis
- Signs of dehydration
- Ultrasound/upper GI series (if olive not felt)
Management:
- NPO
- IV access/blood work
- Replace fluids and electrolytes to correct dehydration and metabolic abnormalities
- Ensure adequate urine output
- Consider NG tube / Surgical consult
- Treatment is surgical repair
intussusception
what? classic triad?
- A loop of bowel has slipped into another section of bowel –telescoped
- Swelling, reduced blood flow, obstruction, and tissue damage
Classic triad
- Vomiting
- Bloody, mucoid (“currant jelly”) stools
- Intermittent colicky abdominal pain – with distention and tenderness
intussusception
managment and complications
Management
- NPO
- IV – rehydrate
- May require NG tube (decompress intestine)
- Radiologist/surgeon will attempt to reduce with an air enema if child stable
- Admit for observation if successful // Prepare for OR if not successful-surgical emergency
Complications
- Necrosis of bowel
- Perforation of bowel
- peritonitis
- Shock
- Sepsis
- Recurrent intussusception
volvulus
Cause? s/s Complications? Managment?
Caused by
- malrotation of bowel –> Bowel twists on itself
- Mid gut volvulus most common type
s/s
- bilious vomiting
- abdominal pain
- constipation
complications
- Surgical emergency
- Severe dehydration
- Electrolyte imbalance
- Prolonged vomiting can lead to shock
Management:
- IV rehydration
- Gastric decompression (consider NG)
- Surgical consult
- Emergency surgery
Blunt trauma // splenic injury
Causes? Signs of splenic injury? Tx
- Causes: falls, MVCs, NAI, etc.
- Can injure Liver, spleen and fluid filled loops of small bowel most commonly injured
- Most common solid organ injury is spleen
Classic sign:
- LUQ pain and referred pain left shoulder
Treatment
- If patient has stable VS will have imaging to confirm
- Treatment is conservative if stable: admit for observation
IV boluses, CBC, type and cross match and analgesia
Blunt trauma complications
why conservatice tx, complications
Why conservative treatment?
- Spleen filters blood and removes old/damaged cells
- Can live without it but
- immuno-compromised
Complications
- Medical and Surgical Medical Emergencies
- Severe dehydration
- Hemorrhagic shock from GI bleed or abdominal injury
- Bowel obstruction // intussusception // malrotation and volvulus
- hernia
- post-operative adhesions –> necrosis of bowel
- Peritonitis
- Sepsis
sickle cell disease
Definition
- Chronic disease with acute exacerbations, Caused by mutation in DNA resulting in absence of normal HbA
RBC effect
- Healthy RBCs are flexible, biconcave discs with lifespan of 120 days
- SCD RBCs polymerize, forming microtubules making cells crescent-shaped and friable with 10–20-day lifespan
- They get stuck in small vessels and occlude them → hypoxia
- Leads to vaso-occlusion
Genetics
- Autosomal recessive trait
sickle cell presentation, pain and managment
result of what 3 factors
Presentation
- Pallor/Jaundice
- Often anemic d/t immature cell death
Result of three factors
1. Ischemia due to occlusion of vessels by misshaped RBCs
2. Endothelial damage
3. Local inflammation
Pain
- Vaso-occlusive crisis is hallmark of SCD
- Debilitating pain
- Hydromorphone is not even effective
- Most common reason to seek care
Management
- Penicillin prophylaxis
- Hydroxyurea
- Folic acid supplement
- Transfusions/Chelation
racism in SCD
Racism
- Sickle cell disease predominantly impacts people of African descent
- Racism in the care of patients living with SCD is well documented
For the child
- Medical nonadherence, mistrust of HCPs, poorer psychical and mental health outcomes across the lifespan
- Pain is not consistently validated; often undertreated and experience longer delays in medication administration than white children
- Lower-quality care for children across
Cancer
mutation results in?
What is Cancer?
- Genetic mutation
- Permanent DNA alteration
- Begins in single cell (clonal)
Mutation results in
- Lack of differentiation
- Loss of contact inhibition
- Unregulated growth
- Cellular immortality
cancer treatment modalities
Treatment Modalities
- Chemotherapy
- Biotherapy
- Immunotherapy
- Radiation
- Surgery
- HSC (stem cells)
- bone marrow transplants
pediatric palliative care differences
- Same definition as palliative care but caters to unique needs of the child and their family
Differences include:
- Prognosis, life expectancy & functional outcome often unclear
- Greater use of intensive disease-modifying or life-sustaining treatments
- Focus on growth & development at the same time as death
- Greater physical & emotional burden for families
- informational, recreational and educational needs change as child grows
- Greater number of congenital anomalies
pain and sx managment
medical
Analgesics
Antacids
Antibiotics/Antivirals
Anticholinergics
Anticonvulsants
Antispasticity
Benzodiazepines
Chemotherapies/Radiation Therapies
NSAIDs
Surgeries
Opioids
pain managment
non pharm interventions
- Arts & Crafts
- Bath
- Change of position
- Change of location
- Distraction
- Essential Oils
- Hot/Cold Compresses
- Massage/Acupuncture
- Music
- Physical activity
- Play (one-on-one, with peers)
