Pedi test 2

• diphtheria, tetanus, pertussis, rotavirs, hep A&B, polio, measles, mumps
• rubella, chindnpox, meningitis, pneumococcal

• 1st 4-6 mo most req from brest/formula
• need vit c, d, iron, fluoride

• 4-6 mo-start cerial
• 7-8 mo-strained foods
• 9-10 mo finger foods

posterior fontanel-usually closes by 2nd-3rd mo

anterior fontanel-may increase slightly in size during 1st few mo of life/after 6mo begins to decrease in size closes @12 mo

• 1st 6mo height increases ~6in
• 2nd 6mo growth slows slightly

• oral stage
• Erikson-trust vs mistrut
• Piaget-sensorimotor phase
• Kohlberg-stage 0 do what pleases me

• id
• ego
• super ego
• Oral stage-0-2
• Anal stage 2-3yrs
• Phallic stage 3-6 yrs
• Latency stage 6-10 yrs
• Genital stage 11-13yrs

• Initiative vs Guilt
• Industry vs Inferiority
• Identity Vs Role Confusion
• Intamacy vs Isolation
• Generativity Vs Self Absorption
• Ego vs Despair

• Infancy
• learn whether baby can trust world

• toddlergain assurance from learning to perform tasks independently
• caregivers' reacts well-up self esteem
•              reacts poorly-shame/doubt

• 3-6 yrs preschool
• improved physical coordination
• expanding social skills
• want to know rules
• show off want attention/approval
• kid dve conscience and accepts punishment-relieves guilt

• School age 6-10 yrs
• seek achievment
• praise helps-build self esteem & avoid feeling of inferiority

• Adolescent 11-18
• confused by marked emotional and physical changes
• peer relationships most important

• early adulthood
• tries to est personal and intamate relationships
• difficulty in intimate relationships = isolation

• young/middle adult
• often marriage/family for others may find other fulfillment
• if fulfillment not found become stagnant/ self-absorbed
• cease to develop socially

• old agefinal phase
• least understood finding satisfication with -oneself -ones achievments -one's condition
• w/o regret for past or fear for future

• Piaget-4 orderly stages
• Kolkerg 3 levels

• Sensorimotor phase 0-2yrs
• Preoperational phase 2-7 yrs
• concrete operations 7-11yrs
• formal operationis 12-15

• Preconventional level (premoral level)
• convrntional level
• postconventional level (principled level)

• physiological need -
• safety and security
• love and belonging
• self-esteem
• self actualization

 breathing, food, shelter

-health, empl, fam, soc stab

- friendship, intimacy

-confidence, achievment,

- morality, experience purpose, inner potential

malformation present at birth

• skeletal
• enzymes- missing enzymes
• organ- missing/damaged
• inborn errors of metabolism  (pku, mass, cystic fibrosis)
• blood disorder
• prenatal damage- esp in premature infants

• heredity
• or inseficient prenatal folic acid

hydrocephalus

inbalance b/w...

• aquired-from tumor/injury
• congenital-born w/ brain defect
• unkown causes

sex linked from mom

• arnold chiari malformaton
• danny walker syndrome
• genital archnoid syst

back flow of CSF

• spina bifida
• menyo myocil

• kid not born with it
• can be complication of
•    menengitus
•    tumor

defect with absorption of CSF

• increased pressure on brain/spinal cord
• may occur later in childhood

• neoplam
• head injury
• infection
• menengitis

• obstruction
• narrowing in aqueduct sylvius- most common cause

• other causes
•    hematoma
•    cyst
•    neoplasm

noncommunicating

• rapid increase in head circ
• widening cranial sutures
• separating suture lines
• excessively large head
• anterior fontanell becomes tense and bulging

enlarged head causes eyes to appear slightly pushed downward

may not be major

has irreplaceable damage

enlarged head


causedby rise in CSF in brain (ventriculum and subarachnoid space)

causes increas in pressure on brain and spinal cord

3

sutures don't fuse

• if untreateds
• head gets too heavy
• neck muscled don't develope suffiently
• hard to lift/turn head

• widening of cranial sutures
• rapidly enlarging head

high pitch-weak/shrill cry

• sutures continue to separate
• posterior fontenel starts to bulge/get ridged
• skull enlarges in all diameters
• see scalp veins/ often w/o hair

area affected

usually is lat vent

• sun setting sign ---head starts to protude eyes
• eyes appear to be pushed downward

head continues to enlarge raise in intracranial pressure continues

• restless
• personality change
• hich pitch cry
• when start walking ataxia
• failure to thrive
• severe headache
• palipadius
• projectile vomit
• raise BP lower Hr
• irritability
• change in LOc

• sugerical
• removal of obstruction if noncommunicating
• most often do ventriculoperitoneal shunting
• or ventriculoatrial shunting

CSF drained from lateral ventricle-through subcutaneou catheter-empties into peritoneal cavity

drains into  R of atrium ofheart

can't be done if have pathologic changes in heart

broad term for sevral d/o of divided spine

• ofen unknown
• can be genetic
• prenatal folic defect
• congenital neuro tube
• congenital neurotube defect

• hidden not evident at birth
• usually occurs at L 5 & S 1

• obvious incomplete closure of vertibrae
• external cyst -tissue sticking out /sac like protrusion

• 2 types
• meningocele
• myelomeningocle

part of spinal meninges protruding through bony defectes th forms cystic sac-no nerve roots involved

protrusion of spinal cord and meninges w/ nerve roots imbeded in wall of cyst

various degrees of severity

• will have defects below
• keep area moist w/ steri

• T  12--flacid lowser extremiti
• b/w L1 & L3 --have some hip flextion may   h
•              ave club foot
• b/2L2 & L 4--hip abduction going to have any motor improvement

b/w L3 & L 2-- hip adduction/ hip extention/ knee flextioin

at sacral root --plantar flexion

based on symptoms and physical

• amneosintesis- abn elevated maternal alpha fetalprotein
• in ultrasoound=incomplete neurotube

• sugery to remove external sac
• make sure no pre op damage/ infection of sac

• immediately after birth put baby in isolet
• keep sterile moist dressing on sac as ordered
• measure head-for hydrocephelus
• baseline neurovascular exam
• always look for lack of bladder/bowel control
• keep in prone positions

• pneumonia
• high inidences of UTI

special care-no diapering

• no normal fusions of maxilary processes in the 5th or 8th wk of gestation
• can be utilateral or bilateral
• often have nasal deformtion- can get dental deformation

boys`

• 2-7 days or 2-4wk-surgery 
• repair lip before palate-so baby can suckle
• usually done w/ in 2 - 4 days after birth

• habermann feeder- have special soft nipple
• medicine dropper
• tube feed if able

• postop
• don't want baby crying, touching lip, rub lip, suckling
• have logan bow-

• special metal device taped to baby face
• prevent tension on sutures

• prevent sucking at surgery site
• elbow /most usual-wrist restraints to prevent touching
• special feeders for 2 wks

• occurs b/w 7-10 wk gestations
• more serious than cleft lip b/c=opening b/w mouth, ear, nasal canal
• w/o plate can't talk

femaie

sergery prior to 18 mo idealy-before start speaking

• asepto syringe/gravity feeder
• 1st wk clear liquids
• 2nd wk soft foods
• avoid hot foods
• if old enough to use spoon- use rubber spoon held sideways
• good oral hygien
• remove restrainst every 2hrs one @ a time

• repiratory problems
• dental decay
•  missing teeth

telescoping of one portion of the bowel into a distal portion

• most commonly in juncture of ileum & colon
• is downward from aboves

more often in boy

• hypertrophy of circular muscle fibers of pylorus w/ a severe narrowing of its lumen
• end of stomach becomes dilated

malformation in which entire foot is inverted, heel drawn up & forefoot is adducted

• usually evident at birth
• most common foot deformity

can be bi or unilateral

high incidences in mylommeningocele kids

positional club foot-from position of bay in utero

can be fixed easliy

• exercise
• positioning

• started soon after birth
• manipulate
• bandae
• casing weekly-
•   -changed everyday for 1st sevrl wks
•    -then every 1-2 wks
• treatment usually takes months

Denis Browne splint w/ shoes attached after cast

used to maintain correction for 6mo or more

• keep both legs in anitopical positoin
• for kids under 2

• aseptic necrosis of the head of femur
• more prevelent in boys esp cauccasions

• can be traumao to hip
• usually unknown

• pain in hip / groin
• a limp accompanied by muscle spasms
• limitation of motion
• mimic synovitis

focuses on containing femoral head w/in acetabulum during the revascularization processic portion of the hed in place

use brace that holds the necrotic portion of the head in place during healing

• eyes set close together/ slanted
• round small head
• protruding tounge
• mouth breathiners
• short thick hands
• cerved pinky
• cemian crease in palm deeper al across
• congen cardiac defects
• lower set ears
• decresed resistance to infection
• suseptible to leukemia