FINAL NEW CONTENT

Question 1

How does sedentary lifestyles affect a child’s growth and development

Answer 1

bone demineralization, loss of strength, low exercise tolerance, decreased metabolism, loss of joint mobility, contractures, spinal deformities, impaired healing, increased stress hormone, hypertension, emboli/thrombi risk, constipation,

Question 2

What is the first intervention for a soft tissue injury

Answer 2

Soft-tissue injuries should be iced immediately.

Then, Elevating the extremity uses gravity to facilitate venous return and reduce edema formation in the damaged area. The point of injury should be kept several inches above the level of the heart for therapy to be effective.

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Question 3

fractures in children younger than 12 months old have been attributed to…

Answer 3

nonaccidental trauma (child abuse)

Any investigation of fractures in infants, particularly multiple fractures, should include consideration of osteogenesis imperfecta (OI) after nonaccidental trauma has been ruled out.

Question 4

What is the most common fracture in children

Answer 4

A distal forearm (radius, ulna, or both) fracture is

Question 5

Describe the 4 types of fractures seen in children

Answer 5

Plastic deformation: Occurs when the bone is bent but not broken. A child’s flexible bone can be bent 45 degrees or more before breaking. However, if bent, the bone will straighten slowly but not completely, producing some deformity but without the angulation seen when the bone breaks. Bends occur most commonly in the ulna and fibula, often in association with fractures of the radius and tibia.

Buckle, or torus, fracture: Produced by compression of the porous bone; appears as a raised or bulging projection at the fracture site. These fractures occur in the most porous portion of the bone near the metaphysis (the portion of the bone shaft adjacent to the epiphysis) and are more common in young children.

Greenstick fracture: Occurs when a bone is angulated beyond the limits of bending. The compressed side bends, and the tension side fails, causing an incomplete fracture similar to the break observed when a green stick is broken.

Complete fracture: Divides the bone fragments.These fragments often remain attached by a periosteal hinge, which can aid or hinder reduction.

Question 6

Why do you need to use traction on a broken bone

Answer 6

Immediately after a fracture occurs, the muscles contract and physiologically splint the injured area. This phenomenon accounts for the muscle tightness observed over a fracture site and the deformity that is produced as the muscles pull the bone ends out of alignment. This muscle response must be overcome by traction or complete muscle relaxation (e.g., anesthesia) to realign the distal bone fragment to the proximal bone fragment.

Question 7

Whats the difference between pediatric and adult bone fractures

Answer 7

Fractures heal in less time in children than in adults.

The child may exhibit the same manifestations seen in adults, which may include swelling, bruising, pain or tenderness, deformity, and diminished function (Box 48.2). However, often a fracture is remarkably stable because of intact periosteum. The child may even be able to use an affected arm or walk on a fractured leg. Because bones are highly vascular, a soft, pliable hematoma may be felt around the fracture site.

Question 8

What are the 6 P’s of a fracture

Answer 8

1. Pain: Severe pain that is not relieved by analgesics or elevation of the limb, movement that increases pain
2. Pulselessness: Inability to palpate a pulse distal to the fracture or compartment
3. Pallor: Pale-appearing skin, poor perfusion, capillary refill greater than 3 s
4. Paresthesia: Tingling or burning sensations
5. Paralysis: Inability to move extremity or digits
6. Pressure: Involved limb or digits may feel tense and warm; skin is tight, shiny pressure within the compartment is elevated

Question 9

Describe late signs of compartment syndrome

Answer 9

Pallor, paralysis, and pulselessness are late signs

Question 10

The six primary purposes of traction are:

Answer 10

1. To fatigue the involved muscles and reduce muscle spasm so that bones can be realigned
2. To position the distal and proximal bone ends in desired realignment to promote satisfactory bone healing
3. To immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting
4. To help prevent or improve contracture deformity
5. To provide immobilization of specific areas of the body
6. To reduce muscle spasms (rare in children)

Question 11

The three essential components of traction management are …

Answer 11

traction, countertraction, and friction

traction (forward force) is produced by attaching weight to the distal bone fragment. Body weight provides countertraction (backward force), and the patient’s contact with the bed constitutes the frictional force.

Question 12

What are the 3 types of traction

Answer 12

Manual traction: Applied to the body part by the hand placed distal to the fracture site. Manual traction may be provided during application of a cast but more commonly when a closed reduction is performed.

Skin traction: Applied directly to the skin surface and indirectly to the skeletal structures. The pulling mechanism is attached to the skin with adhesive material or an elastic bandage. Both types are applied over soft, foam-backed traction straps to distribute the traction pull.

Skeletal traction: Applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture.

Question 13

What is Bryant traction

Answer 13

Bryant traction is a type of running traction in which the pull is in only one direction. Skin traction is applied to the legs, which are flexed at a 90-degree angle at the hips. The child’s trunk (with the buttocks raised slightly off the bed) provides countertraction.

Question 14

What is Buck extension traction

Answer 14

Buck extension traction is a type of traction with the legs in an extended position. Except for fracture cases, turning from side to side with care is permitted to maintain the involved leg in alignment. Buck extension traction is used primarily for short-term immobilization, such as preoperative management of a child with a dislocated hip, or for correction of contractures or bone deformities, such as in Legg-Calvé-Perthes disease. Buck extension traction may be accomplished with either skin straps or a special foam boot designed for traction.

Question 15

What is Russell traction

Answer 15

Russell traction uses skin traction on the lower leg and a padded sling under the knee. Two lines of pull, one along the longitudinal line of the lower leg and one perpendicular to the leg, are produced. This combination of pulls allows realignment of the lower extremity and immobilizes the hip and knee in a flexed position.

Question 16

What is the most common skeletal traction

Answer 16

A common skeletal traction is 90-degree-90-degree traction (90-90 traction). The lower leg is supported by a boot cast or a calf sling, and a skeletal Steinmann pin or Kirschner wire is placed in the distal fragment of the femur, resulting in a 90-degree angle at both the hip and the knee. From a nursing standpoint, this traction facilitates position changes, toileting, and prevention of complications related to traction.

Question 17

Most cervical traction is accomplished with the use of…

Answer 17

halo brace or halo vest. This device consists of a steel halo attached to the head by four screws inserted into the outer skull; several rigid bars connect the halo to a vest that is worn around the chest, thus providing greater mobility of the rest of the body while avoiding cervical spinal motion altogether. If the injury has been limited to a vertebral fracture without neurologic deficit, a halo brace can be applied to permit earlier ambulation.

Question 18

Whats the difference between a sprain and a strain

Answer 18

A sprain occurs when trauma to a joint is so severe that a ligament is partially or completely torn or stretched by the force created as a joint is twisted or wrenched, often accompanied by damage to associated blood vessels, muscles, tendons, and nerves. Common sprain sites include ankles and knees.

A strain is a microscopic tear to the musculotendinous unit and has features in common with sprains. The area is painful to touch and swollen. Most strains are incurred over time rather than suddenly,

Question 19

What does RICE stand for

Answer 19

REST ICE COMPRESSION ELEVATION

Question 20

Define contusion

Answer 20

A contusion (bruise) is damage to the soft tissue, subcutaneous structures, and muscle. The tearing of these tissues and small blood vessels and the inflammatory response lead to hemorrhage, edema, and associated pain when the child attempts to move the injured part. The escape of blood into the tissues is observed as ecchymosis, a black-and-blue discoloration.

Question 21

What is developmental dysplasia of the hip (DDH)

Answer 21

The broad term developmental dysplasia of the hip (DDH) describes a spectrum of disorders related to abnormal development of the hip that may occur at any time during fetal life, infancy, or childhood.

Question 22

What are the 3 predisposing factors associated with DDH:

Answer 22

(1) physiologic factors, which include maternal hormone secretion and intrauterine positioning;

(2) mechanical factors, which involve breech presentation, multiple fetus, oligohydramnios, and large infant size as well as swaddling where the hips are maintained in adduction and extension, which in time may cause a dislocation; and

(3) genetic factors, which entail a higher incidence of DDH in siblings of affected infants and an even greater incidence of recurrence if a sibling and one parent were affected.

Question 23

What are the 2 groups associated with DDH

Answer 23

(1) idiopathic, in which the infant is neurologically intact

(2) teratologic, which involves a neuromuscular defect, such as arthrogryposis or myelodysplasia. The teratologic forms usually occur in utero and are much less common.

Question 24

What are the Three degrees of DDH

Answer 24

1. Acetabular dysplasia: This is the mildest form of DDH, in which there is a delay in acetabular development evidenced by osseous hypoplasia of the acetabular roof that is oblique and shallow, although the cartilaginous roof is comparatively intact. The femoral head remains in the acetabulum.
2. Subluxation: The largest percentage of DDH, subluxation, implies incomplete dislocation of the hip. The femoral head remains in contact with the acetabulum, but a stretched capsule and ligamentum teres cause the head of the femur to be partially displaced. Pressure on the cartilaginous roof inhibits ossification and produces a flattening of the socket.
3. Dislocation: The femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over the fibrocartilaginous rim. The ligamentum teres is elongated and taut.

Question 25

A striking relationship exists between the development of hip dislocation and methods of…

Answer 25

swaddling the hips.

Question 26

Names some Clinical Manifestations of Developmental Dysplasia of the Hip

Answer 26

Shortening of limb on affected side (Galeazzi sign) Restricted abduction of hip on affected side Unequal gluteal folds (best visualized with infant prone) Positive Ortolani test (hip is reduced by abduction) Positive Barlow test (hip is dislocated by adduction)

Question 27

How do you manage an infant’s DDH

Answer 27

the Pavlik harness is the most widely used, and with time, motion, and gravity, the hip works into a more abducted, reduced position (Fig. 48.14). The harness is worn continuously, 22 to 24 hours per day depending on the severity of dysplasia, until the hip is proved stable on both clinical and ultrasound examination, usually within 6 to 12 weeks.

Question 28

What is club foot

Answer 28

The foot is pointed downward (plantarflexed) and inward in varying degrees of severity (Fig. 48.15). Clubfoot may occur as an isolated deformity or in association with other disorders or syndromes, such as chromosomal abnormalities, arthrogryposis, or spina bifida.

Question 29

What are the 3 types of club foot

Answer 29

(1) positional clubfoot (also called transitional, mild, or postural clubfoot), which is believed to occur primarily from intrauterine crowding and responds to simple stretching and casting;

(2) congenital clubfoot, also referred to as idiopathic, which may occur in an otherwise normal child and has a wide range of rigidity and prognosis; and

(3) syndromic (or teratologic) clubfoot, which is associated with other congenital anomalies (such as myelomeningocele or arthrogryposis) and is a more severe form of clubfoot that is often resistant to typical treatment.

Question 30

How do you treat club foot

Answer 30

Treatment of clubfoot involves three stages:

(1) correction of the deformity,

(2) maintenance of the correction until normal muscle balance is regained, and

(3) follow-up observation to avert possible recurrence of the deformity. Some feet respond to treatment readily; some respond only to prolonged, vigorous, and sustained efforts; and the improvement in others remains disappointing even with maximal effort.

Nursing care of the child with clubfoot is the same as for any child who has a cast (see earlier in the chapter). Because the child will spend considerable time in a corrective device, nursing care plans include both long- and short-term goals. Careful observation of the skin and circulation is particularly important in young infants because of their rapid growth rate.

Question 31

Describe Skeletal limb deficiency

Answer 31

characterized by underdevelopment of skeletal elements of the extremities. The range of malformation can extend from minor defects of the digits to serious abnormalities, such as

amelia, absence of an entire extremity, or

meromelia, partial absence of an extremity

Most reduction defects are primary defects of development of the limb, but prenatal destruction of the limb can occur, such as full or partial amputation of a limb in utero from constriction of an amniotic band (amniotic band syndrome).

Heredity appears to play a prominent role, and prenatal environmental insults have been implicated in a number of cases,

The child with a limb deficiency should be fitted with prosthetic devices, and the devices should be applied at the earliest possible stage of development in an attempt to match the infant’s motor readiness.

Answer 32

a temporary disturbance of circulation or vascular supply to the femoral capital epiphysis produces an ischemic avascular necrosis of the femoral head. During middle childhood, circulation to the femoral epiphysis is more tenuous than at other ages and can become obstructed by trauma, inflammation, coagulation defects, and a variety of other causes. The pathologic events seem to take place in four stages:

Stage I: Initial, or avascular, stage: Avascular necrosis or infarction of the proximal femoral epiphysis with degenerative changes producing flattening of the upper surface of the femoral head or a decrease in femoral head height

Stage II: Fragmentation, or resorptive, stage: Femoral head resorption and revascularization produces collapse of the femoral head and fragmentation that gives a mottled appearance on radiographs

Stage III: Reossification stage: New bone formation, which is represented on radiographs as calcification and ossification or increased density in the areas of radiolucency; this filling-in process appears to begin in the periphery of the femoral head and progress centrally

Stage IV: Healing, or remodeling, stage: Gradual reformation of the head of the femur without radiolucency; this occurs until skeletal maturity

Question 33

Describe Slipped capital femoral epiphysis (SCFE)

Answer 33

Slipped capital femoral epiphysis (SCFE) refers to the spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction. It develops most frequently shortly before or during accelerated growth and the onset of puberty (children between 8 and 15 years old

Clinical Manifestations of Slipped Capital Femoral Epiphysis

Very often obese (body mass index > 95%)
Limp on affected side
Possible inability to bear weight because of severe pain
Pain in groin, thigh, or knee
May be acute, chronic, or acute-on-chronic
Continuous or intermittent
Affected leg is externally rotated
Loss of hip flexion, abduction, and internal rotation as severity increases
Affected leg may appear shorter

Question 34

When would a child with scoliosis need surgery

Answer 34

Surgical intervention may be required for treatment of severe curves, which are typically greater than 45 to 50 degrees, as these curves generally continue to progress over time even after skeletal maturity is reached

Question 35

When is the best time to assess a child for scoliosis

Answer 35

during the preadolescent growth spurt. screen girls at 10 and 12 years old and boys once at either 13 or 14 years old

Question 36

When would you use bracing and exercise for scoliosis

Answer 36

For moderate curves (25 to 45 degrees) in the growing child and adolescent, bracing may be the treatment of choice. Historically, bracing has not been shown to be curative; the goal is to slow the progression of the curvature to allow skeletal growth and maturity. The two most common types of bracing are the Boston and Wilmington braces

Question 37

What is septic arthritis

Answer 37

Septic arthritis is a bacterial infection in the joint. It usually results from hematogenous spread or from direct extension of an adjacent cellulitis or osteomyelitis.

The knees, hips, ankles, and elbows are the most common joints affected. Clinical manifestations include severe joint pain, swelling, warmth of overlying tissue, and occasionally erythema. An infection involving the hip, however, is considered a surgical emergency to prevent compromised blood supply to the head of the femur

The child is resistant to any joint movement. Features of systemic illness such as fever, malaise, headache, nausea, vomiting, and irritability may also be present.

Treatment is IV antibiotic therapy based on Gram stain results and the clinical presentation. The benefits of serial aspirations to demonstrate sterility of synovium fluid and reduce pressure or pain are controversial. Pain management is an important aspect of nursing care, particularly with involvement of a large joint such as the hip.

Question 38

Whats the difference between Legg calve perthes and Slipped capital femoral epiphysis

Answer 38

In LCPD, a disrupted blood supply causes deformation of the femoral head and subsequently leads to osteonecrosis.

On the other hand, in SCFE, a weakness of the growth plate causes displacement of the femoral head from the femoral neck.

Question 39

What is Spinal muscular atrophy type 1 (Werdnig-Hoffmann disease)

Answer 39

Spinal muscular atrophy (SMA) type 1 (Werdnig-Hoffmann disease) is a disorder characterized by progressive weakness and wasting of skeletal muscles caused by degeneration of anterior horn cells. It is inherited as an autosomal recessive trait and is the most common paralytic form of the floppy infant syndrome (congenital hypotonia).

the earlier the onset, the more disseminated and severe the motor weakness. The disorder may be manifested early— often at birth— and almost always before 2 years of age; death may occur as a result of respiratory failure by age 2 years

• Inactivity the most prominent feature * Infant lying in a frog-leg position with legs externally rotated, abducted, and flexed at knees * Generalized weakness * Absent deep tendon reflexes

Goes from type 1-4 1 is early in age, 4 is later in life (adult) onset

There is no cure for the disease, and treatment is symptomatic and supportive, primarily preventing joint contractures and treating orthopedic problems, the most serious of which is scoliosis.

Question 40

Describe the 4 classifications of cerebral palsy

Answer 40

Spastic (pyramidal), Dyskinetic (nonspastic, extrapyramidal), Ataxic (nonspastic, extrapyramidal), and Mixed type

Question 41

Describe the Spastic (pyramidal) classification of cerebral apsly

Answer 41

• Characterized by persistent primitive reflexes, positive Babinski reflex, ankle clonus, exaggerated stretch reflexes, eventual development of contractures
• 70%– 80% of all cases of cerebral palsy (CP)
• Diplegia— All extremities affected; lower more than upper (30%– 40% of spastic CP)
• Tetraplegia— All four extremities involved: legs and trunk, mouth, pharynx, and tongue (10%– 15% of spastic CP)
• Triplegia— Three limbs involved
• Monoplegia— Only one limb involved
• Hemiplegia— Motor dysfunction on one side of the body; upper extremity more affected than lower (20%– 30% of spastic CP)
• Hypertonicity with poor control of posture, balance, and coordinated motion
• Impairment of fine and gross motor skills

Question 42

Describe the Dyskinetic (nonspastic, extrapyramidal) classification of cerebral aplsy

Answer 42

• Athetoid— Chorea (involuntary, irregular, jerking movements); characterized by slow, wormlike, writhing movements that usually involve the extremities, trunk, neck, facial muscles, and tongue
• Dystonic— Slow, twisting movements of the trunk or extremities; abnormal posture
• Involvement of the pharyngeal, laryngeal, and oral muscles causing drooling

Question 43

Describe the Ataxic (nonspastic, extrapyramidal) classification of cerebral palsy

Answer 43

• Wide-based gait
• Rapid, repetitive movements performed poorly
• Disintegration of movements of the upper extremities when the child reaches for objects

Question 44

describe the Mixed type classification of cerebral palsy

Answer 44

• Combination of spastic CP and dyskinetic CP
• May be labeled mixed when no specific motor pattern is dominant; however, this term is losing favor to more precise descriptions of motor function and affected area of brain involved

Question 45

How can you tell if a child is developing cerebral palsy

Answer 45

delayed gross motor development, abnormal motor performance, alterations of muscle tone, abnormal postures, reflex abnormalities, associated disabilities

Question 46

What meds would you give a pt with cerebral palsy

Answer 46

muscle relaxers: baclofen, botulinum toxin a for spasticity

AEDs such as carbamazepine (Tegretol) for seizures

Question 47

Define Defects of neural tube closure

Answer 47

Normally, the spinal cord and cauda equina are encased in a protective sheath of bone and meninges (Fig. 49.5A). Failure of neural tube closure produces defects of varying degrees

Question 48

What are the 7 Defects of neural tube closure

Answer 48

Cranioschisis— A skull defect through which various tissues protrude

Exencephaly— Brain totally exposed or extruded through an associated skull defect; fetus usually aborted

Anencephaly— Congenital malformation in which both cerebral hemispheres are absent

Encephalocele— Herniation of brain and meninges through a defect in the skull producing a fluid-filled sac

Rachischisis or spina bifida— Fissure in the spinal column that leaves the meninges and spinal cord exposed

Meningocele— Hernial protrusion of a saclike cyst of meninges filled with spinal fluid (see Fig. 49.5C)

Myelomeningocele (meningomyelocele)— Hernial protrusion of a saclike cyst containing meninges, spinal fluid, and a portion of the spinal cord with

Question 49

Wat is Anencephaly

Answer 49

Anencephaly, the most serious NTD, is a congenital malformation in which both cerebral hemispheres are absent. If the child with anencephaly (where brain protrudes from the skull) survives, degeneration of the brain to a spongiform mass occurs, with no bony covering. The condition is incompatible with life, and many affected infants are stillborn. For those who survive, no specific treatment is available.

Question 50

Describe Myelomeningocele (MMC)

Answer 50

Myelomeningocele (MMC) develops during the first 28 days of pregnancy when the neural tube fails to close and fuse at some point along its length. It may be detected prenatally or at birth, accounts for 90% of spinal cord lesions, and may be located at any point along the spinal column. Usually the sac is encased in a fine membrane that is prone to tears through which cerebrospinal fluid (CSF) leaks.

The location and magnitude of the defect determine the nature and extent of neurologic impairment.

Sensory disturbances usually parallel to motor dysfunction * Below second lumbar vertebra: * Flaccid, partial paralysis of lower extremities * Varying degrees of sensory deficit * Overflow incontinence with constant dribbling of urine * Lack of bowel control * Rectal prolapse (sometimes) * Below third sacral vertebra: * No motor impairment * Bladder and anal sphincter paralysis * Joint deformities (sometimes produced in utero): * Talipes valgus or varus (foot) contractures * Kyphosis * Lumbosacral scoliosis * Hip dislocation

Question 50

When should a child’s car seat be rear facing

Answer 50

Infants and toddlers to the age of 2 years should travel only in federally approved rear-facing safety seats secured in the rear seat using the vehicle safety belt or an anchor and tether system

Question 50

Describe signs of spina bifida

Answer 50

Superficial cutaneous indications include a skin depression or dimple (which may also mark the outlet of a dermal sinus tract that extends to the subarachnoid space); port-wine angiomatous nevi; dark tufts of hair; and soft, subcutaneous lipomas.

Question 51

Describe the origin, susceptibility, and treatment of tetanus

Answer 51

Tetanus, or lockjaw, is an acute, preventable, and sometimes fatal disease caused by an exotoxin produced by the anaerobic, spore-forming, gram-positive bacillus Clostridium tetani.

The organisms are more prevalent in rural areas but are readily carried to urban areas by wind. They enter the body by way of wounds, particularly a puncture wound, burn, or crushed area. In the newborn, infection may occur through the umbilical cord, usually in situations in which infants are delivered in contaminated surroundings and the mother has not been properly immunized against tetanus.

Specific prophylactic therapy after trauma is administration of either tetanus toxoid or tetanus antitoxin. A dose of tetanus toxoid is not necessary for clean, minor wounds in children who have completed the immunization series (see Chapter 31) or who have received a booster within the previous 10 years.

The unprotected or inadequately immunized child who sustains a “tetanus-prone” wound (including wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite) should receive tetanus immunoglobulin (TIG). Concurrent administration of both TIG and tetanus toxoid at separate sites is recommended both to provide protection and to initiate the active immune process

Question 52

Describe how to use a car seat

Answer 52

The harness should be snug, and the retainer clip should be placed at the level of the infant’s armpits, not on the abdomen or neck area.

Position the infant at a 45-degree angle in the car seat to prevent slumping and airway obstruction;

Avoid bulky clothing on the infant;

Perry, Shannon E.; Hockenberry, Marilyn J.; Cashion, Kitty; Alden, Kathryn Rhodes; Olshansky, Ellen; Lowdermilk, Deitra Leonard. Maternal Child Nursing Care - E-Book (Kindle Locations 35935-35936). Elsevier Health Sciences. Kindle Edition.

Question 53

Describe the car seat challenge

Answer 53

• An infant car seat challenge is recommended by the AAP for infants who are born at less than 37 weeks’ gestation. This test is performed for at least 90– 120 min or a period of time equal to the length of the car ride home. The infant is monitored for apnea, bradycardia, and a decrease in oxygen saturation. If the infant exhibits any of these clinical signs, travel home should be in an approved car bed.

Question 54

What is Guillain-Barre (gee-YAH-buh-RAY) syndrome

Answer 54

Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body’s immune system attacks your nerves. Weakness and tingling in your hands and feet are usually the first symptoms.

Question 55

Describe Duchenne muscular dystrophy

Answer 55

DMD is the most severe and most common MD of childhood. It is inherited as an X-linked recessive trait (almost exclusively males affected).

• Early onset, usually between 3 and 5 years of age * Progressive muscular weakness, wasting, and contractures * Calf muscle hypertrophy in most patients * Loss of independent ambulation by 9– 12 years of age * Slowly progressive generalized weakness during adolescence * Relentless progression until death from respiratory or cardiac failure

Question 56

What vaccines prevent meningitis

Answer 56

Haemophilus influenzae type b (Hib vaccine) in 1990 and Streptococcus pneumoniae (pneumococcus)

Question 57

Describe the causes, manifestations and treatments of meningitis

Answer 57

Meningococcal meningitis is the only type readily transmitted by droplet infection from nasopharyngeal secretions and so has the potential to occur in outbreaks

Maternal factors, such as premature rupture of fetal membranes and maternal infection during the last week of pregnancy, are major causes of neonatal meningitis.

A lumbar puncture is the definitive diagnostic test.

Usually abrupt onset Fever Chills Headache Vomiting Alterations in sensorium Seizures (often the initial sign) Irritability Agitation May develop the following: * Photophobia * Delirium * Hallucinations * Aggressive behavior * Drowsiness * Stupor * Coma Nuchal rigidity; may progress to opisthotonos Positive Kernig and Brudzinski signs Hyperactivity but variable reflex responses Signs and symptoms peculiar to individual BULGING FONTANEL FOR BABIES

• Isolation precautions * Initiation of antimicrobial therapy * Maintenance of hydration * Maintenance of ventilation * Reduction of increased ICP * Management of systemic shock * Control of seizures * Control of temperature * Treatment of complications

Question 58

What is the Glasgow Coma Scale (GCS)

Answer 58

Consists of a three-part assessment: eye opening, verbal response, and motor response.
Severe:3-8
Mild: 13-15

Question 59

The hallmarks of a concussion are…

Answer 59

confusion and amnesia.

Question 59

The most common causes of head injury in children are…

Answer 59

falls, being struck by or striking an object with one’s head, and motor vehicle accidents, in that order

Question 60

Define Epilepsy

Answer 60

Epilepsy is defined as two or more unprovoked seizures more than 24 hours apart

Question 61

Most common neurologic dysfunction
in children

Answer 61

seizures

Question 62

Acute symptomatic seizures are caused by

Answer 62

Head trauma or meningitis

Question 63

Remote symptomatic seizures are caused by

Answer 63

Prior brain injury such as encephalitis or stroke

Question 64

Cryptogenic seizures are caused by

Answer 64

No clear cause

Question 65

Idiopathic seizures are caused by

Answer 65

Genetic in origin

Question 66

There difference between simple and complex partial seizures

Answer 66

Simple- motor OR sensory
Complex- motor AND sensory

Question 67

Describe a tonic-clonic generalized seizure

Answer 67

Occur without warning Tonic phase lasts approximately 10 to 20 s Manifestations: * Eyes roll upward * Immediate loss of consciousness * If standing, falls to floor or ground * Stiffens in generalized, symmetric tonic contraction of entire body musculature * Arms usually flexed * Legs, head, and neck extended * May utter a peculiar piercing cry * Apneic, may become cyanotic * Increased salivation and loss of swallowing reflex Clonic phase: lasts about 30 s but can vary from only a few seconds to a half-hour or longer Manifestations: * Violent jerking movements as the trunk and extremities undergo rhythmic contraction and relaxation * May foam at the mouth * May be incontinent of urine and feces

Question 68

Describe a absence generalized seizure

Answer 68

• Brief loss of consciousness * Appear without warning or aura * Usually last approximately 5– 10 s * Slight loss of muscle tone may cause child to drop objects * Ability to maintain postural control; seldom falls * Minor movements such as lip smacking, twitching of eyelids or face, or slight hand movements * Not accompanied by incontinence * Amnesia for episode * May need to reorient self to previous activity

Question 69

How do you treat seizures

Answer 69

Drug therapy
Ketogenic diet
Vagus nerve stimulation
Surgical therapy

Question 70

What is hydrocephalus

Answer 70

Caused by an imbalance in the production and absorption of CSF

Usually apparent in early infancy
Other causes include neoplasms, infection, and trauma
Often associated with myelomeningocele

Question 71

How do you treat hydrocephalus

Answer 71

The treatment is, with few exceptions, surgical.

ventriculoperitoneal (VP) shunt

Question 72

Describe the clinical manifestations of lyme disease

Answer 72

First stage: The lesion begins as a small erythematous papule that enlarges radially up to 30 cm (12 inches) over a period of days to weeks. It results in a large circumferential ring with a raised, edematous doughnut-like border resulting in a bull’s-eye appearance

Second stage: Constitutional symptoms, including fever, headache, malaise, fatigue, anorexia, stiff neck, generalized, lymphadenopathy, splenomegaly, conjunctivitis, sore throat, abdominal pain, and cough are often observed.

Finally, the third stage and the most serious stage of the disease, is characterized by systemic involvement of neurologic, cardiac, and musculoskeletal systems that appear 2 to 12 months after inoculation.

Question 73

How do you test for lyme disease

Answer 73

Serologic testing for Lyme disease at the time of a recognized tick bite is not recommended because antibodies are not detectable in most persons (American Academy of Pediatrics, 2015). Laboratory diagnosis can be established in later stages with a two-step approach that includes the screening test enzyme immunoassay or immunofluorescent immunoassay and, if the results are equivocal or positive, with Western immunoblot testing.

Question 74

How do you treat lyme disease

Answer 74

Children older than 8 years are treated with oral doxycycline; amoxicillin is recommended for children younger than 8 years

The length of treatment depends on the clinical response and other disease manifestations, but it usually lasts from 14 to 21 days

Question 75

How do you treat scabies

Answer 75

The treatment of scabies is the application of a scabicide. The drug of choice in children and infants older than 2 months is permethrin 5% cream (Elimite). Alternative drugs are 10% crotamiton (cream or lotion) or oral ivermectin.

Question 76

Where would you expect to find scabies bites

Answer 76

Generally in intertriginous areas – interdigital, axillary,, popliteal, inguinal

Children older than 2 yo – primarily hands and wrists
Children younger than 2 yo – primarily feet and ankles

Question 77

Describe a ring worm infection

Answer 77

These are superficial infections by fungal organisms that live on, not in, the skin.

Both 2% ketoconazole and 1% selenium sulfide shampoos may reduce colony counts of dermatophytes.

Question 78

Describe a lice infection

Answer 78

The female lays her eggs at night at the junction of a hair shaft and close to the skin because the eggs need a warm environment. The nits, or eggs, hatch in approximately 7 to 10 days.

Clinical Manifestations of Pediculosis Pruritus (caused by crawling insects and insect saliva on skin) Nits observable on hair shaft (see Fig. 50.7A) Distribution Occipital area Behind ears Nape of neck Eyebrows and eyelashes (occasionally) (caused by pubic lice)

The drug of choice for infants and children is permethrin 1% cream rinse (Nix), which kills adult lice and nits.Most experts advise a second treatment at 7 to 10 days to ensure a cure

Question 79

What is impetigo

Answer 79

Begins as a reddish macule Becomes vesicular Ruptures easily, leaving superficial, moist erosion Tends to spread peripherally in sharply marginated irregular outlines Exudate dries to form heavy, honey-colored crusts Pruritus

Topical bactericidal ointment mupirocin or triple antibiotic ointment Oral or parenteral antibiotics (penicillin) in severe or extensive lesions Vancomycin for methicillin-resistant Staphylococcus aureus (MRSA)

Question 80

Define diaper dermatitis

Answer 80

Diaper dermatitis is caused by prolonged and repetitive contact with an irritant (e.g., urine, feces, soaps, detergents, ointments, friction)

The eruption of diaper dermatitis is manifested primarily on convex surfaces or in folds.

Eruptions involving the skin in most intimate contact with the diaper but sparing the folds are likely to be caused by chemical irritants, especially from urine and feces. wipes.

Perianal involvement is usually the result of chemical irritation from feces, especially diarrheal stools.

Chronic diaper rashes can turn into a candida infection that produces perianal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal fold

To fix:
Keep skin dry
apply ointment to protect the skin (use mineral oil to remove)

Question 81

Describe Tinea capitis

Answer 81

Lesions in scalp but may extend to hairline or neck Characteristic configuration of scaly, circumscribed patches or patchy, scaling areas of alopecia Generally asymptomatic but severe, deep inflammatory reaction may occur that manifests as boggy, encrusted lesions (kerions) Pruritic Diagnosis: Microscopic examination of scales

Tx: Oral griseofulvin or terbinafine Oral ketoconazole for difficult cases Selenium sulfide shampoos

Question 82

What is Systemic lupus erythematosus (SLE)

Answer 82

Systemic lupus erythematosus (SLE) is a severe chronic autoimmune disease that results in inflammation and multiorgan system damage.

Erythematosus butterfly rash over bridge of nose and across cheeks, discoid rash, photosensitivity, mucocutaneous ulceration, alopecia, periungual telangiectasias

Question 83

What is the significance of burns greater than 30% of the body

Answer 83

Burns greater than 30% of TBSA = systemic response involves an increase in capillary permeability, allow plasma proteins, fluids, and electrolytes to be lost

Question 84

Describe the secondary effects of large burns

Answer 84

Maximum edema formation in small burn = 8-12 hours after injury

With larger burn, hypovolemia, associated with this phenomenon will slow rate of edema

Systemic response is anemia = direct heat destruction of RBCs, hemolysis of RBCS

Heat burns airways and cases swelling which may compromise the airway

carbon monoxide poisoning makes O2 circ difficult

Immediate threat = airway compromise and burn shock

Sepsis monitoring d/t compromised skin barrier and dysregulated immune system

Question 85

Describe the 4 different degrees of burns

Answer 85

1: Epidermis remains intact, erythema, painful, discomfort lasts 48-72 hours.

2: Wet, weeping surface, painful, very sensitive to touch, healing rate varies with burn depth.

3: Thrombosed vessels visible, Insensate, autografting is required.

4: Charring visible in deepest area, insensate, amputation or autografting.

Question 86

How do you measure the percentage of burns

Answer 86

use the patient’s hand to measure. Each hand worth of burn is equivalent to 1%

Remember the rule of 9s
The whole head is 9, each side 4.5
The top/bottom of trunk is 9 which makes 18 each side
the whole arm is 9 so each side is 4.5
the whole leg is 18 so each side is 9

Question 87

What is cradle cap and how do you treat it

Answer 87

Seborrheic dermatitis is a chronic, recurrent, inflammatory reaction of the skin. The lesions are characteristically thick, adherent, yellowish, scaly, oily patches that may or may not be mildly pruritic.

Cradle cap may be prevented with adequate scalp hygiene. Frequently, parents omit shampooing the infant’s hair for fear of damaging the “soft spots,” or fontanels. The nurse should discuss how to shampoo the infant’s hair and emphasize that the fontanel is similar to skin anywhere else on the body— it does not puncture or tear with mild pressure.

Shampooing should be done daily with a mild soap or commercial baby shampoo; medicated shampoos are not necessary, but an antiseborrheic shampoo containing sulfur and salicylic acid may be used.