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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. 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/. 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) 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 3 Correct (Slide Layer) Incorrect (Slide Layer) 2.2 Match the following (Matching Drop-down, 1 points, 1 attempt permitted) 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/. 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: That's right! You selected the correct response. 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/. 5 Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) Incorrect (Slide Layer) 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/. 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% 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/. 7 Success (Slide Layer) Failure (Slide Layer) 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/. 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 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/. 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 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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 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/. 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. 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/. 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. 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/. 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, visit http://creativecommons.org/licenses/by/4.0/. 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 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/. 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. 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/. 26 X none of the above. Feedback when correct: That's right! Feedback when incorrect: Not correct Correct (Slide Layer) 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/. 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. 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/. 28 giving the mother a short course of steroids to aid fetal lung maturation. X all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 30 multiple gestation. X all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 32 Spina bifida, hydrocephalus, anacephaly. muscular dystrophy, cystic fibrosis, and Down's syndrome. all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 34 chest to chest. X at all of the above points. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 36 X hypertropic cardiomyography. respiratory distress syndrome. none of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 38 46 X 47 48 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 40 retinopathy of prematurity. necrotizing enterocolitis. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 42 caused by a chromosomal abnormality X all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 44 False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 46 False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 48 X False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 49 Incorrect (Slide Layer) 2.33 Results (Results Slide, 0 points, 1 attempt permitted) Results for 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/. 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% 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/. 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 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/. 52 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 54 spinal column Most severe form of spina bifida myelomeningocele Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 58 atria Most common cyanotic cardiac defect tetralogy of fallot Aorta and the pulmonary artery are reversed. transposition of the great arteries Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 59 Incorrect (Slide Layer) 3.5 Results (Results Slide, 0 points, 1 attempt permitted) Results for 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/. 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) 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/. 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 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/. 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) 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/. 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 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/. 64 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. 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/. 65 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. 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/. 66 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. 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/. 67 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. 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/. 68 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 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/. 69 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. 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/. 70 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. 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/. 71 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. 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/. 72 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. 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/. 73 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 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/. 74 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. 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/. 75 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 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/. 76 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 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/. 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. 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/. 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 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/. 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. 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/. 80 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: 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/. 81 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) 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/. 82 Correct Choice spina bifida. muscular dystrophy. down syndrome. X cerebral palsy. Feedback when correct: That's right! Feedback when incorrect: Not correct 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/. 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) 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/. 84 Correct Choice calcium. vitamin D. X folic acid . iron. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 85 Correct (Slide Layer) Incorrect (Slide Layer) 3.32 Duchenne muscular dystrophy (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 87 Correct (Slide Layer) Incorrect (Slide Layer) 3.33 Cerebral palsy is (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 89 Correct (Slide Layer) Incorrect (Slide Layer) 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) 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/. 90 Correct Choice ventricular septal defect. patent ductus arteriosus. X tetralogy of Fallot. none of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 91 Correct (Slide Layer) Incorrect (Slide Layer) 3.35 The diagnostic investigation of a congenital heart defect may include (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 93 Correct (Slide Layer) Incorrect (Slide Layer) 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) 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/. 94 Correct Choice True X False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 95 Correct (Slide Layer) Incorrect (Slide Layer) 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) 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/. 96 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 97 Correct (Slide Layer) Incorrect (Slide Layer) 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) 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/. 98 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 99 Correct (Slide Layer) Incorrect (Slide Layer) 3.39 Results (Results Slide, 0 points, 1 attempt permitted) 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/. 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 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/. 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) 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 106 Impairment of intestinal motility that causes Hirschsprung's disease obstruction of the distal colon an autosomal recessive inherited disorder Cystic fibrosis Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 108 protein metabolism male hypogonadism Klinefelter's syndrome Chromosomal disease in females with a single Turner's syndrome sex chromosome Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 109 Incorrect (Slide Layer) 4.5 Results (Results Slide, 0 points, 1 attempt permitted) Results for 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/. 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) 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/. 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. 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/. 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. 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/. 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 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/. 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. 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/. 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: 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/. 116 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. 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/. 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. 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/. 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) 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/. 119 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. 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/. 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 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/. 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. 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/. 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: 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/. 123 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. 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/. 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 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/. 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. 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/. 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 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/. 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. 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/. 128 X is an abnormal development of the hip joint. Feedback when correct: That's right! Feedback when incorrect: Not correct Correct (Slide Layer) 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/. 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. 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/. 130 cri-du-chat syndrome. Robinow's syndrome. meningocele. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 132 X the failure of the testicle(s) to descend into the scrotum. none of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 134 a shortening of the femur. projectile vomiting, loss of weight, and skin rash. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 136 pyloric stenosis. cryptorchidism. phimosis. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 138 X lungs and digestive system. blood vessels. immune system. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 140 X a protein-restricted diet. surgical intervention. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 142 phenylketonuria (PKU). pyloric stenosis. X cystic fibrosis (CF). Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 144 chromosomal diseases that affect females only. inherited diseases of no significant consequence. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 146 False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 147 Incorrect (Slide Layer) 4.36 Results (Results Slide, 0 points, 1 attempt permitted) Results for 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/. 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% 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/. 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 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/. 150 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 156 Inflammation of the epiglottis Epiglottitis Inflammatory and infectious process affecting Acute tonsillitis the tonsils Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 159 Incorrect (Slide Layer) 5.6 Match the following (Matching Drop-down, 1 points, 1 attempt permitted) Correct Choice Rapid passage of stool through the intestinal Diarrhea tract. 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 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. 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/. 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 Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. Correct (Slide Layer) 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/. 163 Incorrect (Slide Layer) 5.8 Results (Results Slide, 0 points, 1 attempt permitted) Results for 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/. 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% 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/. 165 Success (Slide Layer) Failure (Slide Layer) 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/. 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. 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/. 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: 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/. 168 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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. 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/. 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 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/. 175 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 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/. 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. 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/. 177 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. 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/. 178 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. 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/. 179 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. 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/. 180 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. 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/. 181 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. 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/. 182 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. 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/. 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. 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/. 184 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. 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/. 185 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. 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/. 186 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: 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/. 187 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 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/. 188 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 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/. 189 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 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/. 190 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. 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/. 191 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) 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/. 192 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 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/. 193 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. 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/. 194 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 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/. 195 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 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/. 196 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 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/. 197 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 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/. 198 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 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/. 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 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/. 200 Correct (Slide Layer) Incorrect (Slide Layer) 5.44 Sudden infant death syndrome is (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. 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/. 202 Correct (Slide Layer) Incorrect (Slide Layer) 5.45 The symptoms and signs of anemia include (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 204 Correct (Slide Layer) Incorrect (Slide Layer) 5.46 Childhood immunizations are important because (Multiple Choice, 1 points, 1 attempt permitted) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 206 Correct (Slide Layer) Incorrect (Slide Layer) 5.47 Some warning signs of lead poisoning include (Multiple Choice, 1 points, 1 attempt permitted) 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/. 207 Correct Choice loss of appetite and vomiting. irritability and ataxic gait. X both of the above. none of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 213 Correct Choice rubeola. rubella. X chickenpox. diphtheria. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 215 Correct Choice rubeola X rubella chickenpox diphtheria Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 217 Correct Choice rheumatic fever. rheumatic heart disease. kidney complications. X all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 219 Correct Choice intestinal obstruction and rhonchi. X dehydration and electrolyte imbalance. diaper rash and Reye's syndrome. all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 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. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 222 Correct (Slide Layer) Incorrect (Slide Layer) 5.55 The most common childhood malignancy is (Multiple Choice, 1 points, 1 attempt permitted) 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/. 223 Correct Choice Wilms's tumor. X leukemia. anemia. none of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 224 Correct (Slide Layer) Incorrect (Slide Layer) 5.56 Causes of infantile colic may be (Multiple Choice, 1 points, 1 attempt permitted) 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/. 225 Correct Choice sensitivity to cow's milk. sensitivity to iron. excessive swallowing of air during feeding process. X all of the above. Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 227 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 229 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 231 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 233 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 235 Correct Choice True X False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 237 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 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) 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/. 239 Correct Choice X True False Feedback when correct: That's right! You selected the correct response. Feedback when incorrect: You did not select the correct response. 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/. 240 Correct (Slide Layer) Incorrect (Slide Layer) 5.64 Results (Results Slide, 0 points, 1 attempt permitted) 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/. 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. 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/. 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 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/. 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 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/. 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) 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/. 245 Lesson 2 (Slide Layer) Lesson 3 (Slide Layer) 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/. 246 Lesson 4 (Slide Layer) 7. Next Steps 7.1 Directions to Required Final Assessment 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/. 247