Final Exam Part 2 PDF

HIRSCHSPRUNG DISEASE: Mechanical obstruction from inadequate mobility of intestines Also called Congenital Aganglionic Megacolon Lacking ganglion cells and ganglion nerve tissue Common: Males, Down Syndrome Typically in rectum, does not relax = child cannot defecate Ris...

HIRSCHSPRUNG DISEASE: Mechanical obstruction from inadequate mobility of intestines Also called Congenital Aganglionic Megacolon Lacking ganglion cells and ganglion nerve tissue Common: Males, Down Syndrome Typically in rectum, does not relax = child cannot defecate Risk for enterocolitis to occur Ribbon like stools GOLD STANDARD: Rectal biopsy Nothing we can do but remove portions lacking ganglion cells ○ Bowel rest 6 months for temporary colostomy ○ More than 1 ft removal = permanent colostomy INTUSSUSCEPTION: Telescoping of intestines into another Common in ileum Cutting off blood flow = BIG issue Cause is unknown, occasionally due to intestinal lesions CLASSIC TRIAD: abdominal pain, abdominal mass, bloody stools S/S: intermittent abdominal pain, empty RLQ, red currant jelly stools, sausage shape in RUQ TX: pneumo/air enema, saline enema ( successful = normal brown stool) CYSTIC FIBROSIS: Exocrine gland dysfunction, chloride channel is abnormal. Water does not follow = secretion is thick & viscous Respiratory: Wheezing, dry NP cough, obstructive emphysema, patchy atelectasis, cyanosis, clubbing finger/toes, bronchitis/pneumonia GI: Impaired digestion and absorption of fat/protein, pancreatic enzyme deficiency, sweat gland dysfunction, FTT, increase weight loss despite increased appetite, GI deterioration GI presentation: meconium ileus, distal intestinal obstruction syndrome, excretion of undigested food, wasting of tissues, prolapse rectum Pancreas/Bile duct: type 1 DM, liver cirrhosis (87% develop), lose salt through sweat = risk for dehydration Additional: delayed puberty (F), sterility (M), hyponatremic/hypochloremic alkalosis, hypoalbuminemia DX: Sweat chloride test (1M or older), Chest XR, PFT, stool analysis, barium enema TX: hygiene, antibiotics, aerosol mucolytics, bronchodilators, CPT, exercise, anti-inflammatory agents, lung transplant, vitamins (ADEK), salt supplement,  pancreatic enzymes. HIGH calorie & protein, manage GERD, enemas, iron if deficient, insulin, CFTR modulators Life expectancy: 40-50 years Maximum health potential: nutrition, aggressive treatment, pulmonary hygiene KAWASAKI DISEASE: Acute systemic vasculitis Common: boys and 5 days ○ Bilateral conjunctival infection ○ Change in oral mucosa: Strawberry tongue ○ Rash ○ Cervical lymphadenopathy ○ Change in extremities: edema, erythema, peeling of hands/feet Risk for aneurysm 10-40 days after ↑ WBC, ↑ CRP, ↑ Platelets, ↓ Hgb TX: Antiplatelet (Aspirin), anti-inflammatory (IVIG) EPIGLOTTITIS: Swelling of tissues above the vocal cords LIFE THREATENING Do NOT examine throat Usually caused by HIB (bacteria not virus) SX: sore throat, tripod position, drooling, fever, muffled voice, dyspnea, stridor, absence of spontaneous cry TX: artificial airway, oxygen, corticosteroids, fluids/IV, antibiotics, prevention: HIB vaccine ANTIDOTES: Acetaminophen = N-Acetylcysteine (Mucomyst) Opioid = Naloxone (Narcan) Benzodiazepine = Flumazenil (Romazicon) Digoxin = Digoxin Immune Fab (Digibind) Carbon monoxide = Oxygen CONJUNCTIVITIS: Inflammation of the conjunctiva Pink eye is bacterial, but this can be viral as well RISKS: under 2W old, recent URI, recent ear infection  SX: tearing, pain, redness, crusting TX: antibiotics, surgery SICKLE CELL ANEMIA: Genetic disorder, overabundance of abnormal hemoglobin Hemoglobin electrophoresis: blood test, determines type of hemoglobin individual has Sickle turbidity quick screen test: newborn test Abnormal hemoglobin: C, S, H, A2, E, Barts, O-Arab, etc. Most common: SS hemoglobin with > 40% Hgb S (usually 90%) Sickle cell trait: Carries one gene for Hgb S but rarely displays symptoms ○ 40 sickle cell anemia Glutamic acid should be in 6th position, pushed out and replaced with valine instead RBCs form large rigid rods and become curved Pain results from anoxia and cellular death Short RBC life span = low Hgb, high reticulocyte count, elevated bilirubin and jaundice r/t breakdown of large number of RBCs Triggers: infection, illness, acidosis, stress, dehydration, hormonal changes, high altitudes Clinical findings: renal failure, liver dysfunction, blindness, respiratory distress/ lung disease, pneumonia, joint swelling/damage, skin ulcers, acute chest syndrome, growth retardation in long bones, splenic enlargement and dysfunction Risk for STROKE: 5% chance, after one 75% chance for second TX: penicillin VK (from birth to 6-10y), folic acid, hydration, avoid triggers, screenings, protection of organs, safety measures to protect spleen Clinical management: Hydration, pain management. Treat underlying conditions. Vasodilation, oxygen, anti-inflammatory, blood transfusions, phoresis, hydroxyurea, stem cell transplant, gene therapy Labs: Low - Hgb, K+, RBC, glucose (during crisis) High - Bilirubin CEREBRAL PALSY: Non-progressive disorder that affects motor centers of the brain Affects: ability to move, maintain balance and posture Caused by brain injury & hypoxia Types: Spastic, Dyskinetic, Ataxic, Mixed Manifestations: Seizures, difficulty feeding, delayed motor skills, altered muscle tone, spasticity, involuntary movements, abnormal reflexes TX: prevent injury/deformity, increase caloric intake, muscle relaxers, anticonvulsants No cure but early dx & tx is crucial TYPES OF DEHYDRATION: Hypotonic: losing more electrolytes than water Isotonic: most common, losing same amount of water and electrolytes Hypertonic: losing more water than electrolytes, results in excessive concentration of electrolytes CARDIAC CATH CARE: Common with CHD patients DON’T sandbag side Hold direct pressure if dressing doesn't work Dysrhythmias may occur postoperatively Dye is used, encourage fluid to flush out IRON DEFICIENCY ANEMIA: caused by inadequate supply of dietary iron or excessive loss of iron Usually result from: hemorrhage, inability to absorb iron, in peds sometimes due to growth and inadequate diet SX: asymptomatic, pallor, Pica, fatigue, irritability, milk baby, Hgb < 10, low Hct, low RBC, low serum iron, enlarged spleen, heart murmur NI: foods high in iron (fish, meat, green leafy vegetables), Oral ferrous sulfate, Vitamin C, IM or IV route for malabsorption/noncompliance GASTROESOPHAGEAL REFLUX (GER): transfer of gastric contents into the esophagus GERD is more chronic version, GER is more acute Manifestations: vomiting, excessive crying/irritability/stiffening, wheezing, stridor, gagging, pneumonia, hematemesis, apnea/ALTE, heartburn, dysphagia, asthma TX: position upright 30m after feed, small frequent meals, add rice cereal, no caffeine citrus or spicy foods, zantac, pepcid, tagamet, prevacid, prilosec LAST RESORT: Nissen Fundoplication Surgery- wrap top of stomach around lower esophagus INCREASED ICP: EARLY SX: vomiting, change in vitals, alteration in LOC, blurred/double vision, pupils asymmetrical/setting sun, bulging fontanels, dilated scalp veins, increasing head circumference, irritability and seizures LATE SX: significant deterioration in LOC, respiratory distress/cheyne-stoking, bradycardia, widening pulse pressure, increased SBP, papilledema, pupils fixed/dilated  Deceberate: damage at the level of brain stem, Decorticate: cerebral cortex damage DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH): femoral head and acetabulum are improperly aligned by either partial dislocation or frank dislocation GOAL: keep hip abducted, but promote normal growth and development and movement Manifestations: limited abduction of affected hip, asymmetry if gluteal and thigh fat folds (screen birth - 1y), unequal leg length, tip toe walking (most common) Ortolani’s sign: positive = click or clunk heard on abduction, most reliable at 2M DX: Ultrasounds- yields false positive until 4-6w there tx may be delayed, XRay after 4-6M TX: Pavlik harness- if less than 6 months (maintains flexion 90-100 degrees), wear 23 hrs a day, keep in harness for 3M, after 6M Rigid “cruiser” brace- allows child to crawl and walk, after 18M Closed Reduction w/ Hip Spica Cast for 6-8W CROUP: respiratory condition characterized by brassy or barky cough & stridor Associated with: spasmodic laryngitis, laryngotracheobronchitis Viral cause most common SX: harsh barking cough, hoarseness, stridor, laryngeal edema, fever, respiratory distress TX: vapor mist or tent, oxygen, corticosteroids, inhaled racemic epinephrine, fluids, rest ACUTE RHEUMATIC FEVER: systemic inflammatory disease Effects: joints, heart, CNS, skin, and SQ tissue Follows strep group A beta hemolytic streptococci Complications: arrhythmias, damage to heart valves, endocarditis, HF, pericarditis, sydenham chorea, risk for recurrence of strep throat SX: Must have 2 major or 1 major and 2 minor: ○ Major: chorea, carditis, erythema nodules, subcutaneous nodules, polyarthritis ○ Minor: Fever, elevated ESR or CRP, prolonged P-R interval ECG, arthralgia TX: penicillin, salicylates, steroids, valium/haldol, bedrest, seizure precautions, nutrition, prevent cardiac damage, antibiotic prophylaxis needed until adulthood ACUTE APPENDICITIS: SX: periumbilical pain, nausea, RLQ pain, vomiting McBurney’s point: rebound pressure in RLQ  Sudden relief = indication that it has ruptured 6 hours later pain returns, we now have peritonitis ○ Leukocytosis ○ Increased CRP TX: if ruptured we don’t remove right away if child is stable, we drain, give antibiotics, and then go in for surgery Nursing Care: proper care of incisions site teaching, instruct on antibiotic therapy, promote walking/ambulation For perforation or abscess = go home on 6 week oral antibiotics CHILDHOOD CANCER: Leukemia is most common (26%) 1,600 children in US die from cancer each year 5 year survival rate is 85% Pediatric leukemia: cancer of the WBC ○ ALL- most common (75% of leukemia cases) high survival rate ○ AML- less common (17%) low survival rate ○ SX: bone marrow failure (anemia, neutropenia, thrombocytopenia), splenomegaly, hepatomegaly, lymphadenopathy, bone pain, meningeal irritation ○ TX: chemotherapy, surgery, radiation, biotherapy or targeted therapy, stem cell transplant, immunotherapy LEAD POISONING: Plumbism: ingestion/absorption of lead substance Source: paint, food, water, exhaust, cans, pipes SX: anemia, increased blood lead level, pica, behavioral changes, seizures, G&D delay, coma, death TX: education, anticipatory guidance, screening, remove source, test family TETRALOGY OF FALLOT: Pulmonic stenosis- narrowing of pulmonic valve, restricting blood flow from right to left resulting in reduced blood flow to the lungs Right ventricular hypertrophy- blood getting pushed back and filling up the ventricle and stretching that muscle, results in heart stiffening and weakening. overworking valve/pump Overriding aorta: shifts over to the right into wrong position Ventricular septal Defect  Tet Spells: caused by decreased pulmonary blood flow ○ Cyanosis, hypoxia, risk of emboli, loss of consciousness, sudden death and seizures ○ Triggers: crying, feeding too long, stress Knee/chest position to increase venous return Morphine given to reduce infundibular spasms this increase venous return Defects surgically repaired or palliative shunt is placed ○ 6 months or 10 pounds whichever comes first Goals: fixed by 2 years if possible to prevent G&D delay NI: oxygen, keep PDA open, digoxin, treat like CHF patient, diuretics, rest, lots of supportive care CONGENITAL HEART DEFECTS: Unknown etiology Associated factors: maternal infection, exposure to lithium, phenytoin, warfarin and alcohol, maternal age over 40, maternal metabolic disorder (type 1 DM, PKU), paternal alcoholism Major cause of death in first year of life Most common is VSD INCREASED pulmonary blood flow: ○ Atrial Septal Defect: hole between atria, close within 18M, or corrective surgery needed at 3 ○ Ventricular septal defect: hole between ventricles, closed ½ the time on own by age 2, HF is common ○ Patent Ductus Arteriosus: failure of ductus arteriosus to close, prostaglandin given to help close DECREASED pulmonary blood flow: ○ Tetralogy of fallot ○ Pulmonic stenosis ○ Transportation of the Great Arteries: aorta attached to right ventricle, pulmonary artery attached to left ventricle SX: tachycardia, dyspnea, fatigue, diminished pulses, murmur, cyanosis, poor feeding, FTT DX: chest XRay, EKG, echo, cardiac catheterization DIGOXIN TOXICITY: Nausea, vomiting, anorexia, bradycardia, dysrhythmias  Decreased levels of potassium potentiate the effects of digoxin because it makes it more potent HYDROCELE: excessive fluid in scrotum TX: none- spontaneous resolution, surgery HEMOPHILIA & VON WILLEBRAND DISEASE: hereditary bleeding disorders that result from deficiency of specific clotting factors Hemophilia A (classic): Factor VIII deficiency, 80% of cases Hemophilia B (Christmas disease): Factor IX deficiency, 15% of cases Von Willebrand Disease: vW factor deficiency Soft tissue or joint bleeding is suggestive of hemophilia A or B Favors Males Von Willebrand Disease: ○ Most common congenital bleeding disorder ○ Acquired as a result of underlying pathology Hypothyroidism Seizure treatment with valproic acid Congenital heart disease Wims tumor ○ Resolves when underlying problem is treated TX: avoid aspirin, NSAIDS, meds affecting platelet function, safety (helmets, no contact sports), DDAVP, antifibrinolytic therapy (stabilizes clot by inhibiting clot lysis) ○ Hemophilia: factor IV infusion, factor VIII (30-40%), factor IX (30%) ○ vW: DDVAP, IV vW factor for total absence ○ Nonpharmacological: ice, elevate, microfibrillar collagen (Avitene), passive ROM to prevent contractures once bleed has stopped Adverse reactions to factor: allergic, infection/sepsis, development of inhibitors ASTHMA: Chronic inflammation, obstructed airways, bronchial spasm, mucosal edema, mucus production SX: wheezing, cough, dyspnea, chest tightness, accessory muscle use, increased HR, increased RR, anxiety, fatigue, increased eosinophils Clinical therapies: eliminate allergens, avoid triggers, medications, hydration CELIAC DISEASE: inherited, autoimmune disorder, inability to digest gluten (gliadin)  Damages intestinal mucosal cells, celia damaged and cannot properly absorb nutrients SX: FTT, chronic diarrhea, steatorrhea, abdominal distension, abdominal pain, muscle wasting, anorexia, nausea, vomiting, irritability, neurological symptoms TX: gluten free diet, vitamin supplements BACTERIAL MENINGITIS: acute inflammation of meninges Can be caused by: streptococcus pneumoniae, group B streptococci, Hep B Common 1-5Y, and adolescents Easy droplet transmission from nasopharyngeal secretions Manifestations: fever and chills, headache, irritability, alterations in sensorium, agitation, seizures, vomiting, rashes, joint involvement, otitis media, nuchal rigidity SX: paradoxical irritability, bulging anterior fontanelles, GI upset, cold like sx, nuchal rigidity, headache, rash, hypersensitive reflexes TX: Ampicillin: aerobic, Gentamicin: gram (-), Flagyl: anaerobic, dexamethasone, isolation, low stimulus, very STILL for spinal tap, hydration, ventilation, reduction of increased ICP, management of bacterial shock, seizure control, control extreme temp PROGNOSIS: age of child, type of organism, severity of infection, duration of illness before therapy VIRAL (ASEPTIC) MENINGITIS: Usually subsides in 3-10 days Dx based on clinical features and CSF findings Treatment is asymptomatic: acetaminophen, positioning, decreased environmental stimuli DIFFERENTIATING B VS V: Lumbar puncture is definitive for diagnosis Blood, throat, urine and nasopharyngeal culture CBC and electrolyte panel TREATMENT FOR MENINGITIS AND ENCEPHALITIS: Steroids, acyclovir, antibiotics, sedatives, antipyretics, fluids/IV, seizure precautions, ICP management, low stimulation environment TONSILITIS & ADENOIDITIS: inflammation of the lymph tissue in the pharynx Viral or bacterial SX: dysphagia, sore throat, enlarged cervical lymph nodes  TX: antibiotics if bacterial, manage pain (ice collar), promote nutrition and hydration, tonsillectomy and adenoidectomy ○ Surgery: monitor for hemorrhage, position head midline, suction oral cavity NOT throat, keep throat moist, provide soft diet, monitor for increased pulse, watch for frequent swallowing, observe for pallor Pain & comfort: ice pops (no RED), saltwater gurgles, adequate sleep and rest, no running around for 2 weeks, cold pack, heating pad for ear pain, chew gum to lessen pterygoid muscle spasm Hydration: bland fluids, no red or brown liquids, monitor hydration status, encourage hydration DERMATITIS: inflammation of hypersensitive skin Contact (anyone can get), diaper (irritation in diaper area, avoid alcohol wipes), atopic (tends to run in families, 35% develop asthma) Atopic: weeping vesicles/crusts, prone to infections, scratching, irritability, poor sleep, increase IgE and eosinophils TX: emollients, wet soaks/compresses, antihistamines, keep nails short, supplement with evening primrose oil ACUTE MYELOGENOUS LEUKEMIA (AML): Represents 17% of childhood leukemia Known risk factors: ionizing radiation in utero, constitutional genetic disorders, some prenatal environmental factors, low birth weight HYPOSPADIAS: penile anomalies with an abnormally located urinary meatus Needs surgical correction Ventral: underside, epispadias (above) No circumcision GOALS: straight stream of urine, ability of penis to be used as sexual organ, normal appearance BRONCHIOLITIS:RSV: inflammation of small airways due to virus RSV is a form of bronchiolitis ○ Loss of cilia, mucosal swelling, mucous and exudate, air trapping EARLY SX: rhinorrhea, low grade fever, sneeze/cough, wheezing, tachypnea LATE SX: severe tachypnea, nasal flaring, retractions, cyanosis, decreased breath sounds  TX: if viral, supportive care and treat symptoms: fluids, humidify air, antipyretics IF hospitalized: oxygen, suctioning, fluids, bronchodilators, contact isolation Nasal washing to determine if RSV or other cause Medications: ribavirin (antiviral) Prevention: (monoclonal antibody) synagis requires monthly injection, beyfortus requires one injection that lasts up to 5 months at least UTI: bacterial invasion Gram - negative E coli most common, bladder most common site Risks: girls, congenital malformation, obstructive uropathy and VUR, urinary stasis, tight underwear, bubble baths, poor hygiene, uncircumcised, constipation SX: foul urine, incontinence, frequency, urgency, dysuria, hematuria, V/D, FTT, fever, chills, flank pain, abdominal pain, poor feeding, fussiness, jaundice TX: antibiotics, fluids, follow up urine culture Educate: avoid caffeine, wipe front to back, no wet clothing, no undies at night, good hygiene, no bubble baths/products with fragrance, promote cotton underwear DIABETES MELLITUS: Type 1: cellular mediated autoimmune destruction of B-cells in pancreas, 85-90% have presence of autoantibodies, low or undetectable levels of plasma C-peptides Type 2: many different causes such as obesity, lack of exercise or abdominal body fat, develop insulin resistance with or without insulin deficiency Type 1: autoimmune process that destroys the islet of langerhan Urine glucose checks not necessary but urine ketones are monitored, reagent strips can be pressed into wet diaper or cotton ball places in diaper and squeezed onto strip Lab uses plasma to measure glucose and is higher than capillary level by 10-15% Capillary glucometers use whole blood but may convert reading to plasma values GOALS for BG before meals by AGE: ○ 12 years - 70-150 (at bedtime 90-150) Intensive therapy involves: monitoring blood glucose four times a day and once a week at 3am, monitor dietary intake, varying insulin dose to fit carbohydrate eaten at each meal or snack, anticipating exercise in the routine Biggest drawback of intensive therapy is hypoglycemia DIABETIC KETOACIDOSIS: electrolyte imbalance, thrombosis, pancreatitis, arrhythmia, intestinal necrosis, cerebral edema (life threatening)  SX of CEREBRAL EDEMA: headache, uncharacteristic behaviors, decline in LOC, agitation, change in pupil size, seizure, recurrence of vomiting, bradycardia, hypertension TX of CEREBRAL EDEMA: hyperventilation, intubation and ventilation, mannitol, decrease fluid therapy, elevate HOB Complications of diabetes: death = 810, amputation = 230, kidney failure = 120, blindness = 55 Tidbits: physical activity increases insulin sensitivity and improves metabolic control with a lower dose insulin, absorption rate of insulin varies by site, extremely sleepy and irritable toddler can be sign of hypo/hyperglycemia, puberty can be delayed, medical alert identification is needed, and the school health plan needs to be readily available with info and supplies to manage hypo/hyperglycemia Education: kids can typically perform tasks by 6-8y old, adolescents are able to manage self care although the desire to be like peers often interferes with compliance, the fewer changes to family/child the greater the chance of compliance, child/family need to know how to manage an emergency and have a sick day plan PHYSICAL ASSESSMENT FINDINGS: Acanthosis Nigricans (hyperpigmented skin common sign of insulin resistance) GROWTH HORMONE DEFICIENCY: decreased level of growth hormone r/t decreased activity of the pituitary gland Decreased stature Radiographic imaging of the wrist to evaluate ossification DX: pituitary function testing to confirm diagnosis TX: biosynthetic growth hormone (SQ daily injection while they're growing) PRECOCIOUS PUBERTY: Secondary sex characteristics before 8 years in girls and 9 years in boys Problems: Growth plates could close early, social implications, self esteem issues TX: gonadotropin releasing hormone analog, discontinue at age of puberty Children at risk for self esteem issues Medication is expensive! SPECIAL VULNERABILITY OF INFANTS AND CHILDREN: They are susceptible hosts because their immune system is not yet fully developed Newborns particularly susceptible because they are unvaccinated and have very immature immune systems  Herd immunity: the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease TYPES OF VACCINES: Inactivated (Killed): the microorganism is killed but will still produce an immune response, ex: poliovirus (IPV) Live (attenuated): the microorganism is still alive but weakened, ex: measles, influenza Toxoid: A toxin has been weakened but still has an effect antigen, ex: tetanus, diphtheria Recombinant: Genetically altered organism that is used in a vaccine and will stimulate active immunity, ex: pertussis, HPV, Hep B VACCINE REACTIONS: Common reactions: ○ Local: erythema, pain, and induration at the injection site ○ Systemic: fever, fussiness, irritability, general malaise, anorexia ○ Allergic reaction: mild- minutes to hours after injection, weals rash, urticaria, the tx is observation and benadryl for comfort. Severe- occurs 2-8 hours after vaccination, warmth, erythema, edema near or at airway, petechiae, possible ulceration around site of injection CONTRAINDICATIONS AND BARRIERS: Contraindications: History of anaphylaxis to vaccine or one of it’s components (eggs), moderate to severe acute illness, for specific vaccines, pregnancy or allergy to some component Barriers: limited access to healthcare and misconceptions are biggest two, lack of convenient primary care and hours possible for working parent, parental knowledge deficit, religious/cultural prohibitions, misconceptions Nursing Considerations: document/educate, provide parents with information, informed consent MUST be obtained before, ensure age-appropriate administration and holds, ensure proper storage, check for damaged/expired vaccines, store according to manufacturing guidelines Required documentation: date of administration, manufacturer, lot number, expiration date, site and route, name and title who gave it ERYTHEMA INFECTIOSUM (FIFTHS DISEASE): common and highly contagious childhood ailment causing a distinctive face rash Rash appears after several days and may spread, the facial rash looks as if cheeks were slapped SX: rash, sore throat, slight fever, upset stomach, headache, fatigue, and itching Virus clears up on its own, but pain relievers may help with symptoms MEASLES: Prodrome starts 3-4 days before the rash, it is characterized by a fever and by the “3 C’s” COUGH, CORYZA, and CONJUNCTIVITIS, toward the end, tiny white (Koplik) spots may appear inside the cheeks, photophobia is common Following prodrome, a maculopapular rash typically begins on the forehead or hairline and spreads downwards to the neck, trunk, and upper and lower extremities (palms and soles rarely involved) Rash usually appears 14 days after person is exposed The immunocompromised patient may not develop rash and those with a history of measles or vaccination may have modified disease presentation characterized by milder symptoms PERTUSSIS/WHOOPING COUGH: Highly contagious respiratory infection caused by Bordetella pertussis SX: hacking cough, whooping TX: azithromycin, fluids (IV or oral), small frequent meals to prevent vomiting, O2 as needed ADD/ADHD: CNS processing disorder Some kids with ADD have a dopamine and norepinephrine deficit which lowers their ability to tolerate stimulation (they become easily distracted) Delay in brain maturation as it relates to self regulation Developmentally inappropriate behaviors involving attention SX: sleep difficulties, difficulty forming social relationships, anxiety SX: HALLMARK: decreased attention span, impulsiveness, increased motor activity FAILURE TO THRIVE: Below 5th percentile: inadequate intake, inadequate absorption, increased metabolism, defective utilization DX: ht/wt, diet intake, parent, child interaction, organic problems, laboratory values  SX: growth failure, developmental delay, undernutrition, apathy, withdrawn, feeding disorder, no stranger fear, avoid eye contact, wide eye gaze, stiff, unresponsive, minimal smiling ANOREXIA NERVOSA: Eating disorder- refusal to maintain normal body weight Restrictive eating and extreme exercise/laxatives/diuretics Primarily in adolescent and young adult females, average age of onset is 19, multifactorial cause and life threatening SX: severe weight loss, altered metabolic activity, amenorrhea, bradycardia, decreased BP, hypothermia, cold intolerance, dry skin, brittle hair and nails, appearance of lanugo DEPRESSION: Likely that genetics and environment and culture interact to influence the differences in prevalence that we see among various cultures Unsure if behavior is learned or biological SX: poor school performance, not being friends and not doing activities, sad and hopeless emotions and attitudes, no energy or enthusiasm, anger towards others and people, taking criticism badly, thinking you are unable to finish ideas to the best quality, guilt, forgetfulness, always being tired, changes in eating and sleeping patterns, substance abuse, having problems with authority, suicidal thoughts or actions TX: cognitive behavior therapy, medications, psychotherapy SUICIDE: 15% of youth consider suicide as an option each year 86% of suicide deaths are adolescent males Guns, suffocation and poisoning are most common means of suicide Under reported: labeled “accidents” VACCINES: HEP B: birth, 1M, 9M DTaP/dap: 2M, 4M, 6M Hib: 2M, 4M, 6M IPV: 2M, 4M, 6M PCV13: 2M, 4M, 6M, 12M RV: 2M, 4M, 6M MMR: 12M Varicella: 12M Hep A: 12M