Peds & OB Exam 1 PDF

PEDS EXAM 1 ​ Cleft lip and palate: facial malformations that occur during embryonic development may appear separate or together, Etiology: with other syndromes, genetic, or risk factors (smoking, gestational diabetes, and maternal folate deficiency) -want to know CL befo...

PEDS EXAM 1 ​ Cleft lip and palate: facial malformations that occur during embryonic development may appear separate or together, Etiology: with other syndromes, genetic, or risk factors (smoking, gestational diabetes, and maternal folate deficiency) -want to know CL before birth b/c repair, prepare families, and to test other systems -CL can be diagnosed in utero via ultrasound -CP diagnosed at birth -CL rule of 10s (10 weeks, 10 lbs, hgb of 10), usually done between 2-3 months -CP done between 6-9 months, solid foods and speech Pre op: ensure sucking needs met, family bonding, baby growing okay Post op: protect area, logans bow for 4-6 days for CL, back or side lying position, prevent crying, keep clean (CL- mild soap and water, ½ strength hydrogen peroxide and water, CP- rinse with water after eating) ​ Hypertrophic pyloric stenosis: pyloric sphincter thickens up 4x normal resulting in narrowing of the opening and obstruction of gastric outlet, it is a normal sphincter but just hypertrophy -first born males are more at risk ​ -s/s projectile vomiting immediately after feeding, hungry, irritable, dehydration, poor weight gain, olive shaped mass in RUQ, hyperactive bowel sounds, tachycardic ​ -diagnostic: usually takes 6-8 to be diagnosed ​ -questions you would ask? How much feeding? How often? How many wet diapers? ​ -if still vomiting 48 hours post op contact dr!, start feedings 4-6 hrs post op ​ ​ Intussusception: telescoping of one portion of the intestine into another, most common in children under 2, no known cause -s/s intermittent acute abdominal pain, currant-jelly stools, dehydrated, vomiting, sausage shaped mass wherever it is -nursing: assess all soiled diapers, before and after reduction -air enema, usually diagnosed at same time as correction ​ CASE STUDY: Appendicitis: a blind sac at the end of the cecum, -diagnosis: symptoms, wbc 15,000-20,000, CT scan -management: laparoscopic or open  -s/s: pain, n/v, low grade fever, right lower quadrant pain (McBurney’s point), rebound tenderness, fetal position -Preop: comfort, NPO, pain meds, IV bolus/ maintenance, labs, avoid- heat, enemas, laxatives, education -Postop: NPO until bowel sounds return, home education -”It doesn't hurt anymore”...... ruptured!!! Emergency! -preop emergency: NPO, NG tube placement, IV bolus/maintenance, antibiotics -postop emergency: comfort, monitor for s/s of sepsis, IV antibiotics 5-7 days, wound site care ​ Gastroesophageal Reflux (GER): gastric contents in the esophagus, very common usually will outgrow by 18 months -reduce amount of feeds, increase frequency, increase burping, elevate after feeding ​ Hirschsprung Disease: (Congenital aganglionic megacolon), can happen anywhere in bowel, colon starts to enlarge and stretch for stool, usually diagnosed by 1 year -s/s: failure to pass meconium in first 24-48 hrs, vomiting/abdominal distention/ palpable fecal mass, ribbon like stools ​ Short bowel syndrome: nutrient malabsorption due to small intestine loss, may thin and enlarge ​ Normal specific gravity: 1.10-1.20 ​ Hypospadias: urethral opening is located below the glans penis or anywhere along the underside of the penile shaft, often associated with chordee ​ Epispadias: urethreal opening located along the dorsum (upper aspect of the penile shaft) usually assocated with bladder extrophy, -BOTH usually corrected before 12 months b/c of potty training, double diapering: regular and larger size, clean hands, no baths, blanche tip of penis, watch urine output ​ Obstructive uropathy/reflux: anything that prevents or blocks urine from exiting the urinary system causing hydronephrosis, usually will wait to see if grow out, prophylactic antibiotics for obstruction and reflux ​ UTI’S: E coli most common, urinary stasis is the most important factor influencing the occurrence, female most common, -0-24 months: resemble GI disorders ​ Enuresis: wetting episodes may be a sign of diabetes ​ Nocturnal: wetting occurs during sleep ​ Diurnal: wetting when awake ​ Primary: wetting occurs at least twice a week for >3 months ​ Secondary: wetting begins after at least 6 months or dryness ​ Acute glomerulonephritis (APSGN): primary cause is from a strep infection, abrupt onset, fluid primarily accumulates in the vascular system, will see the hematuria, mild proteinuria, not immediate edema, HYPERTENSION, no hyperlipidemia, lasts 2-3 weeks, can effect cardiac, lungs (crackles), neuro Interventions: possible antibiotics, possible ASO, daily weights, VS, antihypertensives, fluid restrictions, strict I+Os Diet: low sodium, low potassium (K+) ​ Nephrotic Syndrome (MCNS): no known cause but losing protein in the urine, gradual onset but chronic, fluid primarily accumulates in the tissues interstitial spaces, rare to see hematuria, MASSIVE 4+ proteinuria, foamy/frothy urine, edema! Usually starts in face, normotensive or hypotensive, yes to hyperlipidemia Interventions: I+Os, daily weights, give albumin and lasix, steroids,isolate pt, integumentary assessment Cyclosporin (antirejection), cytoxan, Diet: high protein, low sodium (no added salt) ​ Congestive heart failure (CHF) in children: they won't eat, will present like failure to thrives Diagnostic tests: pulse ox (93% or higher is norm), ECG, Halter monitor, Chest x-ray (see structures), ECHO, MRI, Cardiac Cath Assessment: where does it begin? (questions- different in breathing pattern…..and history, then start by looking) skin color, activity, rr, look healthy?, tachycardia, RR (retractions, wheezing, crackles), tachypnea, BP on all 4 extremities, weak cry, pallor skin, matty cool skin Newborns/Infants: failure to thrive, tachycardia, tachypnea, …. Children/Adolescents: tachycardia, JDV, ……. ​ Cardiac catheterization: Pre: prepare child and family, use developmentally appropriate materials, assess and mark pulses, baseline 02 sats, NPO, want decrease anxiety  Post: monitor dressing, check the pulse distal to the site, monitor temp and color of skin, vitals every 15 min for first hr, I+Os, bedrest lay flat for 4-8 hrs, no tub baths, restrict strenuous activity for 3 days, apply pressure and call if dressing saturated ​ Blood flow valves in the heart: TAKE PRIDE IN MAKING A’S, Tricuspid, Pulmonic, inMitral, Aortic ​ Atrial Septal Defect (ASD): (Increased pulmonary blood flow defect) abnormal opening between the right atria and the left atrial, body system is not getting enough oxygen, most spontaneously close by 18 months but surgery if not closed by 3 years s/s: high HR, tired, cyanosis, don't want to eat Nursing: add extra calories to feedings, smaller feedings more frequently, give 20 minutes to feed Medications: Digoxin (to decrease hr and increase cardiac output), give 30 minutes before feeding or 2hrs after eating, check apical rate for full minute (adult= 60, infact= at least 90), check peaks and troughs Dig toxic: haloes, visual changes, decreased HR, vomiting (don't regive medication) ​ Ventricular Septal Defect: (Increased pulmonary blood defect) most common CHD, abnormal opening between right and left ventricles, spontaneous closure 50% by 2 years old, body system is not getting enough oxygen, s/s: high HR, tired, cyanosis, don't want to eat Nursing: add extra calories to feedings, smaller feedings more frequently, give 20 minutes to feed Medications: Digoxin (to decrease hr and increase cardiac output), give 30 minutes before feeding or 2hrs after eating, check apical rate for full minute (adult= 60, infact= at least 90), check peaks and troughs Dig toxic: haloes, visual changes, decreased HR, vomiting (don't regive medication) ​ Patent Ductus Arteriosus (PDA): (increased pulmonary blood defect), should of closed at birth, may spontaneously close, may close with indomethacin, body system is not getting enough oxygen, s/s: high HR, tired, cyanosis, don't want to eat  Nursing: add extra calories to feedings, smaller feedings more frequently, give 20 minutes to feed Medications: Digoxin (to decrease hr and increase cardiac output), give 30 minutes before feeding or 2hrs after eating, check apical rate for full minute (adult= 60, infact= at least 90), check peaks and troughs Dig toxic: haloes, visual changes, decreased HR, vomiting (don't regive medication) ​ Coarctation of the Aorta: (Obstruction), Localized narrowing near insertion of ductus arteriosus, over profuse upper, decreased perfusion lower Upper s/s: decreased LOC, lethargy, bulging/full fontanelle, headache, bloody noses, increased BP Lower s/s: pale, decreased BP, weak pulses, -will not self correct, go in and and balloon open up/stents ​ Aortic Stenosis: (obstruction) narrowing or stricture of aortic valve, will not self correct, go in and balloon open up/stents s/s: cold, clammy, failure to thrive ​ Pulmonic Stenosis: (obstruction), narrowing at entrance to pulmonary artery, surgical repair valvotomy/balloon angioplasty/stents s/s: systemic edema: use lasix ​ Decreased pulmonary blood flow defect- tetralogy of fallot (comprised of four heart defects), 02 sat not normal, may look blue, they have deoxygenated and oxygenated blood in their system s/s: cyanosis, murmur, “tet” spells (anything that stresses them out, getting more deoxygenated blood in their system), clubbing Treatment: surgical repair- shunt, patching, medications, tet spells (knees to chest which brings more oxygenated blood out) s/s: blue/ tachycardia ​ Kawasaki Disease (KD); mucocutaneous lymph node syndrome: an acute systemic vasculitis of unknown cause, child usually younger than 5 years old, child will be followed for years after the disease s/s: WARM CREAM  Warm (high temp) Conjunctivitis (red,pink, sclera) Rash (starts at trunk and spreads) Edema (fingers and toes then peels) Adenopathy (enlarged lymph node) Mucous membranes (dry, strawberry tongue) Treatment of KD: intravenous immunoglobulin (IVIG)- suppresses immune system- avoid sick people- no vaccines for 11 months -asprin 80-100 mg- to try and prevent clotting- dr will op to give unless hx of chicken pox b/c of rhyes syndrome Interventions: assess for s/s of cardiac, I+Os and daily weights, meds, education, these pts are very hard to comfort, OB EXAM 1 VEAL CHOP Interventions: Variable decel Chord compression. Steps 1-4 Early decel. Head compression. Do nothing Accelerations. OK- baby is goood. Do nothing Late decel. Poor placental perfusion Steps 1-4 Steps 1-4Variable and late ​ change moms position ​ increase iv fluids ​ stop pitocin, put 02 ​ call provider 0-20 weeks “early” pregnancy bleeding ​ Abortion ​ incompetent cervix ​ ectopic ​ trophoblastic 20wks- delivery “late” pregnancy bleeding ​ Placenta previa  ​ placenta abruption ​ clotting ​ dic Abortion; spontaneous or therapeutic types of spontaneous ​ Threatened ​ Inevitable- no intervention to stop ​ incomplete - placenta remains ​ missed- fetus remains ECTOPIC; pregnancy outside of uterus- frequently in fallopian tubes. No viable fetus. Rupture= medical emergency look for signs of shock BP low, Pulse up. Non ruptured = methotrexate to treat- stops the proliferation of cells TROPHOBLASTIC-= all S/S of pregnancy with no fetus high hcg asian predisposed ultrasound is snow storm once hcg is to zero, must wait 12 months before trying to conceive CERVICAL INSUFFICIENCY: spontaneous dilation with NO contractions stitch to keep closed removed at 36 weeks or when contractions start no sex or vag exams PLACENT PREVIA: Placenta covering cervix opening - no vag exams can move as pregnancy progresses PLACENTAL ABRUPTION:premature seperation of the placenta sever pain rigid abdomen bleeding- dark in color shock s/s (low BP, high HR) prepare for stat delivery!!!! cocaine users at increase risk CHRONIC HTN- before 20 weeks GEST. HYPERTENSION - after 20 weeks 140/90 for two readings, facial edema PREECLAMPSIA- 160/110, protein 3+, hyper reflexes, oliguria