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Pediatrics Exam 2
Peds
123
Nursing
Undergraduate 4
07/27/2012

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Term
Nephrons
Definition
Continue to grow in size and function until approximately 2 years of age (although all nephrons are present at birth)
Term
Initial Renal function
Definition
Is not as effective, newborn urine production: approx. 1-2ml/kg/hour
Child urine production is approx: 1ml/kg/hour
This is due to the renal system still being immature
The risk for dehydration is heightened, renal metabolis/excretion of drugs is affected by decreased creatinine clearance/ GFR
Term
Characteristics of Urine
Definition
Ph: 5-9
Secific gravity: 1001-1035
Protein <20 mg/Dl (trace)
Color: Clear
Term
Enuresis
Definition
Difficulties with urinary control can occur during the night and or day.
Primary enuresis the child has never experienced a period of dryness
Secondary enuresis: A 6-12 month period of dryness has preceded the onset of wetting (UTI, Stress, DM/polyuria)
Term
Risk factors of Enuresis
Definition
Physical: decreased bladder capacity, UT abnormalities, neurologic alterations, obstructive sleep apnea, constipation, UTI, pinworms, DM

Emotional: increased stress due to family disruption, pressure during toilet training, inadequate attn to voiding cues, sexual abuse.
Term
Therapuetic Management of Enuresis
Definition
Limiting fluids after dinner, frequent voiding imagery training, reward systems behavioral conditioning, Medications (imiprimine, DDAVP vasopression)
Term
Urinary Tract Infections
Definition
Characterized by the presence of bacteria in the urine along with systemic signs of infection, could cause long term complications that include scarring, decreased renal function, high blood pressure and very rarely, end stage renal failure.
Most common cause is e.coli
Term
UTI predispositions
Definition
Urinary tract obstruction, voiding dysfunction, anatomic differences of females vs. males, Individual susceptiblity to infection, Reflux (urine flows back into the kidneys), toddler age, sexually active girls.
Term
Upper Tract UTI
Definition
Involves the renal parenchyma, pelvis, and ureters. Typically causes fever, chills, flank pain.
Term
Lower Tract UTI
Definition
Involve lower urinary tract, Usually no systemic manifestations
Term
Etiology and pathophysiology of UTI
Definition
Physiologic and mechanical defense mechanisms normally maintain sterility, alteration of defense mechanisms increases risk of UTI, organisms introduced via ascending route from urethra.
Urologic instrumentation allows bacteria present in opening of urethra to enter urethra or bladder, UTI is a common hospital aquired infection because of this.
Term
Infant clinical manifestations of UTI
Definition
fever or hypothermia in neonate, irritability, dysuria, change in urine odor or color, poor weight gain, feeding difficulties.
Term
Children clinical manifestations of UTI
Definition
Abdominal or suprapubic pain, voiding frequency and urgency, dysuria, new or increased incidence of enuresis, fever
Term
Treatment of UTI
Definition
Uncomplicated cystits (bladder infection) short term course of antibiotics,
Complicated UTIS- Long term treatment
ABX options: TMP-SMX depends on regional sensitivities
Term
Acute Pyelonephritis
Definition
Inflammation caused by bacteria, fungi, protozoa, or viruses that infect the kidneys, usually infection is via ascending urethral route
Preexiting factors- vesicouretreral reflu (flow of bladder urine into the ureters)
Dysfunction of lower urinary tract function
Term
Clincial Manifestations of Pyelonephritis
Definition
Vary from mild to classic and very severe, presenting symptoms (more systemic): n/v, anorexia, chills, nocturia, frequency, urgency, suprapubic or low back pain, dysuria, fever, hematuria, foul smelling urine
Costovertebral tenderness, symptoms often suabside in a few days without therapy
Bacturia and pyuria still persist
Term
Treatment of Acute Pyelonephritis
Definition
Hospitalization and IV ABX
Term
Cryptorchidism
Definition
Undescended or hidden testes, occurs when one or both testes fail to descend through the inguinal canal into the scrotal sac. Incidence higher in premature and LBW infants since levels of testosterone dictate the descent of the testes (8 -9 months)
Most infants will have spontaneous descent in the first year of life.
Term
Hypospadias
Definition
Urethral endpoint is on the ventral suface of the penis
Term
Episapdias
Definition
Urethral endpoint isn on the dorsal surface of the penis.
Term
Spadias Therapeutic Management
Definition
Surgical intervention, Ideally between 6-12 months, Do not circumcise prior to surgery (commonly use the foreskin to repair)
Term
Wilm's Tumor
Definition
Also called Nephroblastoma (in adrenal gland)
Malignant renal and intraabdominal tumor of childhood, occurs three times more in African American children, peak age of diagnosis is 3 years, more frequent in males (growing since gestation)
Term
Etiology of Wilm Tumor
Definition
Arises from malignant undifferentiated primordial cells, more prevalent in the left kidney
Term
Wilms tumor clinical manifestations
Definition
Abdominal swelling or mass (firm, nontend and confined to one side) DO NOT PALPATE ABDOMEN UNLESS ABSOLUTELY NECESSARY
Hematuria (blood in urine due to pressure on the kidneys)
Fatigue/ maliase (anemia)
HTN (due to pressure on kidney)
Weight loss, fever (inflammation), manifestations resulting from compression of tumor mass
Term
Wilms tumor therpeutic management
Definition
Treatment with surgery, chemotherapy and or radiation

Prognosis: Survival rates are among the highest for childhood cancers
Localized 90% cure
Term
Acute Poststreptococcal Glomerulonephritis
Definition
A greoup of kidney disorders characterized by inflammatory injury in the glomerulus.
Occurs as an immune reaction to a group of A-beta hemolytic streptococcal infection of the throat or skin
Most frequent in ages 5-12
Clinical symptoms usually develop 1-2 weeks after intial strep infection
Term
Glomerulonephritis Symptoms
Definition
Hemautruia (gross or microscopic)
Proteninuria
Oluguria
Generalized edema due to ineffective filtration- begins with periorbital, progresses to lower extremities and then to ascites
HTN
Mild Anemia (not producing adequate levels of EPO)
Term
Acute post streptococcal Glomerulonephritis Prognosis
Definition
95% rapid improvement to complete recovery
5-15% chronic glomerulonephritis
1% irreversible damage
Term
Clincial Management of Glomerulonephritis
Definition
10 day course of ABX may be required, manage edema (daily weights, I/O, daily abdomincal girth)
Nutrition (low sodium, low to moderate protein)
Steroid use to control inflammatory response (risk for infection is heightened)
Bed rest is not necessary
Term
Nephrotic syndrome
Definition
Most common presentation of glomerular injury in children
Characteristic:
Massive preoteinuria, hypoalbuminemia, edema progressing to sever, usually has normal or low BP because the fluid moves to the 3 space.
Term
Physologic changes in Neprhotic syndrom
Definition
Glomerular membrane, normally impermeable to proteins becomes permeable to proteins, especially albumin, albumin lost in urine, serum ablumin decreased, fluid shifts from plasma to intertitial spaces (hypovolemia and ascites)
Term
Nephrotic syndrome management
Definition
Diet: low to moderate protein, sodium restrictions, Steroids (prednisone is the drug of choice, 2mg/kg divided into BID doses), diuretics Pullout 3 space instead of vascular
Term
Acute Renal Failure
Definition
Sudden severe loss of kidney function, kidney can no longer filter waste products, regulate fluid

Etiology:
Most common cause in children is HUS (hemolytic Uremic Disease/Syndrome)
Prerenal: dehydration, hypotension, septic shock, renal artery obstruction
Intrarenal:nephrotoxins (aminoglycosides, contrast media)
Postrenal: structural abnormalities, turmors, kidney stones
Term
HUS Hemolytic Uremic Disease/Syndrome HUS
Definition
Most common cause of acquired acute renal failure in children
Occurs primarily in infants and small children between 6 months to 5 years
Thought to be associated with bacterial toxins, chemicals andviruses
Coxsackie virus, echovirus, and adneovirus, also some cases due to E-Coli
Term
HUS Pathophysiology
Definition
Primary site of injury appears to be the endothelial lining of the small glomerular arterioles. Beomce swollen and occluded, with deposits of fibrin and platelet clots, RBCs are damaged as they attempt to move through the partially occluded vessels (lead to thrombocytopenia due to platelet aggregation within the damaged vessels, nothing gets to the kidney)
Term
Clincial Manifestations of HUS
Definition
The triad of anemia, thrombocytopenia and renal failure is significant for diagnosis)
Vomiting, irritability, lethargy, marked pallor, oliguria, or anuria, CNS involvement (seizures, stupor), hemorrhagic manifestations (bruising, petechia, juandice, bloody diarrhea)
Term
Therapeutic management of HUS
Definition
Early diagnosis and aggressive, Treat ARF and hemolytic anemia (dialysis, blood transfusions (FFP clotting factors and packed RBC)
Term
Prognosis of HUS
Definition
Recovery rate is about 95% with prompt treatment, but residual renal impairment ranges from 10-50%, long term complications (chronic renal failure, HTN, CNS disorders)
Term
ARF clinical manifestations
Definition
F/E and Acid base imbalances, increased BUN and creatinine, oliguria, Anuria, Edema, HTN, nausea, vomiting, lethargy, pallor
Term
ARF therapeutic management
Definition
Treatment of the underlying cause, supportive care, (volume restoration, electrolyte and acid base management, dialysis)
Term
Chronic Renal Failure
Definition
Irreversible loss of kidney function that occurs over months to years
Progressive to ESRD
Initial symptom (polyuria with very dilute urine- everything goes through becuase the nephrons wont work)
The nprogresses to oliguria and anuria
Culminate in uremia (urine in the blood)
Term
Potential Causes of Chronic Renal Failure
Definition
Congential anomalies are most common, reflux associated with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis, HUS
Term
Chronic Renal Failure Clinical Manifestations
Definition
Early (F/E and acid base imbalance, anemia, poor, growth, hypertnsion, fatigue, anorexia, n/v, neurologic s/s/ indicative of waste build up BUN)
Progression (mutli system, uremic syndrom ensues)
Term
Chronic Renal Failure Management
Definition
Manage diet, hypertention, recurrent infections, seizures, electrolyte distrubances, fluid retention
Dialysis:
Peritoneal is the preferred method for children, abdomial cavity acts as a semi permeable membran for filtration, warmed solution enters the peritoneal cavity by gravity, remains for a period of time before removal, can be managed at home in some cases
Term
HemoDialysis
Definition
Requires creation of vascular access and special dialysis equipment, best suite for children who can be brought to the facility 3/week for 4-6hours
Achieves rapid correction of F/E balance
Term
Hematologic Diseases
Definition
Most common diseases in the world, children are often cared for in pediatric centers in the same location as oncology patients, hematology is the science of blood, its nature, function and diseases.
Term
Pediatric Hemotologic system
Definition
Erythrocytes lifespan is shorter in neonates thatn in infants and children due to increased destruction during rapid growth, by age 2 months, erythropoeisis increases, leading to an increase in hemoglobin, erythrocytes are produced initially in the marrow of all bones. As age increases, hematopoieses occurs primarily in the amrrow of the ribs, sternum, bertebra, pelvis, skull, clavicles, and scapulae
Hgb/Hct levels vary by age
Term
Erythrocytes
Definition
Oxygen-carrying capacity, RBC production increases when kidneys produce a hormone called erythropoietin
Polycythemia- Increase in number of RBCs, response to hypoxia (heart disease, high altitude)
Term
Types and Functions of WBCs
Definition
Granulocytes
Nuetrophils (bacteria)
Eosinophils (allergic response and parasites)
Basophils (contain histamine, secrete heparin)
Agranulocytes
Monocytes/macrophages (phagocytize)
Lymphocytes (found in BM, spleen, theymus)
T Cells (cell mediated immunity)
B cells (humoral immunity)
Term
CBC Norms and Importance
Definition
RBC 4.5-5.5
Hgb 11.5-15.5
Hct 35-45%
RBC Indexes (MCV, MCH, MCHC)
Reticulocytes 0.5-1.5% (immature RBCs)
WBC 4.5-13.5
ANC (>1000)
Plt 150-400
Term
Anemia
Definition
condition in which the number of RBCs or the hemoglobing concentration is reduced below normal values.
Consequences:
Decrease in oxygen carrying capacity of blood and consequently a reduction in the amount of oxygen avialable to the cells. Hypoxic, pale, tachycardic to make up for decreased O2
Term
Red Blood Cell Disorders
Definition
Children are able to function well despite low levels of Hgb, (cyanosis is not typically evident, growth retardation found in chronic anemia) In general not noticed on assessment. Lab findings determine decreased level Hgb <11g/dL
S/S:
Lethargy, pale mm and conjuctiva, easy fatigability, irritability, extremem pallow, tachycardia
Treatment:
Revers the process causing anemia, replace deficiency, severe: O2, bed rest, replace blood factors and products
Term
Classification of Anemias
Definition
Decreased RBC Production- nutritional deficiency or bone marrow failure
Increased RBC Loss- Acute blood loss (Trauma)
Increased RBC Destruction-intracorpuscular or extracorpuscular
(HUS, wrong trype of blood give, sickle cell)
Term
Anemia Caused by Nutritional Deficiences
Definition
Iron Deficiency Anemia:Most common hematological disorder, caused by inadequate supply of dietary iron, impaired absorption, blood loss, excessive demands for Fe required for growth (give with citrus), preventable, impact of Fe fortified formula and cereal, adolescents especially at risk due to rapid gwoth and poor eating habits.
Term
Pathophysiology of Anemia
Definition
Any number of factors that decrease the supply of Fe (dietary), impair its absorption (decreased Vit. C), Increase the bodys need for Fe, affect synthesis of Hgb
Term
Management (Inadequate Fe in the diet)
Definition
Fortified formula and cereals, Oral Fie supplements (ferrous iron 3-6mg/kg)
Vit C aids in absorption
Severe: IV/Parenteral Fe, Packed RBC transfusions
Term
Anemia Caused By Increased Destruction of RBC SICKLE CELL ANEMIA
Definition
Hereditary hemoglobinopathy (autosomal recessive disorder 1in 4, mendelian prediction
Ethnicity:
Occurs primarily in African American Population
1 in 12 have trait
1 in 400 black americans have SCD
Term
Sickle Cell Pathophysiology
Definition
Normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin, HGG in the RBCs take on an elongated sickle shape, sickled cells are rigid and obstruct capillary blood flow (lead to microvascular occlusions, ischemia, infarcts, and tissue death)
Hypoxia occurs and further worsens sickling
Term
Infarctions of Sickle Cell
Definition
Occur in tissues (large and small), Cause chronic damage to liver, spleen, heart, kidneys, eyes and bones, pulmonary infarction leadeing to acute chest syndrome, Cerebral infarction leads to stroke, sickled cells are more likely to be destroyed leading to jaundice
Term
Sickle Cell Prognosis
Definition
No cure (BM transplants), supportive care, frequenct bacterial infections due to immunocompromise (spleen unable to filter bacteria), leading cause of death in young children with disease, Strokes in 5-10% of children with disease (neurodevelopmental delay, MR)
Term
Sicle Cell Crisis
Definition
Precipitating Factors
Any event that increases bodys need for O2 or alters transport of O2, (trauma, infection, feber, physical and emotional stress, increased viscosity of blood due to dehydration, hypoxia (high altitude, poorly pressurized flights, hypoventilation, vasocintriction due to hypothermia)
Term
Cerebral Vascular Accident (CVA)
Definition
Emergency, occurs in 7% of children with SCD
Signs (convulsions/slurred speech, ataxia, weakness, paralysis)
Treatment
(Symptoms, exchange transfusion, chronic trnafusion program, neuropsych follow up?
Term
Spelinic Sequestration
Definition
Infarction of spleen at microvascular level, occurs primarily in children <4yrs, Life threatening-death can occur within hours(high mortality), Blood pools in the spleen
S/S
Rapidly enlarging abdomen with left sided pain, profound anemia, hypovolemia, and shock
Term
S/S of Splenic Sequestration
Definition
Irritability, unusal sleepiness, looks pale, weakness, fast heart beat, big spleen, pain on the left side of the abdomen
Term
Aplastic Crisis/ Aplasia
Definition
Temporary cessation of bone marrow function, decreased production and increased destruction of RBCs, Triggered by viral infection or depletion of Folic acid
S/S
Profound anemia/pallor
Treatment
PRBC transfusions, treat infection, monitor closely
Term
Priapism
Definition
Persistent, painful,unwanted erection (stuttering, multple shore episodes, sever prolonged lasting 24hours)
High incidence of sexula dysfunction
Treatment:
Hydration/ opiods, exchange transfusion, avoid temperature extremes
Term
Sickle Cell Treatment
Definition
Agressive treamtnet of infection, hydrations, protection from cold exposure, frequenct transfusion (concern of Fe overload, hemosiderosis- chelation therapy)
Supportive Care- pain relief, oxygen
Term
Vaso Occlusive Crisis (VOC)
Definition
Most common very painful, stasis of blood with clumping of cells in microcirculation->ischemia-> infarction
Sites:
Bones, lungs, liver/spleen, brain, penis
S/S
Fever, pain tissue swelling
Term
Pain episodes
Definition
Can occur anywhere in the body, hands feet (dactylitis)usually if less than 2 years old
Long bones, joints abdomen, usually if greater than 2 years old
Soft tissue swelling, association with infection
Treatment:
Hydration, pain management (opoids, NSAIDs)
Term
Acute Chest Syndrome
Definition
EMERGENCY
Leading caude of dealth in SCD patients older than 10 years
Causes: Infection, infarction, or pulmonary fat embolus
Symptoms:
Fever, chest or back pain, Decreased O2 sats, cough, dyspnea
Term
Acute Chest Syndrome Management
Definition
Symptoms Management: (Antiobiotics/ steroids, pain/fever control/ O2, Maintenance fluids/ rehydration)
Close monitoring: CSR, pulmonary toilet
Term
Thalassemia
Definition
Inherited blood disorders of hemoglobin synthesis (autosomal recessive), classified by Hgb chanin affected (alpha or beta) and by severity of effect, anemia results from defective synthesis
S/S: chronic hypoxia (HA, irritability, precordial and bone pain, exercise intolerance, anorexia, epistaxis)
Treatment:
RBC transfusion to maintain Hct (side effect: hemosiderosis Fe overload) treat with Fe-chelating drugs to bind excess
Term
Anemia caused by impaired or Decreased production of RBCs (Aplastic Anemia)
Definition
Pancytopenia, absent abnormal stem cell production with marked decrease in RBC, WBC, and platelets, profound depression of all 3 cell lines.
Term
Aplastic Anemia
Definition
Etiology: primary or secondary
Acquired (50% idiopathic, activated suppressor lymphocytes, drugs/ toxins/ chemicals, radiation)
Congenital
Fanconi's anemia- diagnosed by chromosome analysis
Term
Presentation of aplastic anemia
Definition
Decreased RBCs
(pallor and weakness)
Decreased platelets
(petuchiae, bruising)
Decreased WBCs
(infections, mouth sores)
NO Hepatosplenomegaly
Term
Aplastic Anemia Treatment
Definition
Remove exposure to hazardous drugs/ toxins
HCT (hematopeoietic cell transplant)
Non HCT treatment (antithymocyt globulin (ATG), Methylprednisone, Cyclosporin, Cytokines (G-CSF/GM-CSF, Epogen/IL-3)
Term
Aplastic Anemia Prognosis
Definition
High risk of late malignancies, AML
Term
Hemophilia
Definition
Group of hereditary bleeding disorders that result from deficinecies of specific clotting factors, x-linked congenital bleeding disorder (protein deficiency affects normal clotting, occurs among all races)
Transmitted by mom mainly effects males
Term
Types of Hemophilia
Definition
A: "Classic hemophilia) deficiency of factor VII (clotting cascade)
80% of hemophilia cases

B: Caused by deficinecy of factor IX, also known as "Christmas disease", 15% of hemophilia cases
Term
Clincial Manifestations of Hemophilia
Definition
Same for both types of hemophilia, excessive/ prolonged bleeding, (life threatening bleeds, tongue throuat, CNS) Signs of bleeding (tingling, pain, swelling)
Term
Hemarthrosis
Definition
Bleeding into joint spaces of knee, ankle, elbow (leads to impaired mobility) Causes dyarthrosis (pain in joints)
Term
Hemophilia Treatmetn
Definition
Prevent bleeding, (close supervision, dental, shaving, pressure for 15 minutes and ice to vasoconstrict any ooze)
DDAVP (Vasopressin)- increases factor VII
Replace missing clotting factors, transfusions of other blood products to prevent hemorrhage.
Term
Hemophilia Prognosis
Definition
Excellent with appropriate management by multidisciplinary center, gene therapy is hope for the future, need hepatitis C screening, HIV no longer an issue
Term
Von Willebrand Disease
Definition
Hereditary bleeding disorder (auto dom), involves deficiency of vWf (carrier for factor VII), necessary for platelet adhesion
S/S:
Easy bruising, espistaxis, gingival bleeding, excessive bleeding with lacerations or surgery
Treatment: Infsuion of vWB protein concentrate
DDAVP infusion before bleeding event
Avoid aspirin and NSAIDS (increases bleeding time and decreased plt)
Term
Immune thrombocytopenia Purpura (ITP)
Definition
Acquired hemorrhagic disorder resulting in excess destruction of circulating platelets (platelet count less than 100K, shortened platelet life span, anti platelet activity, increase megakarycocytes in bone marrow), hisotry of viral infection within 2-4 weeks, present with eccymosis/petechia, epistaxis
Term
Acute ITP
Definition
More common in children, average age 2-6yrs but may occur at any age, follows minor viral infection, average duration 2-6 weeks, 90% have normal platelet count by 4 months
Term
Chronic ITP
Definition
More common in adults, 3:1 females, Insidous onset and lupus antigen association, duration is months to years, fluctuating chronic disease.
Term
ITP presenting symptoms
Definition
Petechia/purpura, decreased circulating platelets, all other blood incies normal, no hepatomegaly, healthy looking child
Term
ITP treamtent option
Definition
No therapy/ observation (safety precautions, quiet play), steroids, IVIG
Term
ITP prognosis
Definition
80-90% resolve in 4 months, 95% resolve by 6 months, chronic if lasts more than 6 months, recurrence in children is rare, not associated with any further disease or malignancy
Term
Nursing Care of Children recieving blood transfusion
Definition
Hemolytic reactions, febrile reactions, allergic reactions, circulatory overload (given over 4 hours), air emobli, hypothermia (due to cold blood), electrolyte distrubances.
Check date of blood, lysse cells relase K+, citrate binds Ca+ and the pts claciul will bind and the heart will be effected.
Term
Immunologic defiency disorders
Definition
SCIDS- severe combined immunodefiecinecy syndrom (absence of both humoral and cell mediated immunity, genetic, chronic infections very early in life) TX: Prevent infection, and stem cell transplant
Term
Wiskott-Aldrich Syndrom
Definition
X-linked recessive disorder, poor prognosis, clotting issues, also affects b and t lymphocytes, triat of abnomralitis, (thrombocytopenia, excema, and immunodeficiency)
Term
Immunologic Deficiency Disorders
Definition
HIV-AIDS
Affects t-lymphocytes
S/S:
Lymphadenopathy, petaosplenomegaly, oral candiasis, chronic or recurrent diarrhea, FTT, DD
Severtiy based on Pediatric HIV classificaation and age specific CD4 and T lymphocyte counts
Term
Musculoskeletal Pediatric Differences
Definition
Muscle tissue is amost completely developed at birth, the infants bones are only 65% ossified at 8 months and are neither as firm nor as brittle as those of the older child, new bony tissue is produced during periods of growth, growing bones heal quickly, sutures of the cranium do not fuse until approx 16-18 months of age, fractures in children <1 yr are unusual because a large amont of force is necessary... consider abuse or underlying pathophysiology
Term
Traction
Definition
extended pulling force may be used to provide rest for an extremity, to help prevent or improve contracture deformity, to correct deformity, to treat dislocation, to allow position and alignment, to provide immobilization, to reduce muscle spasms
Term
Traction: Essential componenets
Definition
Traction: forward forced produced by attaching weight to distal bone fragment (adjust by adding or subtracting weight), Counteraction: backward force provided by body weight (increas by elevating food of bed), Frictional forc: provided by patient's contact with the bed
Term
Skin Traction
Definition
Buck's extension, Russell Traction, Cervical Traction
Term
Skeletal traction
Definition
Halo, balanced suspension, femoral traction
Term
Buck's Traction
Definition
Continous or intermittent boot or circular wrap is applied to the skin, used to treat some fractures, hip disorders, contractures and muscle spasms
Term
Russel Traction
Definition
Continuous traction, used to stabilize fractures femurs until callus forms
Term
Cervical Traction
Definition
May be continuous or intermittent, maintains the head in extension by a halter
Term
Important to assess the five P's
Definition
Pain and point of tenderness, pulse- distal to the facture site, pallor, paresthesia- sensation distal to the fracture site, paralysis- movement distal to the fracture site
Term
The immobilized child
Definition
Immobilization was once thought to be restoratvie for patients with illness and injury, we know now that immobilization has serious consequencyse (physical,social psychological)
Term
Physiologic effects of immobilization
Definition
Muscular, skeletal, cardiovascular, respiratory, GI (slows down), renal metabolism, integumentary
Term
Psychological effects of Immobilization
Definition
Diminished environmental stimuli, altered perception of self and enviornment, increased feelings of frustration, helplessness, anxiety, depression, anger, aggressive behavior, development of regression
Term
Effects on Families
Definition
Extended periods of immobilizations (logistical management of sick child, need for family support and home care assistance, financial and mised work related issues), coping skills
Term
Limb defects
Definition
Club foot, developmental dysplasia of the hip, legg-calve-pethes disease, slipped capital femoral epiphysis
Term
Club Foot
Definition
Congenital malformation of the lower extremity, affects the lower leg, ankle, and foot, genetic predisposition and mulifactorial etiology, plant-flexed foot with an inverted heel and adducted forefoot
Term
Developmental Dysplasia of the Hip
Definition
Head of femur is improperly seated in the acetabulum of the pelvis, varies in sweverity, can be present at birth or develop after birth, multifactorial in origin, genetic factors and prenatal positioning may play a role
Term
Three degrees of developmental dysplasia of the Hip
Definition
Unstable hip- mildest form-hip ligaments are lax, allowing displacement
Sublaxated hip- Head of femur is under lip of acetabulum, but not well seated
Dislocated Hip- femoral head loses contact with acetabulum
Term
Clinical Manifestations of DDH
Definition
Infant
Shortened limb on affected side, restricted abduction of the hip on affected side, unequal gluteal folds when infant prone
Term
Positive Ortolani Test
Definition
Click heard when hips pulled up to flex
Term
Positive Barlow Test
Definition
Child heard when hips abducted
Term
DDH in Older Infant and Child
Definition
Affected leg shorter than the other
Trendelenburg sign- hips should remain level when weight is shifted from one leg to the other
Greater trochanter is prominenet, waddling gait if bilateral dislocations
Term
Therapeutic management of DDH
Definition
Importance of early intervention, newborn to 6 months: pavlik harness for abduction of hip
Ages 6-18 months: Disolocation unrecognized until child begins to stand and walk; use traction and case immobilization (spica)
Older child: operative reduction; tenotomy, osteomy; very difficult after age 4
Term
Legg-Calve'-Perthes Disease
Definition
Osteochondritis deforman juvenilis or coxa plana, self limited, idiopathic, occurs in juveniles ages 2-12, more common in males ages 4-9, avsacular necrosis of the femoral head, 10-15% have bilater hip involvement
Term
Legg-Calve'-Perthes Disease Pathophysiology
Definition
Cause is unknown but involves disturbed circulation to the femoral head with ischemic aseptic necrosis
After resolving may have normal femoral head or may have alteration
Term
Clinical manifestations of Legg-Calve-Perthes Disease
Definition
Insidiuous onset, may have history of limp, soreness or stiffness, limited ROM, vauge history or trauma
Pain and limp most evident on arising and at end of activity, diagnosed by xray
Term
Treatment of Legg-Calve-Perthes Disease
Definition
Keep femur in acetabulum, caontainement with various devices, rest, no weight bearing initially, surgery in some cases, home tractction in some cases, keep abducted.
Term
Slipped Capital femoral epiphysis
Definition
Affects the upper femoral growth plate/ slips backward into the acetabulum
Hip disorder related to times of growth, especially during adolescence, cause is unknown, connection to stress on the epiphyseal plate just prior to clusre, majority of patients exceed 95th percentile for weigh and 90th percentile for heigh
Term
Slipped Capital femoral epiphysis Clinical Manifestation
Definition
Limp, gait disturbance, and pain, pain is usally in the groin, thigh, or knee, Intermittent and worsens with activity, confirmed by xray with patient in frog leg position
Term
Slipped Capital femoral epiphysis Therapeutic Management
Definition
Internal fixation (pin or screw inserted actross the growth plate to secure the femoral head and prevent further slippage
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