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Pediatrics > Fluid and electrolytes and neuro > Flashcards

Fluid and electrolytes and neuro Flashcards

1
Q

Infants and young children have a proportionately larger ___ceullar fluid volume

A

extracellular

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2
Q

water is lost through the lungs because of higher ____and ___ rate in early childhood

A

respiratory and metabolic

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3
Q

water is also lost through the ____

A

skin

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4
Q

Infants and children younger than 2 years have a greater amount of ___ surface

A

skin

2-3x that of an adult

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5
Q

Infants have Immature __________ so they cannot dilute their urine so if they get too much fluid or too little, their kidneys cannot adjust

A

Immature renal system

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6
Q

infants have a much greater need for ______(think about how often a baby needs to drink compared to you)

A

fluids

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7
Q

If a formula is diluted it can cause the child to have _____ (electrolyte imbalance)

A

hyponatremia because the baby getting too much water

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8
Q

____ are at huge risk for dehydration

A

infants/childern

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9
Q

true or false: Primary total brain jury are associated with the direct trauma that occurs at the time of injury

A

True- at the moment of impact

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10
Q

When a baby has an enlarged head due to the sutures closing TOO SOON

A

Craniosyntosis

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11
Q

What is the condition when a child’s head is too small

A

microcephaly:
Abnormally small head: primary or secondary.
Cognitive impairments
Head circumference 2 standard deviations below mean.
Supportive care.

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12
Q

What is the biggest concern with microcephaly

A

cognitive delays and impairments

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13
Q

What is the fire-line treatment for a baby with plagiocephocephaly?

A

repostioning

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14
Q

Baby has a massive head with fluid has

A

hydrocephalus

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15
Q

What condition is most likely associated with cognitive delays

a. craniosynostosis
b. microcephaly
c. plagiocephaly

A

Mircocephaly

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16
Q

The ability of a person to process information and respond to that information verbally or physically

A

Level of consiouness

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17
Q

Which is an early sign of ICP in a child/infant

A

Poor feedings or beavior changes

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18
Q

Unreavtice pupils are an early sign of ICP

true or false?

A

False

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19
Q

true or false

a seizure is the same as epilespy

A

True

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20
Q

How a seizure affects a person depends on what factor?

A

The area of the brain where excitable neurons are firing

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21
Q

What is a prolonged seizure or series of seizures without recovery in between called?
back to back seizures
——- how do u tx it??

A

Status epileptics

——–treatment: medically inducted coma

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22
Q

Some seizure disorders always require medications

A

True

Example: infant seizures

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23
Q

How long should the nurse wait to give medication to stop seizures?

A

5 minutes

-because we want to see how long it would last

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24
Q

What medication do you give to stop seizures

A

Benzos - lorazepam (hospital) or diazepam ( home setting)

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25
Q

rapid myelination occurs during the first _____ years

A

3

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26
Q

Infants are more at risk for head injuries because

A

their heads are larger
thin skin
skull is not thick enough

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27
Q

Signs of abnormal neuro assessments

A 
behavior 
high pitch cry
head swelling
bulging fontlets 
have not high milestones
muscles tone 
pupils
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28
Q

what do you consider when doing a child’s neuro exam

A

is this their baseline?

loss of milestones or delays

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29
Q

a change in cognition could be due to a low ____ level

A

glucose

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30
Q

theses hyperactive cells where neurons are firing are called the _______ (show on an EEG)

A

Epileptogenic focus

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31
Q

symptoms of a seizure depend on

A

where neurons are firing

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32
Q

seizures may cause

A

brain injury, infection, electrolytes imbalance, toxins, brain tumors

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33
Q

chronic seizures

A

seizures that occur with little or no observable cause are most commonly associated with seizure disorder (lifelong)

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34
Q

acute seizures

A

occur once or in a closely associated group are commonly caused by an acute condition…may progress into chronic condition

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35
Q

2 or more unproved seizures

A

epilepsy

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36
Q

Not every child had ___ during a seizure. Not every convulsion means the pt has seizures (ekg will show no seizures)

A

convulsions

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37
Q

a seizure triggered by high fever in a childer younger than 7 years old

A

febrile seziure

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38
Q

seizures are a symptom and epilepsy is a _____

A

diease

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39
Q

body temp greater than ____F causes risk for a febrile seizure

A

101.2

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40
Q

how do you diagnose a seizure?

A

Encephalogram EEG

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41
Q

what is an EEG

A

is a test that detects abnormalities in your brain waves, or in the electrical activity of your brain.

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42
Q

Febrile seizures are self-limiting but provide ___ for parents

A

anxiety

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43
Q

what are the biggest comorbidities for seizures (2 things)

A

depression and ADHD

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44
Q

Focal seizures

A

the patient is aware of their surroundings during a seizure

may have face twitching

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45
Q

Generalized seizures

A

can be suttle movements

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46
Q

Infantile spasms

A

are an emergency that is often overlooked because it looks like colic, reflux, or exaggerated startle reflex. a child can be 400-500 seizures a day— looks like a startle reflex

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47
Q

How do you treat status epilepticus

A

treat aggressively!!! medical coma!!!
Vent. support +++medically induced coma to stop seizures
ICU patient
IV fluids, oxygen, and IV medications to stop seizures

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48
Q

someone is vomiting… what do you do first

A

turn them on their left side

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49
Q

seizures are usally observed for _____ before any medical intervention

A

3-5 mins because seziures are slef limitng so we observe first before we act

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50
Q

Patients with seizures will have ______ for giving medications

A

standard orders

51
Q

Safety meausres with childern who have seizures

A 
helments to protect head
provide safety 
do not place anything in their mouth!!!!!!!
do NOT attempt to hold them down 
keep area safe
52
Q

Assessment during seizure

A

observe carefully!!

- are they shaking?

53
Q

As soon as a seizure stops

A

Get their vital signs!
talk to them and ask if they had an aura before the seizure, are they sleepy
get them to describe as best they can
COMPLETE nueorgical exam

54
Q

Seziure medication, diet, and surgery

A

Medication: usally need multipe medications
Diet: ketogenic diet (hard for kids to be on this diet)
Surgery: surgical mapping
vagal nerve stimular

55
Q

What age group do sugical mapping? what type of seizure, focus or general

A 
School age or older 
focus seziures (only one spot in the brain)
56
Q

vagal nerve stimulator

A

a disc you swip over w a key to stop a seizure

do right away—- don’t wait 5 mins

57
Q

When do you start tx child w antieleptic medications?

A

typically wait until at least 2nd unprovked seizure
- some kids many need more than 1 seizure medication
-

58
Q

All childern with seizures will have PRN medications to treat an

A

active seizure

59
Q

Adverse Reactions to Consider in Antiepileptic Medications

A
  • heaptoxicity ( hard on liver)
  • bone health (reduced bone growth +imparied Vitamin D)
  • depression adn suicdal ideation
  • behavior changes —common in childern
60
Q

What are adverse drug reactions to Phenytoin?

A 
Gingival hyperplasia (abnormal growth of tissue around gums)
skin rash (Steven Johnson syndrome)
61
Q

Phenytoin and Valproic acid drug administration considerations

A

Inject IV form slowly using correct dilution

62
Q

What is the serum drug level of phenytoin?

A

10-20

63
Q

When giving phenytoin montoir vitals because it can cause

A

hypotension and cardiac dysrhythmias

64
Q

phenytoin is used to treat

A

tonic clonic seizures and partial seizures

65
Q

waiting for seizure meds even an hour can

A

trigger a seizure

66
Q

what seizure meds are teratogenic so the pt must be on birth control or not have sex

A

Phenytoin and Carbamazepine

67
Q

A major adverse effect of Carbamazepine is that it can

A

decrease blood cell production

68
Q

what labs to monitor for carbamazpine?

A

WBC and CBC (if low withhold drug)

69
Q

Carbamazepine is contraindicated with pt

A

Pregant

absence/myoclonic seizures

70
Q

__________ occurs during a traumatic brain injury

A

Traumatic brain injury

71
Q

highest risk for head trauma is for _______ age groups

A

toddlers (falls) and adolescents (car accidents)

—Per CDC 0-4 is the HIGHEST age group

72
Q

shaken baby syndrome is often a ____ condition

A

slient condition (presents slowly)

73
Q

brain injurt can results from a direct blow to the head just under the skull where the initial impact occurs (_______)
The secondary impact is cause ________

A

coup-injury

contrecoup injury

74
Q

Children are at more risk for brain injuries due to immature

A

musculature and larger heads

75
Q

2 complications that occur due to head trauma in a child (shaken baby)

A

subdural hematoma

retinal hemorrhages

76
Q

What is the biggest s/s of shaken baby (warning sign!!!)

A

LONGGGG periods of apnea

77
Q

pt on Carbamazepine should be instructed to report

A

fever, sore throat, and bruising to the provider!!!!!!!!!

78
Q

Diminished reflex (ICP) is a _____ sign that should be ______

A

a late sign that should be monitored

79
Q

Nausea/ vomiting is an _____sign to ICP. The nurse should ______

A

early

continue to observe unless in the “am” then it must be evaluated, especially if they bumped their head recently

80
Q

A coma is a ____ sign of ICP

A

late and must be evaulted

81
Q

Headache is a ______ sign of ICP that should be _______

A

early sign
only monitor unless it is persistent occipital or frontal pain or worsening in severity of thunder clap or worse in the am

82
Q

Lethargy is a ____ sign of ICP. and should be

A

early

should be evaluated

83
Q

Unequal or non-reactive pupils are a ____ and

A

late sign of ICP

should be evaluated

84
Q

Poor feedings is a ___ sign of ICP

A

early and should only be evaluated if they are not eating for a long period of time

85
Q

Confusion is an ___ sign of ICP and should be ____

A

early

evualted

86
Q

posturing is a ____ sign of ICP and should be

A

Late

evualted

87
Q

Cushing’s triad is a ___ sign of ICP and should be ____

A

late

evaluated

88
Q

Irritability is a ____ sign of ICP and _____

A

early sign

continue to observe

89
Q

Seizures are a ____ sign of ICP and should be

A

late

evaluated

90
Q

Apena (infants) is an _____ sign and should be

A

early sign
evaluated
—————–apnea is a behavior change

91
Q

signs of ICP

A

Loss of milestones or not gaining milestones
Poor suck
Prolonged or missing reflexes
High pitch cry
Increased head circumference
Worse with the Valsalva maneuver
Weakness, numbness, or decreased coordination
Slurred speech
Becomes increasingly confused, restless, or agitated
Has unusual behavior
Cannot recognize people or places (LOC)
Loses consciousness (even a brief)
loss of consciousness should be taken seriously)

92
Q

An ICP greater than 20 ______

A

must be treated

93
Q

Life-threatening if ICP is greater than _____

A

40mmHg

94
Q

No sedatives if there is NO confirmed increased intracranial pressure (just head trauma). If confirmed, then

A

ok to sedate

95
Q

What to do if someone bumps their head…

A 
ABCs
Seizure precautions
NPO
No analgesics or sedatives…if needed…use with caution
Monitor LOC
Monitor neuro status
96
Q

When a child has a headache give _____ immediately

A

Meds (abortive treatment)

97
Q

Migraine treatment

A
  • give meds immediately
  • triptans (serotonin agonists) are effective
  • cognitive behavioral therapy —EBP
  • child sleeps in a dark room that is quiet
  • acetaminophen and Ibuprofen only effective if given early
98
Q

______ is a premature closure of cranial sutures and can cause increase intracranial pressure and head malformations, it is treated by ________

A

craniosynostosis is tx with surgery before 6 months old. Then a child wears a post-operative helmet afterwards

99
Q

__________ asymmetry and flatting of head from external forces and skull deformations . Is treated with ______

A

Deformational plagicephaly

frequent repositioning and orthotics to treat

100
Q

_______ is a small head that causes cognitive impairments

A

Micrtocephaly

101
Q

______ is an infection of the meninges with cerbral edema

A

Encephalitis

102
Q

Symptoms of Encephalitis

A

increase risk for SEIZURES, flaccid paralysis, headahces, photophobia, letharfy and stiff neck

103
Q

how do you treat encephalitis?

A

IV antiviral medication

104
Q

what causes of reye sydrome

A

aspirin use during viral illnesses
or
viral infection

105
Q

why do you avoid aspiring in childern under 19?

A

reye’s syndrome

106
Q

s/s of reye’s syndrome

A

increased risk for bleeding (liver isnt making clotting factors), cerebal edema (swelling and ICP)

107
Q

s/s of reye’s syndrome

A

increased risk for bleeding (liver isnt making clotting factors), cerebal edema (swelling and ICP)

108
Q

If a child is emesis (vomiting) the nurse should give ________

A

an antiemetic (ondanestron)

109
Q

How offer do you give oral hydration for a child w mild to moderate dehydration?

A

5-15 ml Q10 mins

Goal is to consume 50 mL per kg during the first 2-4 hours

110
Q

If a child can not handle rehydration

A

when to do IV rehydration

111
Q

What is a severe sign of dehydration in a child. weight loss of ____

A

weight loss of 10% or greater

(hard to tell bc children do not get daily weights at home normally, especially infants

112
Q

When to ALWAY use IV fluids

A

ciculatory instability/shock
change in LOC
intractable vomiting (losing fluids)
bloody diarrhea (losing fluids)
Ileus (constient lose of fluid)
abnormal serum NA (hyponateria or hypernateria)
glucose malabsorption (diabetes)- even if they look fine

113
Q

Infants can not get normal water for rehydration so they must get

A

Oral rehydration solution (has electroleyes in it)

114
Q

How do you treat SERVE DEHYDATION??

A

Isotonic solution: 0.9 Normal Saline or LR

115
Q

If we want to replace sodium with

A

0.9 normal saline (isotonic

116
Q

Never want to shift Na+ too fast because it can lead to

A

Cerebral edema

117
Q

Potassium is very senstive to change and we need to make sure the kidneys are working before we give Potassium> how do you check kidney function (besides labs)

A

Urine output

118
Q

Most accurt way to check Intake and output

A
  • strict I + O
  • most accurate is to weight child
  • specific gravity (normal: 0.010 - 00.25
119
Q

Need to give NSS bolus ______ml/kg

A

20

120
Q

how to calcuate oral fluids for childern over 20kg

A

1,500mL + (20mL x ? kg) / 24 hours

121
Q

how to calcuate oral fluids for childern less than 10kg

A

(100ml x ____kg ) / 24 hours

122
Q

how to calcuate oral fluids for childern 10kg to 20kg

A

1,000 + (50mL x ? kg) / 24 hours

123
Q

When do lower incisors erupt in a child?

A

6 months

124
Q

dehydration pathway does not include

A

patients under 6 months

Pediatrics (5 decks)

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