{"id":645,"date":"2009-03-08T15:28:24","date_gmt":"2009-03-08T14:28:24","guid":{"rendered":"http:\/\/www.zdravstvena.info\/vsznj\/?p=645"},"modified":"2010-06-15T10:59:16","modified_gmt":"2010-06-15T09:59:16","slug":"pediatrija-izpit-pediatrija","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/vsznj\/pediatrija-izpit-pediatrija\/","title":{"rendered":"Pediatrija vaja za izpit 3.del"},"content":{"rendered":"

\"pediatrija-pediatria\"Diabetes( znaki, zdravljenje, komplikacije, kontrola pacienta..) !<\/em><\/strong><\/p>\n

DIABETES MELLITUS TIP 1 (JUVENILNI)<\/strong><\/p>\n

(SLADKORNA BOLEZEN TIP 1)<\/strong><\/p>\n

\"*\" Pojavi se v katerikoli starosti, najve\u010d med \u0161olskimi otroki, a tudi \u017ee pred \u0161olo<\/p>\n

\"*\" Za\u010detek je hiter, spro\u017eilec v\u010dasih infekt.<\/p>\n

\"*\" Etiologija<\/em><\/strong> :<\/p>\n

\u00de\u00a0\u00a0\u00a0 avtoimuno dogajanje (ob prehladnem obolenju napade lastne celice)<\/p>\n

<\/p>\n

\u00de\u00a0\u00a0\u00a0 virusi ??<\/p>\n

\u00de\u00a0\u00a0\u00a0 HLA sistem (humani limfocitini antigeni – genska struktura)<\/p>\n

\"*\" Patofiziologija <\/em><\/strong>:<\/p>\n

\u00de\u00a0\u00a0\u00a0 propad \u03b2 celic v langerhansovih oto\u010dkih pankreasa \u2192 padec koli\u010dine insulina \u2192 dvig nivoja sladkorja v krvi, izlo\u010danje glukoze z urinom \u2192 poliurija, dehidracija in ketoacidoza.<\/p>\n

\"*\" Klini\u010dni znaki<\/em><\/strong> :<\/p>\n

\u00de\u00a0\u00a0\u00a0 \u017eeja<\/p>\n

\u00de\u00a0\u00a0\u00a0 poliurija(do 2l\/dan)<\/p>\n

\u00de\u00a0\u00a0\u00a0 velik apetit<\/p>\n

\u00de\u00a0\u00a0\u00a0 huj\u0161anje<\/p>\n

\u00de\u00a0\u00a0\u00a0 dehidracija<\/p>\n

\u00de\u00a0\u00a0\u00a0 ketoacidoza(zaudarjanje po acetonu)<\/p>\n

\"*\" terapija<\/em><\/strong> :<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 insulin –<\/em><\/strong><\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 trajna, do\u017eivljenjska terapija, pozor na ”MEDENI MESEC” na za\u010detku bolezni<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 razli\u010dni tipi insulina – kratko, srednje in dolgo\u00a0 delujo\u010di<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 terapija 2 x dnevno,ob\u00a0 8h in 18h,kombinacija obeh vrst insulina<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 intenzivirana th.: 3x hitro – del.in pred spanjem srednje dolgo delujo\u010di insulin<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 prilagajanje\u00a0 doze – glede na kontrole urina , KS, subjektivne in klini\u010dne znake, telesne obremenitve, infekte, puberteto…<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 spreminjanje mesta aplikacije insulina<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 sedaj tudi mo\u017enost \u010drpalke – \u00bbumetne \u00df celice\u00ab<\/strong><\/p>\n

Druga terapija ne obstaja!<\/p>\n

\u00de\u00a0\u00a0\u00a0 v akutni fazi bolezni<\/em><\/strong> – na za\u010detku, ob poslab\u0161anju s ketoacidozo – infuzije, kristalni insulin v trajni infuziji, korekcija metabolnih motenj<\/p>\n

\u00de\u00a0\u00a0\u00a0 dieta<\/em><\/strong> – zagotoviti kalorije, omejiti OH<\/p>\n

\u00de\u00a0\u00a0\u00a0 \u0161olanje star\u0161ev in otoka<\/em><\/strong> :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 kontrole sladkorja v urinu 3 krat dnevno, pogoste kontrole KS<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 kontrole – sladkorja in acetona(ketonov) v urinu 3x dnevno<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 prilagajanje doze insulina urinskim izvidom, izvidom krvi, zabele\u017eenim ob\u010dutkom (HIPA!!,\u017eeja,poliurija) in predvidenim obremenitvam, pozornost na dneve ve\u010dje fizi\u010dne obremenitve in na puberteto<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 prepoznavanje\u00abhipe\u00ab- ob\u010dutek lakote, bledica, tresenje, potenje, ..omotica, zaspanost,..<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 menjavanje mesta aplikacije insulina<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 dieta, re\u017eim \u017eivljenja, toaleta<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 pozornost ob akutnih obolenjih, ve\u010djih fizi\u010dnih obremenitvah,v puberteti<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 prepoznavanje znakov hipoglikemije in prilagajanje doze inzulina znakom hipoglikemije in izvidom urina<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 vodenje dnevnika<\/p>\n

\"*\" komplikacije<\/em><\/strong> :<\/p>\n

\u00de\u00a0\u00a0\u00a0 hioglikemi\u010dna koma – kocka sladkorja, kozarec sladke vode, injekcija Glukagona, infuzija – \u010de je pri\u0161lo do kome<\/p>\n

\u00de\u00a0\u00a0\u00a0 okvare o\u017eilja<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 o\u010desno ozadje (slepota!!), k okulistu<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 diabeti\u010dna nefropatija – beljakovine v urinu, k nefrologu<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 okon\u010dine – periferni pulti, oscilometrija, UZ doppler o\u017eilja<\/p>\n

\"*\" kontrola pacienta<\/em><\/strong> – redna stroga ,namenjena za :<\/p>\n

\u00de\u00a0\u00a0\u00a0 prepre\u010devanje komplikacij<\/p>\n

\u00de\u00a0\u00a0\u00a0 kontrolo pacientovega dnevnika<\/p>\n

\u00de\u00a0\u00a0\u00a0 za oceno urejenosti bolezni = \u03b1-1 C hemoglobin<\/p>\n

\u00de\u00a0\u00a0\u00a0 dolo\u010danje \u0161\u010ditni\u010dnih hormonov in antigliadinskih protiteles<\/p>\n

\"*\" prognoza <\/em><\/strong>:<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 odvisna od urejenosti<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 komplikacij<\/p>\n

47.Neepilepti\u010dne konvulzije !<\/em><\/strong><\/p>\n

\"*\" afektni kr\u010di : 3-5% otrok do 4.l starosti<\/p>\n

\"*\" febrilne konvulzije (kr\u010di)<\/p>\n

\"*\" vazomotorna sinkopa<\/p>\n

\"*\"<\/p>\n

48.Bolezni srca !<\/em><\/strong><\/p>\n

\"*\" anamneza: <\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 cianoza<\/p>\n

\u00de\u00a0\u00a0\u00a0 dispnea<\/p>\n

\u00de\u00a0\u00a0\u00a0 recedivni respiratorni infekti<\/p>\n

\u00de\u00a0\u00a0\u00a0 zaostanek v telesnem razvoju<\/p>\n

\u00de\u00a0\u00a0\u00a0 znojenje in utrujenost<\/p>\n

\u00de\u00a0\u00a0\u00a0 omejena fizi\u010dna sposobnost<\/p>\n

\u00de\u00a0\u00a0\u00a0 hipoksi\u010dne atake \/ kardialna sinkopa<\/p>\n

\"*\" telesni razvoj in klini\u010dni pregled :<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 dispnoe<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 cianoza<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 edemi<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 periferno o\u017eilje (vrat- pulzacije)<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 frekvenca pulza(kvaliteta,odsotnost ?)<\/p>\n

\u00de\u00a0\u00a0\u00a0 avskultacija srca(toni,\u0161umi,ritem)<\/p>\n

\"*\" preiskave :<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 krvna slika (<\/strong>hemogram – Ery, Hb, Htc!!)<\/p>\n

\u00de\u00a0\u00a0\u00a0 <\/strong>plinska analiza arterije,krvi<\/p>\n

\u00de\u00a0\u00a0\u00a0 \u00a0EKG<\/p>\n

\u00de\u00a0\u00a0\u00a0 <\/strong>rtg srca v dveh projekcijah<\/p>\n

\u00de\u00a0\u00a0\u00a0 <\/strong>ehosonografija srca (UZ); danes najpomembnej\u0161a preiskava !!<\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 <\/strong>kardioangiografija(z merjenjem pritiskov,saturacije s kisikom<\/p>\n

<\/span><\/p>\n

49.Napake z vensko-arterijskem spojem in arterio-venskim spojem !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" napake z vensko-arterijskem spojem :<\/p>\n

\u00de\u00a0\u00a0\u00a0 desno<\/em><\/strong>\u2192<\/em><\/strong>levi ali obojesmerni shunt<\/em><\/strong><\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 Tetralogija fallot<\/em><\/strong><\/p>\n

a.\u00a0\u00a0\u00a0\u00a0\u00a0 stenoza art.pulmonalis<\/p>\n

b.\u00a0\u00a0\u00a0\u00a0 VSD<\/p>\n

c.\u00a0\u00a0\u00a0\u00a0\u00a0 dekstropozicija aorte<\/p>\n

d.\u00a0\u00a0\u00a0\u00a0 hipertrofija desnega ventrikla<\/p>\n

Relativno pogosta napaka.mo\u017ena za\u010dasna(paliativna)operacija in kasnej\u0161a ali pa takoj\u0161nja popolna operativna korekcija.Hipoksi\u010dne atake,po\u010depanje,zelo slaba fizi\u010dna zmogljivost,mo\u017ene tromboze in mo\u017eganski abscesi.<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 transpozicija velikih \u017eil<\/em><\/strong> -TVM – sedaj \u017ee mo\u017ena operativna korekcija<\/strong><\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 atrezija trikuspidalne zaklopke<\/em><\/strong> <\/strong>– nujen poseg (rushkind)po rojstvu z mo\u017eno kasnej\u0161o popolno operativno korekcijo.<\/p>\n

\"*\" arterio-venskim spojem :<\/p>\n

\u00de\u00a0\u00a0\u00a0 L <\/em><\/strong>\u2192<\/em><\/strong>D shunt <\/em><\/strong><\/em><\/strong><\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 Ventrikulum septum defect<\/em><\/strong> – VSD\u2192 med dvema prekatoma; pulm. hipertenzija \u2192 stena plj. \u017eilja se za\u010dne debeliti, ker se upira dodatnemu obtoku<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 Atrium septum defect<\/em><\/strong> – ASD\u2192 prisoten foramen ovale \u2192 po rojstvu se zapre \u2192 pritisk v D srcu ve\u010dji, tlak v L atriju vi\u0161ji<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 Duktus botalli apertus <\/em><\/strong>(odprti botalijev vod) \u2192 trajajo\u010di, ki se ne zapre v prvih dneh \u017eivljenja ogro\u017ea o\u017eilje, zato z zdravili ali OP zapremo.<\/p>\n

50.Znaki anemije !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" anemija = bledica, \u0161ok, tahikardija ( 200\/min ), ohlapnost, nizek RR, slabo tipljiv pulz<\/p>\n

51.Hemoragi\u010dna diateza !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" KOAGULOPATIJE – motnje strjevanje krvi (\u2193 faktorja 8, 9, 11 in 12)<\/p>\n

\u00de\u00a0\u00a0\u00a0 HEMOFILIJA A (faktor VIII), B (IX), in C (XI)<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 recesivno dedna bolezen, vezana na X kromosom<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 zboli le (?) mo\u0161ki, \u017eena je prena\u0161alka, pri \u017eenah Von Willebrandova bolezen<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 tri skupine glede na te\u017eo bolezni pri Hemofiliji A: a.) lahka – kli\u010dina faktorja 20-50% normale; b.) srednje te\u017eka – 5-20%; c.) te\u017eka – 1-5%<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 glede na obliko bolezni so, predvsem pri te\u017eki obliki mo\u017ene spontane krvavitve v notranje organe, med mi\u0161ice in v sklepe. Pojavljanje od 6. mes. starosti, ko pri\u010dne ve\u010d gibati.<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 zdravljenje = substitucija manjkajo\u010dega faktor.: a.) Krioprecipitat, faktor VIII (zmrznjen preparat),; b.) Liofilizirani krioprecipitat (suh preparat); c.) sve\u017ea zmrznjena plazma – se skoraj nikoli ne uporabi.<\/p>\n

PREPARAT IMA PACIENT DOMA IN SI GA APLICIRA TAKOJ!!!<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 timska obravnava: pediatri, hematologi, ortopedi, fizioterapevti…<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 mirovanje, analgetiki – vendar ne salicilatov, Indometacina, Fenilbutazona, ledeni obkladki (skr\u010dijo \u017eile)<\/p>\n

\u00de\u00a0\u00a0\u00a0 PURPURA ANAPHYLACTOIDES = VASULITIS ALLERGICA = MB. HENOCH – SCH\u00d6NLEIN<\/p>\n

52.Levkemija !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" druga\u010dna kot pri odraslih<\/p>\n

\u00de\u00a0\u00a0\u00a0 bole\u010dine<\/p>\n

\u00de\u00a0\u00a0\u00a0 bledica – izpodrinjena rde\u010da krvna ko\u017ea v KM<\/p>\n

\u00de\u00a0\u00a0\u00a0 krvavitve zaradi pomanjkanja trombocitov<\/p>\n

\u00de\u00a0\u00a0\u00a0 pomanjkanje apetita, splo\u0161na slabost<\/p>\n

\u00de\u00a0\u00a0\u00a0 temperatura – posledica napa\u010dnih levkocitov
\n
\n\"*\" klini\u010dni pregled: 1. pove\u010dane bezgavke,2.pove\u010dana vranica in jetra, 3. krvavitve, 4. infekt<\/p>\n

\"*\" laboratorij :<\/p>\n

\u00de\u00a0\u00a0\u00a0 anemija in padec \u0161t. Trombocitov<\/p>\n

\u00de\u00a0\u00a0\u00a0 levkociti: zni\u017eani, normalni ali povi\u0161ani ter levkemi\u010dne celice<\/p>\n

\"*\" diagnozo postavi punkcija kostnega mozga, s katero opredelimo tudi tip levkemje. Najpogostej\u0161a je akutna limfati\u010dna levkemija, ki je ozdravljiva v 60 – 80% ( znotraj skupine ve\u010d podvrsti )<\/p>\n

\"*\" terapija: poteka po protokolih. Ima veliko stranskih u\u010dinkov; potrebne prekinitve; mo\u017enost hudih infekcij in krvavitev.<\/p>\n

Mo\u017enost relapsov. Kriterij uspe\u0161nosti je petletno pre\u017eivetje brez znakov bolezni. Transplantacija kostnega mozga.<\/p>\n

53.Na\u010din spremljanja telesnega razvoja !<\/em><\/strong><\/p>\n

\"*\" meritve telesne te\u017ee:<\/p>\n

\u00de\u00a0\u00a0\u00a0 od porodne te\u017ee:<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 pri 6. mesecih te\u017eo podvoji<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 ob letu te\u017eo potroji<\/p>\n

\u00de\u00a0\u00a0\u00a0 od porodne te\u017ee v prvih \u0161estih mesecih na mesec pridobi 600 – 800g, v drugih \u0161estih mesecih pa 500 – 700g.<\/p>\n

\u00de\u00a0\u00a0\u00a0 spremljanje nara\u0161\u010danja te\u017ee po percentilnih krivuljah.<\/p>\n

\"*\" telesna dol\u017eina – po percentil. krivuljah<\/p>\n

\"*\" obseg glave – po percentil. krivuljah; tudi:<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 ob rojstvu 34 cm,<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 pri 6 – ih mes. 43 cm.<\/p>\n

54.Nizka telesna rast !<\/em><\/strong><\/p>\n

\"*\" familiarna konstitucija<\/p>\n

\"*\" hormonske motnje<\/p>\n

\u00de\u00a0\u00a0\u00a0 hipofizirana nanosomija<\/p>\n

\u00de\u00a0\u00a0\u00a0 hipoterioza ( ob rojstvu in kasneje )<\/p>\n

\u00de\u00a0\u00a0\u00a0 motnje spolnih hormonov<\/p>\n

\"*\" te\u017eja kroni\u010dna obolenja<\/p>\n

\u00de\u00a0\u00a0\u00a0 cianoti\u010dne sr\u010dne napake ( Tetralogia fall. )<\/p>\n

\u00de\u00a0\u00a0\u00a0 te\u017eja kroni\u010dna plju\u010dna obolenja ( mukoviscidoza )<\/p>\n

\u00de\u00a0\u00a0\u00a0 te\u017eja in dolgotrajna obolenja prebavil ( mukoviscidoza )<\/p>\n

\u00de\u00a0\u00a0\u00a0 kroni\u010dna ledvi\u010dna obolenja in odpoved ledvic<\/p>\n

\"*\" zdravila – dolgotrajna kortikosteroid. Terapija<\/p>\n

\"*\" hudo, dolgotrajno pomanjkanje hrane<\/p>\n

\"*\" kromosomske anomalije ( MB. Down sy., turner…)<\/p>\n

55.Sy. Down !<\/em><\/strong><\/p>\n

\"*\" Sy.Down -Trisomia 21, Mongoloidizem<\/em><\/strong><\/p>\n

\u00de\u00a0\u00a0\u00a0 etiologija<\/em><\/strong> :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 kromosomska napaka,cca.1:650 roj.,starost matere,nova mutacija ali mati t.im.balansirani nosilec<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 pri 1-2% otrok mozaicizem<\/p>\n

\u00de\u00a0\u00a0\u00a0 klini\u010dna slika<\/em><\/strong> :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 umska zaostalost razli\u010dne stopnje(do 10 let)<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 zaostajanje v rasti \u017ee intrauterino in kasneje, so nizki,\u010dokati,\u0161irok prsni ko\u0161<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 glava manj\u0161a,plo\u0161\u010dato ztilje,po\u0161evna(mongolska)o\u010desna re\u017ea,hipertelorizem,epikantus – ma\u010dja guba<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 hipotonija mi\u0161i\u010dja,hiperfleksibilni sklepi,kratki prsti rok,ukrivljen mezinec,opi\u010dja brazda na dlani<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 sr\u010dna napaka pri 40% otrok(najve\u010dkrat defekti septuma)<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 napake prebavnega trakta – stenoze in atrezije,Mb.Hirschprung<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 levkemija je 3x pogostej\u0161a kot pri drugih ljudeh<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 slaba odpornost na infekte<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 v celoti imajo kraj\u0161o \u017eivljenjsko dobo<\/p>\n

56.Sy. Turner !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" Sy. Turner <\/em><\/strong>(disgenezija gonad)\u00a0 = <\/strong>44, X0 manjka drugi x<\/p>\n

\u00de\u00a0\u00a0\u00a0 nizka rast od dobe dojen\u010dka dalje,do 150 cm<\/p>\n

\u00de\u00a0\u00a0\u00a0 amenoreja,sterilnost,izostanek sekund.spolnega razvoja<\/p>\n

\u00de\u00a0\u00a0\u00a0 glava :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 mikrognatija,visoko nebo<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 pterigium (guba na vratu)<\/p>\n

\u00de\u00a0\u00a0\u00a0 okon\u010dine :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 limfedemi<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 cubitus valgus navzven izpro\u017een komolec )<\/p>\n

\u00de\u00a0\u00a0\u00a0 anomalije srca(koarktacija aorte) in ledvic(podkvasta ledvica)<\/p>\n

\u00de\u00a0\u00a0\u00a0 (le) v 20% umska zaostalost<\/p>\n

57.Fenilketonurija !<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

Odkrivanje s screening testom ob rojstvu.Recesivno dedno obolenje,defekten je gen za sintezo encima fenilalanin – hidroksilaze( kopi\u010denje F-A v tkivih in se ne pretvarja v tirozin,sledi okvara C\u017dS z mikrocefalijo, epilepsijo,hipertonijo mi\u0161ic in hudim\u00a0 zaostankom v du\u0161evnem in telesnem razvoju.<\/p>\n

Terapija:dieta vsaj do pubertete(Lofenalac mleko)<\/p>\n

58.Inzulinska \u010drpalka<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" Zagotavlja stalne bazalne odmerke insulina ter enostavno doziranje bolusov ob hrani<\/p>\n

\"*\" Lahko se jo programira glede na telesno aktivnost,strese,bolezen,menstruacijo<\/p>\n

\"*\" Lahko se jo izklopi za tu\u0161iranje in \u0161port<\/p>\n

\"*\" Prepre\u010duje previsoke odmerke insulina in s tem zmanj\u0161a mo\u017enost hipoglikemij<\/p>\n

\"*\" Zagotavlja bolj\u0161o urejenost glikemije,kar se preveri s pregledom programa v \u010drpalki in meritvami HbA1c<\/p>\n

\"*\" Gre za najsodobnej\u0161o ra\u010dunalni\u0161ko podprto tehnologijo,ki se \u0161e razvija<\/p>\n

\"*\" Imajo jo \u017ee skoraj vsi otroci<\/p>\n

59.<\/em><\/strong> <\/strong>Kaj vse moramo narediti zdravemu novorojencu v porodni\u0161nici od trenutka rojstva do odhoda domov ?<\/em><\/strong> <\/strong><\/p>\n

<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0\u00a0 apgar- \u00a0otrokovo stanje ob porodu, max – 10<\/p>\n

\"*\" 0 – 3 zamrel= REANIMACIJA<\/p>\n

\"*\" 4 – 7 kriti\u010den =\u00a0 (zahirani) = nadzorujemo jih
\n\u0161e eno leto na nont.nevrologu<\/p>\n

\"*\" 8 – 10 normal.<\/p>\n

\"*\" ocenjujemo : dihanje,pulz,barva ko\u017ee,mm tonus,spontano gibanje
\nI. po 1 min
\nII.po 5 min
\nIII. po 15 min<\/p>\n

2.\u00a0\u00a0\u00a0\u00a0 oznaka – trak otrok in mati<\/p>\n

3.\u00a0\u00a0\u00a0\u00a0 klemanje in prerez popkovnice in oskrba popka<\/p>\n

4.\u00a0\u00a0\u00a0\u00a0 tehtanje,dol\u017eina,obseg glavice<\/p>\n

5.\u00a0\u00a0\u00a0\u00a0 kleredejeve kapljice(zoper Gonorejo)<\/p>\n

6.\u00a0\u00a0\u00a0\u00a0 K- vit.<\/p>\n

7.\u00a0\u00a0\u00a0\u00a0 obri\u0161i,zavij,umij<\/p>\n

8.\u00a0\u00a0\u00a0\u00a0 prvo dojenje<\/p>\n

v porodni sobi 2-3 ure<\/p>\n

10.\u00a0 klini\u010dni pregled otroka s strani pediatra v roku 24 ur po rojstvu – o\u010ditne\u00a0\u00a0 malformacije, anus(atrezija), nosnice(zaprte),avskultacija<\/p>\n

11.\u00a0 odvzem krvi za presejalne teste<\/p>\n

12.\u00a0 BCG – \u010de se dolo\u010di ogro\u017eenost otroka<\/p>\n

13.\u00a0 ZV matere<\/p>\n

14.\u00a0 opazovanje prvega izlo\u010danja blata – mekonij<\/p>\n

\"*\" pomembni so :<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 iskalni refleks<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 po\u017eiralni refleks<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 hodilni refleks<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 objemalni refleks<\/p>\n

\u00d7\u00a0\u00a0\u00a0\u00a0\u00a0 prijemalni refleks<\/p>\n

59.Vse preiskave!<\/em><\/strong><\/p>\n

<\/em><\/strong><\/p>\n

\"*\" izpit: HTC – hemogram: eritrociti, hemoglobin, hematokrit, MCH, trombociti, levkociti<\/p>\n

PAAK: pO2, pCO2, ph krvi, HCO3(bikarbonat), BE (bazalni eksces), SaO2<\/p>\n","protected":false},"excerpt":{"rendered":"

Diabetes( znaki, zdravljenje, komplikacije, kontrola pacienta..) ! DIABETES MELLITUS TIP 1 (JUVENILNI) (SLADKORNA BOLEZEN TIP 1) Pojavi se v katerikoli starosti, najve\u010d med \u0161olskimi otroki, a tudi \u017ee pred \u0161olo Za\u010detek je hiter, spro\u017eilec v\u010dasih infekt. Etiologija : \u00de\u00a0\u00a0\u00a0 avtoimuno dogajanje (ob prehladnem obolenju napade lastne celice)<\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[781],"tags":[782,809,807,815,816,808,810,812,783,813,814,811],"class_list":["post-645","post","type-post","status-publish","format-standard","hentry","category-2-letnik-pediatrija","tag-2letnik-pediatrija","tag-bolezni-srca","tag-diabetes-mellitus-tip-1","tag-fenilketonurija","tag-inzulinska-crpalka","tag-juvenilni-diabetes","tag-levkemija-pri-otrocih","tag-nizka-telesna-rast","tag-pediatrija","tag-sy-down","tag-sy-turner","tag-telesni-razvoj"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/645","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=645"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/645\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=645"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=645"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=645"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}