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ccac 102 Final

Presumptive changes changes felt by women: breast changes,amenorrhea,n/v, urinary freq,fatigue,quickening
Probable signs changes observed by examiner: goodell sign-softening of cervix, chadwick- violet blue cervix, > blood, braxton hicks contraction-irregular painless contractions
What is Pica? Ingestion of nonfood items, or food consumed in abnormal forms Iron & Zinc deficiencies, lead poisoning symptoms Treatment-remove child from substances,ensure proper nutrition,treat dietary deficiencies
Failure To Thrive (FTT) Failure to eat enough to be adequately nourished, mostly non-organic,children at risk-parents with depression,substance abuse, retardation, Lack of weight gain or weight loss in children under 6,not medical. provide nutrition catch up on growth
Anorexia Life threatening,teen girls/women upper middle class, INVOLVED families,FINDINGS:extreme weigh loss,distorted body image,occupied with food,PHY FIND:fluid/electr imbalance, cold intolerance, dizziness,constipation,abd discomfort,
Bulimia Nervosa binge eating- followed by purging, laxative, diuretics, Adolescent-white middle class girls,familys chaotic distant from teen, Depreesion, FINDINGS-occupied with shape, size of body, overweight or thin, dental carries, calus on hand, food log,
Cleft Lip and Palate common in Native Amer. distinct facial feat, History > chance, environmental/genetic, FOLATE Lessened risks, Risk for aspiration:small freq feeds, provide emotional support normal life after surgery, clear fluids w/ dropper, control pain, involve parents
Esophageal Atresia Foregut fails to lengthen, separate and fuse into trachea and esophagus during fetal development,Symptoms:salvation,drooling,cyanosis, chocking, risk for pneumonia,DX try pass NG, HOB lowered to minimize aspiration,G-tube maintain normal G/D,s/s infection
Hirschsprung disease inadequate motility causes mechanical obstruction of intestines,born absence of ganglion cells on wall of rectum/colon-prevents peristalsis,abd distention,FAIL to pass meconium in 48,older child-fail weight gain,malnutrition,constipation:resection bowel
Pinworm parasitic infection,not treat water,Day care children @ risk, Inhaled eggs/carried from hand to mouth,peri itching,irritability,FAMILY is treated,Treat with meds, Teach hand washing,clean toys,
Celiac Disease Gluten sensitive,common in Caucasians,european descent,genetic component,protein in wheat-toxic to mucosa cells on intestines/damage villi,cant absorb CA,VIT D, Fe,folate life long disease,
Intussusception (temporary) Portion of intestines prolapses and telescopes into another-obstructs stool,wall rubbing:inflam,edema,Low blood flow, necrosis,perforation,hemorrahge, onset abrupt, surgery corrects problem,
Bladder extrophy rare defect, post bladder wall potrudes through lower abd wall,surgical repair 1st 24-48, prevent infection/trauma to exposed bladder:cover with sterile plastic wrap,wound/pelvis immobilized,good wound care,monitor renal function, promote self esteem
Hypospadias and Epispadias congenital abnormality with location of urethral meatus in males, Hypo- opening on bottom, Epi-opening on top, should not be circumcised, correct in 1 st year of life, prevent infection, double diaper,antibiotics till stent is removed,pain management
Cryptorchidism undescended testes, result from testosterone deficiency,structural problem, descend in 3 mths, outpatient,discharge:s/s infection,do not straddle,avoid vigorous activity, 33 % > test cancer
Enuresis Meds:imipramine, desmopressin repeated involuntary voiding by child old enough to control bladder, usually at night,day or both, night time mostly boys, day dime girls,primary,intermittent, secondary,fam hist, Primary:small function capacity,TX:fluid restrict,bladder ex,enuresis alarm
Nephrotic syndrome Clinical state characterized by edema,proteinuria,hypoalbuminemia,hyperlipidemia,altered immunity. affects kidney,common in males,autoimmune, edema over weeks, HTN,shiny skin,irritability,<urine output,Steroid:decadron,
Neurosensory:Meningitis Inflammation of the meninges,Bacterial,Newborn/infant @ risk,secondary to other infection:otisis media,sore thoart, bacteremia spreads infect to CNS, WBC cover brain- edematous.clinical findings:quick onset,infant:change in feeding, older:confusion,LOC<
Meningitis...... more symptoms:headache,photophobia,nuchal rigidity:stiff neck, THEARPY:blood cult,lumbar punct,antibiotics:immediately,NPO aspiration risk,IVF,Burdzinski test:legs contract head flexed-postive,FOLLOW UPS IMPORTANT
Reye Syndrome cerebral dysfunction caused by an insult, result in permanent tissue damage, ASPRIN in childern under 12, death common w/ reye, SYMPTOMS:N/V,Mental status change,seizures,LOC <,Liver enzyme >,
Cerebral Palsy Disorder of movement and posture,Immature brain stem affected,ETIOLOGY-congenital,hypoxia,ischemic,or infectious intrauterine to the CNS, abnormal muscle tone,lack of coordination,delayed milestones, Develop max independence,PT,OT,speech,special edu,
Spina Bifida Defect in one or more vertebrae through which spinal cord can protrude,common in lumbar/sacral,Factors:alchol,folic acid def,maternal obesity,DX:after birth,bowel/bladder function eval,cognitive/motor eval,surgery to close lesion 24-48 after birth
Hydrocephalus Body response to imbalance between production/absorption of CSF,FINDINGS:Infant->head,bulge fontenals,distend scalp vein,> tone,Irritability, Children:Headache,vomit in am,fussy, confusion,LATE sign:high pitch cry/vomiting,
Hydrocephalus Pre shunt care: measure head,small freq feedings, POST shunt care:> HOB intervas, Keep bed flat prevent rapid fluid drainage, Problem: clog/ Infection
Juvenile Rheumatoid arthritis Chronic autoimmune inflammatory disease,joint inflam results in decreased mobility,swelling/pain,common in girls:2-5 or 9-12,interferes w/ G/D, scar tissue limits ROM,Fever,rash,splenomegaly,hepatomegaly,lymph swell,Therapy:relieve pain,prevent contractur
Muscular Dystrophy Duchenne Muscle fiber degeneration/muscle wasting,early or late in life, all are terminal,X-linked:only in males, Family hist, genral muscle weakness,no effective treatment, dont push child adapt activities to them, cardiac and lung problems, Promote independence
Childhood Cancer different stages receive different treatment, 3 treatments:surgery,radiation,chemo-therapy, Biggest concern Blood counts, Decreased immunity,ANC- absolute neutriphile count,
Wilms Tumor antiemetics before chemo Intrarenal abdominal tumor:Kideny, Between 2-5yrs,grows quickly-double in size <2 weeks, can palpate but dont, asymptomatic,firm,lobulated mass of midline(lump on back),Surgery 1st treatment,Monitor BP,Fluids,CBC<,WBC,NO IMMUNE SYSTEM:fever life threaten
Neuroblastoma symptoms specific to location of tumor, abd- vomiting. solid,smooth,hard,non-tender tumor,abd or head,younger (less 1yr) the better chance to survive,Mass is removed/chemo follows, Doxorubin:drug used,cardiac function monitored,bone marrow transplant:adv disease,NO PALPATING,monitor VS,weight,
Chemo-therapy CARE Minimize side effects,teach parents about medications, monitor physical and emotional growth and development,
Pediatric Emergencies Drowning Death within 24hrs of submersion,90% in pools or ponds, toddler&teenager,anoxia-no oxygen, leads to cerebral edema,ICP, little done to resuscitate brain,monitor cardiopulmonary status,LOC,non-judgmental,edu family
SIDS Sudden unexpected death of an infant under 1 year DURING SLEEP,leading cause of death 1mth-1year 90% before 6 months,reassure family not responsible,provide comfort family/sibling-wont happen to them, sleep on back, no toys or pillows,
Poisoning common death/injury in children between 1-4 years, young children explore, CALL POISON CONTROL,RN management:assess VS,LOC,obtain specific info from parents,prevent future absorption and eliminate effects
Lead Posioning recommended lead serum level<10,Lead exp:paint,contam food,water,soil,inhaled dust,interferes with normal functioning:nervous cells and kidneys, Offer food Ca & Fe,
Developmental disorders Downs syndrome,
Decrease PreLoad Diuretics-lasix,
Dilate coronary arteries Nitrates
Decrease Heart Rate B-Blockers (metoprolol), (Lopressor)
Decrease after load Vasodilators(ACE inhibitors and other anti-hypertensives)
Decrease Myocardial contractility B-blockers,CA channel blockers
Infertility (IFV/ET): Invitro Embryo transfer-eggs collected, FRETILIZED IN LAB w/ sperm, Transferred to uterus and embryo development
Gamete infra-fallopian transfer (GIFT): eggs collected, placed in catheter with washed sperm and placed in uterine tube, FERTILIZATION IN TUBES
Xygote infra-fallopian transfer (Zift): FERTILIZED IN LAB, then placed in tube 1-2 days
Therapeutic donor insemination: donor sperm injected into uterus at ovulation
Donor embryo: Donated eggs/sperm, fertilized in lab and implanted
Gestational carrier: surrogate-may use couples eggs and sperm
PRE-eclampsia Pregnancy specific gestational hypertension with PROTEINURIA, ECLAMPSIA:includes seizures, PRE-eclampsia @ risk for HELLP syndrome- hemolysis-PT,PTT,bleeding time, elevated liver enzymes-AST,ALT, LOW platelets less than 100,000, TREAT WITH MAG SULFATE
Bleeding: EARLY, LATE EARLY: misscarriage LATE: Placenta Previa: painless vaginal bleeding; 2&3rd trimester Placental Abruption:painfull but may or may not bleed as abdomen fill with blood
Hemorrhage: MASSAGE THE FUNDUS: caused by uterine ATONY,uterus not contracting,contracting controls bleeding, Postion in trendelenberg position(feet above heart) give o2,ensure two iv available,MEDS: pitocin, Involution:returning to pre preg state:2wksSUB:not return
ANTEpartum testing Risk factors in US:gestational diabetes,pulmonary embolism,hemorrhage, Related factors: age,lack of prenatal care, edu,marital status,nonwhite
DAILY fetal movement count "kick count" how many kicks they feel:o2 supply,noninvasive,
Amniotic fluid volume oligohydramnios-decreased fluid,absence of fluid pockets:greater than 3cm is good, Polyhydramnios:increased fluid,multi pockets of fluid,neural tube defects:spinabifita
BIOphysical profile-High risk Breathing,movements,tone,amniotic fluid index, nonstress test: +2 or 0 higher the score the better, below 6 is abnormal
BIOchemical Assessment Amniocentesis-after 14 weeks:second trimester,Color:meconium=stress,normal:clear/yellow,Lungs:L/S 2:1
Antepartum assessment using electronic fetal monitoring Nonstress test: Acceleration of FHR W/ movement-2 or more acceleration of 15 beats/min lasting 15 sec NORMAL BASELINE: 110-160 moderate variability 5-25 beats REACTIVE IF MEETS
VEAL CHOP (Decelerations) variable: CORD compression,baby compensates-reposition mom early:head compression-goes back to normal after compression Acceleration:optimal-desired accel w/ no decel Late:placenta insufficiency-possible c section
Insulin:Rapid acting lispro (humalog):clear Aspart (novalog):Clear onset:15 min peak:60-90 duration:3-4hours
Insulin: short acting REGULAR(humalog R,Novolin R):clear ONLY TYPE THAT CAN BE GIVEN IV onset:1/2-1 hour peak:2-3 hours Duration:3-6 hours
Insulin: Basal-Intermediate-acting insulin NPH:humulin N, Novolin N-cloudy Onset:2-4 hours Peak:4-10 hours Duration:10-16 hours
Insulin: Basal- Long acting LANTUS:clear onset: 1 hour Peak:peakless Duration:24 hours CANT be a pen,mix,no prefill
Created by: Jhoff0328