11th Hour Review Flashcards
What are the key points to spinal fusion?
- For curves >40%, braces are for < 40%
- Anterior or posterior approach, or both
- Most common: posterior spinal fusion w/ instrumentation and bone grafting
- align first, then insert metal rods to keep everything in place
What are our post op concerns for spinal fusion?
- Long recovery
- Post op worried about resp status since we’ve adjusted spine
- May need chest tube
- Mobility will be limited, can’t bend, will need to do logroll in bed
- Will get PCA so they can control the pain meds
- When they’re done and healed, they’ll be completely ok
What are the nursing interventions for GU consequences of immobility?
- I/Os
- Stimulate bladder
What is our nursing care management for spinal cord injuries?
- Acute Phase
- Airway, Neuro checks, Neurogenic shock, UOP, temp
- Stabilizing the mobility of neck
- Neck brace care
- Pain management
- Spasticity management
- Rehab phase
- DVT and PE prevention.
- Autonomic dysreflexia
What are the stages of bone healing?
- Inflammatory
- Callus
- Bone
- Remodeling
What are the six “P’s” that indicate possible compartment syndrome?
- Pain
- Pallor
- Pressure
- Paralysis
- Paresthesia
- Pulselessness
What are our nursing care issues regarding traction?
- Know purpose/function of traction
- Maintain traction
- Not to be d/c’d without physician order
- Do not lift up on weights or hold them for extended amounts of time
- No knots in rope length, knots securing rope to weights/devices need to be secure
- Ropes should move freely through pulleys
- Maintain alignment
- Prevent skin breakdown
How is the dx of osteomyelitis confirmed?
- X-rays/bone scan
- CRP, ESR
- Blood culture
Med care of osteomyelitis?
- abx
- surgery
- symptom management
- No active range of motion
What is Duchenne Muscular Dystrophy?
- Most severe and most common MD in childhood
- Atrophy profound in later stages
- This effects muscle cells!
- Around 2 the s/s start
How is Duchenne Muscular Dystrophy dx’d?
- Waddling gait, falls, lordosis/scoliosis
- Muscle biopsy
- fatty fibrous tissues have invaded muscle cells (indicates positive)
- Blood enzymes
Key points for Progressive Infantile Spinal Muscular Atrophy (SMA)?
- Autosomal recessive trait
- Most common paralytic form of floppy infant syndrome (congenital hypotonia)
- Degeneration in spinal cord and brainstem, resulting in atrophy of skeletal muscles, progressive weakness
- Age of onset variable; earlier onset has poorest prognosis
How is Spinal Muscular Atrophy dx’d?
- electromyography,
- muscle biopsy
Nursing Care for SMA?
- Coordination of care
- Nutrition
- Activities to promote mobility
- Treatment is symptomatic
- Prevent infection or treat infection
- Respiratory is biggest concern
- Family education and support
What is Baclofen
used for,
how is it administered
and why?
- It is used to decrease muscle spasticity
- It is administered interthecally via pump that provides a steady dose
- The steady dose reduces possible sfx (over oral administration)
How does Baclofen work?
It blocks activity of nerves in the part of the brain that controls the contraction and relaxation of skeletal muscles to help them relax.
What is our post-op nursing care for a newborn with a myelomeningocele?
- Prone or side-lying position
- Same as any post-op
- I/O
- Monitor for infection - like a lot a lot
- Pain ctrl
- Neuro checks
- Location of site will determine type of care needed
What are the long-term care issues to keep in mind for a child born w/ myelomeningocele?
- Orthopedic Considerations
- Management of Genitourinary Function
- Bowel Control
What are the 6 steps for degeration of LOC?
- Irritable but consolable
- Irritable and inconsolable
- Lethargic when left alone
- Needs more stimulation to wake up
- No response to touch
- No response to pain
Re: LOC, define Lethargic
- Drowsy but awakens with stimulation, slow to answer questions
Re: LOC, define Obtunded
- Difficult to arouse, falls back to sleep in the absence of stimulation
What is “Cushing’s Triad”?
- A response to increased ICP
- Decreased HR
- Increased BP
- Irregular breathing
- This is a really late sign
- We want to catch it early
What are the early s/s of increased ICP in children?
- Headache,
- vomiting without nausea,
- blurred vision,
- seizures,
- decreased LOC
What are the early s/s of increased ICP in infants?
- Tense or bulging fontanel,
- high-pitched cry,
- changes in feeding,
- vomiting,
- irritability (which is a decrease in LOC)
What are the late s/s of increased ICP in infants and children?
- Cushings Triad
- Bradycardia,
- irregular breathing,
- widening pulse pressure,
- alteration in pupil size or reactivity,
- coma
Treatment for ICP?
- Abx if bacterial cause of ICP
- Antiseizure if they’re seizing
- Corticosteroids to reduce cerebral edema
- Diuretic to decrease fluid
- Restrict fluid
- Watch I/O fluids
- Only hypertonic solutions
- Hypotonic will cross blood/brain barrier and increase ICP
Nursing Care for a Child s/p VP Shunt Placement
- Continually monitor LOC
- Monitor for s/s infection
- Incision site care
What are the considerations for Diastat use?
- If seizure lasts more than 5 mins, then this is used to stop the seizure
- If < then 5 and typical for the child, don’t use and family will keep track of episodes
- Educate family to TAKE THE CAP off before they stick it up their kid’s ass!
- If used, you’ll need to take kid to HCP for f/u
Treatment for febrile seizures, while in hospital?
Pt will be given IV or rectal diazepam
What are the long term complications of meningitis?
- Deafness
- Seizure disorder
- Hydrocephalus
- Cognitive Deficits
What is the tx for Viral (Aseptic) Meningitis?
- Treatment is just manage s/s and sequelae
- Sequelae = whatever happens after
- Sometimes given anti-virals
What are some causes of encephalitis?
Rabies, HSV, ebstein barr, varicella, mesquito virus, measles/mumps
What is responsible for the dramatic decline of bacterial meningitis?
The Hib (Haemophilus influenzae type B) vaccine in 1990
What are two things that can be triggered when you have CNS trauma or illness and what are the key points of each?
- SIADH
- Oversecretion of ADH
- Fluid retention and hypotonicity
- Decreased sodium levels
- Diabetes Insipidus
- Posterior pituitary hypofunction
- Under Secretion of ADH
- Uncontrolled diuresis
What is Measles and how is it spread?
- AKA Rubeola
- Caused by Morbillivirus
- It is airborne
What are the complications (conditions) that can arise from Measles?
- Pneumonia (1:20 infected aquire it)
- Encephalitis
- Death
What is Mumps and how is it spread?
- Epidemic parotitis caused by Mumps virus
- It is droplet
What are the complications that can arise from a Mumps infection?
- Meningitis (occurs in 1:10)
- Encephalitis (causes deafness)
- Testicular swelling (can cause permanent damage)
What is diphtheria and how is it transmitted?
- an acute, highly contagious bacterial disease causing inflammation of the mucous membranes, formation of a false membrane in the throat that hinders breathing and swallowing, and potentially fatal heart and nerve damage by a bacterial toxin in the blood
- contact, droplet transmission
S/S of Diphtheria
- can be asymptomatic
- sore throat,
- fever,
- difficulty swallowing
- DEAD TISSUE ON TONSILS
What complications can arise from Diphtheria?
- suffocation,
- paralysis,
- death,
- endocarditis,
- neuropathy
How is Pertussis transmitted?
- Contact, Droplet
What are two potential complications of Pertussis?
- Bacterial pneumonia
- Neurological d/t hypoxia
Treatment for Pertussis?
- ABX (Erythromycin)
- Supportive
- Tx household contacts (family)
What is the method of transmission for Polio?
Fecal-Oral
S/S of Polio?
- fever,
- HA,
- muscle spasm,
- paralysis
What precautions are put in place for a pt w/ meningococemia?
droplet
How is Meningococemia treated and is it preventable?
- Once dx’d, abx STAT
- It can be prevented with a meningococcal vaccine, rec’d in adolescence
True or False
Rotavirus does not have a vaccine and there is no partial immunity after infection.
False
There is a vaccine and there is partial immunity after infection
Key points for Tuberculosis?
- Airborne
- Dx in Peds is difficult
- Kids don’t cough up sputum like adults do
- TB skin test is key indicator
Key points for Covid in kids?
- Occurs about 4 weeks after COVID-19 exposure, an immune response to the virus
- Overactive immune response
- Also called Pediatric Inflammatory Multisystem Syndrome (PIMS)
- Treatable with anti-inflammatories to bring down the swelling and reduce negative fx, O2 supplementation, etc
What are some contraindications to immunizations?
- Severe febrile illness
- Recent administration of immune globulin (IVIG)
- Altered immunity
- Severe pertussis reaction
- Hypersensitivity to the immunization or preservative
JIA dx key points?
- Onset < 16 years old (peak onset is 1-3 years of age)
- Lasts more than 6 weeks
- No other causes of the inflammation
- Arthritis in <4 joints in 50% of cases
One of the tx for JIA is to suppress the immune system.
What are the key points to keep in mind here?
- May increase the risk for infection as result
- Latent TB may flare up
What is Systemic Lupus Erythematosus (SLE)?
- an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs.
- It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.
S/S of SLE?
- Fever
- Fatigue
- BUTTERFLY RASH ON FACE
General SLE tx?
- Supportive care for inflammation
- Medications
- Nutrition, rest, exercise
- LIMIT UV LIGHT EXPOSURE
What is the max amount of daily milk for toddlers and teens?
- Toddlers = ≤ 32oz
- Teens = ≤ 3 cups (24oz)
What is the medical treatment for Aplastic anemia?
- Immunosuppression if autoimmune cause is suspected
- Bone marrow transplant
What happens if you wait on a bone marrow transplant for aplastic anemia, what happens?
- reduces survival right to 70% as the child would to the human leucocyte antigen (HLA)
- body may now see it as “this isn’t me” and reject the new marrow
Describe the vaso-occlusive crisis of SVA.
- sickled cells cause blockages that result in a painful episode from hypoxia
- Leads to
- Acute Chest Syndrome (similar to pneumonia)
- crisis clogs chest
- leading cause for death in SCA
- CVA (Cerbrovascular Accident - stroke)
- Crisis clogs brain
- Infection
- Acute Chest Syndrome (similar to pneumonia)
Pain is a huge issue with SCA. What are the key points regarding medication?
- want to start meds as soon as possible,
- give PCA if they’re old enough
- want them to feel in control
- nsaids, motrin, ibuprofen and opioid med is typical
How is Beta Thalassemia, “Cooley’s Anemia” acquired?
inherited from parents
What is happening in Beta Thalassemia?
- Red blood cells hemolyze and become non-functional
- Body makes more RBCs to compensate
- Inside the bone marrow AND
- Outside the bone marrow (extramedullary hemotopoiesis)
Simply put, what is Beta Thalassemia and what does the process lead to?
- Constant descruction and production of RBCs result in poor perfusion
- Process leads to
- Brittle bones, hepatosplenomegaly from the process
- Delayed growth
- Facial deformities
What is Idiopathic Thrombocytopenic Purpura (ITP)?
- An aquired hemorrhagic disorder that is characterized by:
- Thrombocytopenia (destruction of of platelets - PLT<20K
- Purpura (advanced peticea)
- NORMAL bone marrow
What is the treatment for ITP?
- IVIG
- Prednisone - to help body settle down and minimize platelet destruction
All kids should be screened for lead poisoning by what age?
12mos
What are five common diagnostic tests for cancer?
- Bone marrow biopsy
- Bone Scintigraphy
- Gallium Scan
- PET Scan
- SPECT Scan
How does a bone marrow biopsy help us diagnose cancer?
- liquid marrow samples & a bone core segment
- Uses:
- Diagnosis
- Evaluates DNA/Chromosomes
- Prognosis/Risk
- Treatment and response to therapy
How does bone scintigraphy help us diagnose cancer?
We use it to ID areas of increased cellular turnover (rapid growth)
How does a PET scan help us diagnose cancer?
- IDs differences in metabolism in tissues
- (tumor cells have faster metabolism)
How does a SPECT scan help us diagnose cancer?
- a nuclear medicine scan
- examines the function of organs
- looks at organs from different angles
What is the nursing care after a bone marrow biopsy?
- put on dressing (possibly pressure to stop in bleeding if present)
- Monitor for bleeding, bruising, infection
- Pain management
When screening for Leukemia, what will x-rays and a CBC show?
- X-Rays/Imaging
- Show enlarged liver and spleen
- abnormal cells are building up in liver/spleen
- Show enlarged liver and spleen
- CBC
- HIGH WBC (With greater % of blasts/immature cells)
- Low WBC of healthy type
- Low H&H
- Low Platelet count (<50,000 admitted to hospital)
- HIGH WBC (With greater % of blasts/immature cells)
What are the first steps taken for a pt w/ a new dx of Leukemia?
Briefly explain each
- Symptom management
- Get the stable
- Bone marrow biopsy
- confirm dx/type of Leukemia
- Lumbar Puncture
- to assess CSF involvement
- Central line placement
- prep for chemo
- Chemo
- prophylactic treatment in case CSF involvement
- focused chemo later in tx
A lumbar puncture is done to evaluate for leukemic presense in the CNS. Explain the process.
- Patient will be side-lying with head flexed and knees drawn up
- Patient may be sedated
- Provider will take 3-4 vials of CSF
- Pressure will be held and an elastic bandage placed to puncture site
- Monitor site for Bleeding, Hematoma, & Infection
- Child should remain in bed for 4-8 hours flat to prevent leakage, which can lead to spinal headache
Explain the three phases of chemo therapy for Leukemia.
- Chemotherapy: three phasesInduction therapy
- 4 to 5 weeks
- Goal: “remission”
- Intensification/Consolidation
- 6 months of “bursts” of treatment
- Goal: make sure it doesn’t come back
- Maintenance therapy
- 2-3 years
- Goal: To preserve remission
What is worse, Hodgkins or non-Hodgkins lymphoma? Why?
- Non-hodgkins
- Because it can appear in the same places as Hodgkins as well as others and when it is discovered, it is usually at an advanced stage
- Hodgkins has a 90% survival rate for ≥ 5yrs
What is Wilms Tumor?
- Tumor on the kidneys, usually unilateral
- Most often diagnosed at 3-5 yrs of age
- 90% survival rate
- If untreated, the mass will block the vena cava/other organs and death will follow
How is Wilms Tumor confirmed?
- Intravenous pyelogram
- dye is injected and observed
What is our Nursing Care for Wilms Tumor?
- Family education/support
- Monitor central line
- Post surgical/chemo care
What are the dx tests for Neuroblastoma?
- CT scan
- Chest x-ray
- Skeletal scintigraphy
- Biopsy of tumor
What is scintigraphy?
A technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning.
What is the Medical tx for Neuroblastoma?
- Surgery
- Chemo
- Radiation
- BMT (Bone Marrow Transplant)
What are the s/s of Neuroblastomas?
- s/s are based on where it happens
- If in spine, child may have leg weakness, balance issues
- May have bowel and bladder issues not present before
- If in face
- May see bruising/swelling around the eyes
True or False
Very commonly the kids will have metastastes somewhere else (bone marrow, lympnodes, bone or skin, etc) before they’re even dx’d w/ neuroblastoma
True
What is the recovery rate for Neuroblastomas?
- 30-90% recovery rate
- Lower numbers are with metastasis at time of dx
- Higher number is when its caught prior to any metastasis
In addition to s/s due to location of Brain Tumor, what are some other manifestations to keep an eye out for?
- Irritability
- lethargy
- increased head circumferance (infants),
- headache
- loss/delay of milestones (waking, crawling, etc)
Dx tests for Brain Tumors?
- MRI
- CT Scan
- PET (to eval tx)
- LP
- Biopsy
- Labs
What are three areas have common complications to chemo?
- Hair
- GI
- GU
What are the chemo complications for GI and how do we address them?
- Nausea/vomiting
- common but manageable w/ anti-emetics
- give cool or bland foods
- Change in appetite
- some kids lose sense of taste
- This was the storry about flaming hot cheetos being popular cause they can actually taste those
- Mucositis- Mucosal irritation/Mouth sores
- Provide good oral hygeine
- “Magic mouthwash” - has benadryl, lydocane and an antacid - that helps them feel better for mouth care and inflammation and acids in stomach that add to pain
- Constipation
- stool softeners
How does chemo effect the GU system?
- Chemo is gonna be in bladder
- Problem is it just sits there against the bladder tissue and can cause hemorrhagic cystitis
- Will give lots of fluids, up to TWICE their proper maintenance dose - trying to flush that out
- MESNA is med protects the bladder tissues
How is radiation treatment delivered?
- In divided treatments (about 5mins ea), every day, over weeks
- Delivered to exact location of cancer cells (unlike chemo)
SFX of radiation?
- fatigue
- skin damage
- hair loss
- n/v
- low blood counts
Key things to remember about pre-op care?
- Consent/assent
- Fam/Pt education on what’s about to happen
- developmentally appropriate for kid
- Parents stay with kid until the last second and parent brought back in for the wake up
What is Tumor Lysis Syndrome?
- It is when the tumor ruptures and its contents are spread throughout the body
- Can cause metabolic abnormalities/electrolyte imbalances - ex. hyperkalemia, hypocalcemia
How is Tumor Lysis Syndrome managed?
- Hydration
- Serial labs
- Monitor I/Os
- Meds for specfic abnromality/imbalance
- ex. if hyperkalemia, reduce potassium
To know the nadir, we need to know the Absolute Neutrophil Count.
What is its formula and what level triggers neutropenic precautions?
- ANC = neutrophils X WBCs
- or
- ANC = (%segs + %bands) x WBCs
- an ANC < 500 is the trigger point for neutropenic precautions
What are neutropenic precautions?
- Neutropenic precautions are steps you can take to prevent infections if you have moderate to severe neutropenia.
- Neutropenia is a condition that causes you to have low neutrophils in your blood.
