Comprehensive Review of Pediatric and Maternal Health Topics

Pediatric Assessment and Distress

  • Signs of Distress in Nonverbal Children:
    • Inconsolable crying (a code word for serious distress).
    • Shrill crying (another code word).
    • Refusal to eat.
    • Flaccidity (limpness).

Child Development and Engagement

  • Developmental Stages:
    • 8-10 year olds: Learning how to make friends.
    • Adolescents: Experiencing significant changes, needing support.
  • Engagement: Involving children in their care can be beneficial.
    • Example: Allowing a child to push the button on a PCA pump (if locked out and safe).

Poisoning in Children

  • Incidence: Higher in 2-year-olds due to their tendency to put things in their mouths.
  • Prevention: Homes with young children should have poison control numbers posted in the kitchen and easily accessible.
  • Guidance: Poison control experts should be consulted before calling 911.
  • In Case of Ingestion: Bring the suspected substance container to the ER.

Respiratory Issues in Children

  • Signs of Respiratory Distress:
    • Subclavicular retractions.
    • Screaming, sweating, snotty nose.
  • Earaches: Can be extremely painful and may involve pus or blood. Often associated with high fever.
  • Febrile Seizures: Prophylactic medications are available but often reserved for specific cases.

Congenital Heart Defects

  • Commonality: Most involve a septal defect (opening in the septum).
  • Shunting:
    • Left-to-right shunt: Oxygenated blood recirculates through the heart.
    • Right-to-left shunt: Unoxygenated blood is sent out (cyanotic).
  • Tetralogy of Fallot:
    • Compensatory Mechanism: Squatting increases venous return, improving cardiac output.
    • Four Defects:
      • Ventricular septal defect.
      • Right ventricular hypertrophy (enlargement).
      • Overriding aorta.
      • Pulmonary stenosis.
  • Transposition of the Great Vessels: The aorta and pulmonary artery are switched.
  • Truncus Arteriosus: Only one vessel exits the heart instead of two.

IV and BP Shunt Occlusion

  • IV Occlusion: A small push on the IV tubing can dislodge obstructions (fibrin, debris).
  • BP Shunt Occlusion: Parents are taught to pump small balloons to maintain flow. Surgery may be required if flow cannot be restored.

Seizures

  • Status Epilepticus:
    • Every second of continued seizure activity results in brain cell loss.
    • Lorazepam is the drug of choice.
    • Anticonvulsants are used, but the specific choice is up to the provider.
  • During a Seizure:
    • Do not put anything in the mouth.
    • If vomiting, turn the patient on their side.

Meningitis

  • Signs of Meningeal Irritation:
    • Chin-to-chest test: Pain upon lifting the head and touching the chin to the chest.
    • Kernig's sign: Pain when extending the leg at a 90-degree angle.
    • Brudzinski's sign.

Muscular Dystrophy (Duchenne)

  • Diagnosis: Muscle biopsy.
  • Enzyme Marker: Elevated CK (creatine kinase).
  • Developmental Delays: Late walking, frequent falls.
  • Gower's Sign: Using hands to "walk up" the legs when standing due to muscle weakness.
  • Prognosis: Likely wheelchair-bound by age 8.

Vesicoureteral Reflux

  • Description: Urine flows backward into the ureters and kidneys.
  • Significance: Abnormal condition requiring evaluation.

Acute Glomerulonephritis

  • Significance: A major cause of intrarenal acute renal failure.

Cerebral Malaria

  • Symptoms: High fever (104-105°F), unresponsiveness, bone-dry.
  • Treatment (in resource-limited settings): Chopping up adult Tylenol suppositories for children when appropriate dosages are unavailable.

Dehydration

  • Management: Oral rehydration with water and electrolytes using a dropper.

Volume, Volume, Volume

  • Importance: Critical in pediatric care, especially in developing countries.

Sickle Cell Crisis

  • Pathophysiology: Cells clump together, obstructing distal blood flow, causing severe pain.
  • Treatment:
    • Pain medication.
    • Hydration to widen vessels.
  • Outcome: Can lead to lasting impairment.

Hip Dysplasia

  • Assessment:
    • Knees to chest, then abduction.
    • Uneven hip height.
    • Audible/palpable clicks or clunks.
  • Importance: Requires referral for follow-up.

Pregnancy & Contractions

  • Contractions: Note frequency, duration, and relaxation time between contractions.
  • Internal Monitoring: Provides numerical data about contraction strength.

Fetal Monitoring

  • Late decelerations: Non-reassuring.
  • Early decelerations: Okay.
  • Variable decelerations: Concerning.

Labor and Delivery

  • Pudendal Block: Local anesthetic administered before episiotomy.
  • Maternal Preferences: Support mothers who decline opioids.

Rhogam

  • Type: Blood product, requires two nurses to verify.
  • Administration: Indirect Coombs test should be negative before administration.
  • Timing: Given within 72 hours post-delivery.
  • Purpose: Protects future pregnancies, not the current one.

Rubella Vaccine

  • Counseling: Advise against pregnancy for 3-4 months post-vaccination due to teratogenic effects.

Gestational Diabetes

  • Screening: Done at 24-26 weeks of gestation.
  • Management: Control blood sugar, administer betamethasone before delivery, and surfactant after delivery as needed. Keep the mother hydrated.

Cervical Incompetence (Incompetent Cervix)

  • Management: Treat physically and emotionally provide cervical cerclage during pregnancy.

Abruptio Placentae vs. Placenta Previa

  • Abruptio Placentae:
    • Hard, rigid abdomen due to blood sequestration.
    • Painful.
  • Placenta Previa:
    • Soft abdomen.
    • Painless.
    • Still involves blood loss.

Newborns & Thermoregulation

  • Temperature Control: Newborns cannot effectively manage their temperature.

Hyperbilirubinemia

  • Newborn Jaundice: Expected and usually resolves on its own.
  • Hyperbilirubinemia: Pathologic jaundice that persists and can cause kernicterus (brain damage).
  • Treatment: Phototherapy (bili lights), eye and genital protection, frequent position changes.

Neonatal Abstinence Syndrome (NAS)

  • Etiology: Drug and alcohol exposure in utero.
  • Management: Gradual weaning, crisis intervention, de-escalation techniques.

De-escalation Techniques

  • Approach:
    • Listen actively.
    • Make a concrete plan.
    • Offer a limited timeframe for resolution (e.g., "20 minutes").
  • Goal: Return the individual to their baseline state.

Hallucinations

  • Reality: For actively hallucinating individuals, the hallucinations are real.
  • Management:
    • Avoid triggers.
    • Acknowledge the hallucination without validating it

Coping Disorders

  • Etiology: Lack of coping skills.
  • Manifestation: Frustration, anger, inappropriate behaviors.
  • Approach: Matter-of-fact, concrete, set boundaries.

Eating Disorders

  • Anorexia Nervosa:
    • High suicide risk.
    • Monitor electrolytes and obtain complete blood work.
    • Look for physical signs: calluses on knuckles, enamel erosion.
    • Do not leave alone after meals.

Depressive Disorders

  • SSRI Onset: Patients will not feel better immediately after starting SSRIs.

MAO Inhibitors

  • Dietary Restrictions: Review tyramine restrictions.

Substance Abuse Withdrawal

  • Assessment: Determine when the last drink or drug use occurred.
  • Quantify Use: Ask about the quantity of substance consumed.
  • Complications of Withdrawal: MI, stroke, suicide.

SeaWalk Technique

  • Description: A tool for managing patients.

Music Therapy for Memory Care

  • Study: Creating personalized playlists for patients with dementia improved their engagement and quality of life.
  • Cost: Only $40 per patient.
  • Documentary: "Alive Inside" showcases the transformative power of music.