Final Exam Flashcards
Describe a febrile seizure
-occurs in children with no previous neurological condition
-fever >38
-resolves within 15 minutes
-for fevers not caused by meningitis, encephalitis or other illness infecting the brain
-most have stopped by the time the child reaches the hospital
-Tylenol for comfort but does not decrease the risk of having a febrile seizure
What is the treatment for febrile seizures?
-no anticonvulsant therapy is indicated for children who have experiences 1 or more simple febrile seizures
-lab tests may be indicated by the nature of the underlying febrile illness
What is a complex febrile seizure?
-Occur in children of any age usually with a neurological impairment consist of a prolonged seizure lasting more than 15 minutes and can reoccur within 24 hours and result in neurological deficits after the seizure
What are the three types of onset for seizure classification?
focal onset, generalized onset, unknown onset
What are the diagnostic evaluations for seizures?
-history and presentation of the seizures (rule out other factors, such as migraines, breath holding spells, TIAs, movement disorders)
-determine whether the events are epileptic or non-epileptic in nature
-define the underlying cause
EEG to help determine the type of seizure
What are some ways of managing seizures?
-Monitoring and recording of symptoms
-Treatment of the underlying illness/condition
-Antipyretics
-Anticonvulsant medications
-Ketogenic Diet
-Vagus Nerve Stimuli
-Surgical Therapy
-Parental support & education
What nursing care should be provided during a seizure?
-assess and document the seizure activity (NOTE the time)
-make sure that the child is safe (won’t fall or hit something)
-remain calm and support the child and family
-monitor vitals and O2 status
What is status epilepticus?
-medical emergency
-defines as seizure activity for 5 minutes or longer or is 3 or more in a 15 min period
-treatment includes Lorazepam, Midazolam or Fosphenytoin
-ECG monitoring should be initiated
What is Meningitis?
-acute inflammation of the meninges
-aseptic or bacterial
Describe nonbacterial (aseptic) meningitis
Etiology is principally viral in nature
* Can occur at any age; more common in younger
children
* Similar presentation as bacterial meningitis
* CSF Clear with mononuclear leukocytes
* Onset is abrupt or gradual (vague in younger
children)
* Clinical findings like bacterial meningitis
Describe bacterial meningitis
Focus of infection initially occurs elsewhere
*The infection spreads via vascular system to the
cerebral spinal fluid & extends to arachnoid space
*Brain becomes edematous & covered with purulent
exudate
* CSF Cloudy with high protein and decreased glucose
*Flow of cerebral spinal fluid may be obstructed
What are the signs and symptoms of meningitis for children and adolescents?
-most children present with fever, headache and vomiting that may change depending on their level of consciousness
-some may only present with lethargy or irritability
-altered sensorium
-seizures
-agitation
What are the clinical manifestations for meningitis in infants and young children
The clinical presentation found in older children and
adolescents are rarely found in younger children
* Fever
* Poor feeding
* Marked irritability
* Vomiting
* Frequent Seizures (with a high-pitched cry)
* Bulging fontanel
What are the clinical findings of meningitis in new borns?
Extremely difficult to diagnose
Manifestation vague and nonspecific
Well at birth but within a few days began to look and behave poorly
* Refusal of feeding
* Poor sucking ability
* Vomiting or diarrhea
* Poor tone
* Lack of movement
* Weak cry
* Full, tense and bulging fontanel sometimes appear late in the course of the illness
What is the diagnostic evaluation of meningitis?
-lumbar puncture (MOST IMPORTANT)
-CT scan
-blood culture
-nose and throat cultures
-urine cultures
What are the complications of meningitis?
-seizures
-shock
-electrolyte and fluid abnormalities
-learning/hearing impairment
-developmental delay
What is some nursing care that we can provide to a patient with meningitis?
*Vaccine administration
*Quiet Environment
*Pain assessments
*Assessment for fevers
*Fluid monitoring
*Neurological assessments
Describe tonsilitis
- Tonsils are masses of lymph tissues in the
palatine/pharyngeal cavity - Filter and protect the respiratory tract
- Children have much larger tonsils than
teenagers or adults - May involve the tonsils and or the adenoids
What is the therapeutic management for tonsilitis?
-Viral-symptomatic is self-limiting
-Bacterial throat cultures for GABHS are treated with antibiotics
Surgical:
* tonsillectomy &/or adenoidectomy
* For recurrent infections (6 episodes per year causing 20 days of missed school, and or airway obstruction that leads to sleep apnea
What are the nursing considerations post-operatively for a tonsillectomy?
-rest
-minimize disturbance of surgical site
-check secretions
-ice collars
-po fluids (liquid to soft diet, no dairy products)
-medications for pain control
Assess for post-op hemorrhage:
-observe throat directly
-assess for s&sx of hypovolemic shock
-observe for continuous swallowing, vomiting of fresh blood, clearing throat, restlessness
-maintain npo, notify HCP and monitor VS
-bleeding risk after surgery, 7-10 days after surgery and up to 14 days post-operatively
What is glomerulonephritis?
the immune process of fighting an infection injures the glomeruli resulting in altered glomerular structure and function of the kidney
What are the signs and symptoms of glomerulonephritis?
Fever
Edema
Lethargy
Headache
Decreased urine output
Abdominal Pain
Vomiting
Anorexia
Tea colored Urine
Describe acute post streptococcal glomerulonephritis?
-most common in children
-develops 5-21 days after an infection
Clinical manifestations:
-generalized body edema
-hypertension
-oliguria
-hematuria
-proteinuria
What are the diagnostic tests for acute post-streptococcal glomerulonephritis?
-blood work (elevated urea and creatinine usually)
-urine dipstick (3-4+ hematuria)
-urinalysis
-ASO titres (test for strep infection)
-C3 levels (rising C3 levels indicates improvement)
-chest x-ray
-kidney biopsies are rarely indicated
What is the therapeutic management for acute post-streptococcal glomerulonephritis?
- Rest
- Restricting sodium
- Potassium restriction in food
- Fluid restriction
- Close monitoring of vital signs/weight/intake and output
- Antihypertensive drugs
- Diuretics
- Antibiotics only for children with evidence of persistent
strep infections
What is the first period of reactivity during the transition to extrauterine life?
-a period of reactivity that lasts up to 30 min after birth
-HR increases to 160-180 beats per min
-resps are irregular and frequent: 60-80 breaths per min
-fine crackles, audible grunting, nasal flaring, and retractions of the chest may be noted
-alert and may have spontaneous startles, tremors, crying, and move head from side to side
-bowel sounds are audible, and meconium may be passed
What is the period of decreased responsiveness in the transition to extrauterine life?
-Lasts 60 to 100 minutes
-Sleeps or has a marked decrease in motor activity
-Pink and respiration rapid but shallow
What is the second period of reactivity in the transition to extrauterine life?
-Occurs 2 to 8 hours after birth (lasts 10 minutes to several hrs)
-Brief period of tachycardia & tachypnea occur
-Meconium commonly passed
-Increased muscle tone, changes in skin colour, and mucus production
What are the chemical factors that occur during the initiation of breathing?
-transient decreases in PO2 and increase on PCO2 that have cumulative effects
-catecholamine surge which promotes fluid clearance
What are the mechanical factors that occur during the initiation of breathing?
-Changes in intrathoracic pressure from pressure of the chest during vaginal delivery to negative
intrathoracic pressure
-Crying increases distribution of air in the lungs and promotes expansion of the alveoli
What are the thermal factors that occur during the initiation of breathing?
-Environmental temperature changes stimulates receptors in the skin
-Cold stress may be important for initializing breathing
What are the sensory factors that occur during the initiation of breathing?
-Handling or drying the infant
-Pain associated with birth
-The lights, sounds, and smells of the new environment
Describe Transient Tachypnea of the Newborn (TTNB)
-Mild degree of respiratory distress
-Fluid retention or transient pulmonary edema
-Delayed clearance of fetal lung fluid producing “wet lung”
-Occurs in first few hours, resolving by 72hrs of age as fluid clears
What are the nursing assessments of Transient Tachypnea of the Newborn?
-perinatal history
Observe for signs of TTNB:
-tachypnea/expiratory grunting/retractions/labor breathing/nasal flaring/mild cyanosis
-barrel chest/hyperextension
-breath sounds-slightly diminished related to reduce air entry
What is the nursing management for TTNB?
-IV fluids and gavage feed until RR decreases
-Maintain a neutral environment (warm and limit
handling)
-O2 (NP or O2 hood)
-Monitor if resolving or persisting
-Assist parents to cope/reassurance as it resolves
What are the signs of respiratory distress in a newborn?
Nasal flaring
Intercostal or subcostal retractions or grunting
Suprasternal/subclavicular retractions with stridor or
gasping
Seesaw respirations
Respiratory rate less than 30 or greater than 60
breaths/min with the infant at rest
Apneic episodes
Colour can indicate respiratory distress
Acrocyanosis, the bluish discolouration of hands and
feet after 10 days
Transient periods of duskiness while crying are not
uncommon immediately after birth; however, central
cyanosis is abnormal and signifies hypoxemia
What are the signs of cardiovascular issues in a newborn?
-Persistent tachycardia (more than 160 bpm) can be associated with anemia, hypovolemia, hyperthermia, or sepsis
-Persistent bradycardia (less than 100 bpm) can be a sign of a congenital heart block, hypoxemia, or hypothermia
-Any central or prolonged cyanosis can indicate respiratory or cardiac problems and requires immediate investigation
What are the physiological adaptations of the cardiovascular system of a newborn?
-foraman ovale
-ductus artiosus
-ductus venosus
What are the physiological adaptations of the renal system in a newborn?
-Voiding increases with age of the infant
-Sometimes pink-tinged uric acid crystal(brick dust) stains appear on the diaper
-Dysfunction resulting from physiological abnormalities can range from the lack of a
steady stream of urine to anomalies such as hypospadias, enlarged or cystic kidneys
What are the physiological adaptations of the thermogenic system in a newborn?
-newborns are dependent on their environment for thermoregulation
-balance between heat loss and heat production
Predisposed to heat loss due to:
-radiation
-convection
-evaporation
-conduction
What are the results of cold stress on a newborn?
-increased anaerobic glycolysis
-metabolic acidosis
What are the physiological adaptations of the intestinal flora in a newborn?
-Intestinal flora, or gut microbiota are established within the first week after birth.
-Normal intestinal flora help synthesize vitamin K.
-Breastfeeding is important in establishing the intestinal microbiome of the newborn
When do most healthy term infants pass meconium?
most within 12-24 hours but must by 48 hours (in a healthy infant)
-black and sticky
-is a physiological adaptation
Describe transitional stools
-stools that usually appear by the third day after feeding
-greenish brown to yellowish brown, thin and may contain some milk curds
When does milk stool appear?
-usually by the fourth day
-in breastfed infants the stools are yellow to golden, pasty in consistency, resemble a mix of mustard and cottage cheese with an odor similar to sour milk
-in formula-fed infants the stools are pale yellow to light brown, have firmer consistency, with an odor more like normal stool
What are the signs of GI problems in newborns?
-failure to pass meconium
-active rectal “wink” reflex shows good sphincter tone so no wink is bad
-amount and frequency of regurgitation (spit up) after feedings should be documented
When does vernix appear?
-starts at about 22-24 weeks and is most abundant at 33-35 weeks
-should be non-existent at term
-babies become dry post-dates
Define lanugo
fine hair noted over the face, shoulders and back
Define milia
distended, small, white sebaceous glands
Define Mongolian spots
Congenital Dermal Melanocytes
-appears over any part of the exterior surface of the body, including the extremities
-looks similar to a bruise
Define Telangiectatic nevi
-stork bite or angel kisses
-flat, pink capillary hemangiomas that are easily blanched
Define erythema toxicuma
-transient rash
-also called newborn rash
Define Nevus Vasculosus
Strawberry Hemangioma
-common type of capillary hemangioma
-raised and rough
-develops in the first year of life and then fades
What is a pilonidal dimple?
-sacral dimple
-requires further inspection to determine whether a sinus is present
What is Caput Succedaneum?
-edematous area between the skin and the scalp, most commonly found on the occiput
-extends across the suture lines of the skull and disappears spontaneously within 3-4 days
What is cephlahematoma?
-collection of blood between a skull bone and its periosteum
-does not cross a cranial suture line
-largest on the second and third day
-resolves in 3-6 weeks
What is a subgaleal hemorrhage?
-bleeding into the subgaleal compartment
-difficult operative delivery
-blood loss can be severe
What are the usual signs of a small for gestational age infant?
-less than 2500g at term or below 10%ile at any gestational age
-poor muscle tone over buttock
-sunken appearance
-decrease amount of breast tissue
-head is disproportionately large
-loose skin that appears oversized
-reduced subcutaneous fat stores
What are the usual signs of a large for gestational age infant?
-greater than 4000g or above the 90%ile at any gestational age
-large body and full face
-more difficult to arouse
-plump appearance
-difficulty regulating behavioural states
-prone to birth injury
-poor motor skills
Describe physiological jaundice
-occurs after 24 hours of age
-high risk infants: exclusive breastfeeding not well established, visible bruising, cephalohematoma, hemolytic disease, asphyxia, sepsis, poor feeding, LGA and SGA
What are the treatments for jaundice?
-prevention is key– early and frequent feeding stimulates the passage of meconium
-phototherapy
-exchange blood transfusions
What are the signs and symptoms of hypoglycemia in newborns?
-jittery
-poor feeding
-seizures
-eye rolling
-weak or high pitch cry
-apnea
-cyanosis
-lethargy
What are the biggest signs of newborn sepsis?
-tachypnea
-tachycardia
-temperature instability
-hypotonia
-feeding intolerance (increasing residuals)
-pallor
What is the treatment for newborn sepsis?
-fluids and vasopressors
-O2 and mechanical ventilation
-obtaining cultures
-antibiotic administration as ordered, observing for side effects
-promoting newborn comfort
-assessing the family’s educational needs and providing instructions as necessary
What are some signs of withdrawal in neonates?
-irritability
-seizures
-hyperactivity
-tremors
-high-pitched call
-hypertonicity
-diaphoresis
-fever
-mottled skin
-nasal stuffiness
-poor feeding
-diarrhea
-dehydration
-vomiting
-disrupted sleep
-tachypnea
-temp instability
What nursing management should be done for newborns of substance abusing mothers?
-decrease stimuli (lights and noise)
-providing adequate nutrition and hydration
-appropriate individualized developmental care should be implemented to facilitate the infant’s self-consoling and self-regulating behaviours
-irritable and hyperactive infants have been found to respond to physical comforting, movement, and close contact (promote skin to skin)
-cluster care to reduce stimulation
-pacifier
-intake and output, watch electrolytes, additional caloric supplementation, and daily weight
-SIDS is high
Define preterm infant
any infant born before 37 weeks gestation
What is the difference between a later preterm, moderate preterm, very preterm and extremely preterm?
late– 34-36+6 weeks
moderate– 32-34 weeks
very– 28-32 weeks
extremely– less than 28 weeks
What is the minimum gestational viability age in Canada?
24 weeks
Why is thermoregulation so important in low-birth-weight infants?
rapid changes in body temp may cause changes in cerebral blood flow which may contribute to intraventricular hemorrhage
What is respiratory distress syndrome (RDS)?
-complication related to prematurity
-caused by a surfactant deficiency
-diagnosed based on clinical manifestations
-tachypnea >/=60
-dyspnea
-pronounced intercostal or substernal retractions
-fine inspiratory grunt
-flaring of the external nares
-cyanosis or pallor
-apnea
What is a periventricular-intraventricular hemorrhage?
-hemorrhage around the ventricles in the brain
-one of the more common neurological injuries of the newborn with severe short and long-term outcomes
-most common in the first 72 horus post birth
-classified according to severity
What are the nursing actions that can be done for periventricular-intraventricular hemorrhage?
-decreasing the risks
-supportive care to the infants that have a bleed
What are the early clinical signs of necrotizing enterocolitis?
-decreased activity
-hypotonia
-pallor
-recurrent apnea
-bradycardia
-respiratory distress
What are the clinical manifestations of necrotizing enterocolitis?
-metabolic acidosis
-oliguria
-hypotension
-decreased perfusion
-temp instability
-cyanosis
-abdominal distension
-bilious vomiting
-bloody stools
-abdominal tenderness
-erythema of the abdominal wall
What are the diagnostic tests for necrotizing enterocolitis?
-abdominal CT
-CBC/lytes/blood culture/blood gas analysis
What is the treatment for necrotizing enterocolitis?
-broad spectrum antibiotics
-NG decompression
-TPN therapy
-surgical intervention
What treatment for syphilis occurs during pregnancy?
- Long acting benzathine penicillin G delivered via IM route
- Maternal neurosyphilis is Pen G IV for 10 days
- 3 doses for latent syphilis or uncertain stage of disease
- Course needs to be successfully be completed greater than
4 week before delivery and show a drop in titer levels
What is seen during the infant physical examination of an infant born from a mom with syphilis?
- Growth-Low birth weight, failure to thrive
- General- Fever, pallor, jaundice,
nonimmune hydrops, generalize lymphadenopathy, severe
sepsis syndrome - Head and Neck- Rhinitis, Chorioretinitis, cataracts, uveitis, keratitis
- Skin maculopapular, desquamating or vesiculobullous lesions
- Cardiorespiratory- myocarditis, congestive heart failure, respiratory
distress, pneumonia
Central Nervous System–cranial neuropathies, meningitis, seizures, hearing loss
Musculoskeletal– dactylitis, periostea, leading to pseudo paralysis
Renal–Proteinuria. Hematuria, or nephrotic syndrome
Other– may mimic other infectious diseases syndromes or congenital infections and non-infectious conditions (e.g., juvenile myelomonocytic leukemia
What is the treatment of an infant born from a mom with syphilis?
- IV dose of Penicillin G for 10
days - LFT
- CSF
- Long bone X-ray
- Screening audiology
- Ophthalmologic assessment
What is cerebral palsy?
- Several disorders related to the development of movement and
posture - Can occur prenatally, and in the natal and postnatal period
- Cerebral Palsy is the most common movement disorder of
childhood, a lifelong condition, most common physical disability. - Anoxia plays the most significant role in the pathological state
of brain damage
What are the possible maternal origins of cerebral palsy in an infant?
- Exposure to radiation
- Infection
- Prematurity, low birth weight, intrauterine growth restriction
- Pre-eclampsia
- Malformation of brain structures, abnormal blood flow to brain
- Assistive reproductive technology
