Block #4 - Integumentary, Neurological, Musculoskeletal Flashcards
1
Q
Common Burn Causes for each age group
A
Toddler: hot water scalds
Older Children: flame-related burns
Child Abuse
2
Q
3 Phases of Healing (and durations)
A
- Inflammation (2-5 days): preps for repair
- Proliferation (2-3 weeks): blood flow reestablished
- Remodeling (3 weeks - 2 years): scar formation
3
Q
Burn Care: 6 C’s
A
Clothing - remove
Cooling - cool burns immediately
Cleaning - wash with mild soap and rinse well
Chemoprophylaxis - topical ointment; tetanus booster
Covering - with sterile gauze
Comfort - give pain medications
4
Q
Burn Therapeutic Management
A
First Priority: airway maintenance
Fluid replacement: critical 1st 24 hr
Nutrition: increased demand
Medication: abx, analgesics, anesthetics for procedure pain
5
Q
Burn Complications
A
- AIRWAY
- Profound shock
- Infection
- Inhalation Injury
6
Q
Frostbite: Cause
A
> 1 hr at lower than 32 degrees
7
Q
Frostbite: S/S
A
Red, Blue, Waxy skin
8
Q
Frostbite: Nursing Care
A
- Place child in a warm area
- Remove wet/cold clothing and replace with warm/dry
- DO NOT MASSAGE area or apply dry heat
9
Q
HPV
A
Causes warts (hands, feet, genital area)
10
Q
HPV Risks
A
Increased cervical cancer risk
11
Q
HPV: S/S
A
- Rough, raised, and flesh-colored
- Occur anywhere on the body
- Usually no pain or itching
12
Q
HPV: Nursing Care
A
- Usually no intervention needed
- OTC or prescription meds
13
Q
HPV Prevention
A
Vaccination: Gardasil after age 9
-makes some females very sick after administration
14
Q
What is another name for Eczema?
A
Atopic Dermatitis
15
Q
Eczema: S/S
A
- Red, raised rash that is itchy (pruritic) and painful
- Rash on infants: usually head, face, arms, and legs
- Rash in older children: usually presents in the folds of the arms and legs
16
Q
Eczema: Nursing Care
A
- Prevent secondary infection
- Provide good hygiene
- Follow prescribed treatment protocols
- Maintain skin hydration
- Conduct frequent monitoring and rash assessment
17
Q
Food Starting Order for Infants
A
Breastmilk/Formula
Rice cereal
Vegetables
Fruits
18
Q
Lice
A
Infest the body, primarily where there is longer hair (nape of neck and behind ears)
19
Q
Lice: Treatment
A
- OTC shampoo
- Mayo on scalp
- Backwards combing
- Whole family needs to be treated
20
Q
Lupus
A
Butterfly rash
Treat with anti-malarials
- Autoimmune condition
- Systemic
- COD is often kidney failure
- Monitor BUN and creatinine
- Immunosuppressants can increase risk of infection
- Avoid sun and use sunscreen (rash cause)
21
Q
Acne: Nursing Care
A
-Assess the acne
-Clean and moisturize with a water-soluble moisturizer
-Treat with benzoyl peroxide –> dries up
-Administer topic abx and then retinoids
Tetracycline: no one under 8 and no pregnant
Accutane (oral) –> toxic to fetus –> do a pregnancy test before admin
22
Q
Accutane Risks
A
Can cause:
- Depression
- Birth Defects
23
Q
S/S of ICP Change: Infants
A
- Irritability; poor feeding
- High pitch cry, difficulty to soothe
- Fontanelles: tense and bulging
- Cranial Suture Separation
- “Sun setting” eyelid
- Scalp veins distension
24
Q
S/S of ICP Change: Children
A
- Headache
- Vomiting (w/o nausea)
- Diplopia (double vision)
- Seizure
- Poor feeding
25
Levels of Consciousness
```
Fully conscious
Confusion - impaired decision making
Disorientation - to time and place
Lethargy - sluggish speech
Obtundation - arouses with stimulation
Stupor - responds only to vigorous and repeated stimuli
Coma - no response to stimuli
Persistent Vegetative State - permanently lost function of the cerebral cortex
```
26
Oculovestibular Test
Put ice water in the ear --> the eyes turn towards opposite ear if NOT brain dead
No movement = brain dead
27
Cerebral Palsy
Most common permanent physical disability in childhood**
Etiology: prenatal encephalopathy
28
Cerebral Palsy: Types
Spastic - tightened musculoskeletal system
Athetoid/Dyskinetic - random movements
Ataxic - Gait issue, rapid repetitive movements
Mixed/Dystonic
29
Cerebral Palsy: Motor S/S
- Poor head control after 3 months old
- Stiff or rigid limbs
- Arching back/pushing away
- Floppy tone
- Unable to sit without support at 8 months
- Clenched fist after 3 months
30
Cerebral Palsy: Behavioral S/S
- Excessive irritability
- No smiling by 3 months
- Feeding Difficulties (hold jaw when feeding)
- Persistent tongue thrusting
- Frequent gagging or choking while feeding
- Impaired socialization
31
Meningitis: Worst Kind
Meningococcal
32
Meningitis: prevention
Hib Vaccine
33
Meningitis: Order of Care
- Private Room
- Isolation precautions (droplet)
- Sign on door
- Blood Cultures
- IV start (fluids)
- Admin broad abx
- Wait for culture results --> focused abx tx
34
Seizure: Priorities
Safety is #1
35
Seizure: Cause
Malfunction of brain's electrical system
Determined by site of origin
Most common neurologic dysfunction in kids
36
Epilepsy
2+ unprovoked seizures
37
Seizure: Major Causes in Children
- Birth injuries (anoxia) or congenital CNS defects
- Acute infections in late infancy and early childhood
- Usually idiopathic if >3 yr
38
Absence Seizures: Motor Signs
```
Lip-smacking
Twitching of eyes
Face
Slight hand movement
May drop held object
Children rarely fall
No incontinence
```
39
Atonic Seizures
Sudden momentary loss of muscle tone
Sudden fall to the ground, often onto their face
Less severe seizure - head droops forward several times
40
Myoclonic Seizures: S/S
- May be single or repetitive
- No loss of consciousness
- Often occur when falling asleep
- May be a nonspecific symptom in many CNS disorders
- May be mistaken as exaggerated startle reflex
41
Infantile Spasms
WORST OUTCOMES
- Onset: 6 to 8 months
- Usually associated with mental retardation
- Specific spike seen on EEG
2x more common in males
42
Common Seizure/Spasm Triggers in Pediatrics
- Changes in light-dark patterns (camera flashes, headlights, rotating fan blades, reflections off snow/water)
- Sudden loud noises
- Extreme temperature changes
- Dehydration
- Fatigue
43
Muscular Dystrophy: definition
symmetrical wasting of skeletal muscle groups
44
Duchenne Muscular Dystrophy (DMD)
Most common and most severe
45
DMD: Characteristics
- Onset b/w 3-5 years
- Progressive muscle weakness, wasting, and contractures
- Calf muscle hypertrophy in most patients*
- Progressive generalized weakness
- Death from respiratory failure or cardiac failure
46
DMD: Clinical Manifestations
- Waddling gait, frequent falls, Gower Sign (must use all 4 extremities to get up)
- Lordosis (inward curve of spine)
- Enlarged muscles, especially thighs and upper arms
- Profound muscle atrophy in late stages
- Mental deficiency
47
Club Foot: S/S
- Plantar flexion
- Inverted heel
- Abducted forefoot
48
Club Foot: Nursing Care
-Serial casting or baby shoe
Start immediately after diagnosis
-Manage pain
-Educate family
49
Myelomeningocele: Prevention
Results from Spina Bifida - prevent with Folic Acid
50
Myelomeningocele: Nursing Care
Place newborn prone (protect sack)
Keep sack moist, clean, and sterile (covered)
Provide post-op care for laminectomy & closure of defect
NO RECTAL TEMP
51
Scoliosis Treatment
- Assess body image and maintain orthotic brace compliance (TLSO brace)
- Surgery for rod placement if severe of when pulmonary function becomes compromised
52
Scoliosis: TLSO Brace
- Wear until skeletal system has fully matured
| - Wear 23 hours a day
53
Legg-Calve-Perthes
Aseptic Necrosis of the Femoral Head
- Wasting
- Flattening
- Takes 12 months for revasculating
- New bone development in 1-2 years
54
Legg-Calve-Perthes: S/S
- Hip or knee soreness or stiffness
| - Painful limp, quadriceps atrophy
55
Legg-Calve-Perthes: Nursing Care
- Monitor non-weight-bearing
- Assess ROM, pain, and neuro status
- Educate the family
- Serial casting 1-3 years of age, will be able to return to normal
56
Osteogenesis Imperfecta
Brittle Bone Disease
Most common genetic bone disorder
Type-2 = incompatible with life (LETHAL)
Type 1,3,4 = can be managed
even changing a diaper may cause fracture
57
Osteogenesis Imperfecta: S/S
- Lax joints
- Small and weak muscles
- Numerous fractures
- Bone deformities (bowing)
58
Compartment Syndrome: Classic Sign
Unrelenting Pain, not relieved by narcotics
59
Compartment Syndrome
Possible complication of fracture
Priority is prevention
Elevate extremity to prevent swelling
Frequent neurovascular checks
Notify HCP immediately if suspected*
60
Shaken Baby Syndrome
Warning Sign: story doesn't match up
S/S:
-unconscious
-retinal bleed
