Term
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Definition
| surgical procedure that brings the end of the small/large intestine through the abdominal wall; ileostomy/colostomy |
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Term
| Why place ileostomies/colostomies? |
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Definition
| anorectal malformations, Hirschsprung's disease (no peristalsis), short gut/bowel resections (necrotizing enterocolitis), trauma |
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Term
| Necrotizing enterocolitis (NEC) |
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Definition
| damage/death of intestinal tissue; cause unknown but intestines thought to be weakened by too little oxygen and blood flow; food can cause bacteria, perforation in intestine, scarring/narrowing, prob. w/ food absoprtion if large amts of intestine must be removed, severe infection; affects mostly premies or sick newborns; 25% death rate |
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Term
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Definition
| abdominal distension, blood in stool, diarrhea, feeding intolerance, lethargy, temp instability, vomiting |
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Term
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Definition
| abdominal x-ray (air pockets), stool for occult blood test, elevated WBC count, low platelet count (indicate bleeding) |
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Term
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Definition
| feeding stopped and IV fluids started; NG tube to relieve gas in stomach; antibiotics; surgery (perforated bowel, inflamm of abdominal wall, sepsis); surgical procedure (remove necrotic tissue and place ostomy, reanatomose several weeks later) |
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Term
| PT considerations for child w/ ostomy |
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Definition
1. communication/lang/cognition (NPO lead to impaired oral-motor skills and/or oral aversion; impact lang. dev)
2. cardiovascular/pulmonary (Hgb/hematocrit levels lowered)
3. integumentary (skin check around ostomy site)
4. musculoskeletal (abdominal weakness)
5. fxnal skills (delayed due to seriousness of underlying medical conditions and limited time in prone) |
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Term
| Intervention for child w/ ostomy |
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Definition
| awareness of bag, empty bag before session, ensure seal is good, prone is OK (modify for poor tolerance) |
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Term
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Definition
| provides an alternate way to offer food and/or medicines; can also be used to vent child's stomach for air or drainage; about 3 week healing time and 3 monts for tract to form b/t stomach and skin |
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Term
| Why would someone get a G-Tube? |
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Definition
| unsafe swallow (high risk for aspiration pneumonia); unable to maintain adequate nutritional intake to sustain wt and support adequate growth; inefficient oral feeding time (>3-4 hrs/day); dependent on nasogastric tube feedings |
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Term
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Definition
| for pts who can't obtain nutrition orally (premies/infants that aren't eating orally); can also be used to vent stomach, provide meds, check residuals; not for long-term use |
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Term
| Potential G-Tube problems |
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Definition
| comes outs/pulled out; redness/irritation/foul smell; leaking |
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Term
| PT considerations for child w/ G-tube |
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Definition
| communication/language cognition (impaired oral-motor skills and/or oral aversion and poor feeding; impact lang. dev); integumentary (check skin around site); fxnal skills (delayed dev.: impaired prone skills and/or UE weakness) |
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Term
| Intervention for child w/ G-tube |
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Definition
| post-op modifications only if child expresses discomfort/pain; specific feeding schedule to work around; caution no to pull or allow child to pull on tube; education for caregivers |
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Term
| Indications of reflux (GER) |
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Definition
| spitting up can vary from a little to a lot and/or be seldom or regular; baby CALMS QUICKLY following spit ups; baby GAINS ENOUGH WT, possible LARGE amts of wt, as inc. spitting up is frequently linked w/ over-feeding |
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Term
| Management of infant reflux/GER |
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Definition
| avoid over-feeding by giving small, frequent meals; dec. mov't after feeding (hold infant upright for 30 min. after feeding, position in right side lying side in crib, w/ head of bed elevated about 30 degrees, avoid inc. abdominal flexion) |
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Term
| Gastro Esophageal Reflux Disease (GERD) |
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Definition
| pathological; impacts infants/ children in 3 primary ways: esophagitis (heartburn), poor growth, respiratory problems |
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Term
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Definition
| frequent emesis (vomiting), blood tinged; irritability (inconsolable crying day and night); hard to feed (screaming and/or refusing to be fed); failure to gain weight OR weight loss; respiratory problems (repeated coughing, wheezing, or chest infections) |
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Term
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Definition
| make sure Dx is accurate!, only 1-3% of healthy babies experience this; management of GER plus formula options (thicker), meds, surgery |
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Term
| GERD in children w/ neurological impairments |
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Definition
| 15-75% due to hiatal hernia, prolonged supine positioning, inc. abdominal pressure secondary to spasticity, scoliosis and/or seizure, CNS dysfxn leading to NM incoord. leading to esophageal sphincter/esophageal and stomach motility impairment |
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Term
| PT considerations for child w/ reflux |
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Definition
| communication/lang/cognition (oral defensiveness and/or aversion leading to impacted oral exploration and lang. skills); cardiovascular/pulmonary (bradycardia/desaturation); fxnal skills (impaired feeding/swallowing) |
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Term
| Intervention for child w/ reflux |
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Definition
| time intervention before meals, consoling, positioning, education on strategies for irritability |
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Term
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Definition
| tube that drains excess CSF from ventricles to another area of the body (ventriculoperitoneal or ventriculopericardial) |
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Term
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Definition
| hydrocephalus (grade III/IV IVH, spina bifida, brain tumor, meningitis, encephalitis) |
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Term
| Hydrocephalus symptoms in INFANTS |
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Definition
| inc. head growth, bulging fontanelle, splayed sutures, sun-setting eyes, poor feeding, high pitched cry, sleepiness, delayed dev. |
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Term
| Hydrocephalus symptoms in CHILDREN |
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Definition
| headache, N/V, low energy and sleepiness, change in school performance (less ability to understand, memory prob.), vision changes |
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Term
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Definition
| infection, blockage, catheter becomes calcified or breaks, catheter needs lengthening for growth, over or under-draining |
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Term
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Definition
| infections (externalized, antibiotics given, then re-internalized); blockage (replaced) |
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Term
| PT considerations for infant/child w/ shunt |
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Definition
| communication/lang/cognition(variable); integumentary (surgical sites, check for infection and proper healing); musculoskeletal (torticollis); neuromuscular (inc. tone, extension posturing, clonus); fxnal skills (variable) |
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Term
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Definition
| caution w/ cervical PROM so as not to occlude shunt; educate care givers regarding signs/Sx of shunt malfxn and not to remove shunt |
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Term
| Acyanotic cardiac condition |
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Definition
| normal oxygenation (pink color); blood shunts left to right (oxygenated blood goes to lungs as well as body) |
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Term
| Cyanotic cardiac conditions |
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Definition
| oxygen saturation 15-30% below normal (bluish purple tint of lips, tongue, and fingernails); blood shunts right to left (unoxygenated blood is returned to body) |
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Term
| Atrial and ventricular septal defects (ASD, VSD) - acyanotic |
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Definition
| hole in either the atrial or ventricular wall; VSDs are most common (20-30%); blood is shunted b/t sides (typically L to R); affects Down's Syndrome and premies |
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Term
| Patent Ductus Arteriosus (PDA) - acyanotic |
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Definition
| failure of vessel connecting aorta and pulmonary artery to close after birth (hypoxia); may indicate a more significant heart defect; affects premies |
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Term
| Coarctation of aorta - acyanotic |
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Definition
| very stenosed aorta leading to high BP before point of coarctation and low BP beyond point of coarctation (high bp in arm and low bp in leg); L ventricle has to pump very hard to get blood past coarctation leading to heart failure if not fixed |
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Term
| Aortic and pulmonary stenosis - acyanotic |
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Definition
| if R ventricle not keeping up with workload, leads to edema; if L ventricle not keeping up, leads to lung/respiratory condition (i.e. SOB) |
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Term
| Tetrology of Fallot - cyanotic |
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Definition
| most common cyanotic cardiac defect (50%); stress test b/c of ventricular arrhythmias; req. early surgical repair; leads to R ventricular hypertrophy, overriding aorta, VSD, and pulmonary stenosis |
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Term
| Transposition of the great arteries - cyanotic |
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Definition
| oxygen poor blood goes to the body and oxygen rich blood goes to the lungs; if untreated, 50% die in 1st month and 90% die in 1st year |
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Term
| Acute management of cardiac conditions p/o |
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Definition
| education, pulmonary management, pain reduction, early mobilization, complications, understand if surgery was corrective or palliative |
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Term
| Age-specific disabilities p/o |
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Definition
1. infant - disruption of ALL aspects of typical newborn life (being held/swaddled/fed; limited attachment)
2. toddlers - anxiety/abandonment over being left alone; parents' restrictions typically more limiting than their own physical limitations
3. adolescents - mobility |
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Term
| PT considerations for child w/ cardiac condition |
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Definition
| CV/pulm (modified autonomic parameters, limited activity tolerance and endurance); integumentary (scar mobility from surgical site and/or chest tube); MS (UE strength and/or ROM deficits); fxnal skills (dev. delay: limited prone, limited activity tolerance/endurance, poor feeding) |
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Term
| Intervention for child w/ cardiac condition |
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Definition
| avoid prone at least for 4-6 weeks, no picking child up from under arms b/c puts too much pressure on sternum, monitor cardiopulmonary system, educate on signs of CHF |
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Term
| Signs of congestive heart failure (CHF) |
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Definition
| abnormal respiratory signs (labored breathing pattern, inc. resp. rate); diaphoretic and tachycardia; edema; dec. urine output; eating problems (impaired coord. of suck and swallow w/ breathing) |
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Term
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Definition
| generic term used to describe a child whose current weight or pattern of weight gain does not equal that of other children of similar age, gender and ethnicity; decelerated or arrested physical growth (ht and/or wt) associated w/ poor developmental and emotional functioning |
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Term
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Definition
| lack of approp. wt gain, irritability, easily fatigued, excessive sleepiness, lack of age-approp. social response (i.e. smile), avoids eye contact, lack of molding to mother's body, does not make vocal sounds, delayed motor dev. |
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Term
| Medical causes of FTT (b/c can also occur w/o underlying medical condition) |
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Definition
| <20%; inadequate caloric absorption (malabsorption: chronic diarrhea, celiac dz, food sensitivities; chronic emesis: reflux, GI obstruction, meds, underlying metabolic dz); inadequate caloric expenditure (congenital heart dz; chronic hypoxia; hyperthryoidism; metabolic dz; chronic immunodeficiency; recurrent infection; malignancy) |
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Term
| Non-medical causes of FTT |
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Definition
| >80%; inadequate caloric intake (abuse/neglect: withholding of food; inapprop. feeding); infants/children are at risk when env'ts include: depression, alchohol/drugs, psychosocial stress, lack of maternal-child bonding, limited education, poverty; new or previously identified challenges w/ infant/child (poor oral-motor skills; sensory issues) |
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Term
| Diagnostic evaluation/testing for FTT |
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Definition
| dietary hx, psychosocial eval, complete blood count, metabolic profile, stool pathogens and fat, urinalysis, TSH, liver fxn tests |
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Term
| PT considerations for child w/ FTT |
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Definition
| communication/lang/cognition (delayed?); CV/pulmonary (limited endurance); MS (dec. muscle mass); fxnal skills (poor feeding skills, delayed dev.) |
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Term
| Intervention for child w/ FTT |
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Definition
| opportunity to gain insight into caregiver/child relationship; calorie expenditure vs. calorie intake??; education! |
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