perfusion index

 If the monitor shows a PERF value of 3.85, it typically refers to the Perfusion Index (PI), which is a numerical value provided by pulse oximeters to indicate the strength of blood flow at the sensor site.

---

🔍 Understanding Perfusion Index (PI):

• Perfusion Index (PI) ranges from 0.02% (very weak) to 20% (very strong).

• A PI of 3.85% is considered a moderate to good perfusion value.

---

✅ Interpretation of 3.85 PI:

• Normal and adequate peripheral perfusion.

• No immediate concern unless symptoms or other vital signs are abnormal.

---

📝 Quick PI Reference:

PI Value (%)	Perfusion Strength
< 0.5	Very weak perfusion
0.5 – 1.0	Weak perfusion
1.0 – 3.0	Moderate perfusion
3.0 – 10.0	Good perfusion (normal)
> 10.0	Strong perfusion

So, a reading of 3.85 indicates that the patient likely has adequate blood flow at the sensor site, such as a fingertip. Always confirm with other signs like heart rate, blood pressure, and capillary refill.

Perform Bone Marrow Biopsies or Aspirations (BMS)

 The role of Peds BMS (Pediatric Bone Marrow Specialist or Bone Marrow Service) depends on the context, but generally refers to a specialized team in pediatrics focused on bone marrow-related conditions, particularly in hematology-oncology (blood and cancer disorders in children).

Key Roles of a Pediatric BMS Team:

Diagnosis and Management of Blood Disorders

Leukemia (ALL, AML)

Lymphomas

Aplastic anemia

Sickle cell disease

Thalassemia

Immunodeficiencies

Bone Marrow Transplant (BMT) Services

Evaluate patients who need stem cell or bone marrow transplant

Find donor matches (sibling, unrelated donor, or cord blood)

Manage transplant procedures and post-transplant care

Perform Bone Marrow Biopsies or Aspirations

For diagnosing cancers, infections, or marrow failure

Analyze cell types, counts, and marrow structure

Coordinate Care with Oncology & Genetics Teams

Work with oncologists, immunologists, and geneticists for complex cases

Monitor for complications like graft-versus-host disease (GVHD)

Research and Clinical Trials

Participate in studies for new treatments or transplant techniques

In Summary:

A Peds BMS team plays a critical role in diagnosing, treating, and supporting children with serious blood and immune system diseases, especially those needing bone marrow transplants. They provide highly specialized care that can be life-saving.

EGD (esophagogastroduodenoscopy)

 When an EGD (esophagogastroduodenoscopy)

biopsy shows pathology concerning for B-cell involvement, 

it usually means the pathologist saw abnormal lymphoid cells in the tissue that may be related to a 

B-cell lymphoma, which is a type of blood cancer that starts in B lymphocytes, a kind of white blood cell.

Here’s why this might happen:

1. Lymphoid Infiltrate in the GI Tract

• The stomach and intestines have lymphoid tissue as part of the immune system.

• Sometimes, B-cells grow abnormally in the lining of the GI tract, forming masses or ulcers.

• If these cells look clonal (all the same) or atypical, it raises concern for lymphoma.

2. Most Common: MALT Lymphoma

• A common type of B-cell lymphoma in the stomach is MALT (mucosa-associated lymphoid tissue) lymphoma.

• Often associated with H. pylori infection.

• Chronic infection stimulates B-cells to grow uncontrollably.

3. What Pathologists Look For

• Immunohistochemistry (IHC) tests: show markers like CD20, which is on B-cells.

• Light chain restriction: too many kappa or lambda chains suggest clonal B-cell growth.

• Cell appearance: large, irregular B-cells may indicate high-grade lymphoma.

4. Why It Matters

• B-cell involvement may mean the patient has a form of gastrointestinal lymphoma, needing further tests like CT scan, bone marrow biopsy, or PET scan.

• Early detection is important because some types (like MALT) respond well to antibiotics or immunotherapy.

---

 PICC INSERTION 

TIME OUT WAS PERFORMED

1. patient education 
2. discussion plan of care and procedure risk and benefit
3. consent 
4. verified correct patient 
5. correct site
6. correct equitment

 

Trisomy

 Trisomy is a genetic condition where a person has three copies of a chromosome instead of the normal two. Humans usually have 23 pairs of chromosomes (46 in total), but in trisomy, one of those pairs has an extra chromosome—making it 47 total.

For example:

• Trisomy 21 is also called Down syndrome, where there are three copies of chromosome 21.

Trisomy can cause physical, developmental, and health problems, depending on which chromosome is affected. 

T21 stands for Trisomy 21, which is the medical term for Down syndrome.

What is Trisomy 21?

It is a genetic condition where a person has three copies of chromosome 21 instead of the usual two. This extra genetic material affects how the body and brain develop.

Key Features of T21 (Down Syndrome):

• Intellectual disability (mild to moderate)

• Distinct facial features (flat face, almond-shaped eyes, small ears)

• Low muscle tone (hypotonia) in infancy

• Developmental delays

• Higher risk of:

  • Heart defects

  • Hearing and vision problems

  • Thyroid issues

  • Leukemia (increased risk in children)

Causes:

• It usually happens by chance during the formation of reproductive cells.

• Most cases are not inherited.

Diagnosis:

• Can be detected before birth with screening and diagnostic tests (like NIPT, amniocentesis).

• Confirmed after birth with a karyotype test showing 47 chromosomes (an extra chromosome 21).

Support:

People with T21 can live long and fulfilling lives with proper medical care, early therapy, and family support.

Moderate to deep procedural sedation for  Echo

pre procedure plan of care -

1. assess for barrier of learning 
2. access for abuse or neglect 
3. access for pain pre procedure check to be completed 
4. patient education plan of care 
5. patient education discharge care 
6. prepare appropriately for procedure 
7. prevent fall safety precaution

intra procedure plan of care 

1. vital sign 
2. respiratory
3.  oxygen requirement observe 
4. observe skin integrity 
5. infection prevention ( immunocompromised)

post procedure plan of  care 

1. access pain
2. oxygenation status maintain
3. hemostasis to be assess
4. maintain treated 
5. post sedation care 

What is Tuberous Sclerosis Complex?

 

✅ What is Tuberous Sclerosis Complex?

TSC is a rare genetic disorder that causes non-cancerous tumors to grow in different parts of the body, especially the:

• Brain

• Skin

• Kidneys

• Heart

• Eyes

• Lungs

---

🧬 Cause:

• Caused by mutations in the TSC1 or TSC2 genes.

• These genes regulate cell growth. When they are mutated, cells grow uncontrollably, forming tumors.

---

🧒🏻 TSC in Children – Key Symptoms:

• Seizures (common and often early sign)

• Developmental delay or intellectual disability

• Autism spectrum disorder

• Skin findings:

  • Hypomelanotic macules (white patches)

  • Facial angiofibromas

  • Shagreen patches

• Behavioral issues

• Kidney cysts or tumors (angiomyolipomas)

---

🩺 Diagnosis:

• Clinical exam + imaging (MRI, CT)

• Genetic testing (TSC1/TSC2 mutations)

• EEG for seizure monitoring

---

💊 Treatment:

• No cure, but symptoms can be managed:

  • Anti-seizure medications

  • Behavioral therapy / educational support

  • mTOR inhibitors (like everolimus) to shrink tumors

  • Regular screening for organs

1. Tuberous Sclerosis Complex (most common in paediatrics)-TSC

 

1. Tuberous Sclerosis Complex (most common in paediatrics)

✅ What is it?

Tuberous Sclerosis Complex (TSC) is a genetic disorder that causes non-cancerous tumors to grow in different parts of the body, especially:

• Brain

• Skin

• Kidneys

• Heart

• 🧒🏻 TSC in Children – Key Symptoms:

  • Seizures (common and often early sign)

  • Developmental delay or intellectual disability

  • Autism spectrum disorder

  • Skin findings:

    • Hypomelanotic macules (white patches)

    • Facial angiofibromas

    • Shagreen patches

  • Behavioral issues

  • Kidney cysts or tumors (angiomyolipomas)

  ---

  🩺 Diagnosis:

  • Clinical exam + imaging (MRI, CT)

  • Genetic testing (TSC1/TSC2 mutations)

  • EEG for seizure monitoring

  ---

  💊 Treatment:

  • No cure, but symptoms can be managed:

    • Anti-seizure medications

    • Behavioral therapy / educational support

    • mTOR inhibitors (like everolimus) to shrink tumors

    • Regular screening for organs

Daily Energy Requirement (DER) function

  Daily Energy Requirement (DER) function

What is the function of the alveoli in the lungs? A. Filter blood B. Produce mucus C. Store oxygen D. Exchange gases

 What is the function of the alveoli in the lungs?

A. Filter blood
B. Produce mucus
C. Store oxygen
D. Exchange gases

DNA (deoxyribonucleic acid) stores the genetic instructions

 

• DNA (deoxyribonucleic acid) stores the genetic instructions used in growth, development, and reproduction.

• RNA helps carry out the instructions encoded in DNA.

• ATP stores energy, not genetic information.

• Enzymes are proteins that speed up chemical reactions, not store genes.

cerebellum

 

The cerebellum is located at the back of the brain and is responsible for:

• Balance

• Coordination

• Fine motor control

Other parts:

• Cerebrum = thought, memory, voluntary movement

• Medulla oblongata = breathing, heart rate

• Hypothalamus = hormones, body temp, hunger

metabolic waste from the blood?

 

Which organ system is primarily responsible for removing metabolic waste from the blood?

A. Respiratory system
B. Digestive system
C. Endocrine system
D. Urinary system

Mitochondrion

 

Mitochondrion

Explanation:

• The mitochondrion is called the "powerhouse of the cell" because it produces ATP (energy) through cellular respiration.

• The Golgi apparatus (your answer) modifies, packages, and ships proteins — important, but not for energy.

cellular respiration is:

 

• The overall equation for cellular respiration is:

$$\text{Glucose (C₆H₁₂O₆)} + \text{O₂} \rightarrow \text{CO₂} + \text{H₂O} + \text{ATP (energy)}$$

• So the products of cellular respiration are:

  • Carbon dioxide (CO₂)

  • Water (H₂O)

  • ATP (usable energy)

• Glucose is actually a reactant, not a product.

hormones

 

The endocrine system produces and regulates hormones that control:

• Growth

• Metabolism

• Mood

• Reproduction

Major endocrine glands include: pituitary, thyroid, adrenal glands, and pancreas.

Pancreas

 

Pancreas

Explanation:

• The pancreas produces the hormone insulin, which:

  • Helps lower blood glucose levels by allowing sugar to enter cells.

• It also produces glucagon (which raises blood sugar) and digestive enzymes.

• The liver stores glucose as glycogen but does not produce insulin.

skeletal

 

The skeletal system:

• Produces blood cells (in red bone marrow)

• Stores calcium and minerals

• Protects organs like the brain, heart, and lungs

Generating body heat is a function of the muscular system, especially skeletal muscle contractions (like shivering).

Metaphase

 

Metaphase

Explanation:

• During metaphase, chromosomes line up in the middle of the cell (along the equator).

• In prophase, chromosomes condense, and the nuclear envelope breaks down.

• Anaphase is when the chromosomes are pulled apart to opposite poles.

• Telophase is when the nuclear envelope reforms around the two sets of chromosomes.

Nephrons

 

Filter blood and form urine

Explanation:

• Nephrons are the functional units of the kidneys.

• They filter waste, excess salts, and water from the blood to form urine.

• Each kidney contains about 1 million nephrons!

Arteries

 

Arteries carry blood away from the heart — typically oxygenated, except for the pulmonary artery, which carries deoxygenated blood to the lungs.

Veins carry blood back to the heart.

Capillaries are tiny vessels where gas and nutrient exchange occurs.

Venules are small veins that collect blood from capillaries.

small intestine

 

• The small intestine is where most digestion and nutrient absorption occurs.

• Tiny finger-like projections called villi increase surface area to absorb:

  • Carbohydrates

  • Proteins

  • Fats

  • Vitamins and minerals

• The large intestine mainly absorbs water and forms feces.

nucleus stores and protects DNA.

 

The nucleus is the control center of the cell and contains DNA, the genetic material.

Other organelles like ribosomes and mitochondria have specific roles, but only the nucleus stores and protects DNA.

Catalyst

 

Catalyst

Explanation:

• A catalyst speeds up a chemical reaction without being used up or changed in the process.

• In biology, enzymes are natural catalysts.

• A substrate is the molecule an enzyme acts on.

• Reactants are the starting materials in a reaction.

• A solvent dissolves other substances (like water dissolving salt).

Luteinizing hormone (LH)

 

Luteinizing hormone (LH)

Explanation:

• A surge in LH (Luteinizing hormone) triggers ovulation, the release of an egg from the ovary.

• Estrogen builds up the uterine lining and helps regulate the cycle but does not cause ovulation directly.

• FSH stimulates follicle growth, and progesterone maintains the uterine lining after ovulation.

Lipids

 

Lipids (fats and oils) are used by the body for long-term energy storage, insulation, and protection.

Carbohydrates provide quick energy.

Proteins are mainly for structure and enzymes.

Nucleic acids store genetic information (DNA/RNA).

Potassium

 

Potassium

Explanation:

• Potassium (K) is an alkali metal — shiny, soft, highly reactive with water.

• Chlorine, oxygen, and sulfur are nonmetals.

The Earth's atmosphere is made up of:

 

Correct Answer: C. Nitrogen

Explanation:

• The Earth's atmosphere is made up of:

  • ~78% Nitrogen (N₂)

  • ~21% Oxygen (O₂)

  • Less than 1% Carbon dioxide, Argon, etc.

• So while oxygen is essential for life, nitrogen is the most abundant gas in the atmosphere.

.Medulla oblongata

 

Explanation:

• The medulla oblongata is part of the brainstem and controls involuntary functions like:

  • Breathing

  • Heart rate

  • Blood pressure

• The cerebellum (your answer) controls balance and coordination, not vital functions.

Mitosis

 

Used for tissue repair and growth

Explanation:

• Mitosis is the process by which somatic (body) cells divide to create two identical daughter cells.

  • It's used for growth, repair, and replacement of cells.

• Answer B describes meiosis, which produces four genetically different sex cells (sperm or egg).

Hydrochloric acid (HCl)

 

Kill bacteria and activate enzymes

Explanation:

• Hydrochloric acid (HCl) in the stomach:

  • Creates a low pH (acidic environment)

  • Kills pathogens

  • Activates pepsinogen into pepsin, which digests proteins

lymphatic system

 

The lymphatic system collects excess fluid (called lymph) from tissues and returns it to the bloodstream, helping maintain fluid balance.

It also plays a key role in the immune system.

Red bone marrow is responsible for hematopoiesis

 

Red bone marrow is responsible for hematopoiesis, which is the production of:

• Red blood cells

• White blood cells

• Platelets

It’s found in flat bones like the pelvis, sternum, and parts of long bones.

Thymine

 

✔️ Answer: C. Adenine – Thymine

Explanation:
In DNA, the base pairs always match up like this:

• Adenine (A) pairs with Thymine (T)

• Cytosine (C) pairs with Guanine (G

Insulin

 

Insulin is a hormone produced by the pancreas that helps move glucose from the blood into cells, where it can be used for energy.

This lowers blood glucose levels.

The opposite hormone is glucagon, which raises blood sugar.

Iodine

 

• Iodine is a critical element used by the thyroid gland to produce thyroxine (T4) and triiodothyronine (T3) — hormones that regulate metabolism.

• A lack of iodine can lead to goiter and hypothyroidism.

alveoli Allow gas exchange

 

Allow gas exchange

Explanation:

• The alveoli are tiny air sacs in the lungs where oxygen and carbon dioxide are exchanged between the lungs and bloodstream.

• Oxygen goes into the blood, and carbon dioxide comes out.

Cardiac straited

 

 Cardiac

Explanation:

• Cardiac muscle is found only in the heart.

• It is involuntary (you don’t control it) and striated (has stripes under a microscope).

• Skeletal muscle is voluntary and striated.

• Smooth muscle is involuntary but not striated.

blood pH by controlling the amount of carbon dioxide (CO₂)

 

The respiratory system helps regulate blood pH by controlling the amount of carbon dioxide (CO₂) in the blood.

When CO₂ levels rise, the blood becomes more acidic. Breathing faster removes CO₂, raising pH (less acidic).

 Which of the following blood vessels carries oxygenated blood?

A. Pulmonary artery
B. Pulmonary vein
C. Superior vena cava
D. Right atrium

1. The pulmonary vein carries oxygenated blood from the lungs to the left atrium of the heart.

2. The pulmonary artery actually carries deoxygenated blood from the heart to the lungs, which is the opposite of most arteries.

3. The superior vena cava carries deoxygenated blood from the upper body to the right atrium.

What is the primary function of white blood cells (leukocytes)?
A. Carry oxygen
B. Fight infections
C. Clot blood
D. Produce hormones

✔️ Answer: B. Fight infections

Explanation:
White blood cells (leukocytes) are a key part of the immune system. Their main job is to:

• Detect and destroy pathogens (like bacteria, viruses, and parasites)

• Support the body’s immune defense

Which process describes water moving across a semipermeable membrane?
A. Active transport
B. Diffusion
C. Osmosis
D. Filtration

Explanation:

• Osmosis is the movement of water molecules through a semipermeable membrane from an area of low solute concentration to an area of high solute concentration, aiming to balance the solute levels.

• It’s a passive transport process (doesn’t require energy).

What type of joint is found in the shoulder and hip?
A. Hinge
B. Pivot
C. Saddle
D. Ball and socket

✔️ Answer: D. Ball and socket

Explanation:

• The shoulder and hip joints are both ball-and-socket joints, which allow for a wide range of motion in almost all directions.

• These joints enable movements like rotation, abduction, adduction, and circumduction.

Which structure connects muscle to bone?
A. Ligament
B. Cartilage
C. Tendon
D. Fascia

• Tendons connect muscle to bone and help transfer the force of muscle contraction to move the bones.

• Ligaments, in contrast, connect bone to bone at joints.

• Cartilage cushions joints, and fascia is connective tissue surrounding muscles and organs.

• Which organ is responsible for detoxifying the blood and producing bile?
  A. Kidney
  B. Liver
  C. Pancreas
  D. Gallbladder

  What’s your answer?

Question 7:

DNA is made up of:
A. Amino acids
B. Fatty acids
C. Nucleotides

D. Monosaccharides

• 
  

• A sugar (deoxyribose)

• A phosphate group

• A nitrogenous base (A, T, C, or G)

DNA (deoxyribonucleic acid) is made up of repeating units called nucleotides, each consisting of:

Amino acids build proteins, fatty acids build lipids, and monosaccharides are simple sugars.

At extremely high temperatures, enzymes denature, meaning:

• Their shape changes

• They lose function

Enzymes only work within an optimal temperature range. Too hot = structure breaks down.

What is the atomic number of an element?
A. Number of protons
B. Number of neutrons
C. Number of electrons + neutrons
D. Number of isotopes

• Golgi apparatus

  Explanation:

  
  

  The Golgi apparatus is the organelle that modifies, sorts, and packages proteins for transport inside or outside the cell.

  
  

  Ribosomes (your answer) are where proteins are made, but they don’t package or transport them.

 

[Brain Ventricles] ← Catheter → Tube → [External Drain Bag + ICP Monitor]

astrocytoma

 An astrocytoma is a type of glioma, a tumor that develops from star-shaped brain cells called astrocytes. These tumors can be benign (non-cancerous) or malignant (cancerous) and can occur in both children and adults. Astrocytomas can vary in their growth rate and aggressiveness, ranging from slow-growing to rapidly growing, and are classified into grades 1 through 4, with grade 4 being the most aggressive. 

🧑‍⚕️ Nursing & Monitoring

• Head must stay aligned and at the correct level (usually 0°–30° angle)

• The drainage system must stay level with the child’s head to prevent over- or underdrainage

• Regular monitoring for CSF output, ICP values, and signs of infection

📤 When is it removed?

• When the underlying issue is resolved (e.g., tumor removed, swelling gone)

• Or when a permanent solution like a VP shunt is placed

1. EVD Placement (External Ventricular Drain)

What is it?

An External Ventricular Drain (EVD) is a temporary catheter (tube) surgically inserted into the ventricles of the brain to:

• Drain cerebrospinal fluid (CSF)

• Relieve intracranial pressure (ICP)

• Monitor pressure within the brain 

  ✅ Normal ICP:

  • 3 to 7 mmHg (millimeters of mercury)

  • 📈 Elevated ICP in children:

    • > 15 mmHg is concerning

    • > 20 mmHg is generally considered pathologic and may require intervention

    • > 40 mmHg is severe and life-threatening

    • 🎯 ICP Management Goals (in critical care):

      For children with brain injury, hydrocephalus, or post-op care:

    • Keep ICP < 20 mmHg

    • Maintain cerebral perfusion pressure (CPP) to avoid brain ischemia

    • 📈 How is ICP monitored?

      • The EVD system is connected to a pressure transducer

      • Normal ICP in a 6-year-old = 3–7 mmHg

      • Readings are continuously monitored in the ICU

      • If ICP rises (e.g., > 15–20 mmHg), doctors may adjust drainage or give medications

• Remove blood or infection (in some cases)

Why is it placed?

EVD is placed when there's:

• Hydrocephalus (too much CSF in the brain)

• Increased ICP from trauma, tumor, hemorrhage, or infection

• Need for CSF diversion while waiting for a permanent solution (e.g., VP shunt)

How is it placed?

1. Preparation:

   • The patient is sedated or under general anesthesia.

   • Head is shaved and sterilized.

2. Burr Hole:

   • A small hole is drilled in the skull (usually in the frontal bone).

3. Catheter Insertion:

   • A soft catheter is inserted through the brain tissue into a lateral ventricle.

   • CSF flows through the catheter and is collected in an external drainage system.

4. System Setup:

• The drainage system is calibrated to drain at a specific pressure level.

• The EVD height relative to the patient’s head determines the drainage rate.

Risks

1. Infection (especially after 5–7 days)

2. Hemorrhage

3. Overdrainage → collapsed ventricles

4. Misplacement or clogging of the catheter

What is SEGA?

SEGA stands for Subependymal Giant Cell Astrocytoma:

• A benign brain tumor

• Often associated with Tuberous Sclerosis Complex (TSC)

• Usually located near the foramen of Monro (the passage between ventricles)

Why is resection needed?

• Tumor blocks CSF flow → causes obstructive hydrocephalus

• Can lead to increased ICP, headaches, nausea, vision changes, seizures

• Though slow-growing, it can become life-threatening due to location

Surgical Resection Procedure:

1. Pre-op Imaging:

   • MRI/CT to visualize the tumor and plan surgery

2. Craniotomy:

   • The skull is opened to access the tumor.

   • Usually done via interhemispheric transcallosal or transcortical approach.

3. Tumor Removal:

   • The surgeon carefully dissects the tumor from surrounding brain tissue.

   • Aim: Total resection, while preserving surrounding structures

4. Post-op Monitoring:

• Watch for CSF leaks, infections, hydrocephalus, seizures, or neurologic deficits

5. \

Alternative Treatment (if surgery is risky):

• mTOR inhibitors like everolimus (Afinitor) may shrink the tumor in patients with TSC.

  • Especially helpful when surgery is not safe or tumor is small.

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Recovery & Follow-up:

• ICU monitoring post-surgery

• Neurologic assessments

• MRI follow-ups to check for residual tumor or recurrence

• Consideration of VP shunt if hydrocephalus persists

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Summary Table:

Topic	Description
EVD	Catheter to drain CSF and reduce ICP
Reason for EVD	Hydrocephalus, increased pressure from SEGA tumor
SEGA Tumor	Benign brain tumor near foramen of Monro, common in TSC
Why Remove SEGA	Blocks CSF flow → hydrocephalus, symptoms, pressure
Surgical Risk	Bleeding, infection, damage to brain tissue
Post-op Care	ICU monitoring, imaging, neurologic checks