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215 Cards in this Set

  • Front
  • Back
What is childhood morbidity comprised of?
Motor vehicle crashes
Drowning
Burns: girls die more than boys
Poisoning
Firearms : teenage more prone
What is mortality?
death
What is considered the neonatal period?
< 28 days of life
What is considered post-neonatal period?
28 days to 1 year
What advances decreased infant mortality?
-advances in neonatal intensive care
-incr #'s of vaccinations
-folic acid use for prevention of spina bifida
What is cephalocaudal development?
Growth in a head-to-tail direction. Head end of org. develops first & is very large & complex. Tail end is small & simple.
What is proximodistal growth & development?
Near-to-far growth. Ex: whole hand is used as a unit before fingers can be manipulated
Differentiation principle of growth & development?
describes development 4m simple operations to more complex activities. All areas of development (physical,mental,social, & emotional) proceed in this direction.
Sequential trends of growth & development?
in all dimensions of growth & development there is a definite, predictable sequence, with each child normally passing thru each stage. Children crawl b4 they creep, creep b4 they stand, stand b4 they walk.
Developmental pace principle?
dvlmpt. does not progress at same rate or pace. Periods of accelerated growth & periods of decelerated growth
Who developed the psychosexual personality development theory?
Freud. Sensual pleasure
“Certain regions of the body assume a prominent psychologic significance as the source of new pleasures and new conflicts gradually shift from one part of the body to another at particular stages of development.”
Oral stage of Freud's psychosexual development?
Oral (birth to 1 year) : biting, sucking
Anal stage of Freud's psychosexual development?
Anal (1 to 3 years) : toilet training, sphincter control
Phallic stage of Freud's psychosexual development?
Phallic (3 to 6 years) : put hands in diaper, etc.
Latency stage of Freud's psychosexual development?
6 - 12 yrs. elaborate on previosly acquired traits & skills.
Genital stage of Freud's psychosexual development?
12 years & older. Maturation of reproductive system & prod. of sex hormones.
Trust vs. Mistrust stage of Erikson's psychosocial development?
(birth to 1 year) : must develop trust that they will be fed, warm, dry, etc.
 Dominates the first year
 Freud’s oral stage taking in through all senses: being fed, held, has much to do with caretaker
Autonomy vs. shame/doubt stage of Erikson's psychosocial development?
(1 to 3 years) :aim is to become independent
 Increasing control of bodies, themselves, and the environment : trying to figure out world and selves
 Imitation is big
Freud’s anal stage-sphincter control
Initiative vs. Guilt stage of Erikson's psychosocial development?
(3 to 6 years) : using imagination, testing waters, may feel guilty
 Enterprise, imagination, conscience
Freud’s phallic stage
Industry vs. Inferiority stage of Erikson's psychosocial development?
(6 to 12 years)
 Achieved (1st 3) critical stages, now work/produce
 Freud’s latency period
Identity vs. Role confusion of Erikson's psychosocial development?
(12-18 years)
 Freud’s genital period
 Rapid and marked physical changes
 Trust in their bodies is shaken, overly concerned with other’s
opinions :conflicts w/ friends
 Trying to fill old roles, while looking for new ones : trying to figure out who they are
 Occupation decisions
Piaget's Cognitive Development Sensorimotor stage?
(birth to 2 years)
Cause and effect, trial and error, object permanence: don’t know where object is, peekaboo, finally representative thought
Preoperational stage of Piaget's Cognitive Development?
(2 to 7 years)
 Inability to put self in place of others
 Concrete, tangible, later, intuitive reasoning (later in stage)
Concrete operations stage of Piaget's cognitive development?
(7-11 years)
 Logical, coherent thought, not abstract yet
 Less self-centered, socialized thinking
Formal operations stage of Piaget's cognitive development?
(11-15 years)
 Abstract thinking, draw logical conclusions
 Can consider abstract, theoretic and philosphical matters
Order that kids usually learn to speak?
Nouns, verbs, adjectives, adverbs, pronouns
Infant Mortality Risk?
Low birth weight
Black race: AA infant mortality is twice as high, reason unknown
Male gender
Short or long gestation
Birth order
Very young or older mother: teenage mother is higher risk
Maternal education
What is the leading cause of death in kids age >1 year? and ex?
Motor vehicle crashes
Drowning
Burns: girls die more than boys
Poisoning
Firearms : teenage more prone
What is the "new" morbidity?
social: obesity both parents work, can’t take kids to sports, etc.
behavioral
educational problems that may alter health
What 3 things define at-risk groups for "new" morbidity?
1. kids 4m low socioeconomic status
2. male gender
3. sibling who has had a previous injury
What is primary prevention?
Health promotion for prevention of disease or injury
Ex of primary prevention?
Well-child clinics
Immunization programs
Safety programs
Sanitation measures
What is secondary prevention?
Screening and early diagnosis of disease
Ex of secondary prevention?
TB screenings/Lead screenings
Isolation of communicable illnesses
-Mental health counseling
Death
Divorce
Community disasters
What is tertiary prevention?
Interventions to optimize function for children with disability or
chronic disease
Ex of tertiary prevention?
Asthma management programs
Rehab programs
Special education programs for children
What is a consanguineous relationship?
blood relationship
What is an affinal relationship?
marital relationship
What is the family systems theory?
The family is a system that continually interacts with its
members and the environment.
Emphasis on “interaction” bw the members. consequently
Problems do not lie in any one member but in the type of interactions used by the family.
Example: Child abuse
Family Stress Theory?
Families encounter stressors, both predictable and
unpredictable. When a family experiences too many stressors
for it to cope adequately, a CRISIS ensues. Adaptation requires
a change in family structure and/or interaction.
Developmental theory addresses?
Examples?
Addresses family change over time, using family life-cycle
ex: Birth of first child marks transition from stage I to
stage II, from being a married couple, to being a married
couple and parents
What is socialization?
The process by which children acquire the beliefs, values, and
behaviors of a given society in order to function within that
group: school
What are social roles?
Culturally prescribed patterns of behavior for persons in a
variety of social positions
Social group consists of?
a system of roles carried out in primary & secondary groups
Primary social groups?
- Intimate, close contact such as family and peers
Secondary social groups?
- Limited contact, less concern such as professional assoc.
Organic failure to thrive?
Physical cause is found
Nonorganic failure to thrive?
Unrelated to dz, often psychosocial
Idiopathic failure to thrive?
–Unexplained by organic or environmental etiologies
ESSR r/t cleft lip & palate feeding?
Enlarged nipple,Stimulate suck (need to suck so can talk later in life, pacifier good for these babies) Swallow appropriately, Rest
What is esophageal atresia?
•Esophagus fails to develop into a continuous tube from the
mouth to the stomach
–May end in a blind pouch
–May develop a connection with the trachea, by a fistula
Tracheoesophageal Fistula (TEF) mgmt pre-op?
•Immediately make NPO, IV fluids started
•Infant positioned with head elevated, suctioned frequently, to
decrease aspiration risk
•Prophylactic antibiotics for early, inevitable aspiration
pneumonia
TEF mgmt post-op?
–Chest tube
–G-tube feeds until esophagus heals
–Barium swallow before start of oral feeds
–Oral feeds start with water
–Complications:
•Strictures, esophageal motility disorders, GERD
What is Hypertrophic Pyloric Stenosis-HPS ?
Hypertrophy and hyperplasia( greater # of cells) of pyloric sphincter muscle
produces obstruction between stomach and duodenum
•Inflammation and edema increase obstruction
Etiology of hypertrophic pyloric stenosis (HPS)?
•Unknown etiology
–Not genetic, but, siblings may be more at risk
•Full term, first born and males
HPS may be associated with?
–Intestinal malrotation, esophageal atresia, anorectal anomalies
Clinical manifestations of HPS?
•Develops over first few weeks of life
–Non-bilious vomiting (no bile, so coming 4m higher in GI tract)
•30-60 minutes after feed, ‘stale’ milk
•Increases with worsening obstruction, ‘projectile’
–Dehydration-- ↓ Na+, K+
–Metabolic alkalosis--↓ Cl-, ↑pH and CO2 (will correct b4 surgery
Physical findings of HPS?
–Olive shaped mass felt in upper abdomen
•Suck on dry sugar in gauze and can be better felt
–Visible peristalsis
•Ultrasound or upper GI if history inconclusive
What is Gastroesophageal reflux (GER) ?
•Passive transfer of stomach contents into esophagus due to
relaxation of the lower esophageal sphincter (LES) due to:
–Transient relaxation of LES
–Incompetent LES
–Anatomic disruption of esophagogastric junction
Clinical manifestations of GER?
•Postprandial (after meals) regurgitation most common sign in infants
–Simple ‘wet’ burp to persistent vomiting
–Hungry and irritable infant
–Weight loss and FTT
–Recurrent respiratory symptoms (4m aspiration)
•Cough, wheezing, pneumonia
–ALTE (acute life threatening event) and cyanosis
What is failure to thrive?
–‘Failure to thrive (FTT) is a sign of inadequate growth
resulting from inability to obtain or use calories required for
growth.’
‘…. the finding of a pattern of persistent deviation from
established growth parameters is cause for concern.’ (Below 3rd parameter is cz for concern
Protest phase of separation anxiety?
Cry and scream, cling to parent
Despair phase of separation anxiety?
Crying stops; evidence of depression
Detachment phase of separation anxiety?
Denial, resignation and malcontent
May seriously affect attachment to parent after separation
Incr risk for stress 4m hospitalization?
“Difficult” temperament
Lack of fit between child and parent
Age (especially between 6 months and 5 yrs)
Male gender
Below-average intelligence
Multiple and continuing stresses (e.g., frequent
hospitalizations)
Influences of self-esteem?
Temperament: (how a child acts) and personality
Opportunities for accomplishment of developmental tasks
Significant others
Social roles and expectations
Infant growth & development in the 1st 6 months?
 5-7 ounces/week weight gain, then slows - Doubles BW by 6 months, triples by 1 year
2.5 cm/month height increase, then slows
50% increase in length by 1 year, mostly truncal
1.5 cm/month head circumference increase
O.5 cm/month during second 6 months
30% increase in head circumference by 1 year
Milestones for 1 - 6 months?
1 month-smiles
2 months-coos
3 months-head control
4 months-rolls : usually easier to go front to back
5 months-hands to mid line :can start to move things 4m 1 hand to another
6 months-sits
Milestones for 7 - 12 months?
7 months-crawls
8 months-pincer grasp : pick up cheerios
9 months-pulls to stand
10 months-stands alone
11 months -cruises : holding on to furniture while walking
12 months-walks
Trust vs. Mistrust phase of Erikson's psychosocial development? (1 mo. - 12 mo.)
 Infants ‘trust’ that their needs will be met
Crucial is the quality of parent-child relationship and the care infant receives
 Delayed gratification needs to be learned
 Until 3-4 months, food is all he cares about
 After that, control is achieved by grasping and biting
Separation in the sensorimotor stage of Cognitive development?
Self from others-4-8 months :6 –8 months is when it really kicks in
Object permanence in the sensorimotor stage of cognitive development?
Object permanence-9-10 months
Recognition of symbols
Beginning of understanding time and place
Language development in the first 12 mo (crying)
Crying is first verbal communication
Urgency to meet physiological needs
Up to 4 hours a day at 6 weeks
By 1 year, crying for hunger, fear, frustration
Language development in the 1st 12 mo (vocalization)
Vocalizations become words
3-4 months, coo and gurgle
By 8 months, imitate sounds
3-5 words with meaning by age 1 year
When should iron supplements be started?
Iron starting at 6-months unless bottle fed : to help body develop RBC’s, can feed iron fortified cereal
What type of milk for first 12 mo?
breast milk alone is first choice for first 6 months of life
Breast or formula for 12-months-no cow’s milk: stomach cannot handle it, at 1 yr can start cow’s milk but until 2 must be whole milk
When start Vitamin D in 1st 12 mo?
200 IU Vitamin D starting at 2-months for all : to prevent rickets
When should solid foods be introduced?
Introduction of solid foods at 4-6 months : brush teeth
-Introduce foods at intervals of 4-7 days to allow for identification of food allergies
Toddler age group?
12 months-36 months
Weight gain & Height for Toddler?
Weight gain slows to 4-6 lbs/year
Birth weight should be quadrupled by 2½
Height increases about 3” per year
Growth is “step like” rather than “linear”
The terrible two's?
Age 12-36 months
Intense period of exploration
Tyrannical, strong-willed, volatile behaviors
 Interspersed with need for comfort
 No! : give them choice so that eliminates possibility of no
Toddler maturation of systems?
Most physiologic systems relatively mature by the end of
toddlerhood
Upper respiratory infections, otitis media, and tonsillitis are common
among toddlers
Voluntary control of elimination
Sphincter control—age 18-24 months
Visual acuity of 20/40 acceptable : from 3 –5 yrs
Milestones of toddlers 1 -3 yrs?
12-months: Walk alone
24-months: Up/down stairs, not alternating
36-months: Stand on one foot, tiptoe, climb stairs alternating feet
18-months: Throw ball, keep balance
24-months: Build towers
36-months: Draw circles
Autonomy vs. shame/doubt for toddler?
n Comfortable with their role as dependent
n Want to exert independence at the same time
n Conflicted between comfort of dependence and need for
independence
 Continued dependence creates doubt at their ability to control their own actions. Feel shame that they want control
Sensorimotor phase for toddler?
Active experimentation to achieve new goals
Uses old learning + new skills to apply the combined knowledge to new situations.
 Beginning of rational judgment and reasoning: turn lights on/off with switch
Pre-conceptual phase of sensorimotor stage of cognitive devlmpt?
(toddler)
Transitional stage bridging self-satisfying infant with socialized toddler
Problem solving based on the here and now
Social development char of toddler?
Understands gender roles
Mimics, plays house
Believes inanimate objects are real and attributes life like qualities to them
Exploration of genitalia is common and acceptable
Sibling rivalry
Language development char of toddler?
Moves from gesturing to words
Increasing comprehension > expressed
By two-years
~300 word vocabulary
Uses some pronouns (I, me, you)
2-3 word ‘sentences’ : not normal sentences
Language red flags at 12 mo?
NO verbal routines
No ma-ma, da-da
Loss of any milestone
Language red flags at 15-18 mo?
No single words
Poor understanding – language
Language red flags at 24 mo?
< 50 words, no 2-word phrases
< 50% intelligible to strangers
Language red flags at 36 mo?
>75% unintelligible to strangers
Flat intonation, echolalia, rote memorization of words or phrases
Growth & Development of Preschool child?
Physical growth slows and stabilizes
n Average weight gain
n 5 lbs per year
n Average height increases
n  2½” to 3” per year
Body systems mature and stabilize; can adjust to moderate stress
and change
Milestones for 3 -5 yr old?
Walking, running, climbing, jumping well established
Refined eye-hand and muscle coordination
Dresses self, ties shoes by 5-years
Wants to please but often challenges values
Has internalized values and standards of family and culture
Initiative vs. guilt char for 3-5 yr old?
Feelings of guilt, anxiety, and fear may result from thoughts that
differ from expected behavior
Development of superego (conscience)
Learning right from wrong/moral development
Language Development in 3-5 yo?
Major mode of communication and social interaction
Vocabulary and complexity increases dramatically between ages 2-5
Increased attention span and memory
Stuttering, stammering or dyslalia: can’t articulate understandable words
Growth & Development of the school-aged child?
More gradual growth and development : still growing but gradually
Physiologically begins with shedding of first deciduous teeth; ends at puberty with acquisition of final permanent teeth
Height increases by 2” per year (until growth spurt)
 Weight increases by 4.5-6.5 lbs per year
Maturation of Systems 6-12 yo?
Bladder capacity increases
Heart smaller in relation to the rest of body
Immune system increasingly effective
Bones increase in ossification  Physical maturity not necessarily correlated with emotional/social
maturity
Industry vs. Inferiority stage (6-12 yo)
Eager to succeed at meaningful social work
Accomplishment with cooperative effort and with competition
Danger is failure leading to inferiority feelings
 Risk for normal children but more so for those with disabilities
Children need and want the chance for real achievement : have worked through the 1st 2 stages to get to this point, less about the family, more about group work
Cognitive Development 6-12 yo?
Concrete operations (Piaget)
Use thought processes to experience events
Egocentrism gone, can see other’s viewpoint
Understand relationships between things and ideas
No longer make judgments on what they see, perceptual thinking, but on what they reason, conceptual thinking.
Moral development 6-12 yo?
Development of conscience and moral standards
Ages 6-7-years
Rewards and punishment guide choices
Know rules but not the reasons behind them
Older school age
Rules and judgments become more founded on needs and desires of others : bc feel peer pressure and need to belong to group
Friends 6-12 yo?
Life lessons learned from peer groups
Learn to appreciate differing points of view
Sensitivity to the social norms and pressures from groups such as rules : need guidelines
Formation of intimate friendships among same-sex peers, secret
clubs, cliques : very important to school age child, a lot of pressure to belong
Identification with peers helps separate from parents
Sleep r/t 6-12 yo?
Amount individualized-9.5 hrs/night
Bedtime resistance at 8-11 years
Maturation of systems 13-19 yo?
Size and strength of heart, blood volume and systolic blood pressure increase
Pulse rate, basal heat production decrease
Adult values for all formed blood elements
Respiratory volume, vital capacity increase
Increased performance capabilities :bc bodies capabilities increase
Adolescent growth spurt during puberty?
20%-25% of total height in 24-36 months
Growth and Development of adolescent girl?
-start growth spurt earlier
9.5-14.5 yrs, done 2.5 yrs after menarche
Growth complete ~ 15 years Average menarche is 12 ¾ yrs + 2.5 yrs = ~15 yrs
Growth and Development of Adolescent boy?
10.5-16 yrs, can grow until 18-20
Primary growth and development sex char of the adolescent?
External and internal organs necessary for reproduction
Secondary sex char of growth & development of the adolsecent?
Secondary sex characteristics : things that you see/hear
Result of hormonal changes: Voice change, hair growth, breast enlargement, fat deposits
Play no DIRECT role in reproduction
Hormonal changes of puberty?
Hypothalamus stimulates anterior pituitary
1-To stimulate the gonads to
Produce sperm in male
Produce, mature and release ova in female
2-To secrete sex-appropriate hormones
Testosterone from the testes Estrogen and Progesterone from the ovaries
What is thelarche in female sexual maturation?
Appearance of breast buds (9-13½ yrs)
What is adrenarche in female sexual maturation?
Growth of pubic hair
(2-6 months after thelarche)
What is menarche?
Start of menstruation
Average age 12 yrs 9½ months in North America
~ 2 yrs after start of sexual changes
First pubescent changes in male sexual maturation?
Testicular enlargement, thinning, reddening, and increased
looseness of scrotum
age 9½ to 14 yrs
Penile enlargement, pubic hair growth, voice changes, facial hair growth
Temporary gynecomastia in ⅓ of boys
Disappears within 2 yrs
Identity vs. role diffusion in the adolescent?
Group Identity vs. alienation: Adolescent must first resolve questions about relationship with
peer group before resolving questions about who they are in
relation to family and society.
Role diffusion: results if unable to formulate a satisfactory identity.
Cognitive development in the adolescent?
Formal operations (Piaget)
No longer only concerned with the real and actual, but the possible
Think beyond the present
How things might change in the future
Consequences of actions Capable of scientific reasoning and logic
Health promotion of the adolescent (nutrition)?
During growth, highest caloric need of life
Substantial need for increased Calcium-skeletal growth, prevention osteoporosis
Iron-expansion of muscle mass and blood volume
Zinc-generation of skeletal and bone tissue
Health promotion of the preschool child (nutrition)?
Sleep-12 hours per night : need consistent bedtime
Sleep issues : nightmares, night terrors, boogeyman, need nightlight
Continued dental health with fluoride
Activities emphasize fun (non-competitive) and safety
Yearly periodic exams, immunization check (by 18-months
What does the upper respiratory tract consist of?
oronasopharynx,pharynx,larynx, upper part of the trachea
Possible probs of oronasopharynx?
URI, sinusitis, thrush
Possible probs of pharynx?
Pharyngitis, tonsillitis
– Group A β-hemolytic streptococcus
Possible probs of larynx & epiglottis?
Croup
The lower respiratory tract consists of?
lower trachea & Lungs, (bronchi, bronchioles, alveoli)
Possible probs of lower trachea?
Tracheitis
About pneumonia as a possible lung prob?
Pneumonia
–Bacterial-S. pneumoniae, H. influenzae, M. catarrhalis,
S. aureus, MSSA: (methicillin sensitive) and MRSA , M. pneumoniae
–Viral-Respiratory Syncytial Virus (RSV): if get when adult will be a cold, baby goes to hospital, Influenza
About asthma as a possible lung prob?
–Inflammation leading to wheezing/asthma
–Can be precipitated by allergy or infection
»Allergic predisposition (for asthma), not asthma, inheritable
Possible reasons for tachypnea?
Heart or lung disease, lung infections, anemia
Possible reasons for bradypnea?
•DKA, liver failure, respiratory failure
What is hypopnea?
shallow and slow breaths
What is hyperpnea?
increased depth and rate
Bronchoscopy pre-pocedure?
• Diagnostic or therapeutic (foreign body)
•Pre-procedure
–Sedative / atropine
–PT, PTT if biopsy being done
Bronchoscopy post-procedure?
–Suction, postural drainage
–Fluids after gag/swallowing returns
–Complications: hemorrhage, respiratory distress
What is nasopharyngitis?
Common cold, very common in children
Symptomatic txment of nasopharyngitis?
will not give antibiotics (unless pneumonia), will tx symptoms
•Fever :have them rest, give fluids
-Congestion
Nasopharyngitis in infants < 2 mo?
can get meningitis/pneumonia easily
– Hospitalized with fever > 100.4 even with cold symptoms
•Nursing care : children under 2 recommended no cold medicine products
Viral etiology of pharyngitis/tonsillitis?
80-90% viral etiology
–Mononucleosis can cause it
Bacterial cz of pharyngitis/tonsillitis?
–Group A β-hemolytic streptococcus (almost always)
•5-years to 15-years : typically when you get it
S/S of bacterial pharyngitis/tonsillitis?
•Sore throat, fever, headache, abdominal pain
Txment of bacterial pharyngitis/tonsillitis?
•Penicillin, with positive test only : bc of MRSA, etc.
–Throat culture if rapid test is negative
–Can return to school after 24 hours on antibiotics (if fever gone), with strep must take all 10 days bc of risk of rheumatic fever
Risk for what w/ bacterial pharyngitis/tonsillitis?
•Risk of acute RF and glomerulonephritis
Acute otitis media is most common in?
•Young children predominate
–< 24-months most common
–> 7-years uncommon
–More common with smokers in the house
–Bottle-feeding supine increases risk: bottle feed only sitting up
•Never prop the bottle
What is acute otitis media more common w/ smokers in the house?
•Pathogens attach to the middle ear epithelium
•Causes a prolonged inflammatory response
•Impedes drainage through the eustachian tube
S/S of acute otitis media?
can have no symptoms
•Mild to severe pain
Low grade to high fever
•Associated symptoms, nausea & vomiting
Causes of acute otitis media?
S. pneumoniae (biggest reason for o.m), H. influenzae, M. catarrhalis
Txment for acute otitis media?
•High dose Amoxicillin initially
(100/k/day), then 2nd line drug
•Watching, waiting : will see if it goes away/gets worse. If < 6 mo, will tx ear inf, under 2yrs w/ fever will also tx. W/o fever or over 2 with fever will watch, wait.
What is otitis media w/ effusion (OME)?
•Fluid in the middle ear without infection
–Sounds are muffled
–Feeling of fullness in ears
–Can significantly impact hearing and can delay speech
Txment for otitis media w/ effusion?
tympanostomy tubes: won’t prevent ear inf, to help pt hear better.
•For OME present 6/12 months ( or fluid for 3 mo after ear inf)
•For failed hearing test
What is croup?
narrowing of airway so when breathe in have stridor (inspiratory)< worse at night, barking cough, steam of shower can help
-If mild, handled at home
About Laryngotracheobronchitis?
•Children < 5-years, post-URI (typically)
–Gradual onset of low-grade fever
–Laryngeal and tracheal inflammation causes narrowing of the
airway
S/S of laryngotracheobronchitis?
• Inspiratory stridor
• Suprasternal retractions
• Retained CO2 leads to respiratory acidosis and and
eventually respiratory failure can develop
Txment if child hospitalized w/ croup?
–Cool mist, humidity and oxygen
–Racemic epinephrine by nebulizer : bronchodilator to open it up
–Steroids
Nursing responsibility for child w/ croup?
–Vigilant observation of respiratory status
–Keep the child calm
What is bronciolitis?
-lower respiratory illness
RSV(babies w/ bronchiolitis almost always czed by this)
–Acute swelling of bronchioles with the lumina filling with
exudate and mucus
–Disease of infants and toddlers < 2-years : don’t know you have it unless test for it
How does bronchiolitis start?
–Starts as a URI, progresses with wheezing, coughing,
tachypnea > 70/min, apnea: can sometimes be only sign
–Severe disease leads to respiratory distress
How to tx RSV?
•Mist therapy and oxygen
•IV or oral fluids
•Bronchodilators and steroids not used
•Spread by droplet, wear shield (by getting droplet in eye)
•Prevention for premature infants
–Synagis® (palivizumab) ( once a mo shot, $1000/shot)
What is RSV?
respiratory synctyial virus
-czs most infections
About bacterial pneumonia?
• Bacterial
–Abrupt onset often following viral URI
–Ill appearing (in the beginning, kid looks sick)
S/S of bacterial pneumonia?
•Fever, tachypnea, cough, chest pain, malaise
•Often present with fever and abdominal pain (preschool age usually)
–‘Atypical’ due to Mycoplasma pneumoniae : tends to be bilateral
–S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus,
MSSA and MRSA (MRSA pneumonia is bad)
Bacterial pneumonia txment?
•Antibiotic therapy: Amoxicillin or Augmentin
•Liberal fluid intake
•Activity as tolerated with rest
•Antipyretics for fever: or if have pain (Tylenol)
Complications of bacterial penumonia?
–Pleural effusion, empyema (pus), pneumothorax
What is respiratory distress?
•Respiratory system is not able to keep up with the oxygen and
gas exchange needs of the patient. :must be watching pulse ox, always making sure that child isn’t getting worse
Respiratory distress symptoms?
•Tachypnea
–>60 infants
•Nasal flaring
–With each breath
•Retractions
–Substernal, intercostal
•Cyanosis
–Decreasing SaO2
•Accessory Muscle Use
–Neck
•Grunting
–Collapse of vocal cords with each breath
•Mental status or speech changes
–Restlessness : sometimes 1st and only sign
–Confusion
Respiratory distress txment?
•Immediate respiratory support
•Worry about the cause once more stable
–Oxygen
–Medications
•Albuterol, epinephrine
If unable to stabilize pt w/ respiratory distress may need?
–Ventilation
–Intubation
•Nasopharyngeal or endotracheal airway
•Tracheostomy
What is respiratory failure?
•A condition resulting in failure of the lungs to function properly.
This causes severe hypoxemia and/or hypercapnia.
Respiratory failure is due to?
–Gas exchange impairment, or
–Ventilation impairment
About respiratory failure r/t a gas exchange problem?
–Hypoxemia
•RDS : respiratory distress syndrome
• High altitudes
• Lung or cardiac disease
About respiratory failure r/t ventilation impairment?
Hypercapnia
•Obstructive lung disease
•Respiratory center fails to drive breathing
•Muscles don’t allow chest expansion
About airway obstruction as a cz of respiratory failure?
–Foreign body, cystic fibrosis, inc. secretions
–Asthma, anaphylaxis
About lung dz as a cz of respiratory failure?
–Severe pneumonia, asthma, cystic fibrosis (can cz obstruction due to secretions, pulmonary edema, cardiac defects causing shunting from the lungs,
radiation therapy
Ex of weakness affecting breathing that czs respiratory failure?
–Drugs, severe obesity, sleep apnea
Ex of muscle weakness that cz respiratory failure?
–Muscular Dystrophy, spinal cord injury
Ex of abnormal chest wall czing respiratory failure?
–Injury, severe pectus excavatum: abnormality in chest wall, when chest caved in, severe scoliosis
Symptoms of respiratory failure?
•Restlessness (can be missed)
•Cyanosis, arrythmia
•Tachypnea, tachycardia, shortness of breath
•Mental confusion
•Headache
•Gasping for breath
–Increased use of neck muscles
•Coma
Respiratory failure mgmt?
• Immediate respiratory support with O2
• Determine, treat underlying condition
– Inspired humidity to decrease secretions
• Suctioning, postural drainage
– Corticosteroids for airway edema
– *Epinephrine
– Intubation
What is asthma?
•Chronic, reversible inflammatory airway disorder, involving
mast cells, leukotrienes, eosinophils
What is asthma char by?
–Airflow obstruction
•Bronchospasm
•Mucosal edema
•Increased mucus production and airway remodeling
–Airway hyperresponsiveness, reactivity
•Sensitivity to allergens
•Often also have eczema, allergic rhinitis
Manifestations of asthma?
•Cough
–Earliest sign, especially nocturnal
–Dry and hacky, or productive
•Tachypnea
•Expiratory wheezing: sometimes audibly w/ no stethoscope
–Retractions
•Restlessness, anxiety, sweating : can cz respiratory failure
•Hunched-over, panting phrases, fatigue
How is asthma diagnosed?
-Pulmonary Function test
•Bronchial challenge testing
•Serum IgE levels or eosinophilia
•Chest x-ray
–Hyperinflation of lungs, atelectasis
Prevention of asthma?
–Identifying and avoiding triggers
•Dust mites, animal dander, mold, cold air, foods
–Avoiding sick contacts
–Annual influenza immunization
Desensitization & Med mgmt of asthma?
•Desensitization
–If stimuli can’t be avoided
•Medications
–Based on severity of asthma
–Use aided by results of Peak Flow Meter
GI effects of cystic fibrosis?
•CFRT defect ↓ water transport to gut
–Meconium ileus at birth can result-1st sign of CF
–Distal intestinal obstruction syndrome (DIOS) can occur in
any aged patient
•Pancreatic Insufficiency :
–↓ intestinal absorption of pancreatic enzymes so must give enzymes
•Rectal Prolapse
•Fecal impaction or intussusception
•Resection of distal ileum further decreases absorption
Pancreatic insufficiency of cystic fibrosis?
•Ducts are blocked by thick secretions
–Pancreatic fibrosis results
–Pancreatic enzymes can’t reach duodenum
•Very decreased absorption of essential nutrients
Pancreatic insufficiency presentation?
–Greasy, bulky stools, from undigested fat
–FTT (failure to thrive), poor weight gain
–Malabsorption of vitamins A,D,E,K
–CFRD can result in older patients
Hepatic effects of cystic fibrosis?
•CFTR defect leads to
–Viscous bile
–Clogged bile ducts
•15% CF patients have gallstones
–If extensive, can lead to obstructive cirrhosis and/or portal
hypertension
Reproductive effects of cystic fibrosis?
•Females
–Fertility maintained, but decreased
•Viscous cervical secretions may block sperm
•Amenorrhea 2° to severe nutritional or pulmonary problems
•Secondary sex characteristics often delayed
•Males
–Vas deferens can be absent
–Un-descended testicles can occur
What is an incarcerated hernia?
protrusion of a portion of an organ or organs thru an abnormal opening.
What is a strangulated hernia?
significant constriction of the organ & loss of bld supply
What is a diaphragmatic hernia?
-herniation of abdominal organs thru the diaphragm
-diagnosed at birth or prenatally
Why is prompt recognition of a diaphragmatic hernia essential?
bc of possible respiratory distress, dyspnea, tachypnea, impaired cardiac output
What is umbilical hernia gastroschisis?
-congenital abdominal wall defect
-herniation of abdominal contents outside the body thru this defect, w/o a peritoneal sac covering the organs
-most often to R of umbilicus
Cz of umbilical hernia gastroschisis?
-cz is multi-factorial
-involves vascular disruption of fetal mesenteric vessels
-young, poor, smoking, malnourished mothers
-ephedrine & phenylpropolalanine implicated
Gastroschisis dx suspected by?
-elevated MSAFP
-maternal serum alpha-fetoprotein
Gastroschisis dx confirmed by?
-prenatal ultrasound or at birth
-early dx allows for transfer prior to delivery to a perinatal center w/ specialists for txment
Immediate txment of gastroschisis?
-protection of exposed viscera: 1st b4 do anything else. Trying to maintain bowel so it doesn't die.
-warm,sterile saline-soaked dressings,plastic
• Radiant warmer and IV fluids
– To replace heat and fluids lost through exposed viscera
• Blood cultures prior to antibiotics
– Broad spectrum antibiotics to prevent infection
• NG/OG tube to prevent distension
Clinical therapy gastroschisis?
• Protective ‘silo’ sutured around viscera
– Until organs can fit in abdominal cavity on their own in 5-10 days
– Until inflammation and swelling of organs decreases enough for surgery to replace them
What is an omphalocele?
intra-abdominal contents herniate thru the base of the umbilical cord: will need to do skin graft after stomach contents are pushed back in
Organs are covered by peritoneal sac
– Can involve any abdominal organs
What is omphalocele commonly seen with?
other anomalies
-Trisomy 13,18,21
-craniofacial, diaphragmatic abnormalities
What is Hirschsprung dz?
• Congenital Aganglionic Megacolon
– Parasympathetic ganglion cells are absent in the distal colon,from the anus and continuing up the colon (portion of bowel w/ no ganglion cells which is what czs peristalsis so cannot pass stool)
– Absence of ganglion cells causes decreased peristalsis at
the site and inability to pass stool
– Stool distends the colon-’megacolon’
Symptoms of Hirschsprung dz in newborns?
-no meconium passed, abdominal distention, bilious emesis, refusal to feed
-90% dzed as newborns
Symptoms of Hirschsprung dz in older infants/children?
abdominal distention, vomiting, constipation alternating w/ watery diarrhea & poor growth
-stool can be normal or ribbon shaped
Hirschsprung Dx?
• Based on history & physical exam
• Barium studies
– Distended small bowel and empty rectum
• Anorectal mamometry
– Internal sphincter doesn’t relax with rectal stimulation
• *Rectal biopsy
– Presence of aganglionic cells
Txment of Hirschsprung in infant?
– Surgery to remove aganglionic bowel
– End-to-end anastamosis to anal canal
– Temporary colostomy until anastamosis
Txment of Hirschsprung in older child?
– Prevention of constipation
– Stool softeners
– Isotonic enemas
– Most end up with surgery as described above
What is intussusception?
normally seen in 3 –5 mo.
• A portion of the intestine prolapses and then telescopes into
another portion
• Most commonly at the ileocecal valve
Intussusception associated w/?
• Associated with viral infections, gut motility medications, body’s
inflammatory mediators
Dx of Intussusception?
-based on history & physical exam
*vomiting
*red, 'currant jelly' stools
*long cylindrical mass in RUQ
Diagnostic tests for Intussusception?
-abdominal ultrasound
-stool guiac
What is malrotation?
-abnormal rotation of the intestine around the superior mesenteric artery during development
S/S of malrotation?
asymptomatic or present w/ vomiting, abdominal pain, bloating or rectal bleeding
What is volvulus?
-twisting of the intestine around itself
-can result in bowel necrosis leading to peritonitis, perforation & death
Dx of malrotation & volvulus?
dx made by upper GI
-consider in ANY infant w/ bilious vomiting
Necrotizing enterocolitis manifestations?
• Symptoms seen from 3-14 days of life :mother didn’t get enough bld flow to baby
• Characteristic symptoms
– Progressive abdominal distension
– Bilious vomiting
– Bloody diarrhea
• Signs of sepsis
– Hypothermia, hypotension, lethargy, apnea
What will x-ray show for dx of necrotizing enterocolitis (NEC)?
– Gas in lumen of bowel
– Dilated and distended loops of bowel
– Thickening of bowel wall
What will labs show for dx of necrotizing enterocolitis?
– Anemia, leukocytosis or leukopenia, thrombocytopenia,
electrolyte imbalance
– Blood cultures to identify bacteria, direct therapy