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Ch. 32 Peds

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Melissa Gatton

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Congenital heart disease

an abnormality of anomally of the heart this present at birth. conquences of many of of these defects include heart hailure, predisposition to infection, hypoxia and alteration in growth

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Ch. 32 Peds - Details



61 questions
Congenital heart disease
An abnormality of anomally of the heart this present at birth. conquences of many of of these defects include heart hailure, predisposition to infection, hypoxia and alteration in growth
Factors that play a role in CHD
Environmental and geneitic risk factors include: intrauterine rubella exposure, maternal alcoholismm DM advanced maternal age, and maternal drug ingestion. sibling or parent with CHD chromosonal anomalies
CHD categories are related to four physiologic characteristics
Increased pulmonary blood flow decreased pulmonary blood flow obstruction to systemic blood flow mixed blood flow
Clinical manifestation of CHD
Cyanosis pallor cardiomegaly pericardial rubs murmurs additional heart sounds in s3 and s4 discrepancies between apical and radical pulses tachypnea dyspnea gruntingdigital clubbing hepatomegaly splenomgaly discrepancies between upper and low extremity bp crackles and wheezing
CHD dx test
ABG urine culture electrocardiography echocardiography fluoroscopy angiography cardiac cath and MRI
Defects involving increased pulmonary blood flow CHD
Increased pulmonary blood flow are the most common CHD in this type of defect there is a communication of some type between the right and left sides of the heart. because of the increased pressure of the left side of the heart, some of the blood is pushed back to the right side of the heart. The most common defects involving increased pulmonary blood flow are patent ductus arteriosus, atrial septal defect, and ventricular septal defect VSD
Atrial septal defect
Abnormal opening in the atrial spetum that enables oxygenated blood to flow from the higher pressure left atrium to the lower pressure right atrium, which causese the blood to become deoxygenated. Clinical manifestations: smaller defects less then 5mm often asysmptomatic or do not have s/s until later in life. manifestation consistent with HF include frequent respiratory infections and difficulty breathing. a characteristic harsh systolic murmur mayybe heard over the third intercostal space.
Ventricular septal defect
A ventricular sptal defect (VSD) is an abnormal opening in the interventriclal septum, resulting in the flow of oxygenated blood from higher pressure in the right ventricle, which causes the blood to become deoxygenated. pin hole to opening to absence of the entire septum ( single ventricle) Clinical manifestations include a loud harsh systolic murmur and a palpable thrill
Defects involving decreased plumamany blood flow
Decreased pulmonary blood flow result when there is some type of obstruction of blood flow to the lungs or if there is no connection between the right side of the heart and the lungs. examples of defects involving decreased pulmonary blood flow include pulmanary stenosis, pulmonary atresia and tetralogy of fallot , the amount of obstruction or lack of connection determins the sysmptoms. the most common CHD reslting in decreased pulmonary blood flow is tetralogy of fallot.
Tetralogy of fallot
Invovles a combination of four defects 1. pulmonary stenosis 2. VSD 3. right ventricular hypertrophy 4. overriding aorta
Four physical characteristics of CHD
Increased pulmonary blood flow decreased pulmonary blood flow obstruction to systemic blood flow mixed blood flow
What is a parasitic infections
Scabies caused by mites the burrow under the skin leaving behid debris, feces, and eggs. this can cause a linear papular rash and intense pruritus. transmission occurs by direct contact with an infected person, bedding or clothing Medical managenment Lindana (kwell 1%) hydoxyzine (atarax) pediculosis ( lice) have the parents check to childs head at the nape of the neck
Spina bifida what where is the defect at?
The spinal cord most commoly ends at the defect: therefore all motor and sensory function below the defect is absent. most myelomeningoceles involve the lumbar and lumbosacral areas. depending on the level of the defect affected infants usually have flaccid paralysis and senosory deficits of the lower extremities, bowel bladder incontinence and talipes equinovarus defects and a subluxated hip, hydrocephaluse is present in the mojority of affected infants.
Spina bifida occulta
No herniation of spinal cord or meninges. vertebral acrches between L5 and S1 fail to fuse. Hair tuft
SID how do you assisted the parents
Clean the infant, wrap the infant in a sheet or blanket, and tidy the room where the family with be able to spend time with the infant. ensure that the parents last moments with their infant are quiet and peaceful, and as meaningful as possible. offer to stay with the family or allow them private time if they wish.
Clinical manifestiations of cerebral palsy
Arching of back, delayed gross motor development, developmental disabitites, difficulty swallowing and excssive drooling, difficulty feeding, hyertonic muscles, involuntary movements, poor sucking.
Clinical manifestations of Hydrocephalus
In early infancy, include widening and bulging of the forntanelles, separation of the cranial sutures, dilation of the scalp veins. a thin shiny scalp, rapidly increasing head circumference. as CSF accumulation continues, frontal bossing ( prominence of the forehead) becomes apparent. depression of the eyes slow pupil response to light, irritability, hight pitched cry difficulty in being consoled, lethargy and altered LOC difficulty in sucking and feeding Headach on awakening heractive reflexes , strabisums, unsteady gait, papilledema , disorientation and progression to stupor
Anemia classifications
Hyprprolifeateive ( defective production of erythrocytes Hemolytic ( premature destruction of erythorctes)
Idiopathic thrombocytopenia purpura (ITP)
Is characterized by a marked decrease in the number of circulation platelets with resultant bleeding beneath the skin. this is most common in kids ages 2-10
Ed for the child with hemophilia
Parents should be taught the RICE method: rest, ice, compression. and elevation. the child and family should be instructed in safely administering factor products at home. parents should seek er care if the child has s/s of intracranial pressure which can indicated intracranial bleeding, secer headache. slurred speech, comiting and disorientiaion.
Idiopathic arthritis What kind of Rx or meds do they need to be on?
NSAID corticosteroids SAARD which include: Methotrexate: sulfasalazine ( Azulfidine): hydroxychloroquine ( Plaquenil) DMARD includes: methotrexate ( Trexall): TNF: etanercept ( Enbrel) : abatacept (orencia) : rituximab ( rituxan)
What is RSD
Acute respiratory infections
S/s of RSD
Nasal flaring, expiratory grunting, intercostal, subcostal, or substernal retractions, dusky color involving the sink , nail beds and mucous membranes, tachypnea 80-120 bpm , dyspnea and low body temp. apnea, flaccidity, absence of spontanceouse movemnet and unresponsiveness and mottling, and death
What influences the severity of RSD
Low surfactant and occurs almost exclusicely in preterm infants of low birth weight.
What can cause RDS in the neonatal period?
Maternal diabetes, asphyxia, maternal hemorrhage and shock.
Pt teaching tonsillectomy
Avoid food that are irritating or highly seasoned. use mild analgsics or an ice collar for pain do not use aspirin hemorrhaging is possible 5-10 after surgery during the healing process. tell the parents if they see any signs of bleeding to notify the HCP immediately
What is the therapy for cystic fibrosis CF, centered on
Good nutrition, prevention and control of respiratory infections chest physiotherapy and high frequency chest wall oscillations breathing exercises and inhalation therapy with bronchodilators before chest physiotherapy facilitates secretion removal. physiotherapy is normally done 2x per day. positive expiratory pressure PEP is another source of treatment.
Cleft palate surgery, what is a priority intervention?
The child with cleft palate repair should lie on the abdomen because this will facilitate drainage of mucus and serosanguineous exudate from the oral cavity.
Pneumonia and the agents
Bacterial pheumonias most common in infants and children and are caused by streptococci, staphylococci, pneumococci and H. influenzae
Clinical manifestations of croup
Children with LTB initially demonstrate hoarseness, inspiratory stridor, tachypnea, nasal flaring, suprasternal, substernal, and intercostal retractions; and characteristice barking cough. body temp in normal to mild fever. a child with epglottitis is acutely ill with high fever, muffled voice, drooling and progressive respiratory distress, anxiety and fear
Dx testing for pneumonia
X-ray peripheral blood tests sometimes reveal an elevated WBC culture and Gram stain of respiratory secretions and the blood as well as diagnostic thoracentesis if fluid is suspected in the pleural cavity.
Acute epiglottitis what is it? what can happen?
Is a severe, potentially life threatening bacterial infection of the epiglottis in older children and usually is caused by H. influenzae type B the inflamed epiglottis becomes cherry red and edematous, which has the potential to lead to total airway obstruction. since the advent of the Iib vaccine the number of episodes have decreased
Opioids during pregnancy: what environment should the infant be in?
In a non stimulating environment that is free from bright lights and loud noises. thy often prefer to be tightly swaddled in a blanket with a pacifier to satisfy their vigorous sucking needs
What are the two classification for seizures?
Partial and generalized. children are most prone to seizures during the period between birth and 2 yrs
Anticonvulsants for seizures
Carbamazepine ( tegretol) phenytoin ( dilantin) fosphenytoin ( cerebyx)
Acute otitis media what is the medical management?
10 days of antibiotics for acetaminiphen for fever and discomfort
Isotretinoin ( Accutane) given to teen having sex, what is an importent to teach about this rx.
They must use an effective contraceptive method during treatment and for one month after.
Dx test for leukemia?
A CBC typically indicates pancytopenia ( decreased amount of RBC's WBC's and platelets) bone marrow aspirate and peripheral blood smear are immature blastic leukocyte cells. lumbar puncture is an option to determine whether the CNS has been infiltrated
Clinical manifestations of hypothyroidism
Congenital- cool, mottled skin dyspnea hypothermia lethargy poor appetite poor sucking reflex prolonged jaundice Acquired- constipation dry skin growth delay lethargy mental slowness puffy eyes
Clinical manifestations for hyperthyroidism
Accelerated frowth advanced bone age excessive appetite exophthalmos ( protruding eyeballs) heat intolerance hyperactivity hypertension irritability nervousness palpable thyroid gland tachycardia tachypena thyroid storm: rapid onset with sever hyperthermia. vomiting, diarrhea, sever tachycardia, may advance to delirium, coma and death tremors warm skin weight loss
What is the primary causes of hypothyroidism
1) congenital defects 2) defective synthesis resulting from an autoimmune process
Hydrocephalus- develops in which age groups?
During infancy and throughout life
What is the treatment of CP
Common treatments include medicine, surgery, braces, and physical, occupational and speech therapy.
Antinatal factors that share responsibility in development of CP ( causes of CP)
Include maternal infections, infections, maternal drug ingestion. hypoxia in utero, and blood incompatibilities
S/s of post hemorrhage following tonsil removal
Include increased pulse greater than 120, pallor, frequent clearing of the throat or swallowing by a younger child, vomiting of bright red blood. restlessness, an indication of hemorrhage, is somethings difficult to differentiate from general discomfort after surgery.
What is BPD? what are the s/s you may see?
Bronchopulmonary dysplasia is a chronic pulmonary disorder that develops in permature infants. Chronic lung changes include thickening and necrosis of alveolar walls with impairment of oxygen, diffusion from the alveoli to the capillaries. edema and inflammation of the capillary bed can cause some alveoli to collapse, some to hyperinflate and other to rupture. S/S: respiratory distress ( wheezing, retracting, nasal flaring, irritability, abundant secretions and cyanosis when stressed)
HIV- occurs as a result of what?
Occurs as a result of the destruction of T helper cells by HIV. A normal CD4+ lymphocyte count is 500/uL to 1600/uL the immune systems remain healthy when CD4+ counts exceed 500
What is the first treatment you should do with acute epiglottitis? As it is life threatening!
Immediate treatment of a child with acute epiglottitis includes establishing an artificial airway. respiratory care includes humidification, gentle oral suctioning and constant observation of respiratory status.
LTB (Croup) affects what age group?
3 months to 3 years and is usually viral in origin
Thrush can be transmitted in what ways?
Contaminated hands, mipples, and pacifiers.
DDH developmental dysplasia of the hip
The abnormoality has familial tendencies and is more prominent in girls this can cause grual muscle wasting
What kind of tests do they do to detect for nero tube defects ( spina bifida)
Pernatally with a uterine ultrasonography and elveated levels of maternal alpha fetoproteins