很重要SAUNDERS Pediatric - DISORDERS( 2 )

Bladder exstrophy 膀胱外翻

Bladder exstrophy is a congenital anomaly that is characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is unknown, and there is a higher incidence among males.

cerebral palsy 脑性麻痹

Cerebral palsy is a chronic disability characterized by impaired movement and posture(考）.

decerebrate posture 去大脑强直体位

Decerebrate (extension) posturing is characterized by the rigid extension and pronation of the arms and legs（考）.

Barlow test

Detection of unstabloe hip by adduction and extension of hip. The "feel" of dislocation is felt as femur leaves acetabulum (记adduction ，Test will dislocate the hip)

Down syndrome

Down syndrome is an example of a congenital condition that results in moderate to severe retardation.

Encephalitis 脑炎

Encephalitis is an inflammation of the brain that occurs as a result of viral illness or central nervous system infection

hemolytic-uremic syndrome 溶血性尿毒症

HUS is thought to be associated with bacterial toxins, chemicals, and viruses that cause acute renal failure in children. Clinical features of the disease include acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms. A child with HUS who is undergoing peritoneal dialysis for the treatment of anuria will be on fluid restrictions（考）. Pain is not associated with HUS, and potassium would be restricted rather than encouraged if the child was anuric. Peritoneal dialysis does not require an AV fistula (only hemodialysis does). 注：Kidney failure can cause anuria: This condition occurs when your kidneys can no longer provide key functions, including urine output. Kidney disease may be treated with dialysis to remove fluids and waste. The nurse is planning care for a child with hemolytic-uremic syndrome (HUS). The child has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to include which intervention in the care of the child? --ANS: Restriction of fluids, as prescribed

Buck's skin traction

Is a type of skin traction that pulls the hip and leg into extension（考）

Epispadias 尿道上裂

a congenital abnormality in males in which the urethra is on the upper surface of the penis.

Decorticate posture 去大脑皮质体位

-"flexor posturing" or "mummy baby" (think Egyptian mummy preservation) -adduction of arms (arms fold to chest); flexion of elbows and wrists

clubfoot 畸形足

1. Clubfoot, one of the most common deformities of the skeletal system, is a congenital anomaly （考）characterized by a foot that has been twisted inward or outward. The condition generally affects both feet（记）, and boys are affected twice as often as girls（记）. 2. The treatment for clubfoot is started as soon as possible after birth（考）. Serial manipulation and casting are performed at least weekly（记）. If sufficient correction is not achieved within 3 to 6 months, surgery is usually indicated（记）. Because clubfoot can recur, all children with the condition require long-term interval follow-up until they reach skeletal maturity to ensure an optimal outcome（记）.

SSRIs

1. Examples of SSRIs used to treat anxiety include: escitalopram (Lexapro) fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) 2. SSRIs can cause several kinds of side effects, but most people tolerate them well. These side effects can include: nausea dry mouth muscle weakness diarrhea dizziness drowsiness sexual dysfunction

Tricyclics

1. Examples of tricyclics used for anxiety include: clomipramine (Anafranil) imipramine (Tofranil) 2. Tricyclics are older drugs that are used less often today because newer drugs cause fewer side effects. Side effects of tricyclics can include dizziness, drowsiness, lack of energy, and dry mouth. They can also include nausea and vomiting, constipation, blurred vision, and weight gain. Side effects can often be controlled by changing the dose or switching to another tricyclic.

Glomerulonephritis

1. Gross hematuria resulting in dark, smoky, cola-colored or red-brown urine（考） is a classic symptom of glomerulonephritis, and hypertension is also common. A mid- to high urinary specific gravity is associated with glomerulonephritis. BUN levels may be elevated. 2. Activity is limited（考） in most children, because of fatigue. Visitors should be limited to allow for adequate rest.

nephrotic syndrome

1. Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria（考）, hypoalbuminemia（记）, edema（考）, elevated serum lipids（考）, anorexia（考）, and pallor（考）. The urine volume is decreased, and the urine is dark and frothy in appearance. The child with this condition gains weight（记）. 2. 1. The nurse is assisting in preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which intervention is most appropriate for this child? --ANS: Encourage the child to eat in the playroom（考）. (Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit.) 注：nephrotic syndrome pt 不需要吃太多protein食品，A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

Antidepressants

1. SSRIs Selective serotonin reuptake inhibitors (SSRIs) work by increasing levels of serotonin, a neurotransmitter that affects mood, sexual desire, appetite, sleep, and memory. 2. Tricyclics Tricyclics work as well as SSRIs do for treating most anxiety disorders except obsessive-compulsive disorder (OCD). 3. MAOIs (MAOIs) are used to treat panic disorder and social phobia. Like tricyclics, MAOIs are older drugs that cause more side effects than newer drugs. MAOIs also come with certain restrictions. For instance, if you take an MAOI, you can't eat certain foods, such as cheese and red wine. You also can't take certain medications, including SSRIs, some birth control pills, pain relievers such as acetaminophen and ibuprofen, cold and allergy medications, and herbal supplements. Using an MAOI with these foods or medications can dangerously increase your blood pressure and cause other potentially life-threatening side effects.

Reye's syndrome (" 瑞氏"）雷氏症候群

1. Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this. 2. Reye's syndrome is an acute encephalopathy that follows a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver. A definitive diagnosis is made by liver biopsy. In Reye's syndrome, supportive care is directed toward monitoring and managing cerebral edema. Decreasing stimuli in the environment by providing a quiet environment with dimmed lighting would decrease the stress on the cerebral tissue and neuron responses（考）. 3. The child should be positioned with the head elevated to decrease the progression of the cerebral edema and promote drainage of cerebrospinal fluid. 4. priority nursing intervention for the child? --ANS: Providing a quiet atmosphere with dimmed lights(考） （The major elements of care for a child who has Reye's syndrome are to maintain effective cerebral perfusion and to control intracranial pressure. Decreasing stimuli in the environment should decrease the stress on the cerebral tissue and the neuron responses)

juvenile idiopathic arthritis （juvenile ['dʒuːvənaɪl] 青少年的）

1. Systemic autoimmune disease that involves the joints, connective tissues, and viscera; pt should exercise large joints, be encouraged to perform independent self-care, sleep on a firm mattress, take NSAIDS with food, splints during the night, high-fiber diet, and monitor for communicable dx 2. JIA is twice as likely to occur in girls as in boys（考）. 3. "Clinical manifestations include morning stiffness and painful, stiff, swollen joints."（记） The cause of JIA is unknown. JIA has two peak ages of onset: between 1 and 3 years of age and between 8 and 10 years of age. （记） 4. Pain management and care during exacerbations of juvenile idiopathic arthritis： The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse should make which response to the mother? --ANS: "Have the child perform simple isometric exercises during this time."(考） During painful episodes, hot or cold packs, splinting, and positioning the affected joint in a neutral position help to reduce the pain. Although resting the extremity is appropriate, it is important to begin simple isometric or tensing exercises as soon as the child is able. These exercises do not involve joint movement.

hypospadias 尿道下裂

1. The nurse provides instructions to the mother, knowing that which long-term complication is associated with hypospadias? --ANS:Renal anomalies(考） （The nurse should ask the child's parents about the child's kidney function because hypospadias may be associated with renal anomalies.) 注：Infertility，Erectile dysfunction，Decreased urinary output are not associated with a long-term effect of hypospadias. 2. After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed to prevent infection（考）. Diapers are placed on the child to prevent the contamination of the surgical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.

Cast care

1. not to use lotion or powders on the skin around the cast edges or inside the cast because they can become sticky or caked and cause skin irritation（考）. 2. Synthetic casts树脂石膏 and plaster casts 传统石膏 Synthetic casts dry quickly (in less than 30 minutes) and are lighter than plaster casts. Synthetic casts allow for greater mobility than a plaster cast（考）. However, synthetic casts are not as strong as plaster casts and are more expensive.

MAOIs

1.MAOIs approved by the FDA to treat depression but used off-label for anxiety include: isocarboxazid (Marplan) phenelzine (Nardil) selegiline (Emsam) tranylcypromine (Parnate) 2. Like tricyclics, MAOIs are older drugs that cause more side effects than newer drugs. MAOIs also come with certain restrictions. For instance, if you take an MAOI, you can't eat certain foods, such as cheese and red wine. You also can't take certain medications, including SSRIs, some birth control pills, pain relievers such as acetaminophen and ibuprofen, cold and allergy medications, and herbal supplements. Using an MAOI with these foods or medications can dangerously increase your blood pressure and cause other potentially life-threatening side effects.

autism spectrum disorder 自闭症谱系障碍

A disorder characterized by deficits in social relatedness and communication skills （考）that are often accompanied by repetitive, ritualistic behavior.

Pavlik harness 帕氏吊带

The harness should be worn 23 hours a day and should be removed only to check the skin and for bathing（考）. The hips and buttocks should be supported carefully when the infant is out of the harness. The harness does not need to be removed for diaper changes or feedings.

Benzodiazepines（精神科用药）

The most common group of antianxiety drugs, which includes Valium and Xanax. alprazolam (Xanax) chlordiazepoxide (Librium) clonazepam (Klonopin) diazepam (Valium) lorazepam (Ativan)

hydrocephalus 脑积水

The nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If the infant's level of consciousness diminishes, which is a priority intervention? --ANS: Palpating the anterior fontanel(考） A full or bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle.

hip dysplasia 髋关节发育不良

abnormal development of the pelvic joint causing the head of the femur and the acetabulum球窝 not to be aligned properly 1. An infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. Which finding is associated with this condition? --ANS: Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table(考）

scoliosis 脊柱侧弯

abnormal lateral curvature of the spine. Instructions for a child in a brace: The nurse is reinforcing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further teaching? --ANS: "I will apply lotion under the brace to prevent skin breakdown."(考） The use of either lotions or powders should be avoided because they can become sticky or cake under the brace, thus causing irritation.

Ortolani test

check hips for congenital dislocation, done until 1 yr old, should be smooth with no sounds , abnormal= feels like a clunk as head of femur pops back into place- positive ortolani sign (记aduction, Test will reduce还原 the hip)

spica cast

encases a portion of the trunk & 1-2 extremities; potential complications severe impairment in mobility: skin breakdown, respiratory dysfunction, constipation, joint contractures The nurse is assigned to care for a child with a spica cast. Which action should be avoided when caring for the child? --ANS：Using pillows to elevate the head and shoulders（考） （Pillows should not be used to elevate the head or shoulders of a child in a body cast because the pillows will thrust the child's chest against the cast and cause discomfort and respiratory difficulty.）

Meningitis 脑膜炎

is an infectious process of the central nervous system.

cryptorchidism [krɪp'tɔrkɪdɪzəm] 隐睾症（krip 拖key敌人） and orchiopexy [,ɔ:ki'ɔpəksi] 睾丸固定术

undescended testicles 1. Cryptorchidism may be the result of hormone deficiency, intrinsic abnormality of a testis, or a structural problem. Diagnostic tests would assess kidney function （考）because the kidneys and testes arise from the same germ tissue. 2. The child with cryptorchidism is being discharged after orchiopexy, which was performed on an outpatient basis. The nurse should reinforce instructions to the parents about which priority care measure?（ANS: C) A. Measuring intake and output B. Administering anticholinergics C.Preventing infection at the surgical site D.Applying cold, wet compresses to the surgical site The most common complications associated with orchiopexy are bleeding and infection(考）. The parents are instructed in postoperative home care measures, including the prevention of infection, pain control, and activity restrictions. The measurement of intake and output is not required. Anticholinergics are prescribed for the relief of bladder spasms; they are not necessary after orchiopexy. Cold, wet compresses are not prescribed. The moisture from a wet compress presents a potential for infection. 3. All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury（考）. This will prevent dislodging of the suture, which is internal.