Exam 4

Question 1

Bacterial meningitis
-Causes, transmission, precautions, vaccines

Answer 1

• caused by streptococcus peneumoniae, neisseria meningitides, influenza
• transmission-> droplet from infected person
• use STANDARD precautions and droplet transmission
• Vaccines; Hib and pneumococcal conjugate vaccines have decreased incidents of infection

Question 2

Meningitis
- clinical manifestations in infants and children

Answer 2

• Infants-> fever, bulging fontanel, poor sucking and feeding, lethargy, and irritability
• Children-> headache, nuchal rigidity, opisthotnos, + Kernig and Brudzinksi signs, photophobia, N/V, and confusion

Question 3

Meningitis diagnosis

Answer 3

• Diagnosis-> lumbar puncture BEFORE antibiotics, measure spinal pressure, check spinal fluid for WBCs, protein, glucose, clear/purulent, gram stain

Question 4

Meningitis Treatment

Answer 4

• appropriate transmission precautions, IV antibiotics and steroids, antipyretics, and anticonvulsants
• aspiration of subdural effusion
• MONITOR NEUROLOGIC STATUS q2h

Question 5

Cerebral palsy Nursing Care

Answer 5

• interview child & family, determine needs, level of development, stage of acceptance and set realistic goals
• encourage child to maintain self care activities and set goals for new ones

Question 6

Disciplining a child w/an intellectual disability

Answer 6

discuss w child the first time, put in a time out the second time after already having to discuss it a first time

Question 7

Drowning in infants, treatment

Answer 7

• Infants more commonly drown in bathtubs
• Toddlers and preschoolers drown in pools or small bodies of water
• Treatment-> immediate CPR, continued until at medical facility

Question 8

The nervous system-> CNS, Peripheral N.S, Autonomic, at birth

Answer 8

• CNS-> brain and spinal cord
• CSF: in brain and spinal c, cushions/protective mechanism

Question 9

Sensory organs-> Eyes

Answer 9

• detetct light/stimuli from env
• @ 2 months, eyes can focus and follow object w eyes
• @ 7 months, depth perception has matured
• visual acuity-> 20-100 and 20-4– until 5 yrs

Question 10

Vision Impairment-> Refractive errors

Answer 10

• Refraction: light rays bend through lens to retina
• Myopia: nearsightedness
• Hyperopia: Farsightedness
• Astigmatism: unequal curve in cornea that bends light rays in diff directions

Question 11

Eye injury and foreign objects in eye
- Small foreign objects

Answer 11

• Ecchymosis of eye (black eye), most concerning
• Small objects-> AVOID the use of COTTON-TIPPED applicators to remove object

Question 12

Eye injury–> Sympathetic ophthalmia s/s

Answer 12

photophobia, pain, dimness of vision, detached retina, atrophy of eyeball

Question 13

Eye surgery Nursing Care

Answer 13

• use of play to teach is helpful-> play with blindfold before surgery to become accustomed
• Restraints may be needed
• speak to child when entering and leaving room

Question 14

Hearing Impairment Nursing Care

Answer 14

• stand/sit face to face, be sure child can see you before touching them , demonstrate procedure before performed, night light, proper care of hearing aid, learn ASL

Question 15

Otitis media
- Spontaneous Rupture
- Myringotomy (incision of ear drum)

Answer 15

• S. rupture= purluent drainage, pain caused by the pressure buildup will be relieved
• Myringotomy est drainage and to insert tiny tubes into the tympanic membrane to facilitate drainage

Question 16

Insertion of foreign bodies into the ear/nose
- HOW to remove from ears
- Nose

Answer 16

• Ears-> irrigation and forceps
• Nose-> speculum used to inspect and remove. Risk of infection if objects remain inside.

Question 17

Acute or Non recurrent Seizures
- Febrile seizures

Answer 17

• 102 f- 106 f, convulse w fever of 100 f to 102 f
• often a symptom of acute infection

Question 18

Clinical manifestations and diagnosis of febrile seizures

Answer 18

rapid onset, restlessness and irritability, body stiffens, LOC, clonic movements, irregular breathing, unable to swallow saliva

Question 19

Focal (partial) onset seizures
- what it causes
- onset may include….

Answer 19

• child awake and aware during seizure
• causes localized motor activity, limited to one side of body or may spread to other parts
• onset seizure includes sensory symptoms (aura)-> the 5 senses.
  -NUMBNESS, TINGLING, PARESTHESIA, or PAIN

Question 20

Generalized onset seizures
- TONIC-CLONIC SEIZURES, 4 stages

Answer 20

1. Prodromal period
2. Tonic phase
3. Clonic phase
4. Posictal Period- >CYANOTIC & RESP ARREST–> MONITOR BREATHING

Question 21

Generalized onset seizures
- ABSENCE SEIZURES

Answer 21

child loses awareness and stares straight ahead, muscle twitching
- after seizure-> child is alert and continues convo like nothing happened

Question 22

Seizure Disorders
- STATUS EPILEPTICUS

Answer 22

lasts longer than 30 min, doesn’t return to normal concoisuness.
- requires immediate treatment to decrease perm brain injury, resp failure, and death

Question 23

Seizure dsorders
STATUS EPILEPTICUS treatment

Answer 23

Diazepam and lorazepam, rectal or IV

Question 24

Seizure disorders Treatment (slide 51)

Answer 24

• Anticonvulsant; carbamazepine, ethosuximide, phenobarbital; phenytoin, valporic acid
• Vagus nerve stim
• Ketogenic diets

Question 25

Seizure disorders, Nursing Care

Answer 25

• keep child safe during seizure
• hx, raised padded side rails, harmful objects kept away, O2 & suction kept at bedside, bed lowered during sleep