exam 2 study guide Flashcards
States of consciousness (OBTUNDED)
the child has limited responses to the environment and falls asleep unless stimulation is provided.
States of consciousness (FULL CONSCIOUSNESS)
the child is awake and alert; is oriented to time, place, and person; and exhibits age-appropriate behaviors.
States of consciousness (CONFUSION)
disorientation exists; the child may be alert but responds inappropriately to questions
States of consciousness (STUPOR)
the child only responds to vigorous stimulation
States of consciousness (COMA)
the child cannot be aroused, even with painful stimuli.
ICP vrs Shock
ICP = systolic BP increases, pulse and respiration decreases
Shock: pulse and respiration increases, BP decreases
Assessment of motor function
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
two distinct types of posturing that may occur with motor functioning
- 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 *
deCortiCate (flexor) posturing
ARMS ARE LIKE C’S
- moves towards the Cord
- problems with cervical spinal tract or cerebral hemisphere
dEcErEbratE (Extensor) posturing
arms like E’s
- problems within midbrain or pons
Risk Factors for Epilepsy
- 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
Nursing Management Epilepsy
- Preventing injury
- Appropriate medications and treatments
- Education and support
Hydrocephalus
- 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
Signs and Symptoms of Shunt Infection
- Elevated vital signs
- Poor feeding
- Vomiting
- Decreased responsiveness
- Seizure activity
- Signs of local inflammation along the shunt tract
Craniosynostosis
- 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
Encephalitis
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
Risk Factors for Reye Syndrome
- 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
Signs and Symptoms of Reye Syndrome
Severe and continual vomiting Changes in mental status Lethargy Irritability Confusion Hyperreflexia
Epilepsy
Epilepsy is a condition in which seizures are triggered recurrently from within the brain.
Types of head injuries
- 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
Common Causes of Head Trauma in Children
Falls
Motor vehicle accidents
Pedestrian and bicycle accidents
Child abuse
Causes of Nonaccidental Head Trauma
- Violent shaking: shaken baby syndrome (SBS)
- Blows to the head
- Intentional cranial impacts against the wall, furniture, or the floor
breathing anatomical differences between children and adults:
- 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
Pediatric Respiratory Assessment
Airway
Breathing
Circulation
- LOOK BEFORE YOU TOUCH
Assessment Triangle
Appearance
Breathing
Circulation
Tonsils
usually refer to palatine tonsils located each side of anterior oropharynx
Adenoids
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
enlarged adenoids
- 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
Tonsils & Adenoids PREOPERATIVE
- Check PT/PTT, Bleeding Time
- Check for loose teeth – What makes this so important?
Check signs of respiratory infection - What makes this so important?
Tonsils & Adenoids Postoperative:
- LOC
- VS
- Positioning
- IV →PO
- Voiding
postoperative measures after tonsil and adenoid surgery
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
Laryngotracheobronchitis etiology
- Viral- Most common Parainfluenzae
- Inflammation→ edema and narrowing of airway
Age: 6 mo – 4 yrs esp
Most toddler
sign and symptoms of Laryngotracheobronchitis
- 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
croup sign and symptoms
- steeple sign
- subglottic narrowing
Laryngotracheobronchitis diagnosis
- Virology Culture from Nasal Pharynx –Swab or Suction
- CBC
- Chest xray
Treatment of Laryngotracheobronchitis
- 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
Bring to ER Laryngotracheobronchitis
- ↑Resp distress Will not lie down - ↑ fever - Will not drink - Drooling - Decreased urine output
Prevention: Handwashing
Croup can reoccur
nursing interventions about Laryngotracheobronchitis
- 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
Acute Epiglottis
- 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!!!
Acute Epiglottis sign and symptoms
4 Ds and 2 Ss
- Dysphagia
- Dysphonia
- Distress – What signs?
- Drooling
2 Ss
- Stridor
- Severe sore throat
other sign and symptoms of acute epiglottis
- 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
diagnosis of acute epiglottis
- 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
treatment of acute epiglottis
- 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
Bronchiolitis
- Occurs frequently in toddlers and pre-schoolers
- Severe in infants < 6 months old
- Infectious agent causes inflammations and obstruction
Signs & Symptoms Bronchiolitis
- URI symptoms with fever
- Rapid, shallow respirations
- Nasal flaring
- Cough
- Wheezing
RSV: Most common cause of bronchiolitis
- Causative agent of bronchiolitis and pneumonia
- Plugging of small airways with mucous and debris
Inflammation and obstruction lead to air trapping (hyperinflation)
RSV is severe and fatal in infants with history of
- Congenital heart disease
- BPD
- Prematurity
- Immunosuppression
diagnosis of RSV
- Diagnosed via RSV culture of nasal secretions
- RSV rapid screen
- Viral culture (microbiology) ELISA (ID the virus)
- CBC
- CXR – Assess for Pneumonia
RSV is often associated with exposure to adults with?
- URI
- older (school aged siblings
- sick children at daycare
RSV is very common during what season (months)
winter months, primarily october - march
RSV is rare during what ages
> 2 years
- Peaks at approx. 6 mo
sign and symptoms of RSV
- 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
Acute Respiratory Distress signs and symptoms
- Nasal flaring
- Tachypnea (often severe)!!!
- Intermittent cyanosis
- Retractions
- Prolonged expiratory phase (hypoxemia)
- Tracheal tug
- Grunting
medical interventions of RSV
- 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!!!
Nursing intervention of RSV
- Frequent respiratory assessments – q2h
- Humidified oxygen
- Elevate HOB
- Comfort
Positioning - Strict I & O
- Maintain Hydration –
Suctioning –
RSV: Prevention
- Handwashing!
- Palivizumab (Synagis®)
- Immunization for RSV prevention
- RSV Globulin
15 mg/Kg/Dose - IM injection monthly during winter months (Oct.- April)
Specific criteria for administration of RSV:
- Chronic lung disease
- Congenital heart defects/disease
- Immunocompromised
- Household/environmental factors
- LATER MAY DEVELOP ASTHMA
asthma airways
- airway lining swollen and red
- muscle tightening
- mucus
symptoms of asthma
- wheezing
- shortness of breath
- coughing
- tightness in chest
Therapeutic management of cystic fibrosis
Most common debilitating disease of childhood among those of European descent
- Minimizing pulmonary complications
- Maximizing lung function
- Preventing infection
- Facilitating growth
Signs and symptoms of cystic fibrosis
- 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
Laboratory and Diagnostic Tests Ordered for Cystic Fibrosis
- 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
