Peds Exam 4 Concept Maps

no roomies

arthritis, muscular dystrophy

developmental dysphagia of the hips

abnormality of head of femur and acetabulum, frog legs are good, can be bilateral, cartilage turns to bone in 6 months, dysplasia -> subluxation -> dislocation

developmental dysphagia of the hips risks

girls, breech birth, multiple births, large baby, oligohydramnios, family history, swaddle methods

oligohydramnios

too little amniotic fluid

developmental dysphagia of the hips signs first month

clicks or clunks in ortolani maneuver (hips out) and/or Barlow maneuver (hips in)

developmental dysphagia of the hips signs older infant

limited abduction, shorter leg, galeazzi sign, increased skin folds

galeazzi sign

developmental dysphagia of the hips signs older child

delayed walking, limp/gait, Trendelenburg sign (stand on one leg, look for droop)

developmental dysphagia of the hips diagnosis

Xray > 6mos, US < 6mos

developmental dysphagia of the hips treatment

<6mos pavlik harness for 3 months, parents dont adjust

if contracture, then bryats traction 102 weeks and then hip spica for 3 months

orthotic hip 1 year

developmental dysphagia of the hips considerations

cast care, skin tx care

juvenile idiopathic arthritis

chronic and autoimmune, genetic plus trigger, collection of diseases, exacerbations and remissions, normally resolves in teens

juvenile idiopathic arthritis symptoms

swelling, decrease ROM after rest or sleep and in AM, slightly warm joints, pain

juvenile idiopathic arthritis treatment

NSAID, DMARD - methotrexate or sulfasalazine, steroids, dont expose to sick people, encourage self care, pool exercises

sulfasalazine

sulfa allergy

methotrexate

risk for infection, use condoms

systemic arthritis signs

fever with ups and downs thats lower in PM, rash, spleen and liver enlarged, cardiac complications aka carditis

oligoarthritis signs

<4 joints affected, asymmetrical, uveitis/iridocyalitits (eye floaters and eye inflamation)

enthesitis

<4 joints, more common in boys, uveitis/spondylitis (joints of spine fuse and eye inflamation)

polyarthritis

can be RF + or -, >5 joints, symmetrical, affects large and small joints, long term joint problems

systemic arthritis labs

ESR/CRP - Pos

Increase WBC - pos

ANA - neg

RF - neg

HLA - neg

Oligioarthritis and enthesitis labs

ESR/CRP - pos

Increase WBC - neg

ANA - pos

RF - neg

HLA - pos

polyarthritis labs

ESR/CRP - pos

Increase WBC - neg

ANA - pos

RF - pos or neg

HLA - neg

ACL sprain

doesnt repair self, tear of ligament, hx of injury with "pop"

decrease ROM function and increased pain

RICE, will have OR repair and crutches for 3-4 weeks

SCFC

hip problem, head of femur displaced from neck, > boys, bilateral, puberty, tall or high BMI

pain, limp, external rotation of leg, decrease ROM

bucks traction, no ambulation, no weight-bearing postop, no contact sports until 20's

Surgery has risk for shorter limb, osteomyelitis, osteoarthritis

Legg-Calve-Perthes Disease

hip problem, head of femure has blood supply problem, becomes mushy, 4-8 YO, >boys, bilateral

insidias limp/pain, decrease ROM, +/- external rotation

no wt bearing, NSAIDS, Hip spica for 2-4 years OR surgery and hip spica for 3 months

Surgery has risk for shorter limb, osteomyelitis, osteoarthritis

Osgood-Schlatter disease

tendonitis, overuse injury (running or jumping)

knee bump and pain, no redness, +/- bilateral

change sports, rest, ice, compression no elevate

osteomyelitis

can be from SCA, salmonella, MRSA, staph, self infection generally or open fracture, happens in school age kids

increase temp, swelling, pain, redness, wamth, decrease function appetite and fluids, increased WBCs CRP and ESR

ABX 6wk-4mos, picc line, no wt bearing, check CRP/OSR, splints and casts

Osteosarcoma

bone tumor, teens - 20's, >Boys, mets to lungs

pain, swelling, decrease ROM, limp, decrease appetitie

sunburst xray

increase in calcium phosphorus and alkaline phosphate in blood

surgery, biopsy, chemo NO RADIATION, implanted CVC, no wt bearing

spina bifida

congenital neural tube defect, multifactorial, low folate in pregnancy, >white and hispanics, maternal diabetes obesity and fever increase risk, have latex allergy

Spina Bifida oculate

meningocele

mylomeningecele

signs of increased ICP in infants

respiratory problems, caugh, not move shoulders, cant use nipples, stridor

spina bifida oculate signs

has dimple on back with tuff of hair, +/- tethered cord, +/- infection

meningocele signs

sac on back without cord, +/- tethered cord, +/- infection

mylomeningecele signs

sac on back with cord, any nerve below is paralyzed, keep sac intact until OR, risk for infection (look for instability of temp), increase ICP = Chiari malformation

increase risk for seizures, constipation, UTI, neurogenic bladder

chiari malformation / increase ICP treatment

VP shunt

spina bifida considerations

bowel management program, self cath, check VP shunt for infection and blockage

spina bifida complications

club feet, hip dysplasia, contractures

spinabifida treatment

OR 12-72 hours, position on abd, no diaper, damp cloth, check head circumference and fontanel, +/- seizure meds

Duchene Muscular Dystrophy (DMD)

progressive degredation, x linked boys, girls are carriers always, death in early 20's by heart or lung problems, starts in feet and moves up, missing dystrophin protein, "woody" feeling muscles

increase in age decrease in moblility

Duchene Muscular Dystrophy (DMD) signs infants

delayed, 3YO stumbles and falls often, no running or climbing, + grower sign, big calves

grower sign

Patient uses upper extremities to help stand up

Classically seen in Duchenne muscular dystrophy, but also seen in other muscular dystrophies and inflammatory myopathies (polymyositis)

Duchene Muscular Dystrophy (DMD) 12 year old + signs

wheelchair bound, muscular wasting, increase obesity, contractures, cardiomyopathy -> CHF, decreased verbal cognition

Duchene Muscular Dystrophy (DMD) diagnosis

CPK/CK, PCR, prenatal, EMG - keeps track of how muscles are functioning

Duchene Muscular Dystrophy (DMD) treatment

roids (watch for increase wt), ROM respiratory and mild strength exercises,bipap, vaccines, no roomies, avoid sick people, check for CHF, independent living, bowel management program, check for skin breakdown

Cerebral palsy

non progressive problem, prenatal event such as infection, genetics, decrease O2, prmie, exposure to drugs

Cerebral palsy problems

motor, vision.hearing, seizures, cognition, language, GER

Cerebral palsy signs newborn

floppy/hypotonic, decrease feeding and reflexes, not symmetrical, +/- irritable

Cerebral palsy signs infant

spastic, arch back, irritable, developmental delay, change oin mobility,

lack of:

3mos

head control

hand open reflex

social smile

6mos

spoon feeding -> push spoon out

clothing self

8mos

sit on own

Cerebral palsy treatment

speech therapy, PT, botox - relaxes muscle, baclofen (muscle relaxant), diazepam/valium (muscle relaxants), OR for tendon release - risk for hip dislocation or scoliosis, dental/oral care

neuroblastoma

cancer of sympathetic nervous system (fight or flight), starts in adrenal medulla, mets to lymph nodes, bones, liver, ABD mass similar to wilms tumor

neuroblastoma staging

1 - local

2 - unilateral

3 - past midline

4 - mets

4s - <1yo

neuroblastoma signs

large abd mass, bulging eyes, bruises around eyes, neck lumps, airway obstruction, blueberry skin, increased wt loss and fatigue

increase BP and temp

decreased plts, RBCs, WBCs

large liver

neuroblastoma labs

n-myc, MIBG scan, urine for VMH and HVA

neuroblastoma treatment

stage 1 and 2 - OR and chemo

stage 3 and 4 - OR and chemo with biopsy and radiation

vitamin A and retin A

medulla blastoma

aka brain tumor, infratentorial, in cerebellum, mets to spinal cord

medulla blastoma signs

increase IOP, headache, vomiting, clumsy, change in LOC, fatigue decrease appetite, C/O x2 vision, head tilt, bulging fontanels, papiledema

increase BP

Decrease Hr and RR

medulla blastoma treatment

OR, chemo, and radiation

postop - ICU with coma, check airway circulation dressing and reflexed, clear drainage on dressing bad, cooling blankey, +/- VP shunt

position flat and on side, stool softners, no suctioning, tylenol for HA, low stem enviroment

manitol to decrease ICP

less fluid than segars

meningitis

inflammation of brain coverings, bacterial (H. flu, s. pneumonia, N meningitis) or viral, transmitted by nasopharyngeal secretions

prevention of meningitis

vaccines

meningitis diagnosis

lumbar puncture, viral has normal glucose and protein, bacterial has low glucose and high protein because bacteria eats sugar and dies protein

meningitis signs bacterial

fever, chills, vomiting, change in LOC, photophobia, nuchal rigidity (kernig and brudzinski signs), DIC and septic shock - late stages

meningitis signs neonate viral

increase fontanel and head circumference, temp unsteady, decreased feeding, change in respiration, decrease muscle tone, diarrhea

meningitis signs infant viral

fever, decreased feeding, increase fontanel and head circumference, high pitch cry, jaundice

meningitis treatment bacterial

ICU, isolation for 24hr worth of abx, cephalosporin, roids (decadron), mannitol (decrease ICP), HOB 15-30 degrees, no suction, low stim, no pillow, side lying, tylenol for HA

meningitis treatment viral

start like bacterial, when cultures come back viral, then dc abx and isolation and remove from ICU

explain to parents less severe

epilepsy

>2 episodes of seizures

status epilepticus

>30 min seizure

seizure > 5 min

emergency

seizure causes

infection/fever, brain bleed, tumor, metabolic function, meds/drugs/toxins, decreased O2, lytes off

partial seizure

simple or complex

general seizure

tonic/clonic, absence, atonic

not a seizure

fainting, breath holdings, tics, migrains, sleep disorders, arythmias

seizure questions

onset, description, family history, family hx of early death, prenatal development

simple partial seizure

no loss of consciousness, good prognosis

complex partial seizure

has aura, change in LOC, lasts longer than simple, poor prognosis

tonic/clonic seizure

+/- aura, change in LOC, fall, sleepy, check airway, increased secretions

Absent seizure

change in LOC, "day dream", motor ability ok, no aura, 5-10 seconds

atonic (drop) seizure

no aura, no motor control, helmet needed, fall to floor

infatile spasms

baby has intense jerking

febile seizure

1mos-5 yr, fever, outgrown

seizure tx home

rectal valium, if repeat seizure than seek help

seizure tx hospital

lorazepam IV/buccal, diazepam IV/rectal, midazolan/versed IV IM PO buccal

>30 mins -> dilantin/phenobarbital

seizure assessment

check airway, side lying, O2, record seizure, VS and neuro check after, look for cause, provide privacy

seizure considerations

rest at school, no swimming w/o supervision, helmets always, no climbing

seizure prevention

2 years no episode then ween off med, meds, keto diet, vagal neurostimulation