Peds Exam 1 Study Guide PDF

GROWTH & DEVELOPMENT STUDY TOOL When is the most rapid time for brain growth in children? - Most rapid time in utero - Rapid growth continues until 2-3 years - Factors that can alter brain growth during this rapid phase: o Avoid cranial radiation before this age is possible...

GROWTH & DEVELOPMENT STUDY TOOL When is the most rapid time for brain growth in children? - Most rapid time in utero - Rapid growth continues until 2-3 years - Factors that can alter brain growth during this rapid phase: o Avoid cranial radiation before this age is possible o Lead levels there is impaired cognitive development When is the brain fully developed? - Brain is fully developed by 25 yrs old o Including the prefrontal cortex and amygdala allows for emotion regulation and impulse control - Brain grows until 21 yrs. old Growth is cephocaudal and proximodistal (general pattern of growth).  Cephocaudal o Growth and development from head  toes  Proximodistal o Motor skills and control develop from the trunk of the body outward toward the arms, hands, and fingers When assessing a growth curve, what are you looking at? What would raise concern? - When using growth curve (screening tool) you’re looking at key indicators of a child’s growth over time compared to standardized growth charts o Make sure you have the right chart there are different chart for premature, down syndrome etc. children - Using height, weight and head circumferences in relation to the child’s age and sex (assigned at birth) - You are looking for: o Percentile o Trends over time  grow trajectory o Proportionality - Concerns: o Grow faltering  Can be a sign of failure to thrive, malnutrition or chronic illness o Significant or rapid growth crossing percentile lines  Can be a sign of growth disorder, endocrine problem, or other medical conditions  E.g. thyroid problems, growth hormones deficiency o Inconsistent growth head growth while height and weight does not  Can suggest development problem or abnormal growth patterns o Extreme percentiles 90% percentiles for height or weight  Could be a sign of obesity, growth hormones deficiency, or other disorders o Disproportionate Growth weight is higher than height percentile  Can be a sign of obesity Circle the correct answer in parenthesis. BMI (decreases/increases) during preschool years then (decreases/increases) to adulthood. Weight category Percentile Range th Calculate the BMI in the following example. Which category would this Underweight 1000copies/mL o Use of antiretroviral therapy (ART), like ZDV decreases risk of transmission; give:  During pregnancy  Labor  Infant birth to 6 wks  Regardless of their HIV status o Complete avoidance of breastfeeding o PJP prophylaxis for infant at:  4-6 weeks until 1yr  Until can be confirmed negative with HIV antibody assay at 12-18 months  Trimethoprine-sulfamethoxazole- example of med What is the current recommendation regarding breastfeeding for an HIV positive mother in the United States? - Currently complete avoidance of BF List several clinical manifestations of HIV/AIDS.  Lymphadenopathy  Hepatosplenomegaly  Oral Candidiasis  Chronic or Recurrent diarrhea  Failure to Thrive o A condition where an infant or child is not gaining weight, growing, or developing as expected for their age  Developmental Delays  Parotitis o Inflammation of the parotid glands, most caused by viral infections like mumps or bacterial infections o Major salivary glands located on each side of the face, just in front of and below the ears How does HIV differ in children and adults? - Shorter timeframe between infection and AIDS dx o Adults~10yrs o Children 1yr o Defer tx for  Normal immune status  Low viral load  Medical compliance risk o Repeat testing for virologic, immunologic and clinical status q3-4 months If a baby is born to a mother who is HIV positive and the newborn’s test comes back negative, what is the next step? - Repeat at 1-2 months and again at 4-6months o Confirmed negative HIV antibody assay at 12-18 months Clinical Stage Depends on Sx Progression of Symptoms Stage N - Infected but asymptomatic - Positive asymptomatic infant stays in this stage until confirmed status - Mild sx 2 or more present Stage A o Lymphadenopathy o Hepatosplenomegaly o Dermatitis o Parotitis o Recurrent/Persistent URI - Infants usually don’t get this far because they will be being treated - Moderate sx- some Stage B o Anemia o Bacterial meningitis o Oral Candidiasis o Etc. Stage C - Severe Symptoms AIDS defining illness Immunological Stage Level of Suppression Stage 1 No evidence of suppression Stage 2 Evidence of moderate suppression Stage 3 Severe dz w/ AIDS List several indicators of AIDS in children under 13 years old  LIP (Lymphoid Interstitial Pneumonia) o Rare form of interstitial lung disease Serious bacterial Injections  PJP (Pneumocystis Jirovecii Pneumonia) o serious fungal infection o Tx trimethoprim-sulfamethoxazole (TMP-SMX)  CMV common virus o E.g. Chicken pox  Encephalopathy  Wasting syndrome o Involuntary loss of body weight, specifically muscle mass and fat, often accompanied by weakness, fever, and malnutrition  Losses >10% wt  Candidal esophagitis o fungal infection of the esophagus  Pulmonary Candidiasis o rare but serious fungal infection of the lungs  Herpes Simplex Dx  Cryptosporidiosis o Intestinal infection caused by the Cryptosporidium parasite  Mycobacterium Avium-Intracellular Complex (MAC) o causes lung infections What is the importance of a CD4+ cell count? - Assess: o Immune system strengths o Risk for dz progression Determines infectious Stage o Response to tx o Need for PCP prophylaxis after 1yr o Higher in children than adults lowers with age  Make sure you are looking the correct table for persons’ age - HIV targets and destroys CD4+ cells causing progressionCD4+ count gradually declines o  CD4+ count indicates a weakened immune system and risk of developing opportunistic infections. Discuss the considerations for HIV testing in an adolescent population. Between which developmental stages would the medication dosage change for an HIV positive adolescent? - 50% are unaware of their diagnosis - Rates have 4x for 13-19yr old - Considerations: o Testing and privacy  Screening at least annually for 13-64yr olds especially if risk  Completed unless declined o Drug Dosing Based on Tanner Stage:  Tanner 1-2 Pediatric dose  Tanner 3-5 Adult dose  Perinatal acquired vs new onset  Pregnancy Efavirenz (NNRTI) tx and preventative teratogenic  Pt ed for females is required toxic to fetus o Adherence  Growth and development  Alternative considerations to initial of therapy o Transition of care pediatric-to-adult - Immunizations o ONLY receive live vaccinations if CD4 30  - Prevent curve - Worn 18- Types of braces include: - Compliance - Increases from progression 23 hr/day biggest 10-25 in short - Or until curve until issues period of time progression growth has poor results can’t be stopped controlled - Part/ nighttime for curves < 35 - Milwaukee - TLSO - Boston - Charleston - Providence - Spine-Core not effective - RSC tx lateral and rotation o Use in partnership with exercises Schroth Methods Surgery: Cobbs Angle >45 - Arrest N/A Complications include: - Fusing vertebrae progression - Bleeding along the curve - Achieve max - Post-op pain - Supporting fused permanent - Infection bones with correction - Nerve damage instrumentation - Improve - Pseudoarthrosis attached to spine appearance - Disk degeneration and low back - Bone grafts fuse - Keep short- pain the vertebrae and long-term - Complication that involves lungs together complications and circulation - Causedetermines to a minimum - Flat back syndrome with procedure type Harrington rod What is the most frequently occurring form of clubfoot? How does it present? - Involves bone deformities and malposition with soft tissue contractions - Early evaluation and treatment for optimal correction o Evaluation:  Antenatally  Visal inspection at birth  Radiographs confirm degrees and severity  MRI o Tx:  Serial casting start immediately  Allows for gradual stretching proof skin and tight structures on medial side of foot - TEV (Talipes Equinovarous) is the most common95% - Talipes Calcaneovarus 2nd most common  Complex deformity of both ankle and foot - Other symptoms: o Small foot o Shortened Achilles tendon o Underdeveloped calf muscle o Empty heel bed o Transverse plantar crease o Normal leg lengths Which gender is more likely to develop clubfoot? - Males are more likely almost twice as often o Bilateral50% of cases - A positive family hx increases risk Name some potential causes of clubfoot:  Intrauterine positioning responds to simple stretching and casting  Neuromuscular or muscle abnormality  Genetic Predisposition  Arrested fetal development of skeletal and soft tissue  Congenital abnormalities (idiopathic or true clubfoot) occur in otherwise healthy infants Most common form  Amniotic banding rare congenital disorder caused by fibrous strands from the amniotic sac entangling parts of a developing fetus  Oligohydramnios  Breeched Syndromic (tetralogic) is a more severe form of clubfoot and is often associated with other congenital abnormalities. With serial casting, how often are casts changed? How long does the process take? - Every few days for 1-2 weeks and then q1-2weeks until max corrections achieved o Max correction takes 8-12 weeks after starting serial casting o Then performs  casted for 1-2 weeks after this procedure - Avoid overcorrection can cause rocker bottom foot= overstretched Achilles tendon - Once corrected via serial casting child wears Denis Browne Splint-corrective shoes o First 3 months for 23hr/day o After 3 months they wear them while napping or overnight until they are 4 years old - If not corrected with serial casting-> surgical intervention is required between 3-12 months Key notes: - Outcomes are not always predictable results vary with: o Severity o Age of child at initial intervention o Compliance w/ tx o Development of bones, muscles and nerves - Surgical intervention doesn’t restore the ankle to the entirely normal state o Affect foot anf leg remains smaller and thinner than nonaffected - Nursing Diagnosis o Impaired physical mobility o Risk for impaired parenting o Risk for delayed motor development o Risk for altered parent/ infant relationship  Type of Injury Location Definition Sprain Ligament Severe trauma to a joint causing a ligament to be partially or completely torn Strain Tendon Injury to the muscle neat the musculotendinous junction resulting from a forceful contraction of the muscle Dislocation Joint - A dislocation displacement of bones that form a joint resulting from trauma that cause complete displacement of adjoining bones= all contact is lost - A subluxation is a partial or incomplete dislocation still some contact between the adjoining bones is retained Separation Salter Harris Fracture Epiphysis Straight across growth plate no bone Plate involvement end part of a long bone Metaphysis above growth plate Epiphysis Rounded end Contusion Muscles - Damage to soft tissue, subcutaneous structure and Soft tissue muscle  - Treatment: o RICE= Rest, Ice, Compress, Elevate o Immobilization o Nursing Intervention - Nursing: o Initial Assessment:  Cause  Examine  Neurovascular evaluation o Assess and manage fat embolism  After crush injury of long bones  Dyspnea, restless, fever over 103, petechia rash, tachycardia, tachypnea, hypoxia o Cast Care - Fracture Complications o Infection o Neurovascular injury  Damage to both nerves and blood vessels at or near the site of a fracture o Vascular injury  Damage to the blood vessels (arteries or veins) in or around the site of a fracture o Malunion or Delayed Union  Malunion occurs when a fractured bone heals in the wrong position or with an improper alignment  Delayed UnionFracture takes longer than expected to heal, but the healing process is still progressing o Leg length discrepancy The five stages of bone healing include: Rapid in children thick periosteum 1. Hematoma w/in first 24hrs a. Localized collection of blood outside of blood vessels, usually in a tissue or organ, caused by trauma, injury, or damage to the blood vessel 2. Cellular proliferation proliferation of bone cells 3. Callus formation provisional callus that envelops the fracture 4. Ossification new bone forms 5. Consolidation and Remodeling regular bone replaces callus What is the most commonly fractures bone in children? - Causes by increased mobility and/or immature motor and cognitive skills - Traumatic musculoskeletal injuries most common - Clavicle most common broken bone Why might fractures be less common in infants and more common in toddlers? - InfantsFractures are less common due to their softer, more flexible bones and limited mobility - Toddlers fractures are more common because of their increased mobility, explorative behavior, and developing bone structure, which puts them at a higher risk for falls and accidents Stress Fracture - An area of chronic pain that is localized don a bone with focal tenderness could likely be a stress fracture. - Overuse injury - Becoming more common in adolescents w. limit calorie and calcium intake that remain lean for sports o Recommended daily allowance (RDA) of calcium for adolescence is 1500 mg/daily. - Symptoms: o Chronic pain changes with intensity o Focal tenderness in a singular site on the bone o Immobility or decreased ROM o Deformity of extremity o Edema, Crepitus, Ecchymosis or Muscle spasms - Diagnostic o X-ray What is the difference between an open and closed reduction? - Closed reduction is a non-surgical procedure used to manually realign a fractured bone without making any incisions in the skin o Use for:  Fracture is simple, non-displaced, or minimally displaced o Muscle relaxant w/ casting and reduction - Open reduction is a surgical procedure used to realign a fractured bone by making an incision to access the bone directly o Used for:  Complex fractures, displaced fractures Compartment Syndrome - Results from swelling cause by trauma and immobilizing device. - Symptoms: o Pallor o Paresthesia o Weak/absent pulses distal to trauma o Severe pain not relived with analgesics o Pain w/ extension of fingers or toes Osteomyelitis is most common between which ages? - Infection of the bone that occurs in the metaphyseal region of long bones above the growth plate; wide area of femur/bone - Most frequent between 5-14 yrs What are the differences between exogenous and hematogenous osteomyelitis? - Exogenous- direct inoculation from outside bone - Hematogenous- spread of organism from pre-exiting infection o Acute develops symptoms