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Flashcards in Final Deck (62):

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


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


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


TEF Preop

Suction any secretions, maintenance IV fluids, monitor VS


TEF Postop

Measure gastrostomy drainage, IV fluids and antibiotics. TPN may be needed. Feedings introduced slowly and in small amounts. Assess for respiratory difficulty



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



abnormal rotation of intestine into abdominal cavity during development


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


Hirschsprung Disease

• Congenital
• Lack proper innervation of colon
• Lack peristalsis, may have constipation
• Tx: remove effected part of the bowel


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



protrusion of an organ through the muscle wall of the cavity that normally contains it. Inguinal and umbilical hernias are common in children



• 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


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



• 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


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


G tube indications

Indications: difficulty swallowing, inadequate nutrition, difficulty gaining weight



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.



• 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


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


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


Hip dislocation

type of developmental dysplasia of the hip. femoral head is dislocated from acetabulum


Dislocatable hip

type of developmental dysplasia of the hip. femoral head is in acetabulum but may be dislocated fully when stressed


Subluxable hip

type of developmental dysplasia of the hip. femoral head moves partly out of acetabulum


Acetabular dysplasia

type of developmental dysplasia of the hip. Acetabulum is shallow and lost its cup shape



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"



Lateral curvature of spine more than 10 degrees


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


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


Muscular Dystrophy treatment

supportive care, prednisone and deflazacort, surgery for deformities, respiratory therapy, mental health support


Slipped capital femoral epiphysis

femoral head falls off. caused by growth spurt, trauma, sports injury, overweight, endocrine disorder


Osteogenesis imperfecta

o Brittle bone disease
o Genetic biochemical defect in production of collagen
o Concern about mobility and safety


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


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


Juvenile idiopathic arthritis treatment

 Pain management (NSAIDs, steroids)
 Surgery – for pain relief or improved function when contractures
 Alternative methods – massage, heat, cold



less than 5 joints, usually in bigger joints (knees, ankles, elbows). Watch for uveitis



5 or more joints. Can be any joints. Uveitis less often


systemic arthritis

high fever, rash, polyarthritis, organ inflammation


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



farsighted, cannot see close up well. can see far away well



nearsighted, cannot see far away well.



light is distorted as it goes through eye. corrected with refraction



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



"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


Retinal hemorrhage

caused by extreme trauma. Probably an intentional injury like abuse


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


Otitis media S/S

– pain, pulling on the ear, irritability, vomiting/diarrhea, fever, discharge, sleeplessness


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


Lymph nodes

• Small, nontender, movable are normal
• Large, tender, immovable, firm, hot should be referred


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



• 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


Foreign body in nasal passage

• Unilateral stinky drainage
• Clear drainage could be CSF and it is serious – head injury


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


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



• 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



• Chronic inflammatory disorder of pilosebaceous hair follicles
• Most common skin disorder in pediatric population
• S/S – whiteheads, blackheads, papulopustular and cystic lesions


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)



• Bacterial
• Vesicle, pustule
• Very contagious
• Can lead to community based MRSA


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


Ringworm (tinea corporis)

• Fungus of skin, hair, nails
• Contagious by touch
• Topical or oral antifungal
• Can also occur in foot, jock or scalp


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


Full thickness burn

3rd degree burns
o Tissue cannot regenerate
o Epidermis, dermis, underlying tissue
o Not painful
o Grafting required


Full thickness burn

3rd degree burns
o Tissue cannot regenerate
o Epidermis, dermis, underlying tissue
o Not painful
o Grafting required