Fluid and electrolytes and neuro Flashcards
Infants and young children have a proportionately larger ___ceullar fluid volume
extracellular
water is lost through the lungs because of higher ____and ___ rate in early childhood
respiratory and metabolic
water is also lost through the ____
skin
Infants and children younger than 2 years have a greater amount of ___ surface
skin
2-3x that of an adult
Infants have Immature __________ so they cannot dilute their urine so if they get too much fluid or too little, their kidneys cannot adjust
Immature renal system
infants have a much greater need for ______(think about how often a baby needs to drink compared to you)
fluids
If a formula is diluted it can cause the child to have _____ (electrolyte imbalance)
hyponatremia because the baby getting too much water
____ are at huge risk for dehydration
infants/childern
true or false: Primary total brain jury are associated with the direct trauma that occurs at the time of injury
True- at the moment of impact
When a baby has an enlarged head due to the sutures closing TOO SOON
Craniosyntosis
What is the condition when a child’s head is too small
microcephaly:
Abnormally small head: primary or secondary.
Cognitive impairments
Head circumference 2 standard deviations below mean.
Supportive care.
What is the biggest concern with microcephaly
cognitive delays and impairments
What is the fire-line treatment for a baby with plagiocephocephaly?
repostioning
Baby has a massive head with fluid has
hydrocephalus
What condition is most likely associated with cognitive delays
a. craniosynostosis
b. microcephaly
c. plagiocephaly
Mircocephaly
The ability of a person to process information and respond to that information verbally or physically
Level of consiouness
Which is an early sign of ICP in a child/infant
Poor feedings or beavior changes
Unreavtice pupils are an early sign of ICP
true or false?
False
true or false
a seizure is the same as epilespy
True
How a seizure affects a person depends on what factor?
The area of the brain where excitable neurons are firing
What is a prolonged seizure or series of seizures without recovery in between called?
back to back seizures
——- how do u tx it??
Status epileptics
——–treatment: medically inducted coma
Some seizure disorders always require medications
True
Example: infant seizures
How long should the nurse wait to give medication to stop seizures?
5 minutes
-because we want to see how long it would last
What medication do you give to stop seizures
Benzos - lorazepam (hospital) or diazepam ( home setting)
rapid myelination occurs during the first _____ years
3
Infants are more at risk for head injuries because
their heads are larger
thin skin
skull is not thick enough
Signs of abnormal neuro assessments
behavior high pitch cry head swelling bulging fontlets have not high milestones muscles tone pupils
what do you consider when doing a child’s neuro exam
is this their baseline?
loss of milestones or delays
a change in cognition could be due to a low ____ level
glucose
theses hyperactive cells where neurons are firing are called the _______ (show on an EEG)
Epileptogenic focus
symptoms of a seizure depend on
where neurons are firing
seizures may cause
brain injury, infection, electrolytes imbalance, toxins, brain tumors
chronic seizures
seizures that occur with little or no observable cause are most commonly associated with seizure disorder (lifelong)
acute seizures
occur once or in a closely associated group are commonly caused by an acute condition…may progress into chronic condition
2 or more unproved seizures
epilepsy
Not every child had ___ during a seizure. Not every convulsion means the pt has seizures (ekg will show no seizures)
convulsions
a seizure triggered by high fever in a childer younger than 7 years old
febrile seziure
seizures are a symptom and epilepsy is a _____
diease
body temp greater than ____F causes risk for a febrile seizure
101.2
how do you diagnose a seizure?
Encephalogram EEG
what is an EEG
is a test that detects abnormalities in your brain waves, or in the electrical activity of your brain.
Febrile seizures are self-limiting but provide ___ for parents
anxiety
what are the biggest comorbidities for seizures (2 things)
depression and ADHD
Focal seizures
the patient is aware of their surroundings during a seizure
may have face twitching
Generalized seizures
can be suttle movements
Infantile spasms
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
How do you treat status epilepticus
treat aggressively!!! medical coma!!!
Vent. support +++medically induced coma to stop seizures
ICU patient
IV fluids, oxygen, and IV medications to stop seizures
someone is vomiting… what do you do first
turn them on their left side
seizures are usally observed for _____ before any medical intervention
3-5 mins because seziures are slef limitng so we observe first before we act
Patients with seizures will have ______ for giving medications
standard orders
Safety meausres with childern who have seizures
helments to protect head provide safety do not place anything in their mouth!!!!!!! do NOT attempt to hold them down keep area safe
Assessment during seizure
observe carefully!!
- are they shaking?
As soon as a seizure stops
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
Seziure medication, diet, and surgery
Medication: usally need multipe medications
Diet: ketogenic diet (hard for kids to be on this diet)
Surgery: surgical mapping
vagal nerve stimular
What age group do sugical mapping? what type of seizure, focus or general
School age or older focus seziures (only one spot in the brain)
vagal nerve stimulator
a disc you swip over w a key to stop a seizure
do right away—- don’t wait 5 mins
When do you start tx child w antieleptic medications?
typically wait until at least 2nd unprovked seizure
- some kids many need more than 1 seizure medication
-
All childern with seizures will have PRN medications to treat an
active seizure
Adverse Reactions to Consider in Antiepileptic Medications
- heaptoxicity ( hard on liver)
- bone health (reduced bone growth +imparied Vitamin D)
- depression adn suicdal ideation
- behavior changes —common in childern
What are adverse drug reactions to Phenytoin?
Gingival hyperplasia (abnormal growth of tissue around gums) skin rash (Steven Johnson syndrome)
Phenytoin and Valproic acid drug administration considerations
Inject IV form slowly using correct dilution
What is the serum drug level of phenytoin?
10-20
When giving phenytoin montoir vitals because it can cause
hypotension and cardiac dysrhythmias
phenytoin is used to treat
tonic clonic seizures and partial seizures
waiting for seizure meds even an hour can
trigger a seizure
what seizure meds are teratogenic so the pt must be on birth control or not have sex
Phenytoin and Carbamazepine
A major adverse effect of Carbamazepine is that it can
decrease blood cell production
what labs to monitor for carbamazpine?
WBC and CBC (if low withhold drug)
Carbamazepine is contraindicated with pt
Pregant
absence/myoclonic seizures
__________ occurs during a traumatic brain injury
Traumatic brain injury
highest risk for head trauma is for _______ age groups
toddlers (falls) and adolescents (car accidents)
—Per CDC 0-4 is the HIGHEST age group
shaken baby syndrome is often a ____ condition
slient condition (presents slowly)
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 ________
coup-injury
contrecoup injury
Children are at more risk for brain injuries due to immature
musculature and larger heads
2 complications that occur due to head trauma in a child (shaken baby)
subdural hematoma
retinal hemorrhages
What is the biggest s/s of shaken baby (warning sign!!!)
LONGGGG periods of apnea
pt on Carbamazepine should be instructed to report
fever, sore throat, and bruising to the provider!!!!!!!!!
Diminished reflex (ICP) is a _____ sign that should be ______
a late sign that should be monitored
Nausea/ vomiting is an _____sign to ICP. The nurse should ______
early
continue to observe unless in the “am” then it must be evaluated, especially if they bumped their head recently
A coma is a ____ sign of ICP
late and must be evaulted
Headache is a ______ sign of ICP that should be _______
early sign
only monitor unless it is persistent occipital or frontal pain or worsening in severity of thunder clap or worse in the am
Lethargy is a ____ sign of ICP. and should be
early
should be evaluated
Unequal or non-reactive pupils are a ____ and
late sign of ICP
should be evaluated
Poor feedings is a ___ sign of ICP
early and should only be evaluated if they are not eating for a long period of time
Confusion is an ___ sign of ICP and should be ____
early
evualted
posturing is a ____ sign of ICP and should be
Late
evualted
Cushing’s triad is a ___ sign of ICP and should be ____
late
evaluated
Irritability is a ____ sign of ICP and _____
early sign
continue to observe
Seizures are a ____ sign of ICP and should be
late
evaluated
Apena (infants) is an _____ sign and should be
early sign
evaluated
—————–apnea is a behavior change
signs of ICP
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)
An ICP greater than 20 ______
must be treated
Life-threatening if ICP is greater than _____
40mmHg
No sedatives if there is NO confirmed increased intracranial pressure (just head trauma). If confirmed, then
ok to sedate
What to do if someone bumps their head…
ABCs Seizure precautions NPO No analgesics or sedatives…if needed…use with caution Monitor LOC Monitor neuro status
When a child has a headache give _____ immediately
Meds (abortive treatment)
Migraine treatment
- 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
______ is a premature closure of cranial sutures and can cause increase intracranial pressure and head malformations, it is treated by ________
craniosynostosis is tx with surgery before 6 months old. Then a child wears a post-operative helmet afterwards
__________ asymmetry and flatting of head from external forces and skull deformations . Is treated with ______
Deformational plagicephaly
frequent repositioning and orthotics to treat
_______ is a small head that causes cognitive impairments
Micrtocephaly
______ is an infection of the meninges with cerbral edema
Encephalitis
Symptoms of Encephalitis
increase risk for SEIZURES, flaccid paralysis, headahces, photophobia, letharfy and stiff neck
how do you treat encephalitis?
IV antiviral medication
what causes of reye sydrome
aspirin use during viral illnesses
or
viral infection
why do you avoid aspiring in childern under 19?
reye’s syndrome
s/s of reye’s syndrome
increased risk for bleeding (liver isnt making clotting factors), cerebal edema (swelling and ICP)
s/s of reye’s syndrome
increased risk for bleeding (liver isnt making clotting factors), cerebal edema (swelling and ICP)
If a child is emesis (vomiting) the nurse should give ________
an antiemetic (ondanestron)
How offer do you give oral hydration for a child w mild to moderate dehydration?
5-15 ml Q10 mins
Goal is to consume 50 mL per kg during the first 2-4 hours
If a child can not handle rehydration
when to do IV rehydration
What is a severe sign of dehydration in a child. weight loss of ____
weight loss of 10% or greater
(hard to tell bc children do not get daily weights at home normally, especially infants
When to ALWAY use IV fluids
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
Infants can not get normal water for rehydration so they must get
Oral rehydration solution (has electroleyes in it)
How do you treat SERVE DEHYDATION??
Isotonic solution: 0.9 Normal Saline or LR
If we want to replace sodium with
0.9 normal saline (isotonic
Never want to shift Na+ too fast because it can lead to
Cerebral edema
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)
Urine output
Most accurt way to check Intake and output
- strict I + O
- most accurate is to weight child
- specific gravity (normal: 0.010 - 00.25
Need to give NSS bolus ______ml/kg
20
how to calcuate oral fluids for childern over 20kg
1,500mL + (20mL x ? kg) / 24 hours
how to calcuate oral fluids for childern less than 10kg
(100ml x ____kg ) / 24 hours
how to calcuate oral fluids for childern 10kg to 20kg
1,000 + (50mL x ? kg) / 24 hours
When do lower incisors erupt in a child?
6 months
dehydration pathway does not include
patients under 6 months
