Archer: Pediatrics

apgar

apperance, pulse, grimace, activity, respiration

scored from 0-2

max score is 10

APGAR: apperance

0 points-blue/pale

1 point-pink body

2 points- pink

APGAR: Pulse

0- absent

1- below 100

2- above 100

when do you do APGAR

1 mins and 5 mins

newborn HR normal

100-160

newborn respirations

50-70

Moro reflex

startle reflex

rooting relfex

Reflex in baby's to open their mouths to feed when touched near the mouth.

sucking reflex

when you stroke a hungry infant's lips, he will start sucking

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched

disappears in 12 months

when do fontanelles close

anterior- closes between 6-18 months

posterior-closes by 2 months

children have what in cardiac

children have an extra wooshing heart sound

normal to hear murmurs

sacral dimple

opening in the skin over the distal spine

might have neuro issues

interventions for meconium aspiration

suction the mouth first immediately after birth

may meed intubation

What indicates meconium aspiration

seeing the meconium

fouls smelling aminotic fluid

discoloration of cord

discoloration of nail/ tongue on infant

physiological jaundice

normal that appears in first 2-3 days of life

pathological jaundice

occurs within 24 hrs of life

could be issues with liver or ABO incompatibility

kernicterus

a type of brain damage that results from high level sof bilirubin in the blood

how to prevent kernicturus

phototherapy that breaks down bilirubin

cover their eyes and genitals (sensitive skin)

this breaks down bilirubin but it does not get rid of it so we need to feed often

fetal circulation lungs

mom is doing oxygenation, no need for blood to go to lungs

foramen ovale

connects the two atria in the fetal heart

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

atresia

does not develop

ductal dependent

dependent on ductus arteriosis for shunting

left to right shunt

causes pulmonary circulation but not cyanosis

because remember the left part has highest pressure so the rests of the body is still gettiong some sort of blood flow

risk factors for heart sunts

maternal infection

maternal diabetes

drug and alc use

advacned maternal age

right to left shunt

shunt causes cyanosis

patent ductus arteriosus assessmet findings

machine like murmur

treatment for PDA

surgery

indomethacin or ibuprofen (antiprostiglandins that clsoe these ductus)

alprostadil

medicaiton that can be administered to keep PDA open in certain heart defects

can allow blood to get out to the body when otherwise couldn't

Artrial septal defect

opening between the atria

will hear murmur

tx surgery or if small can close on its own

child will have DOE fatigue and poor weight gain

ventricular septal defect

opening between two ventricles, typical s/s of HF begin at 2-8 weeks

LOUD MURMUR ADN CHF

tx- CHF TX AND BACTERIAL ENDOCARDITICS PROPHYLACTICS

CHF management

diuretics, ACE inhibitors, b-blockers

atrioventricular canal defect

opening betwene the atria and ventricles (ASD VSD and single AV valve)

mur,ur + heart failure s/s + failure to thrive

tx- tx for CHF and. bacterial prophy;actics

when surgically repairing a heart defect, what must you do

give antibiotics prophylactically

tetralogy of fallot

defects

large VSD

pulmonary stenosis

right ventricular hypertrophy

overriding aorta

tet spells

begins with irritability and hyperpnea

a drop in systemic vascular resistance incrase the right to left shunt and decreases pulmonary blood flow

hypoxic spells, intense cyansosi that leads to sycnope

tet spell interventions

comoft and calm

kneww to chest

supplemental oxygen

sedation-morphone

volume

tricuspid atresia

the tricuspid valve does not grow

VSD/ASD

hypoplastic RV enlarge mitral valave dn LV

tricuspid atresia treatment

Prostaglandin to maintain patency of PDA, Surgical Repair (rashkind procedure)

transposition of great arteries

the aorta and pulomnary artery are switched\

oxygenated blood is continously circulating through the pulmonary circut and deoxygenated blodo is cirulating through the systemic area

assesment - cyanosis within 1 hour of birth

transposition of great arteries management

prostaglandins to keep ductus arteriosis opne

surgical repair

bacterial endocaridditis for life

hypoplastic left heart syndrome

left sided structures don't develop normally

aorta is small

what happens to baby with hypoplastic left heart syndrome

cardiogenic shock is common

cyanosis when DA closes

assessment findings for hypoplastic left heart syndrome

hepatomegaly, murmur

hypoplastic left heart syndrome immediate interventions

prostagalandins

correct acidemia

inotropes

plan for surgery

hypoplastic left heart syndrome procedures

norwood at birth

glenn at 2 months old

fontan at 2 years old

aortic stenosis

narrowing of the aortic valve

aortic stenosis assessment findings

pronounced apical pulse

thrill

exercise intolerance and syncopal episodes

narrowed pulse pressure

treatment of aortic stenosis

balloon valvuloplasty asap to pevent shock

surgical valve replacement

if sever- avoid exercise

pulmonary stenosis

narrowing of pulmonary artery

leads to RV hypertophy

specific assessment for pulmonary stenosis

dyspnea on exertion

murmur

treatment of pulmonary stenosis

pulmonary valvotomy

moderate to severe stenosis; child should avoid high intensitty activities

coarctation of the aorta defect

narrowing of the aorta

impedes blood flow to lower half of body

symptoms appear quick as soon as the arerious close can progress to hypotension acidosis and shock even death

specific findings of coarctation of the aorta

upper extremities- bounding pulses

lower- weak or absent pulses

Coarctation of the aorta treatment

prostaglandins and surgical repair

life time follow up

epiglottitis symptoms

4 ds of epiglottitis

dys[hagia

dysphonia

drooling

distress

interventions of epiglottis

keep child calm

do not irritate throat

tripod positioning

avoid supine postioninf

bronchiolitis

inflammation of bronchiolitis

what is most common cause of bronchiolitis

RSV

assessment and tx of bronchiolitis

hypoxia, irritability, crackles+wheezing, retractions

tx - oxygentation fluid and nutrition

antipyretics and analgesics

croup

laryngotracheobronchitis

results in inflammation and edema of the larynx and/or trachea

croup assessment findings

hoarse, bark like cough

stridor

chest wall restractions

runny nose,fever

symptoms often worsen at night

croup treatment

corticosteroids

epinephrine (racemic epi)

keep pt calm (can worsen distress)

cystic fibrosis

autosomal recessive disorder

mutation leads to a buildup of excessive mucus in the airways

diagnosis of cystic fibrosis

meconium ileus

-meconium is thicker and stickier than normal

sweat chloride test

-sweat is collected and analyzed for increased level of chloride

assessment findings of cystic fibrosis

excessive mucus

cyanosis

barrel chest

clubbing

steatorrhea

intestinal obstruction

fat soluble vitamin deficiency-ADEK

endocrine-diabetes

salty tasting sweat

males are infertile

treatment for cystic fibrosis

chest phsyiotherapy

vest therapy

monitor for resp infections

bronchodilators

cystic fibrosis diet

high calories, high protein

incrased fluid intake

pancreatic enzymes- given within 30 min og eating every meal and snack

sprinkle capsules on food

nursing intervention for vp shunt

they can have MRI

careful with contact sports

can go in airplane

VP shunt can not be working if what happens

vomitting or headache in morning

cerebral palsy

damage to immature brain

-causes disorder in movement, muscle tone, and posture

assessment findings of cerebral palsy

stiff muscles, spasticity, ataxia, tremors, drooling, dysphagia, developmentally delay, intellectual disabilities

treatment of cerebral palsy

anticonvulsants for seizures, muscle relaxants for spasticity

meningocele

protrustion of spinal fluid-filled meninges through a vertebral defect

myelomeningocele

protrusion of spinal fluid-filled meninges and the spinal cord through a vertebral defect

assessment finding for spina befidida

sacral dimple or tuft of hair

preop for spina bifida

prone position

cover the sac with moist, warm, sterile dressing

no diapering if defect is low-keep the sac clean with a protective barrier

microcephaly

head circumference than normal

assessment findings for microcephaly

impaired cognitive development

delayed motor function

facial distortion

dwarfism

hyperactivity

seizures

treatment for microcephaly

decrease impact neurological complications

cleft lip and cleft palete surgery

cleft lip- 3-6 months

palete- 6-24 months

feedings for cleft palete

specialized long bottle

small, frequent feedings

upright position

burp frequently

may take longer to feed than other children

monitor for aspiration

burp frequently

cleft palate vs cleft lip post positioning

lip-should not be prone because this can disrupt suture line

palate- can be pone post op to drain secretions

cleft lip and palete post op

no oral or nasal suctioning

elbow restraints

no hard foods, straws, pacifiers

tracheoesophageal fistula

there is an opening between the trachea and the esophagus

esophageal atresia

part of esophagus does not form

cs of esophageal atresia

choking coughing cyanosis

pyloric stenosis

narrowing of the pyloric sphincter that blocks the passage of food from the stomach into the duodenum

pyloric stenosis assessment

non-bilous

projectile vomiting

right after feeeding

infant is still hungry

PALPABLE OLIVE SHAPED MASS

omphalocele

congentital abnormalityt where the abdominal content protrube through the umbilicus while remaining in perotineal sac

complicaitons for omphalocele

hypothermia, dehydration, sepsis

pre-op omphalocele

keep exposed intestine moist

cover with sterile gaize soaked in saline

iv fluids + antibiotics

thermoregulation

post op omphalocele

parenteral feeds

trophic feeds started enterally very gradually

monitor weight

gastroschisis

not in periotenal sac

only intestinal organs

intussusception

telescoping

occurs when part of intestine slips inside other intestines

intussusception assessment

red curant jelly stool

sausage-shaped mass

cyclical abdominal pain

green-bilious emisis

treatment for intussception

enema to attempt to push the intestine back out

hirschsprung's disease

absence at birth of the autonomic ganglia in a segment of the intestinal smooth muscle wall that normally stimulates peristalsis

causes megacolon

hirschsprung disease assessment

ribbon like stool

swollen belly

vomiting

gas