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WCF > Exam #5 > Flashcards

Exam #5 Flashcards

1
Q

Neural tube defects (NTDs) are a group of birth defects in which malformations of the __________ and __________ __________ occur and the structures lack protection of soft tissue and bone. NTDs develop when the neural tube fails to close during fetal development.

A

brain and spinal cord

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2
Q

Spina Bifida is a __________ __________ defect.

A

neural tube

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3
Q

Risk factors for Spina Bifida

A

o Poor nutrition
o Prolonged hyperthermia
o DM
o Seizure meds

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4
Q

Least severe form of Spina Bifida

A

Spina Bifida Occulta

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5
Q

CSF fluid filled sac w/ no nerve endings or spinal cord in it

A

Meningocele

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6
Q

May be a closed or open sac containing nerve endings and/or spinal cord. Most severe form of Spina Bifida.

A

Myelomeningocele

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7
Q

Spina Bifida management after delivery

A

o Keep patient prone
o Moist, sterile dressing on defect
o Laminectomy

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8
Q

Spina Bifida management in utero

A

surgical repair

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9
Q

Spina Bifida management after surgery

A

o Post-op care: wound, VS (NO RECTAL TEMPS), antibiotics, pain control

o Manage neurological deficits
▪ Bowel/bladder training- anticholinergics and antispasmodics to help with continence and spasms
▪ Constipation/impaction is common
▪ Straight cath

o Head circumference measurements (hydrocephalus)

o Skin care & mobility

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10
Q

Fluid and pressure buildup in the ventricles and intracranial vault due to
-increase of CSF production
-Impedance to absorption
-obstruction to flow

A

Hydrocephalus

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11
Q

S/sx of Hydrocephalus

A

-Increased ICP if disorder is severe enough
-Sun-setting eyes
-Prominent forehead/enlarged
-Difficulty holding head upright

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12
Q

Treatment for Hydrocephalus

A

Shunt

Usually ventriculoperitoneal

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13
Q

When does shunt infection or malfunction typically occur?

A

Can happen at any time

Most often 1-3 months after placement

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13
Q

Common s/sx of shunt infection/malfunction

A

NV
HA
Bulging fontanels
Change in customary behavior
Lethargy, unresponsiveness, sunset eyes
Elevated temp.

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13
Q

Shunt reminders

A

-do not allow child to lie on shunt side continuously
-no contact sports
-prophylactic antibiotics w/ dental & surgical procedures

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14
Q

How do we determine a child’s LOC?

A

-observation
-using the pediatric Glasgow Coma Scale
-subjective (caregiver history)

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15
Q

Patient answers appropriately while opening his eyes and responding fully.

What state of LOC?

A

alertness

Technique: speak in a normal tone of voice

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16
Q

Patient opens his eyes but appears drowsy; answers questions appropriately but falls asleep easily.

What state of LOC?

A

Lethargy

Technique: speak in a loud voice

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17
Q

Patient opens his eyes and looks at the stimuli; appears slightly confused; alertness & interest in surroundings are decreased.

What state of LOC?

A

Obtundation

Technique: shake gently to arouse

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18
Q

Patient only responds to painful stimuli; verbal responses are absent or slow. Responsiveness to painful stimuli ceases.

What state of LOC?

A

Stupor

Technique: use painful stimuli

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19
Q

Patient does not respond to internal or external stimuli; they remain in an unaroused state with eyes closed.

A

Coma

Technique: apply repeated painful stimuli

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20
Q

What are the three parts to the Glasgow Coma Scale?

A

▪ Eyes
▪ Verbal response
▪ Motor response

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21
Q

Glasgow Score 9-15

A

Unaltered Consciousness

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22
Q

Glasgow Score 4-8

A

Coma

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23
Q

Glasgow Score 3 or below

A

Deep coma

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24
Q

Early signs of ICP

A
  • Headache
  • Emesis
  • Change in LOC
  • Irritability
  • Sunsetting eyes
  • Decreased eye contact (infant)
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25
Q

Late signs of ICP

A
  • Further decrease in LOC
  • Bulging fontanelles
  • Posturing
  • Papilledema
  • No pupil response
  • Cushing’s Triad
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26
Q

Meds for ICP

A
  • Antipyretics (no shivering)
  • Barbiturates
  • Anti-seizure/epileptics
  • Mannitol*
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27
Q

Tx for ICP

A
  • HOB at least 15 to 30 degrees
  • PROM q2 hours
  • O2 & Respiratory care: Intubate (VAP care), Suction only as needed
  • Decompressive Craniectomy if
    necessary
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28
Q

Progressive encephalopathy w/ hepatic dysfunction

A

Reye Syndrome

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29
Q

How is Reye Syndrome diagnosed?

A

-liver biopsy
-lumbar puncture
-CT/MRI

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30
Q

What is a risk factor for Reye Syndrome?

A

salicylate use (aspirin)

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31
Q

Treatment for Reye Syndrome is

A

symptom dependent

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32
Q

Rare immune system response that attacks myelin

Caused by:
-EBV
-Cytomegalovirus
-Varicella
-Campylobacter

A

Guillain-Barre Syndrome

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33
Q

S/sx of Guillain-Barre Syndrome

A

-muscle weakness or paralysis
-numbness or tingling
-resp. distress
-hypotension
-areflexia (lack of any reflexes)

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34
Q

How is Guillain-Barre Syndrome diagnosed?

A

-clinical signs
-lumbar puncture to evaluate protein in CSF
-electroyography

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35
Q

How to prepare before a seizure

A

-know the triggers (lights, certain noises or smells, temp. changes, etc. )
-look for alerts: seizure animal, mediAlert jewelry, behavioral responses or complaints

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36
Q

Things to do during a seizure

A

Safety is key

-protect for injury
-keep airway stable (pulse ox, oxygen, prepare suction)
-meds (valium or ativan)

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37
Q

Things to do after a seizure

A

-document how long and patient response
-monitor VS and behavior
-complete a focused neuro assessment

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38
Q

Caregiver education re: seizures

A

-med compliance
-safety @ home, school, community
-limiting certain sports

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39
Q

Inflammation of the meninges that is identified by an abnormal rise in WBC in the CSF

Can be viral or bacterial; Common after OM or URI, penetrating wounds, skull fractures, contaminated LP equipment

A

Meningitis

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40
Q

Acute febrile illness causing inflammation of the brain and meninges

Most commonly viral

A

Encephalopathy

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40
Q

S/sx of encephalopathy

A

High fever
Coma
Confusion

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40
Q

S/sx of meningitis

A

Positive Kernig and Brudzinski sign

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40
Q

S/sx shared by Meningitis & Encephalopathy

A

HA
Photophobia
Lethargy
Irritability
NV
Nuchal rigidity
Seizures

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41
Q

Tx options for Meningitis & Encephalopathy

A

Meds: antibiotics (bacterial), antivirals (acyclovir), anti-inflammatories, antipyretics, analgesics

Nursing care: decreased stimuli, seizure precautions, focused neuro assessment, ICP monitoring, droplet precautions, freq. VS, HOB elevated, fluid hydration, electrolyte monitoring

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42
Q

Disorder of muscle control or coordination caused from an injury to brain during early development; most common permanent physical disability of childhood

Caused by prematurity, perinatal infections, perinatal asphyxia, meningitis, non-traumatic brain injury, near drowning, hyperbilirubinemia

A

Cerebral palsy

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43
Q

S/sx of cerebral palsy

A

-difficulty w/ mobility & coordination, rigidity, spasticity, hyper/hypotonia, ataxia, poor posture
-decrease in vision, hearing, emotions & cognitive abilities
-seizure disorders

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44
Q

Meds for cerebral palsy

A

-reduce spasms (dantrium, baclofen)
-paralyze certain muscles w/ botox
-control seizures (Dilitan)
-control tension (Valium)
-control secretions
-control reflux

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45
Q

Child’s ability to walk indicates the severity of the disease. If the child can sit by 2 years of age, they will probably walk.

Death is usually due to

A

the related problems of immobility, malnutrition, and seizures

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46
Q

Important nursing care points for cerebral palsy

A

nutrition, mobility, skin integrity, safety, growth & development, parental knowledge, emotional support

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47
Q

Decreased circulating RBCs d/t
decreased, production, increased destruction, or acute/chronic blood loss

A

Anemia

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48
Q

General s/sx of anemia

A

-lethargy/fatigue
-SOB
-HA
-difficulty concentrating
-pale skin
-irritability
-tachycardia
-murmur

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49
Q

Decreased iron supply

Most common nutritional disorder in infants & young children worldwide

Microcytic, hypochromic

Iron is needed to make Hgb This type of anemia decreases oxygen carrying capacity of blood.

A

iron deficiency anemia

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50
Q

Causes of iron deficiency anemia

A

dietary, increased demands, blood loss, inability to form Hgb, impaired absorption, lead poisoning

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51
Q

S/sx of iron deficiency anemia

A

mild: asymptomatic, SOB, tachycardiac during exertion

moderate: SOB, tachycardic, palpitations, dizzy, fainting, irritability, & PICA

severe: murmur, CHF, enlarges spleen

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52
Q

Diet for iron deficiency anemia

A

-breast milk or Fe formula for 1st 12 months
-no cow’s milk until 1yr & limit to 18-24oz/day
-beans, whole grains, & cereals for vegetarian

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53
Q

Reminders for elemental Iron supplements

A

-give on empty stomach w/ vitamin C juices
-don’t give w/ milk or tea
-use straw/dropper & rinse mouth (can stain teeth)
-GI side effects such as constipation, GI upset, black tarry stools may be normal

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54
Q

Hereditary bleeding disorder. There is a deficiency in specific clotting factors.

A

Hemophilia

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55
Q

What type of hemophilia?

Factor VIII

A

Hemophilia A

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56
Q

What type of hemophilia?

Factor IX

A

Hemophilia B (Christmas)

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57
Q

What type of hemophilia?

Factor XI

A

Hemophilia C

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58
Q

What type of hemophilia?

Factor VIII & poor platelet aggregation

A

Von Willebrand’s disease

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59
Q

S/sx of hemophilia

A

-excessive & prolonged bleeding
-tingling, pain, swelling
-hemarthrosis

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60
Q

Tx and nursing care for hemophilia

A

-Recombinant Factor replacement therapy (IV)
-prophylactic use
-family teaching is paramount to outcomes
-focus on safety preventing, and promoting quality of life
-genetic counseling

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61
Q

Hemophilia pts should avoid

A

aspirin, IM Injections, and activities that may cause injury

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62
Q

Acquired hemorrhagic disorder causing excess destruction of circulating platelets (platelet count <100K) and/or shortened platelet life span from antiplatelet antibodies

No known cause

Diagnosed by exclusion & labs

A

Immune thrombocytopenia purpura (ITP)

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63
Q

S/sx of ITP

A

-petechiae/purpura
-epistaxis
-mucocutaneous bleeding
-rare: intracranial hemorrhage

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64
Q

Tx & nursing care for ITP

A

Steroids, IVIG, splenectomy

Restrict contact sports & high risk activities, lean forward & pinch for nosebleeds, bleeding precautions (avoid aspirin, straight edge razors, tampons, inserting items in rectum)

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65
Q

Autosomal recessive genetic trait in which globin chain in normal Hgb A replaced w/ Hgb S

A

Sickle cell disease

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66
Q

S/sx of sickle cell disease

Remember all organs are affected

A

PAIN! (cardinal symptom)

Weakness/fatigue, jaundice from hemolysis, chronic anemia, susceptible to infection, delayed growth & sexual maturation, avascular necrosis of shoulder or hip, cholelithiasis

All complications are r/t occlusion.

67
Q

Pt education re: sickle cell anemia

A

-fevers require IMMEDIATE medical attention
-report worsening s/sx
-avoid strenuous activities
-avoid crisis w/ rest & adequate hydration

68
Q

Prophylactic antibiotics and immunizations (Hib, pneumococcal) decrease the rates of _________ in sickle cell anemia patients.

A

sepsis

69
Q

Emergency related to sickle cell anemia

Can occur anywhere in the body (hands/feet long bones, joints, and abd)

Soft tissue swelling and pain

Tx is hydration, pain management w/ opioids and NSAIDs

A

vaso-occlusive crisis

70
Q

Pedi considerations for cancer

A
  • Not strongly linked to lifestyle or environmental factors
  • > 60% participate in clinical trials
  • Originate in mesoderm/ectoderm
  • Fast growing (80% mets at diagnosis)
71
Q

skeletal, muscle, bone tissue formation

A

mesoderm

72
Q

outer parts of the body- skin, spinal cord, eyes

A

ectoderm

73
Q

major organs: liver, pancreas, lungs, etc.

A

endoderm

74
Q

Childhood oncology diagnosis

A

Often presents w/ vague sx (which can delay diagnosis)

Tumor markers, bone marrow aspirate & biopsy, CSF analysis

X-rays, CT scans, MRI, bone scan, PET scan, nuclear med

75
Q

S/sx of pedi cancer

A

Continued, unexplained pain
Headaches, unexplained weight loss
Increased swelling/persistent pain in bones, joints, back, legs
Lump or mass
Development of excessive bruising, bleeding, or rash

Constant infections
A whitish color behind pupil
Nausea that persists or vomiting w/o nausea
Constant tiredness or noticeable paleness
Eye or vision changes that occur suddenly or persist
Recurrent or persistent fevers of unknown origin

76
Q

Tx options for cancer

A

surgery, radiation, chemo, stem cell transplant, biotherapy, complementary therapy

Multimodal treatments have shown increased success

77
Q

Nursing care for a client with cancer (what to monitor, psychosocial considerations)

A
  • Assess fear & anxiety
  • Assess development
  • Regression
  • Body image disturbance
78
Q

Side effects of cancer treatment & corresponding tx

A

NV related to chemotherapy; given antiemetics (Zofran)

Acute or chronic pain; give pain meds, rest & sleep, massage, heat, distraction, & social support

Mucositis- inflammation of mucosa in mouth caused by chemo & radiation; magic mouthwash and oral assessments

Impaired nutrition- higher nutrition needs with lack of appetite; can lead to irritability, susceptibility to infections, reduction in growth and development; offer food choices and small frequent feedings, may need enteral feedings or TPN

79
Q

Proliferation of abnormal blood cells in the body. Stem cells in bone marrow produce immature WBC blasts

Most common cancer diagnosis in children under 14

A

Childhood Leukemia

80
Q

S/sx of childhood leukemia

A

fever, bone pain (refusing to walk), enlarged liver or spleen, increase lymphadenopathy, cold or flu like sx

Persistence of symptoms is key

81
Q

Bone marrow aspirate and biopsy

A

o Should show < 5% blasts
o Definitive if bone marrow reveals > 25% blasts

82
Q

Pediatric Perceptions of Death

Based on degree of discomfort, reactions of parents

What age group?

A

infant

83
Q

Pediatric Perceptions of Death

Separation from parents or disruption in routine

What age group?

A

toddler

84
Q

Pediatric Perceptions of Death

Magical thinker: illness or injury viewed as punishment, death is temporary, death should not be described as “going to sleep”

What age group?

A

preschool

85
Q

Pediatric Perceptions of Death

May feel responsible, at age 8/9 understand the permanence of death, preparation is helpful, important to feel some control

What age group?

A

school age

86
Q

Pediatric Perceptions of Death

Understands at an adult level, difficulty accepting it as reality, more questions about death & afterlife, info about disease is important

What age group?

A

adolescent

87
Q

Before death care

A

Facilitate communication and build trust:
o Family needs HONEST information about treatment options and potential outcomes
o Family care conferences
o Ethics committee for certain situations
o Maintain a consistent message from team
o Encourage the family to keep a log/journal

Aspects to consider:
o Palliative Care or Hospice
o DNR status
o Continue school
o Organ donation (Gift of Life)
o Autopsy

Address Physical and Emotional needs caregiver and patient:
- Spiritual support
- Sleep, food, hygiene, etc.
- Flexible visitation

88
Q

During death care

A

Orient to routines, explain tubes/lines

Prepare family for changes in the child’s appearance such as:
o Respirations-noisy; Cheyne-Stokes
o Loss of senses
o Decreased vital signs
o Decreased appetite
o Confusion
o Incontinence
o Seizures

Comfort measures:
o Manage pain & anxiety
o Use of touch
o Peaceful environment

Continue talking to the child:
o Tell the child that it is OK to let go
o Reassure child that he is loved

89
Q

After death care

A
  • Allow family time with the child/hold child: Do NOT RUSH-allow family to dictate timeline
  • Allow siblings to say good-bye
  • Post-mortem care: Final bath
  • Save all personal items
  • Remembrance boxes (Locks of hair, footprints, etc..)
  • Assist with contacting funeral home
  • Offer information regarding support groups
90
Q

Nurse stress

A

burnout, compassion fatigue, alarm fatigue, moral distress

91
Q

Interventions for burnout

A multifactorial state of “being” in which the nurse experiences an emotional or physical disconnect w/ their working or professional environment

A

-take breaks
-limit overtime
-create a life outside of work environment

92
Q

Interventions for compassion fatigue

Compassion fatigue exists as a result of a continuous display of empathetic feelings and behaviors w/o proper holistic replenishment

A

-support groups
-fair & equitable staff assignments
-attending memorial services (depends on individual)

93
Q

Interventions for alarm fatigue

Delayed or non-existent responses to alarms

A

-hourly rounding*
-proactive planning

94
Q

Interventions for moral distress

Nurse acts contrary to personal/professional values

A

-evaluate your personal judgements on situations
-ask for clarification
-understand your resources (ethics committee, supervisor)

95
Q

Effects of illness (acute and chronic) on the patient & family system

A

Infant - trust
Toddler - autonomy
Preschooler - initiative
School age - industry
Adolescent - identity
Caregiver - burnout

96
Q

Environment of Care

Sensory overload

A
  • Minimize noise levels,
  • Adequate sleep/rest times, when possible
  • Day/night routine
  • Cluster care
97
Q

Patient response to chronic illness

A

-can produce extreme fear, anxiety
-children may appear withdrawn, feel powerless
-sleep affected
-regression
-growth and developmental delays

98
Q

Family response to chronic illness

A

-sense of unknown
-loss of parental role, normal family functions, isolation from other family members
-financial concerns
-siblings may act out

99
Q

Erickson’s theory of psychosocial development

Basic needs must be met, and trust must be learned

“Hold me, feed me, take care of me”

A

Trust vs. Mistrust
(Birth-1 year)

100
Q

Erickson’s theory of psychosocial development

Controlling body excretions, “No”, balance independence and
self-sufficiency

“Watch me do this myself”

A

Autonomy vs. Shame & Doubt
(1-3 years)

101
Q

Erickson’s theory of psychosocial development

Exploring world, creating, resourcefulness to achieve and learn new things

“I want to help you; I can do it too”

A

Initiative vs. Guilt
(3-6 years)

102
Q

Erickson’s theory of psychosocial development

New activities, sports, school, sense of confidence

“I want to fit in”, “What are the rules?”

A

Industry vs. Inferiority
(6-12 years)

103
Q

Erickson’s theory of psychosocial development

New sense of identity, clear sense of self

“I just want my friends”, “Who cares, so what”

A

Identity vs. Role Confusion
(12-18 years)

104
Q

Piaget’s theory of cognitive development

  • Learns from sensory input, language skills
  • Looking hearing touching, mouthing, grasping
A

Sensorimotor (Infant-2 years)

105
Q

Piaget’s theory of cognitive development

  • Increasing verbal, limitations in thought. Development of motor skills.
  • Talking, drawing,
  • Using words and images to represent things. Gradually evolves to pretend play
A

Preoperational (2-6 years)

106
Q

Piaget’s theory of cognitive development

  • Mature, abstract thought and reasoning to handle difficult concepts
  • Forming abstract thought and ask why in a different way
  • Looking at moral reasoning
A

Formal operational (12-adulthood)

106
Q

Piaget’s theory of cognitive development

  • Organize thought in logical order. Manipulates objects
  • Do math, basic word problems
  • Grasping concrete analogies. Performing mathematical operation
A

Concrete operational (7-11 years)

107
Q

Type of play for infants

A

solitary play

reflexive manner
grasps objects

108
Q

Type of play for toddlers

A

Imitative behavior

copying of actions performed by another person

109
Q

Type of play for preschoolers

A

Associative play

children play together, but have different ideas and goals

110
Q

Type of play for school age

A

Cooperative play

111
Q
  • No cervical change (from previous dilation/effacement)
  • CTX do not intensify and may space out
  • Can walk/talk through CTX, walking does not make them stronger
  • Pain medication may stop contractions (Braxton Hicks)

What type of labor?

A

False (latent) labor

112
Q
  • Cervical change
  • CTX get longer, stronger, closer together, & demand attention
  • Walking may make them stronger
  • Pain med may slow or speed up labor, never stop
  • Contractions that are increasing in frequency and duration and intensity along with
    cervical change
  • “5-1-1”
    ▪ Occurring every 5 minutes
    ▪ Lasting 1 minute and happening for 1 hour

What type of labor?

A

True labor

113
Q

Signs of impending labor

Labor is coming soon but doesn’t mean she is in labor

A
  • Lightening: the baby dropped
  • Irregular contractions
  • Energy spurt “nesting”
  • Urinary frequency- baby is pushing on the bladder
  • Bloody show/vaginal discharge: mucus plug and can have blood and the baby is about to come
  • Loss of mucous plug
  • Pelvic pressure- may have to go have a bowel movement- tell your nurse because the baby’s head is coming down
114
Q

Interventions for PPROM

A

o Hospitalization, bed rest PRN
o Fetal surveillance
o Antibiotics
o Tocolytics
o Corticosteroids

Delivery if there are signs of infection

Without intervention, 50% of patients who have ROM will go into labor within 33 hours

115
Q

PPROM nursing care

A

– Obtain vaginal swab for fFN testing
– Collect cervical cultures
– Explain to the patient they will be on modified bedrest with VS checked every 4 hours
– Monitor FHR and contractions
– Explain that frequent US will be done to assess amniotic fluid levels
– Administer tocolytics and betamethasone as ordered
– Provide emotional support

116
Q

Low levels of amniotic fluid –> higher risk of

A

cord compression

117
Q

PPROM treatment

A

– STRICT STERILE TECHNIQUE (Fern/Nitrazine/Amnisure Test)
– No vaginal exams, unless delivery is imminent
– Expectant management (aka watch and wait) is recommended as long as there are no contraindications

118
Q

PTL Prevention: Lifestyle Modifications

A

Avoid:
o Sexual activity
o Riding long distances
o Carrying heavy loads
o Standing for long periods
o Hard, physical labor

119
Q

Barriers to mental health- late diagnosis, treatment, and resolution most often stems from societal stigmas and deflection

A

-negative opinion of psychosocial or cognitive conditions
-childhood is a “sacred” happy time, free of problems
-providers minimize or dismiss parental concerns
-child is going through a stage that “will pass”
-lack of access**

120
Q

Nursing management of hospitalized client with a mental health condition

A

Safety, evaluating risk of harming self or others, liaison w/ family and therapist, support family-child, monitor when receiving antidepressants, vitals, side effects, and dietary intake

Discharge planning- educate s/sx of worsening depression, meds, suicide prevention, and support groups

121
Q

Any type of physical or emotional uneasiness that impedes normal developmental and/or social growth

-generalized, separation, panic, agoraphobia, PTSD

A

Anxiety

122
Q

Constant and consistent feelings of sadness and/or being “low”. Diagnosis requires manifestations in these five areas: persistent sad or irritable mood, changes in appetite/weight/sleep patterns, fatigue/loss of energy, feelings of worthlessness, inability to concentrate, recurrent thoughts of death/suicide, anhedonia (loss of ability to feel pleasure)

Can use PHQ-A or Beck Depression Inventory. No screening tool available to children under 12.

A

Depression

123
Q

Characterized by extreme mood swings between feelings of sadness to hyper excitability and/or aggressiveness

A

Bipolar disorder

124
Q

Bipolar disorder - what phase?

Happy, silly, irritable, wired, very little sleep, easily distracted, hyper-sexuality, risk-taking behaviors, impulsive

A

Manic phase

125
Q

Bipolar disorder - what phase?

Persistent sadness, irritable, anhedonia, increase in amount of sleep, thoughts of death or suicide

A

Depression phase

126
Q

Suicide is the 2nd leading cause of death for youth and young adults between the ages of 10-34. 90% dying by suicide had underlying mental illness.

Signs of suicide

A

Talk of being a burden, feeling trapped, experiencing unbearable pain, having no reason to live, and killing themselves

Mood- depression, loss of interest, rage, irritability, humiliation, anxiety

Behavior- acting recklessly, increased use of drugs/alcohol, withdrawing from activities, isolating, sleeping too much/too little, saying goodbye to love ones, giving away prized possessions

127
Q

Suicide prevention includes

A

-remove or secure harmful objects (guns/weapons, poisons, medications) close
-constant supervision
-resources (crisis hotlines, counseling, inpatient facilities)

128
Q

One of the most common neurodevelopmental disorders of childhood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result may be), or be overly active.

Diagnosis requires symptoms must be:
Present for at least 6 months
Present before 12 years of age
Occur in at least 2 settings (school, home, etc.)
Evidence of impaired social, academic functioning

A

ADHD

129
Q

Presentation of ADHD

Inattention, hyperactivity, impulsivity

A

Inattention- distractibility, inability to complete projects, easily bored, disorganized, inattentiveness, avoidance of detailed tasks, forgetfulness

Hyperactivity & impulsivity- excessive energy and activity, restlessness, overactivity, inability to sit still, excessive talking, poor boundaries, interrupts, difficulty delaying

130
Q

ADHD Tx

A

Environmental changes- decrease stimulation, structured routine, consistent limits

Behavior therapy- play & group therapy, reward for desired behaviors, consequences for undesired behaviors

Pharmacotherapy- stimulants and non-stimulants

Complementary therapy- elimination of processed foods, sugars, aspartame, and yeast from diet; supplements- melatonin, Omega-3, vitamins; “green time”/being out in nature

131
Q

Abnormalities in neurodevelopmental processes resulting in altered sensory perceptions.

A

Schizophrenia

132
Q

Schizophrenia

Safety is the main priority during an active episode.

Active episodes include:

A

Active episode includes hallucinations, delusions (false beliefs), disorganized speech & behavior, flat affect/speech/motivation

133
Q

What eating disorder?

-Weight <85% of expected weight
-Distorted body image
-Absence of 3 consecutive menstrual cycles

A

Anorexia nervosa

134
Q

What eating disorder?

-Lack of control overeating
-Recurrent inappropriate compensatory behavior
-Cycle of binge eating with purging (dental erosion & redness/irritation on fingers)

A

Bulimia nervosa

135
Q

What eating disorder?

-binging w/o purging

A

binge eating

136
Q

Management of eating disorders

A

*Highly structured environment
*Involve client in decision making
*Realistic weight goals
*Assist in changing negative perception to positive
*Monitor weight, VS, I&O, caloric intake, exercise
*Education/discharge instructions

137
Q

Abnormalities in brain structure & function

Essential features:
Impaired socialization, communication, and behavior
Cognitive impairment varies

Characteristics:
Rigid, repetitive, machinelike movements, obsessive
-Head banging, twirling in circles, biting themselves, flapping hands, rocking back and forth
-Prefers to be alone
Abnormal response to stimuli
-extreme aversion to touch, noises, lights
-may not respond to pain
-resists attention and affection
-communication challenges, no eye contact
-difficulty interpreting feelings or gestures of others

A

Autism spectrum disorder

AAP recommends screening for Autism at the 18 and 24 month well child check ups.

138
Q

Safety concerns for children w/ autism

A

Wandering/Elopement
Bullying
Sexual Abuse

139
Q

Global delays in development functioning
-Encompasses number of disorders
-Affects mental and/or physical development
-Wide variability in classification
-May occur w/ variety of physical conditions

A

developmental disorders

140
Q

Conditions responsible to for developmental disorders:

A

*Genetic-DS, FXS
*Metabolic-PKU
*Pregnancy-Fetal alcohol, Maternal Rubella, Birth asphyxia
*External-TBI, Poison, Hypoxia, Environmental deprivation

141
Q

Hormones control

A

*Growth & Development
*Sexual Maturation
*Energy use and storage
*Control of levels of sugar, salt, fluids in the bloodstream
*Response to stress or physical trauma

Alterations in functioning significantly impact children!

142
Q

Pituitary hypofunction causes

A

Growth Hormone Deficiency

■ Delayed growth of less than 2 in a yr needs to be evaluated
■ Delayed closure of the anterior fontanelle
■ Delayed dental eruption
■ Greater weight-to-height ratio
■ Increased abdominal (truncal) fat
■ Poor development of bridge of nose
■ Protrusion of the frontal skull bones
■ Delayed puberty, including a high-pitched voice and a small penis or testes in boys
■ Hypoglycemia in neonatal period

143
Q

Secondary sex characteristics developing before age 8 in girls and age
9 in boys

Can be congenital or acquired

A

Pituitary hyperfunction AKA Precocious Puberty

144
Q
  • Hypofunction of posterior pituitary gland
  • It can be Neurogenic or Nephrogenic

S/sx:
* Infants–> FTT, saturated diapers, fussy
* Older children–> Irritable, polydipsia (excessive
thirst), polyuria, enuresis

A

Diabetes Insipidus

145
Q

How is DI diagnosed and treated?

A

Diagnosis:
* 24 hour urine (specific gravity < 1.005) [lots of dilute urine]
* Hypernatremia (can cause seizures and brain damage)
* Water Deprivation Test (lab testing during forced dehydration)

Tx:
* Monitor output (daily weights) & s/s of dehydration
* Neurogenic–> desmopressin (DDVAP)
* Nephrogenic–> Potassium sparing diuretic

146
Q

Rare in children. Excessive levels of ADH are produced.

S/sx: N/V, seizures, headaches, cramping, changes in
LOC, fluid retention, decreased UOP

A

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

147
Q

How is SIADH diagnosed and treated?

A

Diagnosis:
-High urine specific gravity > 1.030
-Hyponatremia (HA, lethargy, confusion, seizure precautions needed)

Tx:
-Strict I&Os
-Fluid restriction (2/3 maintenance)
-Increase sodium and protein in diet
-ADH receptor agonist (allows for reabsorption of water in kidneys)

148
Q

Thyroid insufficiency can be congenital or acquired
(Hashimoto’s Thyroiditis- acquired 6+, autoimmune)

S/sx:
Congenital hypothyroidism –> Poor feeding, constipation, hypotonia, large fontanelles, large/thick tongue, delayed development
Older child–> Bradycardia, hypothermia, puffy face, delayed puberty, constipation, impaired memory

A

Hypothyroidism

149
Q

How is hypothyroidism diagnosed and treated?

A

Diagnosis:
* Congenital hypothyroidism–> Newborn screening
* Low T4 and high TSH

Tx:
* Thyroid replacement therapy (levothyroxine [Synthroid])
* Adherence to follow-ups

150
Q

An autoimmune disorder that is most frequent cause of hyperthyroidism in children (frequency increases in adolescence)
*Neonatal Graves Disease (born to women with Graves’)

S/sx:
Goiter, raised, thickened skin,
exophthalmos in addition to increased HR/BP,
increased sweating, tremor, poor concentration

A

Grave’s disease

151
Q

How is Grave’s disease diagnosed and treated?

A

Diagnosis:
Low TSH, high T3 and T4

Tx:
Goal=remission
* Antithyroid drugs (methimazole)
* Radioactive iodine
* Thyroidectomy
* Calm environment

152
Q

Often preceded by a stressful event or illness.

Can be life threatening if not treated.

Symptoms include hypermetabolic state, n/v, tremors, and psychosis

A

Thyroid storm

153
Q

Rare. Occurs when there is an inadequate production of PTH. Can be inherited or acquired

S/sx:
Poor tooth development, headaches, seizures,
spasms of face/hands/feet, irritability, vomiting

A

Hypoparathyroidism

154
Q

How is Hypoparathyroidism diagnosed and treated?

A

Diagnosis:
* Low calcium and magnesium
* High phosphates
* Low PTH
* Imaging (increased bone density)

Tx:
* Supplemental calcium and vitamin D
* Adherence to follow-ups

155
Q

Rare in children. Overactive parathyroid glands produce high levels of PTH = increased levels of serum calcium

S/sx:
Bone/joint pain, bone loss (osteoporosis), weakness, n/v, kidney stones, psychiatric conditions

A

Hyperparathyroidism

156
Q

How is Hyperparathyroidism diagnosed and treated?

A

Diagnosis:
* High PTH and calcium
* Imaging (bones may show rickets)

Tx:
* Reduce osteoclastic bone reabsorption (oral
phosphate)
* Diet low in calcium
* Parathyroidectomy

157
Q

Caused by cell destruction resulting indefinite insulin dependency

A

Type I DM

158
Q

Clinical presentation for Type I DM

A
  • Three P’s: Polydipsia, Polyphagia, Polyuria*
  • Fatigue
  • Nausea and vomiting
  • Yeast Infections
  • Dehydration
  • Muscle wasting/weight loss
  • Tachycardia
  • Blurred vision
159
Q

Developmental considerations w/ diabetes

A
  • Establish routines (Find specific place for glucose tests)
  • Allow toddler to participate and predict activities- not able to do injections
  • Preschooler can assist with cleaning their finger, holding still for injection, helping to choose foods
  • School age child can perform site choosing, cleaning, fingerstick, injection
  • School age recognizes needs to eat on time & signs of hypoglycemia and correction
  • Adolescent is able to perform all tasks, can choose own foods, adds extra for increased activity, can treat/recognize hypoglycemia
160
Q

Goals of DM management

A

*Optimal glycemic control
*Normal growth and development
*Minimizing complications
*Family and patient education
*Emotional adjustment to diabetes
*Caregivers know plan

161
Q

Monitor for Hypoglycemia! < 70 mg/dL

S/sx include

A

Cold, pale skin
Light-headed
Shakey, tremors
Sudden hunger
Emotional outbursts
Anxiety
Fainting

162
Q

Interventions for hypoglycemia

A

Can give 10-15 grams of: juice, glucose gel, hard candy, gumdrops, honey,
raisins, regular soda, cake icing and recheck in 15 mins (may need to give
again)

If unconscious = glucagon

163
Q

Caused by insulin resistance in which the body fails to recognize and use insulin properly

A

Type II DM

164
Q

Risk factors for Type II DM

A

*Black, Hispanic, Native American, Asian/Pacific Islander American
*Obesity
*Sedentary Lifestyles
*High calorie/high fat diet
*Family History
*Maternal hx of GDM

165
Q

S/sx of Type II DM

A
  • Numbness or tingling in feet, ankles, legs
  • Complaints of blurry or poor vision
  • Fatigue
  • Weight gain or weight loss
  • Headache
  • Polyuria, polydipsia
  • Enuresis, nocturia
  • Acanthosis Nigricans
  • HTN, dyslipidemia
166
Q

Tx for Type II DM

A
  • Lifestyle modifications
  • Oral hypoglycemic agent (metformin)
  • Insulin
  • Education
167
Q

Breath smells like fruity gum, Kussmaul resp, thirsty, dehydrated, tachy, hypotension, acidosis, high blood sugar (greater than 240mg/dl), hyperkalemia, polyuria

A

diabetic ketoacidosis

168
Q

DKA Tx

A

Hydration, insulin, and electrolyte replacement

169
Q

Goals of DKA management

A

*Restore fluid volume
*Return child to a glucose utilization state by inhibiting lipolysis
*Replace the child’s body electrolytes
*Correct acidosis and restore acid-base balance

170
Q

Diabetes education

A

-Teach how to count carbs
-Monitor glucose around exercise
-Monitor glucose 3-6 times/day
-See HCP every 3 months for follow-up and monitoring
-Teach about DKA
-Giving insulin (rotate sites, room temperature, exact dosing, 45-90° angle for subcutaneous in children, safe needle disposal, don’t reuse syringes)

WCF (12 decks)

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