Peds Final Exam Prep PDF

**Peds Final Exam Prep:** **Chapter 1** **Chapter 13: Development** Influences on Growth and Development: - Nature: traits inherent at birth - Nurture: influence of external events Principles of Growth & Development: - Growth is the continuous physical adjustment - Development is the...

**Peds Final Exam Prep:** **Chapter 1** **Chapter 13: Development** Influences on Growth and Development: - Nature: traits inherent at birth - Nurture: influence of external events Principles of Growth & Development: - Growth is the continuous physical adjustment - Development is the continuous adaptation to life - G&D is cephalocaudal and proximodistal Freud's Psychosexual Theory of Development: - Believed that development was most influenced by biological instincts - Identified three essential aspects of the human personality: - ID - Ego - Superego - 5 stages - Oral stage: birth-1 year - Anal stage: 1-3 years - Phallic stage: 3-6 years - Latent stage: 6years-puberty - Genital stage: puberty-adulthood Erikson's Stages of Psychosocial Development: - 7 stages: - Trust vs Mistrust: birth-1year - Autonomy vs Shame/Doubt: 1-3 years - Initiative vs Guilt: 3-6 years - Industry vs Inferiority: 6-12 years - Identity vs Role Confusion: 12-18 years Piaget's Stages of Cognitive Development: - 4 stages: - Sensorimotor stage: birth-2 years - Pre-operational stage: 2-7 years - Concrete Operational stage: 7-11 years - Formal Operational stage: 12+ years Kohlberg's Moral Development Theory: - Identified 3 levels of moral development: - Preconventional (obedience/punishment & self-interest stages) - Conventional (conformity & social order stages) - Post-conventional (social contract & universal principles stages) - Asserted that children's thinking is concrete and egocentric - 6 levels of moral development: - Obedience/Punishment (infancy, preconventional): no morality, no difference between doing the right thing and avoiding punishment - Self-interest (pre-school, preconventional): focus on rewards over punishment, secure greatest benefit for self - Conformity & Interpersonal Accord (school-age, conventional): effort made to secure approval and maintain friendly relations, "good kid" - Authority & Social Order (school-age, conventional): focus on fixed rules, maintain social order - Social Contract (teens, post-conventional): mutual benefit, reciprocity, morally right and legally right are not always the same - Universal Principles (adulthood, post-conventional): mutual benefits, moral code Infancy: - Birth-12 months - Biggest period of growth - **Chapter 14: Developmentally Appropriate Care** **Chapter 15: Respiratory Conditions** Anatomy of Respiratory System: - Upper Respiratory Tract: nose, nasal cavity, sinuses, pharynx, trachea - Lower Respiratory Tract: lungs, bronchi, bronchioles, alveoli - Ventilation: - Alveoli exchange O2 and CO2 - O2 exchange w/in bloodstream occurs at capillaries Developmental Considerations: - Newborn airway is narrow, easily occluded - Children \ 1yr old Allergic Rhinitis: - Inflammation of nasal membranes, IgE response - S/S: clear/thin/watery rhinorrhea, nasal crease, sneezing, cough, enlarged tonsils, redness, itching, wheezing, shortness of breath - Tx: antihistamines, nasal corticosteroid sprays, decongestants Asthma: - Bronchial smooth muscle spasm, inflammation and edema of bronchial mucosa, retention of secretions - S/S: recurrent wheezing, shortness of breath, nonproductive cough, chest pain/tightness, exercise intolerance - Tx: albuterol inhaler **Chapter 16: Gastrointestinal Conditions** Developmental Aspects of GI System: - Sucking reflex in infancy, rooting reflex - Infant digestion: stomach empties every 2.5-3 hours - Drug absorption is increased - Inadequate pancreatic lipase until 1y - No solids until 4-6 months Cleft Lip & Cleft Palate: - Most common craniofacial abnormalities in the US - Occurs in 5.6/10,000 births - Cleft Lip: - Opening/split in upper lip - Repaired surgically @ 3months - Cleft Palate: - Opening/split in roof of mouth - Repaired surgically @ 6months - Nursing considerations: maintain airway, extra care w/ feeding (aspiration risk) Inguinal Hernia: - Protrusion of bowel/intestine in inguinal canal - Caused by failure of process vaginalis to atrophy and close during 8^th^ month of gestation - More common in males - S/S: bulging in scrotal sac/inguinal area - Tx: surgery Umbilical Hernia: - Protrusion of intestine through abdominal fascia around umbilicus - Most common hernia for infants (1/6 births), most common in premature, LGA, and African american infants - S/S: abdominal bulge that is more prominent when crying - Tx: surgery if \>1.5cm or does not resolve spontaneously by 5yrs Imperforate Anus: - Lack of rectal opening/anus - S/S: no meconium, meconium in urine (fistula), meconium emesis - Diagnosed w/ physical exam, x-ray - Tx: surgical repair Pyloric Stenosis (Hypertrophic): - Enlargement/thickening of the pyloric sphincter - More common in first born males - Occurs at 3-6 weeks - S/S: projectile vomiting, olive-shaped mass RUQ, hungry - Diagnosed w/ US and palpation of mass - Tx: surgery (pyloromyotomy) Intussusception: - One portion of the intestine telescopes/invaginates into another portion - Occurs at 6-36 months - S/S: currant jelly stools, sausage shaped mass R. abdomen (Dance's sign), pain comes and goes every 5-30 minutes, vomiting - Diagnosed w/ barium or air enema - Tx: barium or air enema Malrotation & Volvulus: - Abnormal rotation of the intestine around the superior mesenteric artery during fetal development - S/S (seen in 1^st^ month of life): Intermittent bilious/green vomit, abdominal distention, pain, lower GI bleed, palpable epigastric mass, bloody stools - Diagnosed w/ barium enema, upper GI series - Tx: surgical repair (resection w/ anastomosis: can cause short bowel syndrome) Inflammatory Bowel Disease (Crohn's): - Chronic inflammatory disease characterized by periods of exacerbation and remission, affects any portion of the GI tract - S/S: cobblestone lesions, abdominal pain, diarrhea, blood/mucus in stool, anorexia, fever, fatigue, vomiting, weight loss - Diagnosed w/ endoscopy or colonoscopy - Tx: supportive (diet: frequent small meals, high protein, high carb, supplements, reduce irritating foods) Ulcerative Colitis: - Acute or chronic inflammation of the colon - S/S: recurring bloody diarrhea - Tx: surgery (remove affected portion of bowel) Appendicitis: - Inflammation of the appendix when lumen becomes obstructed - Most common in caucasian males 6-10 years old - S/S: periumbilical pain, RLQ pain, vomiting, constipation, fever - Suspect perforation if pain suddenly disappears: emergency - Diagnosed w/ CBC (elevated WBC's), US, GI scan - Tx: surgery (appendectomy) Meckel's Diverticulum: - Remnant of fetal development in midgut creating a congenital bulge/outpouching - Rule of 2's: - 2% of population - w/in 2 feet of ileocecal valve - 2inches long - Present before 2years old - S/S: currant jelly stools, rectal bleeding, abdominal pain - Diagnosed w. radionucleotide scintigraphy (Meckel scan) - Tx: surgery (diverticulectomy) Irritable Bowel Syndrome (IBS): - Chronic pain and changes in bowel habits, "nervous stomach" - Most common in school-age and adolescents - Caused by motor, autonomic, and psychological factors - S/S: variable stool patterns, alternate diarrhea and constipation, Rome criteria - Diagnosed by ruling out other causes - Tx: supportive (diet: avoid trigger foods) Hirschsprung's Disease: - Congenital absence of ganglion cells resulting in lack of motility in affected portion of the bowel - Associated w/ Down's syndrome - S/S: failure to pass meconium, poor feed - Tx: surgical resection of bowel Short Bowel Syndrome: - Malabsorptive disorder resulting from decreased mucosal surface area which can be caused by surgical resection of small bowel - S/S: malnutrition, diarrhea - Tx: TPN Biliary Atresia: - Absence/narrowing of some/all major biliary ducts causing bile to back up into liver - S/S: jaundice, dark urine, light stools, abdominal distention, enlarged liver & spleen - Fatal w/in first 2 years of life is not corrected - Tx: surgery **Chapter 17: Cardiovascular Conditions** Expected Anomalies: - Ductus Arteriosus: connects aorta and pulmonary artery - Ductus Venosus: - Foramen Ovale: Congestive Heart Failure: - Inability of cardiac muscle to perform properly leads to blood backing up in lungs (left-sided) or body (right-sided) - S/S: JVD (right-sided), crackles (left-sided), poor feeding/irritability (infants), exercise intolerance/poor growth (older kids) - Tx: digoxin (increase contractility), diuretics (decrease preload), vasodilators (decrease afterload) Congenital Heart Disease: - Defect in heart/great vessels or a noted disease pattern after birth - Occurs in 4-8/1,000 births - S/S: vary, heart murmur, cyanosis, respiratory distress, etc - Acyanotic: - Compromise in systemic circuit (left-to-right shunting) - Includes ASD, VSD, PDA, CoA, endocardial cushion defects - Cyanotic: - Compromise in pulmonary circuit (right-to-left shunting) - Includes truncus arteriosus, transposition of the great vessels, TA, TOF, total anomalous pulmonary venous return, and hypoplastic left heart syndrome Common Cardiac Medications: Atrial Septal Defect (ASD): - Foramen ovale fails to close between atria - Acyanotic - S/S: blowing/harsh systolic murmur \@2^nd^ ICS LSB, possible RV enlargement, SOB, resp. distress, periorbital edema, FTT, frequent resp. infections - Tx: small defects will close on own Ventricular Septal Defect (VSD): - Foramen ovale fails to close between ventricles - Acyanotic - Most common defect - S/S (mostly asymptomatic): harsh/whooshing murmur \@LSB, SOB, poor feeding, poor growth, tachycardia, tachypnea - Tx: most resolve independently by 1y Patent Ductus Arteriosus (PDA): - Ductus arteriosus fails to close leading to left-to-right shunting - Acyanotic - S/S: machine-like murmur under left clavicle, BP w/ wide pulse pressure, frequent colds, fatigue, poor feed - Tx: indomethacin (closes PDA) AV Canal Defect (AVC): - Combines ASD and VSD, large hole in center of heart - Endocardial cushion defect - Acyanotic - Associated w/ Down's syndrome - Tx: must be repaired surgically Coarctation of the Aorta (CoA): - Narrowing/stricture of descending aorta - Acyanotic - S/S: BP lower in legs than arms - Tx: prostaglandin E (keeps PDA open), requires surgery (balloon angioplasty) Pulmonary Stenosis (PS): - Malformation of pulmonic valve/artery causing increased workload of RV (RV hypertrophy) - S/S: systolic murmur w/ ejection click, dyspnea and cyanosis w/ increased BP Aortic Stenosis: - Narrowing at aortic valve leads to increased workload of LV (LV hypertrophy) - S/S: systolic click, CP, syncope w/ exertion, fatigue Tricuspid Atresia (TA): - Failure of tricuspid valve to form - Cyanotic - Incompatible with life unless other defect(s) present - S/S: severe cyanosis, demise - Blood trapped in RA, cannot reach RV and lungs Pulmonary Atresia (PA): - Failure of pulmonary artery and/or pulmonary valve to form - Cyanotic - Incompatible with life unless other defect(s) present - S/S: severe cyanosis, demise - Tx: prostaglandin E, surgery Epstein's Malformation: - Tricuspid valve displaced to RV, pulmonary valve in RA - Often seen w/ ASD and supra-ventricular dysrhythmias - Wolff-Parkinson Whyte Syndrome Total Anomalous Pulmonary Venous Return (TAPVR): - Pulmonary blood-flow returns to heart through right atrium instead of left - Often seen w/ ASD - S/S: cyanosis, respiratory distress, tachypnea, dyspnea, RV hypertrophy Transposition of the Great Vessels (TGV): - Pulmonary artery and aorta switched, no communication between systemic & circulatory systems - Fatal if not corrected - S/S: cyanosis, SOB, poor feed, clubbing of fingers - Tx: prostaglandin E, surgery (Jatene procedure) Truncus Arteriosus: - Aorta and pulmonary artery combined, no septum - S/S: cyanosis, CHF, low CO, systolic ejection murmur w/ thrill \@LSB Tetralogy of Fallot (TOF): - 4 components: pulmonary stenosis, overriding aorta, RV hypertrophy, and VSD - Mixed oxygenated/deoxygenated blood is circulated - S/S: Tet spells (knee-chest position) - Tx: surgery w/in 1^st^ year of life Classification of Murmurs: - 1: soft murmur heard in quiet environment by an expert - 2: quiet murmur audible in noisy environment - 3: moderately loud murmur easily heard - 4: loud murmur & thrill - 5: very loud murmur & thrill heard with edge of stethoscope tilted against the chest - 6: very loud murmur & thrill heard without a stethoscope or w/ stethoscope 5-10 mm away from chest - Diastolic murmurs are only graded 1-4 Hypoplastic Left Heart Syndrome: - LV is extremely small (hypoplastic) and unable to maintain adequate cardiac output - Life threatening: must me treated immediately after birth - Tx: prostaglandin E, surgery Subacute Bacterial Endocarditis (SBE): - Infection of heart following bacterial infection in bloodstream - Commonly caused by dental issues/procedures - S/S: low grade fever, malaise, loss of appetite, muscle aches, CHF - Tx: abx Kawasaki Disease (mucocutaneous lymph node syndrome): - Multi-system disease affecting cardiovascular system caused by infectious trigger - S/S; fever to 104F for 5+ days, skin rash, swollen lymph nodes, red peeling hands, strawberry tongue - Tx: high dose aspirin, IVIG Cardiomyopathy (CM): - Cardiac muscle becomes dilated, hypertrophied, stiff, or inflamed leading to inadequate function - Dilated cardiomyopathy (DCM) is most common, and is caused by damage from an outside source and weakened contractions leading to dilation of all 4 heart chambers - Hypertrophic cardiomyopathy (HCM) is genetic and occurs when a ventricle is hypertrophied, swollen, or thickened with no other cardiac issues - Restrictive cardiomyopathy (RCM) is least common and occurs when non-compliant ventricular walls fail to relax leading to enlarged atria - S/S: weakness, SOB, exercise intolerance, CP - Tx: ACE inhibitors & ARBs (improve muscle contractility) Rheumatic Fever: - Caused by Group-A hemolytic strep infection - Affects, heart (aortic & mitral valves), joints, subcutaneous tissue, and nervous system - Occurs 2-3 weeks after strep infection - S/S (Jones criteria): fever \> 38C, joint pain, carditis, nodules, erythema marginatum, sydenham's chorea - Tx: abx Pulmonary Arterial Hypertension (PAH): - High blood pressure in the lungs, vasoconstriction - Can be caused by cardiac defects or be idiopathic - S/S: SOB, CP, exercise intolerance, weakness, fatigue, dizziness, leg swelling - Tx: supplemental O2, CCB Long QT Syndrome: - Electrophysiological condition predisposing the patient to fatal dysrhythmias - Genetic - Diagnosed w/ ECG - Tx: beta blockers **Chapter 18: Immune/Infectious Conditions** Immune Overview: - Antigen: foreign invader - Antibody: immune response to antigen - Immune system includes mucus membranes, tonsils, lymphatic vessels/nodes, thymus, skin, spleen, and bone marrow - Immunoglobulins: - IgG: fights bacterial & viral infections - IgA: protects body's surface - IgE: allergies, fungus, spores, pollen, etc - IgM: made by body in response to infection, supports other immune cells Human Immunodeficiency Virus (HIV): - Selectively targets and destroys helper T-cells which destroys immunity and leaves patient vulnerable to opportunistic infections - Can be latent for 10 years before symptoms appear, CD4 (helper T) cells increase during latent period - S/S: FTT, lymphadenopathy, enlarged liver/spleen, chronic diarrhea, thrush, skin infections, fevers, recurrent infections, mouth sores, fatigues, sore throat, night sweats, muscle aches, rash - Diagnosed w/ ELISA test and then Western blot test - Tx: HAART Systemic Lupus Erythematosus (SLE): - Multisystem chronic autoimmune disorder of blood vessels and connective tissue where autoantibodies attach to body proteins creating antigen-antibody complexes which are then deposited through the body causing widespread tissue damage - S/S: butterfly rash, fever, malaise, chills, fatigue, weight loss - Diagnosed w/ CBC, ANA, ESR - Tx: NSAIDs (pain & inflammation) antimalarials (arthritis, skin rashes, mouth ulcers), steroids (inflammation), immunosuppressants Dermatomyositis: - Autoimmune disorder characterized by muscle weakness and distinctive rash - Uncommon, occurs between 5-15 years - S/S: proximal muscle weakness, heliotropic red-purple (violaceous) rash around eyes, tender/stiff muscles - Tx: steroids Hypermobility Syndrome: - Also known as double-jointedness or ligamentous laxity - S/S: arthralgias, joint pain, joint edema, fatigue, insomnia, early degenerative arthritis - Diagnostic criteria: - Hyperextension of knee - Palms touch floor with both knees extended - Hyperextension of elbow - Passive opposition of thumb to flexor surface of forearm - Passive hyperextension of fingers so they are parallel with extensor surface of forearm Anaphylaxis: - Most severe allergic reaction possible where heart, lungs, and vasculature are all activated (vasodilation, hypotension, tachycardia, shock) - Caused by IgE, activation of mast cells, basophils, eosinophils, histamine, leukotriene, cytokines, T-cells, and neutrophils - S/S: wheezing, tachycardia, hypotension, cyanosis, altered LOC, angioedema, N/V, hives, laryngospasm, cardiac arrest, rash/hives, swollen eyes/face, SOB - Tx: BLS/ABC's, epinephrine Rubeola (Measles): - Caused by measles virus - Airborne precautions - S/S: photophobia, Koplik spots, fever, cough, blanching erythematous maculopapular rash moving head to toe - Tx: supportive - MMR vaccine @ 12 months & 4-6 years Mumps (Parotitis): - Caused by paramyxovirus - Droplet precautions - S/S: swollen parotid glands, low-grade fever, inflammation of testicles - Tx: supportive (easy to chew foods) - MMR vaccine @ 12 months & 4-6 years Rubella (German Measles): - Caused by rubella virus - Droplet precautions - S/S: maculopapular rash begins on face and spreads head to toe, petechiae on soft palate, sore throat, cough, joint pain - Tx: supportive - MMR vaccine @ 12 months & 4-6 years - Rubella infection during pregnancy can cause miscarriage, fetal death, and congenital malformations Fifth's Disease: - Caused by human parvovirus B19 - Droplet Precautions - S/S: 3 stage rash (slapped cheek w/ circumoral pallor, erythema spreads to trunk, itchy maculopapular rash spreads peripherally), URI symptoms - Tx: supportive - Self-limiting (1-3 weeks) Roseola: - Caused by human herpes virus 6 - Standard precautions - S/S: high fever, rash (blanching red spots) follows fever - Tx: supportive Hand-Foot-Mouth Disease (HFMD): - Caused by enterovirus genus viruses - Standard precautions - Most common in children wearing diapers (1-4 years old) - S/S: high fever, football shaped vesicles on mouth/hands/feet - Tx: supportive - Self-limiting Pertussis (Whooping Cough): - Caused by *Bordetella pertussis* bacteria - Droplet precautions - Most common \