exam 2 Flashcards
• Diagnosis:
o streptococcus triggers autoimmune response that damages connective tissue (heart, joints, CNS, skin).
o Erythema marginatum (rash on chest, abdomen, butt, and proximal limbs), throat culture (GABHS),
o ECG/ECHO, chorea
rheumatic fever
• Treatment:
o Antibiotics and aspirin are prescribed, Tepid baths or cool compresses may be provided, IVF are monitored carefully,
o Quiet activities to prevent child from overtaxing the heart
• why we worry about it: Rheumatic heart disease (RHD) – damage to valves
Rheumatic fever
o clinical manifestations: strawberry tongue,
acute: Conjunctival hyperemia, Unresponsive to antibiotics and antipyretics
sub-acute: The skin on the lips, hands, and feet peels off, Increased risk of coronary artery aneurysms
third phase (6-8 weeks): Child gradually progresses with a decrease of inflammation, Resume normal energy, appetite and temperament
o management/interventions:
o monitor temp every 4 hours, aspirin therapy/assess for bleeding, monitor conjunctiva, oral mucosa, and skin every 8 hours for increasing edema,
o spreading of red rash and peeling of skin, assess for dehydration/malnutrition, auscultate heart every 4 hours for abnormal sound/rhythm, IVIG in 1st 10 days
Kawasaki
poor feeding, tachypnea, tachycardia, failure to thrive, poor weight gain, activity intolerance, developmental delays, positive prenatal history, positive family history of cardiac disorders
s/s of heart defects
• Management/interventions
o Manage stress
o Hydration, oxygen, pain management, bed rest, blood transfusions in early treatments
• Etiology
o Hereditary disorder affecting formation of hemoglobin (Hgb S replaces normal Hgb)
o Recessive trait, affecting African Americans
sickle cell
• Pathophys o Increase in abnormal WBC and decreased normal WBC • clinical manifestations o bone pain o easily bruised o tired • treatment/interventions o blood cell count, BMA, early diagnosis improves outcomes, antibiotics, blood replacement, chemo and radiation o high risk for infection
leukemia
• clinical manifestations
o Nontender, firm, enlarged lymph nodes usually in the cervical and supraclavicular area
o Occasionally, the mediastinal lymph nodes are involved, resulting in respiratory distress from pressure against the trachea
o Fever, night sweats, and weight loss.
o Possible genetic factor
• treatment/interventions
o Combination of three to five antineoplastic agents
o Multiple drugs used to help prevent resistance
o Side effects of antineoplastic drugs include…??
o Possibly low-dose radiation
Hodgkin
• Pathophys
o Decrease in number of RBC and/or hemoglobin concentration below normal
o Decreased oxygen carrying capacity of blood
• Etiology
o RBC and Gcb depletion
• Assessments
o CBC: decreased RBC and Hgb and Hematocrit
• Treatments/interventions
o Treat underlying cause: transfusion after hemorrhage if needed and nutritional intervention for deficiency anemias
o Supportive care: IV fluids to replaced intravascular volume, oxygen and bedrest
o Prevent infections
o Decrease oxygen demands
o Takes VS with activity and rest
anemia
• Interventions
o Document body part where seizure began and specific movements
o EEG
• diagnosis of epilepsy
o 2 or more unprovoked seizures
• Assessments
o Control frequency and severity
o Position child on side, clear the airway and assess airway patency
o Check neurologic function
o Implement seizure precautions (padded rails, suction)
seizures
• teaching interventions o infection: greatest risk 1-2 months after surgery • s/s of malfunction o kinking and plugging o medical emergency o increased ICP o worsening neurologic status o altered LOC
VP shunts
• clinical manifestations o Headache o Vomiting, with or without nausea o Seizures o Diplopia, blurred vision o Irritability, poor feeding o High-pitched cry, difficult to soothe o Fontanels: tense, bulging o Cranial sutures: separated o Eyes: setting-sun sign o Scalp veins: distended
increased intracranial pressure
• Diagnosis o ABC FIRST o Vitals o Neuroligic exam – CT, MRI, behavioral assessments, lab • Assessments o Neuro check every 2 hours If loss of consciousness, hospitalize until stable LOC check
head injuries
• clinical manifestations o Headache, vomiting, ataxia o Seizures, visual disturbances, increased intracranial pressure, vomiting o Hydrocephalus o Nystagmus o Behavior changes, poor school performance • treatment/interventions o Surgery, radiation and chemotherapy o Many complications • Assessments o Monitor for neuro status changes
brain tumors
• Treatment/interventions
o Treat with abx
o Treat s/s like headaches, fever, malaise
meningitis
• clinical manifestations: o Shortening of femur o Uneven thigh and gluteal folds o Hip “click” o Limited abduction on affected side
dysplasia of hip
• Diagnosis
o X-ray, MRI, CT
• nursing interventions
o check lungs for compromise
o exercise and stretching for mild scolisos
o therapeutic brace – monitor skin breakdown, must wear 23/24 hours
o spinal fusion for severe: log rolling, pain management, postop hemorrhage, assess bowel sounds, monitor for infection
scoliosis
sac contains meninges and spinal fluid but no neural elemnts of neurologic deficits
meningocele
neural tube fails to close, may be anywhere along spinal column, may be diagnosed prenatally or at birth – sac contains meninges, spinal fluid and nerves
myelomeningocele
• Positioning
o KEEP PRONE and turn head to one side to feed
• treatment/interventions
o prevent infection – sterile moist environment and watch for skin breakdown
Meningocele/Myelomeningocele
• teaching interventions (foods)
o banana, avocado, kiwi, chestnuts can have cross reactions
o increase in severity when it comes in contact with mucous membranes, wet skin, blood stream or airway
latex allergies
- nursing interventions: comfortable positioning – support affected limb, pain meds, admin antibiotics, diversional activities (on strict bedrest)
- assessments: vitals
osteomyelitis
• teaching interventions
o ESR lab values may be elevated
o
• Management
o Goal: control pain, preserve ROM, minimize inflammation and deformity of joints, promote normal growth/development
o Splits
o Comfort measures, dietary management (steroids, NSAIDS, methotrexate)
juvenile idiopathic arthritis
• Treatment/interventions
o Goals: establish locomotion, communication, self help skills, gain optimal appearance and integration of motor function, correct associated defects, provide educational opportunities adapted to needs/capabilities, promote socialization experiences
o Long term PT
o Adaptive equipment (walkers, crutches)
o Botulinum toxin A – helps reduce spasticity in targeted muscles
• dietary needs
o spastic CP needs higher calories due to contraction of muscles
cerebral palsy
• associated defects
o short head, flat forehead, short limbs, wide neck, epicanthal folds, hands short and wide simian crease, moro reflect absent
o congenital heart defects, diabetes, leukemia and hearing loss
• teaching interventions
o provide emotional support
downs
