Exam 3 Flashcards
genetics of club foot
congenital anomaly
s/s of club foot
muscles, tendons and ligaments are twisted out of shape
3 tx for club foot and how long for each
serial casting changed every 1-2 weeks , surgery NO younger then 3 months, denis brown splint
goal of care for club foot
lengthen and straighten ligaments and tendons
s/s of congenital hip dysplasia
limited abduction from asymmetry of gluteal folds + ortolani barlow, and limp and abnormal gait
what is ortolani barlow
Ortolani: Feeling the head of the femur return to the hip joint in infants
Barlow:
Anterior pressure pushes femoral head out of hip joint
2 tx for hip dysplasia
Pavlik Harness (< 6 mo. Worn 23 hours a day) – it maintains correct position of femoral head in the acetabulum
Closed reduction with spica cast (cast that covers lower half of body except perineal area)
path of legg calve
Avascular necrosis of femoral head due to lack of blood supply
who is most at risk for legg caffe
M 2-12 yr olds
s/s of legg caffee
pain
limp
limited ROM
weakness
muscle wasting
tx for leg caffee
toronto splint
alignment
rehab
patho of scoliosis
Curvature of the spine laterally 10% to > 40%
s/s of scoliosis
no pain unless >40%
uneven hips and shoulders
prominent scapula
resp obstruction
tx for scoliosis
boston splin
halo brace
spinal fusion
priority asessment after surgery for scoliosis
oxygenation (chest tube stats, skin color, LOc)
path of osteomyelitis
bone infection usually caused by staph
s/s of osteomyelitis
pain, fever, edema, low mobility
labs needed for osteomyelitis
lyme, CBC, PPD, needle aspiration
tx for osteomyelitis
IV abx for 3-6 wks
achondroplasia patho
dwarfism, 58 inches or less
marfan syndrome patho
MV prolapses, aortic regurgitation, long arms and legs, lens subluxation
what are marfan syndrome poeple at risk for
cardiac pblms
who should marfan syndrome person see
cardiologist, opthalmologist
what causes osteogenesis imperfecta
defect in production of collagen
scan to test for osteogenesis imperfecta
DEXA
infant bones are ___ ossified
65%
what is early sign of Nv complications
pain increasing even with pain meds
4 s/s of basilar head fracture
raccoon eyes
battle sign
cushings
nasal hemorrhage
where do kids with basilar fracture go
PICU
what is muscular dystrophy
inherited progressive muscle degeneration
when is onset of duchenne Md
3-5 years
what does duchnee Md affect
voluntary muscle groups
life expectancy for ducc MD
15-30 yrs
Trendelenburg sign
Hip rises on side of weight bearing. Done on older children
Telescoping of the hip
Movement of the hip above acetabulum in older children
Name 6 differences in children regarding the Musculoskeletal system:
- Fibrous membranes between cranial bones allow for birth (fontanels)
- Brain growth almost complete at 2 y.o.
- Long bones are more porous, less dense
- Epiphyseal cartilage is slowly replaced by bone by 20 y.o.
- Growing pains are real
- Ligaments and tendons are stronger than bone
5 differences in children neuro
- Top heavy head
- Cranial bones thinner
- Neck muscles not strong
- Unfused sutures until age 12 but after 5 y.o., no expansion of skull possible
- By 2 years, fontanels closed
infant increased ICP s/s 7
- Irritability
- Bulging fontanels
- Poor feeding, sucking
- Nuchal rigidity
- Unequal pupils
- Seizures (late)
child increased ICP s/s
- Headache
- Visual changes
- N/V
- Vertigo
- Irritability
- Ataxia
- Nuchal rigidity
decorticate posiiton means damage where
above brainstem
what 3 things does glasgow scale measure
eye opening, verbal response, motor response
severe coma numbers
3-8
status elipticus
seizure >10 min or on and off for 20
tx for status elipticus
airway, suction, O2, Iv access
dx for seizure
LP to test for meningitis
meds for seizure
SLOWLY PUSH ativan, valium
med to treat chronic seizure
phenytoin
Nursing care of a patient who is epileptic and having a seizure in the hospital includes: Select all that apply.
A. Place a padded tongue blade in their mouth
B. Call a code.
C. Check the vital signs
D. Observe respirations and time the seizure
E. Restrict the patient’s movements as much as possible
F. Give epinephrine immediately
D
cause of viral meningitis
enteroviruses
how to dx viral meningitis
neg bacterial culture on LP and PCR
education for viral meningitis
resolves in 3-10 days
cause of bacterial meningitis
HIB
5 s/s of bacterial meningitis
HA , fever, irritability, stiff neck, n/v
what to do if suspect bacterial meningitis
LP and CSF culture then start abx while waiting results
3 complications of bacterial meningitis
ICP, SIADH, DI
enviornment for bacterial meningitis
isolation, dark, quiet room
patho of reyes syndrome
Encephalopathy and lever damage related to viral infection and use of aspirin
cause of hydrocephalus
ventricles blocked or CSF not being reabsorbed
4 s/s of hydrocephalus
poor feeding
poor muscle tone
irritability
sunset eyes
what position for post shunt
flat
what is a shunt
placed in one of the ventricles and the excess CSF travels through a one-way or controlling valve under the skin (tunneled) to the peritoneum where the CSF is absorbed by the body.
What are complications associated with VP shunts and what can the nurse do about them?
- Blockage or valve failure: Signs of Increasing ICP
- Infections: Careful incision care, hygiene
path of C2 mamlfromation
herniation of brainstem into cervical spaces
patho of myelomeningocele
sacs of spinal column contents present at birth
5 caring for myelo.
Cover with moist cover
Leave diaper off
Measure head circumference
Don’t touch it
Avoid latex
3 education for myelomen
Pts may need catheter for life
Have mobility issues
Have latex allergies
s/s of cerebral pasley 9
spastic muscles, abnormal gait, contractures, jerking, temors, seizure, sensory problems, delayed intellect, poor feeding
CP does not __
progress
6 care for CP child
skincare
check splint fittings
refer to other providers
dietary fiber
meds
maintain function
path of ADHD
CNS with variation in its ability to deal with attention
tx for ADHD first
behavior modifications
what must be ruled out before amphetamine therapy for ADHD
cardiac pblms
ADHD enviornment
less stimulation, reward pos behavior, consistency,
intellectual disability is
IQ<70
what is fragile X
Recessive gene abnormality on X chromosome. Lack a protein that enables brain to grow properly.
A nurse is asked by a pregnant woman during prenatal clinic, how much alcohol use in pregnancy will cause an effect on her baby?
The answer is unknown so all women are cautioned against any use in pregnancy.
path of retinopathy
Blood vessel constriction/damage, then vascular overgrowth on retina happening after birth
s/s of strabismus
lazy eye that gets worse
tx for strabismus
occlusion therapy
7 s.s of TBI
Irritability
Cardiac instability
Respiratory depression
Increased ICP
Drowsy to comatose
Seizure risk
Shock
While developing a plan of care for a 7 y.o. child with ASD, the nurse will provide the following interventions: (Select all that apply.) A, B, C, & F (D & E offer too many choices)
A. Allow the child to keep to exactly the same routine each day.
B. Keep explanations short and to the point.
C. Explore what activities are important to the child.
D. Provide explanations in detail and give written handouts.
E. Ask the child to select from a menu what he wants to eat.
F. Ask parents to bring in familiar objects from home.
ABCF
2 causes of iron def anemia
- Poor nutritional intake of iron rich foods
- Loss of blood volume or cells
what is IDA
Onset after 6 months in infants who have not started having solid foods
Excessive milk ingestion
5 s/s of IDA
Fatigue
Heart murmur
Tachycardia
Pale mucous membranes
Headache
5 cell morphology of IDA
- Small RBC microlytic2
- H and H low
- Ferritin
- TIBC
- Serum Fe
foods high in iron
green veg, red meat, raisins, iron cereal
when should child be screened for IDA
9mo-1 yr
preschool
school age
adolesc.
what is sickle cell anemia
autosomal recessive genetic disorder. Cells contain Hemoglobin S which causes sickling of the cells. Sickled cells are unable to attach to oxygen molecules.
what 2 body areas does SCA damage
spleen and bone marrow
4 triggers of SCA
Hypoxia
Dehydration
Stress
Anything that increases O2 demand
8 s/s of SCA
PAIN
Swollen joints
Fatigue
Tachycardia
Abdominal pain
N/V, anorexia
Fever
Pallor
only cure for SCA
stem cell transplant from family who is identical
hemophillia is
is caused by a lack of a factor in the blood clotting cascade. It is an X linked genetic disorder which results in mostly males with the disease.
hemophilia is most common in
males
7 ed for hemophillia
Shave with an electric razor,
Avoid contact sports
Use paper tape
Pain management
Emotional support
Impaired mobility in some cases
Medication and blood administration
3 ss of hemophillia
Bleeding into joint spaces
Bruising more than indicated
Epistaxis, hematuria
4 immmune diff in child
Carry over immunity from mother after birth
until about 18 months
Thymus gland large at birth and play large part
in production of T cells
Spleen and tonsils large and work more in
children
Low in immunoglobins (IgG) but cellular
immunity stronger
child carries HIV igG over after birth for
6 mo and HIB antibodies for 18 months
What role does the thymus gland, spleen, and tonsils play in the immunity in newborns?
All provide T cells and assist in immune system to protect child from infections
How is HIV transmitted to newborn?
Vertical transmission during birth or during breast feeding after birth
5 ss of HIV in infants
FTT
Diarrhea
Skin disorders
Hepatosplenomegaly
Opportunistic infections
If a mother is treated for HIV during her pregnancy with anti retroviral therapy, the risk of passing the HIV to her child drops from 25% to:
2
7 ed for HIV child
Maintain weight, nutrition
Stimulate normal growth & development
Monitor for signs of infection
Fluid maintenance
Universal precautions
Support groups
Education on transmission, risks.
Anti retroviral therapy involves
several medications designed to limit the progression of the disease.
better prognosis for AIDS if
the child takes longer to develop AIDS
5 cell differences in children
More embryonic cell types vs epithelial cells
Cell growth is more rapid in children
Cancer growth, therefore, is more rapid
Fetal cells more vulnerable and present at birth
Fewer phagocytes present in children < 1 month of
age.
proto oncogene
regulates cell division
tumro supressor gene
Counteracts oncogenes to
control cell proliferation.
oncogene
allows for uncontrolled proliferation
Childhood cancers are more aggressive than adult cancers. Why is this? 3
Embryonic cells involved vs epithelial cells
Higher rate of cell growth and metabolism in children
Less phagocytes in children < 1 month old
How does chemotherapy work?
Kills off cells, both healthy and cancerous
what to not give child in mouth after chemo
lidocaine
When planning a bone marrow transplant, the patient will
receive intense chemo followed by radiation to kill off all blood an d bone marrow cells.
After injection of donor bone marrow
, it takes 2-3 weeks for cells to grow.
brain tumor
solid mass, originate in CNS
neuroblastomas
originate in SNS
s/s of wilms tumor
palpable mass, HTN, hematuria
problem is nurse sees what with wilms tumor
palpation
what is leukemia
Immature stem cells create immature lymphocytes that crowd out RBC, WBCs, and platelets in the bone marrow and blood
2 types of leukemia
Acute lymphoblastic leukemia (ALL)
Acute myloid leukemia (AML)
CNS complications have been decreased due to the administration of what antimetabolite?
methotrexate
Symptoms of ALL leukemia include: 6
Pallor, fever, bleeding, joint pain due to loss of RBCs, splenic involvement, loss of platelets, bleeding into joint spaces.
tx for leukemia
chemo radiation and BM transplant
how do infants and toddlers percieve death
Do not understand concept but know they feel bad and other are upset
how do school age child percieve death
Understand death but may not be a realistic understanding. Older school aged children may understand the permanence of death
how do adolescents percieve death
Understand and may go through grieving process. Body image and need for socialization are strong needs at this age. Social isolation may occur as friends may not know how to respond.
milestones for
1
2
4
6
9
12
18
2 yrs
1 - hold hand in fist
2-holds rattle, can turn from side to back, holds head up
4-grasp objects, manipulate objects, stand when being held
6- sit alone without support
9-pincer grasp, crawls
12-place object in hole, standing, walking
18-runs, stairs, pushes and pulls
2 yr - jumps kicks throws ball, draws, scribbles
dev tasks for
preschool
school age
adolesc
initiative v guilt
The young child
initiates new activities and considers new ideas. This interest in
exploring the world creates a child who is involved and busy.
industry v inferiority
new
interests and by involvement in activities. The child takes pride
in accomplishments in sports, school, home, and community. If
the child cannot accomplish what is expected, however, the result
will be a sense of inferiority.
Identity Versus Role Confusion (12 to 18 Years). In adolescence,
as the body matures and thought processes become more
complex, a new sense of identity, or self, is established. The self,
family, peer group, and community are all examined and redefined.
The adolescent who is unable to establish a meaningful definition
of self will experience confusion in one or more roles of life.
common symptom of sickle cell anemia
splenomegaly
what does DDAVP do
hemophillia
ewing sarcoma
type of bone cancer that happens during time of growth
