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ob/peds > exam 2 study guide > Flashcards

exam 2 study guide Flashcards

1
Q

States of consciousness (OBTUNDED)

A

the child has limited responses to the environment and falls asleep unless stimulation is provided.

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2
Q

States of consciousness (FULL CONSCIOUSNESS)

A

the child is awake and alert; is oriented to time, place, and person; and exhibits age-appropriate behaviors.

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3
Q

States of consciousness (CONFUSION)

A

disorientation exists; the child may be alert but responds inappropriately to questions

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4
Q

States of consciousness (STUPOR)

A

the child only responds to vigorous stimulation

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5
Q

States of consciousness (COMA)

A

the child cannot be aroused, even with painful stimuli.

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6
Q

ICP vrs Shock

A

ICP = systolic BP increases, pulse and respiration decreases

Shock: pulse and respiration increases, BP decreases

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7
Q

Assessment of motor function

A

may indicate certain neurologic problems such as increased ICP, head injury, and cerebral infections

It is important to assess for two distinct types of posturing that may occur

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8
Q

two distinct types of posturing that may occur with motor functioning

A
  • Decorticate posturing occurs with damage of the cerebral cortex.
  • Decerebrate posturing occurs with damage at the level of the brain stem.
  • Extremely rigid muscle tone occurs in both *
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9
Q

deCortiCate (flexor) posturing

A

ARMS ARE LIKE C’S

  • moves towards the Cord
  • problems with cervical spinal tract or cerebral hemisphere
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10
Q

dEcErEbratE (Extensor) posturing

A

arms like E’s

  • problems within midbrain or pons
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11
Q

Risk Factors for Epilepsy

A
  • Family history of seizures or epilepsy
  • Any complications during the prenatal, perinatal, or postnatal periods
  • Changes in developmental status or delays in developmental milestones
  • Any recent illness, fever, trauma, or toxin exposure
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12
Q

Nursing Management Epilepsy

A
  • Preventing injury
  • Appropriate medications and treatments
  • Education and support
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13
Q

Hydrocephalus

A
  • develops as the result of an imbalance of production and absorption of CVF
  • Most often congenital
  • Arnold-Chiari malformations
  • Enlarged ventricles and ICP
  • Head circumference abnormally large
  • Treatment consists of ventriculoperitoneal shunt
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14
Q

Signs and Symptoms of Shunt Infection

A
  • Elevated vital signs
  • Poor feeding
  • Vomiting
  • Decreased responsiveness
  • Seizure activity
  • Signs of local inflammation along the shunt tract
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15
Q

Craniosynostosis

A
  • Premature closure of the cranial sutures; complete closure of all sutures does not normally occur until late in childhood
  • Premature closure can inhibit brain growth and a distorted skull appearance will be evident
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16
Q

Encephalitis

A

Encephalitis is an inflammation of the brain that may also include an inflammation of the meninges and can be caused by protozoan, bacterial, fungal, or viral invasion

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17
Q

Risk Factors for Reye Syndrome

A
  • A prodromal viral illness, such as chickenpox, croup, flu, or an upper respiratory infection
  • Ingestion of salicylate-containing products within 3 weeks of the start of the viral illness
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18
Q

Signs and Symptoms of Reye Syndrome

A 
Severe and continual vomiting
Changes in mental status
Lethargy
Irritability
Confusion
Hyperreflexia
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19
Q

Epilepsy

A

Epilepsy is a condition in which seizures are triggered recurrently from within the brain.

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20
Q

Types of head injuries

A
  • Closed
  • Open
  • Coup injury = forehead contusion
  • Contrecoup = contusion opposite to the actual site of impact to the head (hit forhead, feel back of head)
  • Missile injury
  • Impalement injury =pierce through the body to the other side
  • contusion
  • concussion
  • intercranial hemorrhage
  • Epidural hematoma - between the skull and the dura mater
  • Subdural hematoma - between blood and brain
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21
Q

Common Causes of Head Trauma in Children

A

Falls
Motor vehicle accidents
Pedestrian and bicycle accidents
Child abuse

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22
Q

Causes of Nonaccidental Head Trauma

A
  • Violent shaking: shaken baby syndrome (SBS)
  • Blows to the head
  • Intentional cranial impacts against the wall, furniture, or the floor
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23
Q

breathing anatomical differences between children and adults:

A
  • Narrower airway – causes an increase in airway resistance
  • Infants are obligate nose breathers
  • Distal bronchioles are narrower and fewer in number than in adults
  • Children up to 6 years rely on the diaphragm to power respiration
  • The ribs are mainly cartilage and are very flexible
    Intercostal muscles are immature
  • Flexible ribs + immature musculature contribute to retractions seen during respiratory distress
  • Most arrests in children are respiratory in nature, not cardiac
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24
Q

Pediatric Respiratory Assessment

A

Airway
Breathing
Circulation

  • LOOK BEFORE YOU TOUCH

Assessment Triangle
Appearance
Breathing
Circulation

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25
Q

Tonsils

A

usually refer to palatine tonsils located each side of anterior oropharynx

26
Q

Adenoids

A

also called pharyngeal tonsils located posterior in the nasopharynx

= obstruct the eustachian tube = serous and suppurative otitis media = hearing loss or sleep apnea with hypoxia

27
Q

enlarged adenoids

A
  • obstruct the eustachian tube = serous and suppurative otitis media = hearing loss or sleep apnea with hypoxia

SLEEP APNEA WITH AIRWAY OBSTRUCTION #1 REASON

  • recurrent infections especially with abscesses is another reason
  • SURGERY IS THE TREATMENT = usually not done before age 3-4 years
28
Q

Tonsils & Adenoids PREOPERATIVE

A
  • Check PT/PTT, Bleeding Time
  • Check for loose teeth – What makes this so important?

Check signs of respiratory infection - What makes this so important?

29
Q

Tonsils & Adenoids Postoperative:

A
  • LOC
  • VS
  • Positioning
  • IV →PO
  • Voiding
30
Q

postoperative measures after tonsil and adenoid surgery

A

Bleeding

  • *Frequent clearing of throat or swallowing –
  • *Bright Red Blood from Mouth, Nose or emesis
  • Restlessness
  • Tachycardia
  • Place on side - ↑ HOB
    Stop Oral Fluids,
  • Maintain IV –
  • Maintain Airway
  • Call MD
31
Q

Laryngotracheobronchitis etiology

A
  • Viral- Most common Parainfluenzae
  • Inflammation→ edema and narrowing of airway

Age: 6 mo – 4 yrs esp
Most toddler

32
Q

sign and symptoms of Laryngotracheobronchitis

A
  • Associated with URI
  • Develops gradually over several days
  • Often manifests at night
  • Stridor (Where in airway will LTB occur?)
  • Brassy Barky Cough
  • Hoarseness
  • Dyspnea: Mild tachypnea,
  • Mild retractions
  • Low grade temp
  • Irritable
  • Restlessness
33
Q

croup sign and symptoms

A
  • steeple sign

- subglottic narrowing

34
Q

Laryngotracheobronchitis diagnosis

A
  • Virology Culture from Nasal Pharynx –Swab or Suction
  • CBC
  • Chest xray
35
Q

Treatment of Laryngotracheobronchitis

A
  • Racemic epinephrine Nebs – Alpha adrenergic stimulation → mucosal vasoconstriction
  • Assess tachycardia, rebound effect
  • Steroids: e.g. Decadron, Solumedrol(methylprednisolone)
  • Albuterol trial
  • Heli-Ox Therapy
  • Humidification with cool mist
    Pulse Oximetry
    Keep calm & quiet
36
Q

Bring to ER Laryngotracheobronchitis

A 
- ↑Resp distress
	Will not lie down
	-  ↑ fever
	- Will not drink
	- Drooling
	- Decreased urine 	output

Prevention: Handwashing

Croup can reoccur

37
Q

nursing interventions about Laryngotracheobronchitis

A
  • Reassure parents
    If respirations 60 or more Make NPO WHY?
  • If no stridor can be Rx at home
  • assess tachy and rebound effect

Parent Education:
Bathroom with humidity or Cool mist
Stay calm

38
Q

Acute Epiglottis

A
  • An obstructive inflammatory process that usually occurs in young children, aged 2-5
  • Has been known to occur from infancy to adulthood
    The causative agent is primarily Haemophilus influenza (Hib)
  • Virtually eliminated with use of the Hib vaccine given at 2-4, 6 months of age, with a booster shot at 12-18 months

EPIGLOTTITIS IS A TRUE MEDICAL EMERGENCY!!!

39
Q

Acute Epiglottis sign and symptoms

A

4 Ds and 2 Ss

  • Dysphagia
  • Dysphonia
  • Distress – What signs?
  • Drooling

2 Ss

  • Stridor
  • Severe sore throat
40
Q

other sign and symptoms of acute epiglottis

A
  • Upper Airway
  • Rapid Onset with respiratory distress
  • High fever > 102.2
  • Large cherry red epiglottis
  • Tripod position
  • Retractions
  • Resp acidosis
  • Anxious/frightened

The child is usually sicker than the symptoms suggest, and often looks worse than he/she sounds

41
Q

diagnosis of acute epiglottis

A
  • Lateral Neck X-Ray
  • NEVER visualize throat without emergency equipment!!!
  • What other activities should not be performed?

CBC What will this tell you?

Portable CXR only

42
Q

treatment of acute epiglottis

A
  • Antibiotics
  • Ceftriaxone 50-75 mg/Kg/Q12h
  • Ampicillin
  • Code Cart @ Bedside
  • Keep Child Calm
  • NO IVs or Blood Draws -
    without intubation WHY?

Call anesthesia for intubation
- Never force a child to lie down can lead to total obstruction!!!
PICU admission

PREVENTION

  • Hib vaccine
  • Handwashing
43
Q

Bronchiolitis

A
  • Occurs frequently in toddlers and pre-schoolers
  • Severe in infants < 6 months old
  • Infectious agent causes inflammations and obstruction
44
Q

Signs & Symptoms Bronchiolitis

A
  • URI symptoms with fever
  • Rapid, shallow respirations
  • Nasal flaring
  • Cough
  • Wheezing
45
Q

RSV: Most common cause of bronchiolitis

A
  • Causative agent of bronchiolitis and pneumonia
  • Plugging of small airways with mucous and debris
    Inflammation and obstruction lead to air trapping (hyperinflation)
46
Q

RSV is severe and fatal in infants with history of

A
  • Congenital heart disease
  • BPD
  • Prematurity
  • Immunosuppression
47
Q

diagnosis of RSV

A
  • Diagnosed via RSV culture of nasal secretions
  • RSV rapid screen
  • Viral culture (microbiology) ELISA (ID the virus)
  • CBC
  • CXR – Assess for Pneumonia
48
Q

RSV is often associated with exposure to adults with?

A
  • URI
  • older (school aged siblings
  • sick children at daycare
49
Q

RSV is very common during what season (months)

A

winter months, primarily october - march

50
Q

RSV is rare during what ages

A

> 2 years

- Peaks at approx. 6 mo

51
Q

sign and symptoms of RSV

A
  • Runny nose
  • Sneezing/Coughing
  • Low-grade fever
  • Wheezing
  • Decreased breath sounds (the more noise the better)
  • Day 4-5 symptoms increase (mucus) then begins to improve
  • Poor feeding
52
Q

Acute Respiratory Distress signs and symptoms

A
  • Nasal flaring
  • Tachypnea (often severe)!!!
  • Intermittent cyanosis
  • Retractions
  • Prolonged expiratory phase (hypoxemia)
  • Tracheal tug
  • Grunting
53
Q

medical interventions of RSV

A
  • Contact Precautions (Droplet Spread) – Virus can live on surface for 6-8 hours
  • Bronchodilators
  • Steroids
  • Anti-pyretics
  • Mist tent (Croupette)
  • Ribavirin –Anti viral nebulizer for high risk children

RIBAVIRIN
Highly Teratogenic –No Pregnant Caregivers, including Parents!!!

54
Q

Nursing intervention of RSV

A
  • Frequent respiratory assessments – q2h
  • Humidified oxygen
  • Elevate HOB
  • Comfort
    Positioning
  • Strict I & O
  • Maintain Hydration –
    Suctioning –
55
Q

RSV: Prevention

A
  • Handwashing!
  • Palivizumab (Synagis®)
  • Immunization for RSV prevention
  • RSV Globulin
    15 mg/Kg/Dose
  • IM injection monthly during winter months (Oct.- April)
56
Q

Specific criteria for administration of RSV:

A
  • Chronic lung disease
  • Congenital heart defects/disease
  • Immunocompromised
  • Household/environmental factors
  • LATER MAY DEVELOP ASTHMA
57
Q

asthma airways

A
  • airway lining swollen and red
  • muscle tightening
  • mucus
58
Q

symptoms of asthma

A
  • wheezing
  • shortness of breath
  • coughing
  • tightness in chest
59
Q

Therapeutic management of cystic fibrosis

A

Most common debilitating disease of childhood among those of European descent

  • Minimizing pulmonary complications
  • Maximizing lung function
  • Preventing infection
  • Facilitating growth
60
Q

Signs and symptoms of cystic fibrosis

A
  • Salty taste to skin
  • Difficult passage of meconium
  • Abdominal pain or difficulty passing stool
  • Bulky, greasy stools
  • Poor weight gain and growth despite good appetite
  • Chronic or recurrent cough and or upper/lower respiratory infections
61
Q

Laboratory and Diagnostic Tests Ordered for Cystic Fibrosis

A
  • Sweat chloride test: considered suspicious if the level of chloride in collected sweat is above 50 mEq/L and diagnostic if the level is above 60 mEq/L
  • Pulse oximetry: oxygen saturation might be decreased, particularly during a pulmonary exacerbation
  • Chest radiograph: might reveal hyperinflation, bronchial wall thickening, atelectasis, or infiltration
  • Pulmonary function tests: might reveal a decrease in forced vital capacity and forced expiratory volume, with increase in residual volume

ob/peds (4 decks)

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