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Pediatric Nursing > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

Etiology and Pathophysiology of UTI

A

Mostly caused by E. coli

Urinary stasis can contribute to development

Stasis may be caused by abnormal anatomical structures or abnormal function (e.g. neurogenic bladder)

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2
Q

Clinical Manifestations of UTI

A

Many are asymptomatic and discovered accidentally on routine examination

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3
Q

Bladder Exstrophy

A

Rare congenital defect in which the posterior bladder wall extrudes through the lower abdominal wall

Corrected with surgical reconstruction

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4
Q

Obstructive Uropathy

A

Structural or functional abnormalities of the urinary system that interfere with urine flow and result in urine backflow into the kidneys

Often causes hydronephrosis

Early diagnosis and treatment prevents kidney damage and deterioration of kidney function

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5
Q

Vesicoureteral Reflux

A

Retrograde flow of urine from the bladder into the ureters

Creates a reservoir for bacterial growth

Recurrent infection within 1-2 months

Culture and sensitivity every 2-3 months

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6
Q

Prune Belly Syndrome

A

Congenital defect characterized by failure of the abdominal musculature to develop

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7
Q

Primary Enuresis

A

Child has never had a dry night; attributed to maturational delay and small functional bladder

Not associated with stress or psychiatric cause

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8
Q

Secondary Enuresis

A

Child who has been reliably dry for at least 6 months begins bed-wetting

Associated with stress, infections, and sleep disorders

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9
Q

Milestones in the Development of Bladder Control

A

1.5 years: child passes urine at regular intervals

2 years: child announces when voiding is taking place

2.5 years: child makes known the need to void; can hold urine

3 years: child goes to the bathroom alone; holds urge if preoccupied with play

2.5-3.5 years: child achieves nighttime control

4 years: child shows great interest in going to bathrooms when away from home

5 years: child voids approximately 5-6 times per day; prefers privacy; is able to initiate emptying of bladder at any degree of fullness

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10
Q

Nephrotic Syndrome

A

Alteration in kidney function secondary to increased glomerular basement membrane permeability to plasma protein

Characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity

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11
Q

Acute Postinfectious Glomerulonephritis

A

Most common inflammation of the glomeruli of the kidneys

Many children are asymptomatic

Onset usually abrupt with flank or midabdominal pain, irritability, malaise, and fever

Treatment focuses on relief of symptoms and supportive therapy

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12
Q

Acute Renal Failure

A

Sudden loss of adequate renal function in which the kidneys are unable to clear metabolic wastes and to regulate extracellular fluid volume, sodium balance, and acid-base homeostasis

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13
Q

Causes of Acute Renal Failure

A

Hemolytic-uremic syndrome, acute glomerulonephritis, sepsis, poisoning, nephrotoxic medications, hypovolemia, obstructive uropathy, and complication of cardiac surgery

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14
Q

Clinical Manifestations and Treatment of Acute Renal Failure

A

Dark urine or gross hematuria, headache, edema, fatigue, crackles, gallop heart rhythm, hypertension, hematuria, lethargy, nausea and vomiting, oliguria

Treatment depends on the underlying cause of the renal failure

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15
Q

Chronic Renal Failure

A

Progressive, irreversible reduction in kidney function

Usually results from developmental abnormalities of the kidney or urinary tract, obstructed urine flow and reflux, hereditary diseases such as polycystic kidney disease, infections such as hemolytic-uremic syndrome, and glomerulonephritis

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16
Q

Clinical Manifestations and Treatment of Chronic Renal Failure

A

Fatigue, malaise, poor appetite, nausea and vomiting, failure to thrive, short stature, oliguria/polyuria, headache, decreased mental alertness/ability to concentrate, chronic anemia, hypertension, edema, fractures with minimal trauma, rickets, valgus deformity

Treatment is dialysis and eventually a kidney replacement

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17
Q

Hemolytic-Uremic Syndrome

A

Most common cause of acute renal failure in young children

Triad of signs includes hemolytic anemia, thrombocytopenia, and acute renal failure

Treatment focuses on the complications of ARF and includes fluid restrictions and a high-calorie, high-carbohydrate diet that is low in protein, sodium, potassium, and phosphorus

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18
Q

Polycystic Kidney Disease

A

Genetic disorder that has autosomal recessive and dominant forms

Liver abnormalities are associated with both forms of the disease

Low-set ears, small jaw, and flattened nose

Treatment is supportive

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19
Q

Cryptorchidism

A

Undescended testes

Congenital defect of the gonads

Surgery may be necessary for correction

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20
Q

Pelvic Inflammatory Disease

A

Serious infection of the upper genital tract caused by the ascending spread of organisms in the cervix and vagina

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21
Q

Clinical Manifestations and Treatment of Pelvic Inflammatory Disease

A

Fever, mild/dull bilateral lower abdominal pain, dysmenorrhea, dysuria, vaginal discharge, prolonged or increased menstrual bleeding

Antibiotics used for treatment

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22
Q

Normal BUN

A

5-18

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23
Q

Normal CRE

A
  1. 2-0.4 in infants

0. 3-0.7 in children

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24
Q

Confusion

A

Disorientation to time, place, or person; loss of clear thinking. Answers to simple questions may be correct, but responses to complex ones may be inaccurate

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25
Q

Delirium

A

State characterized by disorientation, fear, irritability or agitation, and mental or motor excitement

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26
Q

Lethargy

A

Profound slumber in which speech and movement are limited. The child is aroused with moderate stimulation, but falls asleep easily once stimulation is removed

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27
Q

Stupor

A

Deep sleep or unresponsiveness; the child is aroused only with repeated vigorous stimulation, but returns to the unresponsive state when the stimulus is removed

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28
Q

Coma

A

Unconsciousness; cannot be aroused even by painful stimuli
Caused by pathologic processes (meningitis, trauma, hypoxia, poisoning, seizures, alcohol/substance abuse, endocrine/metabolic disorders, etc.) that cause increased intracranial pressure

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29
Q

Early Signs of Increased Intracranial Pressure

A

Headache, visual disturbances, diplopia, nausea/vomiting, dizziness/vertigo, slight change in vital signs, pupils not as equal or reactive, sunsetting eyes, slight change in level of consciousness

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30
Q

Late Signs of Increased Intracranial Pressure

A

Significant decrease in level of consciousness, seizures, fixed and dilated pupils, papilledema

Cushing Triad (increased systolic blood pressure and widened pulse pressure, bradycardia, irregular respirations)

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31
Q

Focal/Partial Seizures

A

Caused by abnormal electrical activity in one brain hemisphere or a specific area of the cerebral cortex

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32
Q

Generalized Seizures

A

Result of diffuse electrical activity that begins in both brain hemispheres simultaneously

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33
Q

Febrile Seizures

A

Occur in susceptible infants and children in connection with a rise in temperature to 102.2

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34
Q

Bacterial Meningitis

A

Secondary to other infections such as otitis media, sinusitis, pharyngitis, cellulitis, pneumonia, or septic arthritis; brain trauma; or a neurosurgical procedure

Brain becomes inflamed and edematous, leading to cerebral edema

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35
Q

Clinical Manifestations of Bacterial Meningitis

A

Febrile, altered consciousness, vomiting, complaints of muscle/joint pain, headache, photophobia, esotropia, nuchal rigidity

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36
Q

Viral Meningitis

A

Inflammatory response of the meninges characterized by an increased number of blood cells and protein in the CSF

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37
Q

Clinical Manifestations of Viral Meningitis

A

Abrupt onset of fever, headache, photophobia, stiff neck, back pain, myalgia, irritability, lethargy

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38
Q

Encephalitis

A

Acute inflammation of the brain often caused by an arbovirus that is transmitted by a mosquito

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39
Q

Clinical Manifestations of Encephalitis

A

Fever, irritability, severe headache, bulging fontanelle, altered mental status

Flaccid or spastic paralysis

At risk for seizures, respiratory failure, and increased ICP and receives supportive treatment in the ICU

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40
Q

Reye Syndrome

A

Acute encephalopathy caused by drug toxic to the liver or other toxin, metal, or metabolite and results in a poorly functioning organ

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41
Q

Guillain-Barre Syndrome

A

Acute inflammatory peripheral neuropathy with an acute onset of rapidly developing symmetric motor weakness that progresses in an ascending pattern

Postinfectious disorder that affects motor, sensory, and autonomic neurons

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42
Q

Clinical Manifestations of Reye Syndrome

A

Cerebral edema, hypoglycemia, and an enlarged liver

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43
Q

Clinical Manifestations of Guillain-Barre Syndrome

A

Hypotonia, respiratory distress, irritability, feeding difficulties in infants, pain, numbness, paresthesia

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44
Q

Migraine Headaches

A

May be triggered by stress; foods containing nitrates, glutamate, caffeine, tyramine, and salt; menses; fatigue; and hunger

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45
Q

Tension Headaches

A

Associated with stress related to school, anxiety, demanding schedules, fasting, and inadequate sleep

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46
Q

Medication Overuse/Rebound Headaches

A

Associated with the frequent use of medications for headaches

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47
Q

Microcephaly

A

Small brain with a head circumference below the third percentile on growth curves

May be caused by genetic disorder or destructive insult during infancy such as an infection, metabolic disorder, or hypoxia-ischemia

Intellectual disability is common

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48
Q

Hydrocephalus

A

Body’s response to an imbalance between the volume of CSF produced and absorbed

May be congenital or acquired as a result of intraventricular hemorrhage, meningitis, traumatic brain injury, or brain tumor

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49
Q

Clinical Manifestations of Hydrocephalus

A

Increased head circumference, irritability, vomiting, poor appetite, disordered sleep, fever

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50
Q

Anencephaly

A

No development of the brain above the brainstem, which is ultimately fatal

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51
Q

Encephalocoele

A

Protrusion of meningeal tissue or meninges-covered brain through a defect in the skull

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52
Q

Spina Bifida Occulta

A

A vertebral defect in which the posterior vertebral arches fail to fuse, but the spinal cord and meninges are contained in the vertebral canal

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53
Q

Spina Bifida Cystica

A

A posterior vertebral arch defect with protrusion of meninges through the bony spine

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54
Q

Meningocoele

A

Protrusion of a meningeal sac filled with CSF through a vertebral defect, associated with no abnormalities of the spinal cord

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55
Q

Myelodysplasia

A

Protrusion of a meningeal sac that contains CSF, a portion of the spinal cord, and nerves through a vertebral defect

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56
Q

Etiology of Myelodysplasia/Spina Bifida

A

Chemicals, medications, genetic factors, and maternal health conditions

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57
Q

Clinical Manifestations of Myelodysplasia

A

Thoracic Level: paralysis of the legs, weakness and sensory loss in the trunk and lower body region

Lumbar 1-2 Level: some hip flexion and adduction, cannot extend knees

Lumbar 3 Level: can flex hips and extend the knees; paralyzed ankles and toes

Lumbar 4-5 Level: can flex hips and extend the knees; weak or absent ankle extension, toe flexion, and hip extension

Sacral Level: mild weakness in the ankles and toes

Bowel and bladder incontinence occurs with all except sacral

Mobility problems, intellectual disability, and visual impairment

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58
Q

Craniosynostosis

A

Premature closure of cranial sutures in utero or during the first 18 months of life

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59
Q

Positional Plagiocephaly

A

An asymmetric flattening of the skull, associated with sleep position to prevent SIDS

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60
Q

Neonatal Abstinence Syndrome

A

Caused by opioids, CNS stimulants, CNS depressants, antidepressants, and benzodiazepines

Initial signs include irritability, jitteriness, tremors, excessive crying

Other signs include yawning, diarrhea, vomiting, seizures, inconsolable high-pitched crying, difficulty sleeping, hypertonia, and ANS signs

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61
Q

Neurofibromatosis

A

Autosomal dominant genetic disorder in which tumors grow along nerves

Characterized by six or more cafe au lait spots

Pain, vision deficits, precocious puberty, delayed puberty, thinning/bowing of the tibia, fractures that do not heal properly, and scoliosis are all possible signs

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62
Q

Cerebral Palsy

A

Common syndrome of movement and posture development disorders caused by a nonprogressive lesion abnormality in the fetal or infant brain that results in activity limitations

Associated hearing, vision, communication, perceptual, cognitive, and behavioral problems

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63
Q

Etiology of Cerebral Palsy

A

Risk factors include low birth weight, placental abnormalities, birth defects, meconium aspiration, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycemia and neonatal infections

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64
Q

Clinical Manifestations of Cerebral Palsy

A

Diplegia: both legs are affected

Hemiplegia: only one side of the body is involved, the arm is usually more severely affected than the leg

Quadriplegia: all four extremities are affected

Motor impairment, spasticity, delayed developmental milestones

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65
Q

Metatarsus Adductus

A

Most common congenital foot deformity characterized by an inward turning of the forefoot at the tarsometatarsal joints

Treatment depends on the degree of foot flexibility

Braces, casting, orthopedic shoes

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66
Q

Clubfoot

A

Congenital abnormality in which the foot is twisted out of its normal position

Exact cause is unknown, however some believe neuromuscular or vascular problems

Midfoot is directed downward (equinus), the hindfoot turns inward (varus) and the forefoot curls toward the heel (adduction)

Foot is small with a shortened Achilles tendon; muscles in the lower leg are atrophied, but leg lengths are generally normal

Early treatment is essential

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67
Q

Genu Varum

A

Bowlegs; deformity in which the knees are widely separated while the ankles are close together and the lower legs are turned inward (varus)

Braces, osteotomies, casting

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68
Q

Developmental Dysplasia of the Hip

A

Refers to a variety of conditions in which the femoral head and the acetabulum are improperly aligned

Conditions include dislocation, hip instability, subluxation, and acetabular dysplasia

Genetic factors appear to play a role

Common signs and symptoms include limited abduction of the affected hip, asymmetry of the gluteal and thigh skinfolds, and telescoping or pistoning of the thigh

60-80% of hip abnormalities resolve by 2 months of age

Pavlik harness, casting

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69
Q

Legg-Calve-Perthes Disease

A

Self-limiting condition in which there is avascular necrosis of the femoral head

Results from an interruption of the blood supply to the femoral epiphysis

Early symptoms include a mild pain in the hip or anterior thigh and a limp

Later symptoms include limited range of motion and weakness and muscle wasting

Surgery, braces

70
Q

Slipped Capital Femoral Epiphysis

A

Occurs when the femoral head is displaced from the femoral neck

Seen often in adolescents following a growth spurt

Predisposing factors include obesity, a recent growth spurt, and endocrine disorders

Symptoms include a limp knee; thigh, hip, or groin pain; and loss of hip motion

71
Q

Scoliosis

A

Lateral S- or C-shaped curvature of the spine that is often associated with a rotational deformity of the spine and ribs

May be congenital, idiopathic, or acquired

Classic signs include truncal asymmetry, uneven shoulder and hip height, a one-sided rib hump, and a prominent scapula

Does not usually cause pain or discomfort

72
Q

Torticollis

A

Tilt of the head caused by rotation of the cervical spine

Generally an injury sustained to the sternocleidomastoid muscle at the time of birth or to a cervical spine abnormality

Stretching exercises or surgical lengthening of the sternocleidomastoid are usual treatments

73
Q

Osteoporosis

A

A condition in which there is decreased density and mass of bone, promotes the risk of fractures and is commonly associated with aging

Preceded by osteopenia or low bone mass, which is between 1.0 and 2.5 standard deviations below the norm

74
Q

Osteomyelitis

A

Infection of the bone, most often of the long bones of the lower extremity

May be acute or chronic and may spread into surrounding tissues

Caused by a microorganism, often from URIs, trauma to bone, and surgery

Symptoms include pain and tenderness with swelling, decreased mobility of the affected joint, and fever

75
Q

Skeletal Tuberculosis

A

A rare microbacterial infection that can be very destructive; spine is the most frequent site of infection

Clinical Manifestations: depending on the site, pain, limp, severe muscle spasms, kyphosis, muscle atrophy, “doughy” swelling of the joints, decreased joint motion, changes in reflexes, low-grade fever

Diagnostic Tests: TB skin test, CBC, synovial fluid analysis, radiographs

Clinical Therapy: antibiotic therapy

76
Q

Septic Arthritis

A

A joint infection of the synovial space; most common site is the knee, followed by the hip, ankle, and elbow

Clinical Manifestations: fever, pain, local inflammation, joint tenderness, swelling, loss of spontaneous movement

Diagnostic Tests: CBC with differential, ESR, blood cultures

Clinical Therapy: joint aspiration, open drainage and irrigation, followed by antibiotic therapy

77
Q

Achondroplasia

A

Dwarfism is a genetic condition usually resulting in an adult height of 58 inches or less

78
Q

Marfan Syndrome

A

Most common problems are mitral valve prolapse, aortic regurgitation, abnormal aortic root dimensions, pectus excavatum, long arms and digits, scoliosis, elongated head, high arched palate, lens subluxation, and pneumothorax

No treatment for this syndrome

79
Q

Osteogenesis Imperfecta

A

Brittle bone disease; connective tissue disorder that primarily affects the bones

Biochemical defect in the production of collagen

Clinical manifestations include multiple and frequent fractures, blue sclerae, thin soft skin, altered joint flexibility, short stature, enlargement of the anterior fontanelle, weak muscles, and brittle bones

80
Q

Pseudohypertrophy

A

Enlargement of the muscles as a result of their infiltration with fatty tissue

81
Q

Duchenne Muscular Dystrophy

A

X-linked recessive disorder seen in boys

Clinical Manifestations: delayed walking, frequent falls, easily tired when moving, toe walking, hypertrophied calves, waddling gait, lordosis, positive Gowers maneuver, intellectual disability frequently seen

Clinical Therapy: supportive care (physical therapy and braces)

82
Q

Becker Muscular Dystrophy

A

X-linked recessive disorder

Clinical Manifestations: similar to Duchenne but more milder and delayed

Supportive care

83
Q

Facioscapulohumeral Muscular Dystrophy

A

Autosomal dominant disorder

Clinical Manifestations: face, shoulder girdle, lower limbs affected, unable to raise arms over head, lordosis, cannot close eyes or whistle or smile, facial weakness

Physical therapy

84
Q

Emery-Dreifuss Muscular Dystrophy

A

X-linked recessive disorder

Clinical Manifestations: early onset of contractures followed by weakness; achilles tendon elbow and spine affected, cardiac conduction defect may occur

Physical therapy, surgery, pacemaker insertion

85
Q

Congenital Muscular Dystrophies

A

Autosomal recessive group of disorders

Clinical Manifestations: muscle weaknesses present at birth; motor development delay; contractures and joint deformities; hypotonia

Correction of skeletal deformity (orthosis or surgery), usually nonprogressive

86
Q

Fractures

A

A break in the bone that occurs when more stress is placed on a bone than a bone can withstand

Reduction and immobilization indicated

87
Q

Strain

A

Stretching or tearing of either a muscle or a tendon, usually from overuse

88
Q

Sprain

A

Stretching or tearing of a ligament, usually caused by falls, sports injuries, or motor vehicle crashes

89
Q

Skin Traction

A

Pull is applied to the skin surface, which puts traction directly on the bones and muscles

90
Q

Dunlop Traction (Skeletal or Skin)

A

Used for fracture of the humerus

Arm is suspended horizontally with straps placed on both the upper and lower portions for pull from both sides

91
Q

Bryant Traction

A

Used specifically for the child under 3 years of age who has developmental dysplasia of the hip or a fractured femur

92
Q

Buck Traction

A

Used for knee immobilization, to correct contractures or deformities, or for short-term immobilization of a fracture

93
Q

90-90 Traction

A

Used for fractures of the femur or tibia

94
Q

Skeletal Traction

A

Pull is applied directly to the bone by pins, wires, tongs, or other apparatus that have been placed surgically

95
Q

Skeletal Cervical Traction

A

Used for cervical spine injuries to reduce fractures and dislocations

96
Q

Halo Traction

A

Used to immobilize the head and neck after cervical injury or dislocation

97
Q

Russell Traction

A

Used for fractures of the femur and lower leg

98
Q

External Fixators

A

Attached to the extremity by percutaneous transfixing of pins or wires to the bone

99
Q

Spontaneous Reflexes

A

Pupil dilation, swallowing, gag reflexes, withdrawing from pain, tonic neck reflex, stepping reflex, sucking reflex

100
Q

Elicited Reflexes

A

DTRs (want them to be 2+), Babinski, rooting reflex, Moro reflex

101
Q

Decorticate Posturing

A

Flexion

102
Q

Decerebrate Posturing

A

Extended and outward

Indicative of worsening neurological status

103
Q

Eye Assessment

A

Fixed and dilated pupils are emergent

104
Q

Early Signs of Increased Intracranial Pressure

A

Challenging to catch early due to vague symptoms

Irritability, increased head circumference in infants, not feeling normal, decreased appetite, fatigue, mild confusion, nausea

105
Q

Middle Signs of Increased Intracranial Pressure

A

Slower to arouse, changing pupil size/reaction time, nausea and vomiting, generalized weakness, seizures, more severe headache, tense or bulging fontanelles, suture separation

106
Q

Later Signs of Increased Intracranial Pressure

A

Decreasing LOC, decreased motor response on command, decreased sensory response due to pain, pupil size and reactivity worsens, posturing, Cheyne-Stokes respirations, setting-sun eyes, bulging fontanelles

107
Q

Full LOC

A

Responsive, alert and oriented x3, demonstrating perfectly developmentally appropriate behavior

108
Q

Confusion LOC

A

Impaired decision-making

109
Q

Disorientation LOC

A

Disorientation to time/place

110
Q

Lethargy LOC

A

Drowsy, limited spontaneous movement

111
Q

Obtunded LOC

A

Aroused only with stimulation

112
Q

Stupor LOC

A

Responds only to vigorous and repeated stimulation

113
Q

Coma

A

Unable to arouse

114
Q

Persistent Vegetative State

A

No brain activity, only reflexive movement

115
Q

Glasgow Coma Scale

A 
15 points total
13-14 is mild impairment
9-12 is moderate impairment
Less than or equal to 8 is comatose
Less than 3 is persistent vegetative state
116
Q

Lab Tests for Neurological Injury

A

Glucose, CBC, electrolytes, blood culture, evaluate for toxic substances, liver function tests

117
Q

Imaging for Neurological Injury

A

CT, MRI, PET scan, echoencephalography, ultrasound, nuclear brain scans

118
Q

Lumbar Puncture

A

Used when meningitis/encephalitis is suspected

119
Q

EEG

A

Used to diagnose seizure activity, LOC

120
Q

ABCs for Brain Injury

A

Need to guard against cerebral hypoxia (permanent damage after 4 minutes)

Risk of aspiration

Minimize invasiveness, maximize oxygenation

121
Q

Safety Considerations with Brain Injury

A

Positioning: avoid venous neck compression, keep head supported, turn from side to side

Avoid activities that increase intracranial pressure (Valsalva, crying/tantrums, stress)

122
Q

Pain Considerations with Brain Injury

A

Look for behavior changes

Analgesics, opioids, anti-seizure medications, sedatives

Rest is necessary for the brain to heal

123
Q

Concussion

A

Transient and reversible by definitiion

Instantaneous loss of awareness, often amnesia or confusion

May or may not lose consciousness

Standard is asymptomatic for 24 hours

124
Q

Post-Concussion Syndrome

A

Dementia, seizure disorders, chronic headaches, behavior changes

125
Q

Pathophysiology of Spina Bifida

A

Vertebral defect that allows the spinal cord to protrude

Can occur anywhere along the spinal cord–vast majority are lumbar or sacral

126
Q

Risk Factors for Spina Bifida

A

Chemical exposures in utero, medications (anti-epileptic), diet (lack of folic acid), genetics, gestational diabetes, maternal obesity

127
Q

Clinical Presentation of Spina Bifida

A

Paralysis, weakness, sensory loss, sac-like protrusion, bowel and bladder incontinence, neurogenic bladder, hydrocephaly if above the sacral region, intellectual deficit, visual impairment, spinal curvature, musculoskeletal/joint pain, skin sores, pressure ulcers, precocious puberty, sexual dysfunction

128
Q

Diagnosis of Spina Bifida

A

Early fetal ultrasound

Maternal alpha-fetoprotein

CT, MRI, X-ray

129
Q

Medical Management of Spina Bifida

A

Fetal corrective surgery if identified before 26 weeks gestation

Permanent catheter required with bladder incontinence

Laxatives used with chronic constipation

Braces and assistive devices to match degree of function patient needs

Diet includes lots of calcium and vitamin D, weight-bearing exercise is necessary

130
Q

Spina Bifida Initial Nursing Interventions

A

Cover the protrusion with moist sterile dressing

Prone position with legs flexed and abducted

Assess for other congenital deformities
Prevent sac from leaking

Give small bottle feedings in the prone position

Surgical preparation

Support parent-child bonding

131
Q

Spina Bifida Post-Operative Nursing Interventions

A

Prone or side-lying position for healing

Assess site routinely for signs/symptoms of infection and/or CSF leakage

Pain management
Intake and output

Daily head circumference

Bowel/bladder assessment and motor deficit assessment

Gentle ROM

Parental support

132
Q

Hemiplegia

A

Arm and leg on one side

Arm bent; hand spastic or floppy, often of little use

Walks on tiptoe or outside
of foot on affected side

Unaffected side is completely or almost normal

133
Q

Paraplegia

A

Both legs only

Upper body usually normal or with very minor signs

Child may develop contractures of the ankles and feet

134
Q

Quadriplegia

A

Both arms and both legs

When walking, head arms, and mouth may twist strangely

Often have severe brain damage and never are able to walk

Knees pressed together

Legs and feet are turned inwards

135
Q

Pathophysiology of Cerebral Palsy

A

Underlying cause is a nonprogressive brain lesion

136
Q

Clinical Presentation of Cerebral Palsy

A

Activity limitations, abnormal muscle tone and lack of coordination, hemiplegia, diplegia, quadriplegia, some degree of motor impairment and muscle spasticity, muscle weakness, delayed development, delayed speech and language, seizures, feeding difficulties related to decrease in oral muscle tone

137
Q

Diagnosis of Cerebral Palsy

A

Assessment and symptoms

CT, MRI

Genetic/metabolic testing

Functional Mobility Scale in newborns and infants

138
Q

Medical Management of Cerebral Palsy

A

Aimed at developing maximal independence and ability to perform ADLs

Braces, splints, serial casting, positional devices, therapeutic medications

Special Education services

Orthopedic surgery–tendon lengthening, muscle release

139
Q

Cerebral Palsy Mobility Nursing Implications

A

Anything to help maintain proper body alignment

Support their head, especially when younger

Range of motion to prevent contractures

Massage, therapeutic touch, riding therapy

Adaptive device referrals, parent teaching

140
Q

Cerebral Palsy Nutrition Nursing Implications

A

Supplement for a higher calorie diet

Avoid aspiration

Adaptive utensils

G-tube

Bowel program may be indicated

141
Q

Congenital Muscular Dystrophy

A

Present at birth, usually nonprogressive, nonterminal, more rare

142
Q

Duchenne Muscular Dystrophy

A

Onset is around 3-4 years of age, life expectancy is somewhere around adolescence, most common

Wheelchair users by 12 years of age

Cardiovascular/respiratory failure is typically cause of death

Pseudohypertrophic

Responsible gene is absent or deleted

143
Q

Becker Muscular Dystrophy

A

Appears after age 5, life span is around 30-40 years of age

144
Q

Pathophysiology of Muscular Dystrophy

A

Inherited disorder

Muscle fiber degeneration and muscle wasting

Onset can be early or later in life

145
Q

Clinical Manifestations of Muscular Dystrophy

A

Generalized muscle weakness

Gower’s Sign: using hands to push on legs to stand

146
Q

Diagnosis of Muscular Dystrophy

A

Confirmed by muscle biopsy

Initially by clinical signs and pattern of muscle

147
Q

Medical Management of Muscular Dystrophy

A

No effective treatment

Steroids can preserve muscle treatment and walking for a longer amount of time

Rehabilitation/physical therapy

Mental/emotional support

Dietary enhancement

Massage

Aggressive treatment of respiratory infections

148
Q

Growth Hormone Deficiency

A

Inhibits somatic growth throughout the body

Proportional decrease in growth, no dwarfism

Growth hormone injections given until growth plates close

149
Q

Primary Pituitary Hyperfunction

A

Increased production of growth hormones before the growth plates close

Delayed closure of fontanelles, increasing head circumference are early indicators

Vertical growth followed by rapid increase in muscle development

Weight proportional to height

150
Q

Acromegaly

A

Occurs after growth plate closure

No increase in vertical growth; increased size of head, nose, tongue, jaw, lips, malocclusion of teeth, thick creased skin

151
Q

Treatment of Acromegaly

A

Hormone replacement therapy

Tumor removal/radiation

152
Q

Precocious Puberty

A

Sexual development before the age of 9 in boys and before the age of 7 in Caucasian girls and 6 in African American girls

Treated by Leuprolide until normal onset of puberty

153
Q

Diabetes Insipidus

A

Undersecretion of ADH leads to uncontrolled diuresis, polyuria, polydipsia

Biggest risk is dehydration

Treatment is Vasopressin

154
Q

SIADH

A

Hypersecretion of ADH leads to inability to void or lacking the urge to void

Concern is fluid overload

Fluid retention, hypotonicity of muscles, anorexia, nausea, vomiting, irritability, behavioral changes

ADH antagonists used to treat

155
Q

Hyperparathyroidism

A

Hypercalcemia occurs

Rare in children

156
Q

Cushing’s Syndrome

A

Excessive circulating free cortisol

Side effect of prolonged steroid treatment

Moon face, red cheeks, weight gain, pendulous abdomen, red striae, ecchymosis, hyperglycemia

157
Q

Diagnostics for Type I Diabetes

A

Fasting blood glucose under 126 is normal

HbA1C

Urine ketone testing

158
Q

REEDAR

A 
Redness
Edema
Ecchymosis
Drainage
Approximation
Raised
159
Q

Acne

A

Multifactorial (hygiene, genetics)

Use a mild moisturizing soap, products with salicylic acid or benzoil peroxide

160
Q

Penicillin Allergy

A

Extremely urticaric

Appears on day 3-5 of treatment

Stop the medication

161
Q

Eczema

A

Atopic dermatitis

Inflamed, irritated, overly dry skin

Treatment is hydration and moisturize with lipid-soluble creams and lotions

Lichenification common

162
Q

Candida Albicans

A

Yeast infection

Centralized area of erythema surrounded by satellite lesions

Antifungal medications required (nystatin, diflucan)

163
Q

Fifths Disease

A

“Slapped cheek” appearance

Caused by human parvovirus B19

Facial erythema with maculopapular rash that moves proximodistal

Contagious–emergent in kids with sickle cell disease

Symptomatic support

164
Q

Hand Foot and Mouth Disease

A

Coxsackie virus

Presents as 5-10 mucocutaneous lesions that are very painful and hundreds of cutaneous lesions that are painless

165
Q

Warts

A

Human papillomavirus is responsible

Treat with chemicals, laser treatments, cryotherapy, surgery

Prevention using HPV vaccine

166
Q

Moloscum Contagiosum

A

Viral infection

Flesh-colored papules with an umbilicated center

Passed skin-to-skin

Self-resolving

167
Q

Contact Dermatitis

A

Not an allergic reaction, just an inflammatory process

Need to wash poison off as soon as possible

Only be concerned with there is a secondary complication such as periorbital edema

168
Q

Scarlet Fever Rash

A

Strep rash

Will resolve as strep throat resolves

169
Q

Tinea

A

Fungal infection that is contagious

Treatment is over the counter azole medications

Need to treat several times a day for at least 2-3 weeks

170
Q

Herpes Simplex Virus

A

Vesicles that form on the mucocutaneous borders

Tingling on the skin before lesion appears

Contagious when there are active lesions

Pediatric Nursing (7 decks)

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