ccac 102 Final
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| Presumptive changes | changes felt by women: breast changes,amenorrhea,n/v, urinary freq,fatigue,quickening
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| Probable signs | changes observed by examiner: goodell sign-softening of cervix, chadwick- violet blue cervix, > blood, braxton hicks contraction-irregular painless contractions
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| 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
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| 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
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| 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,
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| 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,
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| 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
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| 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
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| 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
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| 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,
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| 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,
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| 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,
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| 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
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| 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
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| 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
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| 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
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| 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,
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| 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<
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| 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
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| 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 >,
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| 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,
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| 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
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| 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,
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| Hydrocephalus | Pre shunt care: measure head,small freq feedings, POST shunt care:> HOB intervas, Keep bed flat prevent rapid fluid drainage, Problem: clog/ Infection
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| 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
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| 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
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| Childhood Cancer | different stages receive different treatment, 3 treatments:surgery,radiation,chemo-therapy, Biggest concern Blood counts, Decreased immunity,ANC- absolute neutriphile count,
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| 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
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| 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,
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| Chemo-therapy CARE | Minimize side effects,teach parents about medications, monitor physical and emotional growth and development,
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| 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
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| 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,
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| 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
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| 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,
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| Developmental disorders Downs syndrome, |
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| Decrease PreLoad | Diuretics-lasix,
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| Dilate coronary arteries | Nitrates
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| Decrease Heart Rate | B-Blockers (metoprolol), (Lopressor)
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| Decrease after load | Vasodilators(ACE inhibitors and other anti-hypertensives)
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| Decrease Myocardial contractility | B-blockers,CA channel blockers
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| Infertility (IFV/ET): Invitro | Embryo transfer-eggs collected, FRETILIZED IN LAB w/ sperm, Transferred to uterus and embryo development
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| Gamete infra-fallopian transfer (GIFT): | eggs collected, placed in catheter with washed sperm and placed in uterine tube, FERTILIZATION IN TUBES
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| Xygote infra-fallopian transfer (Zift): | FERTILIZED IN LAB, then placed in tube 1-2 days
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| Therapeutic donor insemination: | donor sperm injected into uterus at ovulation
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| Donor embryo: | Donated eggs/sperm, fertilized in lab and implanted
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| Gestational carrier: | surrogate-may use couples eggs and sperm
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| 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
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| 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
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| 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
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| ANTEpartum testing | Risk factors in US:gestational diabetes,pulmonary embolism,hemorrhage,
Related factors: age,lack of prenatal care, edu,marital status,nonwhite
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| DAILY fetal movement count | "kick count" how many kicks they feel:o2 supply,noninvasive,
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| 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
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| BIOphysical profile-High risk | Breathing,movements,tone,amniotic fluid index, nonstress test: +2 or 0 higher the score the better, below 6 is abnormal
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| BIOchemical Assessment | Amniocentesis-after 14 weeks:second trimester,Color:meconium=stress,normal:clear/yellow,Lungs:L/S 2:1
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| 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
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| 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
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| Insulin:Rapid acting | lispro (humalog):clear
Aspart (novalog):Clear
onset:15 min
peak:60-90
duration:3-4hours
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| 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
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| Insulin: Basal-Intermediate-acting insulin | NPH:humulin N, Novolin N-cloudy
Onset:2-4 hours
Peak:4-10 hours
Duration:10-16 hours
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| Insulin: Basal- Long acting | LANTUS:clear
onset: 1 hour
Peak:peakless
Duration:24 hours
CANT be a pen,mix,no prefill
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