Pedi test 2

  1. immunizatioins of infant
    • diphtheria, tetanus, pertussis, rotavirs, hep A&B, polio, measles, mumps
    • rubella, chindnpox, meningitis, pneumococcal
  2. infant nutrition
    • 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
  3. suture/fontanel closure
    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
  4. infant ht/wt
    • 1st 6mo height increases ~6in
    • 2nd 6mo growth slows slightly
  5. Dev stages of infant
    • oral stage
    • Erikson-trust vs mistrut
    • Piaget-sensorimotor phase
    • Kohlberg-stage 0 do what pleases me
  6. Freud
    • 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
  7. Erik Erikson stages
    • Initiative vs Guilt
    • Industry vs Inferiority
    • Identity Vs Role Confusion
    • Intamacy vs Isolation
    • Generativity Vs Self Absorption
    • Ego vs Despair
  8. Trust vs mistrust
    • Infancy
    • learn whether baby can trust world
  9. autonomy vs doubt/shame
    • toddlergain assurance from learning to perform tasks independently
    • caregivers' reacts well-up self esteem
    •              reacts poorly-shame/doubt
  10. Initiative vs Guilt
    • 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
  11. Industry vs Inferiority
    • School age 6-10 yrs
    • seek achievment
    • praise helps-build self esteem & avoid feeling of inferiority
  12. Identity Vs Role Confusion
    • Adolescent 11-18
    • confused by marked emotional and physical changes
    • peer relationships most important
  13. Intimacy Vs Isolation
    • early adulthood
    • tries to est personal and intamate relationships
    • difficulty in intimate relationships = isolation
  14. Generativity Vs Self Absorption
    • young/middle adult
    • often marriage/family for others may find other fulfillment
    • if fulfillment not found become stagnant/ self-absorbed
    • cease to develop socially
  15. Ego vs Despair
    • old agefinal phase
    • least understood finding satisfication with -oneself -ones achievments -one's condition
    • w/o regret for past or fear for future
  16. What theorists did cognitive dev
    • Piaget-4 orderly stages
    • Kolkerg 3 levels
  17. Piaget's phases
    • Sensorimotor phase 0-2yrs
    • Preoperational phase 2-7 yrs
    • concrete operations 7-11yrs
    • formal operationis 12-15
  18. Kolberg
    p 530
    • Preconventional level (premoral level)
    • convrntional level
    • postconventional level (principled level)
  19. Moslow's hierarcy from base to top
    • physiological need -
    • safety and security
    • love and belonging
    • self-esteem
    • self actualization
  20. physiological need
     breathing, food, shelter
  21. safety and security
    -health, empl, fam, soc stab
  22. love and belonging
    - friendship, intimacy
  23. self-esteem
    -confidence, achievment,
  24. self actualization
    - morality, experience purpose, inner potential
  25. what is a birth defect?
    malformation present at birth
  26. usual sites of birth defect
    • skeletal
    • enzymes- missing enzymes
    • organ- missing/damaged
    • inborn errors of metabolism  (pku, mass, cystic fibrosis)
    • blood disorder
    • prenatal damage- esp in premature infants
  27. what are most birth defects from
    • heredity
    • or inseficient prenatal folic acid
  28. nervous defect
  29. hydrocephalus
    inbalance b/w...
  30. hydrocephelus can be
    • aquired-from tumor/injury
    • congenital-born w/ brain defect
    • unkown causes
  31. congenital hydrocephalus cause
    sex linked from mom
  32. types of congenitl hydrocephalus
    • arnold chiari malformaton
    • danny walker syndrome
    • genital archnoid syst
  33. danny walker syndrome
    back flow of CSF
  34. arnold chiaria malformatioin
    • spina bifida
    • menyo myocil
  35. what is aquired hydrocephilus
    • kid not born with it
    • can be complication of
    •    menengitus
    •    tumor
  36. communicating Hydrocephalus
    defect with absorption of CSF

    • increased pressure on brain/spinal cord
    • may occur later in childhood
  37. what causes communicating hydrocephalus?
    • neoplam
    • head injury
    • infection
    • menengitis
  38. noncommunicating hydrocephelus
    • obstruction
    • narrowing in aqueduct sylvius- most common cause

    • other causes
    •    hematoma
    •    cyst
    •    neoplasm
  39. what type is congenital hydrocephilus usually?
  40. s/s of hydrocephalus
    • rapid increase in head circ
    • widening cranial sutures
    • separating suture lines
    • excessively large head
    • anterior fontanell becomes tense and bulging
  41. what is sun setting sign
    enlarged head causes eyes to appear slightly pushed downward
  42. why is hydrocephelous sometimes not picked up?
    may not be major
  43. what happens if a child with obvious signs of hydrocephelous is born ?
    has irreplaceable damage
  44. what do you 1st notice with hydrocephalus?
    enlarged head

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

    causes increas in pressure on brain and spinal cord
  45. how many congenital defects is a baby usually born with?
  46. what happens to the head if born with hydroocepalus?
    sutures don't fuse

    • if untreateds
    • head gets too heavy
    • neck muscled don't develope suffiently
    • hard to lift/turn head
  47. classic signs of hydroceph (esp congenital)
    • widening of cranial sutures
    • rapidly enlarging head

    high pitch-weak/shrill cry
  48. what happens as head continues to enlarge in hydrocephalus
    • sutures continue to separate
    • posterior fontenel starts to bulge/get ridged
    • skull enlarges in all diameters
    • see scalp veins/ often w/o hair
  49. what does skull enlargement depend on in hydroceph?
    area affected

    usually is lat vent
  50. if hydroceph left untreated?
    • sun setting sign ---head starts to protude eyes
    • eyes appear to be pushed downward

    head continues to enlarge raise in intracranial pressure continues
  51. s/s of raising intracranial pressure
    • 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
  52. Hydrocephalus treatment
    • sugerical
    • removal of obstruction if noncommunicating
    • most often do ventriculoperitoneal shunting
    • or ventriculoatrial shunting
  53. Ventriculoperitoneal shunting (vp shunting)
    CSF drained from lateral ventricle-through subcutaneou catheter-empties into peritoneal cavity
  54. Ventriculoatrial shunting
    drains into  R of atrium ofheart

    can't be done if have pathologic changes in heart
  55. Spina bifida  p479
    broad term for sevral d/o of divided spine
  56. causes of spina bifda
    • ofen unknown
    • can be genetic
    • prenatal folic defect
    • congenital neuro tube
    • congenital neurotube defect
  57. spina bifida occulta
    • hidden not evident at birth
    • usually occurs at L 5 & S 1
  58. spina bifida cystica
    • obvious incomplete closure of vertibrae
    • external cyst -tissue sticking out /sac like protrusion

    • 2 types
    • meningocele
    • myelomeningocle
  59. Spina bifida Meningotruocele
    part of spinal meninges protruding through bony defectes th forms cystic sac-no nerve roots involved
  60. spina bifida myelomeninrugocele
    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
  61. in spina bifida myelomeninrugocele what happens if occurs in differant areas
    • 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
  62. Dx of spina Bifida
    based on symptoms and physical

    • amneosintesis- abn elevated maternal alpha fetalprotein
    • in ultrasoound=incomplete neurotube
  63. spina bifida treatment
    • sugery to remove external sac
    • make sure no pre op damage/ infection of sac
  64. spina bifida nurse care
    • 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
  65. spina bifida complications
    • pneumonia
    • high inidences of UTI

    special care-no diapering
  66. Cleft Lip p491
    • 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
  67. what gender is cleft lip most prevelent in
  68. treatment of cleft lip
    • 2-7 days or 2-4wk-surgery 
    • repair lip before palate-so baby can suckle
    • usually done w/ in 2 - 4 days after birth
  69. cleft lip pre/post op care
    • 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-
  70. what is a Logan bow
    • special metal device taped to baby face
    • prevent tension on sutures
  71. post op goals
    • prevent sucking at surgery site
    • elbow /most usual-wrist restraints to prevent touching
    • special feeders for 2 wks
  72. cleft palate
    • 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
  73. what gender cleft palate more common?
  74. cleft plate treatment
    sergery prior to 18 mo idealy-before start speaking
  75. cleft palate post op nutrition
    • 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
  76. cleft palate complications
    • repiratory problems
    • dental decay
    •  missing teeth
  77. Intussusception p845
    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
  78. pyloric stenosis
    • hypertrophy of circular muscle fibers of pylorus w/ a severe narrowing of its lumen
    • end of stomach becomes dilated
  79. Club foot  p501 (telipes Equinovarus)
    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
  80. aquired club foot
    positional club foot-from position of bay in utero

    can be fixed easliy
  81. treatment of aquired club foot
    • exercise
    • positioning
  82. treatment of congenital club foot
    • 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
  83. Denis browne splint
    used to maintain correction for 6mo or more

    • keep both legs in anitopical positoin
    • for kids under 2
  84. Legg-Calve-Perthes disease (coxa plana)
    • aseptic necrosis of the head of femur
    • more prevelent in boys esp cauccasions
  85. cause of Legg-Calve-Perthes disease
    • can be traumao to hip
    • usually unknown
  86. s/s of Legg-Calve-Perthes disease
    • pain in hip / groin
    • a limp accompanied by muscle spasms
    • limitation of motion
    • mimic synovitis
  87. Legg-Calve-Perthes disease treatment
    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
  88. s/s of down's syndrome
    • 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
Card Set
Pedi test 2
infant disorders