Home
Flashcards
Preview
Pathophysiology 1.1
Home
Get App
Take Quiz
Create
Neonate
1st month
infant
2 months - 2 years
child
2 - 12 years
adolescent
13-18 years
Toddler
1 - 3 years
Preschool
3-5 years
Early Childhood
2-5 years
Middle to late childhood
6-12 years
Gestational Age
Number of weeks from the onset of the mother's last period until birth
Term Neonate
38-42 weeks
Near Term
34-38 weeks
Preterm
<
34 weeks
Post-Term
>
43 weeks
23~24 weeks
usually survive
immature kidney's
electrolyte problems with immature skin
Growth
Physical changes in the body
Development
changes in body function and psychosocial behaviors
infancy growth
linear
childhood growth
growth spurts
Growth Charts
Measure height, weight and head circumference
Growth charts show all stats below expected for chronologic age
suggest possibility of intrauterine insult or genetic abnormality
Growth chart shows sparing head circumference relative to wt and ht
characteristic of growth delay and genetic short stature
structural dystrophies
endocrine causes of growth failure
Growth chart shows low wt. with normal head circ. and ht
caloric insufficiency
hyper-metabolic state
Average birth wieght
3-4 kg
Birth weight doubles in
4-5 months
birth weight tripples in
12 months
birth weight quadruples by
24 months
Girls growth spurt
begins 10-14 years
completed by 16-17 years
gain 20 cm and 25 kg
Boy's growth spurt
begins later
completed 18-20
gain 30 cm and 30 kg
Low Birth weight
< 2.5 kg
Very low birth weight
< 1.5 kg
Extremely low birth weight
< 1 kg
Large for Gestational Age
LGA
Subject to injuries during birth
usually a sign of uncontrolled diabetes in the mother (increased glucose makes big baby)
Easily hypoglycemic due to high insulin production
Birth Injuries
Cranial Injuries
Fractures
Peripheral nerve injuries
Cranial Injuries
Caput succedaneum
cephalhematoma
subdural/subarachnoid hemorrhage
Caput succedaneum
scalp edema that may cross suture lines
petechiae, purpura, echymosis
resolves over the first week of life
sub q tissue dmg from pressure on head
Cephalhematoma
subperiosteal collection of blood from ruptured blood vessels
does not cross suture lines
not apparent in the first 24-48 hours
skull fracture may be present
2 week to 3 mo resolution
Subdural / subarachnoid hemorrhage
closer to skull
neurosurgery
life threatening
below skull may not show visible signs
Skull fractures
uncommon
usually from forceps delivery
usually linear = no treatment
depressed = palpable indentation; surgery required
Clavicle Fractures
most frequent fractured bone
crepitus (bone creek)
immobilize the arm and shoulder
Peripheral Nerve Injury: Brachial Plexus
C5 to T1 nerves there is a tear
Paralysis of upper extremity
immobilize for recovery in 3 to 6 months
Erb Palsy
paralysis of the upper arm
Klumpke palsy
paralysis of the lower arm
Intrauterine Growth depends on:
efficient placental function
adequate energy
adequate growth substrates
hormonal environment
room in the uterus
Risk Factors for Intra-uterine growth retardation
adolescent mothers
low economic status
short time between pregnancies
diet restrictions
heavy physical work
Pre-pregnancy hypertension
diabetes
chonic infection or illness
drugs
environmental hazards
Craniosynostosis
skull bones completely connected at birth
causes problems for brain growth
Fontanels
spaces of unossified tissue at suture junctions
Anterior fontanel
palpable until 2 years
Primitive reflexes used to evaluate CNS development
Moro = startle
Rooting = sucking
Stepping = placing
Milestones of CNS maturation
spinal cord completely myelinated by 2 years
myelination complete by 7 years
CNS Development
primitive reflex disappears before voluntary movements appear
trunk coordination before extremities
use of upper extremities before lower
Overall assesment of the CNS should evaluate
alertness
responsiveness
persistence
concentration
Speech and language development
best predictors of cognitive performance
hearing impairments may impede
Respiratory Disorders: Middle Ear infections (Otitis media)
eustachian tube short and straight
remains common until age 5
keep baby upright while feeding
Transient tachypnea of the newborn (TTN)
causes hypoxia
Usually in term infants
Respiratory Distress Syndrome (RDS)
Surfactant deficiency
32-34 weeks
Give mom steriods @ 28 weeks
Bronchopulmonary dysplasia
chronic lung disease
COPD
trama to lung tissue
Apnea
CO
2
levels are not registering in the brainstem due to immaturity
Non-Pulmonary causes of Respiratory Distress in newborns
cardiac
infectious
metabolic
CNS
Pulmonary Causes of respiratory distress in newborns
parechymal conditions
developmental abnormalities
airway abnormalities
mechanical abnormalities
Major signs of respiratory distress
Tachypnea > 60 breaths per minute
Cyanosis
Retractions or nasal flaring
TTN (Transient Tachypnea of the Newborn)
Term or near term
immediate onset improvement w/in 12-24 hours
clinical cours < 72 hours
Primary cause
: delayed reabsorption of fetal lung fluid
Due to poor transitioning
RDS (Respiratory Distress Syndrome)
Primarily preterm
Onset w/in 1st 6 hours
starts improving after 72 hours
primary cause is surfactant deficiency
Sudden infant death syndrome
death of infant < 1 year that is unexplained
usually between 2-3 months
brainstem abnormalities
Risk factors for SIDS
positioning during sleep (must be on back on firm matress)
prematurity/LBW
exposure to cigarette smoke
young mother
inadequate prenatal care
Apnea
Cessation of breathing for at least 20 seconds
Caused by immaturity of the respiratory center in the medulla oblongota
failed recognition of increasing CO
2
by the CO
2
receptors.
Periodic Breathing
intermittent failure to breath for 10-15 seconds
Causes of Apnea
Prematurity
Thermal instability
Infection
Drugs
Impaired Oxygenation
Metabolic disorders
GI Reflux
Intracranial pathology
Treatment of Apnea or Periodic Breathing
supplemental oxygen
gentle tactile stimulation
env. temperature control
oscillation water beds
positive airway pressure
Methylxanthines (stimulate brain stem neurons)
Meconium
newborn's first stool
amniotic fluid
intestinal secretions
mucosal cells
sometimes blood
Delayed passage of meconium
underlying illness
cystic fibrosis
hirschprung's disease
AAP recommends breast feeding until ____, why?
12 months
easy digestion
sufficient nutrients and calories
some immune protection
Hypoglycemia Diagnosis
Levels < 40-45 mg/dL
Signs of Hypoglycemia
cyanosis
apnea
hypothermia
hypotonia
poor feeding
lethargy
seizures
Risk Factors for Hypoglycemia
Infants of diabetic mothers
SGA babies
premature babies
Jaundice
excessive circulating levels of unconjugated lipid soluble bilirubin that accumulates in the skin
Causes of Jaundice
new born RBC life span is shorter = higher turnover rate and higher bilirubin from breakdown of hemoglobin
Treatment of Jaundice
hydration
phototherapy (change to conjugated form which increases H
2
O solubility)
blood transfusion > 25-30 mg/dL
Kernicterus / Bilirubin Encephalopathy
Neurologic syndrome from deposition of unconjugated bilirubin in the basal ganglia and brain stem
Iron
Deplete iron stores around 6 months
Introduce iron fortified cereals at this time
Irritable Infant syndrome / colic
Most common < 3 months
Abdominal pain or cramping
Crying
Drawing legs to abdomen
extreme irritablity
Rule of 3
crying for more than 3 hours a day
crying for more than 3 days a week
crying for more than 3 weeks
Failure to thrive
Inadequate growth due to inability to obtain or use essential nutrients
Metabolic genetic defects
parental neglect
BMI
weight in kg divided by height in meters squared
Obesity
BMI at or above the 95th percentile
Risk Factors for Infections
Prematurity (maternal transfer of IgG in later weeks)
Rupture of membranes
Foul smelling amniotic fluid
Maternal fever
GBS colonization
Maternal UTI
Pathogenesis effect
immature immune system
bacterial endotoxins
central vasodilation
peripheral vasoconstriction
systemic hypovolemia
Middle to Late childhood diagnosis
asthma
epilepsy
cancer
developmental/learning disabilities
Adolescents
endocrine system changes
lifestyle choices
motor vehicle accidents 1st cause
cancer = 2nd cause
Thicker skin
Acne
Hair growth
Acne Causes
Sebaceous and sweat gland activity increases
Andrenal androgens stimulate the sebaceous gland
Author
Rx2013
ID
35861
Card Set
Pathophysiology 1.1
Description
Concepts of altered health in children
Updated
2010-09-20T00:54:26Z
Home
Flashcards
Preview