Exam 4 Peds Flashcards

Question

What are risk factors for DKA? S/S?

Answer 1

Infection Stress or illness Untreated/undiagnosed T1DM Missed insulin dose Weight loss Fruity breath odor Kussmaul breathing GI upset Dehydration Confusion

Answer 2

Diagnostics & Labs BG >330mg/dl Ketones in blood & urine Metabolic acidosis Hyperkalemia Treat underlying cause (infection) Administer IV fluids Administer IV insulin Check BG hourly Monitor K+ levels Administer Bicarb for metabolic acidosis

Answer 3

obesity inactivity HTN high triglycerides nutrition exercise anti-glycemic agent such as metformin or glyburide

Answer 4

phenylketonuria Inherited metabolic disorder: Autosomal recessive trait Newborn lacks enzyme to metabolize phenylalanine (amino acid) Builds up in bloodstream & tissues Damages brain leading to cognitive delays Early dietary interventions needed Irritability Microcephaly Vomiting Growth failure Severe cognitive impairment Seizures Newborn metabolic screen Low phenylalanine diet Avoid protein-containing foods Milk, eggs, cheese, nuts, meats, fish Infants: low phenylalanine formula

Answer 5

Diaphysis: shaft of the bone (primary center for ossification) Epiphysis: end of long bones Metaphysis: wide portion of long bone (meeting point of diaphysis and epiphysis) Periosteum: outer layer covering the bone

Answer 6

Skin traction (Buck and Bryant) Skeletal traction Halo traction Nursing Considerations: Don’t manipulate the weights! Maintain alignment Pain control (pharmacologic/nonpharmacologic) Neurovascular checks! Skin integrity Consider elimination needs Incentive spirometry Traction-specific considerations (Halo wrench)

Answer 7

compression on nerves, blood vessels and muscle resulting in ischemia and tissue necrosis forearm and tibial dressing constrictions, burns, surgery, hemorrhage neurovascular checks!!

Answer 8

pain paresthesia pulselessness paralysis pallor

Answer 9

Supernumerary digit to hand and/or foot Treatment options surgical repair/ “tying off” Nursing Considerations -parent bonding Fusion/webbing of fingers and/or toes Treatment options -surgical repair Nursing considerations -post-surgical -parent bonding -social stigma

Answer 10

Fused suture lines nowhere for the brain to grow

Answer 11

“Funnel Chest” Surgical for breathing difficulties

Answer 12

“Twisted neck” Delivery complication Congenital or acquired Assessment findings Visible appearance Treatment and nursing care Muscle stretches Parent education PT

Answer 13

Cranial molding in infancy position changes and helmet care Contributing factor: torticollis Treatment: Physical therapy and specialized skull-molding helmets

Answer 14

Genetic abnormality of connective tissue- “brittle bone disease” Treatment Pamidronate (medication to help increase bone density)

Answer 15

Legg-Calve-Perthes Disease Limp, stiffness, limited ROM, pain Varies based on severity Pain control, PT, traction, surgery

Answer 16

Abnormal development of the hip Acetabular dysplasia: Subluxation or Dislocation When does this occur? Birth order Family history Delivery considerations Asymmetry Limited ROM Positive Ortolani test (noticeable "clunk" Positive Barlow test (palpable dislocation) Trendelenburg sign in older children

Answer 17

Dependent on age and severity Pavlick Harness (newborn-6 months) Bryant traction (adduction contracture) Hip spica cast Surgical correction (6 months-2 years)

Answer 18

clubfoot Deformity to ankle and foot Unilateral or bilateral Positional, syndromic, or congenital Deformity dependent Treatment options Splinting/Casting

Answer 19

Deformity of spine Lateral curvature and rotation of spine with rib asymmetry Asymmetry Routine screening (beginning at 8 years and annually) Bracing Surgical correction (spinal fusion and rod placement)

Answer 20

before: education, topical anesthetic, consider the age of child during: C-shape, pain control, 3 tubes collected (C&S, glucose level, RBC presence) after: spinal headache, lay flat

Answer 21

during: supine, firm hold, concern of hemorrhage after: pressur dressing, keep calm, semi-fowler's

Answer 22

Surgically placed catheter to shunt extra CSF away from brain Ventriculoperitoneal (VP) shunt (most common) Ventriculoarterial (VA) shunt Surgical considerations for shunt placement Shunts require revisions! Family education on shunt complications (irritability, lethargy, vomiting) Infection prevention (infected shunt can lead to meningitis) Reservoirs External drains Ventricular tap

Answer 23

Osmotic diuretics (mannitol) Indication: decrease cerebral swelling Corticosteroids (dexamethasone) Indication: decrease cerebral swelling Antiepileptics (gabapentin, phenytoin, clonazepam) Indication: decrease incidence and severity of seizures Antispasmodics and skeletal muscle relaxants (Botulin toxin, baclofen) Indication: decrease muscle spasms and severe spasticity

Answer 24

↑CSF, blood in CSF, cerebral edema, head trauma, infection, tumors, hydrocephalus, Guillain-Barre Syndrome Can occur with multiple neurologic disorders Headache/irritability/restlessness VS change (↑ Temp/BP, ↓HR/RR) Pupillary changes (diplopia, dilation, Doll’s eye reflex) Infant: bulging fontanel, increased OFC, irritability, restlessness, high-pitched/shrill cry, poor feeding, sunset eyes Children: nausea, headache, vomiting, blurred vision, decline in school performance, seizures Posturing Decorticate (arms adducted/flexed on chest, legs extended/internally rotated) *cerebral cortex dysfunction Decerebrate (rigid extension/adduction of arms, wrists pronated, legs extended) *midbrain dysfunction

Answer 25

Abnormal accumulation of CSF in the ventricles or subarachnoid space typically due to an obstruction or interference with absorption Congenital (at birth) or acquired (incident) In-utero detection Bulging fontanel, widened suture lines Bossing forehead, sunset eyes OFC measurement ICP assessment (↑ Temp/BP, ↓HR/RR) Ultrasound, CT, MRI Transillumination (highlights fluid)

Answer 26

Treatment based on cause Diuretics (if caused by overproduction of CSF) Shunt placement (if obstruction is the cause) Complications Increased ICP leading to brain tissue damage motor/mental deterioration Education Pre/post-op considerations for shunt placement Shunt education and care Psychosocial considerations

Answer 27

A group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction. Caused by abnormal brain development or damage to the developing brain that leads to cell destruction of the motor tracts. Four main types: Spastic/Pyramidal (most common- stiff/tight muscles) Dyskinetic/Extrapyramidal (non-spastic, involuntary muscle movement) Ataxic (non-spastic, shaky movements- affects balance) Mixed (combination damage-severe impairment)

Answer 28

Full health history and evaluation of prenatal/perinatal/postnatal risk factors (anything contributing to anoxia to brain) Sensory alterations (strabismus, refractive disorders, visual perception/field defects, speech impairment) Vision, speech, or hearing impairments Neurologic findings (toe walking, arching, posturing, hyperreflexia, seizures) Attention deficit disorder, Autism Seizure activity Cerebral asymmetry

Answer 29

Neural tube defect characterized by lack of fusion of posterior surface of the embryo Due to maternal malnutrition, medications, insufficient folic acid, and/or family Hx Spina bifida occulta Internal defect common to lumbosacral area (no spinal cord involvement) Dimpling and/or hair tuft to sacral area (follow-up necessary) Spina bifida cystica (protruding sac) Meningocele Spinal fluid and meninge involvement Myelomeningocele (most common) Spinal fluid, meninge, and nerve involvement Encephalocele (cranial meningocele

Answer 30

Dependent upon lesion involvement Muscle flaccidity Lack of bowel control Rectal prolapse Scoliosis/kyphosis Skin integrity Increased ICP Bowel/bladder control Orthopedic considerations (protect the sac and keep moist with NS dressing, prone positioning, OFC measurements Post-op considerations (ICP monitoring, CSF leakage prone positioning infection prevention ROM exercises Intermittent bladder catheterization (inpatient and possibility of home)

Answer 31

Often result of a URI Intense HA (sharp pain upon head movement) Infant: poor suck, weak cry Older child: arched back, neck hyperextension CSF results: ↑WBC/protein, glucose comparison to blood glucose (bacterial meningitis will have cloudy CSF) Medications/Tx Antibiotic therapy (primary therapy) Intrathecal (CSF) injections Corticosteroids (dexamethasone)- for bacterial meningitis Diuretics Analgesics Isolation precautions: droplet

Answer 32

Occurring from protozoan, bacterial, fungal, or viral invasions (enterovirus, mosquito-borne illness, measles, mumps, varicella) Headache, fever, ataxia (muscle loss), lethargy, comatose, + Brudzinksi or Kernig sign Childhood vaccination necessity Long-term considerations from neurologic damage

Answer 33

Group Beta Strep (GBS) Infection Major cause of meningitis in newborns Cause: in-utero/delivery contact Symptoms: respiratory distress/pneumonia  meningitis (lethargy, fever, bulging fontanel) Treatment: antibiotics

Answer 34

Cause: contaminated food (commonly honey) Symptoms are progressive: hypotonia  weak gag  paralysis Treatment: Botulinum immune globulin therapy, supportive

Answer 35

Newborn seizures (head twitching, lip smacking, cyanosis and/or apnea) Cause: trauma, anoxia at birth, hypoglycemia, infection Infantile spasms Generalized seizure typically from trauma, metabolic disease, or infection Poisoning/Drugs Febrile (SUDDEN spike in temp; 102F to 104) Tonic-Clonic Absence

Answer 36

Tonic-clonic (grand mal) No warning Most prevalent Tonic phase (eyes roll upward, contraction of whole body, increase salivation, apnea) Clonic phase (violent jerking, mouth foaming, incontinence) Postictal state (semiconscious, vomiting/headache, lethargic, no recollection of seizure) Absence (petite mal) Loss of consciousness, blank stare, minimal behavior change, momentary confusion, automatisms (lip smacking, eyelid twitching)

Answer 37

temperature and blood pressure increase, and pulse and respiratory rate decrease.

Answer 38

mental status motor function cranial nerves reflexes sensory function

Answer 39

increased white blood cell and protein levels increased ICP glucose level less than 60% of blood glucose (because bacteria have fed on the glucose)

Answer 40

Bryant traction, used for fractured femurs in children younger than 2 years, is an example of skin traction

Answer 41

Buck extension is an example of skin traction used for immobilizing lower extremity fractures in older children.

Answer 42

Because JA is a long-term illness, therapy includes a balanced program of exercise, rest, and medication administration to relieve pain, restore function, and maintain joint mobility

Answer 43

rise from the floor only by rolling onto their stomachs and then pushing themselves to their knees. To stand, they press their hands against their ankles, knees, and thighs (they “walk up their front”), called a Gower sign.

Answer 44

Propranolol PTU PTU can cause immunosuppression so look for leukopenia and thrombocytopenia

Exam 4 Peds Flashcards

(68 cards)