Exam One Outline (Just typing in the topics she put) Flashcards
Instructions for families on managing seizures at home
- ketogenic diet could be helpful (high fat, low carb, low protein diet)
- helmets during sports
- water safety
- avoid triggers
- apply same child-rearing technqiues
- adhere to medication regimen
- do not abruptly stop medications
- medical alert bracelet/necklace
- can attend regular school
- refer to DMV to determine driving laws
What are the key differences between infantile spasms and other seizures?
Infantile spasms (West Syndrome)
- peak: 3-7 months
- sudden, brief, symmetric muscle contractions
- flexed head, extended arms drawn up
- possible nystagmus or eye deviation
- possible LOC
- treatment: adrenocorticotropic hormone (ACTH)
What are the most important actions for the nurse or parent during a seizure?
Nurse:
- protect from injury
- position: maintain airway
- watch the clock
- note onset, time, and characteristics of seizure
- side-lying to prevent aspiration
- do not restrain child
- loosen restrictive clothing
- do not attempt to put anything in the child’s mouth
- prepare for oxygenation
- remove glasses
- remain calm and stay with the child
Key features of tonic clonic seizure
Is a generalized motor seizure
previously called grand-mal
most prevalent
consists of sudden stiffness (tonic) and repetitive jerking (clonic)
Onset: without warning
- Tonic (10-20 seconds)
– Loss of consciousness
– Eyes roll upward
– tonic contraction of the entire body with arms flexed, legs and head extended
– possible piercing cry
– thoracic and abdominal muscles contract
– mouth snaps shut and tongue can be bitten
– flushing
– loss of swallowing reflux
– increased salivation
– apnea leading to cyanosis - Clonic (30-50 seconds)
– violent jerky movements of the body
– can have foaming in the mouth
– trunk and extremities experience rhythmic contraction and relaxation
– can be incontinent of urine or feces
– gradual slowing of the movements until cessation
Key features of complex partial seizure
Psychomotor seizure
Key features of simple partial seizure
Simple partial with motor:
- aversive seizure (most common)
- eyes and head turn away from side of focus with or without LOC
- sudden convulsive seizure
- Rolandic (Sylvan): twitching, numbness, tingling of face and tongue
Simple partial with sensory:
- altered behavior
- auras
- tingling, numbness, or pain in one area of the body then spreading to other parts, with visual sensations
– can be auditory
- distorted sense of time
- motor development (hypertonia or posturing)
Key features of absence seizure
Onset: 4-12 and ceases by teenage years
- LOC 5-10 seconds
- blank stare, motionless
- resembles day dreaming
- can drop items, but rarely falls
- automatisms
- momentarily confused
- can immediately resume previous activities
Key features of myoclonic seizure
Is a generalized motor seizure
consists of short, jerking movement of muscles resembling muscle spasms
- variety of seizure episodes
- brief contraction of muscle or groups of muscles
- symmetric or asymmetric involvement
- NO postictal state
- might not lose consciousness
- can involve only the face and trunk or more extremities
Key features of febrile seizure
- associated with a sudden spike in temperature: 38.9-40 (102-104)
- 15-20 seconds
Treatment:
- acetaminophen or ibuprofen
- dress in light clothing
- administer tepid sponge baths
What are the symptoms of meningitis in infants vs other age groups
Newborn:
- no illness at birth
- vague and difficult to diagnose
- poor muscle tone
- weak cry
- poor suck
- refuses feeding
- vomiting, diarrhea
- possible fever or hypothermia
- no nuchal rigidity
- late sign: bulging fontanel
3 months - 2 years
- bulging fontanels
- seizures
- high pitched cry
- purpuric/petechial rash
- fever
- irritability
- poor feeding/vomiting
- possible nuchal rigidity
2 years - adolescence:
- initial finding: nuchal rigidity
- fever/chills
- severe headache
- vomiting
- positive Kernig’s sign
- positive Brudzinski’s sign
- petechial/purpuric rash
- photophobia and irritability
- progresses to drowsiness, delirium, coma
- involvement of the joints (meningococcal and Hib)
- chronic draining ear (pneumococcal)
What are techniques to help the patient feel better/provide comfort w meningitis?
dim lights, quiet room
What are physical exam signs of meningitis?
- nuchal rigidity
- kernig sign
- brudzinski sign
What is nuchal rigidity and relation to meningitis?
Online response: Nuchal rigidity refers to a stiff neck, where the neck muscles resist bending forward, and is considered a key clinical sign that can indicate the presence of meningitis, a serious infection of the membranes surrounding the brain and spinal cord; essentially, when someone has meningitis, their neck muscles become tight and painful, preventing them from fully flexing their neck forward due to inflammation of the meninges.
What is the Kernig sign?
when bending knee, head will pull up
What is the Brudzinski sign?
child laying flat and pull head up, their knees will come up too
What are key nursing interventions for a child with a concussion?
- ABCs
- may have brief LOC, tonic posturing with clonic movements
- immediate treatment:
– cervical spine stabilization until neuro-assessment of all 4 limbs and no reported neck pain or cervical tenderness - symptoms may not appear until several hours after concussive episode
- athletes may not report symptoms for fear of losing playing time
- monitor ICP, GCS
- oxygen as prescribed
- assess for CSF leakage
- monitor for fluid overload
What is important to educate parents about regarding concussions and prevention?
preventing second impact syndrome
Step 1: back to regular activities (such as school)
Step 2: light aerobic activity
Step 3: moderate activity
Step 4: heavy, non-contact activity
Step 5: practice and full contact
Step 6: competition (can return)
What is second impact syndrome? How to prevent?
second hit before first concussion has resolved
more long term deficits
What is Reye Syndrome?
- life-threatening disorder
- primarily affects the liver and brain
– liver dysfunction
– cerebral edema - peak incidence occurs when influenza is common
- prognosis is best with early recognition and treatment
What are key lab results indicative of Reye Syndrome?
- elevated liver enzymes (ALT, AST, bilirubin)
- elevated blood ammonia level
- blood electrolytes
- extended coagulation times
What is the reason for administering mannitol in certain conditions? in Reye syndrome?
osmotic diuretic; decrease intracranial pressure
reduce cerebral edema in Reye Syndrome
helps prevent seizures
What are preventative strategies for Sudden Infant Death Syndrome (SIDS)?
- ensure the crib is properly assembled
- always place baby on their back to sleep
- keep a smoke-free zone around baby
- remove everything other than the mattress and sheet from crib when baby is sleeping
- use a blanket sleep; never loose blankets
- once breastfeeding established, pacifier after
- keep baby in mom’s room, but in a separate sleeping area
- use a firm mattress with no more than two fingers width between crib and mattress
- do not over-clothe baby while sleeping; baby should not be hot to the touch
- there should not be more than a soda can width between bars
What are measures to prevent burns in toddlers?
- set home’s water heater at a maximum of 120 F
- fill tub prior to child getting in and test temperature (never more than 104F)
- never let child touch the faucet
- turn the hot water on LAST and off FIRST
- faucet covers for safety
- stove covers
What are strategies to prevent ingestion of harmful substances?
- lock cabinets
- keep toxic agents out of reach of children
- discard unused meds
- do not take meds in front of children
- do not call medicine candy!!
- use non-mercury thermometers
- encourage hand hygiene prior to eating
- eliminate lead-based paints
- do not store food in lead-based containers
- have poison control number easily seen
What are key nursing care interventions following a tonsillectomy?
Post-Op Care:
- assessment for excessive bleeding
– vital signs:
— tachycardia
— increased or decreased BP
— increased RR
- assess pallor
- frequent clearing of the throat or swallowing
- watch vomiting bright red blood
- restlessness
- blood on inspection of the throat
Complications:
- hemorrhage
- dehydration
- chronic infection
What are Erikson’s Stages of Development?
- trust vs mistrust
- autonomy vs shame/doubt
- initiative vs guilt
- industry vs inferiority
- identity vs confusion
- intimacy vs isolation
- generativity vs stagnation
- integrity vs despair
