Exam 4 Peds Flashcards
What will be the s/s of the CSF with bacterial meniginitis?
cloudy
decreased glucose
increased WBC
increased protein
What are the precautions for bacterial meningitis?
droplet
What are S/S of growth hormone deficiency or somatotropin insufficiency?
Short stature: proportional height & weigh
Teeth crowding
Delayed epiphyseal closure
Delayed sexual maturation
Delayed onset of pubic, facial, axillary hair, genital growth & high-pitched voice
Labe: decreased GH
GH stimulation test (*NPO 12hr prior)
Bone scan
CT scan of head
Treatment
Somatropin (growth hormone) SQ or IM injections 6-7 days/wk
Continue therapy until x-rays show epiphyseal closure
What are 2 pathos of DI (diabetes insipidus). What can cause these pathologies? What is a complication of DI?
Central (low/absent ADH from pituitary)
Nephrogenic (lack of response to ADH)
Damage to pituitary
Meningitis
Tumors pressing on pituitary
Chronic kidney disease
What are S/S of DI? Treatment? Nursing interventions?
polydipsia
polyuria, high urine output
dehydration
hypovolemia
hypernatremia
high osmolality, low specific gravity
remove tumor
ADH replacement: desmopressin or vasopressin
Monitor I&O
med considerations/education
med bracelet
What are the 2 pathos of SIADH? What are S/S of SIADH? Risk?
High ADH
water intoxication
oliguria
hyponatremia (think diluted)
low serum osmolality
weight gain
seizures
What should your mind think with anything dealing with the thyroid? What are 3 types of thyroid disorders?
think metabolism!!
Thyroid regulates metabolism
3 Types of thyroid disorders
Congenital Hypothyroidism
Acquired Hypothyroidism (autoimmune)
Hyperthyroidism
What can be the causes of congenital hypothyroidism? S/S in an infant? Diagnostic tools? Treatment?
- absent or nonfunctioning thyroid gland in a newborn
- Mom was treated for hyperthyroidism
- Mom with low iodine level or autoimmune disorder
Excessive sleepiness
Poor feeding
Large tongue
Cold, dry, & peeling extremities
Jaundice
Newborn metabolic screen
Labs: ↓ T3 & T4, ↑ TSH & lipid levels
X-ray: Delayed bone growth
Ultrasound
Synthetic thyroid hormone: levothyroxine
Vit D supplements
What can cause aquired hypothyroidism? S/S? Diagnostic tests? Treatment?
Body’s immune system makes antibodies that damage thyroid
Trauma
Surgery/Radiation
Medications
Slowed metabolism
Decreased HR, RR, BP
Cold intolerance
Goiter
Impaired growth
Labs: ↓ T4, Normal T3, ↑ TSH
Presence of antithyroid antibodies (autoimmune)
Radioactive iodine uptake test (RAIU) for carcinomas
Synthetic thyroid hormone
Levothyroxine or Synthroid
What are nursing considerations for hypothyroidism?
Monitor vital signs
Monitor respiratory status
Monitor weight
Assess for feeding difficulties
Administer medication as prescribed
Monitor for s/s
What is the cause of hyperthyroidism? What are S/S of hypertyroidism? Treatment?
genetic or autoimmune reaction causing over-secretion of thyroid hormone
high metabolic rate, weight loss
irritability
fever
rapid pulse, high BP
vomiting, diarrhea
weight loss
heat and cold intolerance
goiter
Administer supplemental vitamin D to support rapid bone growth.
Monitor thyroid levels (T3, T4 and TSH)
What is treatment for a hyperthyroid? What is a thyroid storm (complication of hyperthyroid)
1st-β-Adrenergic blocking agent (propranolol)
Anti-thyroid drug (PTU: “puts thyroid under”)
Surgery
thyroid overactivity: temp/BP/HR extremes
What is the primary cause of hyperparathyroidism? Secondary? Symptoms?
parathyroid tumor (adenoma)
kidney disease?
Hypercalcemia
Hypophosphatemia
Kidney stones
Decalcification of bones
What is the primary cause of hypoparathyroidism? What two minerals can cause a dysfunction in the parathyroid (Think 2 that always affect one another)? S/S? Treatment?
Destruction of parathyroids often the result of total thyroidectomy
too little calcium
too much phosphorus
Hypocalcemia
Paresthesia
Tetany
Chvostek sign (Twitching of facial muscles when tapping cheek)
Calcium supplementation
What is the hallmark of an adrenal insufficieny? What is a common adrenal insufficiency disease? S/S? Nursing considerations?
Under secretion of cortisol and aldosterone production leads to adrenal insufficiency
Addison’s
Extremely low BP
Ashen gray appearance
Weak pulse
Elevating temp, dehydration, hypoglycemia
hyponatremia
high potassium level
possibly seizures
sudden death
watch for S/S of hypovolemic shock
Strict intake & output
Medical alert bracelet
What is hypercortisolism? Primary causes? Is it common in infants? S/S? Treatment? What is the risk of an adrenalectomy?
Cortisol-producing tumors
benign adrenal tumors
adrenal hyperplasia
Chronic steroid use
No, rare
Moon-faced
Large bellies, thin extremities in contrast to trunk
Increased risk of infection
HTN
Hyperpigmented cheeks
Purple striae
Polyuria
Growth cessation
Signs & Symptoms
Fat accumulates on the cheeks, chin, &trunk
Moon-faced
Thin extremities in contrast to trunk
Increased risk of infection
HTN
Hyperpigmented cheeks
Purple striae
Polyuria
Growth cessation
Radiation/surgery
would go hypo and have Addison’s and now need steroids
What is the nature of DM 1? What causes it? What are BG levels for both hypoglycemia and hyperglycemia?
Autoimmune destruction & immunologic damage of beta cells causing absolute or deficiency of insulin
Idiopathic
Hypoglycemia: BG <60mg/dl
Hyperglycemia: BG >250mg/dl
What are S/S for DM1 in children? What are 4 labs used to confirm diagnoses?
SOnset abrupt and present to ED in DKA
Young children: enuresis
3 P’s: Polyuria, Polydipsia, & Polyphagia
Diagnosis & Labs
Casual BG >200mg/dl
Fasting (8 hrs) BG >126mg/dl
GTT BG> 200mg/dl
HbA1C: >7-8%
What are the 5 sick day rules for DM1?
Monitor blood glucose more frequently when sick (every 3 hours)
Test urine for ketones every 3 hours
Do NOT skip insulin or anti-diabetic meds when sick
Stay hydrated: drink 2-3 L of water (sugar-free, non-caffeinated liquids per day)
Notify doctor for blood glucose >240 mg/dl, fever >38C, urine positive for ketones, confusion, or rapid breathing (Kussmaul)
What are treatments for DM1?
Insulin administration
Regulation of nutrition (Count carbs when prepping meals)
Exercise
Stress management
Blood glucose & urine ketone monitoring
What is BG for hypoglycemia? S/S
Hypoglycemia
BG <60mg/dl
Hunger, irritability, shakiness, headache, tachycardia, decreased LOC, slurred speech, seizure/coma
What is BG for hyperglycemia? S/S?
Hyperglycemia
BG >250mg/dl
3 P’s, warm/dry skin, fruity breath, N/V, weakness, lethargy
What is treatment for conscious patients for hypoglycemia? What if they are unconscious?
Consume 10-15g simple carbohydrate (ex: 4 oz juice or soft drink, 8 oz of milk)
Recheck blood glucose frequently
Follow with a complex carbohydrate
Administer IM or subcutaneous glucagon
Repeat in 10 minutes if patient is still not conscious
Once patient is conscious (and can swallow safely), have patient consume a simple carbohydrate
What is some patient teaching for self-monitoring BG and administering insulin?
Do NOT puncture the pads of the fingers (use the skin to either side of the finger pad for better blood flow and less pain)
Perform before meals and at bedtime
Rotate subcutaneous injection sites to prevent lipohypertrophy.
Administer 4-5 injections in one site before switching to another site.
Inject at 90 degree angle (45 degree angle if thin)
Mixing insulins: Draw up clear (shorter-acting insulin) before cloudy (longer-acting insulin)
Never mix long-acting insulin (i.e. insulin glargine) with other insulins
What are risk factors for DKA? S/S?
Infection
Stress or illness
Untreated/undiagnosed T1DM
Missed insulin dose
Weight loss
Fruity breath odor
Kussmaul breathing
GI upset
Dehydration
Confusion
How is DKA confirmed? Medical treatment?
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
What are the risk factors for DM2? Medical management?
obesity
inactivity
HTN
high triglycerides
nutrition
exercise
anti-glycemic agent such as metformin or glyburide
What is PKU and it’s nature? S/S? Doagnosed? Treatment?
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
What is the structure of bone?
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
What sare traction types? Nursing considerations?
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)
What is compartment syndrome? Where is it commonly located? Cause? How can it be identified early on?
compression on nerves, blood vessels and muscle resulting in ischemia and tissue necrosis
forearm and tibial
dressing constrictions, burns, surgery, hemorrhage
neurovascular checks!!
What are the 5 Ps for neurovascular checks?
pain
paresthesia
pulselessness
paralysis
pallor
What is polydactyly? Syndactyly? Treatment and nursing considerations for both?
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
What is craniosynostosis? Why is it a problem?
Fused suture lines
nowhere for the brain to grow
What is the nature of pectus excavatum? Treatment?
“Funnel Chest”
Surgical for breathing difficulties
What is torticollis? Risk factors? Assessment findings? Treatment?
“Twisted neck”
Delivery complication
Congenital or acquired
Assessment findings
Visible appearance
Treatment and nursing care
Muscle stretches
Parent education
PT
What is plagiocephaly? Prevention? Contributing factors? Treatment?
Cranial molding in infancy
position changes and helmet care
Contributing factor: torticollis
Treatment: Physical therapy and specialized skull-molding helmets
What is osteogenesis imperfecta? Treatment?
Genetic abnormality of connective tissue- “brittle bone disease”
Treatment
Pamidronate (medication to help increase bone density)
What is aseptic necrosis of the femoral head? Findings? Treatment?
Legg-Calve-Perthes Disease
Limp, stiffness, limited ROM, pain
Varies based on severity
Pain control, PT, traction, surgery
What is developmental dysplasia (DDH) of the hip? Cause? Findings?
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
What are treatment options for DDH?
Dependent on age and severity
Pavlick Harness (newborn-6 months)
Bryant traction (adduction contracture)
Hip spica cast
Surgical correction (6 months-2 years)
What is talipes? Nature? Findings? Treatment?
clubfoot
Deformity to ankle and foot
Unilateral or bilateral
Positional, syndromic, or congenital
Deformity dependent
Treatment options
Splinting/Casting
What is scoliosis? Nature? Findings? Treatment?
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)
What is the nursing care when a lumbar puncture is performed?
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
What is the nursing care for a ventricular tap?
during: supine, firm hold, concern of hemorrhage
after: pressur dressing, keep calm, semi-fowler’s
What is the natures of a shunt with neurologic disorders? 2 kinds? Nursing care? Complications? What are temporary options until shunt placement?
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
What drug classes are commonly used to treat neurological disorders and their indications?
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
What are causes of increased ICP? Findings? In infants? In children? What are 2 types of posturing?
↑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
What is hydrocephalus? Cause? Findings? Testing?
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)
What is treatment for hydrocephalus? Complications? Nursing care?
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
What is the nature of cerebral palsey? 4 types?
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)
What is assessed with cerebral palsey?
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
What is the nature of spina bifida? Cause? What is the benign spina bifida? How is it identified? What are the more serious form of spina bifida and the 3 types?
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
What are assessment findings with spina bifida? What are complications of surgical closure of the sac? Nursing considerations?
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)
What is the nature of meningitis? Presentation in infants? Children? What will be found in CSF with a confirmed diagnosis? Medications Tx? Precaution measures?
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
What can cause encephalitis? S/S? Considerations?
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
What is GBS? Naute? Cause? Symptoms? Tx?
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
What is the most common cause of botulism? S/S? Tx?
Cause: contaminated food (commonly honey)
Symptoms are progressive: hypotonia weak gag paralysis
Treatment: Botulinum immune globulin therapy, supportive
What are types of seizures based on age and causes? Newborn? Infant/toddler? 3+ years?
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
What is the nature of a toni-clonic seizure? Clonic? Absence?
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)
What are VS changes in ICP?
temperature and blood pressure increase, and pulse and respiratory rate decrease.
What constitutes a neurologic assessment?
mental status
motor function
cranial nerves
reflexes
sensory function
What will analysis of CSF indicate when there is menigitis and why?
increased white blood cell and protein levels
increased ICP
glucose level less than 60% of blood glucose (because bacteria have fed on the glucose)
What is an example of traction used for femur in infant less than 2 years?
Bryant traction, used for fractured femurs in children younger than 2 years, is an example of skin traction
What is an example of traction used for lower extremities in older children?
Buck extension is an example of skin traction used for immobilizing lower extremity fractures in older children.
What is treatment for juvenile idiopathic arthritis?
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
What is the Gower sign?
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.
What meds are used for hyperthyroidism? What are
Considerations
Propranolol
PTU
PTU can cause immunosuppression so look for leukopenia and thrombocytopenia
