Peds Practice

Neonatal Abstinence Syndrome (NAS)

• NAS is a condition in newborns exposed to substances (drugs or alcohol) during pregnancy.
• Symptoms include tremors, irritability, poor feeding, high-pitched cry, poor sleep, increased muscle tone, and nasal stuffiness.
• Other symptoms include sweating, temperature fluctuations, and gastrointestinal issues (like vomiting or diarrhea).
• Respiratory problems, like tachypnea (rapid breathing), can also exist.
• A total score (minimum 0, maximum 35) can be used to assess the severity of NAS symptoms.

Jaundice

• Jaundice is a yellowish discoloration of the skin and other organs caused by excessive bilirubin in the blood.
• Hyperbilirubinemia is the medical term for an excessive level of bilirubin in the blood.
• Infants with severe jaundice or hyperbilirubinemia are at risk of developing encephalitis.

Herpes Simplex Virus (HSV)

• Symptoms typically develop one week after infection and include fever, vesicular rash, poor feeding, and lethargy
• Checking the hairline for rash is important.

Choking

• If a child is choking, open their mouth and check for blockages.
• If nothing is seen, turn the baby face down on a forearm with the head below the trunk and give 5 back blows.
• If no improvement, continue with 5 abdominal thrusts.
  • If the child is not breathing, start CPR.

Pediatric Vaccinations

• Vaccines are given on the lateral side of the thigh.
• Buttocks (dorsal gluteal) are not a good vaccination site due to poor absorption.
• A table outlines age-specific vaccinations:
  • Hepatitis B (2 months old)
  • DR. HIP (2 Months, 4 months, 6 months, 15 months)
  • DTaP
  • RV
  • HiB
  • IPV
  • PCV
  • Influenza
  • MMR
  • Hepatitis A
• FLACC Scale (Face, Legs, Activity, Cry, Consolability) ranks pain intensity in children.

Erickson's Theory

• Key stages of development and their related conflicts/tasks include, from infancy to adolescence:
  • Trust vs. Mistrust (feeding)
  • Autonomy vs. Shame and Doubt (toilet training)
  • Initiative vs Guilt (exploration)
  • Industry vs Inferiority(school)
  • Identity vs Role Confusion(social relationships)
• Favorable and unfavorable outcomes are associated with resolution of each stage

Asthma

• Emergent interventions involve albuterol, oxygen, and IV access.
• Management includes pancreatic enzymes, high protein / high-calorie meals, and chest physiotherapy.

Pulmonary Embolism

• Symptoms are shortness of breath, anxiety, tachycardia, tachypnea, chest pain, hypotension, diaphoresis and sudden change in mental status.
• Emboli travel from the marrow through the bloodstream, lodging in arterioles.

Fracture

• Most likely to occur in long bones (femur)
• Pulmonary embolism symptoms: dyspnea and chest pain

Cystic Fibrosis

• Management involves aggressive treatment of pulmonary infections, home IV antibiotics, aerosolized antibiotics, chest physiotherapy, postural drainage, medication compliance, high-protein/calorie diet, and encouraging exercise..

Neurovascular Assessment

• Assess (5 P's) PAIN, PULSE, PALLOR, PARESTHESIA, PARALYSIS.
• Important in assessing circulation, movement, and sensation of an extremity, especially in cases of fractures or other injuries.

Coarctation of the Aorta

• Localized narrowing near the insertion of the ductus arteriosus.
• Results in increased pressure proximal to the defect and decreased distal to the defect.
• Symptoms are upper extremity bounding pulses, hypertension, poor circulation/perfusion / cool and pale skin in lower extremities.
• Treatment involves antihypertensives, surgery (balloon angioplasty with stent, or resection of narrowed part of the aorta).

Tetralogy of Fallot

• Four heart defects together: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.
• Treatment involves placing the patient in knee-chest position or other modifications based on the condition.

Sickle Cell Anemia

• Acute exacerbations that fluctuate in severity and frequency.
• Types of crises: vaso-occlusive (VOC), thrombotic – most common, painful, and involves blood stasis and clumping in microcirculation, leading to ischemia and infarction.
• Presents with fever, pain, and tissue engorgement, painful swelling in hands and feet, painful joints, as well as other symptoms.
• Treatment involves managing pain, hydration, infection control, oxygenation
• Adequate hydration, IV fluids, pain medication (avoid meperidine), positioning for comfort, and potentially hydroxyurea are components of management
• High-calorie and high-protein diet.

Hirschsprung's Disease

• Lack of peristalsis in the large intestine due to absent ganglionic nerve cells.
• Presents with abdominal distention.
• Includes lack of regular bowel movements, diarrhea or constipation, abdominal distention, and other symptoms.

Pyloric Stenosis

• Patho, includes hypertrophy leading to narrowing of the pyloric valve.
• Symptoms are non-bilious projectile vomiting, visible peristalsis, failure to thrive, dehydration, and weight loss.

Kawasaki Disease

• Complications include aneurysm
• May present with fever, inflammation of blood vessels and cardiovascular symptoms.

Glomerulonephritis

• Inflammation of glomeruli in the kidney, often following a strep infection.
• Symptoms: headache, blood pressure changes, facial/periorbital edema, lethargy, low-grade fever, weight gain, proteinuria (protein in urine), hematuria (blood in urine), oliguria (decreased urine output), dysuria (painful urination)

Diabetes Insipidus (DI) vs SIADH

• DI (Diabetes Insipidus): characterized by under-secretion of ADH leading to uncontrollable diuresis (frequent urination, polyuria, polydipsia); dehydration, electrolyte imbalances
• SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion): characterized by over-secretion of ADH, fluid retention, hyponatremia (low sodium).

Ventriculoperitoneal Shunt (VP Shunt)

• A surgical procedure used to treat hydrocephalus (excess fluid in the brain).
• Possible complications include vomiting , headache, irritability, fever, redness along the shunt line, fluid around the shunt valve, change in LOC, shunt malfunction, and infection (requiring immediate treatment).

Increased Intracranial Pressure (ICP)

• Early signs may include slight changes to LOC, headache, vomiting, seizures (with or without nausea), diplopia (double vision), blurred vision, LOC (early sign of worsening condition)
• Late signs, include significant decrease in LOC, bradycardia, decreased motor and sensory responses, alterations in pupil size or reactivity, posturing, Cheyne-Stokes breathing, and coma.

Scoliosis

• A sideways curvature of the spine, needing care to promote self-esteem, mobility and prevent worsening of the condition via bracing.

Leukemia

• Presents with symptoms like petechiae, fever, fatigue or headache, papilledema, irritability, muscle wasting, weight loss, fatigue or decreased intracranial pressure with psychosis or decreased mental state.

Autism Spectrum Disorder (ASD)

• Affects 1 in 36 children but prevalence changes over time.
• Symptoms include not responding to name, avoiding eye contact or social interaction, not speaking or using a limited vocabulary.
• Parents/support groups might need educating on the need further support in the classroom, and need for interventions to help with therapies or social adjustments.
• Early diagnosis and support are essential for children with ASD.

Trisomy 21 or Down Syndrome

• Can be identified with a blood test from a prenatal screening.
• Physical characteristics often include white spots on the iris, long neck, small jaw, small ears, short neck, short stature, poor muscle tone, and a single crease across the palm of the hand.

This quiz covers critical neonatal conditions including Neonatal Abstinence Syndrome (NAS), jaundice, and Herpes Simplex Virus (HSV) in infants. Test your understanding of the symptoms, risks, and assessment methods related to these conditions. Ideal for healthcare professionals and students in pediatric medicine.