Care of the child Musculo-skeletal,Neuro,Sensory conditions Flashcards
Osteomyelitis
- inflammation of the bone
- staph aureus
- blood bone infection
s/s:
- fever
- pain
- psuedoparalysis(afraid to move)
Diagnosis
-leukocylosis
-elevated esr
+ blood culture
Treatment/Nursing care
- long term course of treatment(6-8weeks)
- bedrest
- iv antibiotics
- analgesic
- immobilization of limb
Duchenne Muscular Dystrophy(etiology)
- Hereditary sex linked recessive
- progressive neuromuscular disease, life expectancy, early 30s
- fatty infiltration of muscle cells tissue breakdown
- occur in males more
diagnosis:
- H&P
- serum enzymes
- muscle biopsy
Duchenne Muscular Dystrophy(signs n symptoms)
- incidious(comes on gradually)
- delayed walking
- decrease muscle strength
- increasing clumsiness
- lordosis(shoulders back,rounded abdomen)
- gowers sign(large muscles break down first, cant stand up straight)
- usually die from PNA, ulcer
Duchenne Muscular Dystrophy(Treatment/Nursing Care)
- poor prognosis, no cure
- life expectancy adolensence
- depititating-crutches w/ bedridden
- prevention of complication
- skin care
- PT/OT
- emotional support
COXA-PLANA Disease aka LEGG-CALVE-PERTHES Disease(Etiology)
- lack of circulation to femoral head
- 4-8 years with limp cause unknown
- trauma of synovities prior
COXA-PLANA Disease aka LEGG-CALVE-PERTHES Disease(nursing care/treatment)
- Rest, allow child to repair itself
- Bucks traction-puls in one place keeping in alignment
- hip bracing
- maintain ROM
- limit activity during treatment
- prognosis is good for hip degeneration in later years
Bone Tumors
- Benign: causes deformity and pain
- malignant-development of abnormal cells
Bone Tumors(Ewing Sarcoma)
- growth in marrow of the long bones
- metastisis tp lungs and other bones
s/s: pain,possible mass at the site,possible fx
tx:chemo and radiation, good prognosis provided caught early
Bone Tumors(Osteosarcoma)
-primary malignant tumor of long bones
-metas to the lungs
s/s:pain,limited mobility,obvious tumor mass
TX:amputation and chemo
Nursing care: post op care,potential for infection,coping family support,phantom limb pain,prosthesis-P/T
Juvenilele Rheumatoid Arthritis(Stills Disease)(Etiology)
-most common form of arthritis
-systemtic fever x10days, invovle internal organs(liver,spleen enlargement)
-polyarticular=arthritis in 5 or more joints
-pauciarticular=arthritis in 4 or more joints
S/S:swollen joints,enlarged liver and spleen,anemeia,anorexia,rash,pericarditis,myocarditis,potential for
-uueitis=inflammation of anterior chamber of the eye, check eyes every year for blindness
Dx:ANA, no cure
Juvenilele Rheumatoid Arthritis(Stills Disease)(Treatment/nursing care)
- no cure, treat symptoms
- NSAIDs, ,anti-inflammatory-hepatoxcity,effect the Gi system, ROM exerxcies
- prevent ankylosis(deformity of the joints)
- PT/OT to decrease ankylosis
- heat packs and warm showers-increase blood supply and decrease swelling
- good nutrition
- immunization delay because immunity decreased because of the use of corticorsteroids
- prognosis: subsides over a few years
Scoliosis(Etiology)
- curvture of the spine
- common in females
Functional:poor posture, no treatment
Structural:congenital,neuromuscular,diopathic(just happens we dont know)
Screening:pt. bends over feel spine
Dx: X-ray
Scoliosis(Treatment & Nursing care)
-curves under 20degrees=observation,good posture,backpack safety
-curves 20-40degrees=boston brace,milwaukee brace,daily exercise
-curves greater than 40degrees=harrington rods,spinal fusion
patient education:
-wear brace 23 hrs a day
-tee shirt under brace(skin integrity)
-body image in adolescents
-surgery:pre-op teaching,post op care, potential for constipation,log rolls,physical therapy,going to be immobile after surgery,dehersereanants after surgery because skin tight in the back, physical therapy
Hydrocephalus(etiology)
- excessive fluid in head around the brain
- increase CSF in ventricles of the brain
- increase intracranial pressure
- increase head circumference
- congenital or acquired
Hydrcephalus(Sign and symptoms)
- lethargy
- shrill cry,poor muscle tone,poor appetite
- seizures
- bulging fontanels
- increase head circumfeence
- seperated cranial sutures(increase fluid pushed them apart)
- getting sun eyes
Hydrcephalus(assessment)
- head circumference
- transillumnation
- MRI,cat scan
Hydrcephalus(treatment)
-ventriculo-peritoneal shunt
Hydrcephalus(pre-op care prior to shunt placement)
- Temp and Pulse q2h
- support head
- quiet feeding/quiet environment,prone to vomitting and seizures
- check fontanels
- monitor head circumference
Hydrcephalus(post-op care vp shunt)
- position baby on unoperative side
- initally flat then gradually increase HOB
- observe signs of malfunction
- monitor fontanels,sunken or bulging,adjust position
- observe for s/s of infection,possible menigitis/peritonitis
- skin care
- nutrition and emotional support
Hydrcephalus(parent teaching for VP shunt)
- recognize signs of increase intercranial pressure,malfunction,infection
- importance of the flu care and need for shunt revision
- safety-child may have tendency to be unbalanced
- early intervention: PT/OT/SPEECH
Spina Bifida(etiology)
- congenital embryonic neutal tube defect
- imperfect closure of spinal vertebrae
prenatal diagnosis
- alfa-fetal protein(AFP) level at 3-15weeks
- amniocentesis is indicated
- folic acid decreases incidence
Spina Bifida(2 types)
- Spina bifida Occulta
2. Spina Bifida Cystica
Spina Bifida Occulta
-minor varistion, opening in spinal column small and no protrusion of structures
s/s: -tuft of hair or small dimple
- occurs at L1 or S1 - no treatment unless symptomatic
Spina Bifida Cystica
- Meningocele: cyst containing meninges and CSF
- size varies
- usually no neuromuscular symptoms
- surgery needed
Myelomeningocele
- defect in bony canal meninges csf. and spinal cord
- S/S:
- visible sac
- B&B control poor
- leg paralysis
- hydrocephalus
Tx of Spina Bifidas
- intra-uterine surgery
- c-section and surgery within 24hrs
- repairs defect
- prevents hydrocephalus
- latex free environment
Nursing care Spina Bifida
Pre-OP
- moist saline dressing
- assesment of sack
- avoid pressure on sac
- neuro assessment
- skinn care(no diapering)
- help promotoe parent-infant relationship
Post-Op
- observe dressing
- monitor for ICP, VS,for infection,for leakage
- parent teaching/expectations
- intelligence/learning ability not effected
- independence is compromised
- long term family goals
- focus on childs accomplishments
- catherization procedures
- bowel control
- precautions of latex allergic reaction
- observe for s/s of complication of immobility
Reyes Syndrome
- viral infection
- hepatopathy: ammonia level, bleeding
- encephalopathy
- no aspirin
- neuro checks
- HIB vaccine
Meningitis(etiology)
- inflammation of the meninges
- may be viral or bacterial
- peak incidence 6 to 12 months
- droplet infection/resp infection
- HIB vaccine useful to decrease risk
Meningitis(s/s)
- severe headache
- stiff neck
- irritability
- fever
- restlessness
- petechiae
- vomiting
- nuchal rigidity
Lumbar puncture
- small amount of CSF is extracted
- CSF should be clear
Lumbar puncture(nursing care)
- place child in lateral position
- hold neck and thighs to make a curve in spine
- talk quietly to child for reassurance
- quiet environment
- iv fluids and iv antibiotics
- anticonvulsants
- comfort and safety measures post LP
- resp isolation-72 ABX
- monitor iv fluids I/O
- observe for signs of increase ICP
- neuro checks
- tylenol for fever
- immunizations
Encephalitis(defintion)
- inflammation of the brain
- usually viral
Encephalitis(s/s)
- headaches
- drowsiness
- change in mental status
- coma
- seizures
Encephalitis(Tx)
- supportive care
- oxygen
- sedatives
- antipyretics
- iv fluids
- antibiotics
Encephalitis(nursing care)
- neuro check
- v/s
- i&o
- T&P
Brain turmors
-2nd common childhood cancer
-s/s depend on site
-treatment: radiation,surgery,chemotherapy
nursing care:monitor vs,observe for increase ICP,emotional support
Neuroblastoma(eitology)
- develops in utero
- adrneal gland
- abdominal mass
- HTN-tachycardia
- resp depression
Neuroblastoma(Dx)
- palpated mass in abdomen
- ct scan
- biopsy
Neuroblastoma(Tx)
- surgery
- chemo
- radiation
Neuroblastoma(nursing care)
- poor prognosis, due to metastasis before discovery
- emotional support
Mental retardation
- below average mental functioning
- deficit in adaptive behavior
- onset before 18
- 3 components: memory,mood,language
- early intervention
- emphasize strengths
- family support
- AHRC
Downs Syndrome(Trisomy 21)
mild-severe mental retardation
-
Downs Syndrome(Trisomy 21)(S/S)
- small head
- round face
- flat nose
- protruding tongue
- close set eyes
- simian crease
- short thick hands: congenital heart defects
- family counseling
- strive to potential
- self-actualization
Head Injuries(etiology)
- concussion/skull fx
- shaken baby syndrome
Head Injuries(s/s)
- increased ICP
- headache
- hypoxia
- change of LOC
Head Injuries(nursing care)
- observe for LOC- wake child if neccessary
- monitor for ICP
- observe for posturing
- decerebrate=all 4 limbs extended, hands flexed back
- decorticate=arms wrist fingers flexed up
Decerebrate
all 4 limbs extended, hands flexed back
Decorticate
arms wrist fingers flexed up
Otitis Media(etiology)
- inflammation of middle ear due 2 upper resp infection
- communicable disease complication
- haemophilius influenzae
- baby w/ bottle in bed
- second hand smoke
Otitis Media(s/s)
- pain in ear, pulling on ear
- irritability
- diminished hearing
- fever
- headache
- vomit and diarrhea
- potential for rupture of eardrum
Otitis Media(Tx)
- broad spectrum antibiotic if throat culture positive
- analgesics
- ear drops
- under 3yrs: pinna down n back
- over 3yrs-inna up an back
- no cotton in ears
- myringotomy
Otitis Media(Nursing care)
- meds as ordered-Ax and tylenol
- no cotton in ear
- place child on affected side if drum is ruptures
- cold compress for pain relief
- check temp
- avoid water in ears
Hearing Impairment(etiology)
- prenatal viral infection or german measels
- acquired deafness: measles, mumps, meningitis exposure to loud noise
- temporary due to wax build up
- chronic ear infections
- neurological deficit
Astigmitism
- irregular shaped cornea or lense
- causes blurring vision
- treated with corrective lenses
Amblyopia
- lazy eye
- decrease muscle
- vision reduction
- patch good eye(unpatch 2hrs/24)
- can occur up to 9yrs of age
Strabismus
- cross eyes-unable to focus both eyes at same time
- move head instead of just eyes
- glasses
- patch unaffected eye
- vision therapy
conjuctivitis
- conjuctiva inflamed
- redness,drainage
- transferable
- treated with eye drops or ointment
- handwashing
- keeping person items seperate
hyphema
etiology: bleeding into the anterior chamber of the eye usually cause by blunt or penetrating trauma
- tx: both eyes are patched, cbr to prvent increase intracranial pressure and allows the re-absorption of the blood
cataracts
- opaque lens
- congenital
- hereditary
- non-hereditary
- surgery
Retinoblastoma(etiology)
- malignant tumor
- chromosome 13
Retinoblastoma(s/s)
- yellow/white reflex
- cats eye
Retinoblastoma(tx)
- cyrosurgery-freezing by laser
- photocoagulation-destroys blood vessels by laser
- enucleation-removal of eye
- chemotherapy
Retinoblastoma(Nursing Care)
- pressure dressing
- elbow restraints
- eye prothesis
- emotional support
Cerebral Palsy(etiology)
- anoxia at bitrth(lack of o2 to brain)
- prenatal
- preinatal
- non pregressive
- intelligence not necessarily affected
- person responsible for american disability act had cp
Cerebral Palsy(nursing care)
- early intervention
- Rom
- socializaiton
- family support
Seizures(etiology)
- altered neurological impulse causing rapid muscle contraction
- causes unknown, fever, trauma,brain tumor
- tonic-clonic(gran mal)
- aura
- tonic/clonic
- postictal lethary
Status epilepticus
- prolonged seizures
- sudden stopping of medication
Epilepsy
-chronica medical condition causeing seizures
Absence(petit mal)
-twiching , facial tics,blinking of eyes
Febrile
- most common
- caused by rapidly increasing temp
myoclonic
-sligh short lasting seizures
infantile spasms
- seen in premies with under developed nerous systems
- child is very jumpy and twitching
