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Peds Exam 3 > Neuro/ Respiratory > Flashcards

Neuro/ Respiratory Flashcards

1
Q

What is one of the first body system to form in uterus?

A

Nervous system-neural tube

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2
Q

How much CSF do infants have?

A

50 mL

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3
Q

Does the brain continue to grow throughout childhood?

A

Yes

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4
Q

Are the pediatric brain and peripheral nerves fully developed at birth?

A

No

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5
Q

Neurological Alterations

A
  • IICP
  • head injury
  • hydrocephalus
  • seizure disorders
  • spina bifida
  • cerebral palsy
  • Reyes syndrome
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6
Q

Causes of IICP

A

Space-occupying lesion- brain tumor, hematoma
Swelling- head trauma, infection, hypoxic episode
Overproduction of fluid
Malabsorption of fluid
Communication problem w/in
Aneurysms w/in the brain
Acute liver failure

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7
Q

What is Hydrocephalus?

A

A condition in which fluid accumulates in the brain
Typically I young children
Enlarging the head
Sometimes causing brain damage

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8
Q

What is Spina Bifida

A

A congenital neural tube defect(NTD)

Incomplete closure of the vertebrae and neural tube during fetal development

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9
Q

What is Cerebral Palsy?

A

A chronic, non progressive disorder of posture and movement

Difficulty in controlling the muscles b/c of an abnormality in the extrapyramidal or pyramidal motor system

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10
Q

What is Reye Syndrome

A

Exposure to a viral agent or toxin in at-risk children leads to liver cell damage w/rising serum ammonia levels

The toxic ammonia levels result in cerebral dysfunction (encephalopathy, cerebral edema), fluid and electrolyte and acid base imbalances, and coagulopathies

May be related to giving aspirin to children w/a viral disease

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11
Q

Diagnostic testing for neurological alterations

A 
CT-SCAN
MRI
Nuclear brain scan
Angiography
Echopencephalography (EEG)
Lumbar puncture
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12
Q

Lumbar puncture RN intervention

A

Keep child still (side-lying, knees to chin)

Monitor cardiorespiratory status

Help parents comfort child

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13
Q

Lumbar puncture teaching points

A

EMLA cream used to numb the area(only form of pain management

Site will be cleansed w/cool antiseptic solution

Collection of CSF takes several minutes

Lie flat after procedure and encourage fluids

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14
Q

S/S IICP infants

A 
Bulging fontanel 
High- pitched cry
Increased head circumference
Eyes deviating downward(sun-setting)
Altered response to pain(increased or decreased)
Poor feeding/ vomiting
Irritability 
Lethargy
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15
Q

S/S of IICP in child

A

Headache
Altered LOC
Vomiting(esp. morning due to rising from laying position= shift in pressure)
Mood swings
Slurred speech
Changes in normal behavior(not acting like themselves)

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16
Q

IICP nursing interventions

A

Elevate bed to 30 degrees
Medication: osmotic diuretic(mannitol), sedation, analgesics
Avoid aggressive use of passive ventilation (wind)
Monitor intraventricular catheter, if placed
Monitor LOC

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17
Q

Posturing- DECORTICATE

A

Flexor

Arms are like a C

Moved inward (on chest)

PROBLEMS W/ CERVICAL SPINAL TRACT OR CEREBRAL HEMISPHERE

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18
Q

Posturing- DECEREBRATE

A

Extensor

Arms are like E

Outward

PROBLEMS W/IN MIDBRAIN OR PONS

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19
Q

Head injury- infant signs of skull fracture/trauma are…

A

Scalp hematoma and seizures

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20
Q

Head injury assess

A

Airway

Respiratory function

Neurologic status

Other injuries

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21
Q

Head injury nursing interventions

A

Maintain vital functions (adequate Oxygenation/perfusion)

Frequent neurological checks monitor for IICP

Encourage rest-NO SCHOOL OR TV OR VIDEO GAMES JUST SLEEP

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22
Q

Mild head injury S/S EXPECTED

A
  • Periods of confusion
  • Behavior changes
  • Irritability
  • Vomiting
  • Headache
  • Sleepy
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23
Q

Severe head injury S/S

CALL HCP

A
  • Seizures
  • Severe headache
  • Severe/constant vomiting
  • Blurred vision
  • CSF (watery) or blood from ears/nose
  • Hard to wake (decreased LOC)
  • Slurred speech
  • Unequal pupils or crossed-eyes
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24
Q

Hydrocephalus infant early S/S

A
  • Born w/ large head
  • Rapid head growth
  • Bulging anterior fontanel
  • Irritability
  • Poor feeding
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25
Q

Hydrocephalus infant late S/S

A 
“Setting sun” sign
Vomiting
Difficulty feeding/swallowing
Increased BP
Decrease HR
Altered respiratory pattern
Shrill/high-pitched cry
Sluggish or unequal pupillary response to light
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26
Q

Hydrocephalus early S/S in children 12-18 months

A

Strabismus (cross-eyed appearance)
Morning frontal headache relieved by vomiting or sitting upright
Behavior/personality changes
Irritability
Sluggish or unequal pupillary response to light
Confusion
Lethargy

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27
Q

Hydrocephalus late S/S in children 12-18 months

A
  • Seizures
  • DECEREBRATE posturing and rigidity
  • Increased BP
  • Decreased HR
  • Altered respiratory pattern
  • Blindness (vision issues)
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28
Q

Causes of hydrocephalus

A

Head injury

Meningitis

Congenital defect

Tumor

Spina Bifida

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29
Q

Hydrocephalus nursing intervention

A

Monitoring the shunt to prevent further CSF accumulation and reducing disability and death

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30
Q

Hydrocephalus treatment

A

VP shunt (ventricular peritoneal shunt)

Permanent shunt from ventricle in brain to peritoneum

Drains CSF into abdomen where extra CSF can be absorbed, decreasing ICP

Internal system

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31
Q

Seizure disorder-febrile

A
  • Children under 5 years old
  • Caused by high and rapidly elevating temps
  • Child at risk for additional febrile seizures
  • Usually harmless and doesn’t cause other health problems
  • ONLY TREATMENT IS GIVE ANTIPYRETICS
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32
Q

Neonatal seizure disorder

A

Birth to 4 weeks old (first month of life)

Subtle signs of seizures b/c immaturity of neonates nervous system

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33
Q

Neonatal seizure disorder causes

A

Underlying pathological process

  • Drug withdrawal
  • Hyperthermia
  • Hypoglycemia
  • IICP
  • Intracranial hemorrhage
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34
Q

Neonatal seizure subtle signs of seizure activity

A

Staring

Rapid eye blinking

Rapid/constant lip smacking or sucking

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35
Q

Neonatal seizure disorder treatment

A

Medications during seizure activity and daily for 3-6 months

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36
Q

What is Epilepsy

A

Recurrent seizure activity that does not occur in association w/acute illness

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37
Q

Epilepsy treatment

A

Maintenance medication

For seizures lasting more than 5 minutes- give Dilantin (phenytoin) rescue drug RECTALLY AND KEEP THIS MEDICATION AT THE BEDSIDE

Ketogenic diet if medication doesn’t work! LAST RESORT (high fat, low/no carbs)

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38
Q

Seizure rn interventions

A 
Place child on soft surface
Remove furniture/ objects from area
Turn gently to the side
Protect head
Stay w/child
Time and observe seizure
Do not restrain or put anything inside mouth
May need ketogenic diet if medications fail (high fat, low/no carbs)
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39
Q

Spina Bifida -occulta

A

Mild

Open vertebrae, nothing protruding

likely asymptomatic

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40
Q

Spina Bifida- cystica: meningocele

A

Moderate

Saclike protrusion containing meninges and CSF

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41
Q

Spina Bifida- cystica: myelomeningocele

A

Severe

  • Saclike protrusion containing CSF, meninges, nerve roots and spinal cord
  • Bowel/ bladder involvement
  • Flaccid muscle tone
  • respiratory issues
  • paralysis of lower extremities
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42
Q

Treatment for Spina Bifida

A
  • VP shunt
  • Straight cath
  • Leg braces
  • Wheelchairs
  • intrapartum-utero surgery
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43
Q

Complications of a VP shunt

A

Infection

Clog

Outgrow w/age

Migration

Breakage

44
Q

Spina Bifida pts are at risk for…

A 
Hydrocephalus and IICP
Cerebellum protrudes down top of spine causing CSF blockage-causing hydrocephalus
Respiratory apnea/cyanosis
GI dysfunction
Paralysis in lower extremities
Bowel ants bladder dysfunction
Club feet
45
Q

Spina Bifida assessment

A

Lesion on back (dimple, hair tuft, saclike protrusion)
Flaccid lower extremities
Decreased sensation
Bowel/bladder incontinence
Improper positioning of hip, knee, plantar

46
Q

Spina Bifida RN interventions

A

Prone position

Cover defect w/sterile, moist dressing prior to surgery

Latex precautions from birth due to repeated exposure to latex

Life long management of neurologic, orthopedic, and urinary problems

47
Q

What is cerebral palsy?

A
  • Chronic, non-progressive disorder of posture and movement.
  • characterized by difficulty in controlling the muscles
  • abnormality in the extrapyramidal or pyramidal motor system
48
Q

Cerebral palsy co-mobidities

A
  • cognitive impairments
  • hearing impairments
  • speech impairments
  • visual impairments
  • seizures
49
Q

Risk factors

A
  • being in a hot car
  • shaking baby syndrome
  • brain not going w/o oxygen during birth
  • brain trauma
  • maternal drug use intra-utero
50
Q

How do we maximize a child with cerebral palsy’s abilities?

A

Early recognition and intervention

OT/PT

51
Q

What is the main test for a lumbar puncture?

A

Meningitis

52
Q

Strabismus

A

Cross-eyed appearance

53
Q

Cerebral palsy assessment

A
  • delayed gross motor development
  • spastic or uncontrolled movements in extremities
  • gait disturbances
  • seizures
  • sensory impairment
  • primitive reflexes
  • abnormal muscle tone
  • lack of progression thru developmental milestones
  • speech and swallowing impairments
54
Q

How to prevent Reye syndrome?

A

Vaccinations of MMR, VARICELLA,FLU…

don’t give aspirin

55
Q

S/S of Reye Syndrome

A
  • prior viral infection
  • progressive neurological decline
  • malaise
  • N/V
  • elevated ammonia levels
  • liver dysfunction
  • low blood sugar
  • bleeding issues
  • IICP w/ respiratory dysfunctions
56
Q

What two organs does Reye syndrome attack?

A

Liver

Brain

57
Q

Monitoring w/ Reye syndrome

A
  • Neurological status
  • IICP
  • hydration
  • acid-base balance
  • cardiorespiratory status
58
Q

Treatment for Reye syndrome

A
  • manage symptoms caused by virus
  • IV Fluid to regulate glucose and electrolyte levels
  • mannitol or IICP
59
Q

Considerations for Reye syndrome

A
  • Can cause permanent neurological damage (brain damage)

- can’t be fatal w/in days if not treated

60
Q

What is Otitis Media?

A

Fluid or infection in the middle ear

61
Q

What risk factors for otitis media

A
  • Infants and small children d/t their Eustachian tube is not as slanted and is shorter
  • daycare
  • smoking in home
  • supine position while being bottle fed
  • pacifier users
  • 6-24 months
62
Q

S/S of otitis media

A
  • bulging, red,opaque tympanic membrane(MD)
  • earache,pulling ears
  • fever
  • V/D
  • sleep disturbances
  • hearing & speech problems
  • yellow/green foul smelling drainage(indicates perforated tympanic membrane (not common)
63
Q

Treatment of otitis media

A
  • watch and wait 3-4 days to see if it resolves itself before giving antibiotics
  • antibiotics
  • tympanostomy tubes
64
Q

What is tympanostomy tubes?

A
  • surgical placement on tubes into the ear canal

- treatment of otitis media

65
Q

What is croup

A
  • Viral infection
  • upper airway
  • let it run its course
66
Q

S/S of croup

A
  • sore throat
  • INSPIRATORY STRIDOR
  • RESPIRATORY DISTRESS
  • fever
  • BARKY COUGH (worse at night)
67
Q

Croup treatment

A
  • COOL MIST/ HUMIDIFICATION (#1)
  • apply oxygen depends on vitals
  • breathing treatments (respiratory therapy)
  • manage symptoms
  • may be treated at home or in the hospital
68
Q

What is Pharyngitis

A

Inflammation or infection of the throat

Usually strep

69
Q

S/S of pharyngitis & treatment

A
  • sore throat
  • redness/inflammation -throat
  • fever
  • cough
  • runny nose
  • hoarseness voice

TREATMENT-antibiotics, pain/ symptoms managed

70
Q

S/S of tonsillitis

A
  • Sore throat
  • redness/inflammation of tonsils
  • difficulty swallowing
  • decreased appetite
  • decreased thirst
  • WHITE EXUDATE ON TONSILS
  • fever
  • UNPLEASANT MOUTH ODOR
  • often present w/ pharyngitis
71
Q

Treatment of tonsillitis

A
  • antibiotics

- tonsillectomy if recurrent

72
Q

RN interventions for tonsillitis

A 
ASSESS FOR BLEEDING 
-excessive swallowing
-bloody drainage
-bloody vomitus
-restlessness associated w/ pain 
-high/low BP
-high HR
MAINTAIN HYDRATION
SCHEDULED PAIN MEDS
FLUIDS ORALLY
73
Q

Epiglottis is

A

Inflammation of the flat that closes the opening of the windpipe when swollen.

EMERGENCY SITUATION!!!!!

74
Q

S/S of epiglottis

A

-abrupt onset and gets worse very quickly
- the 4 D’S
-drooling
-dysphasia
-dyphonia
-distressed inspiratory efforts
(trouble breathing)
-tripod position
-HIGH FEVER
-Gasping for air

75
Q

Treatment for epiglottis

A
  • Antibiotics (IV until extubated)
  • antipyretics (IV or rectal)
  • USUALLY INTUBATED/ maintain patent airway
76
Q

What vaccine can prevent epiglottis

A

HIB

77
Q

RN intervention for epiglottis

A
  • stay w/ child
  • continually assess for respiratory distress
  • have intubation equipment at the bedside
  • radiographs at the bedside
  • keep child and parents calm and quiet
78
Q

What is the most important intervention for a pt w/ epiglottis

A

DO NOT PUT ANYTHING IN PTS MOUTH

DO NOT SWAB THROAT UNTIL READY W/ INTUBATION EQUIPMENT

SWABBING WILL INCREASE IRRITATION AND INFLAMMATION CAUSING COMPLETE AIRWAY OBSTRUCTION

79
Q

What is Bronchiolitis

A

Inflammation and edema causing constriction of the bronchioles (lower airway)

CAUSED BY THE VIRUS RSV

80
Q

S/S of bronchiolitis

A
  • Sneezing
  • A LOT OF CLEAR NASAL DRAINAGE
  • ALTERED LUNG SOUNDS(crackles,wheezes, rhonchi)
  • respiratory distress
  • LOW GRADE FEVER
81
Q

When to suction a pt w/ bronchiolitis(RSV)

A

Hospital or home

ESPECIALLY BEFORE FEEDING AND AT BEDTIME

82
Q

When can a pt go home with bronchiolitis

A

When secretions can be controlled with a bulb suction

83
Q

RN interventions for bronchiolitis

A
  • suction
  • apply cool humidified O2
  • respiratory therapy
  • IV fluids if necessary
  • MAINTAIN HOB 30-40 degrees w/ Neck slightly extended
  • TEACHING RSV PREVENTION IS MOST IMPORTANT
84
Q

What is asthma?

A

Spasms in the bronchi of the lungs causing difficulty breathing

Usually caused by allergic reaction or hypersensitivity to stimulus

85
Q

S/S of asthma

A
  • Retraction
  • nonproductive cough
  • stridor
  • respiratory distress
  • apprehension, restlessness, diaphoresis
  • abdominal pain
  • SOB
  • chest tightness followed by dry cough, wheezing, and suspend
  • symptoms worsening at night
86
Q

Triggers for asthma attack

A
  • pet dander
  • mold
  • dust
  • perfumes
  • air fresheners
  • tobacco smoke
87
Q

How to treat asthma

A
  • remove carper/curtains
  • avoid allergens
  • inhalers and nose spray SPACERS OR FACE MASKS ARE BETTER FOR KIDS TO INHALE MEDICATION
  • rescue inhaler
88
Q

What is cystic fibrosis

A

Chronic, genetic, multi system disorder affecting exocrine glands (bronchioles, small interesting, pancreatic and bile ducts) produces abnormally thick mucous causing obstruction of small passageways

89
Q

What organs are affected w/ cystic fibrosis?

A
  • Sinuses
  • lungs (thick, sticky, mucus buildup, pneumonia, widened airway)
  • skin(salty sweat)
  • liver(blocked bile ducts)
  • pancreas(blocked pancreatic ducts)
  • intestines (cannot absorb nutrients)
  • reproductive organs
90
Q

How is cystic fibrosis dx

A

Newborn screening

Sweat test

91
Q

First sign of cystic fibrosis?

A

Lack of meconium (meconium ileum)

Difficult for infant to have their first poop

92
Q

What system does cystic fibrosis affect first

A

Digestive!

Then the respiratory develop later

93
Q

S/S of cystic fibrosis

A
  • Lack of meconium
  • loose, bulky, fat stool
  • diminished lung sounds
  • hoarse voice
  • wheezing(b/c of mucus)
  • recurrent infection (like pneumonia)
  • they are thin/ small for their age due to malabsorption
94
Q

Treatment for cystic fibrosis

A
  • give pancreatic enzymes w/food to aid in nutrient digestion and absorption
  • chest percussion therapy (usually a vest)
  • breathing treatments
  • medications
  • lung transplant is an option but not for all kids.
95
Q

What is Apnea

A

The absence of breathing for 20 seconds or longer

Or

shorter period but w/ bradycardia or cyanosis present

96
Q

S/S of apnea

A

Absence of breathing

Low HR

Cyanosis

Low O2 sat

97
Q

What’s is important to observe ina pt w/ apnea

A

Observe for cause!!!

Like sleeping or feeding or pooping

98
Q

RN interventions for apnea

A
  • Monitor HR and respiratory continuously
  • keep resuscitative equipment available at all times
  • record time, duration, color change, HR, O2 sat during an episode
  • what the pt was doing during the episode
99
Q

What to do during an episode of apnea

A

Rub their

  • back
  • feet
  • chest
100
Q

What is most important for parents and care givers to do for apnea pts

A

CPR training!

101
Q

What is SIDS

A

Sudden infant death syndrome

Sudden and unexplained death in infants

102
Q

What age are they no longer at risk usually

A

6- 12 months depending if they can roll then the risk decreases

103
Q

Risk factors for SIDS

A
  • male gender
  • prematurity
  • prenatal exposure to alcohol or smoke
104
Q

S/S of SIDS

A

Death

Child may be found in ANY POSITION AND MAY BE CLUTCHING BEDDING

105
Q

Diagnosis of SIDS

A

Autopsy

106
Q

Interventions or avoid SIDS

A
  • no bed sharing! Sleep alone
  • used ONLY firm mattress
  • no loose bedding blankets or bumpers
  • use sleepwear designed to keep baby warm
  • do not put baby in car seat, carrier, or swing to sleep
  • remove cigarette smoke

Peds Exam 3 (2 decks)

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