Term
| what are the caloric and protein intakes from 0-12 yo |
|
Definition
0-1yo 100 kcal, 2.5-3 kg protein
1-7yo 75-90 kcal, 1.5-2.5 kg
7-12yo 60-75 kcal, 1.5-2.5 kg
12yo+ 30-60 kcal, 1-1.5 kg |
|
|
Term
| define colostrum, what is its composition, what is the purpose |
|
Definition
high protein low fat fluid in the first few days post partum
high immunological and maturational properities |
|
|
Term
| what is engorgement, how is it treated |
|
Definition
in primiparous women before milk comes on third post-partum day breasts become hard and painful, nipples non-pratractile, poor temperment
manage with enhancement of milk flow |
|
|
Term
| what is the recommended time period of breast feeding along |
|
Definition
|
|
Term
| what is the feeding frequency determined by |
|
Definition
| inversley related to level of bilirubin, more feeding means more milirubin in stool |
|
|
Term
| what are complications of breast feeding |
|
Definition
breastfeeding jaundice
breast milk jaundice
mastitis |
|
|
Term
| what is breastfeeding jaundice |
|
Definition
| decreased intake causes build up on unconjugated bilirubin |
|
|
Term
| what is breast milk jaundice |
|
Definition
| unknown factor in milk enhances absorption of bilirubin |
|
|
Term
| what is matastitis symptoms and cause |
|
Definition
fever, chills malaise in mom
due to frequent incomplete emptying
can lead to breast abcess |
|
|
Term
| what are contraindications to breast feeding |
|
Definition
| HIV, some Rx and OTC, breast herpies, syphillis |
|
|
Term
| what does breast feed stool look like, how often |
|
Definition
yellow seedy, diarrhea like
6-8 times a day |
|
|
Term
| what are ther advantages of breast feeding (8) |
|
Definition
convenience
no steralization-free of microbes
mom infant bonding
less post partum depression
possible IQ increase
passive immunity
medical benifits leading to less hospitalization
mom medical benifits too |
|
|
Term
| what immunity is qcquired from breast feeding, what other immunologic benifits does it give (4) |
|
Definition
IgA, macrophages, nucleotide introduction
possible allergen protection |
|
|
Term
| what medical benifits do babies get from breast feeding (9) |
|
Definition
less diarrhea, respiratory illness, otitis media, baceremia, bacterial meningitis, necrotizing entercolotis
absorption of nutrients, vitamins, and trace elements
good nutrition
less obesity |
|
|
Term
| what nutrients are there in breast milk if mom dosent eat like crap (7) |
|
Definition
high bioavailable protein, FA, omega-3, Ca, Fe, zinc
low Na |
|
|
Term
| what are medical benifits for mom when breast feeding (5) |
|
Definition
less post-partum hemorrhage
longer amenorrhea
reduced ovarian and premenopausal breast cancer
reduced osteoporosis risk |
|
|
Term
| cows milk (skim) formula: what babies should get it, what nutrients does it have |
|
Definition
for babies who cannot breast feed
has big proteins that dont get absorbed and pull water
iron fortified, electrolyte depleted |
|
|
Term
| cows milk: calories, what is the carb, what is another option if that carb is bad |
|
Definition
same as human 20 kcal/oz
carb is lactose, they make lactose free ones tho |
|
|
Term
| milk fortifier: what is it, calories, who gets it |
|
Definition
mix with breast milk
24 kcal/oz
for premature babies |
|
|
Term
| soy formula: who gets it, what nutrients, what carb, calories |
|
Definition
for babies with intolerance to cow proteins, not for premature babies
carb is glucose, sometimes sucrose
20 kcal/oz
methionine supplementation |
|
|
Term
| what is the benifit of a hydrolyzed formula |
|
Definition
|
|
Term
| what is a theraputic formula |
|
Definition
| specific nutrients to help with digestion, absorption, increase nitrogen or AA, increase FA, etc |
|
|
Term
| when can food be added to baby diet, why now, what should it be |
|
Definition
6 mo because baby needs zinc, protein, and iron
begin with vitamin fortified single grain (rice, oatmeal, barley) cereals mixed with breast milk
mix with fruit a little later |
|
|
Term
| what foods should never be given in 1st year (6) |
|
Definition
honey: infant botulism
cows milk: occult intestinal blood loss
eggs
nuts
fish
aspiration risks: hot dogs, popcorn, grapes, etc |
|
|
Term
| what are the stages of food introduction |
|
Definition
stage 1: introduce one food at a time add every 5 days so you know what an allergy was to
stage 2: add two food mixes
stage 3: she talks fast and this isnt in book or notes |
|
|
Term
| what are the three types of weight teting |
|
Definition
mid-arm circumference: measure with arm hanging, tape mid arm
triceps fat fold: grasp skin and subcutaneous fat on midpoint
BMI: >25 overweight, >30 obease |
|
|
Term
| obesity complications (13) |
|
Definition
every organ and system
peer and career discrmination
advanced bone age
early menarche
sleep apnea
hypertension
ischemic heart disease
cardiac hypertrophy
slipped fromral epiphysis
insulin resistance
hyperglycemia
hypercholesterolemia
gout |
|
|
Term
| marasmus: cause, symptoms (8) |
|
Definition
caloric deficiency
body weight less than 60% median
muscle wasting
weight to height reduction
loss of subcutaneous fat
lusterless sparse hair
poor nail growth
skin dry and thin
simian apperance
no edema |
|
|
Term
|
Definition
protein and caloric deficiency
hypoalbuminemic, edematosus malnutrition
pitting edema starting in legs, discoloration of skin, hyperkerytosis, scaly dermatitis
can look obease
maintience of subcutaneous fat
hair sparse, loose, brown/red/yellow
apathy
enlarged soft liver
abdomen distended
bowel active |
|
|
Term
| celiac disease: signs, treatment |
|
Definition
| potbelly, vomitting, weight loss, psychosocial failure |
|
|
Term
| why would a kid have osteoperosis |
|
Definition
| protein calorie malnutrition, vit C deficiency, steroid therapy, endocrine disorders |
|
|
Term
|
Definition
| nerve conduction, muscle contraction, blood clotting, membrane permeability, bone |
|
|
Term
|
Definition
| has retinol which is use in eye to make rhodopsin and differentiate epithelium |
|
|
Term
| vit A deficiency signs (5) |
|
Definition
night blindness
xerophthalmia
bitots spots
follicular hyperkeratosis
xerosis of conjunctiva and cornea |
|
|
Term
|
Definition
| cholecalciferol is made via UV radiation of skin precursors which are metabolized in liver and kidney |
|
|
Term
|
Definition
| enhance absorption of minerals in bone, direct feedback on PTH |
|
|
Term
| who is most at risk for Vit D deficiency |
|
Definition
|
|
Term
| signs of vit D deficiency (7) |
|
Definition
rickets
osteomalacia
craniotabes: thinning skull
rachitic rosary: thick wrists and ankles
anterior frontanell enlarged and delayed closure
valgus and varus |
|
|
Term
| vit C deficiency signs (3) |
|
Definition
scurvy- bleeding gums
bone lesions
bleeding |
|
|
Term
| what are the two functions of vitamin E |
|
Definition
stabilize membranes
antioxidant |
|
|
Term
| vit E deficiency signs (6) |
|
Definition
fat absorbtoin diseases
sensory and motor neuropathy
hemolytic anemia
peripheria edema
thrombocytosis |
|
|
Term
|
Definition
| needed for prothrombin, plasma proteins, osterclacin in bone needs it |
|
|
Term
| what disease is a vit K deficiency, 3 symptoms |
|
Definition
hemorrhagic disease of the newbown
GI hemorrhage, petechiae, ecchymoses |
|
|
Term
| thiamine (B1) functions 3 |
|
Definition
carb metabolism
pentose pathway
decarbodylation of branched chain AA |
|
|
Term
| what vitamin is deficient in alcoholics |
|
Definition
|
|
Term
| what diseases are a thiamine deficiency |
|
Definition
|
|
Term
|
Definition
heart failure, increased ICP
breast feeding moms with thiamine deficiency |
|
|
Term
|
Definition
aphonic cry (no sound)
cardiac symptoms
vomitting
apathy
restlessness
cyanosis
dyspenia
death |
|
|
Term
|
Definition
in cyenzymes NAD and NADP
fat synthesis
respiratory metabolism
glycolysis |
|
|
Term
|
Definition
| conversion from tryptophan |
|
|
Term
| what is a niacin deficiency called, symptoms? (8) |
|
Definition
| weakness, lassitude dermatitis, photosensitivity, inflammation of mucous membranes, diarrhea, vomiting, dysphagic dementia |
|
|
Term
| functions of riboflavin B2 (3) |
|
Definition
glutathionne reductase and xanthine oxidase of the ETC
glucose, FA, and AA metbolism |
|
|
Term
| what is a B2 deficiency called, symptoms (6) |
|
Definition
ariboflavinosis
angular stomatitis, cheilosis, sevorrheic dermatitis around nose and mouth, reduced tears, photophobia, corneal vascularization, cataracts |
|
|
Term
|
Definition
| interconversion reactions of AA, conversion of trypthophan to niacin, metabolism in brina, synthesis of heme and prostaglandins |
|
|
Term
| what is a B6 deficiency called, symptoms (7) |
|
Definition
hyperchornic microcytic anemia
anemia dermatitis, neuropathy, vomiting, diarrhea, failure to thrive, seizures |
|
|
Term
|
Definition
| folate function, lipid and carb metabolism, protein and nucleic acid synthesis |
|
|
Term
| what does B12 require, why |
|
Definition
| intrinsic factor for absorption |
|
|
Term
| symptoms of B12 deficiency |
|
Definition
|
|
Term
|
Definition
transport single carbon fragments in the synthesis of AA
convert homocystine to methionine |
|
|
Term
| where is folate found (3) |
|
Definition
| leafy greens, oranges, whole grains |
|
|
Term
| what causes neural tube defects in babies, how much do they need |
|
Definition
| need 10x adult dose of folate to avoid defect |
|
|
Term
| folate deficiency symptoms |
|
Definition
| anemia, hypersegmented neutrophils |
|
|
Term
|
Definition
| synthesis of Hb, myoglobin, enzyme ion |
|
|
Term
| where does iron come from (2) |
|
Definition
| meat, non-heme ions come from salts |
|
|
Term
| symptoms of iron deficiency anemia |
|
Definition
anemia
koilonycchias
lethargy
impaired neurocognative development |
|
|
Term
| signs of a biotin deficiency 2 |
|
Definition
rash (hyperlimentation developed dermatitis)
hair loss |
|
|
Term
|
Definition
| synthesis of nucleic acids, stabilization of cell membranes, cofactor, growth, wound healing tissue, turn over of GI tissue |
|
|
Term
| where does zinc come from |
|
Definition
| grains, legumes, animal products, human milk |
|
|
Term
| signs of a zinc deficiency (11) |
|
Definition
rash (acrodermatitis) comes from inability to absorb
growth failure (dwarfism)
delayed sexual development
ageusia and poor appetite
anorexia
immune impairment
rough skin
hepatosplenomeagly
mood changes
night blindness
photophobia |
|
|
Term
| signs of a copper deficiency (4) |
|
Definition
| bone changes, hypopigmentation, anemia, neutropenia |
|
|
Term
| signs of selenium deficiency |
|
Definition
|
|
Term
| fetus: TBW, ECF to ICF ratio |
|
Definition
|
|
Term
|
Definition
|
|
Term
| puberity: TBW, ECF, ICF, dominant ions in ECF/ICF |
|
Definition
males 60%
females 50%
ECF 25% - plasma 5%, IF 15%
ECF: NaCl
ICF: K |
|
|
Term
| what is osmolality dependent on |
|
Definition
water balance
intake and excretion |
|
|
Term
| what is normal osmolality |
|
Definition
|
|
Term
| what can change osmolality, how |
|
Definition
ADH increases renal tubular reabsorption of water and decreases urinary loss,
low volumes trigger thirst and ADH secretion |
|
|
Term
| what is volume status dependant on |
|
Definition
| regulation of sodium balance |
|
|
Term
| how does the kidney regulate sodium |
|
Definition
| altering percent filtered Na reabsorbed with RAAS |
|
|
Term
|
Definition
| increase volume > juxtaglomerular apparatus releases renin > renin cleaves angiotensiongen > angiotensin 1 > Ace cleaves it > angiotensigen II |
|
|
Term
| how does the heart regulate sodium |
|
Definition
| it senses distension in the atria and releases ANP which increases glomerular filtration rate and inhibits Na reabsorption and urinary excretion |
|
|
Term
| where does excretion of water occur |
|
Definition
| kidney 50%, lungs, skin, GI |
|
|
Term
| how are fluids calculated if pt is 10 kg or less |
|
Definition
| (100mL) x kg = required water |
|
|
Term
| how are fluids calculated if pt is >10kg |
|
Definition
| (1000mL) + (50mL x(kg-10)) = required water |
|
|
Term
| how are fluids calculated if pt is >20kg |
|
Definition
| (33500mL) + (20mL x (kg-20)) = required water |
|
|
Term
| what would cause increased water intake (6) |
|
Definition
| fever, vomiting, diarrhea, high renal flow, trachypenia, DI |
|
|
Term
| what would decrease water intake (4) |
|
Definition
| CHF, meningitis, mech ventilation, olifuric renal flow |
|
|
Term
| what qualifies minor water loss, what symptoms |
|
Definition
3-5% loss
few signs and symptoms, decreased urine and thirst |
|
|
Term
| what are the signs of moderate water loss |
|
Definition
| intravascular space depletion, increased HR, decreased urine |
|
|
Term
| what are the signs of severe water loss 15% |
|
Definition
| very ill, decreased BP, vomitting, diarrhea |
|
|
Term
| what are the causes of dehydration(5) |
|
Definition
| hyponatremia, hypernatremia, pseudohyponatremia, gastroenteroitis, inadequate intake |
|
|
Term
| what are physical exam findings in dehydration |
|
Definition
| dry mucous membranes, depressed frontanelle, sunken eyes, decreased skin turgor, oliguria |
|
|
Term
| what is decreased skin turgor a sign of |
|
Definition
|
|
Term
| in a dehydration emergency what is the first thing you do be specific |
|
Definition
draw lab and dont wait for them to move onto next stage
electrolytes, BUN, Cr, Glu, Ca, ABG, CBC |
|
|
Term
| during dehydration what does BUN tell you |
|
Definition
| if creatinine is normal, the situation is secondary to passive reabsorption of urea in PCT caused by appropirate renal conversion of Na and water. can also be increassed with increased urea production due to GI bleed or renal injury |
|
|
Term
| what does specific gravity tell you in dehydration |
|
Definition
| the higher the specific gravity the more dehydrated |
|
|
Term
| what are signs you can see in lab tests during dehydration that will return to normal with hydration |
|
Definition
| few WBC and RBC, proteinuria, hyaline and granular casts |
|
|
Term
| when someone is in shock from dehydration what do you do |
|
Definition
| 20-60 mg/kg LR/NS then PRBC or albumin casts |
|
|
Term
| what do you give a dehydrated person whose pH is <7.1 |
|
Definition
|
|
Term
| what happens to neurons in dehydration |
|
Definition
| fluid shifts from cells to blood, neurons shrink and generate molecules to increase osmolarity inside |
|
|
Term
| if you rehydrate with hypoosmolar (lots of water and no molecules)fluid you get |
|
Definition
|
|
Term
| if you rehydrate with hyperosmolar fluid (lots of molecule sin it like juice) you get |
|
Definition
|
|
Term
| during the repletion phase explain how fluids are maintained, what is the exception |
|
Definition
0% of deficit over 8 hours and balance over next 16 hours
correct Ne deficits first, replace intracellular ions once urine output is estabilished
if hypernatremia replace over 48 hours |
|
|
Term
| daily maintience fluid also needs what in it |
|
Definition
| glucose at 20% of caloric needs, Na, Cl, K |
|
|
Term
| why cant you just live on iv fluids |
|
Definition
| because it is only 20% of glucose you need. not enough calories, proteins, fats, or minerals so you loose 0.5-1% of weight a day |
|
|
Term
| what is the most common fluids order |
|
Definition
| 5% dextrose (d5) in 1/4 normal saline (NS) + 20 mew/L KCl |
|
|
Term
|
Definition
|
|
Term
| calculate fluid deficit: 15 kig child is 5% dehydrated |
|
Definition
|
|
Term
| define insensible loss and portion of maintience water is it, what demographic looses a lot of this |
|
Definition
evaporative loss from skin and lungs what does not have electrolytes
1/3
premature babies especially in phototherapy |
|
|
Term
|
Definition
| as it is measured with a fluid the same electrolyte concentration as GI fluids every 1-6 h |
|
|
Term
| what conditions can decrease urine volume |
|
Definition
|
|
Term
| what conditions can cause increased urie volume |
|
Definition
| polyuric phase tubular necrosis, diabetes melltius and insipidus |
|
|
Term
| how is insensible loss replaced |
|
Definition
| 1/3 the the normal maintience rate |
|
|
Term
| what are normal Na levels |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what GI loations are prodominatly K |
|
Definition
|
|
Term
| what GI locations are prodominatly NA |
|
Definition
|
|
Term
| causes of hypernatremia due to Na (4) |
|
Definition
| improper formula, hypernatremic enamia, ingestion of sea water, iatrogenic invitro fertilization |
|
|
Term
| causes of hypernatremia due to water (6) |
|
Definition
| diabetes incupidus, diebetes mellitus, inadequate intake, breast feeding, increased water loss, gastric emptying |
|
|
Term
| sings of hypernatremia (4) |
|
Definition
tachycardia less likley
lethargy
iritability
idogenic osmoles in the brain to protect from shrinkage |
|
|
Term
| treatment of hypernatremia (4) |
|
Definition
emergency phase of dehydration treatment
give 75% of maintience fluid
slow correction over 48 hours
avoid rapid Na falls >10 meq/d |
|
|
Term
| hyponatremia causes due to increased renal loss (4) |
|
Definition
| due to mineralcorticoid deficiency, diruetics prematurirly,renal tubular acidosis, acute tubular necrosis |
|
|
Term
| hyponatremis causes due to external loss (6) |
|
Definition
| vomiting, diarrhea, burns, sweating, neogastric tube, cystic fibrosis |
|
|
Term
|
Definition
| volume depletion stimulates secretion of ADH preventing water excretion that should correct hyponatremia |
|
|
Term
|
Definition
doughy skin due to elevated serum sodium
neurologic symptoms |
|
|
Term
| treatment of hyponatremia |
|
Definition
| slow ocrrection so you dont get central pontine myelinolysis |
|
|
Term
| pseudohyponatremia: cause, treatment |
|
Definition
associated with lipids of increased glucose
serium sodium decreaed 1.6 meq/L for each increase in glucose 100 mg/dl |
|
|
Term
| hyperkalemia: K levels, causes, signs |
|
Definition
>5.5 meq/L
causes: iatrogenic, renal failure
signs: tall T waves, wide QRS, increased PR, ST depression, prolonged QT |
|
|
Term
| hyperkalemia treatment, warnings |
|
Definition
Na/K exchange resins
NaHCO3: shifts K into cells used for K>7 because it can cause hypocalcemia
10% Ca glyconate reverse EKG issues
insulin with dextrose infusion
dialysis |
|
|
Term
|
Definition
| vomiting, diarrhea, stomach pumping, decreased intake, gastroenteritis, lukemia, renal loss, transcellular shift, albuterol side effect |
|
|
Term
|
Definition
weakness, parasthesia, ileums
low T and U wave, ST depression dysrhythmia |
|
|
Term
|
Definition
| 40-60 meq/L CKl to IVF (standard is 20) |
|
|
Term
| where is Cl located mostly in the GI |
|
Definition
|
|
Term
| where is bicarbonate located mostly in the GI |
|
Definition
|
|
Term
| where is H located mostly in the GI |
|
Definition
|
|
Term
|
Definition
| hypokalemia, hypochloremia metabolic acidosis, hyperaldosteronism, hyperreninemia |
|
|
Term
| girelman syndrme: cause signs |
|
Definition
| autosomal recessive with hypokalemia and hypomagnesia |
|
|
