Flashcards in Final Deck (62):
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cleft lip and palate
• Failure of development in first trimester of gestation
• Prevented by folic acid
• Can be lip or palate or both
• Usually occurs in isolation w/o any other problems
• Etiology: can be caused by smking, alcohol, anticonvulsants, phenytoin, steroids
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cleft lip and palate treatment
• Special feeders, keep upright after and during feedings, burp more frequently
• Repair lip in 6 months and palate in 18 months
• Post op – airway management, maintain suture line, nutrition
• Long term needs – dental care, orthodontia, speech/hearing, plastic surgery, self image
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Tracheo-Esophageal Fistula / TEF
• Esophagus ends and trachea is attached to stomach
• Malformation that happens in week 4 or 5 of gestation
• Triad S/S – drooling/choking, cyanosis and cough
• High aspiration risk. Surgical emergency – close fistula of trachea and esophagus, insert G tube and reattach esophagus
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TEF Preop
Suction any secretions, maintenance IV fluids, monitor VS
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TEF Postop
Measure gastrostomy drainage, IV fluids and antibiotics. TPN may be needed. Feedings introduced slowly and in small amounts. Assess for respiratory difficulty
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intussusception
part of intestine prolapses into another (small intestine into large). abrupt onset, pain, vomiting and currant jelly stools (bright red, mix of mucus and blood). can cause bowel ischemia, perforation and periodontitis
tx: enemas or surgery. then watch for return of normal brown stools
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volvulus
abnormal rotation of intestine into abdominal cavity during development
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pyloric stenosis
• Overgrowth of pyloric muscle
• Obstruction in passage of stomach and duodenum
• Causes projective vomiting, dehydration, irritability and hunger, hard mass abdomen w/ visible peristalsis, scrawny baby
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Hirschsprung Disease
• Congenital
• Lack proper innervation of colon
• Lack peristalsis, may have constipation
• Tx: remove effected part of the bowel
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imperforate anus
anus is not fully developed. repair surgically. risk for fibrosis or scarring of tissue during surgery (so they have less control or feeling there). may need anal dilation
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hernias
protrusion of an organ through the muscle wall of the cavity that normally contains it. Inguinal and umbilical hernias are common in children
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appendicitis
• Most common cause of emergency abdominal surgery in children
• Inflammation of appendix
• S/S – vomiting, fever, localized pain
• If they suddenly feel better it likely means they ruptured
• Tx – surgical removal
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short bowel/gut syndrome
decreased capacity to absorb/digest food due to loss of intestine (can be from many different causes/conditions). may need TPN, may recover. goal is to get to enteral and oral feedings
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colic
• Paroxysmal abdominal pain in young infants
• Onset is 2 to 6 weeks and resolves by 3 months
• Baby cries a lot
• Tx - Need to support families, rocking baby rhythmically, white noise, swaddling, pacifier
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Gastroesphageal reflux
• Most common cause of organic failure to thrive
• Backflow of gastric contents into esophagus bc sphincter is inappropriately relaxed
• Common < 3 months of age
• Tx – depends on severity. Positioning (on left side), meds (Zantac, PPI), smaller feedings with food that digests quicker
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G tube indications
Indications: difficulty swallowing, inadequate nutrition, difficulty gaining weight
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gastroenteritis
inflammation of stomach and intestines. 2nd leading cause of death worldwide in children under 5. very common, dehydration, vomiting, diarrhea. wash hands to prevent spread.
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constipation
• Difficulty passing stool or hard stool
• ¼ of all GI referrals
• Managed with diet, fluids, meds (stool softener or enema) and toileting routine
• Encopresis – hold BM so long that it builds up in gut
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clubfoot / talipes equinovarus
• Genetic component and more common in males, may be secondary to abnormal uterine positioning, may be neuromuscular or vascular problems
• Foot folded up against leg, muscles in lower limbs atrophied, smaller foot
• Tx: surgery is last resort. Serial casting – regular and aggressive stretching of soft tissue until foot is in more of a natural position
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Developmental dysplasia of the hip
4 types
• S/S – no pain in infancy, not always apparent at birth. Less mobility/flexibility on one side. Painless limp in toddler, waddling duck-like gait in older child. Overtime untreated will cause limp and pain
• Treatment – observation, pavlik harness (to keep kid flexed and abducted), Seattle seat, surgery, Spica cast
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Hip dislocation
type of developmental dysplasia of the hip. femoral head is dislocated from acetabulum
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Dislocatable hip
type of developmental dysplasia of the hip. femoral head is in acetabulum but may be dislocated fully when stressed
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Subluxable hip
type of developmental dysplasia of the hip. femoral head moves partly out of acetabulum
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Acetabular dysplasia
type of developmental dysplasia of the hip. Acetabulum is shallow and lost its cup shape
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Legg-Calve-Perthes
hip joint loses circulation, atrophies and becomes necrotic. Self limiting. Lasts several months to a year. Dead bone is resorbed and replaced in 1-3 yrs.
S/S - pain worse with activity, limp, "stiff hip"
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Scoliosis
Lateral curvature of spine more than 10 degrees
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Scoliosis treatment
observation (up to 30 degrees), bracing, surgery if > 40 degrees, cosmesis, sitting balance, pressure sore prevention. If 100 degrees then surgery to prevent cardiopulmonary compromise
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Muscular Dystrophy
• Muscle fibers replaced by disease, fatty, cartilage tissues. Progressive to entire musculature and terminal.
• S/S – muscle weakness, unusual gait, progressives to otheries systems (scoliosis, respiratory difficulty, cardiomyopathy), die in 20s
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Muscular Dystrophy treatment
supportive care, prednisone and deflazacort, surgery for deformities, respiratory therapy, mental health support
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Slipped capital femoral epiphysis
femoral head falls off. caused by growth spurt, trauma, sports injury, overweight, endocrine disorder
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Osteogenesis imperfecta
o Brittle bone disease
o Genetic biochemical defect in production of collagen
o Concern about mobility and safety
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sports injury prevention
o Protective gear
o Gradual increase of duration and intensity of exercise
o Warm up and cool down
o Need coaches who are prepared in sport, developmentally appropriate expectations and emergency care
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Juvenile idiopathic arthritis
3 major types: oligoarthritis, polyarthritis, systemic arthritis
o S/S
Joint swelling, pain
Stiffness when walking
Limp, uneven growth
Loss of joint motion
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Juvenile idiopathic arthritis treatment
Pain management (NSAIDs, steroids)
Surgery – for pain relief or improved function when contractures
Alternative methods – massage, heat, cold
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oligoarthritis
less than 5 joints, usually in bigger joints (knees, ankles, elbows). Watch for uveitis
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polyarthritis
5 or more joints. Can be any joints. Uveitis less often
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systemic arthritis
high fever, rash, polyarthritis, organ inflammation
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Conjunctivitis causes
o Bacteria – sudden onset, bilateral, red eyes, eyes stick together, contagious
o Viral – unilateral, watery eyes, milder, light sensitive, contagious
o trauma
o irritants
Tx: eye drops or ointment
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Hyperopia
farsighted, cannot see close up well. can see far away well
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Myopia
nearsighted, cannot see far away well.
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astigmatism
light is distorted as it goes through eye. corrected with refraction
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Strabismus
in newborns and should clear up by 3 years old
muscle quits when tired and eye doesn't focus - see double vision.
Tx - surgery, eye patches, eye exercises
If untreated can lead to amblyopia
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Amblyopia
"lazy eye". caused by untreated strabismus
neurologically the brain forgets about an eye. nerve pathways don't develop from eye to brain. This needs to be picked up and treated by age 5-6
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Retinal hemorrhage
caused by extreme trauma. Probably an intentional injury like abuse
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Otitis media causes
• Risk factors: boys, winter, children who use pacifiers a lot, smking households, allergies, clefts and Down syndrome
• Causes: relation to Eustachian Tube Dysfunction, associated with URI, Strep Pneumo, H. flu, Moraxella catarrhalis, enlarged adenoids, allergic rhinitis
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Otitis media S/S
– pain, pulling on the ear, irritability, vomiting/diarrhea, fever, discharge, sleeplessness
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Otitis media treatment
o Wait and watch, pain control with Tylenol and ibuprofen. Comfort measures (fluids, don’t lie flat)
o Watch for hearing and speech problems
o If it becomes acute, use antibiotics, amoxicillin is first line
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Lymph nodes
• Small, nontender, movable are normal
• Large, tender, immovable, firm, hot should be referred
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Post Op Tonsillectomy
o Signs of bleeding (freq swallowing could mean they are swallowing blood)
o Pain management (oral narcotic)
o Hydration
o Hygiene
o Teaching (white patchy throat, referred ear pain, and smelly breath in normal). Worry if there is a fever or bleeding or not drinking fluids
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Epistaxis
nosebleeding
• Common from picking nose
• Anterior treatable with first aid
o keep kid calm
o keep head in neutral position (leaning head back will drain blood into throat)
o apply pressure to soft part of nose for about 10 min
• Posterior more serious
• Evaluate if recurring or severe
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Foreign body in nasal passage
• Unilateral stinky drainage
• Clear drainage could be CSF and it is serious – head injury
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Diaper dermatitis (rash)
• Primary reaction to urine, feces, moisture or friction
• Candida albicans
• Glazed red plaques – severe shows fiery red raised rash and possible pustules
• Treatment depends on severity and nature
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Seborrheic dematitis
found over areas of body where sebaceous glands are more prolific.
S/S - mild erythema, scaling yellow-red patches, greasy scaling, less itchy than atopic dermatitis.
Tx - good hygiene
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Thrush
• Caused by oral candidiasis
• Acute in newborns
• Chronic in children with immune suppression, corticosteroid inhalers or antibiotic therapy
• S/S – white patches that look like coagulated milk, difficulty feeding
• Tx – nystatin suspension and other antifungals
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Acne
• Chronic inflammatory disorder of pilosebaceous hair follicles
• Most common skin disorder in pediatric population
• S/S – whiteheads, blackheads, papulopustular and cystic lesions
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Acne treatment
o good skin care with no astrigents or vigorous scrubbing
o avoid picking or squeezing lesions
o shampoo
o balanced diet
o meds (like Accutane)
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Impetigo
• Bacterial
• Vesicle, pustule
• Very contagious
• Can lead to community based MRSA
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Impetigo treatment
o Remove crusts
o Antibiotic oral or cream
o Avoid cross-contamination
o Stay out of school 48 hours after Rx begins, alert other parents
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Ringworm (tinea corporis)
• Fungus of skin, hair, nails
• Contagious by touch
• Topical or oral antifungal
• Can also occur in foot, jock or scalp
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Partial thickness burn
1st and 2nd degree burns
o Tissues can regenerate
o Epidermis and dermis affected
o Painful bc there are nerve endings here
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Full thickness burn
3rd degree burns
o Tissue cannot regenerate
o Epidermis, dermis, underlying tissue
o Not painful
o Grafting required
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