MCN exam 3 short

patent ductus arteriosus

SE: murmur, widening pulse pressure due to low diastolic BP

coarctation of the aorta

SE: bounding pulses, high BP in upper extremities

tetralogy of fallot

SE: polycythemia, <94% O2

hypoplastic left heart syndrome

SE: cyanosis, shock

ventricular septal defect

heart failure seen thru tachypnea, periorbital edema, hepatosplenomegaly

rheumatic fever

SE: fever, maculopapular red rash, random jerky movements of face and upper extremities, painful joints, history of throat infection

treat: penicillin

hypercyanotic episode / tet spells

knee-to-chest position to increase systemic vascular resistance and increase pulmonary bloodflow

steps for extrauterine life

1. lungs take first breath

2. pulm vascular resistance decreases

3. right atrial pressure decreases

4. foramen ovale closes

5. ductus arteriosus closes

neonatal sepsis

SE: hypothermia, poor feeding, irritability

fetal alcohol syndrome

SE: growth restriction, cognitive disability, heart defect, kidney defect

craniofacial abnormalities

hypoxic ischemic encephalopathy

SE: resp distress, hypoxemia, acidosis, bradycardia

neonatal abstinence syndrome

SE: tremors, diarrhea, yawning, sneezing

agitation, crying, sneezing

preterm newborn hypothermia

RF: limited brown fat, immature thermoreg, thin skin, poor flexion

post-term newborn

SE: long fingernails, meconium staining

infants of diabetic mothers

polycythemia: low O2 → more RBCs

resp distress syndrome: high insulin → low surfactant production

macrosomia: high insulin → somatic growth

hypoglycemia: after maternal glucose ends, baby keeps making insulin

hypocalcemia: PTH production is low

infant tobacco SE

premature birth, SGA

infant cocaine SE

high HR, high RR

infant marijuana SE

photophobia, sleep pattern disturbance,

ballard scale for gestational age

scoring for gestational age

physical maturity:

• skin

  • preterm: thin, shiny, wet

  • term/postterm: dry, flakey, cracked skin

• lanugo

  • preterm: body hair

  • term/postterm: less body hair

• plantar surface

  • preterm: few foot creases

  • term/postterm: creases on bottom of foot

• breasts:

  • preterm: flat nips

  • term/postterm: palpable breast buds

• eyes

  • preterm: eyes still fused shut

  • term/postterm: eyes can open

• ears

  • preterm: fold ear cartilage, stays folded

  • term/postterm: ear cartilage springs back

• genitals

  • preterm: smaller labia (clitoris visible) or undescended testes

  • term/postterm: labia is fatter and covers clitoris or descended and wrinkly testespreterm:

neuromuscular maturity:

• posture:

  • preterm: extended limbs

  • term/postterm: flexed

• square window

  • preterm: pushing palm of hand down toward wrist, square shape

  • term/postterm: palm can touch wrist flat

• arm recoil

  • preterm: bend elbows to put baby hands by their head, then down. arms stay down

  • term/postterm: elbows flex and move hands back up

• popliteal angle

  • preterm: stretch leg upwards toward sky while laying

  • term/postterm: does not tolerate straightening the knee

• scarf sign

  • preterm: place arms to hug their collarbone. elbow crosses midline

  • term/postterm: elbows do not cross midline

• heel to ear

  • preterm: leg can be stretched to head

  • term/postterm: does not allow leg stretching upwards to ear

physiologic jaundice vs pathologic

SE: short RBC life, immature liver → cannot breakdown bilirubin

GERD SE

effortless vomiting after eating

pyloric stenosis

SE: projectile vomiting

postop: slow feeding if vomiting after feeding

infant dehydration

mod:

encourage at-home fluid and food, monitor wet diapers

50-100mL/kg Pedialyte

severe:

SE: sunken fontanels, tenting skin, dry mucus membranes, low/no urine output

treat: peripheral IV, IV fluid bolus, maintain IV fluid rate, antiemetic, strict I/Os

no oral rehydration and no maintenance fluids

Hirshsprung disease / congenital aganglionic megacolon

SE: persistent constipation