👧🏾- Musculoskeletal, Vaccines & Neuro Test Flashcards
Spastic (pyramidal) CP
Hypertonicity with poor posture, balance, coordination, fine & gross motor functions, maintaining infant reflex’s
Cerebral palsy
Characteristics of, causes
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
Dyskinetic (extrapyramidal) CP
Abnormal involuntary movements, also known as athetoid movements, which are slow wormlike writhing movements with pharyngeal & oral muscle involvement causing drooling & speech problems
Ataxic CP
Characterized by a wide based gait, difficulty with rapid, repetitive movements & incoordination of movements of the upper extremities
Mixed type CP
A combination of spasticity & dyskinetic
Associated disabilities with CP
CI (30-50%)
Sensory impairments
Respiratory problems
Orthopedic complications
ADHD
Seizures
Dental problems (related to seizure meds)
Diagnosis of CP
Delayed gross motor development , abnormal motor performance , alteration in muscle tone (floppy baby) , abnormal posture , reflex abnormalities, associated disabilities
5 Drugs that are therapy for CP
Baclofen pump (⬇️ spasticity)
Ritalin (ADHD)
Tegretal (seizures)
Valium (anxiety & spasticity)
Botox (relaxes muscles)
Spina bifida occulta vs spina bifida cystica
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)
Meningocele vs myelomeningocele
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
Myelo associated complications
Hydrocephalus
Bowel & bladder problems
Paralysis
Orthopedic problems
Meningitis
Latex allergies
Goal of treatment for CP
Promote child’s optimal development
Gross motor Communication Self-help skills Treat associated disabilities Provide education Promote socialization
Myelomeningocele goal of treatment
Protect sac
Prevent infection
Prevent rupture
Surgical closure 24-72hrs after birth
Nursing care for myelo (3 things)
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
Post op care for myelo
4 things
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
Latex allergy
Cause, allergies related to latex, foods
Cause- repeated exposure (multiple surgeries & urinary catheterizations)
Allergies related- balloons & balls, pacifiers, band-aids, catheters and gloves
Foods- bananas 🍌, avocados 🥑, kiwi 🥝, chestnuts 🌰
Symptoms of latex allergy
Urticaria (hives)
Wheezing
Watery eyes
Rashes
Anaphylactic shock
Muscular dystrophy
Progressive wasting of muscle groups
Progressive weakness of symmetrical skeletal muscles
Resulting in disability & deformity
Duchenne MD
Pseudohypertrophic MD
Increased muscle mass related to fatty infiltration (calves, thighs & upper arms)
Cause of duchenne MD
X-linked recessive disorder
Seen in males
Transmitted by females
Early onset (3-7 years)
S & S of duchenne MD
- waddling gait with frequent falls
- lordosis
- loss of ambulation
- enlarged muscles
- slow progressive weakness
- CI (mild to moderate)
- gower sign
Diagnosis of DMD
S&s of disease
Gene analysis
Increased CPK, AST, ALDOLASE
electromyography (emg)
Muscle biopsy
Care of child with DMD
- corticosteroids
- maintain function for as long as possible
- stay active (breathing exercises)
- ROM
- bracing
- release of contractures
- cough & ventilation assistance
- genetic counseling
Gullain barre’ syndrome (infectious polyneuritis)
Cause
Acute demyelinating polyneuropathy with a progressive, usually ascending flaccid paralysis
Cause- immune mediated disease, associated with viral or bacterial infection or vaccines
Patho of Guillain barre’
Inflammation & edema of the spinal and cranial nerves occur
Followed by impaired nerve conduction
The impaired nerve conduction results in symmetrical ascending paralysis
S&S of guillain barre’
- 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
Diagnosis of guillain barre’
History
S&S
Increased protein in CSF
EMG (shows evidence of acute muscle denervation)
Nursing care for GBS
- assessment of respiratory function
- pharyngeal assessment
- skin care
- CA Monitor
- good body alignment
- suction
- position changes/rom
Nursing care for GBS
Severe paralysis
- 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)
Contusion
Damage to soft tissue, subcutaneous structures & muscles causing injury to blood vessels and inflammation
Dislocation
Stress on ligament causing displacement of two bones or bone to its socket
Sprain
Joint trauma so severe, ligaments partially or completely tear or stretch causing damage to blood vessels, muscles, tendons & nerves
Strain
Microscopic tear to the musculotendinous unit
Treatment of soft tissue injuries
R - rest
I - ice
C - compression
E - elevation
First 12 to 24hrs is critical
Why is ice used for soft tissue injuries
6 things
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)**
Why are rest , compression and elevation used for soft tissue injuries
Rest- prevents further damage to tissue
Compression - stops active bleeding or fluid loss into tissue, decreases edema, reduces pain
Elevation- increases venous return
Fracture
Goal of treatment
A break in the bone structure
Goal- regain & maintain alignment, restore function, prevent further injury
S&S of fractures
Generalized swelling
Pain or tenderness
Deformity
Decreased use
Ecchymosis
Muscle rigidity
Crepitus
Compartment syndrome / 6 P’s
Compression of nerves, blood vessels and muscle inside a closed space
Pain Pulselessness Pallor Paresthesia Paralysis Pressure
Emergency treatment of fracture
- 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
Fracture complications
8 things
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
Cast care
8 things
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
3 essential components of traction
Done to align bone
1 traction (weights)
2 counter traction (body weight)
3 friction (bed)
Bryant traction and something to note about it
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 **
Acyanotic heart defect vs cyanotic heart defect
Acyanotic- left to right shunting of blood
Cyanotic- right to left shunting of blood
Atrial septal defect
Abnormal opening between the atria, allowing blood from the higher-pressure left atrium to flow to the lower-pressure right atrium
Coarctation of the aorta
High blood pressure and bounding pulses in arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure
Ventricular septal defect
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
Patent ductus arteriosus
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
Tetralogy of fallot
The classic form includes four defects: 1 ventricular septal defect 2 pulmonic stenosis 3 overriding aorta 4 right ventricular hypertrophy
Transposition of great arteries
The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle with no communicable between the systemic and pulmonary circulations
Blood flow pattern groups of classifying heart disease
Increased pulmonary, obstruction, decreased pulmonary, mixed
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
Congestive heart failure
Inability of the heart to pump adequate amounts of blood to meet the body’s metabolic demands
The most common cause of congestive heart failure in children is
Increased blood volume and increased pressure within the heart secondary to structural abnormalities
List the four goals of the therapeutic management of congestive heart failure
1 improve cardiac function (⬆️ contractility ⬇️ afterload)
2 remove accumulated fluid & Na (⬇️ preload)
3 ⬇️ cardiac demands
4 improve tissue oxygenation and ⬇️ O2 consumption
What are the two meds primarily used in kids with CHF
Digoxin and ace inhibitors
Identify the signs of digoxin toxicity in children
Nausea, vomiting 🤮, anorexia, ⬇️ ❤️ rate, dysrhythmias
Clinical manifestations of systemic congestion , a consequence of right-sided heart failure
Systemic venous congestion
Weight gain
Peripheral edema
Ascites
Neck vein distention
⬆️❤️ rate
Sweating
⬇️ urine output
Fatigued
Hypoxia vs cyanosis
Hypoxia- ⬇️ tissue oxygenation
Cyanosis- blue discoloration with ⬇️ o2 sat
Children with tetralogy of fallot May have hypercyanotic spells , how are they treated
Place infant in knee/chest position
Administer 100% “blow-by” O2
Give morphine SQ or IV
Begin fluid replacement
The most common causative agent of bacterial endocarditis is
Treatment
Staph aureus and streptococcus viridans
Treatment- high dose antibiotics IV for 2-8wks
Rheumatic Fever
Sequela, Cause, prevention, treatment
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
Kawasaki disease
Treatment
Acute systemic vasculitis which primarily involves the cardiovascular system
Treatment- high doses of IV immunoglobulin along with salicylate therapy
True or false. In fetal circulation, the pressure on the left side of the heart exceeds the pressure on the right side
False
Buck extension traction
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
Russell traction
Uses skin traction on the lower leg and a padded sling under the knee
90 degree-90 degree 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 in the distal fragment of the femur, resulting in a 90-degree angle at both the hip and the knee
Traction nursing care
Maintain traction at all times
Maintain correct body alignment
Assess skin for breakdown
Provide pin care (skeletal traction)
Assess 6 P’s
Overuse syndrome
S&S, treatment, nursing interventions
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
Distraction
Process of separating opposing bone to encourage regeneration of new bone in the created space
Ilozarov external fixators
System of wires, rings and telescoping rods that permits limb lengthening to occur by manual distraction
Developmental dysplasia of hip
3 degree of dysplasia
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
S&S of developmental dysplasia of hip
Limited abduction
Asymmetrical skin folds
+ galeazzi or allis test
+ ortolani & barlow signs
+ trendelenburg sign
Galeazzi or allis test vs ortolani & Barlow
Shortened femur w/ flexion of knees
Ortolani- femoral Head moves out & into the acetabulum
Treatment and nursing care of developmental dysplasia of hip
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)
Congenital club foot
Abnormal rotation of foot & ankle
Rigid= defective development Flexible= position in utero
Treatment for clubfoot
Correction of the deformity
Maintain correction
Follow up to prevent recurrence
Dennis-brown splint (shoe w/ bar), serial casting, ponseti sandal, surgical correction
Leg-calve-perthes disease
Aseptic necrosis of femoral Head due to decreased circulation to area
Stages of necrosis of femoral Head
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
Children with hip issues , often present with
Groin, thigh or knee pain
Leg-calve-perthes
S&S, treatment
S&S- persistent hip pain, joint dysfunction w/ limp, limited ROM
Treatment- no weight bearing, abduction brace, casts, traction, surgical correction
Slipped femoral capital epiphysis
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
Slipped femoral capital epiphysis
S&S, treatment
S&S- hip, groin, thigh or knee pain
(Limp, rotation & shortening of leg)
Treatment- pin fixation, non weight bearing, use crutches
Idiopathic scoliosis
Treatment
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)
Spinal fusion
- 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
2 types of osteomyelitis
Infection in bone
Hematogenous- spread from preexisting infection
Exogenous- invasion from an outside wound
Osteomyelitis
S&S, treatment
2-7 days of : Swelling Warmth Pain & tenderness ⬇️ ROM fever Irritability Lethargy
Treatment- cultures, IV antibiotic therapy (long term): mycins , immobilize affected leg
Why must peak & troughs be done on antibiotics in the mycin family
Because too high doses causes otoxicity
Juvenile idiopathic arthritis
Chronic inflammation of the synovia with joint effusion & eventual erosion, destruction & fibrosis of the articular cartilage
Occurs before age 16
Juvenile idiopathic arthritis
S&S
- 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
Juvenile idiopathic arthritis
Goal of treatment , treatment
Goal- control pain, preserve joint function, prevent deformity
Treatment- PT & OT, moist warm heat, casting & splinting, routine eye exams (slit lamp), medications
First line of treatment against juvenile idiopathic arthritis
NSAIDS
(Asa, ibuprofen, tolmetin, naproxen
Side affects- GI upset, hyperventilation, increased bleeding, tinnitus, lethargy, drowsiness
Second line of treatment against juvenile idiopathic arthritis
Educate
Antirheumatic Drugs / cytotoxic Drugs
(Methotrexate)
Side effects: headache, n/v, photosensitivity, thrombocytopenia, Fever, NEPHROTOXIC
Educate- periodic labs, birth defects, avoid alcohol
Third line of treatment against juvenile idiopathic arthritis
Biologic agents
(Etanercept, infliximab, adalimumab)
Side effects: headache, n/v, sore throat, dizziness, heartburn, lowers immune system
Glucocorticoids
Side effects
(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
S&S of bone tumors
- localized pain (with relief on FLEXION)
- limp
- ⬇️ physical mobility
- mass
- regional lymph node enlargement
- anemia
- weight loss
- frequent infections
Diagnosis of bone tumors
X-ray, ct, mri
Bone marrow aspiration (Ewing’s)
Increased Serum alkaline phosphate
Osteogenic sarcoma
Treatment
(Osteosarcoma)
Spindle cell sarcoma, distal end of long bones (femur)
Treatment- amputation, limb salvage procedure, chemotherapy, 75% survival rate if no metastasis
What medication is used to treat phantom limb pain
Gabapentin (neurontin)
Ewing’s sarcoma
Treatment
Small cell sarcoma , Marrow spaces of long bones (femur)
Treatment- radiation & chemotherapy, 70% cure rate, psychological affects less traumatic
Cognitive impairment
Classification
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
Nursing care for cognitive impairment
- 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
Care during hospitalization with cognitive impairment
- encourage parental involvement
- identify child’s abilities
- identify special devices & normal routines
- provide developmental stimulation
- provide activities appropriate to developmental age
Clinical manifestations of Down syndrome
- 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
Down syndrome associated risk factors
Increased incidence of
- cardiac anomalies (30-40% septal defects)
- respiratory infections
- immune system dysfunction
- leukemia
- congenital hypothyroidism
- atlantoaxial instability
Atlantoaxial instability
S&S
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
Nursing care for Down syndrome
- 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
Clinical manifestations of fragile x
Physical features, behavior features
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
Nursing care for fragile x
- 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
Retinoblastoma
Diagnosis
Congenital malignant tumor, arising from the retina
Diagnosis - ophthalmoscopic exam w/ sedation
Symptoms of retinoblastoma
- 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
Retinoblastoma
Treatment , nursing care
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
Clinical manifestations of increased ICP in INFANTS
- 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
Clinical manifestations of increased ICP in CHILDREN
Headache
Vomiting with or with nausea
Seizures
Diplopia, blurred vision
Sleepy
Poor school performance
⬇️ activity level
Late signs of increasing ICP
- 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
Decorticate vs decerebrate posturing
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
Pediatric Glasgow coma scale assessment of what 3 parts
Eye opening , verbal response , motor response
Score 15= unaltered LOC
Score of 8 or below= coma
Score of 3= extremely ⬇️ LOC
Major causes of brain damage in childhood
Falls
Motor vehicles
Bicycle accidents
Sport injuries
Major complications of head injuries
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)
Hallmark signs of concussion
Confusion & amnesia (with or without loss of consciousness)
Post concussion syndrome
Worsening of symptoms
- acute brain swelling occurs
- coma
Emergency treatment of head injury
Assess CAB’s Stabilize neck & spine Clean wounds NPO assess pain, pupil reaction, LOC
Seek medical care
A lot of things 😂
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
Hospital nursing care of head injuries
- 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
Submersion injury
Affects
Near drowning
Affects- pulmonary/cardiovascular/neurological systems
Cerebral hypoxia
Aspiration
Hypothermia (better survival rate)
Hypoxia
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
Meningitis
Prevention, complications
Prevention- HIB & pneumococcal vaccines
Complications- ⬆️ ICP, shock, DIC
Bacterial meningitis
Precursors, diagnosis
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)
Clinical manifestations of abrupt onset meningitis
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
Kernig & brudzinski sign
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
Nursing care for bacterial meningitis
First priority
Respiratory isolation at least for 24hrs after initiating antibiotics
Begin antibiotics ASAP after cultures drawn
Restrict fluids
Treat symptoms
Seizures
Classifications, diagnosis
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
Treatment options for seizures
- antiepileptic Drugs (phenobarb or Dilantin)
- ketogenic diet (⬆️ fat, ⬇️ carb, adequate protein, deficient in vitamins & minerals)
- vagus nerve stimulation
- surgery
What is something to remember about phenobarb and Dilantin
Phenobarb - don’t give with milk
Dilantin- causes hyperplasia of Gums
Treatment of status epilepticus at home
- bucal or intranasal midazolam (versed)
- bucal lorazepam (Ativan)
- rectal diazepam (Valium (diastat))
Nursing care during a seizure
- 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
Febrile seizures
Usually occur between 1 month and 5 years
Temperature 100.4’ (38’C)
Benign in nature
⬇️ temp won’t prevent
2 types of hydrocephalus
Communicating (acquired)- impaired CSF reabsorption within the subarachnoid space
Non-communicating (developmental malformation)- obstruction of CSF flow through the ventricular system
Clinical manifestations of hydrocephalus in INFANTS
- 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
Clinic cal manifestations of hydrocephalus in CHILDHOOD
- S&S of ICP
- HA
- papilledema & strabismus
- changes in LOC & behavior
- confusion & irritability
- lethargy
- vomiting
Diagnosis: CT or MRI
Treatment of hydrocephalus
-surgical shunt placement or removal of tumor
Ventricular shunt (ventricular catheter, flush pump, unidirectional flow valve, distal catheter to perineum)
Complications of VP shunts
- 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
Nursing care VP shunt
Pre-op, post-op
•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
S&S of brain tumors
- enlarged head circumference
- hyperthermia
- HA/changes in behavior
- vomiting
- papilledema /⬇️ visual activity
- Cushing triad
- changes in mobility
Cushings triad
⬇️ pulse
Irregular respirations
⬆️ blood pressure
Preoperative care of brain tumor
- teach what to expect post op
- shaved head
- large head dressing
- ICU (post op)
- induced coma
- HA
reinforce dressing during a bleed never remove
Postoperative care of brain tumors
- 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
Pain management for HA
Quiet environment Dim lights Restrict visitors Avoid sudden jarring Prevent straining Ice bag to forehead Medications (morphine, Tylenol 3)
S&S of neuroblastoma “silent tumor”
Tumor made of neuroblasts (immature nerve cells)
Firm abdominal mass
Non-tender
Crosses mid line of abdomen
Other sites: Head, neck, chest, pelvis
Diagnosis of neuroblastoma
•CT scan
•bone scan
•24 hour urine test
Vanillylmandelic acid= metabolite of catacholimines (⬆️ excretion with this cancer)
⬆️ catacholimines = ⬆️ BP
Craniostenosis
Early suture closure
Prevents normal skull expansion
Brain growth h restricted
Treatment- surgical opening of fused sutures
Microcephaly
Causes
Small brain
Causes- autosomal recessive trait, chromosomal disorder, prenatal toxins, zika virus
Cognitive impairment
Active vs passive immunity
Active:
Naturally acquired- you get sick
Artificially acquired- immunization
Passive:
Naturally acquired- breast milk, placenta
Artificially acquired- globulin injection. Short term, example rabies shot
Hepatitis b
Complications, vaccine contraindications, route
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
Hepatitis A
Spread, s&s
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
Diphtheria
S&S, complications
Bacterial infection
S&S- nasopharyngitis, obstructive laryngotracheitis & upper airway obstruction
Complications- cardiomyopathy
Tetanus
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
Pertussis (whooping cough)
Cause, complications
Cause- by a bacteria
Complications- diagnostic cough, apnea, pneumonia, weight loss, loss of bladder control, loss of consciousness , rib fractures
DTaP
Contraindications , route
Contraindications- fever 101, immunosuppressed, seizures
Route- IM
Schedule (2,4,6, 15 months, 4-6 years)
Tdap from 11-64 years
Polio
Contraindications
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)
Measles (rubeola)
S&S, vitamin 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
Mumps
Hallmark sign, s&s
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
Rubella (German measles)
S&S
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
MMR
Contraindications , schedule, education, route
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
Haemophilus influenzae type b (HIB)
Complications, contraindications, route
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
Varicella (chicken pox)
Complications, contraindications
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)
What to know/educate about varicella vaccine
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
Prevnar 13 (pneumococcal conjugate)
Complications, contraindications, route
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
Influenza
Most prevalent, transmission, contagious, complications, contraindications
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
Influenza
S&S, interventions
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
What is something to know about oseltamivir and relenza
Oseltamivir (tamiflu) - not given less than 12 months old
Relenza- live virus, given nasally, not to children under 5yrs
antivirals given for flu
Rotovirus
Transmission, contagious, complications, contraindications, route
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
Rotovirus
S&S, interventions
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
Erythema infectiosum (fifth disease)
Transmission, contagious, complications
Transmission- respiratory secretions, blood & placenta
Contagious- highest the week before onset of symptoms
complications- secondary infections, arthritis, arthralgia, fetal death
Erythema infectiosum
S&S, interventions
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
Red rash associated with fifth disease
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
Exanthem subitum (roseola)
Most common, transmission, complications
No vaccine
Herpes virus
Most common between 6-15 months
Transmission: respiratory droplets & intrauterine transmission
Complications- febrile seizures
Exanthem subitum (roseola)
S&S, interventions , rash
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
S&S of pinworms
Intense perianal itching Generalized irritability Restlessness Poor sleep Bed wetting Distractibility Short attention span
Medication treatment of pinworms
Antiminth (pyrantel pamoate)
Medications is red and stains , urine & bowel
All household members must be treated
Repeat treatment in 2 weeks
Zika virus
Cause, risk, complications, s&s, diagnosis
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
Zika virus
Prevention
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
MMR side affects
Side affects 1 week to 2 months after injection
Fever
Rash
Swelling of glands
Aching joints
Abnormal side effects of immunizations
Fever 105 Screams for more than 3 hours Excessive drowsiness Seizures Fever lasts 4 days Swelling greater than .50 piece
School attendance of child didn’t follow infant/child immunization schedule
3 DPT
3 IPV (polio)
3 HEP-B
2 MMR
2 VZV
