Bones, Bones, Bones
What is the age clubfoot is typically treated with serial casting?
Usually before 1 month of age
What are the broad categories of CHD and what are their primary concerns?
Acyanotic - HF
Cyanotic - Hypoxia
What is considered neutropenic?
ANC <1000
What complication do almost all spina bifida cystica (myelomeningocele) patients have?
Hydrocephalus
What is the FLACC scale?
Faces, Legs, Activity, Cry, Consolability
What are two DDH assessments?
Most reliable up to 2-3 months of age, before adduction contractures develop (only done by an experienced clinician)
Barlow: dislocates hip
Ortolani: dislocates hip posteriorally then "reduces" hip back into joint
Asymmetry of thigh/gluteal folds, limitation of hip abduction after 6 weeks old, Galeazzi sign (different leg lengths at walking age)
Diagnosed with ultrasound up to 6m, then x-ray; CT/MRI after reduction and casting Barlow: dislocates hip
Ortolani: dislocates hip posteriorally then "reduces" hip back into joint
What are two clinical manifestations of ventricular septal defects?
CHARACTERISTIC MURMUR
failure to thrive
frequent respiratory infections
bilateral lung sounds with rales and rhonci
at risk for bacterial endocarditis and pulmonary vascular obstructive disease
How is AML/ALL diagnosed?
bone marrow biopsy/aspiration
labs
lumbar puncture
What are two considerations for siblings at the end of life?
- Include siblings throughout the illness and dying process
- Allow them to go about their routine, school, friends, etc.
- Talk with them honestly about what is going on so they don't feel isolated and left out
- Encourage parents to spend extra time with siblings. This can be hard as the focus of attention is usually on the dying child
- Let siblings participate in care and decisions if they want
- Funerals are a way to say goodbye and for people to show how much they care. - Encourage families to let them help with the plans, and to attend the funeral
What is the daily MFR of a child weighing 24kg?
First 10 kg: 100 mL/kg/day
Next 10 kg (11–20 kg): 50 mL/kg/day
Each kg >20 kg: 20 mL/kg/day
Answer: 1580 mL/day
What are the three phases of bone healing?
Inflammatory (hours to days) - inflammatory reaction, torn vessels lead to hematoma
Reparative (days to weeks) - soft calluses on bone ends from hematoma and new osteocytes, becomes hard callus "clinical union"
Remodeling (weeks to years) - responds to activity/functional demand/growth, fractures site becomes smoother and sculpted
What medication can be used in Tetraology of Fallot and how does it help?
Prostaglandins
Keep the ductus arteriosus OPEN
allows more blood to reach the lungs, improving oxygenation
What are some causes of gynecomastia in male adolescents?
Normal if transient and during puberty
Should not persist longer than 2 years
Prepubescent or Tanner stage 5
Need evaluation for adrenal or gonadal tumors, liver disease, or Klinefelter syndrome
Drug-induced
Spironolactone, cimetidine, ketoconazole, estrogens and antiandrogens
When is the ketogenic diet started? What is it?
usually after the failure of 3 anticonvulsant trials or unacceptable side effects
prolonged carb deficiency, high fat, limited protein; start NPO except water
What are some late signs of respiratory distress in pediatric populations?
decreased LOC, bradycardia, apnea, hypotension
What ages should children be screened for scoliosis?
Girls: 10-12
Boys: 13-14
What are four nutrition considerations for infants with CHD?
nipple size, fluid restrictions, adding calories
polycose, MCT oil, smaller and frequent calorically dense feeds
supplementing with NG feeds
monitoring feeding time
Name four safety considerations for adolescents.
Gun related violence
Suicide
1 in 5 teens "seriously considered suicide in the past year"
PSQ-2 - suicide questionnaire with two questions
SLAP: Specificity, Lethality, Accessibility, Proximity
Self-harm
Importance of complete physical assessment
Motor Vehicle Accidents - Distracted Driving
Substance Use
Smoking and Vaping
Disordered Eating
Recognizing early signs: changes in eating, changes in growth, withdrawing for social interaction, changes in exercise
Physical Fitness and Health
Sedentary activities
Sexual Health
Prevention and Screening for STIs
Testing for HIV
What are the two signs of meningitis and what are they?
Brudzinski's Sign - severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed
Kernig's Sign - sever stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed 90 degrees
What is the minimal acceptable output for urine in pediatrics?
1 mL/kg/hour for infants/children
0.5 mL/kg/hour for adolescents
What are some signs of Duchenne Muscular Dystrophy?
A. Abnormal early gross motor development
B. Weakness in toddlerhood
C. Waddling gait
D. scoliosis in toddlerhood
E. Lordosis
F. Gower position
B, C, E, F
most common and most severe form of muscular dystrophy
- typical early gross motor development
- weakness and gross motor delays begin in toddlerhood (between 3-5 y/o)
- waddling gait, lordosis, Gower position, multiple body systems affects (pulm, cardio, GI, neuro)
- develop contractures in small joints, scoliosis, loss of ambulation by early adolescence
Name the CHDs we need to know for the exam
VSD
Coarctation of Aorta
TOF
How does a nurse promote health autonomy for teens?
Developing self-advocacy - addressing them directly, asking them questions
Confidentiality - being careful of what's documented in the EHR
Creating a safe environment
Creating adolescent friendly spaces
Advocating for nurses and health care in easy to access location
What are five nursing considerations for a pediatric seizure patient?
Observe closely (time)
ASK for help!
Maintain pt safety
Seizure precautions: suction, O2, bag and mask available, padded bedrails, oral airway
Maintain IV access
Monitor VS
Keep family informed
Post-seizure: Pt may need glucose check to see if it is due to metabolic disease or undiagnosed diabetes can cause hypoglycemic induced seizures
What are five differences in a pediatric GI system?
Dec HCl = children cannot break things down as well as adults
Smaller stomach capacity
intestinal motility is increase = inc risk of dehydration
small intestine has more secretory glans = inc risk of dehydration
Pancreas: enzymes decreased until 4-6 months
Large intestine: proportionately shorter than an adults - less epithelial lining means less availability for water re-absorption = inc risk of dehydration
Liver: functionally immature until at least 1 year of age
-less effective glycogen storage and synthesis
- inadequate vitamin storage and iron stores
- less efficient drug metabolism
- lower prothrombin (inc risk of bleeding) and albumin levels (inc risk of toxicity)
- secretes less bile (dec fat aborption)