Lip Repair 3-6 mo Palate repair 6-12 mo

Feeding: longer nipples, NG/GU tube, feed & leave upright, frequent burping cuz swallow more air.

- thicken formula w/rice ceral

- spoon pour milk in mouth

- check gag reflex and breath sounds post op & post feeding

- palate post op wk 1: liquid wk 2: soft wk 3: full

- no oral temps, elbow restraints

* can cause ofitis media *

Candidiasis

- past to infant at birth or unclean bottles/pacifiers or breastfeeding

- white, curdlike plaques on tongue, gums and buccals

- _______ can pass through intestines and cause diaper candidiasis.

Colic

excessive crying every evening for several days a week. probably outgrow by 3-4 months. 

maybe .. allergy, cow milk interolerance, maternal anxiety, family stress, rapid/over feeding.

* Fluid requirements

 less than 10kg is 100 ml/kg

10-20 kg=1000 ml + 50 ml per kg 10-20

more than 20 kg = 1500 ml + 20 ml per kg over 20

* minimal UOP

infants/toddlers - > 2-3ml/kg/hr

preschool/young school age - > 1-2 ml/kg/hr

school age/adolescent - > .5 - 1 ml/kg/hr

F&E Balance

Eliminate the cause

mostly rectal to oral causes

No carbonated/sugar drinks, eat full diet

bacterial, viral, parasites, fungus

Dehydration

Bad 3%-5%, a lil thirsty, slightly decressed UOP

Worse 6%-10% ↑ HR, slightly ↓BP, thirsty, dry mouth, cap refill 3-5 sec, decreased skin turgor.

worst >10%, weightloss, ↑ Hr and weak, very ↓ BP, RR rapid & deep, drowsy, coma, cold, cap refill >5 sec.

How to Treat Dehydration

Mild - rehydrate, pedialyte, infalyte

mild/moderate - rehydrate, pedialyte, infalyte, 50 to 100 ml/kg over 3-4 hrs

severe - lactated ringer or NS initially in bolus

Pyloric Stenosis

- narrowing of pyloric

- DX ultrasound, upper GI

- watch resp & breath sounds hydration status

* Rt side semiflowlers after feeding; frequent burping

(projectile vomiting and olive shaped mass)

Hirschsprung

No ganglion fire in a portion of colon

Chief sign no BM 1st 24 hrs (ribbon stool)

*DX: barinm enema, punch BX, rectal exam, temp may indicate rupture colon

*Treat: mild case- enema, stool softener

severe case - remove portion of bowl

- Strong heredity, common w/down's syndrome

Post op: bowl sounds, NG tube, watch for passing stools

Intussusception

the little bowl goes into the big bowl. look for current jelly stools, a sausage shape mass in the RU.  Treat w/NS or Barium Enema.  IV pain meds observe for Barium return

 - may develop to shock, sepsis

- if enema unsuccessful, must do surgery

Helminths (worms)

Types: roundworms, pinworms, tapeworms and hookworms.

* Treat: pyrantel, wash hands.

Lead Poisoning

- Lead interfers w/RBC production, lead absorbed thru GI, lead stored in blood, bone -≥ 10 meg is toxic

* S&S Tethargy, anorexia, abd pain, nausea, vomitting, increased long bone density

- severe: clumsiness, retardation

* TREAT: Succimer (chelating agent) remove source, diet ↓ fat, ↑ iron

Failure to thrive fell below five (%)

Appendicitis

McBurney Point

increasing pain is cardinal sign

S&S N/VID, fever, chills

DX S&S; ultrasound will show enlarged appendix

Celiac Disease

(wheat, barely, rye, oats)

- growth <25%

profuse, watery diarrhea & V

usually found 9-12 mo

Dx by S&S: fat in diarrhea & intestine Bx

diet change

need supplements

Esophageal Atresia w/Tracheoesophageal Fistula

Classic signs (3 C's - choking, coughing, cyanosis)

the stomach attaches to the trachea

Dx if can't pass in an NG tube

keep baby supine & HOB 30º

must place an NG & aspirate every 5-10 mins

* Found at birth; emergency surgery

- Post Op chest tube, G Tube, use a pacifier

U.T.I

E.Coli most common

if its upper: fever abd pain, vomit (Systemic)

Lower: burning, pressure (Local)

Dx: "dipstick", bacteria & ↑ WBC

IVP, CT Scan

Trent w/Ax

Peridium, uristat for pain relief/stains urine will stain clothes

Enuresis

(it's cool to pee in your pants)

Primary - never been potty trained

Secondary - there was a period of dryness

Vesicoureteral Reflux

malfunctioning valve allows urine from the bladder back up the ureter to the kidney

causes recurring UTI's

Most spontaneously resolve so prophalactic Ax are used & frequent screening from UTI's

*Deflux, injecteable gel that builds a protective wall inside ureter to prevent backflow*

Cryptorchidism

(drop your balls)

most spontaneously descend in first year

↑ rate in premature births

↑ risk for malignancy & infertility

surgical correction if not self-resolved

Hypospadias (pee hole on bottom)

Epispadias (pee hole on top)

Chordee downward curve of shaft

surgery done at 6-12 months

Don't circumcise, foreskin may be used in surgery repair

PHimosis

(inability to retract foreskin)

accumulation of sebacious glands

mild cases corrected thru cleaning & gentle manual retraction

severe - surgical enlargement of phimotic ring or circumcision

Hydrocele

a painless swelling of the scrotum

no need to treat for first 12-18 mo

Testicular Torsion

Rotation of testicle that interrupts blood supply, causing irreparable damage if not corrected quickly.

* S&S: severe pain, erythema, edema

* Surgical emergency

 Bladder Exstrophy

Bladder extrusion to the outside of the body

protect w/nonadhering plastic wrap until surgery, can be 1 or more stages.

Wilms Tumor

renal tumor

avg Dx 2-5 yrs most by 7 yr

usually unilateral

S&S: most common is an asymptomatic, mobile abd mass also HTN, abd pain, fatigue, anemia & feber

Dx: Ab'd CT/MRI

Treat: Surgery, chemo, radiation

Tay-Sachs

Jewish

abnormal buildup of gangliosides

after 6 mo normal infacts show development & delay & deterioation

Macroencephaly, seizures, blindness & deafness

death in early childhood

Treat: symptomatic & supportive

Congenital Hypothyroidism

Skin molting

large fontanel

large tongue

slow reflexes

prolonged jaundice

dull expression

Test about day 3 after post delivery rise in TSH has passed

Hyperthyroidism

(Graves Disease)

↑ appetite, weightloss, bulging eyes, ↑ HR

propylthiorceil PPU

Lagol's Soln, 10-14 days, pre thyroidectomy

Diabetes Insipidus

S&S ↑ thirst

Polyuria

DDAVP

Precocious Puberty

puberty comes early < 9 yr boys <8 yr girls

check for elevated hormone levels

TREAT: Gn RH against

RF Profalaxis

10-40

10-21

5-21

Diseases

Fetus - 5ths, measles x2, chickenpox

Transmission by secretions: EpsteinBarr & 6th

Airborne: Measles and Chickenpox

Droplet: Everything else

Protects the patient from others immuno suppressed etc.

Active/Passive Immunity

Active - acquired by fighting the disease

Passive - acquired thru immunization or in utero

Beta -Thalassemia

abnormality in hemoglobin synthesis

signs: pallor, growth retardation, severe anemias, characteristic face, enlarged speen/liver, bronze skin

diagnostic - CBL, serum iron, hemoglobin A

Treatment - RBL transfusion, chelation therapy & splenectomy

Hemophilia

A- Factor VIII

B - Factor IX

Three causative factors are: 8,9,11

Recombinant antihemophilic factor

Kawasaki

Unknown cause

3 phases: 1st acute lasts 10-14 days has high fever longer than 5 days, signs bilateral nonpurulet conjunctivitis; change in mucosa "strawberry tongue"; change in periphrial extremeties (swelling, redness hands & feet)

rash, swollen cervical lymph nodes, tachycardia

2nd phase lasts from day 15-25 fever & most symptoms gone.  Present anorexia, desquamation fingers/toes, CHF, arrhymias & aneurysm.

Treat with high dose IV immume globulin (IVIG) & high dose aspirin

Bacterial Endocarditis

an inflammation resulting from infection of the cardiac valves & endocardium.  Most cases present in patients w/CHD.

Staph usually responsible

Symptoms include: fever, anorexia, nausea, fatigue, arthealgias, chest pain, heart failure, petechiae & embolism caused by "vegitation"

- symptoms & positive blood culture= diagnosis

- Treatment is 2-8 weeks antibotics; surgical removal of "vegitation" or infected valvue is indicated in CHF

RF

- caused by untreated Strep throat

-penicillin to kill Strep (Erythromycin if allergic to Penicillin)

-Aspirin or steroids (if severe carditis) for inflammation

-Major signs - carditis, arthritis, chorea, red lesions, subq nodules

ARDS

- Treated in ICU, treat underlying cause, O2 or mechanical ventalation, cont pulse ox, maintain cardiac function, stabalize hematoma

- Monitory resp status, ABG's, monitor urine output, cop refill, perfusion