Download 1. Developmental, Congenital, and Childhood

HD_CD: Mechanisms of Disease, Diagnosis, and Treatment
1. Developmental, Congenital, and Childhood Diseases and
Disorders
1.1 Welcome
Notes:
This course focuses on Developmental, Congenital, and Childhood Diseases and Disorders. My name is Mary Juenemann and I will be
facilitating the review of the materials contained in the reading. Please note that the conditions mentioned in the text as well as this
presentation is not a complete list of all of the diseases and conditions possible, but rather a highlight of some of the most common
ones.
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1
1.2 Module Objectives
Notes:

At the completion of this module, the student should be able to:

List the possible causes of congenital anomalies.

Discuss genetic disorders and syndromes.
2. Lesson 1
2.1 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
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2
Correct
Choice
Birth before the 37th gestational week of
preterm birth
pregnancy
also known as hyaline membrane disease
IRDS
Serious, chronic lung disease which is a result
BPD
of an insult to the neonate's lungs
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That's right! You selected the correct response.
Feedback when incorrect:
You did not select the correct response.
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3
Correct (Slide Layer)
Incorrect (Slide Layer)
2.2 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
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4
Correct
Choice
abnormal growth of the blood vessels in the
retinopathy of prematurity
retinas of the infant's eyes
acute inflammatory process caused by
necrotizing enterocolitis
ischemic necrosis of the mucosal lining of the
small intestine, large intestine, or both
Small stature and interorbital distance, bulging
robinow syndrome
(bossing) forehead, depressed nasal bridge,
malaligned teeth, and short limbs
Congenital disorder in which a portion of the
hypertrophic cardiomyopathy
heart muscle thickens without any apparent
cause.
Feedback when correct:
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Feedback when incorrect:
You did not select the correct response.
Correct (Slide Layer)
Incorrect (Slide Layer)
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6
2.3 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
2.1 Match the following
2.2 Match the following
Result slide properties
Passing Score
80%
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Success (Slide Layer)
Failure (Slide Layer)
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8
2.4 Lesson 1 Start
Notes:
At the completion of this lesson, the student will be able to :
Describe the ways in which pathogens may cause disease.
Explain the inflammation response to disease.
Detail differences between benign and malignant neoplasms
Describe the hospice concept of care
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9
2.5 Pathology at First Glance
Notes:
It is important to start out with some basic definitions about pathology.
Homeostasis: internal stability of the body. When all systems and organs function, then
the body maintains an internal stability of homeostasis.
Pathology: abnormal condition causing measurable changes in structure and function
What causes a pathologic state? (A pathologic state exists when body systems or organs
can no longer maintain normal processes.)
These changes are measurable and can be assessed using such procedures as lab tests,
imaging techniques, biopsies, and endoscopies.
Pathogenesis: development of disease in stages
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10
2.6 Congenital Anomalies
Notes:
Congenital anomalies can be mental or physical and can vary widely in severity, from
trivial to fatal. They are present at birth but might not be detected until later in infancy
or childhood. These can be the result of genetic abnormalities. Genetic disorders and
syndromes are the result of an abnormal gene taking up residence on one of the 22
pairs of nonsex chromosomes, such as Turner's syndrome. They may also be nongenetic
in origin, such as the effect on the fetus of maternal alcohol ingestion, infection in the
mother, drugs taken by the mother, or the age of the mother. Sometimes they are the
result of the interplay of genetic and nongenetic causes. The anomalies can affect
physical as well as mental development. Quite often more than one structural problem
exists and may manifest as a well-defined group of signs and symptoms such as Down
syndrome. Congenital anomalies may become more evident as the child grows and
starts to crawl, walk, and talk.
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11
2.7 Methods of Prenatal Diagnosis
Notes:
Many, but not all, congenital disorders can be detected through prenatal diagnosis. One
can diagnose congenital anomalies in a fetus by taking a fluid sample from the amniotic
sac between the 15th and 18th weeks of pregnancy. This procedure, known as
amniocentesis, allows amniotic fluid to be tested and cells to be microscopically
examined for abnormal substances or chromosomal abnormalities. Amniocentesis is not
without risk to the mother and baby. Abnormalities of the spine, skull, and many organs
such as the heart and kidneys may be discovered during ultrasound studies of the fetus.
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12
2.8 Prematurity
Notes:
Preterm birth or prematurity is the result of birth before the 37th gestational week of
pregnancy. The condition of prematurity describes the birth of a low-weight,
underdeveloped, and short-gestation infant and is considered the leading cause of
death during the neonatal period. The neonate may be considered premature when he
or she: has little subcutaneous fat and few creases in palms and soles; lacks the ability to
suck or swallow; has weakened swallowing and sucking reflexes; has underdeveloped
lungs and immune system; has increased risk of infection. All of these factors may
increase neonate morbidity and mortality.
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13
2.9 Prematurity Etiologies
Notes:
Causes of premature labor resulting in a premature infant are an incompetent cervix,
bicornate uterus, toxic conditions, maternal infection, trauma, premature rupture of the
amniotic membranes, history of previous miscarriages, multiple gestations, intrauterine
fetal growth retardation, and other physical conditions of the mother, such as
pregnancy-induced or chronic hypertension. Diabetes, heart disease, kidney disease,
poor nutrition, substance abuse, and lack of prenatal care also contribute to the
incidence of the mother giving birth to a preterm infant. In some cases, the etiology is
never identified.
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Employment and Training Administration.
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14
2.10 Infant Respiratory Distress Syndrome (IRDS)
Notes:
IRDS or hyaline membrane disease is similar to adult respiratory distress syndrome in
that the patient suffers acute hypoxemia caused by infiltrates within the alveoli. Shortly
after birth, the neonate exhibits signs of respiratory distress, including nasal flaring,
grunting respirations, and sternal retractions. Blood gas studies indicate reduced oxygen
tension and ineffective gas exchange. The infant becomes cyanotic, with mottled skin.
The lungs of the neonate lack the surfactant needed to allow the alveoli to expand. The
surfactant normally is produced relatively late in fetal life; consequently, premature
infants are at risk. The outcome of this inability of the lungs to expand is inadequate
surface area for proper gas exchange and a potentially fatal lack of oxygen in the blood.
Prevention is the best treatment; therefore, if time permits, the mother is injected with
a corticosteroid 24 hours before delivery in an attempt to mature the surfactantsynthesizing system. Treatment of the infant consists of the administration of carefully
titrated supplemental oxygen, usually administered by mechanical ventilation and
positive end-expiratory pressure (PEEP), and is of primary importance. Drug therapy,
including the aerosol infusion of an exogenous surfactant, into the pulmonary tree by an
endotracheal tube as soon as possible after birth, helps to provide an artificial surfactant,
allowing the alveoli to expand.
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15
2.11 Bronchopulmonary Dysplasia (BPD)
Notes:
Bronchopulmonary Dysplasia (BPD), is a serious, chronic lung disease, which results
after an insult to the neonate's lungs. This may be a sequela to Infant Respiratory
Distress Syndrome , a lung infection, or extreme prematurity. The lungs are stiff,
obstructed, and hard to ventilate. The infant experiences periods of dyspnea, including
tachypnea, wheezing, cyanosis, nasal flaring, and sternal retractions. The infant may
experience coughing and difficulty feeding. The goal of treatment is replacement of the
damaged alveoli. Children grow new alveoli until about 8 years of age. Infants who have
BPD need to grow new alveoli to replace those damaged by scarring. Supportive
treatment includes supplemental oxygen and adequate nutritional support. The types of
medications used include diuretics and bronchodilators. Antiinflammatory drugs such as
steroids also may help.
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16
2.12 Retinopathy of Prematurity (Retrolental Fibroplasia) (ROP)
Notes:
Retinopathy of Prematurity (ROP) is also known as retrolental fibroplasia, is an abnormal
growth of the blood vessels in the retinas of the infant's eyes. The condition occurs in
the eyes of premature infants. The vascularization of the retina begins at the back
central part of the eye, as vessels grow out toward the edges. The blood vessels to the
retina do not begin development until about the 28th week of gestation. In premature
infants, this vascularization is incomplete.
Retinal screening exams are done at 4 to 6 weeks old. mild forms of this condition may
resolve by themselves. Laser surgery may be required in more serious cases. Blindness
may result from serious damage. ROP that has resolved can have later complications.
These include crossed or wandering eyes (strabismus), “lazy eye” (amblyopia),
nearsightedness (myopia), glaucoma, and late-onset retinal detachment.
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17
2.13 Risk Factors for Development of ROP
Notes:
No specific risk factors for the development of Retinopathy of Prematurity have been
identified. Therefore, there is a group of risk factors that contribute to it. The more
premature and the lower the birth weight of the infant, the greater is the risk of
developing Retinopathy of Prematurity . High supplemental oxygen concentrations are
responsible for many incidents of ROP. Certain drugs, such as surfactant and
indomethacin, administered to the neonate for treatment of immature lungs, as well as
PDA, may increase the risk for the premature infant. Recently, intense artificial lighting
in the nursery or crib has been considered a risk factor. Other risk factors cited include
seizures, mechanical ventilation, anemia, blood transfusions, and multiple spells of
apnea and bradycardia.
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18
2.14 Necrotizing Enterocolitis (NEC)
Notes:
Necrotizing enterocolitis is caused by ischemic necrosis of the mucosal lining in the large
and/or small intestine. Feeding intolerance, abdominal distention, bile-colored emesis,
diarrhea, blood in the stool, decreased or absent bowel sounds, lethargy, and body
temperature instability a few days after birth are some of the initial symptoms exhibited
by the preterm or low-weight infant. The infant is supported with fluids, and a tube may
be inserted into the stomach to decompress and relieve distention. Some infants do not
survive, even with immediate and aggressive treatment.
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19
2.15 Genetic Syndromes and Conditions
Notes:
Genetic syndromes are a form of congenital anomalies. Genetic information is
contained in microscopic threadlike structures in the nucleus of human body cells.
Genetic disorders and syndromes are the result of an abnormal gene taking up
residence on one of the 22 pairs of nonsex chromosomes. Here are three such genetic
syndromes: Robinow syndrome, hypertrophic cardiomyopathy, and Down's syndrome.
2.16 Robinow Syndrome
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20
Notes:
Robinow syndrome is a condition of small stature and related incidence of interorbital
distance, bulging (bossing) forehead, depressed nasal bridge, malaligned teeth, and
short limbs. Other manifestations of the syndrome may be present. Individuals with
Robinow syndrome have been found to be of normal intelligence; however, they may
experience medical issues throughout childhood and the developmental stages.
2.17 Hypertrophic cardiomyopathy (HCM)
Notes:
Hypertrophic cardiomyopathy (HCM), a congenital disorder, occurs when a portion of
the heart muscle thickens without any apparent cause. This condition is a major cause
of sudden cardiac death in young athletes who have appeared to be completely healthy.
Tragically, the first sign is the collapse of a seemingly healthy young athlete during a
strenuous sporting event or other period of stressful exercise. This collapse can be
followed by cardiac arrest caused by a cardiac arrhythmia. Many have no symptoms
until the collapse. Prognosis of the young person who has collapsed is very guarded
because most are not responsive to immediate cardiac resuscitation.
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21
2.18 Down Syndrome
Notes:
Patients with Down syndrome have Trisomy 21, an extra chromosome 21. It occurs
more commonly in infants born to mothers over age 35. Severe conditions are usually
diagnosed at birth, but milder forms may not be evident until later.
Clinical picture includes a small skull, a slant to the eyes, flat nasal bridge, low-set ears,
and simian creases in palms. Heart defects may be more severe than the neurologic
picture suggests. Treatment may include corrective heart surgery and antibiotics for
susceptibility to pulmonary disease.
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22
2.19 Lesson Summary
Notes:
To summarize, the developmental process begins with conception and progresses as a
gradual modification of the structure and characteristics of the individual. The first 2
months of the gestational period is considered the embryonic period, after which the
developing human being is considered a fetus. At any point in this prenatal development,
during the birth process (perinatal period), or during the neonatal and postnatal periods,
the development may diverge from normal, generating a developmental dilemma.
Congenital anomalies can be mental or physical and can vary widely in severity, from
trivial to fatal. They are present at birth but might not be detected until later in infancy
or childhood. These can be the result of genetic abnormalities. They may also be
nongenetic in origin, such as the effect on the fetus of maternal alcohol ingestion,
infection in the mother, drugs taken by the mother, or the age of the mother.
Sometimes they are the result of the interplay of genetic and nongenetic causes. The
anomalies can affect physical as well as mental development. Quite often more than
one structural problem exists. Many, but not all, congenital disorders can be detected
through prenatal diagnosis. One can diagnose congenital anomalies in a fetus by
amniocentesis and/or ultrasound. Preterm birth or prematurity is the result of birth
before the 37th gestational week of pregnancy. The condition of prematurity describes
the birth of a low-weight, underdeveloped, and short-gestation infant and is considered
the leading cause of death during the neonatal period. Causes of premature labor
resulting in a premature infant are an incompetent cervix, bicornate uterus, toxic
conditions, maternal infection, trauma, premature rupture of the amniotic membranes,
history of previous miscarriages, multiple gestations, intrauterine fetal growth
retardation, and other physical conditions of the mother, such as pregnancy-induced or
chronic hypertension. Diabetes, heart disease, kidney disease, poor nutrition, substance
abuse, and lack of prenatal care also contribute to the incidence of the mother giving
birth to a preterm infant. In some cases, the etiology is never identified. Infant
Respiratory Distress Syndrome or hyaline membrane disease is similar to adult
respiratory distress syndrome in that the patient suffers acute hypoxemia caused by
This workforce solution was partially financed through a $12,695,959 grant from the Department of Labor’s
Employment and Training Administration.
This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by/4.0/.
23
infiltrates within the alveoli. Shortly after birth, the neonate exhibits signs of respiratory
distress, including nasal flaring, grunting respirations, and sternal retractions.
Bronchopulmonary Dysplasia (BPD), is a serious, chronic lung disease, which results
after an insult to the neonate's lungs. This may be a sequela to Infant Respiratory
Distress Syndrome , a lung infection, or extreme prematurity. The lungs are stiff,
obstructed, and hard to ventilate. Retinopathy of Prematurity is also known as
retrolental fibroplasia, is an abnormal growth of the blood vessels in the retinas of the
infant's eyes. The condition occurs in the eyes of premature infants. The blood vessels
to the retina do not begin development until about the 28th week of gestation. In
premature infants, this vascularization is incomplete. Severe cases may result in
blindness. Necrotizing enterocolitis is caused by ischemic necrosis of the mucosal lining
in the large and/or small intestine. Feeding intolerance, abdominal distention, bilecolored emesis, diarrhea, blood in the stool, decreased or absent bowel sounds,
lethargy, and body temperature instability a few days after birth are some of the initial
symptoms exhibited by the preterm or low-weight infant. Genetic syndromes are a form
of congenital anomalies. Genetic information is contained in microscopic threadlike
structures in the nucleus of human body cells. Genetic disorders and syndromes are the
result of an abnormal gene taking up residence on one of the 22 pairs of nonsex
chromosomes. Here, we looked at three such genetic syndromes: Robinow syndrome,
hypertrophic cardiomyopathy, and Down's syndrome. Robinow syndrome is a condition
of small stature and related incidence of interorbital distance, bulging (bossing)
forehead, depressed nasal bridge, malaligned teeth, and short limbs. Individuals with
Robinow syndrome have been found to be of normal intelligence; however, they may
experience medical issues throughout childhood and the developmental stages.
Hypertrophic cardiomyopathy (HCM), a congenital disorder, occurs when a portion of
the heart muscle thickens without any apparent cause. This condition is a major cause
of sudden cardiac death in young athletes who have appeared to be completely healthy.
Patients with Down syndrome have Trisomy 21, an extra chromosome 21. It occurs
more commonly in infants born to mothers over age 35. Severe conditions are usually
diagnosed at birth, but milder forms may not be evident until later.
This workforce solution was partially financed through a $12,695,959 grant from the Department of Labor’s
Employment and Training Administration.
This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license,
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24
2.20 Lesson Summary
Notes:
In summary, we defined Homeostasis as the internal stability of the body. When
all systems and organs function, then the body maintains an internal stability of
homeostasis. Pathology is the abnormal condition causing measurable changes
in structure and function. When the internal equilibrium is disrupted and the
body is no longer able to adapt to internal and external challenges or stressors,
then a disease state develops. The collection of objective, measurable findings
(signs) is compared with the subjective patient reports (symptoms) to give an
overall clinical impression or presentation with the provider. Acute illnesses: can
be quite time-limited, like a common cold or a bout of influenza, and more
severe, like a heart attack or appendicitis. Chronic illness: can start out as an
acute illness that does not resolve, such as sinusitis. Some illnesses can be
chronic conditions with recurrent, acute exacerbations, such as asthma or sickle
cell anemia. We learned that individuals have Predisposing Factors to disease
such as Age, Gender, Lifestyle, Environment, and Heredity. Genetic mutations
are changes in the genetic code that: Are passed from one generation to the
next, May occur spontaneously, May be caused by agents that disrupt the
normal DNA sequence. Acute inflammation is a normal protective physiologic
response to tissue injury and disease. Acute inflammatory response is marked
by: Redness, Heat, Swelling, Pain, and loss of organ or extremity function. Being
an exudative response, acute inflammation attempts to wall off, destroy, and
digest bacteria as well as dead or foreign tissue. Pathogenic agents include:
Bacteria, Viruses, Fungi, and Protozoa. The skin is the ultimate mechanical
barrier that keeps us safe from a multitude of pathogens. Chemical barriers
include such things as the body pH, which creates a hostile environment and
prevents certain organisms from successfully taking over. Cancer is a group of
diseases characterized by uncontrolled cell proliferation or growth. It is that
uncontrolled growth and proliferation at the expense of healthy cells and tissues
and this uncontrolled growth can develop into masses of abnormal cells or
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25
tumors. Benign tumors Develop slowly, Can arise from any tissue, Usually remain
encapsulated and self-contained and Rarely recur after surgical removal. On the
other hand, malignant neoplasms are Cells that multiply rapidly, these cells do
not usually resemble the tissue of origin, the tumors invade surrounding tissue,
and are often recurrent and may Infiltrate to distant sites (metastasize).Hospice
care can be described as Comfort and supportive care for the patient and family
during the terminal stages of illness and into the bereavement period, care
where Emphasis is on palliative treatment not curative. Hospice neither hastens
nor postpones death and considers dying as a normal process. Hospice care
provides physical, psychological, and spiritual support and may be home-based
or in a facility with dedicated hospice services/beds
2.21 Self Check 1
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
always fatal.
always genetic.
always nongenetic.
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X
none of the above.
Feedback when correct:
That's right!
Feedback when incorrect:
Not correct
Correct (Slide Layer)
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27
Incorrect (Slide Layer)
2.22 Attempts to halt premature labor include
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
having the mother on complete bedrest.
using drug therapy to slow or halt contractions.
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28
giving the mother a short course of steroids to aid fetal lung maturation.
X
all of the above.
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You did not select the correct response.
Correct (Slide Layer)
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29
Incorrect (Slide Layer)
2.23 Causes of prematurity include
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
incompetent cervix, bicornate uterus, and premature rupture of membranes
maternal physical conditions including infection and hypertension.
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30
multiple gestation.
X
all of the above.
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You did not select the correct response.
Correct (Slide Layer)
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31
Incorrect (Slide Layer)
2.24 Conditions often resulting from premature birth include
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
X
necrotizing enterocolitis (NEC), infantile respiratory distress syndrome (IRDS), and
retinopathy of prematurity.
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32
Spina bifida, hydrocephalus, anacephaly.
muscular dystrophy, cystic fibrosis, and Down's syndrome.
all of the above.
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Correct (Slide Layer)
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33
Incorrect (Slide Layer)
2.25 Conjoined twins may be joined
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
head to head (cranial).
posteriorly at the sacrum and coccyx.
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34
chest to chest.
X
at all of the above points.
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35
Incorrect (Slide Layer)
2.26 The collapse of a seemingly healthy young athlete during a strenuous
sporting event or other period of stressful exercise is known as
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
patent ductus arteriosis.
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36
X
hypertropic cardiomyography.
respiratory distress syndrome.
none of the above.
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37
Incorrect (Slide Layer)
2.27 Down's syndrome, a genetic syndrome, is the result of the child
having ______ pairs of chromosomes:
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
45
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38
46
X
47
48
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39
Incorrect (Slide Layer)
2.28 Hyaline membrane disease refers to
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
bronchomalacia.
X
infant respiratory distress syndrome.
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40
retinopathy of prematurity.
necrotizing enterocolitis.
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41
Incorrect (Slide Layer)
2.29 Down syndrome is
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
a congenital form of mild-to-severe mental retardation.
associated with distinctive physical abnormalities and heart defects
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42
caused by a chromosomal abnormality
X
all of the above.
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43
Incorrect (Slide Layer)
2.30 Genetic disorders and syndromes are the result of an abnormal gene
taking up residence on one of the 22 pairs of nonsex chromosomes.
(True/False, 1 points, 1 attempt permitted)
Correct
Choice
X
True
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44
False
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45
Incorrect (Slide Layer)
2.31 The lungs of the neonate lack the surfactant needed to allow the
alveoli to expand.
(True/False, 1 points, 1 attempt permitted)
Correct
Choice
X
True
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False
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47
Incorrect (Slide Layer)
2.32 Necrotizing enterocolitis is an acute inflammatory process resulting
from ischemic necrosis of the lining of the bronchial tubes.
(True/False, 1 points, 1 attempt permitted)
Correct
Choice
True
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48
X
False
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49
Incorrect (Slide Layer)
2.33 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
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50
2.21 Self Check 1
2.22 Attempts to halt premature labor include
2.23 Causes of prematurity include
2.24 Conditions often resulting from premature birth include
2.25 Conjoined twins may be joined
2.26 The collapse of a seemingly healthy young athlete during a strenuous sporting event or
other period of stressful exercise is known as
2.27 Down's syndrome, a genetic syndrome, is the result of the child having ______ pairs of
chromosomes:
2.28 Hyaline membrane disease refers to
2.29 Down syndrome is
2.30 Genetic disorders and syndromes are the result of an abnormal gene taking up residence
on one of the 22 pairs of nonsex chromosomes.
2.31 The lungs of the neonate lack the surfactant needed to allow the alveoli to expand.
2.32 Necrotizing enterocolitis is an acute inflammatory process resulting from ischemic necrosis
of the lining of the bronchial tubes.
Result slide properties
Passing Score
80%
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51
3. Lesson 2
3.1 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
The most common crippler of children is a
cerebral palsy
condition consisting of a group of disorders
possibly involving the brain and nervous
system functions
Progressive degeneration and weakening of
muscular dystrophy
the skeletal muscles
Malformations of the spine in which the spinal
spina bifida
cord is completely or partially absent
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52
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53
Incorrect (Slide Layer)
3.2 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Posterior arches of the vertebrae, fail to fuse
spina bifida occulta
Meninges protrude through an opening in the
meningocele
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54
spinal column
Most severe form of spina bifida
myelomeningocele
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55
Incorrect (Slide Layer)
3.3 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Abnormal enlargement of the head caused by
hydrocephalus
increase in or blocked circulation of CSR
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56
Failure of the cephalic aspect of the neural
anencephaly
tube to close
Abnormal opening between the right and the
ventricular septal defect
left ventricles of the heart.
Narrowed aortic lumen causing a partial
coarctation of the aorta
obstruction of the flow of blood through the
aorta.
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57
Incorrect (Slide Layer)
3.4 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Ductus fails to close
patent ductus arteriosus
Abnormal opening between the right and left
atrial septal defect
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58
atria
Most common cyanotic cardiac defect
tetralogy of fallot
Aorta and the pulmonary artery are reversed.
transposition of the great arteries
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Incorrect (Slide Layer)
3.5 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
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60
3.1 Match the following
3.2 Match the following
3.3 Match the following
3.4 Match the following
Result slide properties
Passing Score
80%
Success (Slide Layer)
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61
Failure (Slide Layer)
3.6 Start Lesson 2
Notes:
At the completion of this lesson, the student will be able to:
 Describe diseases of the nervous system
 Identify congenital cardiac defects
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62
3.7 Diseases of the Nervous System
Notes:
There are several diseases relating to the nervous system. We will look at Cerebral Palsy,
Muscular Dystrophy, Spina Bifida, Spina Bifida Occulta, Meningocele, Myelomeningocele,
Hydrocephalus, and Anencephaly.
3.8 Cerebral Palsy (CP)
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63
Notes:
Cerebral palsy (CP), the most common crippler of children, is a condition consisting of a
group of disorders possibly involving the brain and nervous system functions that deal
with movement, learning, hearing, sight, and thinking. This disorder may be congenital
or acquired, bilateral or unilateral in the form of a nonprogressive paralysis that results
from damage to the central nervous system (CNS). CP usually stems from inadequate
blood or oxygen supply to the brain during fetal development, during the birth process,
or in early childhood. There are three major types of cerebral palsy: spastic cerebral
palsy (70 percent of cases); athetoid cerebral palsy (20 percent of cases); and ataxic
cerebral palsy (10 percent of cases). A patient may show signs of all three types in
varying degrees.
The symptoms tend to worsen as the child grows. Some patients have related
complications such as seizures, retardation, and sensory deficits. Long-term treatment
may include speech and physical therapy, orthopedic intervention, and even corrective
surgery.
3.9 Muscular Dystrophy
Notes:
 Muscular dystrophy (MD) is a progressive degeneration and weakening of the
skeletal muscles where muscle fibers are abnormally vulnerable to injury. Duchenne
muscular dystrophy is the most common form of the disease. Signs and symptoms
usually are present by age 5. Muscles atrophy and walking becomes difficult. Mobility
becomes more compromised and contractures develop. Mental impairment often is
present. Duchenne MD is the result of a genetic defect. It is caused by the absence of
dystrophin, a protein involved in maintaining the integrity of muscle. As is the case
for hemophilia and color blindness, the disease affects only males and generally is
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inherited through female carriers.
 Physical therapy, exercise, surgery, and orthopedic appliances may help to minimize
deformities and preserve mobility. The prognosis for a child with MD is poor. The
child usually is confined to a wheelchair by the age of 9 to 12 years. Death usually
results from cardiac or respiratory complications within 10 to 15 years of the onset of
the disease.
3.10 Spina Bifida
Notes:
Spina bifida is a group of malformations of the spine in which the posterior portion of
the bony canal containing the spinal cord (usually in the lumbar region) is completely or
partially absent. Also called neural tube defects, the three different levels of the
condition originate during early weeks of gestation as the spinal cord and bony canal
develop. During this developmental stage, there is a failure of the posterior spinal
processes to close, usually in the lumbar region. This failure of complete closure allows
the meninges and, in severe cases, the spinal cord to herniate. The three types of spina
bifida are spinal bifida occulta, meningocele, and myelomeningocele.
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3.11 Spina Bifida Occulta
Notes:
In the defect called spina bifida occulta, the posterior arches of the vertebrae,
commonly in the lumbosacral area, fail to fuse, but there is no herniation of meninges
or spinal cord. Usually there is no spinal cord or spinal nerve involvement. When this
malformation occurs without displacement of the cord or the meninges, spina bifida
occulta is asymptomatic. At other times, the only evidence of the neural tube defect is a
dimpling, a tuft of hair, or a hemangioma over the site where the vertebrae have not
completely fused. The etiology of this congenital anomaly is unknown, but it has been
associated with exposure to ionizing radiation during early uterine life. Reduced levels of
vitamin A and folic acid consumed during pregnancy may contribute to the incidence of
spina bifida. Spina bifida occulta usually requires no intervention other than prudent
observation throughout the child's growth and development.
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3.12 Meningocele
Notes:
The second level of failure of the spinal column to fuse during the developmental stage
is meningocele. The meninges protrude through an opening in the spinal column, thus
forming a sac that becomes filled with cerebrospinal fluid (CSF). There is no nerve
involvement; therefore the infant usually has no neurologic problems. Treatment
usually consists of surgical intervention to correct the defect in the first 24 to 48 hours
of life. Because the spinal cord is not involved, paralysis usually does not occur. These
children require prudent follow-up and usually develop normally.
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3.13 Myelomeningocele
Notes:
Myelomeningocele (also known as spina bifida cystica) is a protrusion of a portion of the
spinal cord and the meninges through a defect in the spinal column, usually in the
lumbar region. Myelomeningocele is the most severe form of spina bifida. Because
spinal nerves or the spinal cord are present in this herniation, the infant exhibits
neurologic symptoms. The infant may have musculoskeletal malformation, immobile
joints, or paralysis of the lower extremities. Treatment is surgical intervention, usually
within the first 24 hours of life, to prevent further deterioration of the involved nerves,
infection, and rupture of the herniation. As the child grows, additional procedures may
be required to correct evolving problems. Children with myelomeningocele may have
other anomalies, including hydrocephalus. Many of these children have no bowel or
bladder control and may never be able to walk. A large number of these children die
before the age of 2 years.
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3.14 Congenital Spinal Chord Defects
Notes:
According to the Agent Orange Benefits Act, Public Law 104-204, which became law in
1996, the federal government and Department of Veterans Affairs recognized the
possibility that exposure of a parent before conception to Agent Orange could result in
the child being born with a form of spina bifida.
3.15 Hydrocephalus
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Notes:
In hydrocephalus, the amount of CSF is increased greatly or its circulation is blocked,
resulting in an abnormal enlargement of the head and characteristic pressure changes in
the brain. In hydrocephalus, a large amount of CSF accumulates in the skull, causing
increased intracranial pressure. An impairment of the circulation of the CSF in the
ventricular circulation (obstructive hydrocephalus) may be caused by a lesion within the
system or by a congenital structural defect. An impairment of the flow of the CSF in the
subarachnoid space (communicating hydrocephalus) prevents the CSF from reaching the
areas where it normally would be reabsorbed by the arachnoid villi. This may be the
result of intracranial hemorrhage resulting from head trauma, a blood clot, prematurity,
or infection. Head circumference increases at a faster rate than expected for normal
growth. The infant has a high-pitched cry, is irritable, and may have episodes of
projectile vomiting.
3.16 Treatment of Hydrocephalus
Notes:
Treatment consists of surgical intervention to place a shunt in the ventricular or
subarachnoid spaces to drain off the excessive CSF. Some catheters empty into the
peritoneal cavity, and other shunt catheters empty into the right atrium of the heart. If
left untreated, the increasing intracranial pressure of hydrocephalus causes mental
retardation and eventually death.
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3.17 Anencephaly
Notes:
 Anencephaly is the most severe form of neural tube defect occurs early in gestation
with failure of the cephalic aspect of the neural tube to close. The microcephalic fetus
or neonate has very small amounts of cerebral tissue and may survive a few hours or
days. Although most of these infants die before birth or during the birth process, a
few survive for a short time.
 Occasionally diagnosis is not made until after birth, based on clinical presentation and
confirmation by ultrasound or CAT scan.
 No treatment available.
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3.18 Congenital Cardiac Defects
Notes:
Congenital cardiac defects are developmental anomalies of the heart or the great
vessels of the heart. They are present at birth, and the defects cause mild to fatal stress
of the cardiac muscle. Signs and symptoms vary according to the nature of the anomaly,
the severity of the defect, and its effect on the heart and the circulatory system. The
common defects generally are categorized as follows: acyanotic, in which deoxygenated
and oxygenated blood do not mix, and cyanotic, in which oxygenated and deoxygenated
blood mix.
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3.19 Fetal Circulation
Notes:
 Fetal circulation is necessary because oxygen is available only from maternal blood
supply. The exchange of oxygen occurs in the placenta rather than in the fetal lungs,
which are nonfunctioning in utero. Oxygen-rich blood flows into the left ventricle and
aorta, some to the carotid and coronary arteries. Eventually all blood travels back to
the placenta via the umbilical arteries.
 After delivery, with the termination of umbilical blood flow and the start of lung
function, the neonatal circulation undergoes several key changes. The ductus
arteriosus, which is no longer needed, closes up within days of birth.
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3.20 Acyanotic Defects
Notes:
In these conditions, Acyanotic defects, oxygenated blood does not mix with
deoxygenated blood and the infant usually maintains a fairly normal pink skin
color. Cyanosis is not prevalent. The greatest medical concern for infants with
acyanotic cardiac defects is congestive heart failure. Conditions that are
acyanotic include: Ventricular septal defect, Patent ductus arteriosus, Atrial
septal defect, and Coarctation of the aorta
3.21 Ventricular septal defect
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Notes:
The most common congenital cardiac disorder, ventricular septal defect (VSD), is an
abnormal opening between the right and the left ventricles. When the defect is small,
there is little functional disease; when it is large, the results are serious. In this condition,
blood is shunted from the left to the right side of the heart due to higher pressure in the
left ventricle. Clinical features include failure to gain weight, restlessness, irritability,
sweating when feeding, and increased heart rate and respirations. This condition may
go undetected until later in childhood, adolescence, or adulthood.
3.22 Patent Ductus Arteriosus
Notes:
Patent ductus arteriosus may be present with other cardiac defects. The ductus
arteriosus, which shunts blood from the pulmonary trunk to the descending aorta, does
not close within a few days of birth. The condition causes mild to fatal cardiac stress.
Surgical intervention may be the only option for correcting the condition. The infant
maintains a normal pink skin color (acyanotic). The infant's growth and development
may be slowed, and various signs of heart failure may be present. Closure may be
attempted by drug therapy using an antiprostaglandin or ibuprofen. The other option is
surgical closure of the ductus.
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3.23 Coarctation of the aorta
Notes:
Coarctation of the aorta, this defect is characterized by a narrowed aortic lumen,
causing a partial obstruction of the flow of blood through the aorta. signs of left
ventricular failure with pulmonary edema. The patient is pale and cyanotic with
weakness, dyspnea, and tachycardia.
3.24 Atrial Septal Defect
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Notes:
Atrial Septal Defect is an abnormal opening between the right and left atria. closure is
achieved with surgical repair.
3.25 Cyanotic Defects
Notes:
In Cyanotic defects, deoxygenated blood mixes with oxygenated blood.
Decreased circulating blood oxygen causes the infant to appear slightly blue in
color (cyanotic). Most cases are evident at the neonatal exam. The two most
common defects are discussed here: the Tetralogy of Fallot
And Transposition of the great arteries
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77
3.26 Tetralogy of Fallot
Notes:
Tetralogy of Fallot is the most common cyanotic cardiac defect is a combination of four
congenital heart defects: (1) ventricular septal defect, an abnormal opening in the
ventricular septum; (2) pulmonary stenosis, a tightening of the pulmonary valve or
vessel; (3) dextroposition (displacement to the right) of the aorta, which overrides
(receiving circulation from both ventricles) the ventricular septal defect; and (4) right
ventricular hypertrophy, caused by increased pressure in the ventricle. This diagnosis
requires major surgical correction.
 The neonate will show signs of hypoxia, such as increased heart rate, rapid breathing,
and even seizures. Cardiac murmurs are often present, as is delayed physical growth.
 Treatment depends on the type of defect, severity of symptoms, and presence of lifethreatening complications. Surgical techniques and medications can correct some
abnormalities.
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78
3.27 Transposition of the Great Arteries
Notes:
In Transposition of the Great Arteries, the aorta and the pulmonary artery are reversed:
the aorta originates from the right ventricle, and the pulmonary artery originates from
the left ventricle. The result is two closed-loop circulatory systems: one between the
heart and the lungs, and the other between the heart and systemic circulation. Within a
few hours of birth, neonates with this defect exhibit cyanosis and tachypnea, followed
by signs of heart failure.
3.28 Lesson Summary
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79
Notes:
In summary, there are several diseases relating to the nervous system. We took a look
at Cerebral Palsy, Muscular Dystrophy, Spina Bifida, Spina Bifida Occulta, Meningocele,
Myelomeningocele, Hydrocephalus, and Anencephaly. Cerebral palsy, the most
common crippler of children, is a condition consisting of a group of disorders possibly
involving the brain and nervous system functions that deal with movement, learning,
hearing, sight, and thinking. This disorder may be congenital or acquired, bilateral or
unilateral in the form of a nonprogressive paralysis that results from damage to the
central nervous system (CNS). CP usually stems from inadequate blood or oxygen supply
to the brain during fetal development, during the birth process, or in early childhood.
Muscular dystrophy (MD) is a progressive degeneration and weakening of the skeletal
muscles where muscle fibers are abnormally vulnerable to injury. Duchenne muscular
dystrophy is the most common form of the disease. Muscles atrophy and walking
becomes difficult. Mobility becomes more compromised and contractures develop.
Mental impairment often is present. Spina bifida is a group of malformations of the
spine in which the posterior portion of the bony canal containing the spinal cord (usually
in the lumbar region) is completely or partially absent. Also called neural tube defects,
the three different levels of the condition originate during early weeks of gestation as
the spinal cord and bony canal develop. During this developmental stage, there is a
failure of the posterior spinal processes to close, usually in the lumbar region. This
failure of complete closure allows the meninges and, in severe cases, the spinal cord to
herniate. The three types of spina bifida are spinal bifida occulta, meningocele, and
myelomeningocele. In the defect called spina bifida occulta, the posterior arches of the
vertebrae, commonly in the lumbosacral area, fail to fuse, but there is no herniation of
meninges or spinal cord. The second level of failure of the spinal column to fuse during
the developmental stage is meningocele. The meninges protrude through an opening in
the spinal column, thus forming a sac that becomes filled with cerebrospinal fluid (CSF).
There is no nerve involvement; therefore the infant usually has no neurologic problems.
Myelomeningocele (also known as spina bifida cystica) is a protrusion of a portion of the
spinal cord and the meninges through a defect in the spinal column, usually in the
lumbar region. Myelomeningocele is the most severe form of spina bifida. Because
spinal nerves or the spinal cord are present in this herniation, the infant exhibits
neurologic symptoms. In hydrocephalus, the amount of CSF is increased greatly or its
circulation is blocked, resulting in an abnormal enlargement of the head and
characteristic pressure changes in the brain. In hydrocephalus, a large amount of CSF
accumulates in the skull, causing increased intracranial pressure. Anencephaly is the
most severe form of neural tube defect occurs early in gestation with failure of the
cephalic aspect of the neural tube to close. The microcephalic fetus or neonate has very
small amounts of cerebral tissue and may survive a few hours or days. Congenital
cardiac defects are developmental anomalies of the heart or the great vessels of the
heart. They are present at birth, and the defects cause mild to fatal stress of the cardiac
muscle. In these conditions, Acyanotic defects, oxygenated blood does not mix with
deoxygenated blood and the infant usually maintains a fairly normal pink skin color.
Cyanosis is not prevalent. The greatest medical concern for infants with acyanotic
cardiac defects is congestive heart failure. Conditions that are acyanotic include:
Ventricular septal defect, Patent ductus arteriosus, Atrial septal defect, and Coarctation
of the aorta. The most common congenital cardiac disorder, ventricular septal defect
(VSD), is an abnormal opening between the right and the left ventricles. When the
defect is small, there is little functional disease; when it is large, the results are serious.
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In this condition, blood is shunted from the left to the right side of the heart due to
higher pressure in the left ventricle. Clinical features include failure to gain weight,
restlessness, irritability, sweating when feeding, and increased heart rate and
respirations. Patent ductus arteriosus may be present with other cardiac defects. The
ductus arteriosus, which shunts blood from the pulmonary trunk to the descending
aorta, does not close within a few days of birth. The condition causes mild to fatal
cardiac stress. Coarctation fo the aorta, this defect is characterized by a narrowed aortic
lumen, causing a partial obstruction of the flow of blood through the aorta. signs of left
ventricular failure with pulmonary edema. Atrial Septal Defect is an abnormal opening
between the right and left atria. In Cyanotic defects, deoxygenated blood mixes with
oxygenated blood. Decreased circulating blood oxygen causes the infant to appear
slightly blue in color (cyanotic). Most cases are evident at the neonatal exam. The two
most common defects are discussed here: the Tetralogy of Fallot, and Transposition of
the great arteries. Tetralogy of Fallot is the most common cyanotic cardiac defect is a
combination of four congenital heart defects: (1) ventricular septal defect, an abnormal
opening in the ventricular septum; (2) pulmonary stenosis, a tightening of the
pulmonary valve or vessel; (3) dextroposition (displacement to the right) of the aorta,
which overrides (receiving circulation from both ventricles) the ventricular septal defect;
and (4) right ventricular hypertrophy, caused by increased pressure in the ventricle. In
Transposition of the Great Arteries, the aorta and the pulmonary artery are reversed:
the aorta originates from the right ventricle, and the pulmonary artery originates from
the left ventricle. The result is two closed-loop circulatory systems: one between the
heart and the lungs, and the other between the heart and systemic circulation. Within a
few hours of birth, neonates with this defect exhibit cyanosis and tachypnea, followed
by signs of heart failure.
3.29 Lesson Summary
Notes:
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In summary, we defined Homeostasis as the internal stability of the body. When
all systems and organs function, then the body maintains an internal stability of
homeostasis. Pathology is the abnormal condition causing measurable changes
in structure and function. When the internal equilibrium is disrupted and the
body is no longer able to adapt to internal and external challenges or stressors,
then a disease state develops. The collection of objective, measurable findings
(signs) is compared with the subjective patient reports (symptoms) to give an
overall clinical impression or presentation with the provider. Acute illnesses: can
be quite time-limited, like a common cold or a bout of influenza, and more
severe, like a heart attack or appendicitis. Chronic illness: can start out as an
acute illness that does not resolve, such as sinusitis. Some illnesses can be
chronic conditions with recurrent, acute exacerbations, such as asthma or sickle
cell anemia. We learned that individuals have Predisposing Factors to disease
such as Age, Gender, Lifestyle, Environment, and Heredity. Genetic mutations
are changes in the genetic code that: Are passed from one generation to the
next, May occur spontaneously, May be caused by agents that disrupt the
normal DNA sequence. Acute inflammation is a normal protective physiologic
response to tissue injury and disease. Acute inflammatory response is marked
by: Redness, Heat, Swelling, Pain, and loss of organ or extremity function. Being
an exudative response, acute inflammation attempts to wall off, destroy, and
digest bacteria as well as dead or foreign tissue. Pathogenic agents include:
Bacteria, Viruses, Fungi, and Protozoa. The skin is the ultimate mechanical
barrier that keeps us safe from a multitude of pathogens. Chemical barriers
include such things as the body pH, which creates a hostile environment and
prevents certain organisms from successfully taking over. Cancer is a group of
diseases characterized by uncontrolled cell proliferation or growth. It is that
uncontrolled growth and proliferation at the expense of healthy cells and tissues
and this uncontrolled growth can develop into masses of abnormal cells or
tumors. Benign tumors Develop slowly, Can arise from any tissue, Usually remain
encapsulated and self-contained and Rarely recur after surgical removal. On the
other hand, malignant neoplasms are Cells that multiply rapidly, these cells do
not usually resemble the tissue of origin, the tumors invade surrounding tissue,
and are often recurrent and may Infiltrate to distant sites (metastasize).Hospice
care can be described as Comfort and supportive care for the patient and family
during the terminal stages of illness and into the bereavement period, care
where Emphasis is on palliative treatment not curative. Hospice neither hastens
nor postpones death and considers dying as a normal process. Hospice care
provides physical, psychological, and spiritual support and may be home-based
or in a facility with dedicated hospice services/beds
3.30 Self Check 2
(Multiple Choice, 1 points, 1 attempt permitted)
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82
Correct
Choice
spina bifida.
muscular dystrophy.
down syndrome.
X
cerebral palsy.
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That's right!
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Not correct
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83
Correct (Slide Layer)
Incorrect (Slide Layer)
3.31 All females of child-bearing age capable of becoming pregnant are
encouraged to take the recommended amount of
(Multiple Choice, 1 points, 1 attempt permitted)
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84
Correct
Choice
calcium.
vitamin D.
X
folic acid .
iron.
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Correct (Slide Layer)
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3.32 Duchenne muscular dystrophy
(Multiple Choice, 1 points, 1 attempt permitted)
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86
Correct
Choice
is usually the result of trauma.
X
is progressive and causes crippling and immobility.
affects males and females equally.
is none of the above.
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87
Correct (Slide Layer)
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3.33 Cerebral palsy is
(Multiple Choice, 1 points, 1 attempt permitted)
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88
Correct
Choice
X
a result of damage to the central nervous system (CNS).
a condition that can be cured with treatment.
a condition that primarily affects intelligence.
all of the above.
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89
Correct (Slide Layer)
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3.34 The most common cyanotic congenital heart defect that is actually a
combination of four defects is called
(Multiple Choice, 1 points, 1 attempt permitted)
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90
Correct
Choice
ventricular septal defect.
patent ductus arteriosus.
X
tetralogy of Fallot.
none of the above.
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91
Correct (Slide Layer)
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3.35 The diagnostic investigation of a congenital heart defect may include
(Multiple Choice, 1 points, 1 attempt permitted)
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92
Correct
Choice
physical examination and patient history.
radiographic studies of the chest and blood tests.
heart catheterization and electrocardiogram.
X
all of the above.
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93
Correct (Slide Layer)
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3.36 A congenital spinal defect in which no herniation of spinal cord or
meninges exists is called a myelomeningocele.
(True/False, 1 points, 1 attempt permitted)
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94
Correct
Choice
True
X
False
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95
Correct (Slide Layer)
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3.37 In hydrocephalus a large amount of cerebrospinal fluid accumulates
in the skull, causing increased intracranial pressure.
(True/False, 1 points, 1 attempt permitted)
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96
Correct
Choice
X
True
False
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97
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3.38 Closure of patent ductus arteriosus may be achieved by medication
or by surgical closure of the ductus.
(True/False, 1 points, 1 attempt permitted)
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98
Correct
Choice
X
True
False
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99
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3.39 Results
(Results Slide, 0 points, 1 attempt permitted)
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100
Results for
3.30 Self Check 2
3.31 All females of child-bearing age capable of becoming pregnant are encouraged to take the
recommended amount of
3.32 Duchenne muscular dystrophy
3.33 Cerebral palsy is
3.34 The most common cyanotic congenital heart defect that is actually a combination of four
defects is called
3.35 The diagnostic investigation of a congenital heart defect may include
3.36 A congenital spinal defect in which no herniation of spinal cord or meninges exists is called
a myelomeningocele.
3.37 In hydrocephalus a large amount of cerebrospinal fluid accumulates in the skull, causing
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101
increased intracranial pressure.
3.38 Closure of patent ductus arteriosus may be achieved by medication or by surgical closure of
the ductus.
Result slide properties
Passing Score
80%
4. Lesson 3
4.1 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
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102
Correct
Choice
Anterior half of foot is adducted and inverted
Clubfoot
Abnormal development of the hip joint
DDH
Birth defect consisting of one or more holes in
Cleft lip
the upper lip
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103
Incorrect (Slide Layer)
4.2 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Birth defect in which there is a hole in the
Cleft palate
middle of the roof of the mouth
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104
Failure of one or both of the testicles to
Cryptorchidism
descend from the abdominal cavity into the
scrotum.
Stenosis of the foreskin opening
Phimosis
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105
Incorrect (Slide Layer)
4.3 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Narrowing of the pyloric sphincter at the exit
Pyloric stenosis
of the stomach
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106
Impairment of intestinal motility that causes
Hirschsprung's disease
obstruction of the distal colon
an autosomal recessive inherited disorder
Cystic fibrosis
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107
Incorrect (Slide Layer)
4.4 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Inherited autosomal recessive trait which
Phenylketonuria
causes defective enzymatic conversion in
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108
protein metabolism
male hypogonadism
Klinefelter's syndrome
Chromosomal disease in females with a single
Turner's syndrome
sex chromosome
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109
Incorrect (Slide Layer)
4.5 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
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110
4.1 Match the following
4.2 Match the following
4.3 Match the following
4.4 Match the following
Result slide properties
Passing Score
80%
Success (Slide Layer)
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111
Failure (Slide Layer)
4.6 Start Lesson 3
Notes:
At the completion of this lesson, the student will be able to:

Recall musculoskeletal conditions.

Identify genitourinary conditions.
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112

List diseases of the digestive system.
Describe metabolic and endocrine disorders.
4.7 Musculoskeletal Conditions
Notes:
These are some common congenital defects of the musculoskeletal system. Clubfoot
and hip dysplasia can often be corrected with various external fixation devices such as
braces or serial casts. Cleft lip and palate usually require corrective surgery.
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113
4.8 Clubfoot (talipes equinovarus)
Notes:
A true clubfoot cannot be manipulated to the proper position, while distortions that are
caused by intrauterine position usually can be. With Clubfoot the heel is drawn up, with
the lateral side of the foot being convex and the medial aspect being concave.
Treatment consists of either cast application or the use of splints.
4.9 Developmental Hip Dysplasia
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114
Notes:
Developmental dysplasia of the hip, previously known as congenital hip dysplasia, is an
abnormal development of the hip joint that ranges from an unstable joint to dislocation
of the femoral head from the acetabulum. The exact cause is unknown. Typical
developmental dysplasia of the hip occurs shortly before, during, or shortly after birth,
possibly as a result of softening of the ligaments caused by the maternal hormone
relaxin. Developmental dysplasia of the hip may result from a breech presentation and
is more common in female infants. Treatment includes the use of various devices to
reduce the hip dislocation. After the femoral head is returned to its proper position in
the acetabulum, the legs are held in place by a Pavlik harness, a splint, or a cast,
allowing stable maintenance of the hip in a position of flexion and abduction. Early
treatment offers the best results and may avoid the necessity of surgical intervention.
4.10 Cleft Lip and Palate
Notes:
Cleft lip (harelip) is a congenital birth defect consisting of one or more clefts in the
upper lip. Cleft palate is a birth defect in which there is a hole in the middle of the roof
of the mouth (palate). The cleft may extend completely through the hard and soft
palates into the nasal area. The defects appear singularly or may be linked and vary in
severity. Some infants have difficulty with nasal regurgitation and feeding because of air
leaks around the cleft. A major problem is the infant's appearance.
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115
4.11 Genitourinary Conditions
Notes:
Genitourinary conditions that will be discussed are Cryptorchidism (undescended testes),
Wilms' Tumor (malignant neoplasm of the kidney), Phimosis (narrowing of foreskin)
4.12 Cryptorchidism (undescended testes)
Notes:
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 Cryptorchidism is failure of one or both of the testicles to descend from the
abdominal cavity into the scrotum. The condition may be unilateral or bilateral.
During infancy and early childhood, there are no symptoms, just the absence of the
testes. The condition is more common in premature infants. The testes often descend
spontaneously during the first year of life. If this does not happen by 4 years of age,
the treatment is to place the undescended testes into the scrotum by either surgical
manipulation (orchiopexy) or hormonal drug therapy (B-HCG or testosterone).
Treatment is important because untreated cryptorchidism may lead to sterility in the
adult male. There is an increased risk of testicular cancer in untreated cryptorchidism.
4.13 Wilms' Tumor (malignant neoplasm of the kidney)
Notes:
 Wilms' tumor, or nephroblastoma, is a highly malignant neoplasm of the kidney that
affects children younger than 10 years. It is the most common kidney tumor of
childhood and the fourth most common childhood cancer. Symptoms may include a
firm, nontender mass in the kidney region, hematuria, pain in the abdomen or chest,
vomiting, anemia, intestinal obstruction, weight loss, and fever.
 Children experiencing signs and symptoms of the condition should be assessed
immediately. Prompt recognition and treatment are imperative because the tumor is
locally invasive and tends to metastasize. Surgical removal of the tumor and
accessible metastatic sites is followed by chemotherapy with or without radiation
therapy. Prognosis is usually good with prompt treatment.
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117
4.14 Phimosis (narrowing of foreskin)
Notes:
 Phimosis is stenosis, or narrowing, of the opening of the foreskin in the male that
leads to an inability to retract the foreskin. It is rare for the foreskin to be retractable
in the neonatal period. This is normal and in some cases can persist into adolescence.
Phimosis can be problematic if acquired after the neonatal period. Phimosis may be
corrected with surgical intervention. More than one procedure may be necessary as
the boy grows up.
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118
4.15 Diseases of the Digestive System
Notes:
In looking at the diseases of the digestive system, we have Congenital Pyloric Stenosis
and Hirschsprung's Disease.
4.16 Congenital Pyloric Stenosis (narrowing of the pyloric sphincter at the
exit of the stomach)
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Notes:
Pyloric stenosis, a congenital disorder, is a gastric obstruction associated with narrowing
of the pyloric sphincter at the exit of the stomach. This condition may also be called
congenital hypertrophic pyloric stenosis. The infant has episodes of projectile vomiting
after feedings and fails to gain weight. Symptoms usually begin at 2 to 3 weeks of age.
The infant appears hungry, continues to feed, and yet fails to gain weight. If left
untreated, the infant becomes dehydrated and experiences electrolyte imbalances. A
small olive-shaped hard mass may be palpated in the region of the pyloric sphincter, and
left to right peristalsis may be noted, followed by reverse peristalsis. The emesis
contains no bile. Treatment consists of surgical intervention in which the constricted
pylorus is incised (pyloromyotomy) and sutured to relieve the obstruction.
4.17 Hirschsprung's Disease
Notes:
Hirschsprung's disease, a congenital condition, is an impairment of intestinal motility
that causes obstruction of the distal colon. In Hirschsprung's disease, the
parasympathetic nerve ganglion cells are absent in a segment of the colon, usually in the
rectosigmoid area. This deficiency of innervation results in lack of peristalsis in the
affected portion of the colon and the succeeding backup of fecal material. The proximal
portion of the colon becomes grossly distended, and intestinal obstruction results. The
affected bowel is excised, and the normal colon is joined to the anus. A temporary
colostomy is performed proximal to the aganglionic section of the colon. Electrolyte and
fluid balance must be maintained. After the colon recovers function (6 months to 1 year),
the colostomy is closed.
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120
4.18 Metabolic Disorders
Notes:
The metabolic disorders we will examine are cystic fibrosis and Phenylketonuria (PKU).
4.19 Cystic Fibrosis
Notes:
 Cystic fibrosis (CF), an autosomal recessive inherited disorder, is a chronic
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121
dysfunction of a gene called the cystic fibrosis transmembrane conductance regulator
that affects multiple body systems. It is the most common fatal genetic disease.
Diagnosis is based on pulmonary function tests, chest x-rays, stool studies, and
elevated sodium and chloride levels in sweat. The disease primarily attacks the lungs
and the digestive system, producing copious thick and sticky mucus that accumulates
and blocks glandular ducts. The clinical effects of CF can be immense, including a dry
paroxysmal cough, exercise intolerance, pneumonia, bulky diarrhea, vomiting, and
bowel obstruction. Pancreatic changes occur, with fat and fiber replacing normal
tissue. Involvement of sweat glands causes increased concentrations of salt in sweat.
Normal growth and ability to thrive are reduced. Because CF is considered a fatal
disease, the long-term prognosis is not favorable. Early diagnosis and compliance
with treatment have improved the possibility for these children to have as near
normal a life as possible and an increased life expectancy. At the present time, life
expectancy of a CF patient in the United States has increased into the 30s.
4.20 Phenylketonuria (PKU)
Notes:
 PKU is inherited as an autosomal recessive trait and causes defective enzymatic
conversion in protein metabolism, resulting in the accumulation of phenylalanine in
the blood. A mandatory blood and urine test is given to the infant shortly after birth
to test for phenylketonuria.
 Restricting phenylalanine from the newborn's diet will help prevent brain damage.
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122
4.21 Endocrine Syndromes
Notes:
Klinefelter's syndrome and Turner's syndrome are examples of genetic, chromosomal
diseases that are not inherited. They result from nondisjunction, or the failure of a
chromosome pair to separate, during gamete production
4.22 Klinefelter's Syndrome (male hypogonadism)
Notes:
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 Klinefelter's syndrome (XXY condition) is male hypogonadism, appearing in males
after puberty with at least two X chromosomes and one or more Y chromosomes
(typically the 47,XXY pattern). In Klinefelter's syndrome, there is abnormal
development of the testes that results in infertility. The male infant appears normal
at birth and symptoms are often not noted until puberty. The condition cannot be
cured. Testosterone injections may be given to help maintain normal muscle and
bone mass.
4.23 Turner's Syndrome (female gonadal dysgenesis)
Notes:
 Turner's syndrome is a chromosomal disease that occurs in females with a single sex
chromosome, 45,XO. In Turner's syndrome, there is abnormal development of
ovaries that results in infertility. The female infant usually exhibits external physical
characteristics at birth that become more apparent with time. Patients exhibit lack of
sexual maturity, dwarfism, and cardiac and kidney defects. The condition cannot be
cured. Estrogen and growth hormone may be given to reduce symptoms.
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124
4.24 Lesson Summary
Notes:
To summarize, these are some common congenital defects of the musculoskeletal
system. Clubfoot and hip dysplasia can often be corrected with various external fixation
devices such as braces or serial casts. Cleft lip and palate usually require corrective
surgery. A true clubfoot cannot be manipulated to the proper position, while distortions
that are caused by intrauterine position usually can be. With Clubfoot the heel is drawn
up, with the lateral side of the foot being convex and the medial aspect being concave.
Developmental dysplasia of the hip, previously known as congenital hip dysplasia, is an
abnormal development of the hip joint that ranges from an unstable joint to dislocation
of the femoral head from the acetabulum. The exact cause is unknown. Cleft lip (harelip)
is a congenital birth defect consisting of one or more clefts in the upper lip. Cleft palate
is a birth defect in which there is a hole in the middle of the roof of the mouth. The cleft
may extend completely through the hard and soft palates into the nasal area. The
defects appear singularly or may be linked and vary in severity. The genitourinary
conditions that we looked at included: Cryptorchidism (undescended testes), Wilms'
Tumor (malignant neoplasm of the kidney), Phimosis (narrowing of foreskin).
Cryptorchidism is failure of one or both of the testicles to descend from the abdominal
cavity into the scrotum. The condition may be unilateral or bilateral. During infancy and
early childhood, there are no symptoms, just the absence of the testes. The condition is
more common in premature infants. The testes often descend spontaneously during the
first year of life. Wilms' tumor, or nephroblastoma, is a highly malignant neoplasm of
the kidney that affects children younger than 10 years. It is the most common kidney
tumor of childhood and the fourth most common childhood cancer. Symptoms may
include a firm, nontender mass in the kidney region, hematuria, pain in the abdomen or
chest, vomiting, anemia, intestinal obstruction, weight loss, and fever. Phimosis is
stenosis, or narrowing, of the opening of the foreskin in the male that leads to an
inability to retract the foreskin. In looking at the diseases of the digestive system, we
have Congenital Pyloric Stenosis and Hirschsprung's Disease. Pyloric stenosis, a
congenital disorder, is a gastric obstruction associated with narrowing of the pyloric
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125
sphincter at the exit of the stomach. This condition may also be called congenital
hypertrophic pyloric stenosis. The infant has episodes of projectile vomiting after
feedings and fails to gain weight. Hirschsprung's disease, a congenital condition, is an
impairment of intestinal motility that causes obstruction of the distal colon. In
Hirschsprung's disease, the parasympathetic nerve ganglion cells are absent in a
segment of the colon, usually in the rectosigmoid area. This deficiency of innervation
results in lack of peristalsis in the affected portion of the colon and the succeeding
backup of fecal material. The proximal portion of the colon becomes grossly distended,
and intestinal obstruction results. The metabolic disorders we examined are cystic
fibrosis and Phenylketonuria (PKU). Cystic fibrosis (CF), an autosomal recessive inherited
disorder, is a chronic dysfunction of a gene called the cystic fibrosis transmembrane
conductance regulator that affects multiple body systems. It is the most common fatal
genetic disease. The disease primarily attacks the lungs and the digestive system,
producing copious thick and sticky mucus that accumulates and blocks glandular ducts.
PKU is inherited as an autosomal recessive trait and causes defective enzymatic
conversion in protein metabolism, resulting in the accumulation of phenylalanine in the
blood. A mandatory blood and urine test is given to the infant shortly after birth to test
for phenylketonuria. Klinefelter's syndrome and Turner's syndrome are examples of
genetic, chromosomal diseases that are not inherited. They result from nondisjunction,
or the failure of a chromosome pair to separate, during gamete production. Klinefelter's
syndrome (XXY condition) is male hypogonadism, appearing in males after puberty with
at least two X chromosomes and one or more Y chromosomes (typically the 47,XXY
pattern). In Klinefelter's syndrome, there is abnormal development of the testes that
results in infertility. The male infant appears normal at birth and symptoms are often
not noted until puberty. Turner's syndrome is a chromosomal disease that occurs in
females with a single sex chromosome, 45,XO. In Turner's syndrome, there is abnormal
development of ovaries that results in infertility. The female infant usually exhibits
external physical characteristics at birth that become more apparent with time. Patients
exhibit lack of sexual maturity, dwarfism, and cardiac and kidney defects. Neither
condition can be cured.
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126
4.25 Lesson Summary
Notes:
In summary, we defined Homeostasis as the internal stability of the body. When
all systems and organs function, then the body maintains an internal stability of
homeostasis. Pathology is the abnormal condition causing measurable changes
in structure and function. When the internal equilibrium is disrupted and the
body is no longer able to adapt to internal and external challenges or stressors,
then a disease state develops. The collection of objective, measurable findings
(signs) is compared with the subjective patient reports (symptoms) to give an
overall clinical impression or presentation with the provider. Acute illnesses: can
be quite time-limited, like a common cold or a bout of influenza, and more
severe, like a heart attack or appendicitis. Chronic illness: can start out as an
acute illness that does not resolve, such as sinusitis. Some illnesses can be
chronic conditions with recurrent, acute exacerbations, such as asthma or sickle
cell anemia. We learned that individuals have Predisposing Factors to disease
such as Age, Gender, Lifestyle, Environment, and Heredity. Genetic mutations
are changes in the genetic code that: Are passed from one generation to the
next, May occur spontaneously, May be caused by agents that disrupt the
normal DNA sequence. Acute inflammation is a normal protective physiologic
response to tissue injury and disease. Acute inflammatory response is marked
by: Redness, Heat, Swelling, Pain, and loss of organ or extremity function. Being
an exudative response, acute inflammation attempts to wall off, destroy, and
digest bacteria as well as dead or foreign tissue. Pathogenic agents include:
Bacteria, Viruses, Fungi, and Protozoa. The skin is the ultimate mechanical
barrier that keeps us safe from a multitude of pathogens. Chemical barriers
include such things as the body pH, which creates a hostile environment and
prevents certain organisms from successfully taking over. Cancer is a group of
diseases characterized by uncontrolled cell proliferation or growth. It is that
uncontrolled growth and proliferation at the expense of healthy cells and tissues
and this uncontrolled growth can develop into masses of abnormal cells or
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127
tumors. Benign tumors Develop slowly, Can arise from any tissue, Usually remain
encapsulated and self-contained and Rarely recur after surgical removal. On the
other hand, malignant neoplasms are Cells that multiply rapidly, these cells do
not usually resemble the tissue of origin, the tumors invade surrounding tissue,
and are often recurrent and may Infiltrate to distant sites (metastasize).Hospice
care can be described as Comfort and supportive care for the patient and family
during the terminal stages of illness and into the bereavement period, care
where Emphasis is on palliative treatment not curative. Hospice neither hastens
nor postpones death and considers dying as a normal process. Hospice care
provides physical, psychological, and spiritual support and may be home-based
or in a facility with dedicated hospice services/beds
4.26 SELF CHECK 3
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
causes cleft lip.
is a nontraumatic deformity of the foot.
is more common in male infants.
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128
X
is an abnormal development of the hip joint.
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Not correct
Correct (Slide Layer)
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129
Incorrect (Slide Layer)
4.27 The birth defect in which the is a hole in the middle of the roof of the
mouth is
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
X
cleft palate.
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130
cri-du-chat syndrome.
Robinow's syndrome.
meningocele.
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131
Incorrect (Slide Layer)
4.28 Cryptorchidism is
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
a congenital malignant tumor.
also known as phimosis.
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132
X
the failure of the testicle(s) to descend into the scrotum.
none of the above.
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133
Incorrect (Slide Layer)
4.29 Symptoms of Wilms's tumor may include
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
nasal regurgitation during feeding.
X
hematuria, pain, and hypertension.
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134
a shortening of the femur.
projectile vomiting, loss of weight, and skin rash.
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135
Incorrect (Slide Layer)
4.30 The disease that involves impairment of intestinal motility, which
causes obstruction of the distal colon, is called
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
X
Hirschsprung's disease.
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136
pyloric stenosis.
cryptorchidism.
phimosis.
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137
Incorrect (Slide Layer)
4.31 Cystic fibrosis (CF), a chronic dysfunction of the exocrine glands,
primarily attacks the
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
nervous system.
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138
X
lungs and digestive system.
blood vessels.
immune system.
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139
Incorrect (Slide Layer)
4.32 The primary treatment of phenylketonuria includes
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
oxygen therapy.
high-sodium chloride diet.
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140
X
a protein-restricted diet.
surgical intervention.
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141
Incorrect (Slide Layer)
4.33 The production of copious thick and sticky mucus that accumulates
and blocks glandular ducts is characteristic of
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
Wilms's tumor.
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142
phenylketonuria (PKU).
pyloric stenosis.
X
cystic fibrosis (CF).
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143
Incorrect (Slide Layer)
4.34 Klinefelter's syndrome and Turner's syndrome are examples of
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
inherited chromosomal diseases.
X
genetic, chromosomal diseases which are not inherited.
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144
chromosomal diseases that affect females only.
inherited diseases of no significant consequence.
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145
Incorrect (Slide Layer)
4.35 PKU is an inborn error in metabolism of amino acids causing brain
damage and mental retardation when not corrected.
(True/False, 1 points, 1 attempt permitted)
Correct
Choice
X
True
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146
False
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147
Incorrect (Slide Layer)
4.36 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
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148
4.26 SELF CHECK 3
4.27 The birth defect in which the is a hole in the middle of the roof of the mouth is
4.28 Cryptorchidism is
4.29 Symptoms of Wilms's tumor may include
4.30 The disease that involves impairment of intestinal motility, which causes obstruction of the
distal colon, is called
4.31 Cystic fibrosis (CF), a chronic dysfunction of the exocrine glands, primarily attacks the
4.32 The primary treatment of phenylketonuria includes
4.33 The production of copious thick and sticky mucus that accumulates and blocks glandular
ducts is characteristic of
4.34 Klinefelter's syndrome and Turner's syndrome are examples of
4.35 PKU is an inborn error in metabolism of amino acids causing brain damage and mental
retardation when not corrected.
Result slide properties
Passing Score
80%
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149
5. Lesson 4
5.1 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Systemic disease with superficial cutaneous
Chickenpox
lesions that begin as red macules progress to
papules and then become vesicles that form
crusts
Acute communicable disease that causes
Diphtheria
necrosis of the mucous membrane in the
respiratory tract
Acute communicable viral disease causing
Mumps
inflammation and swelling of one or both
parotid glands
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150
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151
Incorrect (Slide Layer)
5.2 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Highly contagious bacterial infection of the
Whooping cough
respiratory tract
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152
Acute, highly contagious viral disease which
Measles
starts with fever, followed in 3 to 7 days by a
red blotchy rash.
Contagious viral disease, resembling measles
Rubella
but with a shorter course and fewer
complications.
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153
Incorrect (Slide Layer)
5.3 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Acute, potentially deadly, systemic infection
Tetanus
characterized by painful involuntary
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154
contraction of skeletal muscles
Acute, highly contagious viral infection of the
Influenza
respiratory tract transmitted by droplet nuclei
or direct contact with moist secretions
sudden death of an infant under the age of 1
SIDS
year for which a cause cannot be established
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155
Incorrect (Slide Layer)
5.4 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Acute, severe inflammation and obstruction of
Croup
the respiratory tract.
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156
Inflammation of the epiglottis
Epiglottitis
Inflammatory and infectious process affecting
Acute tonsillitis
the tonsils
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157
Incorrect (Slide Layer)
5.5 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Abnormal enlargement of the lymphoid tissue
Adenoid hyperplasia
located in the space above the soft palate of
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158
the mouth.
Chronic reversible obstructive disease caused
Asthma
by increased reactivity of the tracheobronchial
tree to various stimuli.
Inflammation of the bronchioles
Bronchiolitis
Parasites occurring in the intestinal tract
Helminth infestation
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159
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5.6 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Rapid passage of stool through the intestinal
Diarrhea
tract.
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160
ejection of stomach contents through the
Vomiting
mouth.
Abnormal reduction in the concentration of
Anemia
red blood cells
Cancer of blood-forming tissues
Leukemia
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161
Incorrect (Slide Layer)
5.7 Match the following
(Matching Drop-down, 1 points, 1 attempt permitted)
Correct
Choice
Incompatibility of fetal and maternal blood
Erythroblastosis fetalis
resulting in red blood cell destruction.
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162
Environmentally caused blood toxicity
Lead poisoning
Combination of brain disease and fatty
Reye's syndrome
invasion of the inner organs
birth defects and other associated problems in
FAS
infants born to mothers who consume alcohol
during the gestational period.
Cancer of the sympathetic nervous system
Neuroblastoma
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163
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5.8 Results
(Results Slide, 0 points, 1 attempt permitted)
Results for
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164
5.1 Match the following
5.2 Match the following
5.3 Match the following
5.4 Match the following
5.5 Match the following
5.6 Match the following
5.7 Match the following
Result slide properties
Passing Score
80%
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165
Success (Slide Layer)
Failure (Slide Layer)
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166
5.9 Lesson 4 Objectives
Notes:
At the completion of this lesson, the student will be able to:

List and discuss contagious diseases of children.

Identify respiratory system diseases and disorders.

Describe the infant born with fetal alcohol syndrome.
Recall blood disorders.
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167
5.10 Infectious Diseases
Notes:
Infectious diseases can disrupt normal growth and development and may result in longterm consequences. Except for the common cold, these diseases can be prevented with
immunizations.
5.11 Chickenpox (varicella)
Notes:
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Chickenpox is a systemic disease with superficial cutaneous lesions that begin as red
macules that progress to papules and then finally become vesicles that form crusts. The
lesions first are seen on the face or the trunk and then spread over the extremities; they
can be distributed everywhere on the body and even have been found internally. A day
or two before the rash appears, the patient may experience fever, malaise, and anorexia.
The lesions can continue to erupt for 3 to 4 days and cause intense itching. The virus is
transmitted by direct or indirect droplet nuclei spread from the respiratory tract of the
infected person or a carrier. Fluid from the cutaneous lesions is also infectious, but dried
crusty lesions are not contagious. The causative organism is the varicella-zoster virus.
Recovery is usually complete within 2 weeks, leaving the person with lifetime immunity.
Individuals who have had chickenpox are at risk of developing herpes zoster (shingles)
later in life.
5.12 Diphtheria
Notes:
Diphtheria is an acute communicable disease that causes necrosis of the mucous
membrane in the respiratory tract. The patient, most often a child, has sore throat,
dysphagia, a cough, hoarseness, and chills. Fever, swollen regional lymph nodes, foul
breath, and in some cases, cyanosis can be noted. As the bacteria invade the
nasopharynx, they multiply and produce a powerful exotoxin that travels in the blood
throughout the body. Locally, the infection and inflammation cause grayish patches of
thick mucous membrane to appear along the respiratory tract known as
pseudomembrane, or false membrane. The membrane, which can be extensive, is
composed of bacteria, inflammatory cells, dead tissue, and fibrin; it is surrounded by
inflammation and swelling that can interfere with the airway, impairing swallowing and
speech. Diphtheria antitoxin is given as soon as possible. The administration of
antibiotics, such as penicillin and erythromycin, is indicated to kill the organism. The
patient is isolated, restricted to bed rest, and given a diet as tolerated.
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169
5.13 Mumps (epidemic parotitis)
Notes:
Mumps is an acute communicable viral disease causing inflammation and swelling of
one or both parotid glands. The causative agent of mumps is an airborne virus that is
spread by droplet nuclei from the respiratory tract. The incubation period is long,
usually 14 to 21 days. The patient is contagious for 1 to 7 days before the swelling of the
parotid glands and up to 9 days thereafter. Acetaminophen is given, and warm or cold
compresses are applied for pain. Most children recover from mumps; however, orchitis,
meningitis, and encephalitis are possible complications of mumps. Lifelong immunity
develops after a clinical or subclinical infection; active immunization with the mumps
vaccine also affords prolonged immunity.
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170
5.14 Pertussis (whooping cough)
Notes:
Whooping cough is a highly contagious bacterial infection of the respiratory tract and
the individual exhibits symptoms of violent coughing with high-pitched inspiratory
whoop and vomiting of thick mucus. The disease has three stages: (1) the highly
contagious catarrhal stage, when the child seems to have a common cold; (2) the
paroxysmal stage, when the cough becomes violent, ending in a high-pitched inspiratory
whoop, often followed by vomiting of thick mucus; and (3) a convalescent period, when
the cough gradually diminishes. It is transmitted by droplet nuclei spread via direct or
indirect contact with nasopharyngeal secretions of the contagious patient. Erythromycin
is the antibiotic of choice for treatment. Fluid intake is encouraged to prevent
dehydration. When untreated, pertussis can be fatal.
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171
5.15 Measles (rubeola)
Notes:
Measles is an acute, highly contagious viral disease occurring in children who have not
been vaccinated. Early symptoms include cough, coryza, conjunctivitis, and photophobia.
The child has a fever, followed in 3 to 7 days by a red blotchy rash. The rash starts
behind the ears, hairline, and forehead and then progresses down the body. The
causative agent of measles is the measles virus. The infection is airborne, spread by
direct contact with secretions from the nose or throat. The patient is contagious from
about 4 days before the onset of the rash until about 4 days after the onset. The
incubation period is 8 to 12 days after exposure. Acetaminophen is given to treat the
fever. The prognosis for uncomplicated measles is good. The complications of measles
include pneumonia, otitis media, conjunctivitis, and encephalitis.
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172
5.16 Rubella (German measles, three-day measles)
Notes:
Rubella, a highly contagious viral disease, resembles measles clinically, but it has a
shorter course and fewer complications. In this viral disease, the child has a rose-colored,
slightly elevated rash that appears first on the face and head and then progresses
downward on the body. In addition, the child has a low-grade fever and can have
tenderness and enlargement of the lymph nodes. Complications include transient
arthritis, myocarditis, and hemorrhagic manifestations. The causative agent is the
rubella virus, which is spread by direct contact with nasal or oral secretions. The
incubation period after exposure is 14 to 21 days. The patient is contagious from 1 week
before eruption of the rash until 1 week after the onset of rash. Treatment consists of
supportive measures, including the administration of a mild analgesic for fever and joint
pain.
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173
5.17 Tetanus
Notes:
Tetanus is an acute, potentially deadly, systemic infection characterized by painful
involuntary contraction of skeletal muscles. The patient is extremely febrile
(temperature greater than 101° F), is irritable, and sweats profusely. He or she has a stiff
neck, a tight jaw (lockjaw), spasms of the facial muscles, and difficulty in swallowing. As
the infection progresses, the muscles of the back and abdomen become rigid, with
generalized convulsive muscle spasm. These tonic spasms may cause death from
asphyxiation. Patients who have experienced a soft tissue wound, including animal bites
and punctures from nails, burns, and abrasions, should be assessed for tetanus
prophylaxis and instructed about the importance of receiving the “tetanus shot.”
Puncture wounds are excellent breeding grounds for the bacillus because they lack a
good oxygen supply and the bacillus thrives in dead tissue, producing a powerful
exotoxin that attacks the nervous system. The incubation period is 3 to 21 days, with the
onset commonly occurring at about 8 days. Tetanus antitoxin immunizations followed
by booster doses every 10 years create immunity. The medical management is chiefly
supportive, with the administration of sedatives and muscle relaxants to relieve spasms
and seizures; a quiet, dark environment promotes rest. If the patient suffers convulsions,
respiratory integrity must be preserved.
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174
5.18 Influenza
Notes:
Influenza is an acute, highly contagious viral infection of the respiratory tract. Influenza
occurs sporadically or as an epidemic and is transmitted by droplet nuclei or direct
contact with moist secretions. Children tend to have high fevers with influenza and are
susceptible to pulmonary complications and Reye's syndrome. Because of the latter,
acetaminophen, and not aspirin, is given to children and adolescents for fever and pain.
5.19 Respiratory Diseases/Disorders
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Notes:
These following respiratory conditions range from acute and fatal to chronic and
recurrent. Even a relatively minor condition may become life-threatening quickly if the
airway is compromised. Recurrent infections of the throat, ears, and upper and lower
airways can result in long-term issues and impaired pulmonary function.
5.20 Sudden Infant Death Syndrome (SIDS)
Notes:
Sudden infant death syndrome (SIDS), formerly called crib death, is defined officially as
the sudden death of an infant under the age of 1 year for which a cause cannot be
established. It is the number 1 cause of death among infants from 1 to 12 months of age.
Death occurs within seconds during sleep without sound or struggle, and the baby does
not suffer. Most SIDS infants appeared healthy before death. When found, the dead
infant may have a mottled complexion and cyanotic lips and fingertips. Many maternal
and infant risk factors are known: mother's age less than 20 years, poor prenatal care,
smoking and drug abuse during pregnancy, exposure of the infant to secondhand smoke,
prematurity, recent upper respiratory tract infection in the infant, sleeping in the prone
position, and a sibling with apnea. The incidence is higher in males and during the
winter months likely due to overbundling of the infant during sleep. Resuscitation
attempts fail. At this time, SIDS is not predictable or preventable. The American
Academy of Pediatrics has added sleeping in the prone position or the baby sleeping on
its side to the list of risk factors. To reduce that risk, the academy recommends placing
babies in bed on their backs instead of on their stomachs or sides. Exposure to cigarette
smoke should be prevented. Firm bedding materials in a safety-approved crib are
prudent. All blankets and pillows should be removed from the crib. Research shows that
overheating an infant by dressing in excessive clothing, especially during illness, is to be
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176
avoided. Other important factors include good prenatal care and breast-feeding.
5.21 Croup
Notes:
Croup is an acute, severe inflammation and obstruction of the respiratory tract. The
symptoms include hoarseness, fever, a harsh, high-pitched cough, and stridor during
inspiration. Croup is usually a viral disease that involves the larynx, trachea, and bronchi.
The clinical manifestations are caused by edema and spasm of the vocal cords, creating
varying degrees of obstruction and narrowing of the upper airways. The patient is
treated symptomatically, with the administration of antipyretic agents, rest, increased
fluid intake, cool humidification of air, and, if the cause is bacterial, antibiotic therapy.
The hot steam from a shower may be beneficial. A dose of steroids may decrease airway
edema.
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5.22 Epiglottitis
Notes:
Epiglottitis is an inflammation of the epiglottis, the thin, leaf-shaped structure that
covers the entrance of the larynx during swallowing. Epiglottitis typically strikes children
between ages 3 and 7 years. The symptoms include a sore throat, croupy cough, fever,
and respiratory distress caused by laryngeal obstruction. Visual inspection reveals a red
and swollen epiglottis. Rapidly increasing dyspnea and drooling are the most significant
signs of this critical respiratory emergency. The most common cause is Haemophilus
influenzae type B (Hib) bacteria. Antibiotics, usually ampicillin, are given and the patient
is closely monitored.
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5.23 Acute Tonsillitis
Notes:
Acute tonsillitis is a painful inflammatory and infectious process affecting the tonsils.
The patient has a mild to severe sore throat, chills, fever, headache, malaise, anorexia,
and muscle and joint pain. The tonsils appear inflamed and swollen, with yellowish
exudate projecting from crypts. Lymph glands in the submandibular area are tender and
enlarged. The throat is examined, and a throat culture is performed to identify the
causative organism. Tonsillitis is caused by many organisms, with group A betahemolytic streptococci the most common cause. When the throat culture is positive for
group A streptococci (strep throat), a full 10-day course of penicillin is given. This strict
regimen is necessary to prevent rheumatic fever, rheumatic heart disease, and kidney
complications. The child may need a liquid diet or saline throat irrigations if the pain is
debilitating. Tonsillectomy may be recommended for chronic tonsillitis.
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5.24 Adenoid Hyperplasia
Notes:
Adenoid hyperplasia is an abnormal enlargement of the lymphoid tissue located in the
space above the soft palate of the mouth, causing a partial breathing blockage,
especially in children. Adenoid hyperplasia can contribute to recurrent otitis media and
conductive hearing loss resulting from obstruction of the eustachian tube. The child is
usually a mouth breather and snores during sleep. The cause of adenoid hyperplasia is
unknown. Contributing factors include repeated infection, chronic allergies, and
heredity. Adenoidectomy is indicated for obstructive adenoids with recurrent otitis
media or chronic serous otitis media with conductive hearing loss. It may also be
indicated if the child is experiencing obstructive sleep apnea.
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5.25 Asthma
Notes:
 Asthma is a chronic reversible obstructive disease caused by increased reactivity of
the tracheobronchial tree to various stimuli. There are two major processes at work:
constriction of the bronchioles and inflammation of the airway. It is a leading cause of
chronic illness and school absenteeism in children. Signs and symptoms of asthma
include incessant cough, wheezing, and rapid, shallow breathing. The patient has a
rapid pulse, pale color, perspiration, anxiety, and difficulty speaking. Prompt medical
intervention is indicated. A hereditary factor is strongly associated with the disease.
Asthma is the result of hyperactive and hypersensitive bronchial tubes. The bronchial
spasms of asthma can be triggered by many extrinsic (allergic) or intrinsic
(nonallergic) factors, including stress, heavy exercise, infection, and inhalation of
allergens or other substances. Allergens may include pollen, cockroaches and their
excrement, molds, household dust mites, and pet dander. Additional “triggers”
include air pollutants and irritants (perfumes, colognes, and aftershaves), smoke and
secondhand smoke, cold air, emotional upsets, and exercise.
 Use of an inhaler may not be enough and the child may require a nebulizer treatment.
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5.26 Bronchiolitis
Notes:
Bronchiolitis describes an inflammation of the bronchioles, the smallest air passages of
the lungs, which is usually caused by viruses. It is a common disease in infancy. The
infant or small child will have a cough and nasal congestion that evolve into wheeze,
tachypnea, and respiratory distress. Fever and posttussive emesis may be present. The
patient may be breathing too fast to feed properly and can become dehydrated. In very
young infants, especially in those who were premature, apnea may occur. Bronchiolitis
is most commonly caused by infection with respiratory syncytial virus (RSV). Many other
viruses can cause this disease, including parainfluenza and adenovirus. Bronchiolitis is
most common during the winter months (October through April). Infants in day care or
who have school-age siblings are at highest risk. The natural progression of the infection
is that symptoms worsen over the first few days of infection, peaking in severity around
day 4 or 5, and then slowly improve. Treatment is supportive care. Albuterol, racemic
epinephrine, or hypertonic saline given via a nebulizer may improve respiratory
symptoms. Supplemental oxygen may be required.
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5.27 Infantile Colic (intermittent abdominal distress)
Notes:
Colic is intermittent distress in the newborn or during early infancy of unclear etiology.
Infantile colic can present 4 to 6 weeks after birth and last into the third month. The
infant intermittently draws up the legs, clenches the fists, and cries as if in pain. During
the episode, the infant may pass gas by mouth and rectum. It can be very disruptive to
the family. Episodes usually occur in late afternoon or evening. The causes are
speculative, and common remedies include changing feeding techniques and/or
eliminating cow's milk and/or iron from the infant's and lactating mother's diet. The
infant usually outgrows the condition at about 3 months of age. Probiotics or
simethicone can provide relief in some cases.
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183
5.28 Helminth (Worm) Infestation (infestation of gastrointestinal tract)
Notes:
Helminth infestation describes the condition of parasites, such as roundworms,
pinworms, hookworms, and tapeworms, occurring in the intestinal tract.
Typically introduced into the gastrointestinal tract after children put contaminated eggs
into their mouths; worms can migrate to other tissues. Pinworms are the most common.
After pinworm eggs are swallowed, they hatch in the intestine. The female worms
migrate to the perianal area at night, where they lay their eggs. This process causes mild
to intense itching and irritation in the area. A complete course of anthelmintic agents is
given; some physicians treat the entire family. Frequent showering and hand washing
are advised.
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5.29 Diarrhea
Notes:
Vomiting and diarrhea are common disorders in children and are usually self-limiting.
However, because of low body weight, rapid dehydration is a serious consequence.
Diarrhea is rapid passage of stool through the intestinal tract, with a noticeable change
in the frequency, fluid content, appearance, and consistency. Depending on the cause,
the symptoms could include intestinal cramping, weakness, nausea, irritability, and
fever. Diarrhea has multiple causes: infection (viral, bacterial, or parasitic), medications,
allergic reactions, emotions, anatomic abnormalities, malabsorption syndromes,
mechanical or chemical irritation resulting from the diet, and toxicity. The treatment of
diarrhea is directed at the cause, if known. Oral intake may be restricted to rest the
intestinal tract and to reduce intestinal irritability. When infection is the cause,
appropriate antibiotics may be given.
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5.30 Vomiting
Notes:
Vomiting is the ejection of stomach contents through the mouth. Vomiting can range
from a mild regurgitation to projectile expulsion. The infant has a distended abdomen, is
irritable, and often has a fever. Aspiration of vomitus into the lungs can result in
pneumonia. Vomiting, which is more common in infants than in children, usually results
from trivial or temporary factors. However, it has a host of possible causes, including
overfeeding, food allergy, gastric irritation, infection, drug poisoning, elevated
intracranial pressure, defects such as pyloric stenosis, and habitual voluntary vomiting.
Most vomiting can be expected to abate spontaneously. Food may be withheld for a
time to rest the upper GI tract and to reduce gastric irritation. When treatment is
indicated, it depends on the cause, severity, and nature of the vomiting.
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5.31 Blood Disorders
Notes:
In looking at important blood disorders for this age group, we look at Anemia, Leukemia,
Erythroblastosis fetalis, and Lead Poisoning.
5.32 Anemia
Notes:
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Anemia is an abnormal reduction in the concentration of red blood cells (RBCs) or in the
hemoglobin content of circulating blood. It is not a disease, but a symptom of various
diseases. Iron deficiency is the most common form of anemia in children. Other causes
include acute or chronic blood loss, decreased blood formation, nutritional deficiency
disorders, hemolytic diseases, inhibition or loss of bone marrow, and sickle-cell disease.
Pallor, weakness, fatigability, and listlessness are noted initially in the anemic child or
infant. Palpitations, tachycardia, cardiac enlargement, jaundice, and mental sluggishness
are symptoms of severe anemia. Nutritious diets, together with vitamin supplements,
are used to treat the condition. The prognosis varies depending on the cause. When diet
modification can be recommended and followed, the prognosis is good. When the
problem is bleeding and the source of the bleed can be determined and corrected, the
prognosis is good with blood replacement and dietary supplement. Hemolytic disorders
have a fair prognosis with aggressive treatment once the hemolytic disorder is identified.
5.33 Leukemia
Notes:
 Leukemia, a cancer of blood-forming tissues, is the most common childhood
malignancy. It is characterized by an abnormal increase in the number of immature
WBCs or undifferentiated blastocytes. Bone marrow infiltration by leukemic cells
leads to anemia, susceptibility to infection resulting from neutropenia, and prolonged
bleeding time resulting from the reduction in the amount of platelets. Common signs
and symptoms include fever, easy bruising, pallor, weakness, weight loss, and bone
and joint pain. The abnormal cells can invade various organs of the body, causing
pressure symptoms in those areas. Lymph nodes and the spleen may become
enlarged. Two general types of leukemia are found in children, acute lymphoid
leukemia (ALL) and acute myelogenous leukemia (AML). About 80% of childhood
leukemias are acute lymphoid leukemias. The disease is treated through systemic
chemotherapy to eradicate leukemic cells and to induce remission. Bone marrow
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transplantation is a possible treatment for children with poor prognosis. Most
children with leukemia survive the disease. Of those treated solely with
chemotherapy, 80% achieve long-term, disease-free survival. Long-term survival for
those undergoing bone marrow transplantation (BMT) ranges from 25% to 50%.
However, these long-term survivors can experience late adverse effects from the
treatment, including CNS impairment, growth retardation, infertility, and even
secondary cancers. Because of this, these children should be closely followed after
treatment.
5.34 Erythroblastosis fetalis (hemolytic disease of the newborn)
Notes:
Erythroblastosis fetalis stems from an incompatibility of fetal and maternal blood,
resulting in excessive rates of RBC destruction. Erythroblastosis fetalis is characterized
by anemia, jaundice, kernicterus, and enlargement of the liver and spleen. In the most
severe form, called hydrops fetalis, the fetus or infant is in great jeopardy because of
extreme hemolysis. If the infant survives, the condition is marked by heart failure,
edema, pulmonary congestion, lethargy, seizures, and mental retardation. The cause is
Rh factor incompatibility. If an Rh-negative woman has children with an Rh-positive man,
some or all of the infants will be Rh positive. During pregnancy, blood from the Rhpositive fetus may move from fetal circulation into the mother's bloodstream, where it
can stimulate the mother's body to form antibodies against the Rh factor. When
sufficient quantities of the antibodies pass back into the infant's circulation, the
antibodies can clump and destroy Rh-positive cells, causing the symptoms of
erythroblastosis fetalis. The treatment is dictated by the degree of erythroblastosis
fetalis and its effect on the fetus or newborn. Intrauterine transfusions may be indicated
when the fetus shows signs of distress. When necessary, the delivery of the infant is
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planned 2 to 4 weeks before term. Exchange transfusion gives the infant fresh group-O,
Rh-negative blood. Phototherapy and albumin infusion are used to reduce the amount
of circulating bilirubin in the newborn. The prognosis is good when the disease is
discovered early in pregnancy and closely monitored. Early delivery with immediate
transfusion usually treats this condition successfully.
5.35 Rh incompatibility of maternal and fetal blood
Notes:
Mothers with Rh-negative blood factor need to continue Rho-GAM injections for
protection in subsequent pregnancies, including any spontaneous or induced abortions
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5.36 Lead Poisoning
Notes:
Lead poisoning is an environmentally caused blood toxicity resulting from ingestion or
inspiration of lead dust or particles. Acute lead toxicity results in encephalopathy
(cerebral edema) with vomiting, loss of appetite, headache, convulsions, stupor,
irritability, and ataxic gait. Chronic symptoms include anemia, weakness, colic, and
peripheral neuritis. Evidence of mental retardation resulting from brain damage is
possible. Any lead in the blood is abnormal. Exposure results from breathing or
swallowing substances containing lead. The condition has developed in children who eat
flakes of peeling lead paint, drink water from lead pipes, or ingest lead salts in certain
foods. Some imported toys have been found to contain lead or are painted with leadbased paint.Children with any symptoms should be assessed immediately. Treatment
includes removing the lead from the body and removing the sources from the patient's
environment. Prognosis is good, depending on the extent of damage.
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5.37 Miscellaneous Diseases, Syndromes and Disorders
Notes:
In looking at some important miscellaneous diseases, syndromes, and disorders that by
themselves are important to identify, we find Reye' Syndrome, Fetal Alcohol Syndrome,
and Neuroblastoma.
5.38 Reye's Syndrome (combination of brain disease and fatty invasion of
inner organs, especially the liver)
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Notes:
Reye's syndrome is a combination of brain disease and fatty invasion of the inner organs,
especially the liver. The pathogenesis includes a disruption in the urea cycle that causes
swelling of the brain, resulting in increased intracranial pressure. The symptoms of
Reye's syndrome progress through five stages: (1) lethargy, listlessness, irritability,
combativeness, vomiting, and hepatic dysfunction; (2) hyperventilation, hyperactive
reflexes, hepatic dysfunction, disorientation, convulsions, and delirium; (3) organ
changes and coma; (4) deeper coma and loss of cerebral functions; and (5) seizures, loss
of deep tendon reflexes, and respiratory arrest. The cause of Reye's syndrome is
unknown. However, it typically follows infection with influenza A or B viruses or
chickenpox. It has been linked to the use of aspirin during these infections. Successful
management with early diagnosis involves hospitalization to stabilize the patient, to
control cerebral edema, to monitor blood chemistries, to manage seizures, and to
provide mechanical ventilation if needed. Recovery can be complete.
5.39 Fetal Alcohol Syndrome (birth defects in infants whose mothers
ingested large amounts of alcohol during pregnancy)
Notes:
 Fetal alcohol syndrome (FAS) describes birth defects and other associated problems
in infants born to alcoholic mothers who consume alcohol during the gestational
period. Intrauterine exposure to sufficient levels of alcohol has been associated with
fetal growth retardation, in which the infants are short and below average in weight.
Facial characteristics of FAS include smaller eye openings with eyes spaced widely
apart and a thin upper lip. The infant may experience growth deficiencies and central
nervous system problems. Heart defects including atrial septal defect and ventricular
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septal defect may be present. FAS also is associated with mental retardation. The
infant may exhibit signs of alcohol withdrawal shortly after birth. These children may
experience learning difficulties, including decreased attention span and memory,
visual and auditory problems, and communication difficulties. Poor development of
social skills may be present. Because neurologic damage cannot be reversed, the
focus is on prevention. The hazards of chronic or routine alcohol ingestion during
pregnancy should be part of prenatal screening assessments and teaching.
5.40 Neuroblastoma
Notes:
Neuroblastoma, a cancer of the sympathetic nervous system, is the third most common
childhood malignancy. It arises from primitive sympathetic ganglion cells. Symptoms
include abdominal mass, abdominal pain or fullness, anemia, bone pain, fever,
hypertension, and weight loss. For patients with low-risk tumors, surgical removal is the
only treatment required. For higher stage tumors, chemotherapy with or without
radiation therapy is employed. For children with high-risk disease, high-dose
chemotherapy followed by autologous hematopoietic stem cell rescue may be beneficial.
Even after therapy is completed, the patient needs to be followed closely to monitor for
development of late effects from treatment, including second malignancies.
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5.41 Lesson Summary
Notes:
In summary, Infectious diseases can disrupt normal growth and development and may
result in long-term consequences. Except for the common cold, these diseases can be
prevented with immunizations. Chickenpox is a systemic disease with superficial
cutaneous lesions that begin as red macules that progress to papules and then finally
become vesicles that form crusts. The virus is transmitted by direct or indirect droplet
nuclei spread from the respiratory tract of the infected person or a carrier. The
causative organism is the varicella-zoster virus. Recovery is usually complete within 2
weeks, leaving the person with lifetime immunity. Individuals who have had chickenpox
are at risk of developing herpes zoster (shingles) later in life. Diphtheria is an acute
communicable disease that causes necrosis of the mucous membrane in the respiratory
tract. The patient, most often a child, has sore throat, dysphagia, a cough, hoarseness,
and chills. Fever, swollen regional lymph nodes, foul breath, and in some cases, cyanosis
can be noted. As the bacteria invade the nasopharynx, they multiply and produce a
powerful exotoxin that travels in the blood throughout the body. Locally, the infection
and inflammation cause grayish patches of thick mucous membrane to appear along the
respiratory tract known as pseudomembrane, or false membrane. Mumps is an acute
communicable viral disease causing inflammation and swelling of one or both parotid
glands. The causative agent of mumps is an airborne virus that is spread by droplet
nuclei from the respiratory tract. Most children recover from mumps; however, orchitis,
meningitis, and encephalitis are possible complications of mumps. Whooping cough is a
highly contagious bacterial infection of the respiratory tract and the individual exhibits
symptoms of violent coughing with high-pitched inspiratory whoop and vomiting of
thick mucus. The disease has three stages: (1) the highly contagious catarrhal stage,
when the child seems to have a common cold; (2) the paroxysmal stage, when the
cough becomes violent, ending in a high-pitched inspiratory whoop, often followed by
vomiting of thick mucus; and (3) a convalescent period, when the cough gradually
diminishes. It is transmitted by droplet nuclei spread via direct or indirect contact with
nasopharyngeal secretions of the contagious patient. Measles is an acute, highly
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contagious viral disease occurring in children who have not been vaccinated. Early
symptoms include cough, coryza, conjunctivitis, and photophobia. The child has a fever,
followed in 3 to 7 days by a red blotchy rash. The rash starts behind the ears, hairline,
and forehead and then progresses down the body. The complications of measles include
pneumonia, otitis media, conjunctivitis, and encephalitis. Rubella, a highly contagious
viral disease, resembles measles clinically, but it has a shorter course and fewer
complications. In this viral disease, the child has a rose-colored, slightly elevated rash
that appears first on the face and head and then progresses downward on the body. In
addition, the child has a low-grade fever and can have tenderness and enlargement of
the lymph nodes. Complications include transient arthritis, myocarditis, and
hemorrhagic manifestations. The causative agent is the rubella virus, which is spread by
direct contact with nasal or oral secretions. Tetanus is an acute, potentially deadly,
systemic infection characterized by painful involuntary contraction of skeletal muscles.
The patient is extremely febrile (temperature greater than 101° F), is irritable, and
sweats profusely. He or she has a stiff neck, a tight jaw (lockjaw), spasms of the facial
muscles, and difficulty in swallowing. As the infection progresses, the muscles of the
back and abdomen become rigid, with generalized convulsive muscle spasm. These tonic
spasms may cause death from asphyxiation. Influenza is an acute, highly contagious viral
infection of the respiratory tract. Influenza occurs sporadically or as an epidemic and is
transmitted by droplet nuclei or direct contact with moist secretions. Children tend to
have high fevers with influenza and are susceptible to pulmonary complications and
Reye's syndrome. These following respiratory conditions range from acute and fatal to
chronic and recurrent. Even a relatively minor condition may become life-threatening
quickly if the airway is compromised. Recurrent infections of the throat, ears, and upper
and lower airways can result in long-term issues and impaired pulmonary function.
Sudden infant death syndrome (SIDS), formerly called crib death, is defined officially as
the sudden death of an infant under the age of 1 year for which a cause cannot be
established. It is the number 1 cause of death among infants from 1 to 12 months of age.
Death occurs within seconds during sleep without sound or struggle, and the baby does
not suffer. Most SIDS infants appeared healthy before death. Croup is an acute, severe
inflammation and obstruction of the respiratory tract. The symptoms include
hoarseness, fever, a harsh, high-pitched cough, and stridor during inspiration. Croup is
usually a viral disease that involves the larynx, trachea, and bronchi. The clinical
manifestations are caused by edema and spasm of the vocal cords, creating varying
degrees of obstruction and narrowing of the upper airways. Epiglottitis is an
inflammation of the epiglottis, the thin, leaf-shaped structure that covers the entrance
of the larynx during swallowing. Epiglottitis typically strikes children between ages 3 and
7 years. The symptoms include a sore throat, croupy cough, fever, and respiratory
distress caused by laryngeal obstruction. Acute tonsillitis is a painful inflammatory and
infectious process affecting the tonsils. The patient has a mild to severe sore throat,
chills, fever, headache, malaise, anorexia, and muscle and joint pain. The tonsils appear
inflamed and swollen, with yellowish exudate projecting from crypts. Lymph glands in
the submandibular area are tender and enlarged. Adenoid hyperplasia is an abnormal
enlargement of the lymphoid tissue located in the space above the soft palate of the
mouth, causing a partial breathing blockage, especially in children. Adenoid hyperplasia
can contribute to recurrent otitis media and conductive hearing loss resulting from
obstruction of the eustachian tube. The child is usually a mouth breather and snores
during sleep. The cause of adenoid hyperplasia is unknown. Asthma is a chronic
reversible obstructive disease caused by increased reactivity of the tracheobronchial
tree to various stimuli. There are two major processes at work: constriction of the
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bronchioles and inflammation of the airway. It is a leading cause of chronic illness and
school absenteeism in children. Signs and symptoms of asthma include incessant cough,
wheezing, and rapid, shallow breathing. The patient has a rapid pulse, pale color,
perspiration, anxiety, and difficulty speaking. Prompt medical intervention is indicated.
Bronchiolitis describes an inflammation of the bronchioles, the smallest air passages of
the lungs, which is usually caused by viruses. It is a common disease in infancy. The
infant or small child will have a cough and nasal congestion that evolve into wheeze,
tachypnea, and respiratory distress. Colic is intermittent distress in the newborn or
during early infancy of unclear etiology. Infantile colic can present 4 to 6 weeks after
birth and last into the third month. The infant intermittently draws up the legs, clenches
the fists, and cries as if in pain. During the episode, the infant may pass gas by mouth
and rectum. Helminth infestation describes the condition of parasites, such as
roundworms, pinworms, hookworms, and tapeworms, occurring in the intestinal tract.
Typically introduced into the gastrointestinal tract after children put contaminated eggs
into their mouths; worms can migrate to other tissues. Pinworms are the most common.
Vomiting and diarrhea are common disorders in children and are usually self-limiting.
However, because of low body weight, rapid dehydration is a serious consequence.
Diarrhea is rapid passage of stool through the intestinal tract, with a noticeable change
in the frequency, fluid content, appearance, and consistency. Depending on the cause,
the symptoms could include intestinal cramping, weakness, nausea, irritability, and
fever. Vomiting is the ejection of stomach contents through the mouth. Vomiting can
range from a mild regurgitation to projectile expulsion. The infant has a distended
abdomen, is irritable, and often has a fever. Aspiration of vomitus into the lungs can
result in pneumonia. In looking at important blood disorders for this age group, we
looked at Anemia, Leukemia, Erythroblastosis fetalis, and Lead Poisoning. Anemia is an
abnormal reduction in the concentration of red blood cells (RBCs) or in the hemoglobin
content of circulating blood. It is not a disease, but a symptom of various diseases. Iron
deficiency is the most common form of anemia in children. Leukemia, a cancer of bloodforming tissues, is the most common childhood malignancy. It is characterized by an
abnormal increase in the number of immature WBCs or undifferentiated blastocytes.
Bone marrow infiltration by leukemic cells leads to anemia, susceptibility to infection
resulting from neutropenia, and prolonged bleeding time resulting from the reduction in
the amount of platelets. Common signs and symptoms include fever, easy bruising,
pallor, weakness, weight loss, and bone and joint pain. Two general types of leukemia
are found in children, acute lymphoid leukemia (ALL) and acute myelogenous leukemia
(AML). Erythroblastosis fetalis stems from an incompatibility of fetal and maternal blood,
resulting in excessive rates of RBC destruction. Erythroblastosis fetalis is characterized
by anemia, jaundice, kernicterus, and enlargement of the liver and spleen. In the most
severe form, called hydrops fetalis, the fetus or infant is in great jeopardy because of
extreme hemolysis. If the infant survives, the condition is marked by heart failure,
edema, pulmonary congestion, lethargy, seizures, and mental retardation. Mothers with
Rh-negative blood factor need to continue Rho-GAM injections for protection in
subsequent pregnancies, including any spontaneous or induced abortions. Lead
poisoning is an environmentally caused blood toxicity resulting from ingestion or
inspiration of lead dust or particles. Acute lead toxicity results in encephalopathy
(cerebral edema) with vomiting, loss of appetite, headache, convulsions, stupor,
irritability, and ataxic gait. Chronic symptoms include anemia, weakness, colic, and
peripheral neuritis. Evidence of mental retardation resulting from brain damage is
possible. In looking at some important miscellaneous diseases, syndromes, and
disorders that by themselves are important to identify, we find Reye' Syndrome, Fetal
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Alcohol Syndrome, and Neuroblastoma. Reye's syndrome is a combination of brain
disease and fatty invasion of the inner organs, especially the liver. The pathogenesis
includes a disruption in the urea cycle that causes swelling of the brain, resulting in
increased intracranial pressure. The symptoms of Reye's syndrome progress through
five stages: (1) lethargy, listlessness, irritability, combativeness, vomiting, and hepatic
dysfunction; (2) hyperventilation, hyperactive reflexes, hepatic dysfunction,
disorientation, convulsions, and delirium; (3) organ changes and coma; (4) deeper coma
and loss of cerebral functions; and (5) seizures, loss of deep tendon reflexes, and
respiratory arrest. The cause of Reye's syndrome is unknown. However, it typically
follows infection with influenza A or B viruses or chickenpox. It has been linked to the
use of aspirin during these infections. Fetal alcohol syndrome (FAS) describes birth
defects and other associated problems in infants born to alcoholic mothers who
consume alcohol during the gestational period. Intrauterine exposure to sufficient levels
of alcohol has been associated with fetal growth retardation, in which the infants are
short and below average in weight. The infant may experience growth deficiencies and
central nervous system problems. Heart defects including atrial septal defect and
ventricular septal defect may be present. FAS also is associated with mental retardation.
The infant may exhibit signs of alcohol withdrawal shortly after birth. These children
may experience learning difficulties, including decreased attention span and memory,
visual and auditory problems, and communication difficulties. Poor development of
social skills may be present. Because neurologic damage cannot be reversed, the focus is
on prevention. Neuroblastoma, a cancer of the sympathetic nervous system, is the third
most common childhood malignancy. It arises from primitive sympathetic ganglion cells.
Symptoms include abdominal mass, abdominal pain or fullness, anemia, bone pain,
fever, hypertension, and weight loss. For patients with low-risk tumors, surgical removal
is the only treatment required. For higher stage tumors, chemotherapy with or without
radiation therapy is employed
5.42 Lesson Summary
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Notes:
In summary, we defined Homeostasis as the internal stability of the body. When
all systems and organs function, then the body maintains an internal stability of
homeostasis. Pathology is the abnormal condition causing measurable changes
in structure and function. When the internal equilibrium is disrupted and the
body is no longer able to adapt to internal and external challenges or stressors,
then a disease state develops. The collection of objective, measurable findings
(signs) is compared with the subjective patient reports (symptoms) to give an
overall clinical impression or presentation with the provider. Acute illnesses: can
be quite time-limited, like a common cold or a bout of influenza, and more
severe, like a heart attack or appendicitis. Chronic illness: can start out as an
acute illness that does not resolve, such as sinusitis. Some illnesses can be
chronic conditions with recurrent, acute exacerbations, such as asthma or sickle
cell anemia. We learned that individuals have Predisposing Factors to disease
such as Age, Gender, Lifestyle, Environment, and Heredity. Genetic mutations
are changes in the genetic code that: Are passed from one generation to the
next, May occur spontaneously, May be caused by agents that disrupt the
normal DNA sequence. Acute inflammation is a normal protective physiologic
response to tissue injury and disease. Acute inflammatory response is marked
by: Redness, Heat, Swelling, Pain, and loss of organ or extremity function. Being
an exudative response, acute inflammation attempts to wall off, destroy, and
digest bacteria as well as dead or foreign tissue. Pathogenic agents include:
Bacteria, Viruses, Fungi, and Protozoa. The skin is the ultimate mechanical
barrier that keeps us safe from a multitude of pathogens. Chemical barriers
include such things as the body pH, which creates a hostile environment and
prevents certain organisms from successfully taking over. Cancer is a group of
diseases characterized by uncontrolled cell proliferation or growth. It is that
uncontrolled growth and proliferation at the expense of healthy cells and tissues
and this uncontrolled growth can develop into masses of abnormal cells or
tumors. Benign tumors Develop slowly, Can arise from any tissue, Usually remain
encapsulated and self-contained and Rarely recur after surgical removal. On the
other hand, malignant neoplasms are Cells that multiply rapidly, these cells do
not usually resemble the tissue of origin, the tumors invade surrounding tissue,
and are often recurrent and may Infiltrate to distant sites (metastasize).Hospice
care can be described as Comfort and supportive care for the patient and family
during the terminal stages of illness and into the bereavement period, care
where Emphasis is on palliative treatment not curative. Hospice neither hastens
nor postpones death and considers dying as a normal process. Hospice care
provides physical, psychological, and spiritual support and may be home-based
or in a facility with dedicated hospice services/beds
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199
5.43 SELF 4
(Multiple Choice, 1 points, 1 attempt permitted)
Correct
Choice
Antibodies in the mother's blood destroy the red blood cells of the fetus.
X
It is characterized in the fetus by anemia, jaundice, and enlargement of the liver
and spleen.
Both a and b are true.
None of the above are true.
Feedback when correct:
That's right!
Feedback when incorrect:
Not correct
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Correct (Slide Layer)
Incorrect (Slide Layer)
5.44 Sudden infant death syndrome is
(Multiple Choice, 1 points, 1 attempt permitted)
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201
Correct
Choice
most likely to occur in a sick infant.
not known to have any risk factors
X
the number-one cause of death of infants between age 1 month and 12 months.
predictable and preventable.
Feedback when correct:
That's right! You selected the correct response.
Feedback when incorrect:
You did not select the correct response.
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202
Correct (Slide Layer)
Incorrect (Slide Layer)
5.45 The symptoms and signs of anemia include
(Multiple Choice, 1 points, 1 attempt permitted)
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203
Correct
Choice
pallor, weakness, fatigability, and listlessness.
an abnormal reduction of red blood cells.
tachycardia, jaundice, and mental sluggishness.
X
all of the above.
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204
Correct (Slide Layer)
Incorrect (Slide Layer)
5.46 Childhood immunizations are important because
(Multiple Choice, 1 points, 1 attempt permitted)
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205
Correct
Choice
they are needed to obtain a passport.
they help prevent colds.
X
they prevent epidemics of serious contagious diseases.
all of the above are true.
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206
Correct (Slide Layer)
Incorrect (Slide Layer)
5.47 Some warning signs of lead poisoning include
(Multiple Choice, 1 points, 1 attempt permitted)
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207
Correct
Choice
loss of appetite and vomiting.
irritability and ataxic gait.
X
both of the above.
none of the above.
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208
Correct (Slide Layer)
Incorrect (Slide Layer)
5.48 Which of the following statement(s) is(are) true about asthma?
(Multiple Choice, 1 points, 1 attempt permitted)
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209
Correct
Choice
The bronchial tubes are hyperactive and hypersensitive.
Severe attacks require hospitalization.
It is a leading cause of absenteeism in school children.
X
All of the above are true.
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210
Correct (Slide Layer)
Incorrect (Slide Layer)
5.49 Which of the following statements is true about lead poisoning?
(Multiple Choice, 1 points, 1 attempt permitted)
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211
Correct
Choice
X
The child suffering from acute lead intoxication presents a medical emergency.
It is hard to detect, since lead is normally present in the blood.
It is a silent disease, because there are no warning signs or chronic symptoms.
None of the above are true.
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212
Correct (Slide Layer)
Incorrect (Slide Layer)
5.50 A systemic disease with superficial cutaneous lesions that begin as
red macules that progress to papules then to vesicles that form crusts is
(Multiple Choice, 1 points, 1 attempt permitted)
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213
Correct
Choice
rubeola.
rubella.
X
chickenpox.
diphtheria.
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214
Correct (Slide Layer)
Incorrect (Slide Layer)
5.51 Pregnant women should be isolated from individuals infected with
_________ to prevent perinatal infection.
(Multiple Choice, 1 points, 1 attempt permitted)
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215
Correct
Choice
rubeola
X
rubella
chickenpox
diphtheria
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216
Correct (Slide Layer)
Incorrect (Slide Layer)
5.52 Prompt and complete treatment of acute tonsillitis caused by A Betahemolytic streptococci is necessary to prevent
(Multiple Choice, 1 points, 1 attempt permitted)
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217
Correct
Choice
rheumatic fever.
rheumatic heart disease.
kidney complications.
X
all of the above.
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218
Correct (Slide Layer)
Incorrect (Slide Layer)
5.53 Serious side effects of uncontrolled diarrhea in the infant or child
include
(Multiple Choice, 1 points, 1 attempt permitted)
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219
Correct
Choice
intestinal obstruction and rhonchi.
X
dehydration and electrolyte imbalance.
diaper rash and Reye's syndrome.
all of the above.
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220
Correct (Slide Layer)
Incorrect (Slide Layer)
5.54 Which of the following statements is (are) true about leukemia?
(Multiple Choice, 1 points, 1 attempt permitted)
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221
Correct
Choice
It is the most common childhood malignancy.
It is a primary malignant disease of bone marrow.
The diagnosis is confirmed by microscopic examination of the bone marrow.
X
All of the above are true.
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222
Correct (Slide Layer)
Incorrect (Slide Layer)
5.55 The most common childhood malignancy is
(Multiple Choice, 1 points, 1 attempt permitted)
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223
Correct
Choice
Wilms's tumor.
X
leukemia.
anemia.
none of the above.
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224
Correct (Slide Layer)
Incorrect (Slide Layer)
5.56 Causes of infantile colic may be
(Multiple Choice, 1 points, 1 attempt permitted)
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225
Correct
Choice
sensitivity to cow's milk.
sensitivity to iron.
excessive swallowing of air during feeding process.
X
all of the above.
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226
Correct (Slide Layer)
Incorrect (Slide Layer)
5.57 Because anemia is a symptom of various diseases, it is important to
determine the cause of the anemia.
(True/False, 1 points, 1 attempt permitted)
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227
Correct
Choice
X
True
False
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228
Correct (Slide Layer)
Incorrect (Slide Layer)
5.58 Reye's syndrome has been linked with the use of aspirin to treat
chickenpox and influenza
(True/False, 1 points, 1 attempt permitted)
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229
Correct
Choice
X
True
False
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230
Correct (Slide Layer)
Incorrect (Slide Layer)
5.59 Rh factor incompatibility occurs when the mother through prior
pregnancy has become sensitized to the Rh factor of the fetal red blood
cells.
(True/False, 1 points, 1 attempt permitted)
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231
Correct
Choice
X
True
False
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232
Correct (Slide Layer)
Incorrect (Slide Layer)
5.60 The infant born with fetal alcohol syndrome may experience alcohol
withdrawal shortly after birth.
(True/False, 1 points, 1 attempt permitted)
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233
Correct
Choice
X
True
False
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234
Correct (Slide Layer)
Incorrect (Slide Layer)
5.61 Leukemia is characterized by an abnormal decrease in the number of
immature white blood cells.
(True/False, 1 points, 1 attempt permitted)
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235
Correct
Choice
True
X
False
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236
Correct (Slide Layer)
Incorrect (Slide Layer)
5.62 Tetanus is an acute, potentially deadly, systemic infection
characterized by painful involuntary contraction of skeletal muscles.
(True/False, 1 points, 1 attempt permitted)
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237
Correct
Choice
X
True
False
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238
Correct (Slide Layer)
Incorrect (Slide Layer)
5.63 Epiglottitis typically strikes children between ages 3 and 7 years.
(True/False, 1 points, 1 attempt permitted)
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239
Correct
Choice
X
True
False
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240
Correct (Slide Layer)
Incorrect (Slide Layer)
5.64 Results
(Results Slide, 0 points, 1 attempt permitted)
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241
Results for
5.43 SELF 4
5.44 Sudden infant death syndrome is
5.45 The symptoms and signs of anemia include
5.46 Childhood immunizations are important because
5.47 Some warning signs of lead poisoning include
5.48 Which of the following statement(s) is(are) true about asthma?
5.49 Which of the following statements is true about lead poisoning?
5.50 A systemic disease with superficial cutaneous lesions that begin as red macules that
progress to papules then to vesicles that form crusts is
5.51 Pregnant women should be isolated from individuals infected with _________ to prevent
perinatal infection.
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242
5.52 Prompt and complete treatment of acute tonsillitis caused by A Beta-hemolytic
streptococci is necessary to prevent
5.53 Serious side effects of uncontrolled diarrhea in the infant or child include
5.54 Which of the following statements is (are) true about leukemia?
5.55 The most common childhood malignancy is
5.56 Causes of infantile colic may be
5.57 Because anemia is a symptom of various diseases, it is important to determine the cause of
the anemia.
5.58 Reye's syndrome has been linked with the use of aspirin to treat chickenpox and influenza
5.59 Rh factor incompatibility occurs when the mother through prior pregnancy has become
sensitized to the Rh factor of the fetal red blood cells.
5.60 The infant born with fetal alcohol syndrome may experience alcohol withdrawal shortly
after birth.
5.61 Leukemia is characterized by an abnormal decrease in the number of immature white
blood cells.
5.62 Tetanus is an acute, potentially deadly, systemic infection characterized by painful
involuntary contraction of skeletal muscles.
5.63 Epiglottitis typically strikes children between ages 3 and 7 years.
Result slide properties
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243
Passing Score
80%
6. Course Home
6.1 Course Home
Notes:
This module has three subject areas. For each area you will
complete the following:
 READING ASSIGNMENT
Refer to your textbook and read assigned pages
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244
 QUICK CHECK
Check your knowledge of key terms and definitions from this section
 LESSON
Instructor guided content
 OPTIONAL SELF CHECK
Designed to evaluate your understanding of the material read and
reviewed in this section
To visit a different subject area, simply return to the COURSE
HOME.
Lesson 1 (Slide Layer)
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245
Lesson 2 (Slide Layer)
Lesson 3 (Slide Layer)
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246
Lesson 4 (Slide Layer)
7. Next Steps
7.1 Directions to Required Final Assessment
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247