Exam 1 Study Guide KEY TERMS FROM EVOLVE

It would be helpful to know the presentation & signs/symptoms (what would the kid look
like), diagnostic studies, and treatment for each disorder listed below.
-APPLICATION QUESTIONS know what is abnormal and what to do with abnormal
1. Resp

Upper respiratory tract: oronasopharynx, pharynx, larynx, and upper part of the
trachea

Lower respiratory tract: lower trachea, mainstem bronchi, segmental bronchi,

subsegmental bronchioles, terminal bronchioles, alveoli

Infections of epiglottis & larynx Croup disorders

Respiratory tract infections

Account for majority of acute illnesses in children
Etiology and course influenced by:
o Age
Younger than 3 months presumed to have a lower infection rate
because of maternal antibodies; however may be susceptible to
pertussis during this period.
Infection rate increases from 3-6 months of age, when
disappearance of maternal antibodies and infants own antibody
production.
Viral infection high in toddler and preschool years
By age of 5 viral respiratory tract infections les frequent but
incidence of mycoplasma penumoniae and GABHS infections
increases
Lymphoid tissue increases as age, and repeated exposure to
organisms increases immunity
o Size
o Resistance
Conditions that weaken the defense of respiratory tract: allergies,
preterm birth, bronchopulmonary dysplasia, asthma, history of
RSV, cardiac anomalies that cause pulmonary congestion, and
cystic fibrosis
o Season
Most common respiratory pathogens during winter and spring
months
Mycoplasmal infections- autumn and early winter
Infection related asthma- cold weather
RSV season- winter and early spring
o Living conditions
o Preexisting medical problem

a. Respiratory Assessment
i. Color (cyanosis), LOC know baseline, respiratory effort/pattern,
position bending over/tripod, breath sounds, evaluation of
oxygen (>94%), talking/crying?, nasal flaring, grunting,
retractions, metabolic acidosis (pH<7.35, HCO3<22 mEq/L),
alterations in perfusion (decreased capillary return), HR, SOB,
respirations/min, finger clubbing,
ii. Assessment should include respiratory rate, depth, and rhythm,
heart rate, oxygenation, hydration status, body temperature,
activity level, and level of comfort.
iii. A noninvasive pulse oximeter (oxygen saturation) measurement to
be performed for ALL children as apart of a routine physical
assessment.
Normalrangesforvitalsigns
VitalSign

Infant

Child

PreTeen/Teen

0to12months

1to11years

12andup

HeartRate

100to160beatsper
minute(bpm)

70to120bpm

60to100bpmdrin

Respiration
(breaths)

0to6months
30to60breathsperminute
(bpm)
6to12months
24to30bpm

1to5years
20to30(bpm)
6to11years
12to20bpm

12to18bpm1

Temperature

Allages
Allages
Allages
98.6F
98.6F
98.6F
(normalrangeis97.4Fto (normalrangeis97.4Fto (normalrangeis97.4Fto
99.6F)
99.6F)
99.6F)

Water or cool mist is common therapeutic measure for respiratory discomfort

o Safety precautions
Time honored method (albeit not evidence based!) of producing steam is the
shower
o Keeping child in this environment for approximately 10-15
minutes humidifies inspired air and can help relieve symptoms

Saline nose drops may be administered 15-20 minutes before feeding and at a
bedtime. Two drops are instilled and because this shrinks only the anterior
mucous membranes, two more drops are instilled 5-10 minutes later
o Phenylephrine 0.25% (for infants and children older than 6 months
of age)
o Ephedrine 1% (for children older than 6 years of age)
o Oxymetazoline 0.04% (children older than 6 years of age)
o Nasal sprays (older children)
Taught to compress the plastic container at the moment of
inspiration while occluding the other nostril
Should not be administered for more than 3 days due to
easy contamination
To prevent cross contamination with nose drops, draw the
nose spray solution into the childs nostrils using the blunt
syringe
Hot or cold applications provide relief for children with painful cervical
adenitis
Reducing body temperature
o Acetaminophen or ibuprofen (for infants and children 6 months
and older)
o Cool liquids
Dehydration is a potential complication in respiratory infections, and are
febrile or anorectic, especially when vomiting or diarrhea is present
o Infants especially prone to fluid and electrolyte deficits due to
rapid RR
o Adequate fluid intake encouraged by offering small amounts of
favorite fluids (clear liquids if vomiting at frequent intervals)
o Oral rehydration solutions: Infalyte or Pedialite (infants) & water
or a low carb flavored drink (older children)
o Fluids should not be forced, gentle persuasion more successful
o To assess level of hydration
Observe voiding frequency
Counting # of wet diapers in 24 hours
In hospital, diapers weighed to assess output, which should
be at least 1 ml.kg.hr up to 30 kg in weight
Then it should be at least 30 ml per hour in patients
weighing more than 30 kg

b. Upper Respiratory Infections

i. Acute Laryngotracheobronchitis (Croup)

1. Viral, cause - RSV or parainfluenza, varied degrees of

subglottic obstruction, prior hx of URI 3-4 days ago
2. S/S laryngeal spasm (Decreases with cool temp), barking
cough, inspiratory stridor (squeaky), hoarseness sounds
worse than it is, 3mo-5year
3. Diagnosis based on symptoms, possible chest x-ray
4. Treatment cool mist, fluids, recemic epinephrine open
upper airway, steroids decrease inflammation, no
antibiotics (VIRAL), at home keep calm and comfortable
encourage clear fluids and steroids. May be advised to go
in to ER; however if drive during cold weather with
windows open symptoms may subside.
ii. Epiglottitis
1. Acute inflammation of supraglottal structures precipitating
mechanical obstruction life threatening, complete airway
obstruction can develop after onset with manipulation of
neck or airway
2. Cause H. flu, incidence decrease with vaccination
3. Presentation acute sudden onset, high fever, soar throat,
dysphagia (difficulty swallowing), muffled voice, drooling,
tripod position, progresses to respiratory distress,
inspiratory stridor, retractions, 3-8years
4. Diagnosis pulse ox, throat examination, chest or neck xray, throat culture and Hib. Blood cultures
5. Management medical emergency, trach equipment
nearby, keep child calm, antibiotics, swelling will decrease
by 24hrs
iii. LTB vs Epiglottis
1. LTB

a. Cough, no dysphagia, no or low fever, prior URI,

sounds worse than looks, usually viral, position of
comfort, 3 months-5 years
2. Epiglottis
a. No cough, drooling, high fever, +/- URI, looks
worse than sounds, usually h. flu, tripod position, 38 years
iv. URI (viral) - COLDS
1. Frequent in children younger than 3
2. Reassure that this is a normal part of childhood and that by
5 years of age immunity will be more further developed
3. S/S- rhinitis (nasal congestion), cough, fever, irritability,
anorexia, vomiting, diarrhea, irritability
4. Diagnosis based on symptoms
5. Treatment isolation, elevate HOB, saline nose drops or
warm water/bulb suction (<1 year 1 drop each nostril til
clear), monitor fever, SOB, cough, encourage fluids,
medication to control fever, antahistamine (>5yr)
a. Fever = >104 F, fever is a symptom not disease.
Usual fevers 37.8-40 C are not harmful. Most
caused by viral illnesses. may last 2-3days,
acetaminophen OR ibuprophen (AAP doesnt
recommened prescribing both at the same time for
fevers as there is a high risk for liver/kidney
problem r/t overdose)(no aspirin), recheck temp,
remove clothing, fan, ice packs under arms/groin,
sponge bath if H20 T.40 C (104 F), fan

i. Call HCP if < 3 mo. Old, T > 41.5 C (105F),

looks sick, lethargic
ii. Reset set point (antipyretic meds) before
using environmental issues
b. Cannot use decongestants for children younger than
5 years old. Alternatives: normal saline/humidifier
c. Antihistamines can be used for other situations
however when suppressing cough and clearing
airway may lead to death
c. Lower Respiratory Infections
i. RSV
1. Most important respiratory disease of infancy and early
childhood
2. Transmitted: direct contact with respiratory secretion, direct
inoculation from aerosolized particles, distant aerolized
inoculation unlikely, can live for hours in dry environment
3. Virus, inflammation of respiratory tract mucosa,
bronchiolar mucosa swell, epithelial cells lose cilia, lumina
filled with exudate, mucus, cells shed into bronchioles
causing partial obstruction, hyperinflation, atelactasis, air
trapping, airborne precautions, recover 2-3wks if healthy
4. Increased risk of developing asthma after RSV
bronchiolitis (due to scarring)
5. S/S- initial= rhinorrhea (nasal congestion), cough, low
grade fever, otitis (ear pain), conjunctivitis (pink eye),
pharyngitis, wheezes, in winter or spring, less than 2yr
peark 2-5 months, Later= increase wheeze, cough, air
hunger, tachypnea (^resp), retractions, cyanosis, crackles,

decreased breath sounds SERIOUS= listless, poor fluid

intake, respiratory compromise, tachypneic, retractions,
hypoxic, O2 stat less than 94%
6. Cause bronchiolitis (inflammation of the bronchioles)
a. In the bronchiolitis, the airway becomes obstructed
from swelling of the bronchiole walls; Easier for
pathogens to get into childrens bronchioles as they
have less defense in lower amounts of lymphatic
tissue and shorter distance to bronchioles
7. Management diagnosis by nasal NP swab rapid results,
90% accurate, humidity, fluid (IV), rest, elevate HOB,
saline to clear nares, oxygen, ribavirin rare, antiviral
agent, Synagis immunization monthly IM, given <2yr
with chronic lung disease, preterm infants, CHD
(monoclonal antibody)
8. When to hospitalize- listless, poor fluid intake, respiratory
compromise, tachypnea, retractions, hypoxic
9. Treatment- symptomatic and supportive care (IV fluids,
nutrition, oxygen, treat bronchospasm); Ribavirin
controversial (antiviral agent, aerolized via hood, mask,
ventilator, controversy)
a. AAP recommendations for Ribavirin use
i. High risk infants w/ RSV
1. Complex CHD
2. Lung disease
3. Preterm infant (<37 weeks)
ii. Hospitalized, severely ill infants w/ RSV
bronchiolitis
iii. Immunocompromised infants w/ RSV

1. Severe combined immunodeficiency

(SCID)
2. HIV
3. Transplant patients
d. Respiratory Emergencies
i. Choking/foreign body aspiration
1. Upper airway is smaller with inspirations and larger with
expirations, lower is opposite, Types partial, larger,
complete (no O2)
2. Causes hot dogs, round candy, neanuts, grapes, latex
balloons, button, coin, ect.
3. S/S rapid onset, sudden onset coughing/choking,
inpiratory stridor, SOB, hoarse cry/voice, suprasternal
retractions, aphonia (cant speak), pneumonia, wheezing,
cyanosis, dyspnea
4. Treatment removal of foreign object depending on size,
risk
ii. Obstruction
1. Infant airway is 4mm vs adult 10mm
2. First degree obstruction: obstruction allows passage of air
in both directions
3. Second degree obstruction: air able to move past the
obstruction in one direction only. Air passages enlarge
during inspiration and diminish during expiration.
4. Complete obstruction: Air unable to move in either
diretion. FB and edematous mucosa obliterate passage.
iii. Epiglottitis
1. life threatening, complete airway obstruction can develop
after onset with manipulation of neck or airway
2. Acute inflammation of supraglottal structures precipitating
mechanical obstruction
3. H. flu is most common cause; High mortality

4. Mortality rates decreased 32-7% since 1970s--Significantly

decrease with the introduction of Hib vaccine in 1991, also
H flu is responsible for bacterial meningitis and has greatly
decreased with the vaccination.
5. Clinical Manifestations: acute, sudden onset; high fever;
severe sore throat, dysphagia; muffled voice; drooling;
tripod position; progresses to respiratory distress;
inspiratory stridor retractions
6. MEDICAL EMERGENCY- do NOT instrument throat,
keep child calm in parents lap, antibiotics, swelling usually
down by 24 hours.
e. Asthma
i. Release of inflammatory mediators from bronchial mast cells,
altered ANS control of airway tone, increase smooth muscle
reativity, accumulation of thick secretions of muscus,
bronchospasm, imflammation/edema of mucus membranes, spasm
of smooth muscle of bronchi
1. Early response antigen > histamine release >
bronchospasm, resolves 1-3hrs
2. Late response onset of airway obstruction 4-6hrs later,
persistent inflammatory response
ii. s/s episodic wheezing in response to triggers, cough at night
without cold, inflammation, bronchial hyper-responsiveness, age of
onset is older, diminished lung function, related to allergic
reaction, hyper-resonance, coarse breath sounds, long expiratory
phase, I&E wheezes, absence of wheezes may be ominous sign

iii. Diagnosis The most certain way to diagnose asthma is with a

lung function test (spirometry, allergy tests, bronchoprovocation
test), a medical history, and a physical exam (allergy tests).
However, it's hard to do lung function tests in children younger
than 5 years. Thus, doctors must rely on children's medical
histories, signs and symptoms, and physical exams to make a
diagnosis.
iv. Treatment infant treat cause, supportive care, possible
bronchodilators, classic allergin control(dust, animals), Meds B
agonists (albuterol), anticholinergics (atrovent), corticosteroids
(inhales or systemic), cromolyn (prevents histamine, leukotriene
release)
v. Management Education! know triggers, allergin control,
recognize early signs, use of MDI and spacer, use of PEFM (assess
status of asthma), promote activity, promote health, team approach
to management and plan, involve school
f. Otitis
i. Media
1. One of most prevalent diseases in early chidhood;
incidence highest in winter months
2. Two viruses most likely to cause- RSV & Influenza
3. Most common, r/f smoker in house, daycare, bottle
feeding(must bottleprop) (bottle feeding can allow for
pooling of formula in posterior area of oral cavity and work
its way to ears and sinuses; formula great medium for
bacterial growth), children at greater risk due to shorter and

straighter eustachian tube, caused by allergies or upper air

way infection (influenza, strepp, catarrhalis)
4. S/S 6mo-2yr, fever, pain, decreased hearing, diarrhea,
irritability, fever, pain, anorexia, URI symptoms
(congestion, conjunctivitis, sore throat/pharyngitis,
sinusitis, diarrhea (young children will be seen pulling at
their ears)
5. Diagnosis pneumatic otoscope (reddened), must pull
DOWN ear
6. Treatment monitor temp, s/s, dehydration, monitor SI of
medications, acetaminophen for pain and inflammation,
reassure parents, antibiotics shorten course of infection,
must have >3 infections/year, >3days of infection, +culture,
immunosupression, daycare, smoker in the home.
a. Amoxicillin PO, 80-90mg/kg/day
i. 1st line of treatment (CDC)
b. Cefuroxime PO, 30mg/kg/day
c. Augmentin PO, 80-90mg/kg/day
i. Parents always want; just cause they got for
last ear infection doesnt mean they should
get it everytime
d. Ceftriaxone IM x3 days
i. Only for SEVERE
e. Auralagen drops pain
i. Antibacterial, analgesia, and anesthetic
combination
f. Cortisporin drops otitis externa
g. Debrox drops cerumen removal
7. Nursing care
a. Monitor fever, symptoms of illness, dehydration
b. Antibiotics for 10 days
c. Acetaminophen
d. Reassure parents of treatment plan

ii. Externa
1. An inflammation or infection of the external auditory canal
(EAC), the auricle, or both
2. S/S otalgia (ear pain), hearing loss, ear fullness or
pressure, tinnitus, fever, itching, severe deep pain,
discharge
3. Diagnosis history and physical exam, rare- gram staining,
discharge culture, skin exam showing inflammation with
exudate
4. Treatment management of pain, removal of debris,
topical medications to control edema and infection, acetic
acid drops (change pH), antibacterial drops
iii. Effusion
1. thick or sticky fluid behind the eardrum in the middle ear,
but there is no ear infection, causes allergies, irritants
(smoke), resp infections, increases in air pressure
(airplane), drinking lying down, more common in winter or
early spring, mostly <2yrs,
2. S/S asymptomatic in young children, older children
muffled hearing, sense of fullness in the ear, turning up the
TV to loud
3. Diagnosis follow up after treated ear infection, airbubbles
on the surface of the eardrum, dullness of the eardrum
when lit, no movement with puffs of air, fluid observed
behind the eardrum, tympanometry test (amount and
thickness of fluid), acoustic otoscope or reflectometer
(presence of fluid), audiometer (hearing test)

4. Treatment - Unless there are also signs of an infection,

most health care providers will not treat OME at first.
Instead, they will recheck the problem in 2 - 3 months. If
OME persists antibiotics or ear tubes
g. Cystic Fibrosis
i. Most common life threatening recessive genetic disease in
Caucasians, inherited as an autosomal recessive disease, exocrine
gland dysfunction (increased viscosity of mucous gland secretion)
that produces multisystem involvement results in mechanical
obstruction, respiratory tract and pancrease are predominantly
affected, collection of mucus and bacterial colonization result in
destruction of lung tissue , 80% cases diagnosed by age 3 in past,
newborn screening leads to diagnosis at birth and is implemented
in many countries around the world; almost 10% diagnosed >18
years
1. Defective gene for the protein cystic fibrosis
transmembrane conductance regulator (CFTR) that controls
sodium and chloride transfer in and out of the epithelial
cells within the body body
ii. Presentation variable onset and extent, decreased O2-CO2
exchange, hypoxia, hypercapnia (too much CO2 in blood),
acidosis, pulmonary hypertension, cor pulmonale (R ventricle
failure), respiratory failure, death, impaired digestion and
absorption of fat (steatorrhea) and protein (azotorrhea), pancreatic
fibrosis (diabetes mellitus), multitilobular biliary cirrhosis,

impaired salivation, pancreatic enzyme deficiency ( Normal serum

amylase results: 25 to 160 U/L, lipase 56 to 239 U/L), COPD,
sweat gland dysfunction, failure to thrive, decreased weight despite
increased appetite, gradual respiratory deterioration, wheezing, dry
nonproductive cough, generalized obstructive emphysema, patchy
atelectasis, cyanosis, clubbing of fingers and toes, repeated
bronchitis, pneumonia, taste salty, muconium ileus (1st sign), distal
intestinal obstructive syndrome, excretion of undigested food and
stool
iii. Diagnosis All States screen newborns for CF using a genetic test
or a blood test. The genetic test shows whether a newborn has
faulty CFTR genes. The blood test shows whether a newborn's
pancreas is working properly. If a genetic test or blood test
suggests CF, a doctor will confirm the diagnosis using a sweat test.
This test is the most useful test for diagnosing CF. A sweat test
measures the amount of salt in sweat.
iv. Treatment encourage airway clearance, inhaled bronchodilator,
chest PT, Pulmosyme, antibiotics (fluoroquinolones), pancreatic
enzyme supplements, multivitamins, mucolytics, antibiotics, antiinflammatory
2. GU know how system works for application questions!!!!! Know abnormal
values and what to do about it, health history will provide a lot of information
a. Renal Tests variances in morning
i. BUN/creatinine
ii. Urine culture and sensitivity
iii. Urinalysis
b. Infections
i. UTI

1. Definition: E. COLI diapering, wiping,

2. Presentation & signs/symptoms -MAY SEE NOTHING AT
ALL (dehydrations)
3. Diagnostic studies look at chart in book
4. Treatment
ii. Pyelonephritis
1. Definition: look at classification of UTI
2. Presentation & signs/symptoms
3. Diagnostic studies
4. Treatment
c. Disorders of the bladder
d. Nephrotic Syndrome
i. Definition:
ii. Presentation & signs/symptoms
iii. Diagnostic studies
iv. Treatment
e. Acute Glomerularnephritis
i. Definition: NONINFECTIOUS RENAL DISEASE postinfection
from b-hymolytic streptococci infections
ii. Presentation & signs/symptoms - hematuria resulting in smoky tea
looking urine, proteinuria, low protein in blood, daily weights

f.

g.
h.
i.

edema, low protein damage to kidneys as protein blows through,

iii. Diagnostic studies
iv. Treatment
Wilms Tumor
i. Definition:
ii. Presentation & signs/symptoms
iii. Diagnostic studies
iv. Treatment radiation to shrink before surgical removal
Renal Failure
i. Acute
ii. Chronic
Dialysis
i. Peritoneal
ii. Hemodialysis
Transplantation

3. GI
a. Diarrhea/Gastro

i. Types acute (antibiotic associated augmentin), acute

infectious, chronic, (IBS of diabetes) intractable diarrhea of
infancy (malnutrition), chronic nonspecific diarrhea (CNSD)
toilet training will fix
ii. Causes abnormal intestinal water, electrolyte transport,
infectious organisms: E. coli, rotavirus, Norwalk-like organisms,
campolybacter jejuni, clostridium, samonella, shigella strains,
yersinia, giardia, cryptosporidium
iii. Associated disorders gastroenteritis, colitis, enterocolitis,
antibiotic-associated
b. Dehydration
i. Types isotonic (Na/H2O lost), hypotonic (hyponatermia),
hypertonic (hypernatermia) chart on slides
ii. Oral Rehydration weight in kg, 100ml/kg first 10, 50ml/kg
second 10, 20ml/kg for remaining
1. 75-90mEq Na/L
2. maitanance 40-60mEq Ma/L
3. <150ml/kg/day
c. Fever
i.
ii.
iii.
iv.

Definition:
Presentation & signs/symptoms
Diagnostic studies
Treatment

d. GER/D
i. Definition: pathologic entry of gastric contents into the esophagus
ii. Presentation & signs/symptoms: with or without vomiting, can
happen at any time not necessarily related to feedings, failure to
thrive, bleeding, dysphagia, pneumonia, bronchospasm, persistant
passive regurgitation or vomiting, poor weight gain and growth,
FTT, inconsolable, sever crying, irritability, difficult to feed,

choking with feedings, cough, frequent respiratory infections,

asthma, positive hemoccult with aspirate, anemia, bradycardia in
premies
iii. Diagnostic studies: CBC, occult blood in aspirate, stool,
electrolytes, Ph probe definitive test w/ 24 hr observation
(normal Ph is 5-7, with reflux <4), barium swallow evidence of
reflux and anatomic deviations, endoscopy inflammation or
ulceration
iv. Treatment: resolves by 18 mo with out surgery, diaphragmatic
control is developed, surgery Nissen Fundoplication only
severe last option (apnea) g-tube post-op, Thal procedure, Toupet
procedure, post-opno large bolus feeds, NPO 1-2 days, VS, NGT
low intermittent suction (priority), resp and GI assessment, IV
fluids, pain meds, position changes prone after feeding and
during sleep, flat or head of bed elevated 30 degrees for at least 30
min , vent GT tube, Feeding- thicken formula with rice cereal,
slow feedings, frequent burping, Medications - prilosec OTC,
maylox (older)
e. Pyloric Stenosis
i. Definition: an elongation or narrowing of the pyloric channel
which causes obstruction and compensatory dilation, hypertrophy
and hyperperistalsis of the stomach, thickening of the circular
muscle of the pyloric sphincter from an increased size or mass
possibly genetic, full-term white males
ii. Presentation & signs/symptoms - projectile nonbilious vomiting,
dehydration, hypochloremic alkalosis, hypokalemia, metabolic

alkalosis, growth failure, hunger, irritability, constipations, upper

abdominal distention, peristalsis waves visible on abdomen, olive
size mass occasionally palpable in left epigastric region,
hypertrophy of pylorus, low chloride and potassium
iii. Diagnostic studies abdominal ultrasound, serum electrolytes
(decreased chloride, sodium, potassium, Increased BUN, HCO3,
ph), urine specific gravity (increased)
iv. Treatment surgical pyloromyotomy lap into pyloric muscle
f. Intussesception
i. Definition: telescoping of one portion of the intestine into another
- no apparent cause
ii. Presentation & signs/symptoms - sudden periodic moderate to
severe abdominal pain, screaming child with knees drawn to chest,
vomiting soon follows the pain, currant jelly-like stool within 12
hours, eventual fever secondary peritonitis, prostration, altered
consciousness, lethargy, possible seizures
iii. Diagnostic studies abdominal x-ray (air bowel perforation),
ultra sound, abdominal exam (palpation of a sausage shaped
mass/LRQ empty)
iv. Treatment pneumatic-enema with Shield Kit, barium enema (not
with perf), surgery if in shock, perf, or peritonitis bowel resection
g. Crohns Disease (chart in slides)
i. Definition: a chronic disorder of the GI tract characterized by
inflammation of the intestine and resulting in abdominal cramping
and persistent diarrhea
ii. Presentation & signs/symptoms
iii. Diagnostic studies
iv. Treatment
h. Ulcerative Colitis (chart in slides)

i. Definition: a chronic disorder of the GI tract characterized by

inflammation of the intestine and resulting in abdominal cramping
and persistent diarrhea
ii. Presentation & signs/symptoms
iii. Diagnostic studies
iv. Treatment
i. Cleft lip/palate
i. Definition: LIP incomplete fusion of embryonic oral cavity, may
be uni or bilateral, complete or incomplete, PALATE incomplete
fusion of the hard and/or soft palate: may be uni of bilateral,
complete or incomplete
ii. Presentation & signs/symptoms (picture in slides)
iii. Diagnostic studies visual exam
iv. Treatment: LIP: 3-5mo of age at least 10wks, Hgb 10gms/dl, or
10lbs, out-patient option, unrestricted breast or bottle feeding after
surgery, PALATE 9-18mo, 2days in hospital, tongue sutured in
place until AM during 1st day
1. Pain acetaminophen with lip, IV narcotics for palate
2. Post-op 48hrs plastic medicine cup w/ blenderized food,
soft food 2wks, unrestricted diet 1mo (palate), mist tent
(palate) 1-2wks for infection and airway, 48hrs for bottle
after palate, NO STRAWS
j. Failure to Thrive
i. Definition: a sign of inadequate growth resulting from inability to
OBTAIN or USE calories required for growth weight below 5th
percentile for age or drastic change, cause inadequate caloric
intake, inadequate absorption, defective utilization, increased
metabolism
ii. Presentation & signs/symptoms - general appearance (redundant
skin folds, doughy feeling of large muscle masses, listless),

behavioral (preference for objects over people, avoidance posture,

watchful), nutrition (feeding skills, behavior and development,
anthropometric, dietary analysis, breast feeding vs bottle, allergies,
intolerances, food restrictions, parental eating habits/attitudes
iii. Diagnostic studies Hgb smear, urinalysis (ketones), stool
(ova/parasites), sweat test (CF), tuberculin
iv. Treatment nutrition therapy (main goal), caloric supplementation,
behavioral (routine meals, pleasant and relaxed atmosphere,
minimize distractions, 15-20/meal, 5-15/snack, avoid gracing and
nibbling, utensil use)