Exam 3 Flashcards
(253 cards)
1
Q
Growth of bone + bone plates
A
300 at birth- ossify to form 206 bones
plates- open until early 20’s
2
Q
child v adult bone composition
A
more porous + elastic- less dense
inc strength
thicher periosteal sleeves
3
Q
bone abnormalities characteristic of childhood
A
flat feet until 6 yrs old (inc stability)
pigeon toed gait until 8 yrs
knock knees until 7 yrs
4
Q
importance of early ambulation
A
risk for DVT, ileus, and pneumonia
5
Q
pectus excavatum- def, cause
A
cause- congenital deformity- ribs and sternum grow inward
severity inc during growth spurts
inc risk w/ scoliosis
more common in boys
6
Q
pectus excavatum- s/s
A
inc risk respir infections, chest pain, fatigue
7
Q
pectus excavatum- treatment
A
surgery physical therapy straight posture- no lifting for 1st mo PO PO 3 mo resume normal act. no contact sports until 6 mo PO metal plates removed 2 yrs PO
8
Q
pectus excavatum- PO considerations
A
pain management breathing exercises IS monitor respir system circulation (pulses and cap refill)
9
Q
pectus excavatum- immediate wheezing
A
med emergency
lung compression
10
Q
osteogenesis imperfecta- cause, types
A
genetic collagen (CT protein) disorder 8 types type 1 most common and mildest form
11
Q
osteogenesis imperfecta- s/s
A
frequent fx, blue sclera, hearing loss, short stature, triangular face
12
Q
osteogenesis imperfecta- trtmnt
A
palliative can have rods in femurs strengthening muscles and preventing fx aqua therapy (no PT) encourage activity w/ peers growth hormones and bisphosphonates (bone growth) pain management!!!!
13
Q
osteogenesis imperfecta- considerations during care
A
avoid blood p cuffs, rough handling, no tourniquets
14
Q
blount disease- cause, def
A
bowed legs
tibial growth plates turns inward of lower legs- worsens w/ time
NOT normal after age 3
15
Q
blount disease- s/s
A
diff. leg lengths
knee pain
16
Q
blount disease- inc risk
A
obsese
vitam d deficient
17
Q
blount disease- trtmnt
A
bracing if < 4yrs
surgery
casts
ex fix postop
18
Q
blount disease- complications post op
A
inc risk compartment syndrome, DVT (d/t delayed ambulation)
19
Q
blount disease- PO care
A
psychosocial support (inc risk of depression) CMS- cap refil, color, pulses, sensation, skin checks (ex fix) good nutrition (vitamin D supplementation)
20
Q
congenital clubfoot
A
more common in boys serial casting change casts weekly (begin early before bones ossify) bracing 2-4 wks after COMPLIANCE w/ nonsurg trtmnt key
21
Q
developmental dysplasia of the hip- def and cause
A
diagnosed during newborn examination (ROM w/ legs and listen for clicks)
may not be noticed until walking
socket more horizontal- easier to dislocate
socket does not cover ball adequately
22
Q
developmental dysplasia of the hip- s/s
A
limited hip ABduction
uneven thigh skin (if displaced, leg longer and less skin folds)
clicking (Ortolani/barlow test)
limping gait
23
Q
developmental dysplasia of the hip-trtmnt
A
< 6 mo- bracing (Pavlik harness)
6-24 mo- closed reduction
> 2yrs- open reduction
24
Q
developmental dysplasia of the hip- PO care
A
spica casting= allow for tissue repair
double diaper, watch for skin brkdwn
CMS, infection and bleeding
25
rickets- def/ cause
young bone does not calcify
cause- vitamin D deficiency
common in dark skin + limited exposure to sun who are exclusive breastfed and do not have vitam d supplement
26
rickets- trtmnt, s/s
diagnosed before 1 yr
s/s- weakness and inability to walk
trtmnt- vitam D supplementation
foods- fortified dairy, eggs, fatty fish, chicken livers
sunlight
27
rickets- magnesium
AVOID mag products
28
slipped capital femoral epiphysis- def & cause
hip disorder
most common disorder in teens
cause- growth spurts
29
slipped capital femoral epiphysis- inc risk
```
male
obesity
renal dis
thyroid dis
pituitary disorders
family hx
if happens once unilaterally more common to happen again bilaterally
```
30
slipped capital femoral epiphysis- stable v unstable
stable- mildy aches, pain and limping
unstable- completely off, cannot walk
MEDICAL EMERGENCY
31
slipped capital femoral epiphysis- trtmnt
non WB
surgery
crutches w/ toe touch WB for 6wks PO
32
slipped capital femoral epiphysis- PO care
dressing change, pain management, CMS
33
legg calve perthes disease (LCP)- def/cause
blood supply to femoral head disrupted
causes necrosis and bone cell death
common in 6-10 yrs
inc risk boys
34
legg calve perthes disease (LCP)- stage 1
1- avasc necrosis (LCP can cause SCFE)
damages bone cells
femoral head becomes flattened and deformed
35
legg calve perthes disease (LCP)- stage 2
fragmentation and absorption 1-2 yrs
| body remodels dead bone w/ new soft bone
36
legg calve perthes disease (LCP)- stage 3
bone hardens and begins to look regular- multiple years
37
legg calve perthes disease (LCP)- stage 4
healing
38
legg calve perthes disease (LCP)- s/s
dec muscle mass and limping
39
legg calve perthes disease (LCP)- trtmnt goals
relieve pain, protect femoral head shape, restore hip movement
40
legg calve perthes disease (LCP)- trtmnt
< 6yrs- self limiting
6-8- casting
> 8 yrs- surgery
casting PO
41
legg calve perthes disease (LCP)- PO care/ pt ed
trtmnt modes
use assistive devices for ambulation
limit weight bearing
42
osteomyelitis- def
inflamm of bone
secondary to bac infection
cause- bacterial staph aureus
50% happen after trauma or surgery
43
osteomyelitis- s/s initial v late
intitial- vague, systemic, fever, malaise, fatigue
| late- bone pain, difficulty bearing weight, swelling, redness, warmth of extremity
44
osteomyelitis- trtmnt
antibiotics
*get blood cul. before prescribing
PIC line w/ long term antib 4-8 wks
IV antib at first, PO after several wks
45
osteomyelitis- pt ed
how to care for drains (wash hands before), changing dressings, s/s of infection, how to care for PIC line
46
scoliosis- cause/def
progressive LATERAL curvature of spine w/ rotation of vertebrae
classified by curve location/ cause
80% idiopathic adolescent
47
scoliosis- types
Infantile scoliosis- < 3yrs Diagnosed after freq respir infections and pneumonia bracing q monthly
Juvenile 3-10
Adolescent > 10yrs
Neuromuscular- diagnosed secondary to neuromusc disease
Idiopathic- most common (happens in adolescents)
48
scoliosis- s/s
truncal asymm, uneven shoulders, raised hips, rib hump
49
scoliosis- trtmnt
bracing
16-23 hours/day
surgery- spinal fusion
50
scoliosis- PO care + goals day 1 v day 2
goals-
day 1- sitting in chair
day 2- ambulating on feet
51
scoliosis- PO care
PCA
epidurals due to muscle spams
neurovasc checks
CMS
52
scoliosis- pt ed
```
activity limitations
no bending, lifting or twisting
parental support of child
no school 2-4 wks
normal act. 3-4 mo
wean off pain meds
```
53
strain v sprain
strain- stretched or torn muscle/tendon
sprain- injury to ligament
inc risk during growth spurts
common in ankle, knee and shoulder
54
strain + sprain- s/s
pain, swelling, difficulty moving area
55
strain + sprain- trtmnt
```
RICE
rest- avoid WB for 48-72 hrs
ice- 10-20 min 3x daily
compression
elevation- above level of heart
immob- 10-14 days
bracing
PT
```
56
fx- growth plate
higher risk deformity and impaired healing
57
fx- s/s
swelling, pain, abnormal positioning, inability move affected area
58
fx- upper extremity
more common in kids bc inc activity and dec coordination
59
fx- trtmnt
```
reduce fx and immobilize
closed or open
closed- pop back and cast
open- surgery w/ pins/plates
need antib
splint
traction
```
60
fx PO care- education
educate on s/s infection (fever, myalgia, chills, night sweats)
61
fx PO care
infection control
| CMS, tingling, pulses, cap refil
62
spiral fx and greenstick
spiral- < 4ys toddler fx
nondisplaced spiral fx of tibia common
greenstick- break one side of bone
63
cast care
```
elevate and ice to prevent swelling
assess s/s infection (odor, drainage, fever, warmth)
assess skin brkdwn
hair dyer blow up cast to dec itching
avoid prolonged sun exposure
```
64
compartment syndrome- def
fascia not allow swelling to distribute
| can impair tissue circ. and cause necrosis
65
compartment syndrome- inc risk
cast, trauma, bone fx
| casting- edema builds inside rigid cast
66
compartment syndrome- s/s
```
pain unrelieved by meds and not proportional to injury
pallor
pain
paresthesia (tingling)
paralysis
pulselessness
```
67
compartment syndrome- trtmnt
MED EMERGENCY
| remove cast or fasciotomy
68
compartment syndrome- PO care
freq dressing changes
wound vac
CMS
monitor for s/s worsening compartment syndrome
69
traction- purpose
puts bones in alignment before surgery
| improves pain and dec music. spasms
70
traction- types skin v skeletal
skin- indirect pulling on skin, puts traction on muscle and bone (BUCKS, bryant or russel)
skel- surgically placed pins through bone
ex. cervical halo
71
traction-positioning and care
straight and supine espec w/ skin traction
| freq repositioning, and neurovasc checks
72
traction- common types
buck extension- 20 lbs
russell
cervical
73
stress fx- stage 1
pain after physical activity
74
stress fx- stage 2
pain during act- not restrict performance
75
stress fx- stage 3
pain during act- restricts performance
76
stress fx- stage 4
chronic pain during act. And rest
77
stress fx- def
microtrauma damage to bone, muscle, tendon from repetitive stress w/o time to heal
common in athletes- 4 stages
78
common overuse injuries
osgood schlatter dis (patellar issue)
patellar tendonitis
stress fx
throwing injuries
79
stress fx- trtmnt
```
prevention is key
PT, stretching
limit activity
take 2-3 mo off / yr
multisport athletes should have strength/conditioning training
```
80
sensory v motor
sensory- afferent
| motor- efferent
81
neuromusc system in children
fully formed at birth but immature
| gross and fine dev over first 2 yrs
82
age specific developmental milestones
3 mo- hold head up
6 mo- sitting
9 mo- crawling
12 mo- walking
83
intrinsic v extrinsic factors neuromusc dev
intrin- event at birth
| extrin- neglect
84
developmental primitive reflexes
Babinski, rooting, palmar
| not normal after 3 mo
85
Cranial nerves- 1-6
```
I - olfactory
II- optic
III- oculomotor
IV- trochlear
V- trigeminal
VI- abducens
```
86
Cranial nerves- 7-12
```
VII- facial
VIII- vestibulochoclear
IX- glossopharyngeal
X-vagus
XI- accessory
XII- hypoglossal
```
87
CN- I
olfactory
| reaction to noxious odor
88
CN- II
optic
ability to regard person's face
maintain eye contact
trach and reach for object
89
CN-III
oculomotor
move bright color toy through visual fields to see if tracking
corneal light reflex
pupillary respone
90
CN- IV
trochlear
| symm. eye movmnts and corneal light reflex
91
CN- V
trigeminal
| response to light touch on face
92
CN- VI
abducens
| same as trochlear (IV)- symm eye mvmnt
93
CN I, II, III, and VI
move bright toy to assess
94
CN VII
facial
| Facial symmetry during crying (motor) and response to salt solution on tongue (sensory)- saline solution on tongue
95
CN VIII
vestibulocochlear
| Ability to startle to loud noises and turn to a familiar voicenormal- turn towards noise
96
CN IX
glossopharyngeal
observe strength, quality of cry
ability to suck/swallow
gag reflex
97
CN X
vagus
same as glossoph.
gag reflux
suck and swallow
98
CN XI
accessory
| ability to perform coord movmnts of neck and shoulders
99
CN XII
hypoglossal
| symm movmnts of tongue
100
neuromusc assessment- musc tone
```
hypotonia or hypertonia (contractures)
active and passive ROM
5 point scale
0- flaccid
3- overcome gravity
5- normal
```
101
neuromusc assessment- coordination
walking, finger and thumb
102
neuromusc assessment- tendon reflexes
biceps, triceps, brachiorad, patellar, achilles
103
diaphragmatic weakness care
positive pressure ventilation
104
cerebral palsy- cause/def
```
nonprogressive, permanent disorder
cause- improper dev or insult to brain
85-90% congenital
ex. brain damaged at birth or in utero
uterine infection, infarct (cord compression)
```
105
cerebral palsy- aquired
after birth up to first 28 days
infection - group b strep, meningitis, trauma, bleeding or stroke
*importance of vitamin K
106
cerebral palsy- spastic
most common
| hypertonic, rigid
107
cerebral palsy- dyskinetic
inc and dec tone, difficulty using voluntary muscles
108
cerebral palsy- ataxic
abonormal gait
109
cerebral palsy- considerations
not always cognitively delayed
| most common disability in kids
110
cerebral palsy- s/s
inc or dec musc tone, gross/fine motor delays, feeding difficul, seizures, joint deformities
111
cerebral palsy- what o/ condition is commonly associated
scoliosis
112
cerebral palsy- trtmnt
```
PT, OT, Speech
case manager- community resources
EARLY INTERVENTION
assistive technology
baclofen pump- dec music. spasticity
vagal nerve stimulator
```
113
spinal muscular atrophy- cause/def
loss motor function of entire body
cause- mutation in survival of motor neuron
degen of motor neurons in anterior horn cells of SC
114
spinal muscular atrophy- characteristics
progressive
symmetrical weakness
atrophy of prox muscles
premature death
115
spinal muscular atrophy- infantile
most severe
freq respir complications, belly breathingdiagn 1-3 mo ages.
Do not live past 2yrs w/o medical intervention
116
spinal muscular atrophy-s/s
musc weakness, hypotonia, respir compromise, inadeq weight gain, contractures, scoliosis
cannot hold head up, can't roll over
diaphragmatic breathing
117
spinal muscular atrophy- trtmnt
early PT
braces/orthotics
stretching
118
spinal muscular atrophy- pulmonary interventions
chest physiotherapy- shaky vest
1-2x day break up secretions
trac/vent
noninvasive BPAP/CPAP
119
spinal muscular atrophy- feeding interventions
enteral feeding
| risk of aspiration
120
spinal muscular atrophy- medications
```
Beta-2 adrenergic agonist to facilitate breathing (albuterol)
Medications for gastrointestinal reflux
Prophylactic antibiotics (UTI, pneumonia)
```
121
spinal cord injury- common locations based on age
toddlers- cerv
5-8 yrs- thoracic
teens- lumbar
122
SC injury- SCIWORA
spinal cord injury w/o obvious radiographic abnormality
spinal cord moved but bone was not affected, only impinged
common in kids
123
SP injury- s/s- cervical
C-5 and below = stay alive
| C-5 and above= diaphragm not innervated, need vent
124
spinal shock
Low sensation, movement below location of injury
| No reflexes, flaccidity
125
autonomic dysreflexia
internal stimuli to spinal cord- ex. Full bladder brain activates parasympathetic
s/s bradycardia, hypertension, facial flushing & HA
Trtmnt- resolve underlying cause
126
SC injury- trtmnt
immobilize
surgical decompression
manage spasticity (PT, stretching, splinting, meds)
127
poikilothermia
(child adapts environmental temperature)
128
guillain barre syndrome- def/cause
after respir infection or acute otitis media (recent bac or viral infection)
acute inflamm demyelinating polyradiculoneuropathy
autoimmune attack on periph nerves
demyelination of periph nerves
129
guillain barre syndrome- charac
ascending
paralysis
starts in feet and moves up
CSF has protein levels 2x more than normal value
130
guillain barre syndrome- s/s
```
ascending hypotonia
numbness
pain
dec or absent DTR
weakness develops over days and up to 4 wks
```
131
guillain barre syndrome- trtmnt
intubation, respir support
IVIG - IV immune globulin
5 consec days
plasmapheresis= alternative to IVIG- not preferred
periph nerve function + strength will return
132
guillain barre syndrome- pt ed
can progress 4-6 wks after initial diagnosis
133
botulism- cause/def
neuroparalytic
cause- clostridium botulinum bacteria
neurotoxin from spores
not give honey < 1yrs
134
botulism- classification cause
foodborne, wound, adult intestinal colonization, dirt/soil, poorly canned food
135
botulism- s/s
poor feeding, drooling, floppy, constipation
hypoxia, tachypnea
DESCENDING
136
botulism- trtmnt
supportive care
botulism immune globulin
fluids, nutrition, respir support, therapy
137
botulism- considerations
delay immunizations for 11 mo after admin
| rash most common side effect
138
immune- natural barriers
skin (low pH) hard for bac to live
| normal flora
139
inflammatory response
chem released in response to an infection
macrophages attack foreign antigens
presents bac on surface after attacking
140
specific immune response- antibody and antigen
antibody- proteins produced in the body, specific to different antigens
antibody binds to antigen (marks for macrophage)
141
ability to "gain immunity" means
ability to produce antibodies
142
b lymphocytes
type of WBC
humoral response- w/in fluids of the body
made in bone marrow
function- to produce antibodies in response to antigens
143
T lymphocytes
Cell mediated response
Kill cells already replicated by virus
Made in thymus
Produces cellular death
144
killer t cells
find infected cells, bind to them and kill
145
helper T cell
initiates cell mediated AND humoral response
cells are activated after they bind to the antigen
activate killer T cells- cell mediated response
signal macrophages to kill
tells B cells the shape of the antigen (creates antib)- humoral response
146
stages of immunity- initial response
```
b cells (humoral) and killer t cells (cell mediated)
first exposure
```
147
protective immunity
inapparent reinfection
| body takes care of itself
148
immunity memory
mild or inapparent reinfection
149
function of immune system
defend against infection and maintain equilibrium
150
immunodeficiency v autoimmune disorder
immunodef- under-functioning
| autoimmune disorder- over functioning (hypersensitivity reactions)
151
humoral immunity
involves b cells
| recognized specific antigens and secrete antibodies
152
cell mediated immunity
t cells
| attack antigens marked by the b cells
153
innate immunity
nonspecific immune functions
protective barriers
activated in presence of antigen but not specific to that antigen
first line of defense
154
adaptive immunity
humoral or cell mediated
2nd line of defense
lasts wks-months even yrs
155
child differences- immune function
lymphoid organs are large at birth - adult size by 6wks
shrink at puberty
*except -spleen does not reach full size until adulthood
less fat on stomach= higher risk for splenic rupture
immune system less effective- dec amnts of immunoglobulins
lymphoid (peyers patches) line intestine- peak btw 15-25 and then dec
156
immune system responses- abnormalitites
higher risk of developing infections and sepsis
s/s of infection less prominent in kis
inc spread of infection d/t close contact and poor hygiene
157
active immunity v passive immunity
active- humoral and cell-mediated (adaptive)
passive- immediate but short term (innate)
158
live attenuated vaccine
ex. MMR
made of weakened pathogen
contraindicated if immunocompromised
159
inactive vaccines
ex. polio
dead virus
dont create long lasting immunity
160
Sub-unit vaccine
ex. influenza
| made from antigen of virus
161
DNA vaccine
Genes injected stimulate body to make antigens (of virus)
Body reacts and produces antibodies
Creates memory
162
immune- nursing interventions
prevent/manage allergic response (teach about triggers)
promote skin integrity
promote comfort/pain relief
163
immunity- vaccine considerations
If vaccine admin 4-5 days before minimum age
not valid
Ex. Recommended at 4 months
If kid is 3 months and 25 days. Have to repeat vaccine
164
immunodeficiency disorders- cause and s/s
usually inherited/ congenital
s/s- repeated and persistent infections
opportunistic infections (yeast), frequent skin lesions
(rash/ skin condition first sign)
165
immunodeficiency disorders- risks assoc. w/ and trtmnt
risks- developmental delay!!
trt- hematopoietic stem cell transplantation
IVIG prophylactically until transplantation (intravenous immune globulin)
166
allergy- def
response to antigen (allergen) from exposure to environment or food
causes hypersensitivity rxn
after 2nd exposure to allergen rxn can be immed or delayed
167
allergies- diagnosis
personal/medical hx
physical examination
diagnostic testing (lab)
can use allergy testing to diag. and id allergens
168
allergy- s/s and trtmnt
s/s- itchy eyes, hives, cough, wheezing, sob, redness, pain, throat closing, rash
trtmnt- antihistamines, bronchodilators, corticosteroids, preventative inhaled meds
169
food allergies
IgE mediated or non IgE mediated
170
allergies- wheezing
indicates edema in airway
| sign of respiratory distress
171
food intolerance
abnormal physiological but not immunological response
| provide teaching on how to read food labels
172
key consideration w/ allergy trtmnt
avoid exposure to allergen
173
reactions to natural latex
IgE mediated
cell-mediated contact dermatitis
irritant dermatitis
174
anaphylaxis
acute, immed IgE mediated response to an allergen
occurs w/ in 5-10 min of contact w/ allergen
common triggers- nuts, shellfish, eggs, insect stings, penicillin, nsaids, dyes and latex
175
anaphylaxis- s/s
rash, coughing, lip/tongue swelling, stridor, extreme anxiety, asthma, loss of consciousness
176
anaphylaxis trtmnt/interventions
trt- epinephrine, corticosteroids, antihistamines
support airway w/ intubation and ventilation if tongue swelling and airway compromise occurs
assess circulation
admin IV fluids- promote volume expansion
monitor for 2+ hrs after reaction
outpatient setting- epi pen and call 911
177
epi pen instructions
sit/lie down
fist grip
press colored end into leg, hold for 10 seconds
call 911
admin if 2+ symptoms (harder to stop rxn the longer you wait)
178
function of endocrine system
glands secrete hormone to entire body via blood stream
| target cells receive hormone and create rxn
179
water soluble v lipid soluble hormones
water sol.- ex. epinephrine
bind to cell protein, use signal transduction
lipid soluble- ex. testosterone
move through cell bilayer
direct contact w/ cell nucleus
180
peds v adult endocrine
gonads develop overtime
gonads differentiate into testes/ovaries by week 10 gestation
important for growth and dev
181
anterior pituitary
Anterior pituitary:
Hormones: growth hormone, thyroid-stimulating, adrenocorticotropic, prolactin, follicle-stimulating, and luteinizing
Action- cell growth
Location- hypothalamus
182
posterior pituitary
Hormones: Antidiuretic and oxytocin
Action- water balance (retains fluid)
Location- hypothalamus
183
thyroid
```
Hormones: Thyroxine (T4), triiodothyronine (T3)
Action- metabolism
Hyperactive thyroid- high metabolism
Cushing syndrome- hypoactive thyroid
s/s- obesity, moon face, abdominal striae
Calcitonin
Action- lowers blood Ca
Location- throat
Stimulated by High blood Ca
```
184
parathyroid
Hormones: Parathyroid
Action- raises blood Ca
Stimulated by low blood Ca
185
adrenal medulla
Hormones: Epinephrine and norepinephrine
| action- fight or flight
186
adrenal cortex
Hormones: Cortisol and aldosterone (glucocorticoids)
Action- anti inflammatory
Activated by pituitary glands
187
pancreas
```
Hormones: Insulin
Action- lowers blood glucose
glucagon
Action- raises blood glucose
Releases glycogen from liver
```
188
testes
Hormones: Testosterone
189
ovaries
Hormones: Estrogens and progesterone
190
thymus
Hormones: Thymosin
location- btw lungs
spot of T cell maturation
191
pineal
w/in brain
Hormones: Melatonin
Secreted at night
Action- circadian rhythm
192
congenital hypothyroidism- def and cause
cause- congenital, autosomal recessive trait
deficient production of thyroid hormones
thyroid absent, or reduced in size
193
congenital hypothyroidism- s/s, diagnosis
s/s= low t3/t4, persistent open posterior fontanel, thickened tongue, dull expression, hypotonia, protruding abdomen, bradycardia, trouble feeding, constipation
id via neonatal metabolic screening
194
congenital hypothyroidism- trtmnt
synthetic thyroid hormone (sodium levothyroxine); frequent monitoring of levels.
Administer before eating (30- 1hr before breakfast)
Begin w/in 1-2 wks after birth
If untreated- can develop intellectual disabilities + slow growth
Monitor growth using growth charts and follow-up with pediatric endocrinologist.
195
acquired hypothyroidism- cause
underactive thyroid
| cause- diet, hashimotos (autoimmune), thyroiditis, meds, isolated thyroid-stimulating hormone deficiency
196
acquired hypothyroidism- s/s and diagnosis
s/s- inc fatigue, weight gain, cold intol, goiter, joint muscle pain, constipation, depression, bradycardia
diagnosed- t3/t4 tests, radiology
197
acquired hypothyroidism- trtmt
Treat with supplemental thyroid hormone (lower dose than in congenital hypothyroidism).
Avoid administering this medication near food consumption because it impairs absorption.
198
diabetes patho
```
CHO (carbs) used for energy
broke down into glucose (simple sugar)
Glucose absorbed into blood
enter cells w/ help of insulin
excess stored in liver
```
199
glucagon pathway
low blood sugar
secretes glucagon
stimulates liver to release stored glucose
200
insulin pathway
high blood sugar stimulates insulin secretion
| allows cells to absorb glucose
201
diabetes- cause
```
type 1 or type 2
Decrease in insulin production or insulin resistance
Overload of glucagon in blood
not consumed by cells
hyperglycemia
```
202
DM type 1- diagnosis, s/s, management
Autoimmune condition resulting in pancreatic damage and lack of insulin.
Manifestations: weight loss, polydipsia, polyphagia, polyuria, fatigue, blurred vision, and mood changes.
Diagnose with laboratory testing (e.g., hemoglobin A1C, fasting glucose, and plasma glucose).
Management is multi-faceted and includes:
Insulin therapy
Glucose monitoring
Insulin education
Maintaining proper nutrition
Patient and family education
203
type 1 diabetes s/s
weight loss, polydipsia (thirst) , polyphagia (hungry), polyuria (urination), fatigue, blurred vision, mood change
204
insulin types
```
rapid acting- Novolog, humalog
duration 3-5 hrs
short-acting- regular 5-8 hrs
intermediate-acting- NPH 10-18 hrs
long-acting- lantus 18-24 hrs
```
205
DM type 2- cause and def
May occur in teenage and school-aged children due to the increase in childhood obesity.
Pancreas produces insulin, but it is unable to be used by the body (insulin resistance).
206
DM type 2- inc risk and s/s
Inc risk- girls, early teens, weight, family hx, black, Hispanic, American Indian, maternal GA, LBW, preterm birth
can develop slowly, acanthosis nigricans (darkening of skin on back of the neck), polydipsia, polyphagia, and polyuria
207
DM type 2- trtmnt and considerations
increase in physical activity, diet changes, and metformin (antidiabetic agent) and insulin
insulin sub q 2xday before meals
Consider ethical concerns and the family’s socioeconomic status
208
DM associated conditions
affects kidneys, blood vessels, nerves, and eyes
| depression, adhd, anxiety, hypertension, kidney disease, nerve damage
209
DM- inc risk for
high cholesterol, stroke, kidney damage, hyper/hypoglycemia, DKA
210
DKA- characteristics
hyperglycemia, hyperketonemia, metabolic acidosis
Kussmaul respirations
osmotic diuresis
inc Na- initial lvls may be normal due to excess free water
dec K- can be normal at first d/t extracellular k migration from acidosis
211
considerations w/ insulin admin- electrolyte shifts
push K into cells
can cause hypokalemia
weakness, muscle cramps, palpitations
212
DKA- s/s, cause and trtmnt
```
S/S
n/v, cerebral edema
Causes
Infection, dehydration, lack of insulin, trauma
Treatment
Volume expansion
Insulin replacement (drip)
Prevention of hypokalemia
Cardiac monitoring
Prevention of cerebral edema
```
213
emergency assessment priority steps
ventilation, oxygenation and perfusion
vent- is airway patent and maintainable?
hear adven sounds, inc rate?
oxygenation- o2 sat
perfusion- cap refil, pulses, color, temperature
214
initial emergency assessment- SABCD
```
S- scene safety
A- assess need for CPR
spend less than 10 sec assessing for central pulse
head tilt/ jaw thrust to assess airway
monitor chest rise/ respirations
cap refill, bleeding, perip pulses, bp
neuro assessment, Glasgow coma scale
```
215
neuro assessment- avpu
alert
verbal stim
painful stim
unresponsive
216
central pulses
kid- carotid
| baby-brachial
217
immed signs- need for CPR
HR < 60
| brain, kidneys, and heart not adeq perfusing
218
atropine
anticholingergic
inc hr and cardiac output
use if hr <60
for intubation and suctioning
219
epinephrine
inc hr and systemic vasc. resistence
vasoconstrictor
used to realign heart rate
220
naloxone
for opioid overdose
reverses respir depression and hypotension
ae- pulmonary edema
221
respiratory arrest- def
severe respir dysfunction that leads to inadqe ventilation and oxygenation
usually proceeded by respir distress
222
respir distress pathway
distress (interventions= intubation, cpap) s/s= compensatory mech.
failure (s/s grunting)
arrest
death
223
respir arrest- complications
cardiopulmonary arrest if untreated
224
respir arrest- s/s
respir rate change
shallow chest rise
cynaosis
altered mental status
225
respir arrest- trtmnt
```
reverse if fix cause of distress
open airway
use bag valve mask until advanced airway placed (endotrach tube)
chest should rise symmetrically
encourage parent presence during CPR
ventilation needed after intubation
```
226
respir arrest- common causes- upper, lower, neuro, cardiac and trauma
upper airway- croup, epiglottitis- trt w/ steroids and racemic epineph
lower airway- asthma, bronchitis, pneumonia- albuterol
neuro- seizures, SIDS
cardiac- arrhythmias, myocarditis
trauma- burns, drowning, MVA
shock, CF, DKA, reflux!!
227
submersion- risk factors
can't swim, no physical barriers to water, lack close supervision
age 1-4 leading cause of death
males inc risk
228
submersion- pathway
after submersion
hold breath, panic, swallow water, aspirate, laryngospasm
hypoxia and hypercapnia= unconciousness
229
submersion- complications
brain damage, acute respir distress syndrome, lung infection
| 5 min under can cause brain damage
230
submersion- s/s
tachypnea, labored breathing, wheezing, sob, hypoxemia
231
submersion- trtmnt
```
CPR
high flow O2
ventilation to dec CO2
monitor temp
fluids and inotropic to restore volume
```
*monitor for pulmonary edema
232
submersion- trtmnt goals
optimizing oxygenation and cardiac output and controlling temp
233
shock- def
reduction in tissue perfusion= dec oxygen delivery to tissues and dec removal of metabolic by products (lactic acid)
prolonged o2 deprevation= cellular hypoxia and death
234
shock- types
hypovolemic, distributive, obstructive, cardiogenic
235
shock- classificaitons
type and then
compensated (homeostatic mech)
decomp (hypoten and rapid deterioration)
irrev (death)
236
shock- compensated
inc hr, inc rr, warm or cool skin
| bp last thing to change usually normal
237
shock- decomp
cool skin, dec periph pulses, dec urinary output, high hr, hypotension, altered neuro
238
shock- irreversible
dec hr, dec bp that is
UNresponsive to trtmnt
End organ damage
239
hypovolemic shock
loss of plasma or blood from intravasc space
DKA, n/v, dirrhea, dehydration, sepsis, burns
admin IV fluid replacement
assess for s/s fluid overload
inotropic meds if unresponsive to flid replacemnt
240
distributive shock
abnorm distribution of blood 2ndary to vasodil and cap perm.
less blood is returned to the heart- more blood in periphery
vessel problem
cause- sepsis, Spinal cord injury, anaphlaxis
241
distrib shock- trtmnt
anaph- fluids, epinephrine, hydorcortisone
sepsis- antib therapy and fluids
s/s- fever, <1 sec immed cap refil
spinal cord- reverse cause
242
obstructive shock
blockage blood to heart and major vessels
cause- tension pneumo (needle aspir + chest tube)
PE, congenital outflow obstruction, chest trauma
trt underlying cause- pericard drain for tamponade
chest tube for pneumoth
anticoag for PE
surgery
243
cardiogenic shock
impaired myocard function
unable maintain cardiac o and tissue perfusion
cause- cardiomyopathy, myocarditis (gallop when listening), electrolyte imbal, acid base imbal
trt- SMALL fluid bolus 10mL/kg- admin slowly 10-20 min
vasodilators
244
corrosives- trtmnt
give milk
do not induce vomiting
can cause respir compromise and respir depression (opioids)
245
poisoning- s/s
pallor, sweating, n/v, hypoten, tachypnea, seziures, bradycardia
246
hydrocarbons- trtmnt
call poison control
| need mechanical ventilation
247
beta blocker antidote
glucagon
| monitor w/ EKG for hypoten and bradycardia
248
meth antidote
supportive care- fluids
| tachycardia and hallucinations
249
activated charcol
use w/in 1 hr of ingestion
250
tylenol antidote
```
mucomyst
acetylcystiene
s/s- inc LFTs and bilirubin
r upper quadrant pain upon palpitation
n/v
```
251
aspirin antidote
sodium bicarb and charcol
| monitor for bleeding and kidney function
252
compensatory mech for shock- maintain cardiovasc function
heart- inc hr and contractility
blood vessels- vasoconstriction of vessels in skin and nonvital organs
253
compensatory mech for shock- maintain blood volume
hypothal- stimulatino of thirst
posterior pit- stimulation of ADH release and RAAS activated
adrenal cortex- release of aldosterone
kidney- sodium and water retention
dec urine output
liver- constriction of veins and sinusoids w/ mobilization of blood stored in liver
produces glucose
