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Infant Unit III

Unit III

Toddler task; they need to learn ______ _______. Delayed Gratification
By this age know that out of sight is not out of reach (Object Permanence). 1.5 y/o
18mo has ________ level of understanding. Expanding
Is a medical emergency type of croup, needs Abx and airway treatment. Epiglottitis
LTB have mom stay at bedside as often as possible to _______ child’s distress. Decrease
Sweat chloride test >60 (gold standard), Fecal Fat, Chest X-ray showing patches of atelectasis. CF Diagnosing
Bronchodilators given ______ chest physiotherapy(CPT) to ease expectoration. Before
_______ can be taken w/food or sprinkled on food at beginning of meal. Enzymes
Rheumatic Fever can l/t _______ ______ damage. Cardiac Valve
A major s/s of rheumatic fever. Polyarthritis
What is the goal for rheumatic fever pts. Eliminate Streptococci w/ Penicillin G
Helps with s/s of Chicken pix. Acyclovir
Given to high risk children to prevent chicken pox. VariZig
Chicken pox no longer contagious when lesions are _______. Crusted
Koplik spots; 2 days before rash. Measles(Rubeola)
Is harmful to fetus (teratogenic, do not give vaccine if pregnant. Rubella
Abused child contributes to _______ w/o knowing. Situation
Sex offenders pressure victim and ask this. “Can you keep a secret”
Story does not match w/ injuries. Suspect abuse
External; non-invasive; visualizes kidneys. Renal US
Best clinical s/s of GFR. Creatinine Clearance
Pt with nephrotic syndrome receiving Prednisone is at risk for what. Infection(immunosuppression)
Etiology of Acute Glomerulonephritis. Streptococcal Infection
Acute base of glomerulonephritis shows _____ urine and _____ in urine. Blood; Protein
Sign that glomerulonephritis is resolving. Increase Urine Output
Nursing Diagnosis for acute glomerulonephritis. Fluid Volume Excess
Increase urine specific gravity and ↑WBC. Dehydrated & UTI
No cure; treatment is supportive. Osteogenesis Imperfecta
Is genetic; recommend genetic counseling for parents. Duchenne Muscular Dystrophy
Maintain muscle function as long as possible by remaining as active as possible. Muscular Dystrophy Goal
________ meningitis has been almost eliminated in places that use vaccine. Bacterial
Main cause of meningitis in newborn E.Coli, Bacterial Streptococci
Immunize, No Bottle propping, only breast feed if possible, upright following feeding. OM Prevention
These pts may have bone pain when moved. Leukemia pt
Do NOT give ______ vaccine to leukemia pt because it is a live virus. MMR
If allergic reaction ____ drug immediately. D/C
The period between 12 to 36 mo of age; Temper tantrums. Toddler years
Toddler years reveal steady growth curve. Steplike in nature
Head & chest equal by this age. 1 to 2 y/o
Visual acuity 20/40 in toddler years. Normal
Much less likely than infants to try new foods because of their appearance, texture, or smell, not just _____. Taste
Respirations cont. To be ______ for toddlers. Abdominal
3 most common infections of toddlers. OM, Tonsillitis, URT infections
Toddlers; RR & HR ______ and BP _____. Decrease; ↑
Sphincter control by this age. 18-24mo
Major gross motor skill during toddler years. Locomotion
Toddlers can walk up and down stairs by this age. 2y/o
Toddlers can go ↑↓ stairs alternating feet; jump with Both feet; stand on one foot; manage to tiptoe few steps; BW x4. 2.5 y/o
Can drop a raisen into a narrow neck bottle; build a tower of 2 blocks by this age. 15mo
Can throw a ball w/o loosing balance; builds tower 3-4 blocks; takes off shoes, gloves, socks, unzips zippers. 18mo
What are the 4 major behaviors of toddlers. D.S., D.G., T.S., C.F., S.B.
What stage of Erikson; Toddler. Autonomy vs Shame
What stage of Piaget; Toddler. Sensorimotor(B-2y/o); Preoperational(2-7 y/o)
Able to imitate a circular stroke and vertical line. 24mo
The 4 major problems of toddlers. Tantrums, Sibling Rivalry, Toilet Training, Ingestions
Typical behaviors of toddler in quest for autonomy. Negativism & Ritualism
The need to maintain sameness and reliability, provides sense of comfort. Ritualism
Ego is evident as children are able to tolerate _______ _______. Delayed Gratification
Domestic _________ is common in toddlerhood. Mimicry
(13-18mo)uses active experimentation to achieve previously unattainable goals. Tertiary Circular Reactions
Toddlers are unable to _______ knowledge to new situations. Transfer
The discovery of objects as objects l/t the awareness of their _____ ______; able to recognize different shapes and there relationship with each other. Spatial Relationship
Toddlers will now ____ search for an objects in several potential hiding places. Actively
Implies that children cannot think in terms of operations- the ability to manipulate objects in relation to each other. Preoperational Thought
Toddler; problem solving is based on what they can _______ & _______ directly rather than on what they can recall about objects and events. See; hear
Inability to envision situations form perspectives other than ones own. Egocntrism
Child refuses to eat a food because something previously eaten did not taste good? Transductive Reasoning
Reasoning that changes one part of the whole changes the entire whole. Global Organization
Focusing on one aspect rather than considering all possible alternatives. Centration
Attributing lifelike qualities to inanimate objects. Animism
When told to stop doing something, such as talking, child is unable to think of a + activity. Irreversibility
Believing that thoughts are all powerful and can cause events. Magical Thinking
Inability to understand the idea that a mass can be changed in size, shape, volume, or length w/o losing or adding to the OG mass. Inability to Conserve
What are 8 characteristics of Preoperational Thought. TAG ME In. Im-Coach Carter
Prelogical reasoning; “A needle is something that hurts” Mental Symbolization
Gender i.d. Is developed by __y/o. 3
By 2y/o they recognize ______ differences an drefer themselves by name and then pronoun. Gender
Means that child moves/separates away but returns to mother for assurance. Rapproachment
Favorite blanket or toy, provide security for children, especially when they are separated from their parents, dealing with stress or fatigue. Transitional Objects
300words; comprehension >speech; Multiword sentences (2-3 words). Number of words by 2y/o.
By __ y/o acquire 5-6 new words daily, know age/gender; can count three objects correctly; ride a tricycle; may use fork. 3
Gestures that accompany language phase out by this age. 30mo
By ___ mo of age, children feed themselves, drink well from a covered cup and manage a spoon with considerable spilling. 15
What are 3 age appropriate disciplines for toddlers. + Reinforcement, Redirection and Time-outs
One of the most distinguishing characteristics of play and ↑ fantasy. Imitation
What are 4 appropriate toys for toddlers. Push-pull toys, Jungle gym/slide, balls of diff sizes, riding toys.
TV might be considered appropriate after this age. >2y/o; for <1hr/day
Parents are encouraged to allow the child to engage in _______ playtime. Unstructured
May demonstrate readiness for beginning daytime control of bowel and bladder; turns pages of book one at a time. 24mo
By 24 mo develops _____ recognition and verbal self reference (“Me Big”). Visual
Sphincter control, dry for 2hrs, gross/fine motor, Urge, Willingness to please, sit 5-8min, curiosity, impatience with soiled diapers. Child Readiness TT
Willing to invest time, recognize child’s level of readiness, consistency, psotive encouragement, absence of family stress. Parental Readiness TT
Night time bladder control normally takes several mo to yrs after _____ training begins. Daytime (>6y/o need intervention)
________ training, before _______ training. Bowel; Bladder
Leading cause of death ages 1 to 4 y/o Transportation related (MVA)
Poorly developed ______ perception may contribute to ↑ falls in toddlers. Depth
Suitable for infants and toddlers in the rearward facing position. Convertible Restraitnts
Do not D/C unless proper _____ is in car. Restraint
Ride rear-facing until ______ & at least ______ in the backseat. >1y/o & 20lb (AAP recommends until 2y/o)
>1y/o & >20lb (AAP recommends until 2y/o). Front Facing Seat ok
Booster seat after child reaches _____ (Booster till 6y/o) or until they can sit w/o the belt going across the neck. 40lb
Should not ride in the front seat until ____. 12y/o (at least 4ft 9inch)
The most common type of thermal burn in children. Scald (<120°F Thermostat)
The major reason for poisoning. Improper Storage
Is an authoritative source of information on vaccines and other important pediatric infectious diseases. “Red Book”
This illness has abrupt onset with fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and “Jaundice” Hep A, @1y/o(12-23mo), x2 with 6mo gap
Can lead to cirrhosis and liver CA during adulthood; receive vaccine before D/C from hospital. Hep B @Birth,1→2mo & 6-18mo (x3)
Both full term and preterm infants born to mothers who’s HBsAg status is + or unknown should receive these w/in 12hrs of birth. Hep B & HBIG vaccine
Give this equine antitoxin IV to the child with clinical s/s bacause of the often fulminant progression of the disease. Diphtheria
Boosters for Diphtheria given every ____ years. 10
What is the schedule for DTaP vaccine. 2mo, 4mo, 6mo,15-18mo, 4-6yrs. (x5)
The Tdap vaccine is recommended at what age. 11-12y/o (7-10 y/o if not received any or all the DTap series)
Recommended schedule for IPV. 2mo, 4mo, 6-18mo, 4-6yrs (x4)
Is a combination vaccination containing DTaP, Hep B, and IPV Pediarix
Recommended schedule for MMR-V. 12-15mo & 4-6yrs
After receiving MMR-V. ↑ risk for seizures
This supplement has been effective in ↓ the morbidity and mortality associated with measles(rubeola) in developing countries. Vit A
Recommended vaccination for all prepubertal children and susceptible adolescents and adult women in childbearing age. Rubella (Not Given to Pregnant ♀)
Protects against B. Meningitis, epiglotitis, B. Pneumonia, septic arthritis, and sepsis. Hib @ 2mo, 4mo, 6mo, 12-15mo (x4) NO catch-up
Varicella vaccine is administered __________. Sub-Q
What is the schedule for PCV vaccine. 2mo,4mo, 6mo, 12-15mo (x4)
Children with CF, sickle cell, chronic renal failure, Immunosuppression, DM, organ transplantation should receive this vaccine. PCV ↑ risk (x1) 6-18 y/o
Is recommended annually from 6mo to 18y/o. Influenza Vaccine (Dont give if Egg Allergy)
This type of infection is ↑ in college freshman dormitories. Meningococcal Infections
Schedule for MCV4 & booster. 11-12 y/o & Booster 16-18 y/o (x2)
Schedule for Rotavirus. 2mo, 4mo, 6mo (if not complete; dont get)
Yeast hypersensitivity might preclude one from receiving this vaccine. Hep B
General contraindication for all immunizations. Severe fever; Immunosuppression, Pregnancy; Allergy to Egg, Thimerosal; Neomycin
What 2 things must be given to parents before immunization. VIS & Informed Consent
Has improved concept of space, as demo. By understanding of prepositions and ability to follow directional commands. Preschooler (3y/o)
Questioning is at its peak; exaggerated stories; associative play; imaginary playmates common; intuitive thought; poor concept of numbers; rebellious; aggressive. Preschooler (4y/o)
Eruption of permanent teeth; handedness established; Vocab 2100 words; strongly identifies with parent of same sex. Preschooler (5y/o)
Symptoms that occur between early manifestations of the disease and its clinical syndrome. Prodromal Symptoms
Rests almost exclusively on immunizations. Primary Prevention
Droplet/contact; Inc. 2-3wks(4-16days); Pruritis (Papule, Vesicle, Crust); Fever malaise, anorexia; Acyclovir(Zovirax); Benadryl; Prevent 2ndary Infection. Chicken Pox (Varicella)
Spreading to face and proximal extremities but sparse on distal limbs and less on areas of exposed heat. Centripetal (Varicella)
Discharge from mucus membranes; Direct contact, carrier or contaminated objects; Inc. 2-5days or longer; lasts until Negative cultures, resembles common cold “Bulls Neck”; l/t septic shock, death; Tx w/ Abx. Diptheria
Human Parvo Virus (HPV); school age; Resp. Secretions and blood; Inc. 4-14 days (21days); Tx supportive; possible blood trans for aplastic anemia; Arthritis; Droplet; ↑risk of fetal death; “Slapped Face”. Erythema Infectiosum (Fifth Disease)
Fifth disease; erythema on face; “Slapped Face”; goes away 1-4 days. Stage I
Fifth disease; about 1 day after rash appears on face, maculopapular red spots appear, symmetrical; progresses from proximal to distal may last >1wk. Stage II
Fifth disease; rash subsides but appears if skin is irritated or traumatized (sun, heat, cold, friction). Stage III
Human herpes virus type 6; mucous membranes; ↑ risk <3y/o (P:6-15mo) Inc. 5-15 days; persistent ↑ fever; appear well; ↓fever to normal→rash appears; rose pink macules; 1st on trunk→neck, face and extremities; Non-pruritic; blanching, last 1-2 days. Roseola
Describing the symptoms of a cold. Coryza
Paramyxovirus; contact/droplet; Inc. 14-21 days; most commu. Immediately before and after swelling; earache; by 3rd day Parotid enlargement; supportive care; deafness, orchitis, pancreatitis; Sterility in Males. Mumps
Virus; RTS, blood & urine; Droplet; Inc. 10-20 days; commu. 4 days before & 5 days after rash appears; Koplik spots 2 days before rash; Rash 3-4days after prodromal stage; maculopapular rash from face→downward; isolate till 5th day of rash; supportive Tx. Measles (Rubeola)
Bordetella Pertusis; Droplet/contact; Inc. 6-20 days(7-10days); dry hacking cough; posttusive vomiting; Abc Tx(Erythromycin); Obtain nasopharyngeal culture; cough medicine not recommended <2y/o. Pertusis (Whooping Cough)
Rapid coughs with sudden inspiration associated with a high pitched crowing sound. Whooping Cough Sign’s
Enterovirus 3 types; Paralysis; Feces/oral secretions; Direct contact; Inc. 7-14days (5-35 days); prevent contractures; skin breakdown. Poliomyelitis
Rubella virus; blood, stool, urine, Inc. 14-21 days; commu. 7 days before and 5 days after rash; first on face →downward; pinkish maculopapular; disappear same order by 3rd day; Tx supportive; ↑Risk Teratogenic; Droplet precatutions. Rubella (German Measles)
GABHS; secretions (naso); Droplet/Direct/Indirect; Inc 2-5 days (1-7 days); ↑fever, halitosis; 1-2 days “Strawberry White”→ “Red Strawberry” by 4-5th day; fine sandpaper rash by <1wk; Tx PNC-G Abx; Antipuritics; soft diet No citrus. Scarlet Fever
For severe itching use these medications. Benadryl or hydroxyzine(Atarax)
Flat; nonpalpable; circumscribed Rubella & Rubeola. Macule
Elevated; palpable; firm; circumscribed; i.e. Warts. Papules
Elevated; circumscribed; superficial; filled with serous fluid; i.e. Varicella. Vesicle
Vesicle; Large Blister. Bulla
Elevated; irregulary shaped area of cutaneous edema, transient, changing, variable diameter; i.e. Urticaria, PPD. Wheal
Elevated firm circumscribed; palpable; deeper in dermis than papule. Nodule
Elevated; superficial; similar to vesicle but filled w/ purulent fluid. Pustule
Elevated; circumscribed; palpable; encapsulated; filed with liquid or semisolid material. Cyst
An cute inflammation of the meninges and CSF. Bacterial Meningitis
This type of Meningitis occurs predominantly in school-age, adolescents and college students. Meningococcal
Fever, n/v, irritability, anorexia, HA, photophobia, confusion, back pain, and nuchal rigidity; sometimes preceded by URT infection. B. Meningitis S/S
Supine position; cannot extend the knee more than 135 degrees and pain is felt in the hamstring. Kerning Sign
Flexes the lower extremities if passive flexion of the neck is attempted. Brudzinski Sign
↑WBC (Polys), ↑Protein, ↓Glucose, +Gram stain, Cloudy. B. Meningitis CSF labs
Abx of choice for B. Meningitis (initially). Cephalosporins
________ loss is common with B. Meningitis. Hearing(Auditory eval 6mo after resolution)
________ are the most common cause of viral meningitis. Enteroviruses
An inflammation of the middle ear w/o reference to etiology or patho. Otitis Media (OM)
An inflammation of the middle ear space with a rapid onset of s/s of acute infection; namely fever and otalgia. Acute Otitis Media (AOM)
Fluid in the middle ear w/o symptoms of acute infection. Otitis Media w/ Effusion (OME)
The two most important identifiable factor for occurrence of OM. Family socioeconomic status and Exposure to other children.
How do you diagnose acute OM and differentiate from different types of OM. Pneumatic Otoscope
An immobile tympanic membrane or an orange, discolored membrane indicates this. OME
Appearance of tympanic membrane in AOM. Bulging yellow or Red
Teach parents of AOM to do this >6mo of age. Wait 72hrs; to see if improves (Not recc. If under <2y/o w/ persistent s/s)
Recommended Abx therapy for AOM. 10-14 days
Defined as three bouts in 6mo, six in 12mo, or six by 6y/o. chronic OM(Need Tympanostomy Tubes)
↓Incidence of AOM in some infants. PCV7 (↓exposure to tobacco & pacifier >6mo)
Parents should be aware of ______ so that they can recognize if it falls out; normal notify MD. Grommet
Normal color of Tympanic Membrane. Pearly White/gray
A broad term given to a group of malignant disease of the bone marrow and lymphatic system; unrestricted proliferation of immature WBC in blood forming tissues of the body. Leukemia
Most commonly affected organs in Leukemia. Liver and Spleen
Three main consequences of Leukemia. Anemia, Hemorrhage, and Infection
Definitive diagnosis for Leukemia. Bone Marrow Aspiration/Biopsy
Achieves a complete remission or less than 5% Leukemic cells in the bone marrow. Induction Therapy
Prevents Leukemic cells from invading CNS. CNS prophylactic therapy
Eradicates residual leukemia cells; prevents emergence of resistant leukemic clones. Intensification
Serves to maintain the remission phase. Maintenance Phase
What are the risks of HSCT. Graft Versus-host disease, infection, organ damage, (Last Resort)
Most important factors for determining long term survival for children with ALL. Initial WBC, Age @ time of Dxg, Cell type, sex, Karyotype analysis.
Side effects of several drugs is GI mucosal cell damage, which can produce _____ anywhere along the alimentary tract (stomatitis). Ulcers; (provide; bland, moist, soft diet, soft sponge toothbrush, mouth washes, Oral anesthetics for pain)
A side effect of chemical irritation to the bladder from cyclophosphamide. Hemorrhagic Cystitis (↑Fluids x1.5, frequent voiding, MESNA)
Hair regrows in ___ to ___ may be of a different color and texture. 3; 6mo (Not everyone looses)
Short term steroid therapy. ↑appetite & sense of well being (“Moon Face” goes away after stoping steroids) Pre-warn of Mood changes.
Most common osteoporosis syndrome in children; rare; Heterogenous Autosomal Dominant disorder characterized by Fx’s and bone deformity[Rare can be Autosomal Recessive also]. O.I. (Dominant=1 parent)
OI; mild bone fragility; blue sclerae, normal teeth; hearing loss ; Dominant. Type I (Most common)
OI; lethal; stillborn or die early; severe bone fragility; multiple fx at birth; 10% of cases; Recessive. Type II (most severe)
OI; severe bone fragility l/t progressive deformities; normal sclerae; growth failure; most recessive; few dominant. Type III (2nd worse; rare to live >30y/o)
Error results in faulty bone mineralization, abnormal bone architecture, and ↑ susceptibility to fx. COL1A1 or COL1A2
R/O ______ ______ &_______ because of multiple fx at multiple stages of healing. Child Abuse; OI
No cure; care is supportive; caution with handling; family education; occupational planning and genetic counseling. OI Teaching
Attains standing position by kneeling and then gradually pushing torso upright (with knees straight) by walking hands up his legs. Gowers Sign
Gradual degeneration of muscle fibers; characterized by progressive weakness and wasting of symmetrical groups of skeletal muscles with ↑ disability and deformity. Muscular Dystrophies (MD)
The most severe and the most common MD in childhood; X-linked recessive trait; Genetic counseling important; affects Males. Duchenne Muscular Dystrophy (DMD)
Is absent from the muscles of children with DMD. Dystrophin
Early onset 3-7 y/o; progressive muscle wasting/contractures; calf hypertrophy; loss of independent ambulation by 9 to 12 y/o; waddling gait and Lordosis. DMD Characteristics
Children with DMD should be involved in ___________ and eventually moved into ______ classrooms as much as possible. Early learning programs; Regular
Primary Dxg of DMD. Blood Polymerase Chain Reaction (PCR)
Serum enzymes; prenatal Dxg 12 weeks gestation; muscle biopsy and EMG may also be used to establish diagnosis. DMD Dxg
Maintaining optimal function in all muscles for as long as possible in the primary goal; secondary is prevention of contractures. DMD Tx
Inherited autosomal recessive trait (both parents); 1 in 4 chance, ↑Viscosity of MM, ↑ electrolytes→ mechanical obstruction. Cystic Fibrosis
The earliest postnatal manifestation of CF. Meconium ileus
Bulky stools, frothy from undigested fat (steatorrhea), foul smelling azoterrhea. CF stools
Most common complication of CF. DM
↑Fat ↑Calorie diet (150% RDA). CF nutrition
R/t bulky stools; malnutrition; ↑ abdominal pressure 2° to paroxysmal cough. Prolapse of Rectum
Most men (95%) w/ CF are ______. Sterile
Women w/ CF who become pregnant have an ↑ risk of _____ _____ and _____. Premature labor; LIBW
Swear chloride test; absence of pancreatic enzymes; Family Hx; “Taste Slaty”; >60mEq/L. CF Diagnosis
Bronchodilators are administered _______ percussion and postural drainage. Before
Sudden drop in SpO₂ (early); Tachypnea, Tachycardia, Dyspnea, Pallor, Cyanosis. Pneumothorax
Are administered w meals and snacks. Pancreatic Enzymes (or w/in 30min)
Need 2 lungs and heart for correct therapeutic Tx. CF Transplantation
Gasoline, Kerosine, Lamp oil, Mineral Seal oil, lighter fluid, Turpentine, paint thinner and remover→ l/t Chemical Pneumonia Hydrocarbons (↑ humidity O₂, hydration, Abx)
Drain toilet and oven cleaners; electric dish washer detergent; mildew remover; batteries; Clinitest Tablets; Denture Cleaner; Bleach. Corrosives (Strong Acids or Alkalis) Contact PCC, Do Not Neutralize, Patent Airway, Analgesics.
Acetaminophen; 2-4hrs; N/V, sweating, pallor. Initial Period
Acetaminophen; May last < 7 days and be permanent; Pain RUQ; Jaundice; confusion, stupor, coagulation abnormalities. Hepatic Involvement
Most common accidental drug poisoning. Acetaminophen (Tx N-Acetylcysteine)
Most common heavy metal poisoning. Lead
Use of chemical compound that combines with the metal for rapid safe excretion. Chelation
What is normal blood lead level. <5 mcg/dl (1 to 2y/o & 3-6 IND)
Wet cleaning to remove lead dust on floors; windowsills; and other surfaces (Do Not Vacuum) Lead Prevention
Two Chelation agents used in the past. Calcium EDTA & DMSA
Determines presence of pathogens and the drugs to which they are sensitive. Urine Culture and Sensitivity
Allows visualization of renal parenchyma and pelvis w/o radiation. Renal & Bladder US
Direct visualization of bladder and lower urinary tract through a small scope inserted via urethra. Cystoscopy
UTI involving urethra and bladder. Lower Urinary Tract
UTI involving ureters; renal pelvis, calyces; and renal parenchyma. Upper Urinary Tract
Contrast medium injected through urethral catheter to visualize pelvic calyces, ureters, and bladder. Retrograde Pyelography
Presence of a fever typically implies ______. Pyelonephritis (Fever, Chills, vomiting)
Most common organism responsible for UTI’s. E. Coli
An end product of protein metabolism in muscle and a substance that is freely filtered by the glomerulus and secreted by the renal tubular cells. Creatinine (Check BUN & Creatinine=Renal Function)
The single most important factor influencing the occurrence of UTI. Urinary Stasis
Visualizes the bladder outline and urethra, reveals reflux of urine into ureters and shows complications of bladder emptying (uses contrast). VCUG
Is managed conservatively with daily low-dose Abx therapy. VUR
Wipe Front to Back; ↑fluids, Void frequently, “Double Void”, Avoid constipation. Teaching UTI Prevention
A clinical state that involves massive proteinuria, hypoalbuminemia, hyperlipidemia and edema; Idiopathic or Autosomal Recessive; Male ↑x2; steady ↑weight gain; Periorbital edema. Nephrotic Syndrome (Nephrosis)
The shift of fluid from the _______ to the _______ _____ ↓the vascular volume(hypovolemia). Plasma; interstitial spaces
First line therapy for Nephrotic Syndrome. Corticosteroids
Parents are taught urine dipstick; relapse may occur; ↓salt intake; prevent infection. Nephrotic Syndrome Teaching
Oliguria, edema, HTN, Hematuria, & Proteinuria; associate w/ pneumococcal, streptococcal, and viral infections; ↑risk Male (x2); GABHS; Impedigo. Acute Glomerulonephritis
Immune complexes are deposited in the glomerular basement membrane; “Tea Color or Cola Urine” ↑BUN↑Creatinine; + ASO titer. APSGN
The most common useful means for assessing fluid balance. Daily weights
Overnight cotton balls in diaper. Method of assessing Proteinuria
The most common malignant renal and intraabdominal tumor of childhood; <5y/o; common L kidney; Do Not Palpate abdomen; Sxg/Chemo/Radiation. Wilms Tumor
The tumor, affected kidney and adjacent adrenal gland are removed. Sxg Wilms Tumor (24-48hrs)
The most common type of abuse in children. Neglect(60%)
Failure of parent or other legal guardian to provide for the childs basic needs and an adequate level of care (physical, & emotional). Neglect (definition)
Intentional physical abuse or neglect, emotional abuse or neglect and sexual abuse of children usually by adults. Child Maltreatment
Involves deprivation of necessities, such as food, clothing, shelter, supervision, medical care and education. Physical Neglect
Failure to the childs need for affection, attention and emotional nurturance. Emotional Neglect
Deliberate attempt to destroy or significantly impair a childs self esteem or competence. Emotional Abuse or Psychologic Maltreatment
Deliberate infliction of physical injury on a child. Physical Abuse
Causes retinal hemorrhages; Subdural and Subarachnoid hematomas. Shaken Baby Syndrome (SBS)
Caregivers deliberately exaggerate or fabricate histories and symptoms or induce symptoms. Munchousen Syndrome by Proxy (MSBP)
“The use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing any visual depiction of such conduct, or rape, molestation, prostitution or incest w children. Sexual Abuse
The priority is to _______ the child from the abusive situation to prevent further injury. Remove
Passive; depressed; disinterested; loss of newly acquired skills; wont eat or sleep. Despair of Separation (Toddler)
Rigid schedules, altered caregiving activities, separation from parents, unfamiliar surrounding and medical procedures. L/t Loss of Control (Toddlers)
Egocentric and Magical Thinking; feels powerful and omnipotent; Feels hospitalization is a punishment; may react w/ uncooperativeness; crying. Preschooler (Loss of Control)
Fears intrusive procedures- especially those involving genitals; (Castration; Mutilation). Fear of Bodily injury and Pain (Preschooler)
Vaccines work ___ % of the time. 93
Varicella stays alive in _____ endings for life. Nerve
Low grade fever <101°F may be therapeutic. Helpful
Pain goes away when ear drum ______ which may cause scaring if repeated. Ruptures
Give ______ or ______ w/ difficult PO patients. Jello; Popsicles
Avoid ______; ingestion/poison; absorbed through the skin. Hand-gels
Shower with hot water running, sit on toilet Not in tub; parents need to be _______. Present (Spasmotic Croup)
Best way to view Epiglottitis. Lateral X-ray
If <3y/o small objects should not fit through ______ roll. Toilet paper
***Drug Study: works on ion flow, ↑motility of cilia in lungs; 5y/o>older; 3x/week for 24wks; ↑Lung function after 24mo; <cough, congestion, ↑lung expansion. Denufosol
Most commonly affected organs in CF. Respiratory & Pancreas
Have liquids, juice, milk; helps w/ passage of food. Impaired Salivation (CF pt)
Encourage this supplementation w CF patients. Salt
May cause Carditis; Polyarthritis; Erythema Marginatum: Red ares w/ white patching; SubQ Nodules. Rheumatic Fever (Jones Criteria)
***Long term sequelae: after 5 years 49% reported 1 long term sequelae; of those 45% had intellectual or behavior disorder; academic problems. Meningitis Study
Brudzinski and Kernigs sign only good for pts >___y/o. 2
Monocuclear; ↑Protein; Normal Glucose; Clear. Viral Meningitis
Polymorphonuclear; ↑↑Protein;↓Glucose; Turbid/Cloudy. Bacterial Meningitis
Mononuclear; ↑↑Protein; ↓↓Glucose; Clear. TB Meningitis
May turn Urine & Stool Orange; bladder anesthetic; doesnt Tx Infection. Pyridium.
***Steroid study; early administration of steroids at time of NS diagnosis; achieved remission w/ steroid Tx; Prognosis good; Remission w/in 7 days; 7-14 days ↑relapse. Nephrotic Syndrome Study
A noninfectious disease; Autoimmune; Common 6-7y/o; Uncommon <2y/o; Approx 10 days after strep; Bed rest not necessary. APSGN
*** AGN Nepal; ↑rare symptoms than classical symptoms; ↑different symptoms in Nepal. AGN study
***Study: St. Jude ALL; Mutation found; single change PAX5; first time PAX5 have been linked to CA; ↑risk of developing ALL. ALL study
Blood smear=immature WBC; L.P. To r/o CNS involvement; Bone marrow aspiration or biopsy. ALL Diagnosing
***Lead pollution in China; blood levels between 20-50 impair math skills, the younger the child ↑ permeability of lead. Lead Study
Possible _____ later in life due to APAP poisoning. Anemia
***DMD; 10-17 y/o Males; injected with AVI4658 on foot top; 3-4wks muscle biopsy=↑Dystrophen which helps with muscular fibers. DMD Study
______ ok after hospitalization. Regression
Created by: BOjangles1006
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