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Children's Health > EXAM #3 > Flashcards

EXAM #3 Flashcards

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1
Q

When should solid foods be initiated?

A

4 months

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2
Q

Dehydration clinical manifestations:

A

-Tachycardia
-Hypotension
-Decreased tears
-Weight loss
-Thirst
-Irritability
-Sunken eyes & fontanels

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3
Q

Management of dehydration:

A

-Fluid replacement
-Electrolyte monitoring & replacement
-Safety considerations

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4
Q

What electrolytes should we monitor in dehydration?

A

Na and K

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5
Q

Which electrolytes are major extracellular?

A

-Na
-Cl
-HCO3 bicarbonates

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6
Q

Which electrolytes are major intracellular?

A

-K
-PO42 phosphate
-Mg

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7
Q

What is the intake to maintain fluids?

A

-0-10kg 100ml/kg of body weight
-11-20kg 1000ml/kg
->20kg 1500ml + 20ml/kg

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8
Q

What should hourly output for an infant be?

A

2-3ml

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9
Q

What should hourly output for a toddler/preschoolers?

A

2ml

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10
Q

What should hourly output for a school-aged child?

A

1-2ml

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11
Q

What should hourly output for an adolescent?

A

0.5-1ml

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12
Q

Risk factors for cleft lip/palate

A

-Males and native americans

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13
Q

Clinical manifestations of cleft lip/palate

A

-Unilateral or bilateral cleft lip
-With or without hard soft palate
-Uvula
-Poor feeding/suck

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14
Q

Nursing/other Management of cleft lip or palate:

A

-CL & no palate abnormality: Longer nipple but can take breast (after surgical repair) or bottle
-CP: shorter nipple
-Promote bonding
-Speech therapy
-Dentistry
-Audiology
-Dietician

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15
Q

Surgical management for CP/CL:

A

Multiple surgeries
-CL at 3 months
-CP before 18 months
-Site care
-Elbow splints
-Pain control

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16
Q

Anorectal types:

A

Rectal atresia: closure of the rectal passage
Rectal stenosis: constriction/narrowing of the rectal passage
Imperforate anus: Absence of a rectal opening. Can have fistulas

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17
Q

Rectal stenosis clinical manifestations:

A

Vomiting, abdominal distention, difficulty passing stool, ribbon-like or narrow stool.

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18
Q

How to dx anorectal malformations:

A

physcial exam, X-ray, US, MRI, IV pyelogram, rectal biopsy

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19
Q

Nursing care for anorectal malformation (surgical):

A

-NPO & IV fluids before surgery.
-Pain control

Post op:
-I & Os
-fluids
-v/s
-pain control

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20
Q

Surgical care for anorectal malformations:

A

Manual dilation
&
Two stage repair:
-step 1: Resection and creation of temporary ostomy
-step 2: closing ostomy and connecting the blind pouch to the anus

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21
Q

Education/discharge info for anorectal malformations:

A

Colostomy care, wound care and anal dilation
-Fiber, fluids, bulking agents

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22
Q

Pyloric stenosis clinical manifestations:

A

-Insatiable appetite
-Projectile vomiting
-Weight loss
-Dehydration
-Olive-shaped mass
-Constipation

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23
Q

How to diagnose pyloric stenosis:

A

-US
-Palpatation
-X-ray
-Upper GI series

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24
Q

Nursing care for pyloric stenosis (include pre & post-op):

A

-Monitor skin turgor, mucous membranes, depressed fontanels, absence of tears, UO, weight loss and vs
-Before surgery: NPO, NG tube, give fluids and elctrolytes.
-After: Pain control, vs, infection, feedings 6 hours after surgery, fluids if theres vomiting, measure diapers, monitor for dehydration

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25
Q

Surgical management for pyloric stenosis:

A

Pyloromyotomy

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26
Q

Post-op feeding protocol for Pyloromyotomy

A

Give food 6 hours after
-increase fluid volume for every 2 successful feeds
-if the baby vomits, baby will stay at that level for 2 consecutive feeds until they are tolerated

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27
Q

Education for pyloric stenosis:

A

-Incision care
-Infection
-report vomiting 48 hours after surgery

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28
Q

Clinical manifestations for intussusception:

A

-Acute abdominal pain waxes and wanes (paroxysmal)
-Pain goes away once the abdomen relaxes
-Pulls legs towards abdomen
-Vomiting ( may or may not be projectile)
-Fever
-Dehydration
-Abdominal distention
-Lethargy
-Currant jelly stool
-Sausage-shaped mass
-Grunting

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29
Q

Diagnosis of intussusception:

A

-Hx
-Sausage-shaped mass
-Barium enema
-US

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30
Q

Nursing care: complications for pre & post-op intussusception:

A

NPO, NG tube, IV fluids

-Monitor for perforation (rigid, N/V, tachycardia, fever, confusion, and decreased urinary output), peritonitis, shock & pain
-Record stools passed

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31
Q

Medical care: How can barium/air enema help with intussusception and what should the nurse educate on?

A

Helps dx and can cure it.
Will stay at the hospital for 24 hours as it can occur again and will require surgery

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32
Q

Surgical care for intussusception:

A

Repair or removal of bowels.

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33
Q

Education/discharge instructions for intussusception:

A

Care for incision, signs of infection, educate on feedings, dehydration and pain management.

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34
Q

Clinical manifestations for appendicitis:

A

-Starts with periumbilical pain
-Right lower quadrant pain
-Vomiting
-Anorexia
-Stool changes (low in volume & mucus-like)
-High fever with perforation but will otherwise be afribrile or have a low grade fever

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35
Q

How to Dx appendicitis:

A

-Elevated WBCs
-Abdominal radiograph
-CT

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36
Q

Post-op nursing care for appendicitis:

A

-I & O
-Wound care
-Pain control
-NPO for 24 hours
-May or may not have drains
-Perforated: IV antibiotics

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37
Q

Education/discharge instruction for appendicitis:

A

Wound care, infection, pain management, progessively resume normal activity and nutritional intake as tolerated

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38
Q

Acute diarrhea etiology:

A

-Diet or food allergies
-Toxic substances
-Infections
-Medications (antibiotics)

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39
Q

How to dx acute diarrhea:

A

-Hx of recent family illness, ingestion of chemicals, diet & last normal BM
-Physical exam: abdomen & perineum (rash)
-Blood work
-C&S

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40
Q

Preventing acute & chronic diarrhea:

A

Hand hygiene & food handling

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41
Q

Nursing care for acute & chronic diarrhea:

A

-Monitor fluid intake and output & electrolytes
-Observe for dehydration
-Skin integrity of perineum
-Daily weights & diapers
-BRAT diet
-No dairy only yogurt

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42
Q

What medication do we give for bacterial acute diarrhea

A

Metronidazole (flagyl)

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43
Q

Education & discharge instructions for acute & chronic diarrhea:

A

-Prevention (hygiene)

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44
Q

Chronic diarrhea definition:

A

3 + stools passed per day for 14 days +

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45
Q

Chronic diarrhea clinical manifestations:

A

-Abdominal distention
-Hyperactive bowel sounds
-Weight loss
-Dehydration
-Perineal irritation
-Blood in stool

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46
Q

How to diagnose chronic diarrhea:

A

-Stool for C&S
-Occult blood test

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47
Q

GERD pathophysiology:

A

-Transfer of gastric contents into the esophagus

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48
Q

Clinical manifestations of GERD:

A

-Irritability and fussiness
-Dysphagia or refusal to feed
-Choking
-Chronic cough
-Wheezing
-Apnea
-Weight loss
-Respiratory infections
-Bloody vomit
-Sore throat
-Halitosis
-Chronic sinusitis

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49
Q

Diagnosis of GERD:

A

-H&P
-GI series
-pH monitoring
-Barrium swallow
-Endoscopy

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50
Q

Prevention of GERD:

A

-Proper formula preparation, feeding and position

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51
Q

Nursing care for GERD:

A

-Manage reflux through positioning & frequent burping

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52
Q

What medication do we give for GERD?

A

proton-pump inhibitor

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53
Q

Surgical intervention for GERD:

A

-Nissen fundoplication
-Feedings jejunostomy

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54
Q

Education/ discharge instructions for GERD:

A

-Diet modifications
-Positioning
-Medication as prescribed
-Burping
-Avoid: chocolate, caffeine, citrus, tomatoes)
-Avoid playing after eating
-Thickened feedings with an enlarged nipple hole

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55
Q

What is Hirschsprung’s Disease?

A

-Absence of ganglion cells (tells us to release stool) in the colon.
-Mechanical obstruction from inadequate motility of intestine

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56
Q

Clinical manifestations of Hirschsprung’s Disease?

A

-Failure to pass meconium w/in 1st 48hr of life
-FTT
-Poor feeding
-Chronic constipation
-Vomiting
-Abdominal obstruction
-Diarrhea, explosive
-Ribbon-like stools in older children

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57
Q

What is a complication of Hirschsprung’s Disease?

A

Enterocolitis
-Abrupt foul-smelling diarrhea, abdominal distention, and fever.

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58
Q

How to dx Hirschsprung’s Disease:

A

-Intestinal biopsy
-Radiographic studies
-Barium enema

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59
Q

Pre-op nursing care for Hirschsprung’s Disease:

A

-NPO
-NG tube
-IV fluid and electrolytes
-I&O

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60
Q

Surgical management of Hirschsprung’s Disease:

A

Resection & temporary colostomy

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61
Q

Post-op nursing care for Hirschsprung’s Disease:

A

-Assess bowel sounds and distention
-NPO
-Pain management
-Wound care
-fluids
-Patency of NG tube

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62
Q

Education/discharge instructions for Hirschsprung’s Disease:

A

-Colostomy care until surgical repair heals
-Community resources

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63
Q

Failure to thrive patho

A

Failure of the infant to meet age-appropriate weight gain

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64
Q

How to dx FTT:

A

-Trackin growth rate demonstrates lack of adequate progress
-Lack of cognitive and emotional development
-Physical exam
-Chemistry panel
-CBC
-Iron

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65
Q

Clinical manifestations of FTT:

A

-D/V/constipation
-Recurring infection
-Abdominal distention
-Loss of SQ fat
-General wasting
-dehydration
-Evidence of abuse of neglect
-scaling skin
-edema
-alopecia
-spoon-shaped nails
-labial fissures
-inability to be comforted-lack of preference

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66
Q

Celiac disease patho:

A

Proximal small bowel mucosa is damaged as a result of dietary exposure to gluten, leading to permanent intolerance to gluten.

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67
Q

Clinical manifestations of celiac disease:

A

-D/V/constipation
-Abdominal distention and bloating
-Steatorrhea
-Abdominal pain
-Anorexia

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68
Q

How to dx celiac disease:

A

Clinical symptoms, serial markers, small bowel biopsy (atophy of the villi & deep crypts)

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69
Q

What should a patient with celiac avoid in their diet?

A

Wheat, rye, barley, and oat

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70
Q

What can a patient with celiac have in their diet?

A

Corn, rice, and millet

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71
Q

Education/discharge instructions for celiac disease:

A

-Avoid processed foods with thickening agents, cookies, ice creams, soups, and lunch meats
-Recommend normal amounts of fats
-Supplement calories, vitamins and minerals in acute phase

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72
Q

UTI clinical manifestations:

A

-Poor feeder
-V/D
-fever
-malodorous urine
-dribbling urine
-abdominal pain
-malaise
-enuresis
-dysuria
-flank pain

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73
Q

How to dx a UTI:

A

-Urine C&S
-US
-VCUG

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74
Q

How to prevent UTIs

A

-Handwashing
-Wiping front to back
-Cotton underwear
-Loose fitting clothes
-Avoid bubble baths
-Avoid sittin in wet clothes for extended periods of time
-Prevent constipation

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75
Q

Nursing care for UTIs

A

-Assess perineal area (irritation, pinworms, sexual abuse or trauma, edema, discharge, vaginitis & urine stream)

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76
Q

What medication is given for UTIs?

A

Antibiotics depending on the culture

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77
Q

Education/discharge instructions for UTIs:

A

-Handwashing
-Constipation and soiled diapers
-Perineal care

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78
Q

Vesicouretera reflux patho:

A

Urine backflows from the bladder to the utreters and possibly the kidneys
-Primary: Valvular defect causing backflow. May resolve on its own
-Secondary: Obstruction from abnormal tissue fold within the urethra may cause backflow causing hydronephrosis (distention of the kidney)

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79
Q

Clinical manifestations of Vesicouretera reflux:

A

-UTI symptoms
-Flank or abdominal pain
-Enuresis
-Fever
-N/V
-Enlarged kidneys

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80
Q

How dx Vesicouretera reflux:

A

VCUG radiograph & IVP

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81
Q

How to prevent Vesicouretera reflux:

A

Preventing and treating UTIs & pyelonephritis

82
Q

medical mangement for Vesicouretera reflux:

A

-Urine culture every 2/3 months
-Depends on the grade but child will need to see nephrologist and urologist

83
Q

Medications for Vesicouretera reflux:

A

Prophylatic daily low dose antibiotics until the child is infection-free

84
Q

Surgical care for Vesicouretera reflux:

A

Deflux: sugar gel that goes in the ureter to stop urine from refluxing
-Nurse should monitor I&Os and pain

85
Q

Education/discharge instructions for Vesicouretera reflux:

A

-S/S of UTIs
-medication adherence

86
Q

What is an early sign of kidney problems?

A

Hypertension

87
Q

Acute Glomerulonephritis patho:

A

-Imflammation of the glomeruli interferes with filtering waste products from the blood
-Glomeruli become edematous and infiltrated
with leukocytes, occlude capillaries
-Decrease in urine filtration-water accumulates and retention of sodium leading to circulatory congestion, hypertension and edema, primarily periorbital and peripheal

88
Q

What pathogen causes Acute Glomerulonephritis?

A

Streptococcal infection

89
Q

Signs and symptoms of Acute Glomerulonephritis:

A
  • Gross hematuria (tea or red-colored urine)
  • Periorbital edema
  • Hypertension
  • Headache
  • Possible ascites
90
Q

How to Diagnose Acute Glomerulonephritis:

A
  • ASO titer
    -Monitor Creatinine and BUN
91
Q

Prevention of Acute Glomerulonephritis:

A

Handwashing and preventing and managing infection.

92
Q

Nursing care for Acute Glomerulonephritis:

A

-Monitor for HTN
-Monitor urine output & gross hematuria
-All 3 of these s/s, the patient will have to be hospitalized due to risk of acute renal failure
* Strict I&O
* Daily weights
* Dietary restrictions
* BP monitoring every 4 hours

93
Q

Medications for Acute Glomerulonephritis:

A
  • Antibiotics
  • Diuretics
    -Corticosteroids and plasma in severe cases
94
Q

Hemolytic Uremic Syndrome patho:

A

Associated with ingesting beef with E. Coli or other bacteria

95
Q

Hemolytic Uremic Syndrome clinical manifestations:

A
  • Gastroenteritis (abdominal pain, vomiting, bloody diarrhea)
  • Upper respiratory infection
  • Hematuria
  • Proteinuria
  • Pallor
  • Lethargy/Irritability
  • Decreasing urine output
  • Hepatosplenomegaly
  • Dehydration
  • Seizures
  • Consciousness alteration
96
Q

Prevention of Hemolytic Uremic Syndrome:

A
  • Ensure ground beef is fully cooked
  • Clean fruits and veggies
  • Pasteurized products
97
Q

Diagnosis Hemolytic Uremic Syndrome:

A
  • Elevated BUN and creatinine
  • Elevated Potassium levels
  • Serum glucose levels
  • Calcium decreases
  • phosphorus increases
  • Platelet count (reticulocyte count rises)
98
Q

Nursing care for Hemolytic Uremic Syndrome:

A
  • Monitor LOC & signs of increased ICP
  • Monitor for signs of CHF (lung sounds)
  • bleeding
  • HTN
  • Tachycardia
  • Strict I&O (4hr or 1hr)
  • Daily weights & edema
  • Electrolytes (Na, K, Cl & bicarb)
  • ABG’s
  • ECG/EKG, cardiac monitor
99
Q

Patient education for Hemolytic Uremic Syndrome:

A
  • Avoid unpasturized foods
    -Avoid pools when the child has diarrhea
    -Wash hands
    -Proper food handling
    -Cook beef to 106 degrees
100
Q

Acute Kidney Injury Pathophysiology

A
  • Treatable condition
  • Life threatening
  • Sudden decreased capacity of the kidneys
    to eliminate waste products, resulting in an
    inability to maintain fluid and electrolyte or
    acid-base balance
101
Q

Causes of acute kidney injury

A
  • Pre-renal: dehydration, hemorrhage, sepsis
  • Intrarenal (intrinsic): Glomulonephritis
  • Post-renal (obstruction): tumors & congenital malformations
102
Q

How to diagnose AKI

A
  • Determine cause, history, physical examination
  • Nursing physical assessment
  • Lab work evaluation: uranalysis, blood chemistry, BUN, Creatinine, pH
  • Renal biopsy
103
Q

Therapeutic Management of AKI

A
  • Analyze category
  • Monitor labs and hemodilution
  • Increase renal perfusion, prevent fluid, electrolyte and acid base imbalances
  • Renal replacement therapy
  • Monitor weight, BMI
  • Monitor intake, collaborate with dietitian
104
Q

Education/Discharge AKI

A
  • Nephrologist referral
  • Renal replacement therapy
  • Holistic care: family support and education, nutrition, I&O, VS, dietician counseling
105
Q

Medications for AKI

A

*steroids
*diuretics
*antibiotics
Monitor peak and trough times

106
Q

Chronic Kidney Disease patho:

A

Greater than 2 years of age, glomerular
filtration rate may progressively deteriorate in 4 stages

107
Q

What are patients at risk for with CKD?

A

At risk for End-Stage Renal Disease (ESRD)

108
Q

What are complications of CKD?

A
  • Hypertension
  • Anemia
  • Metabolic Bone Disease
  • Growth Failure
109
Q

How to prevent CKD:

A
  • Nutrition/good prenatal care
  • Monitor growth
  • Early assessment
110
Q

Clinical manifestations of CKD:

A
  • Failure to thrive or anorexia
  • Nausea/vomiting/loss of appetite
  • Lethargy
  • Headaches
  • High blood pressure
  • Reduced urine output
  • Polyuria and polydipsia
  • Bed wetting
111
Q

How to diagnose CKD:

A
  • Urinalysis
  • Review of systems
  • Fluid, electrolyte, and acid-base abnormalities
  • Radiographs, bone films, renal ultrasounds, electrocardiogram
112
Q

Nursing management for CKD:

A

Consults to dietitian & pastoral care

113
Q

What 2 diseases are treated with renal replacement therapy?

A

ESRD and AKI/CKD-stage 4

114
Q

What is the criteria to get renal replacement therapy?

A

Volume overload, hyperkalemia, metabolic acidosis, BUN, neurological symptoms, calcium and phosphorus imbalance, dialyzable toxin or poison, uremic induced mental changes, neuropath, pericarditis

115
Q

What is peritoneal dialysis?

A

Uses peritoneal membrane to filter blood.
-Dialysis solution is inserted into the abdomen throught catheter.
-Osmotic process
-Drains

116
Q

What are complications of peritoneal dialysis?

A
  • Peritonitis
  • Catheter dysfunction and obstruction
  • Pain
  • Pulmonary complications
  • Fluid and electrolyte imbalance
117
Q

Prevention of complications from peritoneal dialysis

A
  • Determine if safe to start the PD
  • I and O
  • lab work
  • VS
118
Q

Nursing care for peritoneal dialysis:

A

-Monitor catheter for signs of infection & returning dialysate
-Monitor pain
-Weigh the patient before and after
-Sterile procedure

119
Q

What is hemodialysis?

A
  • Prevent accumulation of fluid and toxins; extracorporeal circulation through a dialyzer
  • Vascular Access
  • Time frame is 3x/week
120
Q

Criteria for hemodialysis

A
  • GFR
  • Intractable complications of AKI
121
Q

Complications of hemodialysis

A
  • Hypotension, hypovolemia, anemia, infection, muscle cramps, bleeding, fluid shifts
122
Q

How to prevent complications of hemodialysis

A

Monitor potassium, foods

123
Q

Therapeutic Management of hemodialysis:

A
  • Access clean and safe
  • Fluid and dietary restrictions
124
Q

What is hypospadias?

A

Urethral opening located behind glans penis or anywhere along ventral surface of penile shaft.

125
Q

Signs and symptoms of hypospadias:

A

-Opening of the urethra below the tip of on the bottom side of the penis
-Incomplete foreskin
-Curvature of the penis during an erection
-Abnormal position of the scrotum in relation to the penis

126
Q

What is Epispadias?

A

Urethral opening is located on dorsal surface of the penis

127
Q

Signs and symptoms of epispadias:

A

-Opening of the urethra above the tip of the penis
-Curvature of the penis
-Urinary incontinence

128
Q

Surgical management for Hypospadias/ Epispadias

A

-Surgery at 6-12 months before toilet training
-No circumcision
-Pain management

129
Q

Education/discharge information for Hypospadias
/ Epispadias:

A

-Monitor for UTI (cloudy, foul smelling urine with blood)

130
Q

Enuresis Pathophysiology:

A
  • Involuntary discharge of urine
131
Q

Clinical Manifestations of enuresis:

A
  • Urgency, jiggling of legs
  • Foul smelling urine odor
  • Psychological stress
132
Q

Therapeutic Management for enuresis:

A
  • DDAVP: causes the kidneys to conserve body water and concentrate the urine, decreasing urine output during sleep
  • Voidance of fluids
  • Bed, bladder alarms
133
Q

Pathophysiology/
Etiology of ICP

A

ICP is the pressure of the CSF in the subarachnoid space between the skulls and the brain.

134
Q

Clinical manifestations of ICP in infants:

A
  • Irritability, poor feeding
  • High-pitched cry
  • Fontanels: tense, bulging
  • Cranial sutures: separated
  • Eyes: setting-sun sign
  • Scalp veins: distended
135
Q

Clinical manifestations of ICP in children:

A
  • Headache
  • Vomiting: with or without nausea
  • Seizures
  • Diplopia, blurred vision
  • Irritability, restlessness
  • Drowsiness
  • Memory Loss
  • Papilledema
136
Q

Nursing care for ICP:

A
  • Monitor V/S, LOC, reflexes, & pupil reaction (Q15 min to 2hrs)
    *Respiratory staus & trach care in needed
  • Pediatric Glasgow Coma Scale
  • Position HOB 15-30 degrees, head/neck midline
  • Check for intact gag & swallow reflexes
  • Caution with suctioning/overstimulation
  • Avoid hypotonic IV solutions
  • Monitor for fever and use hypothermic blanket if indicated
    *Seizure precautions
137
Q

What is a normal score for the pediatric Glascow Coma scale?

A

9-15

138
Q

What meds are used to treat ICP?

A

-Sedatives (barbs, fentanyl, Ativan)
-Paralytics
-Antipyretics
-Anticonvulsants if at risk for seizure
-Pain meds (morphine)

139
Q

Seizure patho:

A
  • Electrical disturbance in brain
  • Generalized or partial (focal)
140
Q

Etiology of seizures:

A
  • Genetics; traumatic brain injury, CNS infection, toxic ingestion, endocrine dysfunction, AV malformation, or an anoxic episode
  • Febrile is the most common 1st time seizure in children
141
Q

How to dx seizures:

A

-Neuro exam and testing
-CT/MRI, EEG, PET
scans
* New onset –> malignant
neoplasm possible

142
Q

Clinical manifestations of seizures

A
  • Loss of consciousness/loss of
    awareness
  • Motor signs
  • Stiffing of body
143
Q

Nursing care for seizures:

A
  • History of antecedent events & characteristics of seizure
  • Review of prenatal care and review of systems
  • Seizure precautions
  • Keto diet
144
Q

Seizure precautions:

A

-Maintain airway, give oxygen
-Suction available
-Monitor O2
-Give meds IV (ativan, diazepam)
-Raise padded ride rails & turn lateal side
-Medical alert bracelet

145
Q

What should be monitored with anti-epileptic drug therapy?

A

-Liver function
-Renal function
-Hematological function
-Anticonvulsant serum level q 3-6mths

146
Q

Surgical intervention for seizures:

A

Excision of located seizure focus

147
Q

Education/Discharge instructions for seizures:

A
  • CPR & emergency procedures
  • Medication education
  • Day care/school fully informed
  • Adolescents may drive (dependent on state law)
148
Q

Patho of meningitis:

A

Inflammation of CSF & meninges due to infection

149
Q

Etiology of meningitis:

A
  • Septic/Bacterial
  • Aseptic/Viral
150
Q

Clinical manifestations of meningitis (general)

A
  • Fever
  • HA
  • Stiff neck
  • Lethargy
  • N/V
  • Decreased LOC
  • photophobia
  • irritability
  • anorexia
  • emesis
  • seizures
151
Q

Clinical manifestations of meningitis (infant to 18mths):

A
  • Tense, bulging fontanelle
  • increasing head circumference
  • high- pitched cry
152
Q

How to Dx meningitis: What does an infected csf look like?

A

Lumbar puncture: chemistry, cell counts, culture & gram stain.
* Infected CSF (bacterial) = cloudy, increased protein, decreased glucose, & increased CSF pressure
* Blood cultures

153
Q

How is meningitits prevented?

A

Inmmunizations (children under 2 who are immunocompromized & under 21 who are not vaccinated)

154
Q

Nursing care for meningitis:

A

-Assess neruo status q 2-4 hours
-monitor for s/s of increased ICP (go to MRI or CT)
-Keep room quiet & dark
-Seizure precautions
-NPO

155
Q

Meds for meningitis:

A

-Antipyretics
-Anticonvulsants
-NSAIDS
-Bacterial: IV antibiotics
-Viral: self-limiting

156
Q

Patho & etiology of encephalitis:

A

Inflammation of brain tissue most commonly caused by mosquito- borne viruses & herpes simplex type 1

157
Q

Clinical Manifestations of Encephalitis:

A
  • Confusion
  • HA
  • Nuchal rigidity
  • High fever
  • Photophobia
  • Lethargy
  • Seizures
  • Coma
158
Q

How to diagnose encephalitis:

A
  • Hx: Exposure to possible sources: mosquitos, outdoors, unvaxed pets, meds, illnesses
  • MRI/CT, CSF analysis, EEG, & lab work
  • Definitive diagnosis: brain biopsy
159
Q

Prevention of encephalitis

A
  • Protection from vectors, bug spray
160
Q

Nursing management for encephalitis:

A

-Seizure precautions
-Neuro assessments

161
Q

Meds for encephalitis:

A
  • Viral origin –> antiviral med (acyclovir)
  • Bacterial origin –> narrow spectrum antibiotic
  • Antipyretics, anticonvulsants, analgesics, & anti inflammatory
    agents
162
Q

Patho & etiology of Reyes syndrome:

A
  • Results in an increase in ICP & accumulation of fat to internal organs
  • Administration of acetylsalicylic acid (aspirin) during viral illnesses
  • Primarily affects ages 4-14yo
163
Q

Clinical manifestations of Reye’s syndrome:

A

-Restlessness
-Vomiting
-Drowsiness
-Seizures
-Loss of consciousness

164
Q

Diagnosis for Reye’s syndrome:

A
  • History of recent viral illness & use of acetylsalicylic acid (ASA)
  • Liver biopsy
  • Serum tests: liver enzymes, blood glucose, ammonia level & coagulation studies
165
Q

Nursing interventions for Reye’s syndrome

A
  • Neuro assessment
  • Seizure precautions
  • Assess airway
  • Administer & monitor oxygen
166
Q

Parent education for Reye’s syndrome

A

read all labels of over-the-counter medications/products; no ASA under 19 years old

167
Q

Patho of Spinal Bifida:

A

Neural tube fails to close early in fetal development

168
Q

Clinical Manifestations of Spina Bifida:

A
  • Symptoms vary based on lesion location
  • Dimple or tuft of hair on back “tethered cord”
  • Meningocele: protruding sac with meninges & CSF
  • Myelomeningocele: meninges, CSF, & spinal cord elements
  • Neuro deficits
  • Impaired bowel & bladder function
169
Q

Diagnosis of Spina Bifida: Prenatal age & what is elevated?

A
  • Prenatal diagnosis 12 –14 weeks gestation via US
  • Elevated alpha-fetoprotein level
170
Q

Nursing management of spina bifida:

A

-Measure and type of defect & birth
-Infection
-Cover with sterile gauzed moistened by sterile saline
-Lay baby in prone position
-No diaper (monitor for perineal & skin breakdown)
-Assess orthopedic function
-Bladder & bowel function
-Monitor for hydrocephalus
-Latex free
-Monitor pain

171
Q

A baby with spina bifida must be delivered via…

A

C-section

172
Q

What surgery will a patient with spina bifida have?

A

Laminectomy

173
Q

Patho & etiology of hydroceohalus:

A
  • Accumulation of cerebrospinal fluid in
    intracranial vault & spinal cord
  • Congenital anomalies & After surgical closure of myelomeningocele
174
Q

Clinical Manifestations of hydrocephalus:

A
  • Age, cause, & rate of hydrocephalus development
  • Head enlargement
  • Prominent forehead
  • Difficulty holding the head upright
  • Increased ICP s/s
175
Q

How to dx hydrocephalus:

A
  • Imaging: CT, MRI ,& US.
  • Increasing head circumference
176
Q

Nursing management for hydrocephalus:

A
  • Head circumference assessment
  • Monitor S/S increased ICP
  • Shunt pre-operatively: Administer antibiotics
177
Q

Post-operative Shunt neuro assessment: Hydrocephalus

A
  • Assess for increased ICP
  • Vital Signs
  • Monitor Mead circumference
  • Assess fontanelles
  • Monitor for seizures, lethargy
  • Position on non-operative side & elevate head no higher
    than 30 degrees MD orders
  • Monitor S/S infection
178
Q

Education/Discharge instructions for hydrocephalus:

A
  • Teach recognition of infection & of shunt malfunction
  • No contact sports
179
Q

What does a Ventriculoperitoneal Shunt do?

A

Relieves pressure on the brain by removing CSF from head and draining into abdomen

180
Q

Clinical Manifestations of Shunt Malfunction:

A
  • Headaches
  • Vomiting
  • Lethargy
  • Irritability
  • Swelling or redness along the shunt tract
  • Decreased school performance
  • Periods of confusion
  • Seizures
181
Q

Treatment for shunt malfunction:

A
  • Antibiotics
  • Shunt removal
182
Q

Patho of cerebral palsy:

A

Most common physical disability due to brain injury before development is complete.
-Mild to severe physical & mental dysfunction

183
Q

Prenatal, Perinatal, & Postnatal risk factors of cerebral palsy:

A
  • Prenatal risk factors: asphyxia, infections, hemorrhage, trauma.
  • Perinatal risk factors: low birth weight, preterm, hemorrhage.
  • Postnatal risk factors: encephalitis, meningitis, falls, abuse, crashes
184
Q

Ataxic cerebral palsy is characterized by:

A

Difficulties with balance & depth perception. Fine motor control and walking is poor

185
Q

Athetoid CP is characterized by:

A

Uncontrolled movements of the limbs.
Drooling, speech, & grimacing in severe cases

186
Q

Spastic CP is characterized by:

A

Increased muscle tone (contracture risks), poor posture, coordinated movement & balance

187
Q

Mixed CP is characterized by:

A

two or more types

188
Q

Clinical Manifestations of cerebral palsy

A
  • Vary, depending upon area of brain involved & extent of damage
  • Muscle rigidity, muscle spasticity, poor control of posture, ataxia
  • Speech difficulties
  • Swallowing problems
  • Breathing difficulties
  • Bowel/bladder incontinence
  • Vision & sensory impairments
  • Learning disabilities, attention & behavior problems
189
Q

How to dx cerebral palsy:

A
  • Based on clinical symptoms & developmental delay
  • Imaging: CT, MRI, Cerebral US
190
Q

Nursing management for cerebral palsy:

A
  • Splints & braces
  • Assistive devices
  • Frequent rest periods to reduce muscle spasm.
  • Enroll in school
  • Education for parents on maintaining a safe environment
  • Feeding supervision & support actions based on individual needs
191
Q

Medications used to manage Cerebral palsy:

A
  • Lioresal delivered intrathecally via implanted pump. Continuous & controlled relief
  • Neurolytic agent nerve block injections
  • Antianxiety medications
  • Antiseizure medications
192
Q

Education/Discharge instructions for Cerebral palsy

A
  • Expected growth & development
  • Early detection of deterioration
  • Symptoms of infection
193
Q

Clinical manifestations of TBIs

A
  • Scalp laceration
  • Altered LOC
  • Seizures
194
Q

How to Dx TBIs:

A
  • Imaging: CT, MRI
  • EEG
  • ICP
  • CPP
195
Q

Therapeutic Management for TBI

A
  • Airway PRIORITY
  • Assessment w/ Glasgow Coma Scale
  • Palpate for fracture; associated symptoms
  • No NG tubes/suction
  • Quiet, non-stimulating environment
  • Relief of high ICP
  • Seizure meds
196
Q

Abusive Brain Trauma Pathophysiology:

A
  • “Shaken baby syndrome” (non-accidental)
  • Prognosis depends on
    severity of injury & response
    to therapy
  • Neuromotor &/or visual
    impairment & developmental delays
  • High incidence of death
197
Q

Clinical manifestation of abusive brain trauma: Severe and less severe

A
  • Severe: Seizures, apnea, buldging fontanelles, coma, hemorrhage, bradycardia.

*Less severe: Vomiting, FTT, Hypothermia, Increased sleeping, lethargy, irritability, difficult to arouse

198
Q

Diagnosis of abusive brain trauma:

A
  • Imaging: CT, MRI
  • Ocular funduscopic exam: retinal hemorrhage (classic sign)
199
Q

Nursing management of Abusive brain trauma:

A
  • Initiate respiratory & cardiovascular support
  • Assess increased intracranial pressure
  • Gather health Hx & gather information of event. DOCUMENT.
  • Skin and pressure ulcer prevention
  • Seizure monitoring/prevention; seizure meds
    *NG tube or OG tube
  • Adequate fluid & nutritional intake.
200
Q

What is the gold standard for intussiception?

A

Barium enema

201
Q

True or False. Gross Hematuria is not common in epispadias repair or enlargement of the kidneys.

A

True

202
Q

Obesity is in what percentile?

A

95th

Children's Health (4 decks)

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