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Peds > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Physical Cues of Cerebral Palsy

A

Nonprogressive impairment of motor function, especially muscle control, coordination and posture

Can cause abnormal perception and sensation, visual, hearing and speech impairments; Seizures and Cognitive disabilities

Exact cause is unknown; associated with several prenatal, perinatal and postnatal factors with the majority of causes (80%) occurring before delivery

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2
Q

6 Cerebral Palsy Priority Care

A

Oxygenation/Ventilation – positioning, suctioning, incentive spirometry, aspiration prevention

Pain management – management of muscle spasms
Adequate nutrition – oral & enteral (tailored to ability), monitor ht & wt. Can use Baclofen, botulinum toxin A (botox), and carbidopa

Skin care – repositioning, monitoring skin under splints/braces

Communication – electronic devices, picture boards, touch screen computers

Psychosocial – promote independence & positive self-image; support family

Developmental – monitor developmental milestones, interact based on developmental level rather than chronological age

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3
Q

5 Complication of Cerebral Palsy

A

Complications:
Seizures
Delayed G&D
Hydrocephalus
Aspiration
Injury r/t limited mobility

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4
Q

Cues of Muscular Dystrophy

A

Absence of dystrophin that causes progressive weakness of voluntary muscle of hips, thighs, pelvis, and shoulders initially
+ Gower’s sign

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5
Q

3 Lab/Diagnostics of Muscular Dystrophy

A

Electromyography (EMG): reveals nerve/muscle dysfunction

Muscle BX: Definitive DX showing absence of dystrophin

DNA Testing: Positive for dystrophin gene mutation

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6
Q

Nursing Priorities of Muscular Dystrophy

A

Primary goal is to promote mobility, maintain cardiopulmonary function, prevent complications, and maximize quality of life

Optimize physical function – ROM, strength & muscle training

Oxygenation/Ventilation – breathing exercises, suctioning, O2, cough devices, Assess WOB

Adequate Nutrition – low calorie, high protein & fiber

Skin Care – repositioning, monitoring

Psychosocial – support groups, respite care/palliative, End-of-life care

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7
Q

Cues of Dysplasia of the Hip

A

Incomplete dislocation of the hip with intact femoral head

Asymmetry of gluteal folds in prone position

Unequal number of skin folds on posterior thigh

Shorter affected limb, walk with limp (older child)

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8
Q

Priority Care/assessment of Dysplasia of Hip

A

Neurovascular assessment
Skin care
Parent teaching

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9
Q

Parent teaching of Pavlik Harness

A

Do not take off and adjustment by provider only 24/7 for a week or longer

Skin care

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10
Q

Cues of Scoliosis

A

Lateral curvature of the spine exceeding 10° and spinal rotation that causes rib asymmetry, idiopathic being the most common cause

Asymmetry in shoulder height, prominence of one scapula, uneven curve of waistline, or rib hump on one side

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11
Q

Management of Scoliosis

A

Moderate curves (25-45°) usually treated with thoracolumbosacral (TLSO) bracing and exercise

Surgical Intervention if curve >45° or progresses despite bracing or if cardiac/respiratory compromise

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12
Q

Scoliosis Post-Op Care

A

Frequent NV assessment of extremities with VS; TC&DB; Hemovac; Foley care; PRBCs (severe blood loss anticipated)

Log-rolling only to prevent damage to hardware

Pre-medicate for pain prior to moving, and slow ambulation to avoid orthostasis; PCA pump

Operative site assessment

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13
Q

What is Meningocele?

A

Less serious form of spina bifida cystica (only has CSF in sac)

Visible defect with saclike protrusion of meninges through defect in vertebrae

Usually minor or no neurological deficits

Requires surgical correction

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14
Q

Priority care of Meningocele (Sac Care)

A

Surgery can be delayed if normal neurological function and sac intact

Report any leakage -> infection

Prone positioning

Monitor head circumference(↑ICP)

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15
Q

What is Myelomeningocele?

A

Most serious form of spina bifida cystica (sac contains CSF, nerves leading to degrees of neuromuscular, limb, and sensory deficits)

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16
Q

Nursing Action for Myelomeningocele

A

NS moistened dressings to keep sac moist

Report leaking of sac

Prone position

Avoid swaddling and blankets (keep in isolette/warmer)

Atraumatic care

Avoid Latex and post-op contamination from pee and poo

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17
Q

Result most frequently from accidental trauma and are the

2nd most common injury in child physical abuse

A

Fractures

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18
Q

What are the neural assessment for fractures?

A

Sensation
Skin temperature
Skin color
Spontaneous movement
Capillary refill
Pulses
***It is similar to the 5 Ps (pain, paresthesia, pulselessness, pallor, and paralysis)

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19
Q

What are the complications of fractures?

A

Compartment syndrome (5Ps) and osteomyelitis (irritability, fever, tachy, edema, constant pain, and tenderness )

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20
Q

What are the nursing priorities of care for fractures?

A

Promote & monitor tissue perfusion – NV assessment on a regular schedule; skin assessment

Pain management – use age-appropriate pain tool; provide both pharmacological & nonpharmacological interventions

Infection prevention & monitoring
Promote mobility – proper alignment; ROM of fingers, toes & unaffected extremities

Pt/family support & education – activity restrictions; cast application & care; proper crutch use; signs to report

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21
Q

What is hydrocephalus?

A

Not a specific brain disorder but caused by an underlying condition

Accumulation of excessive CSF within the cerebral ventricles and/or subarachnoid spaces = ventricular dilation & IICP

Prognosis depends on cause and whether brain damage has occurred

Increased risk for developmental disabilities, visual problems, abnormalities in memory, and reduced intelligence

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22
Q

What are physical Cues of hydrocephalus?

A

They are the same as increased ICP

S/S vary by age
◘Baby: bulging fontanelles, sunken eyes, prominent sutures
◘Older children: HA (headache)

Common Signs: irritability, lethargy, poor feeding, vomiting, complaint of HA (older children), altered, diminished, or change in LOC

Physical: Wide, open, bulging fontanels; Large head or recent change in HC; Thin, shiny scalp w/ prominent, visible scalp veins; Sun-set eyes; Seizures

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23
Q

What is the most common complication of VP shunts?

A

Most common complication of blockage/obstruction and infection

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24
Q

What is VP shunt used for?

A

Therapeutic management of hydrocephalus

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25
Q

What are the s/s cues of VP blockage/obstruction?

A

Increased ICP

Vomiting, drowsiness, and HA typically r/t shunt malfunction

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26
Q

What to do for a Shunt infection?

A

Shunt infection treated with IV antibiotics; if persistent, shunt is removed and external ventricular drain (EVD) placed until CSF is sterile ​

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27
Q

When do most shunt infection happen?

A

Shunt infection most common 1-2 months after placement (can occur any time as well)​

28
Q

Early Sign of Increased ICP

A

HA
Vomiting, possibly projectile
Blurred vision, double vision (diplopia)
Dizziness
Decreased pulse and respiration

29
Q

Late signs of increase ICP

A

Lowered LOC
Decreased motor and sensory response
Bradycardia
Irregular respiration (cheyne-strokes respiration)
Decerebrate or decorticate posturing
Fixed and dilated pupils

30
Q

What characterizes Cushing Triad

A

Irregular breathing
HTN
Bradycardia

31
Q

Intervention to decrease ICP

A

Head midline with 30° on bed
Decrease stimuli
Avoid suctioning/blowing nose/coughing
Use stool softeners
Fever management
ICP monitoring
Careful fluid regulation (I/Os)
Sedation and analgesia
Mannitol or hypertonic saline
Seizure treatment/prophylaxis

32
Q

Labs for Bacterial Meningitis

A

Increased WBCs and Protein
Decrease Glucose
Cloudy in color

33
Q

Sudden s/s onset of meningitis

A

HX of URI or sore throat
Fever, chills, HA, vomiting
Photophobia
Stiff neck
Rash
Irritability, drowsiness, lethargy
Muscle rigidity or SZ

34
Q

Bacterial Meningitis Management

A

PICU admission with strict droplet precaution until 24H of antibiotics

IV broad-spectrum antibiotic after all CXs

Measures to reduce ICP

35
Q

What are S/S of Reye syndrome

A

Severe and persistent vomiting, lethargy, positive Babinski, sluggish pupils, and hepatomegaly

36
Q

Priorities of Care for Reye syndrome

A

Measures decrease ICP

Supportive care for the sequalae r/t to liver failure

37
Q

Reye Syndrome Management

A

Hyperammonemia may be treated with Lactulose (osmotic laxative) but may require hemodialysis if level greater than 500mcg/dl.​
​
Coagulopathy may be treated (especially before invasive procedures or with clinically significant bleeding) using fresh frozen plasma (FFP) or Vit.K.​

Hypoglycemia may be treated with dextrose-containing fluids (D50, D10, D5) with a serum glucose goal of 100-120mg/dl.​

38
Q

What to do during a seizure?

A

Protection from injurie, do not attempt to restrain; loosen restrictive clothing

Patent airway - position, oral suction, O2 and side-lying

Do not attempt to open jaw or insert airway

Stay with the patient

39
Q

What to do after a Seizure

A

Maintain side-lying position

Monitor breathing/VS/ head position, tongue

Assess for injuries (head, tongue, body)

Neuro checks

Swallow reflex before food/fluid

40
Q

Seizure precations

A

Padding of side rails and other hard objects

Side rails raised on bed at all times when child is in bed

Oxygen and suction at bedside

Supervision, especially during bathing, ambulation, or other potentially hazardous activities

Bracelet

41
Q

Febrile Seizures

A

Most common type of seizure in children <5 and peak incidence between 12-18 months​

SZ lasting 15-20 seconds once in a 24 hr period​

Brief postictal period​

42
Q

Tonic-clonic seizure

A

Most common of all seizure types​

Starts with phase where body & limbs stiffen; piercing cry & loss of swallowing reflex to phase with violent jerking of body; incontinence​

Long postictal period

43
Q

Absence seizures

A

Motionless, blank stare with minimal change in behavior; resembles daydreaming​

SZ lasting 5-10 seconds; may lip smack or twitch eyelids/face​

Immediately resumes previous activities/no postictal period​

44
Q

Seizure Management​

A

Phenytoin (IV and PO; IM is contraindicated)

Fosphenytoin (IM or IV only)

45
Q

Phenytoin Vs Fosphenytoin

A

Phenytoin can be administered PO/IV and Fos can be administed IV/IM

Phenytoin has more adverse effect (gingival hyperplasia, etc), you also need to monitor for adequate intake of Vit D, mg, calcium, folate, and vitamin B levels
Phenytoin HAS TO BE GIVEN WITH NORMAL SALINE

Fosphenytoin does not cause local irritation, but is more expensive drug. faster and easire administration and does not precipitate

46
Q

Lab/diagnostics for Seizures

A

Glucose, Electrolytes, Ca+: Rule out ↓ BS and ↓ Ca+​

LP: Rule out meningitis or encephalitis​

Skull XR: Rule out FX or trauma​

CT/MRI: Identify abnormality, bleeds, tumors​

EEG: Evaluate SZ type; “normal” does not rule out epilepsy​

Video EEG: Evaluate behavior and “catch a SZ” (Requires admission to hospital)​

47
Q

Decerebrate

A

Rigid Extension

Damage to brainstem and extrapyramidal tracts = rigid extension and pronation of arms/legs, flexed wrists and fingers, clenched jaw, extended neck, and possibly arched back

48
Q

Decorticate

A

Rigid Flexion

Damage to cerebral cortex or lesion to corticospinal tracts above brainstem = rigid flexion of arms held tightly to body, flexed elbows/wrists/fingers, plantar flexed feet, legs extended and internally rotated, and possibly fine tremors or intense stiffness​

49
Q

Opisthotonos

A

Abnormal posturing caused by muscle spasms due to immature nervous

50
Q

Pupils Indication

A

Pinpoint: poison, brainstem dysfunction, and opiate use

Dilated (reactive): after seizures

Dilated (fixed): brain stem herniation increased ICP

Anisocoria: naturally different sized pupils

Sunset eyes: increased ICP/hydrocephalus

Unilateral sudden dilation: intracranial mass

51
Q

Level of Consciousness

A

Full consciousness (AxOx4, playful)

Confusion: disorientation, may not respond appropriately to questions

Obtunded: limited responses and fall asleep unless stimulated

Stupor: response to vigorous stimulation

Coma: cannot be aroused, even with painful stimuli

52
Q

What are physical cues of a child with Growth Hormone Deficiency?

A

Large/prominent forehead; under-developed jaw​

High-pitched voice​

Delayed sexual maturation​

Delayed dentition/skeletal maturation​

Decreased muscle mass​

53
Q

How is Growth Hormone Deficiency Diagnosed?

A

Skeletal Survey: 2+ SD < normal in bone age​

CT/MRI: Rule out tumors/other abnormalities​

Pituitary Function Test to confirm​

Growth Chart deviations​

54
Q

How is it treated?

A

SOMATROPIN​

SUBQUTANEOUS​

GIVEN DAILY ​

​0.18-0.30 mEQL/Kg/Wk

55
Q

Physical Cues of Congenital Hypothyroidism

A

Poor sucking, hypothermia, constipation, lethargy, hypotonia, periorbital puffiness, cool/dry/scaly skiing, bradycardia, RR distress, large fontanelles and delayed closures

Macroglossia and coarse facial features

56
Q

Medication for Hypothyroidism? Medication management and teaching?

A

Thyroid hormone replacement (Levothyroxine)

Mush be crushed
Never use in whole bottle of feeding

Give in a small amount of formula

Medication absorption is affected by soy-based formulas, fiver, calcium, iron preparation, and antacids

Reduce L-thyroxine effects
Missed doses may lead to developmental delay/poor growth

57
Q

Diagnosis/Labs for Congenital Hypothyroidism

A

Thyroid function test done at 2 nd day of life

Free T4: 0.8-2.4 ng/dL
TSH: 0-10 mu/L

T4 low and TSH high

58
Q

Teaching for Levothyroxine

A

If untreated can cause intellectual disability, delayed physical maturation, short stature, and growth failure

Medication education

59
Q

What is Diabetic Ketoacidosis?

A

An acute life-threatening condition characterized by glucosuria & breakdown of body fat for energy.​

60
Q

What are expected Lab findings for DKA?

A

Main ones: Hyperkalemia, Metabolic Acidosis, Glucosuria, Ketonuria

Blood glucose > 300
Decrease serum bicarb
Acidic pH
Increased creatine
decrease sodium
increased potassium
increase hemo-A1c
increased WBC
Urinalysis (+ketones)

61
Q

KDA management

A

PICU admission

Hourly blood glucose monitoring to prevent BS falling more than 100 mg/dL/hr (can cause cerebral edema)

IVFs to treat dehydration, correct Na+ and K+, and improve peripheral perfusion

IV regular insulin via titrated infusion based on protocol sliding scale

62
Q

DM diagnostics

A

BS >200 mg/dL
Fasting Glucose (>126 mg/dL)
Oral GTT (>200 mg/dL at 2 hrs)
HgbA1C: >6.5%

63
Q

DM Labs

A

Chem Panel: Evaluate BUN/Creatinine, Ca+, Mg+, PO4-, Na+, K

CBC; UA

C-Peptide: After glucose challenge to verify endogenous insulin secretion

64
Q

Hypoglycemia management

A

If child coherent: feels S/S of hypoglycemia and glucose monitor shows low BS:
-Give glucose paste/tablets or 10-15 g of simple carbohydrate (OJ or milk); Followed with complex carbohydrates (peanut butter and crackers) to maintain glucose level

If incoherent: Glucagon Sub-Q or IM:
Under 20kg - give 0.5mg
Over 20kg - give 1mg
D50: IV PRN

65
Q

Down Syndrome (Trisomy 21) Complications

A

1 PREVENTING COMPLICATIONS

Aspiration: (Due to small mouth, large tongue, poor suck/tone, increased nasal stuffiness
-Use of bulb syringe & humidification
-Chin/neck support

Hypothyroidism: Thyroid testing at 6 months, 12 months, then annually

Atlantoaxial instability: Cervical XR at age 3-5 yr to screen: Report changes in gait or continence or weakness in head, neck

Cardiopulmonary issues

Hearing/Vision Impairments: screen regularly (cataract, OM)

66
Q

How to promote nutrition for trisomy 21 patients

A

Plot length, weight, head circumference on Down Syndrome growth charts only; grow more slowly

FTT: Poor suck/tone, nasal stuffiness, cardiac issues
-Altered feeding positions
Monitor GI conditions (celiac disease, constipation, Hirschsprung disease, imperforate anus)

Routine dental care every six months and daily teeth brushing

Regular diet and exercise

67
Q

Name insulins and their generic names

A

Rapid acting

Peds (4 decks)

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