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Nursing School > 👧🏾- Musculoskeletal, Vaccines & Neuro Test > Flashcards

👧🏾- Musculoskeletal, Vaccines & Neuro Test Flashcards

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0
Q

Spastic (pyramidal) CP

A

Hypertonicity with poor posture, balance, coordination, fine & gross motor functions, maintaining infant reflex’s

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1
Q

Cerebral palsy

Characteristics of, causes

A

Impaired muscular control resulting from non-progressive abnormalities in the nervous system

Characteristics of CP- abnormal muscle tone, impaired coordination

Causes- ⬇️ oxygen to the 🧠, prenatal brain abnormalities, prematurity (LBW), perinatal conditions, birth anoxia

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2
Q

Dyskinetic (extrapyramidal) CP

A

Abnormal involuntary movements, also known as athetoid movements, which are slow wormlike writhing movements with pharyngeal & oral muscle involvement causing drooling & speech problems

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3
Q

Ataxic CP

A

Characterized by a wide based gait, difficulty with rapid, repetitive movements & incoordination of movements of the upper extremities

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4
Q

Mixed type CP

A

A combination of spasticity & dyskinetic

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5
Q

Associated disabilities with CP

A

CI (30-50%)

Sensory impairments

Respiratory problems

Orthopedic complications

ADHD

Seizures

Dental problems (related to seizure meds)

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6
Q

Diagnosis of CP

A

Delayed gross motor development , abnormal motor performance , alteration in muscle tone (floppy baby) , abnormal posture , reflex abnormalities, associated disabilities

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7
Q

5 Drugs that are therapy for CP

A

Baclofen pump (⬇️ spasticity)

Ritalin (ADHD)

Tegretal (seizures)

Valium (anxiety & spasticity)

Botox (relaxes muscles)

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8
Q

Spina bifida occulta vs spina bifida cystica

A

Occulta- a defect that is not visible externally (sacral dimple, hair tufts, color difference)

Cystica- a visible defect with an external saclike protrusion (types meningocele & myleomeningocele)

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9
Q

Meningocele vs myelomeningocele

A

Meningocele- hernial protrusion of a saclike cyst of meninges filled with spinal fluid

Myelomeningocele- hernial protrusion of a saclike cyst containing meninges, spinal fluid & a portion of the spinal cord with its nerves

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10
Q

Myelo associated complications

A

Hydrocephalus

Bowel & bladder problems

Paralysis

Orthopedic problems

Meningitis

Latex allergies

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11
Q

Goal of treatment for CP

A

Promote child’s optimal development

Gross motor 
Communication 
Self-help skills 
Treat associated disabilities 
Provide education 
Promote socialization
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12
Q

Myelomeningocele goal of treatment

A

Protect sac

Prevent infection

Prevent rupture

Surgical closure 24-72hrs after birth

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13
Q

Nursing care for myelo (3 things)

A

1 prevent infection - antibiotics prophylactically

2 protect sac - keep sterile, keep moist (cover with sterile graze), change dressing q 2-4hrs, good hygiene (keep clean & dry)

3 proper positioning - prone, flat, hips flexed

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14
Q

Post op care for myelo

4 things

A

1 prone & flat

2 good skin care (urine & feces)

3 Monitor for complications - daily head circumference, CSF leakage (looks like a halo on dressing)

4 neuro assessment - movement of extremities, sphincter control, signs of increased ICP, supportive care

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15
Q

Latex allergy

Cause, allergies related to latex, foods

A

Cause- repeated exposure (multiple surgeries & urinary catheterizations)

Allergies related- balloons & balls, pacifiers, band-aids, catheters and gloves

Foods- bananas 🍌, avocados 🥑, kiwi 🥝, chestnuts 🌰

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16
Q

Symptoms of latex allergy

A

Urticaria (hives)

Wheezing

Watery eyes

Rashes

Anaphylactic shock

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17
Q

Muscular dystrophy

A

Progressive wasting of muscle groups

Progressive weakness of symmetrical skeletal muscles

Resulting in disability & deformity

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18
Q

Duchenne MD

A

Pseudohypertrophic MD

Increased muscle mass related to fatty infiltration (calves, thighs & upper arms)

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19
Q

Cause of duchenne MD

A

X-linked recessive disorder

Seen in males
Transmitted by females
Early onset (3-7 years)

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20
Q

S & S of duchenne MD

A
  • waddling gait with frequent falls
  • lordosis
  • loss of ambulation
  • enlarged muscles
  • slow progressive weakness
  • CI (mild to moderate)
  • gower sign
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21
Q

Diagnosis of DMD

A

S&s of disease

Gene analysis

Increased CPK, AST, ALDOLASE

electromyography (emg)

Muscle biopsy

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22
Q

Care of child with DMD

A
  • corticosteroids
  • maintain function for as long as possible
  • stay active (breathing exercises)
  • ROM
  • bracing
  • release of contractures
  • cough & ventilation assistance
  • genetic counseling
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23
Q

Gullain barre’ syndrome (infectious polyneuritis)

Cause

A

Acute demyelinating polyneuropathy with a progressive, usually ascending flaccid paralysis

Cause- immune mediated disease, associated with viral or bacterial infection or vaccines

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24
Q

Patho of Guillain barre’

A

Inflammation & edema of the spinal and cranial nerves occur

Followed by impaired nerve conduction

The impaired nerve conduction results in symmetrical ascending paralysis

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25
Q

S&S of guillain barre’

A
  • usually begins with a viral or bacterial infection
  • 10 days later neurological signs begin
  • ascending bilateral paralysis from lower extremities occurs
  • prognosis for these children is good
  • most children recover in 2-4 weeks
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26
Q

Diagnosis of guillain barre’

A

History
S&S
Increased protein in CSF
EMG (shows evidence of acute muscle denervation)

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27
Q

Nursing care for GBS

A
  • assessment of respiratory function
  • pharyngeal assessment
  • skin care
  • CA Monitor
  • good body alignment
  • suction
  • position changes/rom
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28
Q

Nursing care for GBS

Severe paralysis

A
  • IV immunoglobulin
  • temporary trach
  • ventilator assistance
  • IV steroids
  • NG feeds
  • bowel & bladder care
  • prevention of DVT’s
  • plasmapheresis (removal, treatment and return of blood plasma)
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29
Q

Contusion

A

Damage to soft tissue, subcutaneous structures & muscles causing injury to blood vessels and inflammation

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30
Q

Dislocation

A

Stress on ligament causing displacement of two bones or bone to its socket

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31
Q

Sprain

A

Joint trauma so severe, ligaments partially or completely tear or stretch causing damage to blood vessels, muscles, tendons & nerves

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32
Q

Strain

A

Microscopic tear to the musculotendinous unit

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33
Q

Treatment of soft tissue injuries

A

R - rest
I - ice
C - compression
E - elevation

First 12 to 24hrs is critical

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34
Q

Why is ice used for soft tissue injuries

6 things

A 
1 decreases edema 
2 decreases tissue oxygen needs 
3 decreases peripheral vasoconstriction 
4 increases deep tissue vasodilation 
5 reduces pain

** apply for only 30 mins (effects last up to 7hrs)**

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35
Q

Why are rest , compression and elevation used for soft tissue injuries

A

Rest- prevents further damage to tissue

Compression - stops active bleeding or fluid loss into tissue, decreases edema, reduces pain

Elevation- increases venous return

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36
Q

Fracture

Goal of treatment

A

A break in the bone structure

Goal- regain & maintain alignment, restore function, prevent further injury

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37
Q

S&S of fractures

A

Generalized swelling

Pain or tenderness

Deformity

Decreased use

Ecchymosis

Muscle rigidity

Crepitus

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38
Q

Compartment syndrome / 6 P’s

A

Compression of nerves, blood vessels and muscle inside a closed space

Pain
Pulselessness
Pallor
Paresthesia
Paralysis
Pressure
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39
Q

Emergency treatment of fracture

A
  • assess 6 P’s
  • determine mechanism of injury
  • move injured part as little as possible
  • cover open wounds
  • immobilize injured limb
  • apply traction if circulatory compromise (no pulse, blue, cold)
  • elevate injured limb
  • apply cold to injured area
  • call ems
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40
Q

Fracture complications

8 things

A 
1 circulatory impairment 
2 Nerve compression syndrome 
3 compartment syndrome 
4 epiphyseal damage (effect leg length) 
5 non or malunion 
6 osteomyelitis 
7 kidney stones 
8 pulmonary embolus
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41
Q

Cast care

8 things

A 
1 elevate extremity 
2 handle w/ palms of hand 
3 perform frequent neurovascular checks 
4 don’t put anything in cast 
5 petal cast edges
6 keep clean of urine & feces 
7 assess for “hot spots” = infection 
8 assess for compartment syndrome
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42
Q

3 essential components of traction

A

Done to align bone

1 traction (weights)

2 counter traction (body weight)

3 friction (bed)

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43
Q

Bryant traction and something to note about it

A

1 Bryant traction - pull is in only one direction. Skin traction is applied to the legs and child’s trunk (with butt raised slightly off the bed) provides counter traction

** only used in patients less than 2 years old or <30 lbs cuz of postural hypertension **

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44
Q

Acyanotic heart defect vs cyanotic heart defect

A

Acyanotic- left to right shunting of blood

Cyanotic- right to left shunting of blood

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45
Q

Atrial septal defect

A

Abnormal opening between the atria, allowing blood from the higher-pressure left atrium to flow to the lower-pressure right atrium

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46
Q

Coarctation of the aorta

A

High blood pressure and bounding pulses in arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure

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47
Q

Ventricular septal defect

A

Abnormal opening between the right and left ventricles

Small defects surgically repaired with a purse-strung approach; large defects repaired by a Dacron patch sewn over the opening; both procedures done via cardiopulmonary bypass

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48
Q

Patent ductus arteriosus

A

Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life - allows blood to flow from higher pressure aorta to lower pressure pulmonary artery which causes a left-to-right shunt

Has a characteristic machine-like murmur

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49
Q

Tetralogy of fallot

A 
The classic form includes four defects: 
1 ventricular septal defect 
2 pulmonic stenosis 
3 overriding aorta 
4 right ventricular hypertrophy
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50
Q

Transposition of great arteries

A

The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle with no communicable between the systemic and pulmonary circulations

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51
Q

Blood flow pattern groups of classifying heart disease

Increased pulmonary, obstruction, decreased pulmonary, mixed

A

Increased pulmonary blood flow- atrial or ventricular septal defects , patent ductus arteriosus

Obstruction blood flow- coarctation of aorta, aortic or pulmonic stenosis

Decreased pulmonary blood flow- tetralogy of fallot

Mixed blood flow- transposition of the great arteries

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52
Q

Congestive heart failure

A

Inability of the heart to pump adequate amounts of blood to meet the body’s metabolic demands

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53
Q

The most common cause of congestive heart failure in children is

A

Increased blood volume and increased pressure within the heart secondary to structural abnormalities

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54
Q

List the four goals of the therapeutic management of congestive heart failure

A

1 improve cardiac function (⬆️ contractility ⬇️ afterload)

2 remove accumulated fluid & Na (⬇️ preload)

3 ⬇️ cardiac demands

4 improve tissue oxygenation and ⬇️ O2 consumption

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55
Q

What are the two meds primarily used in kids with CHF

A

Digoxin and ace inhibitors

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56
Q

Identify the signs of digoxin toxicity in children

A

Nausea, vomiting 🤮, anorexia, ⬇️ ❤️ rate, dysrhythmias

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57
Q

Clinical manifestations of systemic congestion , a consequence of right-sided heart failure

A

Systemic venous congestion

Weight gain

Peripheral edema

Ascites

Neck vein distention

⬆️❤️ rate

Sweating

⬇️ urine output

Fatigued

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58
Q

Hypoxia vs cyanosis

A

Hypoxia- ⬇️ tissue oxygenation

Cyanosis- blue discoloration with ⬇️ o2 sat

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59
Q

Children with tetralogy of fallot May have hypercyanotic spells , how are they treated

A

Place infant in knee/chest position

Administer 100% “blow-by” O2

Give morphine SQ or IV

Begin fluid replacement

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60
Q

The most common causative agent of bacterial endocarditis is

Treatment

A

Staph aureus and streptococcus viridans

Treatment- high dose antibiotics IV for 2-8wks

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61
Q

Rheumatic Fever

Sequela, Cause, prevention, treatment

A

Sequela- heart damage to mitral valve

Cause- abnormal immune response to a group a strep infection

Prevention- prompt diagnosis & treatment of strep infections

Treatment- penicillin, salicylates, bed rest, quiet activities, good nutrition, prophylactic treatment against recurrence

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62
Q

Kawasaki disease

Treatment

A

Acute systemic vasculitis which primarily involves the cardiovascular system

Treatment- high doses of IV immunoglobulin along with salicylate therapy

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63
Q

True or false. In fetal circulation, the pressure on the left side of the heart exceeds the pressure on the right side

A

False

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64
Q

Buck extension traction

A

Type of traction with the legs in an extended position

Primarily used for short-term immobilization , such as preoperative management of a child with a dislocated hip or for correction of contractures or bone deformities

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65
Q

Russell traction

A

Uses skin traction on the lower leg and a padded sling under the knee

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66
Q

90 degree-90 degree traction

A

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 in the distal fragment of the femur, resulting in a 90-degree angle at both the hip and the knee

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67
Q

Traction nursing care

A

Maintain traction at all times

Maintain correct body alignment

Assess skin for breakdown

Provide pin care (skeletal traction)

Assess 6 P’s

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68
Q

Overuse syndrome

S&S, treatment, nursing interventions

A

Repetitive microtrama due to the same movements over a long period of time

S&S- inflammation, pain, swelling & disability

Treatment- rest & alteration in activities, PT (whirlpools, taping, bracing, splinting), medications (NSAIDS)

Nursing interventions - prevention & treatment of injuries, rehabilitation

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69
Q

Distraction

A

Process of separating opposing bone to encourage regeneration of new bone in the created space

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70
Q

Ilozarov external fixators

A

System of wires, rings and telescoping rods that permits limb lengthening to occur by manual distraction

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71
Q

Developmental dysplasia of hip

3 degree of dysplasia

A

Head of femur not well placed in acetabulum

3 degrees:
•acetabular dysplasia- shallow acetabulum

  • subluxation- incomplete dislocation (femoral Head remains in contact w/ acetabulum)
  • dislocation- femoral Head loses contact w/ acetabulum
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72
Q

S&S of developmental dysplasia of hip

A

Limited abduction

Asymmetrical skin folds

+ galeazzi or allis test

+ ortolani & barlow signs

+ trendelenburg sign

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73
Q

Galeazzi or allis test vs ortolani & Barlow

A

Shortened femur w/ flexion of knees

Ortolani- femoral Head moves out & into the acetabulum

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74
Q

Treatment and nursing care of developmental dysplasia of hip

A

Treatment- Head of femur has consistent pressure in acetabulum

Pavlik harness, hip spica cast, closed operative reduction

Nursing care- assess for hip abnormalities, teaching (correct positioning, harness use, activity, safety, car seat, care of cast), assess skin, assessment (6 P’s)

75
Q

Congenital club foot

A

Abnormal rotation of foot & ankle

Rigid= defective development 
Flexible= position in utero
76
Q

Treatment for clubfoot

A

Correction of the deformity
Maintain correction
Follow up to prevent recurrence

Dennis-brown splint (shoe w/ bar), serial casting, ponseti sandal, surgical correction

77
Q

Leg-calve-perthes disease

A

Aseptic necrosis of femoral Head due to decreased circulation to area

78
Q

Stages of necrosis of femoral Head

A

I aseptic necrosis of femoral Head

II revascularization occurs

III reossification occurs w/ new bone

IV remodeling stage & reformation of the head of the femur

79
Q

Children with hip issues , often present with

A

Groin, thigh or knee pain

80
Q

Leg-calve-perthes

S&S, treatment

A

S&S- persistent hip pain, joint dysfunction w/ limp, limited ROM

Treatment- no weight bearing, abduction brace, casts, traction, surgical correction

81
Q

Slipped femoral capital epiphysis

A

Spontaneous displacement of the proximal femoral epiphysis

(Slipping produces deformity of the femoral Head and stretches the blood vessels to the epiphysis)

Most often seen between 8-15 years & obese children

82
Q

Slipped femoral capital epiphysis

S&S, treatment

A

S&S- hip, groin, thigh or knee pain
(Limp, rotation & shortening of leg)

Treatment- pin fixation, non weight bearing, use crutches

83
Q

Idiopathic scoliosis

Treatment

A

1 observation
2 bracing
3 surgical correction of curves > 45
(Anterior spinal fusion w/ rod placement, flank incision with chest tube, posterior spinal fusion, back incision)

84
Q

Spinal fusion

A
  • bed rest for24hrs
  • log roll post op
  • pain management (PCA)
  • IV fluids/accurate I&O
  • foley catheter
  • wound drainage
  • neurovascular checks (sensation in feet b4 ambulate)
  • T/C/DB (incentive spirometer)
  • post op brace
85
Q

2 types of osteomyelitis

A

Infection in bone

Hematogenous- spread from preexisting infection

Exogenous- invasion from an outside wound

86
Q

Osteomyelitis

S&S, treatment

A 
2-7 days of : 
Swelling
Warmth 
Pain & tenderness 
⬇️ ROM
fever 
Irritability 
Lethargy

Treatment- cultures, IV antibiotic therapy (long term): mycins , immobilize affected leg

87
Q

Why must peak & troughs be done on antibiotics in the mycin family

A

Because too high doses causes otoxicity

88
Q

Juvenile idiopathic arthritis

A

Chronic inflammation of the synovia with joint effusion & eventual erosion, destruction & fibrosis of the articular cartilage

Occurs before age 16

89
Q

Juvenile idiopathic arthritis

S&S

A
  • morning stiffness
  • swelling
  • pain & tenderness
  • warmth
  • loss of motion
  • ESR maybe elevated
  • leucocytosis
  • rheumatoid factor is negative in 90% of kids
  • antinuclear antibodies (ANA) May be positive
  • radioactive findings
  • UVEITIS: common eye inflammation is a complication and must be followed by ophthalmologist
90
Q

Juvenile idiopathic arthritis

Goal of treatment , treatment

A

Goal- control pain, preserve joint function, prevent deformity

Treatment- PT & OT, moist warm heat, casting & splinting, routine eye exams (slit lamp), medications

91
Q

First line of treatment against juvenile idiopathic arthritis

A

NSAIDS
(Asa, ibuprofen, tolmetin, naproxen

Side affects- GI upset, hyperventilation, increased bleeding, tinnitus, lethargy, drowsiness

92
Q

Second line of treatment against juvenile idiopathic arthritis

Educate

A

Antirheumatic Drugs / cytotoxic Drugs
(Methotrexate)

Side effects: headache, n/v, photosensitivity, thrombocytopenia, Fever, NEPHROTOXIC

Educate- periodic labs, birth defects, avoid alcohol

93
Q

Third line of treatment against juvenile idiopathic arthritis

A

Biologic agents
(Etanercept, infliximab, adalimumab)

Side effects: headache, n/v, sore throat, dizziness, heartburn, lowers immune system

94
Q

Glucocorticoids

Side effects

A

(Prednisone)

Side effects: cataracts, osteoporosis, increased ICP & occular pressure, glucose intolerance, slow wound healing, growth suppression, fluid retention, Cushing syndrome

*short term use, given in conjunction with 2nd and 3rd line treatments

95
Q

S&S of bone tumors

A
  • localized pain (with relief on FLEXION)
  • limp
  • ⬇️ physical mobility
  • mass
  • regional lymph node enlargement
  • anemia
  • weight loss
  • frequent infections
96
Q

Diagnosis of bone tumors

A

X-ray, ct, mri

Bone marrow aspiration (Ewing’s)

Increased Serum alkaline phosphate

97
Q

Osteogenic sarcoma

Treatment

A

(Osteosarcoma)

Spindle cell sarcoma, distal end of long bones (femur)

Treatment- amputation, limb salvage procedure, chemotherapy, 75% survival rate if no metastasis

98
Q

What medication is used to treat phantom limb pain

A

Gabapentin (neurontin)

99
Q

Ewing’s sarcoma

Treatment

A

Small cell sarcoma , Marrow spaces of long bones (femur)

Treatment- radiation & chemotherapy, 70% cure rate, psychological affects less traumatic

100
Q

Cognitive impairment

Classification

A

Sub-average intellectual function (IQ at 70-75 or below) , defects in adaptive behaviors, onset before age 18

Classifications: 
Mild- educable (85%) 
Moderate- trainable (10%) 
Severe- supervision/life 
Profound- total care
101
Q

Nursing care for cognitive impairment

A
  • educate family and child
  • teach self-care skills
  • promote optimum development (acceptable social behaviors, personal feelings & self-esteem, physical well being)
  • encourage play & excerise (based on developmental age)
  • communication
  • discipline
  • socialization
  • sexuality
102
Q

Care during hospitalization with cognitive impairment

A
  • encourage parental involvement
  • identify child’s abilities
  • identify special devices & normal routines
  • provide developmental stimulation
  • provide activities appropriate to developmental age
103
Q

Clinical manifestations of Down syndrome

A
  • intelligence (severe CI to low-average)
  • congenital heart disease eyes (upward slant, speckled iris)
  • simian crease in hand
  • hypotonia (muscle weakness)
  • protruding abdomen
  • hyper flexibility
  • underdeveloped nasal bone = stuffiness
  • protruding tongue
  • rough, dry, cracked skin
  • wide space between big & second toe
104
Q

Down syndrome associated risk factors

Increased incidence of

A
  • cardiac anomalies (30-40% septal defects)
  • respiratory infections
  • immune system dysfunction
  • leukemia
  • congenital hypothyroidism
  • atlantoaxial instability
105
Q

Atlantoaxial instability

S&S

A

Excessive movement at the junction between the atlas (C1) and axis (C2)

S&S- persistent neck pain, loss of established motor skills OR bowel/bladder control, changes in sensation

106
Q

Nursing care for Down syndrome

A
  • hyper flexibility & hypotonia (wrap snuggly in blanket)
  • ⬇️ muscle tone (resp problems)
  • underdeveloped nasal bone (suction B4 feeding)
  • mouth breathers & protruding tongue (feeding problems)
  • ⬇️ GI motility = increased constipation: diet (high fiber, small frequent feeds & fluids)
  • skin care
  • prenatal testing available
107
Q

Clinical manifestations of fragile x

Physical features, behavior features

A

Physical- ⬆️ HC, large ears, long face w/ prominent jaw, hypotonia, large testes, cardiac anomalies

Behavior- mild to severe cognitive impairment, speech problems, short attention with hyperactivity, hypersensitivity to taste/sound/touch, intolerance to routine changes, autistic behaviors, aggressive behavior

108
Q

Nursing care for fragile x

A
  • no cure
  • serotonin agents (tegretol or Prozac)- temper outburst
  • CNS stimulants (catapres & Ritalin)- improve attention span
  • early intervention programs - speech, language & OT therapy
  • genetic counseling
109
Q

Retinoblastoma

Diagnosis

A

Congenital malignant tumor, arising from the retina

Diagnosis - ophthalmoscopic exam w/ sedation

110
Q

Symptoms of retinoblastoma

A
  • White eye reflex (whitish appearance of lens is produced as light falls on tumor mass in eye)
  • strabismus (cross eyed)
  • red, painful eye, often with glaucoma
  • blindness is a late sign
111
Q

Retinoblastoma

Treatment , nursing care

A

Treatment- irradiation (destroy circulation to tumor), implants, photocoagulation, cryotherapy, chemo, removal (enucleation), attempt to preserve useful vision in affected eye

Nursing care- preparation for surgery, postoperative care, family support

112
Q

Clinical manifestations of increased ICP in INFANTS

A
  • enlarged head size, sleepy
  • irritability, restlessness, poor feeding
  • macewen sign (“cracked-pot” sound on percussion over sutures)
  • high pitched cry, difficult to soothe
  • fontanels: tense, bulging
  • cranial sutures: separated
  • eyes: setting-sun sign
  • distended scalp veins
113
Q

Clinical manifestations of increased ICP in CHILDREN

A

Headache

Vomiting with or with nausea

Seizures

Diplopia, blurred vision

Sleepy

Poor school performance

⬇️ activity level

114
Q

Late signs of increasing ICP

A
  • bradycardia
  • ⬇️ motor response to command
  • ⬇️ sensory response to painful stimuli
  • alterations in pupil size and reactivity
  • decerebrate or decorticate posturing
  • cheyne-stokes respirations
  • papilledema (swelling of the optic nerve)
  • ⬇️ LOC & COMA
115
Q

Decorticate vs decerebrate posturing

A

Decorticate- flexion posturing occurs with severe dysfunction of the cerebral cortex or with lesions to corticospinal tracts above the brainstem (towards the core)

Decerebrate- extension posturing is a sign of dysfunction at the level of the midbrain or lesions to the brainstem

116
Q

Pediatric Glasgow coma scale assessment of what 3 parts

A

Eye opening , verbal response , motor response

Score 15= unaltered LOC
Score of 8 or below= coma
Score of 3= extremely ⬇️ LOC

117
Q

Major causes of brain damage in childhood

A

Falls
Motor vehicles
Bicycle accidents
Sport injuries

118
Q

Major complications of head injuries

A

Coup (bruising at the point of impact)

countercoup (bruising at a distance as the brain collides with the unyielding surfaces far removed from the point of impact)

119
Q

Hallmark signs of concussion

A

Confusion & amnesia (with or without loss of consciousness)

120
Q

Post concussion syndrome

A

Worsening of symptoms

  • acute brain swelling occurs
  • coma
121
Q

Emergency treatment of head injury

A 
Assess CAB’s
Stabilize neck & spine 
Clean wounds 
NPO
assess pain, pupil reaction, LOC
122
Q

Seek medical care

A lot of things 😂

A

Loss of consciousness, bulging fontanel (⬆️ ICP), amnesia, discomfort more than 10 minutes, worsening or severe HA, fluid loss from ears or nose (clear=CSF), black eyes, vomiting 3 or more times, swelling around earlobe, changes in behavior, difficulty arousing child, difficulty with speech, blurred vision, pupils dilated, unequal or fixed, unsteady gait, neck pain or stiffness, seizures

Changes in VS: ⬆️ RR, ⬇️❤️ rate, changes in BP, widened pulse pressure

123
Q

Hospital nursing care of head injuries

A
  • vs q1-2h
  • bed rest
  • raise head of bed
  • seizure precautions
  • quiet environment
  • assess pupils, LOC, drainage & posturing
  • analgesics (HA)
  • NPO (depends on loc)
  • neurological assessment
  • rehab services
  • support family & educate on prevention
124
Q

Submersion injury

Affects

A

Near drowning

Affects- pulmonary/cardiovascular/neurological systems

Cerebral hypoxia
Aspiration
Hypothermia (better survival rate)

125
Q

Hypoxia

A

Death after 4-6 minutes

Aspiration of fluid- pulmonary edema, atelectasis, airway spasms, pneumonitis

Hypothermia (cold water submersion) leads to the diving reflex - blood shunts to brain & heart, bradycardia

126
Q

Meningitis

Prevention, complications

A

Prevention- HIB & pneumococcal vaccines

Complications- ⬆️ ICP, shock, DIC

127
Q

Bacterial meningitis

Precursors, diagnosis

A

Inflammation of the meninges & CSF

Precursors- nasopharyngitis, skull Fx or disease process

Diagnosis- CSF via lumbar puncture
(Culture & sensitivity, cloudy, ⬆️ pressure, ⬇️ glucose, ⬆️ protein and ⬆️ WBC)

128
Q

Clinical manifestations of abrupt onset meningitis

A 
Fever & chills
Loss of appetite
Vomiting 
Irritability 
Seizures
Bulging fontanel 
Nuchal rigidity (pain in neck , been head down)
\+ kernig & brudzinski sign 
Severe HA 
Photophobia 
Rash
129
Q

Kernig & brudzinski sign

A

Kernig - present if the patient in the supine position with hip & knee flexed at 90’ can’t extend the knee more than 135 degrees and pain is felt in the hamstring, flexion of opposite knee may also occur

Brudzinski - is present if the patient while laying supine, flexes the lower extremities and passive flexion of the neck is attempted

130
Q

Nursing care for bacterial meningitis

A

First priority

Respiratory isolation at least for 24hrs after initiating antibiotics

Begin antibiotics ASAP after cultures drawn

Restrict fluids

Treat symptoms

131
Q

Seizures

Classifications, diagnosis

A

Abnormal electrical charge in the brain, most common neuro disorder in children

Classifications- partial seizure and generalized seizure

Diagnosis- eeg, other tests to rule out causes

132
Q

Treatment options for seizures

A
  • antiepileptic Drugs (phenobarb or Dilantin)
  • ketogenic diet (⬆️ fat, ⬇️ carb, adequate protein, deficient in vitamins & minerals)
  • vagus nerve stimulation
  • surgery
133
Q

What is something to remember about phenobarb and Dilantin

A

Phenobarb - don’t give with milk

Dilantin- causes hyperplasia of Gums

134
Q

Treatment of status epilepticus at home

A
  • bucal or intranasal midazolam (versed)
  • bucal lorazepam (Ativan)
  • rectal diazepam (Valium (diastat))
135
Q

Nursing care during a seizure

A
  • stay calm & stay w/ child
  • don’t stop the seizure
  • place on side
  • maintain airway
  • protect child from injury
  • suction
  • identify triggers
  • observe & record seizure activity
  • educate on anti seizure medications

Safety concerns: helmets, no swimming alone, awareness by school & care givers

136
Q

Febrile seizures

A

Usually occur between 1 month and 5 years

Temperature 100.4’ (38’C)

Benign in nature

⬇️ temp won’t prevent

137
Q

2 types of hydrocephalus

A

Communicating (acquired)- impaired CSF reabsorption within the subarachnoid space

Non-communicating (developmental malformation)- obstruction of CSF flow through the ventricular system

138
Q

Clinical manifestations of hydrocephalus in INFANTS

A
  • enlarged head size
  • bulging fontanels, dilated scalp veins
  • “cracked pot sound” (macewen sign)
  • setting sun eyes
  • high pitched cry
  • irritability
  • lethargy
  • poor feeding (FTT)
  • sluggish pupils
  • changes in LOC & seizures
139
Q

Clinic cal manifestations of hydrocephalus in CHILDHOOD

A
  • S&S of ICP
  • HA
  • papilledema & strabismus
  • changes in LOC & behavior
  • confusion & irritability
  • lethargy
  • vomiting

Diagnosis: CT or MRI

140
Q

Treatment of hydrocephalus

A

-surgical shunt placement or removal of tumor

Ventricular shunt (ventricular catheter, flush pump, unidirectional flow valve, distal catheter to perineum)

141
Q

Complications of VP shunts

A
  • infection (1-6 months) after placement
  • malfunction (kinking, plugged, separation of tubing)
  • do NOT pump shunt to assess

They can cause blockage, HA or obstruction

142
Q

Nursing care VP shunt

Pre-op, post-op

A

•pre-op:
Assess for s&s of hydrocephalus
Protect enlarged head
Prepare for shunt placement

•post-op:
Assess s&s ⬆️ ICP 
pupil dilation 
B/P 
Abdominal distention (peritonitis can occur)
  • CSF infection (fever, poor feeding, vomiting, seizures, EVD)
  • lie on unaffected side
  • keep HOB flat
  • pain management

check for blood sugar in CSF fluid

143
Q

S&S of brain tumors

A
  • enlarged head circumference
  • hyperthermia
  • HA/changes in behavior
  • vomiting
  • papilledema /⬇️ visual activity
  • Cushing triad
  • changes in mobility
144
Q

Cushings triad

A

⬇️ pulse

Irregular respirations

⬆️ blood pressure

145
Q

Preoperative care of brain tumor

A
  • teach what to expect post op
  • shaved head
  • large head dressing
  • ICU (post op)
  • induced coma
  • HA

reinforce dressing during a bleed never remove

146
Q

Postoperative care of brain tumors

A
  • observe for ⬆️ ICP
  • VS (cushings triad)
  • TEMP 2 DAYS POST OP= INFECTION
  • hypothalamus regulates body temp
  • move slowly
  • head dressing/CSF leakage (halo)
  • observe for bleeding
  • position (HOB flat or ⬆️ 20-30’)
  • NPO & IV fluids
  • monitor I&O
  • pain management for headaches
  • manitol
147
Q

Pain management for HA

A 
Quiet environment 
Dim lights 
Restrict visitors 
Avoid sudden jarring 
Prevent straining 
Ice bag to forehead 
Medications (morphine, Tylenol 3)
148
Q

S&S of neuroblastoma “silent tumor”

A

Tumor made of neuroblasts (immature nerve cells)

Firm abdominal mass
Non-tender
Crosses mid line of abdomen
Other sites: Head, neck, chest, pelvis

149
Q

Diagnosis of neuroblastoma

A

•CT scan
•bone scan
•24 hour urine test
Vanillylmandelic acid= metabolite of catacholimines (⬆️ excretion with this cancer)

⬆️ catacholimines = ⬆️ BP

150
Q

Craniostenosis

A

Early suture closure

Prevents normal skull expansion

Brain growth h restricted

Treatment- surgical opening of fused sutures

151
Q

Microcephaly

Causes

A

Small brain

Causes- autosomal recessive trait, chromosomal disorder, prenatal toxins, zika virus

Cognitive impairment

152
Q

Active vs passive immunity

A

Active:
Naturally acquired- you get sick
Artificially acquired- immunization

Passive:
Naturally acquired- breast milk, placenta
Artificially acquired- globulin injection. Short term, example rabies shot

153
Q

Hepatitis b

Complications, vaccine contraindications, route

A

Spread via blood or body fluids

Complications- cirrhosis and liver cancer

Contraindications- fever 101, allergy to bakers yeast

Route- IM (3 doses)

required for school attendance

154
Q

Hepatitis A

Spread, s&s

A

Spread: fecal-oral route
Found in contaminated food or water

S&S: abrupt onset of fever, malaise, anorexia, nausea, abdominal pain, dark urine & jaundice

under 6 May be asymptomatic

2 dose immunization (given at 1yr and 6 months after first)

Route- IM

155
Q

Diphtheria

S&S, complications

A

Bacterial infection

S&S- nasopharyngitis, obstructive laryngotracheitis & upper airway obstruction

Complications- cardiomyopathy

156
Q

Tetanus

A

Bacterial infection found in dirt and animal droppings

Affects nervous system

Commonly called lockjaw

Causes muscle contractions in the jaw & neck

Can become life-threatening without treatment

157
Q

Pertussis (whooping cough)

Cause, complications

A

Cause- by a bacteria

Complications- diagnostic cough, apnea, pneumonia, weight loss, loss of bladder control, loss of consciousness , rib fractures

158
Q

DTaP

Contraindications , route

A

Contraindications- fever 101, immunosuppressed, seizures

Route- IM
Schedule (2,4,6, 15 months, 4-6 years)

Tdap from 11-64 years

159
Q

Polio

Contraindications

A

Caused by virus

Affects brain & spinal cord can lead to life-threatening muscular paralysis

Contraindications- fever 101, allergy to neomycin, allergy to streptomycin

Route- SQ
Schedule (2,4,6 months, 4-6 years)

160
Q

Measles (rubeola)

S&S, vitamin A

A

Viral infection

Affects respiratory system

S&S- cough, fever, red eyes, light sensitivity, muscle aches, runny nose, sore throat, red spots with white centers inside the mouth (koplik spots), skin rash

vitamin A ⬇️ symptoms

161
Q

Mumps

Hallmark sign, s&s

A

Viral infection

Affects parotid glands (salivary glands)

HALLMARK SIGN= SWELLING OF SALIVARY GLANDS

S&S- fatigue, body aches, headache, loss of appetite, low-grade fever, earache

162
Q

Rubella (German measles)

S&S

A

Viral infection

Dangerous to developing fetus

S&S- mild fever, runny nose, headache, muscle pain, red eyes, swollen lymph nodes, RASH THAT STARTS ON FACE AND SPREADS DOWNWARD

163
Q

MMR

Contraindications , schedule, education, route

A

Live virus

Contraindications- fever 101, allergy to neomycin, immunosuppressed, pregnant

Route- SQ

Schedule (12 months, 4-6 years)

Education- assess LMP, can’t get pregnant for 28 days

164
Q

Haemophilus influenzae type b (HIB)

Complications, contraindications, route

A

Bacterial infection

Complications- bacterial meningitis, epiglottis, pneumonia, septic arthritis, sepsis

Contraindications- fever 101, reaction to diphtheria

Route- IM
schedule (2,4,6 months, 12 months)

15 months without immunization only need 1 shot

dont give after 4 years old

165
Q

Varicella (chicken pox)

Complications, contraindications

A

Varicella-Zoster virus

Complications- secondary infections (abscesses, cellulitis, pneumonia, sepsis) encephalitis/thrombocytopenia

Contraindications- fever 101, allergy to neomycin or geletin, immunosuppressed, pregnant

Route- SQ
Schedule (12 months & 4-6 years)

166
Q

What to know/educate about varicella vaccine

A

1 live virus & should be kept frozen until use (once reconstitution must be used within 30mins)

2 no aspirin for 6 weeks may cause rye syndrome

167
Q

Prevnar 13 (pneumococcal conjugate)

Complications, contraindications, route

A

Bacterial infection

*associated with day care attendance**

Complications- septicemia, meningitis, otitis media, sinusitis, pneumonia

Contraindications- fever 101, immunosuppressed, coagulation disorder

Route- IM
Schedule (2,4,6,12 months)

not given after 4 years old

168
Q

Influenza

Most prevalent, transmission, contagious, complications, contraindications

A

Most prevalent: October- March

Transmission: airborne spread & direct contact

Contagious: 1 day before symptoms until 5 days after onset

Complications- otitis media, pneumonia, croup, wheezing, bronchiolitis, myositis, myocarditis, encephalitis, reye syndrome, gullain barre’ syndrome

Contraindications- allergic to eggs

169
Q

Influenza

S&S, interventions

A

S&S- fever (chills), cough, runny nose, sore throat, malaise, body aches, headache, anorexia, n/v, diarrhea

Interventions- droplet & contact precautions, encourage fluids, antipyretic, antiviral medications, prevention

170
Q

What is something to know about oseltamivir and relenza

A

Oseltamivir (tamiflu) - not given less than 12 months old

Relenza- live virus, given nasally, not to children under 5yrs

antivirals given for flu

171
Q

Rotovirus

Transmission, contagious, complications, contraindications, route

A

Transmission: fecal - oral route

Contagious: 1 to 3 days prior to symptoms and persists up to 21 days

Complications- dehydration & electrolyte imbalance

Contraindications- fever 101, gastroenteritis (vomiting/diarrhea), immunosuppressed, blood transfusion w/in last 42 days

Route- PO
Schedule (2,4,6 months)

dont start of over 12 months

172
Q

Rotovirus

S&S, interventions

A

S&S- acute onset of fever & vomiting, watery diarrhea, 10-20 diarrhea stools per day

Interventions- oral rehydration solution, regular diet, monitor labs, standard contact precautions, hand hygiene

173
Q

Erythema infectiosum (fifth disease)

Transmission, contagious, complications

A

Transmission- respiratory secretions, blood & placenta

Contagious- highest the week before onset of symptoms

complications- secondary infections, arthritis, arthralgia, fetal death

174
Q

Erythema infectiosum

S&S, interventions

A

S&S- headache, fever (chills), malaise, nausea, body aches, red rash

Interventions- DROPLET PRECAUTIONS, antipyretics, aveeno or oatmeal bath, admin Benadryl or apply calamine, encourage fluids, avoid sunlight, avoid pregnant women

175
Q

Red rash associated with fifth disease

A

1 slapped face appearance rash

2 maculopapular rash- trunk & limbs and spreads proximal to distal

3 rash fades after 1-3 weeks but reappears with irritation or sun

4 mild pruritus

176
Q

Exanthem subitum (roseola)

Most common, transmission, complications

No vaccine

A

Herpes virus

Most common between 6-15 months

Transmission: respiratory droplets & intrauterine transmission

Complications- febrile seizures

177
Q

Exanthem subitum (roseola)

S&S, interventions , rash

A

S&S- HIGH FEVER for 3-4 days, precipitous drop in fever with appearance of rash

Rash- discrete rose-pink macules, starts on trunk & proximal extremities, fades with pressure

Interventions- benign infection, antipyretics, Monitor for seizures, encourage fluids

178
Q

S&S of pinworms

A 
Intense perianal itching 
Generalized irritability 
Restlessness 
Poor sleep 
Bed wetting 
Distractibility 
Short attention span
179
Q

Medication treatment of pinworms

A

Antiminth (pyrantel pamoate)

Medications is red and stains , urine & bowel

All household members must be treated

Repeat treatment in 2 weeks

180
Q

Zika virus

Cause, risk, complications, s&s, diagnosis

A

Cause- bite of infected mosquito

Risks- pregnant woman to fetus

Complications- birth defects to newborn (microcephaly : small brain)

S&S- fever, rash, joint pain, conjunctivitis

Diagnosis- blood or urine test

181
Q

Zika virus

Prevention

A

Wear long sleeves & long pants

Wear insect repellent

Remove standing water

Women: wait 8 weeks after exposure to get pregnant

Men: wait 6 months after exposure & use contraception

182
Q

MMR side affects

A

Side affects 1 week to 2 months after injection

Fever

Rash

Swelling of glands

Aching joints

183
Q

Abnormal side effects of immunizations

A 
Fever 105 
Screams for more than 3 hours 
Excessive drowsiness 
Seizures 
Fever lasts 4 days 
Swelling greater than .50 piece
184
Q

School attendance of child didn’t follow infant/child immunization schedule

A

3 DPT

3 IPV (polio)

3 HEP-B

2 MMR

2 VZV

Nursing School (36 decks)

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