Exam 4 Flashcards by Destiny Lafever

Signs of impending death

Pt feels hot but body feels cold
Loss of senses
Decreased appetite and thirst
Cheyne stokes resp
Weak, slow pulse
Decreased BP

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Leukemia

Too much WBC not enough RBC for clotting

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S/S of leukemia

Dx may occur when a “cold” doesn’t go away
Wt loss, petechiae, bruising
Bone/joint pain
Anemia
Thrombocytopenia
Low H/H and Plt
Immature WBCs

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Leukemia precautions

Neutropenia and bleeding precautions:
private room, visitors wear mask, no fresh flowers, thoroughly cooked foods

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Tx for leukemia

Low level chemo 4-5 wks
Bone marrow transplant if poor response to chemo

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Sickle cell crisis

Sensitive to low o2 levels (o2 PRN)
#1 priority- IV site for hydration THEN pain (opioids)
Extend extremities- nothing bent

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Teaching for sickle cell crisis

Avoid triggers: illness, stress, dehydration, high altitude

Repeated sickling= perm sickle cells

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Meds for sickle cell crisis

Hydroxyurea antimetabolite= makes RBCs rounder and flexible

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Blood transfusions

2 RNs verify order
VS q15 min
Y tubing w/ filter with only 0.9% NS
4 hrs MAX for 1 unit

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Hemolytic reaction

HTN and HA

STOP infusion
New tubing and flush with NS

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How toddlers view death (1-3)

Death is reversible
Egocentric= everything revolves around them
May act like they’re still alive
React to emotions of others

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How preschoolers view death (3-6)

Death temp and reversible
Magical thinking= guilt or shame
May inappropriately giggle

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Retinoblastoma

Caused by mutation in gene (sporadic or inherited)

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S/S of Retinoblastoma

Cats eye reflex: whitish pupil “glows”
Strabismus (cross-eyed)- late sign
Heterochromia (different colored eyes)

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Teaching for Enucleation (removal of the eye)

Socket is covered in mucosal lining
Fitting for prosthesis in 3-4 weeks
Face will be edematous and bruised
Usually little to no drainage (bright red drainage is red flag)
Eye patch changed daily
Prosthesis cleaned by placing in hot water and allowing to soak

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Iron supplements teaching

Use straw (stains teeth)
Take on empty stomach
No milk
Vit C helps with absorption
Calcium stops absorption

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Foods high in iron

Organ meats
Green leafy vegetables
Kale
Shellfish
Fortified dry cereal

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Osteosarcoma

Bone tumor arising from osseous tissue
Most common in children in long bones (femur)

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S/S of osteosarcoma

Bone pain (commonly mistaken for growing pains)
Swelling
Fractures limb
Limited ROM
Palpable mass
Extremity my feel warm

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Ewing sarcoma

Arises from the bone marrow

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S/S of Ewing sarcoma

Bone pain
Swelling
Fractures

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Neuroblastoma (Wilms tumor)

Silent tumor primarily in abdomen that crosses midline (firm, irregular, non tender mass)
Palliative care

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S/S of Wilms tumor

Painless
Wt loss
Fever
Anemia
Possible HTN
Urinary retention
Hematuria

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Teaching for Wilms tumor

DO NOT PALPATE ABDOMEN = could cause rupture
Put sign on bed

Hemophilia A

Clotting factor 8 missing Caused by x linked recessive gene (mom passes down to son)

S/S of hemophilia A

Prolonged bleeding Hemorrhage Bruising Hemarthrosis Spontaneous hematuria Nose bleeds Joint stiffness

Tx for hemophilia A

Replace clotting factor 8 No contact sports (isometric exercises) Corticosteroids NSAIDS - no ASA Desmopressin RICE

Nursing considerations for hemophilia A

NO IM injections Only subQ (pressure for 5 min after)

Causes of ICP

Trauma Hemorrhages Meningitis Hydrocephalus

S/S of increased ICP

Bulging fontanelles Separated suture lines Irritability Drowsiness Shrill cry/ seizures (late sign) Increased head circumference Distended scalp veins HA Forceful vomiting Sunset eyes

Interventions for increased ICP

Semi Fowler- NOT flat and not too high Quiet and dim lit room Low stimuli No airway suctioning Avoid baby crying Mannitol Strict I&O

Sluggish constriction of pupils

From barbituates Optic nerve injury Brain stem lesions

Pinpoint pupils

High/overdose

Tx for increased ICP

Lactated ringers (isotonic solution) only VP shunt= fluid drains into peritoneal cavity

Bacterial meningitis

Droplet precautions- very contagious Caused by haemophiles influenzae B

S/S of bacterial meningitis

HA Nuchal rigidity Photosensitivity Fever Adv seizures

Kerning sign

Positive for meningitis On back, flex and then straighten leg= pain

Brudzinski sign

Positive for meningitis Head up ad neck flexed= pain when flexed knees/hip

Dx for meningitis

LP (CSF is cloudy) Preop= empty bladder before During= round back Post= monitor insertion site and lay flat on back

Nursing care for VP shunt

Tx for hydrocephalus Monitor for shunt malfunction (seizures and ICP Sx return) or infection

Submersion injury

Irreversible brain damage after 4 min

Nursing interventions for meningocele

No diaper Keep prone Keep sac sterile and moist (saline)

Causes of cerebral palsy

Birth asphyxia Prenatal brain abnormalities Usually caused by birth injury

S/S of cerebral palsy

Abnormal muscle tone and reflexes Impaired motor skills Contractures Difficulty with speech and voluntary movement Stiff rigid posture Arching back floppy tone Feeding difficulties

Early red flags of autism

No smiling 3 months No eye contact No babbling Failure to interact socially

S/S Down syndrome

Slanted eyes Short stare Wide neck Depressed nasal bridge Short stubby digits Hyper reflexive Protruding tongue Low set ears

Comorbidities with Down syndrome

Hypothyroidism Resp problems Heart defects

Reye’s syndrome S/S

Cerebral edema that leads to seizures and liver damage Fever

Dx of Reye’s syndrome

Liver biopsy (lay on right side after) AST, ALT

Decorticate posturing

Extremities towards body core

Decerebrate posturing

Away from the body

PKU

Dx after 24hrs of first feeding Phenylamine >20 is PKU

PKU S/S

Failure to thrive Vomit Digestive issues Irritability Hyperactivity

Tx of PKU

Eliminate phenylamine (protein) from diet : Meats, eggs, peanut butter, legumes, dairy, artificial sweeteners Tyrosine supplement for child

S/S of hypothyroidism

Cold intolerance Receding hairline Facial eyelid edema Thick tongue Dry skin Brittle nails LATE SIGNS Wt gain, low LOC, thick skin,

Lordosis

S shape in lower back

Kyphosis

Upper back hump

Pavlik harness

For nonmobile pts with hip dysplasia Worn 24/7 Follow up every 2 weeks for adjustment Spica cast for mobile pts