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1 ALVIN COMMUNITY COLLEGE DIAGNOSTIC CARDIOVASCULAR SONOGRPAHY SYLLABUS DSPE 2255 NEONATAL AND PEDIATRIC PATIENT CARE SKILLS INSTRUCTOR: Jessica Murphy, BS, RRT-NPS, RCP, RDCS, RCS, RVT, CCT SUMMER 2015 2 3110 Mustang Road Alvin, TX 77511-4898 Phone: 281-756-3500 INSTRUCTOR: Jessica Murphy E-MAIL: [email protected] OFFICE: S108 D PHONE: 281-756-5650 Lecture TBA Thursday 1:00-1:50 Lab TBA Thursday 2:00-2:50 OFFICE HOURS: TBA See Door schedule WELCOME TO: Course Title: Neo/Pedi Patient Care Skills Course Number: DSPE 2255.HY01 Credit Hours: 2 Lecture Hours: 1 Lab Hours: 3 Total Contact Hours: 64 Term and Year: Summer Class Days & Times: Hybrid course meets on day 1 and on last day. Meetings in between are TBA Classroom Location: S109 COMMUNICATING WITH YOUR INSTRUCTOR: The preferred method for communicating with your instructor is through the ACC email or you may call me at the office. Please leave your first and last name, a phone number or e-mail address where I can contact you and tell me what you need to discuss with me. I will normally respond within 48 hours Monday-Thursday and by the next business day on Friday-Sunday. I am usually quicker in returning emails. Likewise, I will be sending important communication to students via their personal email address supplied to ACC during registration. Please check your email daily for important information and updates. COURSE DESCRIPTION: This course will provide an overview of neonatal and pediatric patient care including care of the pediatric patient with congenital heart diseases or other problems affecting circulation and cardiopulmonary diseases. The course also includes age appropriate care, patient safety especially in the intensive care units, infection control in special populations such as neonates, patient monitoring, vital signs, assessment, physical examination, thermal regulation, sedation, pharmacology, CPR, PALS, and NRP guidelines. The course will review fetal circulation, labor, delivery, transition, anatomical and physiological differences in children and infants. Equipment and therapeutic techniques used in the care of neonates, infants, and children in critical care settings will also be discussed. STUDENT LEARNING OUTCOMES Describe the techniques associated with the care of neonatal and pediatric patients, demonstrate care of the neonatal and pediatric patient, and perform neonatal and pediatric assessment and monitor vital signs. COURSE GOALS & OBJECTIVES: By the end of this course the student will be able to: Review patient records and record pertinent information required for appropriate diagnosis. Review other procedures/diagnostics to obtain additional data. Collect and evaluate additional pertinent clinical information. Assess pt's overall status. Observe and identify equipment appropriate to care plan. Assemble, check for proper function, identify malfunctions of equipment, and take action to correct malfunctions. Maintain stability of patient during echocardiographic procedures. Conduct dignostic procedures to achieve adequate diagnostic results while maintaining a safe patient environment. 3 Evaluate and monitor patient's response. List and Define Critical Care procedures. Initiate, conduct, or modify techniques in an emergency setting. PRE-REQUISITES None CO-REQUISITES: None METHODOLOGY: This is an on-line course. Lectures will be presented electronically and in conjunction with the material found in the book. Students will read and study each unit and then be evaluated via unit examination. The class may meet on campus for specific subjects and to review equipment or procedures. Students may also attend in-services at local hospitals regarding intensive care procedures. Those meetings will be scheduled in advance. The instructor is available to answer questions, provide feedback, and to conduct in-services as needed. RATIONALE: The care of neonatal and pediatric patients with cardio-respiratory problems is a serious concern for the pediatric/neonatal/fetal sonographer. These patients have very specific requirements, precautions, complications and needs for assessment, monitoring, treatment, which are very different from caring for adults. This course is required so that pediatric echocardiographers can operate in a safe and effective manner when working with these patient populations. TEXTBOOKS: Hertz, Care of the Newborn Lippincot Williams and Wilkinson. ISBN 9780781755856 This book is out of print. If you can’t find it in the bookstore or online I have a set available for check out in the office. S108D. Must be returned at the end of the semester. REFERENCES Walsh, Perinatal and Pediatric Respiratory Care, 2010 Third Edition. ADDITIONAL MATERIALS: USB/ Jump Drive Pediatric stethoscope Pediatric sphygmomanometer Felxible measuring tape Scantron Test Answer sheets COURSE OUTLINE Unit I - Neonatal Development, Assessment Unit II - Neonatal and Pediatric Intensive Care Equipment and Treatment Unit III - Neonatal/Pediatric Diseases 4 TENTATIVE SCHEDULE DSPE 2255 DATE SUBJECT READINGS June1 Week 1 Introduction to Course Neonatal resuscitation June 8 Week 2 Embryologic Development of Cardiopulmonary System, & Assessment of Fetal Growth & Development June 15 Week 3 Labor, Delivery and Physiologic Changes After Birth & Assessment of Neonatal & Pediatric Patient General Considerations of Continuing Care June 22 Week 4 Unit 1 Exam Common Ventilators, Special Procedures & Nonconventional Ventilatory Techniques June 29 Week 5 Apnea, Assessment of Oxygenation/Ventilation ECMO July 07 Week 6 Care Procedures Pharmacology July 14 Week 7 Unit II Exam . July 21 Week 8 Perinatal Diseases Causes of Persistent Perinatal Illness Pediatric Diseases Requiring Care July 28 Week 9 Unit III continued Aug 04 Week 10 Unit III Exam Aug 11 Week 11 FINAL EXAM Aug 17 Grades DUE Ch 1,2,3,4,5,6,7,8 Ch 11,12,20,21 Apendix - Formulary Ch 9,10,13,14,15,16,17,18,19, 5 LATE COURSE WORK POLICY QUIZZES Quizzes are usually announced in advance. Quizzes cannot be made up if missed. The lowest quiz grade will be dropped prior to calculating the final course average. ASSIGNMENTS Assignments are to be completed and turned in on the date specified in class. Five (5) points will be deducted on the assignment for every day the assignment is late. EXAM POLICY An examination will be given at the end of each unit. The exam will be made available from the Learning Lab during a specified time frame. (See Learning Lab policies for more details) If the exam is not taken during the allowed time period, a grade of "0" will be averaged into the final grade. A comprehensive final examination is given at the end of the course and can be used to replace the lowest test grade if no unit exams have been missed. If a student misses a unit exam, the final will be used to replace that missing test grade. Make up exams are not given in this course. ASSIGNMENTS, EXAMS AND GRADING SUMMARY Major Grades Total Assignment Average Unit 1 Exam Unit 2 Exam Unit 3 Exam Final Exam Total of major grades Final Average Record Lab and Assignment grades below: Grade Title Your grade is based on the AVERAGE of the major grades you received on all course assignments and activities. Student evaluations are based on completion of all quizzes, written unit examinations, written comprehensive final examination and completion of all assigned homework. The final average is calculated by averaging all of the major grades together evenly. Major Grades include: Each unit exam, (and or the final exam), homework/quiz/assignment average. Always notify your instructor if you are concerned with your grades or your status in the class. Keep track of your AVERAGE on an ongoing basis. If you notice any trouble with your academic performance, please make arrangements to meet with the course instructor. GRADING SCALE Points 91-100 Grade A 82-90 77-81 B C <77 F 6 WITHDRAWING FROM CLASS/COLLEGE It is recommended that the student talk to the instructor before withdrawing. Current course withdrawal information can be found in the printed version of the ACC Schedule for this semester or online at ACC Course Withdrawal Instructions. Students who file withdrawal requests by the published deadline and have not exceeded the withdrawal maximum will receive a grade of W. Six Drop Limit The Texas Legislature passed a ruling that limits the number of classes a student can drop during their years as an undergraduate student to six. This policy applies to any student who was a first time college freshmen fall, 2007, or later, who attends a Texas public institution of higher education. Courses dropped while attending a private or out of state college do not count toward the six drop limit. For further information, refer to the ACC Catalog or contact Student Services. GRADE APPEAL PROCESS Students have one year from the date of the grade assignment to challenge a grade. Refer to the grade appeal process as published in the ACC Catalog at http://www.alvincollege.edu/Programs-Degrees/Course-Catalogs. CLASS ATTENDANCE POLICY: Each student is expected to attend class regularly. Any student who accumulates an equivalence of four class absences will possibly be dropped from the course. Attendance in on-line courses includes weekly communication with the instructor via Blackboard messaging or email. EXPECTATIONS: 1. Students are expected to obtain a textbook and send the instructor an e-mail stating that they have read this syllabus and schedule and understand what is expected of them by the second week of class. Include your first and last name and student ID number in the e-mail. I will not attempt to guess who [email protected] is. 2. Students are expected to allocate a minimum of 10 hours per week on textbook readings, interacting with course materials, participating in class discussions, and completing assignments, quizzes and exams. 3. Students are expected to use the ACC campus computers or have a workable computer that can access the course website. Any technical problems on the student’s side WILL NOT be an acceptable excuse for late work. CLASSROOM PROTOCOL It is the right of each student to participate in his or her learning, and it is the responsibility of each student to not interfere with the learning of other students. It is the expectation of the college that each student assumes the responsibility to follow college policies and procedures governing campus and classroom conduct. This information is published in the ACC Student Handbook on page 42. DISCLAIMER: The instructor reserves the right to modify this syllabus as needed and will notify the students of any changes using the ACC e-mail or MyBlackboard e-mail or announcements. ACC ACADEMIC SUCCESS AND SUPPORT SERVICES The ACC Tutoring/Learning Lab, located upstairs in building A, provides students with a variety of services including tutoring (math, writing, and other disciplines); computers and printers; and tables/carrels. Call 281-756-3566 or visit the ACC Tutoring/Learning Lab Website for more information. The ACC Library is an excellent source for research and writing help. Quiet rooms are available for studying and doing class work. For more information, visit the ACC Library Website or call 281-756-3559. ACC Counseling Services assist students with issues that may negatively impact academic success. To contact a counselor, call the office of Advising Services at 281-756-3534. 7 Americans with Disabilities Act ACC complies with ADA and 504 Federal guidelines by affording equal access to individuals who are seeking an education. Students who have a disability and would like classroom accommodations must register first with the Office of Disability Services, A 136, or call 281-756-3533. Instructors are not able to provide accommodations until the proper process has been followed. Assessment and Care Team (ACT) The Assessment and Care Team is committed to improving community safety through a proactive, collaborative, coordinated, objective, and thoughtful approach to the prevention, identification, assessment, intervention and management of situations that pose a threat to the safety and well-being of the campus community. To educate and empower all members of the College community, resources and procedures are in place to prevent, deter, and respond to concerns regarding acts of violence. Alvin Community College offers assistance to departments and individuals in detecting indicators for concern and resources to protect themselves and their environments. The Alvin Community College ACT accepts reports regarding any individual or incident at any time through an online referral form on the Assessment and Care Team page at http://www.alvincollege.edu/ACT, direct email to: [email protected], or by contacting the Alvin Community College Police Department at 281-756-3700 or 832-250-3365 (after hours). MY Blackboard support can be obtained by completing the Online Support Form. WEBACCESS, Passwords or ACC Computer Lab Information: If you experience problems with WebACCess, please call the Help Desk at 281-756-3544 or email [email protected]. MENTAL HEALTH COUNSELING AND SUICIDE PREVENTION SERVICES As a student, you may experience a range of challenges that can interfere with learning, such as strained relationships, increased anxiety, substance use, feeling down, difficulty concentrating, and/or lack of motivation. These mental health concerns or stressful events may diminish your academic performance and/or reduce your ability to participate in daily activities. Advising services employs two Licensed Professional Counselors who can assist students with issues that negatively impact academic success. Consultation and referrals are confidential. The Counseling Referral form is located at: http://www.alvincollege.edu/CounselingServices.aspx Emergencies: If you or someone you know at ACC feels overwhelmed, hopeless, depressed, and/or is thinking about dying by suicide, supportive services are available by requests at the Enrollment Services Center or by calling 281-756-3531, ask for a Counselor. You may also call the National Suicide Prevention Hotline 1-800-273-8255. This is a 24 hour, toll free, confidential suicide prevention hotline available to anyone in suicidal crises or emotional distress. If, however, you or someone you know is in an immediate crisis, go to the nearest Emergency Room, or call 911. 8 UNIT I - EMBRYOLOGIC DEVELOPMENT AND ASSESSMENT OF THE CARDIOPULMONARY SYSTEM OBJECTIVES - Upon completion of this unit of study, the student will: Review existing data in patient record: (F1, F12, C5, C7) . perinatal history and data . APGAR scores . gestational age (F8, F13, C2, C4, C18) . chest x-ray . cardiac cath reports . blood gas analysis . hemodynamic monitoring (F1, F5, F10, F12, C5, C7, C13) . APGAR score . gestational age (Dubowitz) . vital signs . signs of distress . heart sounds Identify the four (4) periods of embryonic lung growth and describe the features of each period. With regard to surfactant, describe the following: function and purpose the approximate gestational age at which it appears components and methods to detect its presence how lung maturity is determined Regarding fetal lung fluid, describe the following: composition function the hazards of lung fluid retention Describe the embryologic development of the heart With regard to fetal circulation, describe and explain: the cause of pressure differences between the right and left heart the flow of blood from the placenta, through the body and back to the placenta each shunt that is encountered with the approximate amount of blood that passes each shunt Describe the development of the placenta and umbilical cord and identify the major anatomical fluid and define the following: Polyhydramnios Oligohydramnios ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT Describe how ultrasonography is used to assess fetal status. Define amniocentesis and describe the role of each of the following: L/S ratio Determination of (alpha)-fetoprotein Bilirubin level Creatinine level identification of meconium staining Cytologic examination of cells Explain how fetal scalp pH is used to assess fetal asphyxia. List and describe the five (5) methods used to estimate the date of delivery. Compare and contrast the contraction stress test to the nonstress test. Describe how each is performed, advantages and disadvantages. Describe the use of acoustic stimulation and fetal movements as methods of assessing fetal well-being. 9 Describe the six (6) tests used in the biophysical profile. Discuss the implications of meconium-stained fluid in assessing fetal status. Describe chorionic villus sampling, cordocentesis, and magnetic resonance imaging in assessing fetal status. Compare and contrast maternal estriol determination and human placental lactogen (HPL) levels as to their roles in determining fetal status. Given an appropriate history, determine whether a pregnancy is high-risk. LABOR, DELIVERY, AND PHYSIOLOGIC CHANGES AFTER BIRTH Compare and contrast cervical dilatation and effacement. Compare the most common presentation. Define station and how it is expressed. Define tocolysis and describe the various methods used to achieve tocolysis. Define dystocia and describe the three (3) etiologic factors that cause it. Identify and describe the three (3) types of placenta previa. Describe the three (3) categories of abruptio placentae. List the indications for a cesarean birth. Explain why multiple gestations create high-risk pregnancies. List factors that are responsible for the first breath. Describe the importance of overcoming surface forces in adapting to extrauterine life. Identify and describe factors that cause the change from fetal to adult circulation. ASSESSMENT OF THE NEONATAL AND PEDIATRIC PATIENT State at least ten (10) anatomic and physiologic differences between the infant and adult. Identify the physical and neurologic signs examined in the Dubowitz and the Ballard gestational age assessments. Compare and contrast the Dubowitz and Ballard gestational age assessments. Describe seven (7) physical signs that are used to determine gestational age. List five (5) purposes of the neonatal physical examination. Perform review of monitoring and interpret results to determine: (F1,F5,F10,F12,C5,C7,C9,C13,C18,C19) . oximetry . transcutaneous monitoring (PO2, PCO2) . invasive monitoring lines ventilator and other equipment alarms hemodynamic monitoring, GENERAL CONSIDERATIONS OF CONTINUING CARE Discuss the physiology of thermoregulation including a description of the thermo neutral zone andnon-shivering thermogenesis. Define the internal thermal gradient (IG) and describe the reasons why a preemie has a decreased ability to maintain its ITG. Describe each of the following as it relates to the external thermal gradient (ETG). Include examples for each type of heat loss and a description of how each method of heat loss may be prevented or reduced in the nursery. radiant conductive convective evaporative Describe how a neonate reacts to cold stress and to hyperthermia. Discuss thermoregulation of the neonate in the delivery room and nursery to include methods of heat loss prevention. Compare and contrast incubators and open warmers, focusing on the advantages, disadvantages, and thermoregulation in each. Explain the physiologic effects of overstimulation of the premature neonate. Identify and describe those factors involved in behavioral-based care. 10 Describe the use of environmental controls and parental involvement in reducing overstimulation and increasing more normal interactions and relationships. Describe the physiologic factors that make the skin of the preemie more susceptible to trauma. Discuss those factors that will reduce skin trauma on the neonate. Identify and describe the three (3) methods of determining fluid deficit. Estimate the degree of deficit when given patient clinical data. Identify at least five (5) factors that influence insensible water loss. Describe the functions of sodium, potassium, calcium, magnesium chloride, and phosphate in the neonate. With regard to jaundice, describe the following: Physiology, causes, pathologic jaundice, complications, treatment Describe the clinical signs and treatment of necrotizing enterocolitis. TECHNIQUES OF RESUSCITATION AND STABILIZATION List the four (4) factors that can lead to fetal asphyxia. Compare and contrast primary to secondary apnea. Describe the cardiovascular events that occur during periods of intrauterine asphyxia. Discuss the effects of asphyxia on the lungs. List and describe the three (3) factors that provide proper preparation for resuscitation. Describe the ABC's of resuscitation. When provided with patient data, assign an appropriate APGAR score Describe and discuss each step in resuscitation. Describe each of the following skills as it relates to neonatal resuscitation: thermoregulation maintenance of the airway tactile stimulus evaluation of heart rate positive pressure ventilation intubation chest compressions List the drugs used during a resuscitation. Describe the sources of fetal and neonatal glucose. List the serum glucose values that indicate hypoglycemia. List and describe the causes of hypoglycemia, techniques used to measure glucose, and the treatment for hypoglycemia. (F3,F4,F5,F8,F10,F11,F12,F13,F14,F16,C1,C3,C5,C6,C7,C8,C9,C10,C11,C12,C13,C14,C15,C16,C17,C18,C19,C20) . position patient properly monitor patient’s tolerance of procedures maintain patent airway observe for signs of distress, apneas and bradycardias Perform required steps needed to ensure patient safety. minimal stimulation protocols recognize and take action for patients response to procedure monitor tubes, lines and drains while moving or positioning patients (F1,F2,F3,F4,F5,F6,F8,F10,F11,F12,F13,F14,F15,F16F17,C1,C3,C5,C6,C7,C8,C9,C12,C13,C15,C16,C17,C18,C19,C20) Monitor cardiac rhythm Monitor vital signs Monitor patients breathing especially when sedated Modify procedure as needed for patient tolerance 11 UNIT II – EQUIPMENT USED IN THE CARE OF CRITICAL INFANTS AND CHILDREN OBJECTIVES - Upon completion of this unit of study, the student will: OXYGEN THERAPY Discuss the indications for, and hazards of, oxygen therapy. Describe the indications, hazards, and approximate FIO2's for each of the following: a. oxygen hood b. oxygen cannula c. simple oxygen mask d. nonrebreathing mask e. Venturi mask f. tent g. incubator h.. resuscitation bags (F3,F4,F5,F8,F12,F16,C3,C5,C7,C18,C12,C20) List Oxygen administration devices oxygen hoods, tents, and incubators Nasal CPAP device Blenders Flowmeters Aerosol generators Ventilators Nebulizers Heaters Incubators, Isolettes, radiant warmers (F3,F4,F5,F8,F12,F16,C3,C5,C7,C18,C12,C20) Suctioning devices Resuscitation devices Artificial airways ASSESSMENT OF OXYGENATION AND VENTILATION List the indications for obtaining an arterial blood gas sample in neonates and pediatric patients. Identify the four (4) methods of obtaining blood samples for analysis and describe why the UAC is the preferred blood sampling site. Identify those arterial sampling sites that are preductal and postductal. Describe how a right-to-left shunt through the ductus arteriosus can be detected using blood gas PaO2s, transcutaneous monitors, or pulse oximeters. Briefly describe the mechanical aspects of a transcutaneous monitor (TCM). Discuss how a TCM can be useful even if not reading arterial values. List six (6) factors that could cause a TCM to read lower than the actual PaO2. Describe how a TCM detects skin perfusion. Explain the hazards of TCMs and how those hazards can be avoided. CONVENTIONAL METHODS OF MECHANICAL VENTILATION Identify methods for providing ventilator support: continuous positive airway pressure (CPAP), volume ventilation, pressure ventilation, oxygen delivery Discuss the precautions and hazards sonographers will encounter when working with patients who are on oxygen and mechanical ventilation: equipment issues oxygen toxicity ventilator tubing, moisture, potential lavage care not to extubate patient, position of ETT COMMON VENTILATORS AND MONITORS Identify various ventilators and monitoring systems SPECIAL PROCEDURES AND NONCONVENTIONAL VENTILATORY TECHNIQUES High Frequency Ventilation HFV, High frequency Jet Ventilation (HFJV), High Frequency Oscillation Ventilation (HFO) Explain why a conventional ventilator is used in conjunction with HFJV and HFO. Compare and contrast venoarterial and venovenous methods of bypass. 12 Describe the basic components of the ECMO circuit. Identify and describe the methods used to select potential ECMO patients. List the contraindications for ECMO. Describe how ECMO is initiated, the indications for termination, and the complications associated with its use. Define Surfactant Replacement Therapy and why it is used. Key Words: ECMO Surfactant replacement, Sedation Umbilical Lines, Invasive Lines Bedside procedures such as PDA ligation Chest Tubes (C9,C12,C13,C18,C19,C20) Assist with ventilation - 1) BVM, 2) ETT Assist with suctioning Assist with intubation Provide Oxygen – 1) BVM, 2) CPAP, 3) Blow by, 4) NC PHARMACOLOGY IN NEONATAL AND PEDIATRIC CARE List and discuss the physiologic factors and mechanisms of drug transfer across the placenta. Define a teratogenic substance and describe its actions on the fetus. As provided, list and describe, for each of the following medications, the indications, concentrations,dosages, effects, contraindications, adverse effects, and precautions. ANTIBIOTICS Ampicillin Gentamicin sulfate Acyclovir Stimulants: Caffeine DIURETICS Furosemide CARDIOVASCULAR DRUGS Digoxin Indomethacin sodium trihydrate Alprostadil Dopamine Hcl Dobutamine Tolazoline Nifidipine RESPIRATORY DRUGS Inhaled bronchodilators Inhaled steroids Racemic epinephrine Inhaled Antivirals: Ribavirin (special precautions) Pentamidine Methylxanthines Surfactant ANTICONVULSANTS Phenobarbital Phenytoin sodium STEROIDS Dexamethasone SEDATION AND CONTROL OF VENTILATION Chloral hydrate Diazepam Morphine sulfate Fentanyl citrate Succinylcholine chloride RESUSCITATION Epinephrine Narcan Pancuronium bromide Describe the effects of maternal drug abuse on the fetus. 13 UNIT III - PERINATAL LUNG DISEASE AND OTHER PROBLEMS OF PREMATURITY OBJECTIVES - Upon completion of this unit of study, the student will: List and describe the following neonatal disorders respiratory distress syndrome atelectasis transient tachypnea of the newborn pneumonia meconium aspiration syndrome diaphragmatic hernia congenital lobar emphysema pneumothorax pneumomediastinum pneumopericardium pulmonary interstitial emphysema bronchopulmonary dysplasia Diaphragmatic hernia Tracheoesophageal fistula Omphalocele Gastroschisis Meningomyelocele Cyanotic heart disease ROP PPHN TTN HIV Issues related to fluid and electrolyte management Inspect chest x-ray to determine: (F1,F5,F10,F12,C5,C7,C13,C18,C19) presence of, or changes in, pneumothorax or subcutaneous emphysema presence of, or changes in, consolidation and/or atelectasis position of endotracheal tubes position and presence of foreign bodies position of, or changes in, hemidiaphragms presence of, or changes in hyperinflation presence of, or changes in, pleural fluid presence of, or changes in, pulmonary edema/opacification presence of, or changes in, Swan-Ganz, pacemaker, CVP, and other catheters presence, or changes in, mediastinal shift cardiac silhouette specific CXR findings consistent with congenital heart disease CAUSES OF PERSISTENT PERINATAL ILLNESS Explain how infections are acquired by the fetus and neonate. Define chorioamnionitis and describe the various bacterial organisms seen in the neonatal population. Review the etiology of Acquired Immune Deficiency Syndrome (AIDS), and discuss the five (5) methods in which the fetus and neonate may become infected with the HIV virus. Describe the clinical signs, diagnosis, treatment, and outcome associated with HIV infection. Identify the effects of cytomegalovirus, rubella, herpes simplex, and toxoplasmosis on the developing fetus. Describe the diagnosis, prevention, and treatment of infection in the neonate. For each of the following cardiac anomalies, identify the defect by too much or too little pulmonary blood flow and describe the diagnosis and treatment: 14 patent ductus arteriosus atrial septal defect ventricular septal defect Tetralogy of Fallot complete transposition of the great vessels subaortic stenosis coarctation of the aorta tricuspid atresia anomalous venous return truncus arteriosus hypoplastic left-heart syndrome CAUSES OF PEDIATRIC DISEASES REQUIRING CARE Describe the pathophysiology, signs, symptoms, and treatment of the following disorders: adult respiratory distress syndrome (ARDS) asthma cystic fibrosis Describe for each of the following infectious diseases, the causative organisms, symptoms, diagnosis and treatment. pneumonia bronchiolitis epiglottitis croup RSV Foreign body aspiration Describe the care of the postoperative congenitally corrected heart patient