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67 Cards in this Set
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- Back
- 3rd side (hint)
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5 functions of endocrine system
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Endocrine system controls/ regulates metabolic processes-energy production, growth, F&E, response to stress & sexual reproduction
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6 anterior pituitary hormones
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TSH (stim by TRH)
GH (stim by GHRH) FSH LH ACTH (stim glucocorticoids, mineralocorticoids, androgens) PRL (stim by TRH) MSH (melanocyte-stimulating hormone) |
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6 hypothalamus hormones
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TRH
somatostatin (inhibits GH and TSH) GHRH GnRH CRH dopamine (inhibits PRL) |
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2 posterior pituitary hormones
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ADH (vasopressin)
oxytocin |
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clinical manifestations of GH deficiency
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short stature but proportional height and weight
delayed epiphyseal closure * seizures within 24 hours of birth retarded bone age in proportion to height premature aging in later life increased insulin sensitivity |
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clinical manifestations of TSH deficiency
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Abdominal distention w/ umbilical hernia, puffy face (TH def)
short stature with infantile proportions dry, course skin; yellow discoloration, pallor cold intolerance constipation somnolence bradycardia dyspnea on exertion dealyed dentition, tooth loss |
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clinical manifestations of ACTH deficiency
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severe anorexia, weight loss
hypoglycemia hypotension hyponatremia, hypokalemia adrenal apoplexy in response to stress circulatory collapse |
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clinical manifestations of ADH deficiency
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polyuria, polydipsia, dehydration
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clinical manifestations of MSH deficiency
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decreased pigmentation
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the two types of excessive GH disorders
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Before fusion of epiphyses = GIGANTISM
After fusion of epiphyses = ACROMEGALY |
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clinical definition of precocious puberty
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Puberty before 8 yrs in girls, 9 yrs in boys
(< 6 yrs in African American girls) |
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2 subtypes of precocious puberty
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1. True Premature puberty: premature maturation of hypothalmic-pituitary axis (initiates sexual development)
2. Pseudoprecocious puberty: autonomous secretion of sex steroids as a result of adrenal or gonadal tumor or exogenous hormones |
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what's the drug that can arrest premature puberty?
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Lupron (monthly injections)
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most common preventable cause of MR?
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congenital hypothyroidism
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managment/nursing care of addison's crisis
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Replacement of cortisol, body fluids
Glucose, antibiotics Prompt recognition Monitor vital signs Seizure precautions I & O |
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s&s congenital adrenal hyperplasia
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Ambiguous genitalia
Increased skin pigmentation Failure to gain weight, hyponatremia Early sexual maturation (can be excess or deficiency in sex hormones) extra androgens - masculinize girls' genitalia, does not usually present changes in boys' autosomal recessive disorder |
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management/nursing of congenital adrenal hyperplasia
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Glucocorticoids
Aldosterone replacement for some Recognition early is crucial Assignment of sex according to genotype ? surgery Education, support Genetic counseling |
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leading cause of death in children older than 1 year?
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trauma
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multiple effects of immobilization
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Decreased muscle activity- loss of muscle strength, bone demineralization, loss of joint mobility
Cardiovascular – increased work load of heart, thrombus formation, orthostatic intolerance Respiratory –shallow, slower resp, chest expansion is limited by supine state, abdominal distension, mechanical restrictions, weak cough, decreased secretions GI-decreased po/ anorexia, increased risk of aspiration, constipation Renal-stasis of urine, risk of infection, incontinence, kidney stones Metabolism-decreased metabolic rate, fatigue, hypercalcemia Skin-breakdown, poor healing, pressure ulcers Neurosensory- Psychological- patient/ family effects |
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most common early childhood fracture?
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radius.
next hand bones. (breaking falls) femur is more common for older children |
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types of fractures most frequently associated with child abuse
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greenstick and spiral (twisting)
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5 Ps indicative of severe fracture
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pain
pulselessness pallor parasthesias paralysis |
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what is reduction?
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Reduction is a medical procedure to restore a fracture or dislocation to the correct alignment.
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3 possible complications of fracture
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Circulatory compromise
Nerve compression Compartment syndrome |
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what's the MVA triad?
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head, trunk, femur injuries
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what's one method for guarding against or treating compartment syndrome with fractures?
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bivalving casts
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what is plagiocephaly?
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Plagiocephaly – flattening of one side of the head.
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treatment of torticollis
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Stretching
Encourage movement so condition does not worsen |
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describe legg-clave-perthes syndrome
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Degenerative disease of the hip joint. Collapse and deformity of ball and socket.
Ischemic necrosis of the hip. 2-12 years of age- common ages 4-8 yr. Boys > girls 4:1 Cause unknown 18months-2 years symptoms Intermittent limp Stiffness, aching Pain > AM and at night |
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management of legg-calve-perthes syndrome
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Rest, non weight bearing
Active motion later Casting Traction (not common) Surgery Self limiting illness |
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describe slipped capital femoral epiphysis (scfe)
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Spontaneous displacement of proximal femoral epiphysis
Ages 10-16 years Boys > girls Overweight 60 % bilat Osteonecrosis -complication side 3:S&S |
History of mild trauma
Gradual displacement- no known injury Intermittent c/o hip pain, limp, groin pain Restriction of internal rotation Diagnosed by x-ray |
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treatment of SCFE
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Non weight bearing
Surgical rx Traction Pinning SCFE is an emergency ( goal is to prevent loss of cartilage, necrosis) |
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3 categories of scoliosis
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Congenital, infantile (birth to 3 years),
childhood/ juvenile (4 to 10 years), adolescent (increases with puberty) |
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3 S&S scoliosis
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Uneven hips
Uneven, more prominent scapula Uneven spine |
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degrees for
no problem no treatment in scoliosis |
(curve of less than 10 degrees no problem- curve less than 20 degrees no treatment)
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describe osteomyelitis
+ give S&S |
Infection of bone
Age < 10 years (half of all cases in children under 5) Bacteria adheres to bone Usual inflammatory reaction S&S - Severe pain Fever Irritability Tenderness Decreased movement |
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describe osteogenesis imperfecta
+ give S&S |
Osteoporosis syndrome- excessive fractures and bone deformity.
Genetic collagen synth disorder. Blue sclera Bone deformities Hearing loss Discolored teeth Some types lethal side 3: managment |
Prevent contractures
Deformities correction PT Fracture prevention Genetic counseling Careful handling Pillows Education Diaper changes can be hurtful |
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describe CP
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2.4-3.6/ 1000 births
Group of permanent disorders of the development of movement and posture Activity limitations Result of disturbances of fetal or infant brain Sensation/ motor/ communication/ cognition/ muscloskeletal/epilepsy Most common permanent physical disability of childhood causes: Preterm birth, LBW, ELBW Birth asphyxia Existing prenatal brain abnormalities Maternal infections Some with no identifiable cause side 3 S&S CP |
Delayed gross motor delay
Abnormal motor performance Spastic movements Ataxia Hemiparesis Alt in muscle tone Posture defects Abnormal reflexes |
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treatment of CP
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PT / orthotics
Adaptive equipment Surgery Medications for spasticity, seizures, pain, other OT Speech Equestrian therapy (promotes balance) aquatics |
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describe muscular dystrophies
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Largest group of muscular diseases in children
Genetic origin With gradual degeneration of muscle fibers-leads to progressive weakness and wasting of skeletal muscles Increasing disability and deformity with loss of strength |
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describe duchenne's MD
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Most severe/ most common in childhood
X linked recessive Boys 1 in 3500 male births Missing protein of muscle cells- no regeneration, necrosis of muscle cells results + sensation side 3: S&S |
Loss of ability to walk by 9-12 years
Often IQ < 90 Depression is common Death results from respiratory/ cardiac failure S&S Onset ages 3-5 years Progressive muscle weakness, wasting, contractures (hips first affected-shoulders next) Gower’s sign Calf muscles hypertrophy Adolescents- progressive generalized weakness |
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describe developmental dysplasia of the hip
more common in males or females? |
Abnormal development of hip
1 in 1.5 / 1000 births 30-50% were breech births Females – 80% Caucasian > incidence predisposing factors: physiologic, mechanical (e.g., breech), genetic side 3: S&S |
Unequal skin folds*
Limited abduction limp Unequal knee Ortalani & Barlow tests Audible “ clunk” Ultrasound / x-ray (older than 4 months) |
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treatment of childhood hip dysplasia
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Newborn to 6 months
Pavlick harness (used for 6 mo) Abduction devices 6-18 months Traction Surgery with casting |
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describe congenital clubfoot
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Deformity of ankle and foot
(forefoot adduction,midfoot supination,hindfoot varus, ankle equinus) Also known as talipes equinivarus (TEV)- most frequent type |
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treatment of clubfoot
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Serial casting –after birth (up to 8-12 weeks)
Surgical intervention (after failure to achieve alignment by 3 months) |
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describe metatarsus adductus
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Most common foot deformity
2 per 1000 Result of intrauterine positioning Forefoot is adducted and in varus, giving the foot a kidney bean shape. Most often resolves on own or with simple exercises. warping in toward the middle of the foot side 3 treatment |
usually self-correcting.
if more serious, stretching, splinting, or casting |
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diagnostic criteria for diabetes (according to CHB lady)
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Patient presents with polyuria, polydipsia, and/or weight loss
AND/OR Fasting plasma glucose higher then 126 mg/dl (first thing in the morning before eating or drinking for at least 8 hours) Random plasma glucose > 200mg/dL |
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diagnostic criteria for DKA
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Plasma glucose > 200mg/dL and
Acidemia: venous pH < 7.30, tCO2 or venous HCO3 < 15 mmol/L or mEq/L and Moderate or large ketonuria |
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term for abnormally increased coloration (hyperpigmentation) and "velvety" thickening of the skin.
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acanthosis nigraicans
90% of type II diabetes will have this feature. |
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what's the only oral diabetes med that's approved for use in the pedi population?
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metformin (a biguanide)
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first intervention for type II diabetes?
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First interventions: cutting out fast-acting carbs, sodas.
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describe CFRD
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Insulin deficiency in CFRD is due to scarring and destruction of the pancreatic islets and their beta cells
CFRD is not associated with the autoimmune process and the auto antibodies seen in Type 1 diabetes Scarring (fibrosis) occurs due to thickened exocrine secretions |
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describe steroid-induced diabetes
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Steroids increase “insulin resistance” making the insulin less effective
This side effect of is often temporary and goes away when steroid use is no longer needed Treated with insulin during hyperglycemic state |
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target A1C?
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6.5% or less
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what is the A1C?
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the fraction of glycolated hemoglobin in blood. it's a type of hemoglobin that's made in response to high plasma glucose levels, and is an approximate measure of plasma glucose for the past 3 months.
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what A1C necessitates a change in the current treatment plan?
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8% (unless under 5 years, when hyperglycemia is less problematic due to brain development)
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what is used for diabetic low emergencies?
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glucagon
(hormone secreted by pancreas that raises blood sugar) IM or SC |
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what's the honeymoon period in diabetes?
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a period of time during which beta cells may recover some function and lead to a false sense of security in pt.s. Blood sugar can quickly spike.
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when do you give rapid-acting insulin to infants?
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AFTER eating, due to the possibility of food refusal.
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2 types of rapid-acting insulin
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Human insulin analogs lispro (Humalog) and aspart (Novolog)
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what are the two types of longest-acting (basal) insulin?
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Analog insulins glargine (Lantus) and detemir (Levemir) have the longest action profiles
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why isn't insulin-pump therapy used at first diagnosis?
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pt.s and families need to learn to carb-count and calculate with MDI (multiple daily injections)
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how do you prime a pen?
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waste 2 units.
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insulin pump cannula site rotation frequency?
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Site has to be rotated q 2 days for kids. Q 3 days for adults.
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what should diabetics do before exercise?
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eat a snack (give mild hyperglycemia to reduce risk of hypoglycemia during workout)
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insulin to carb ratio?
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this is individual for every child.
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what is the "correction factor" in DM?
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amount 1 unit of insulin will drop a child's blood sugar.
this is individual to a child, and is based on their physiology. |
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