Neurology, Integumentary and cancer Final Flashcards
Problems in the neuro is system can start where ?
Can lead to what
Brain
Spine
Nerves
Muscles
-seizures, headaches, developmental delays
What scale to use that determines level of consciousness?
What it measures?
Higher numbers means?
Used For what ages
Glascow coma scale
alert , lethargy, obundation, stupor, coma (eye opening, motor response0-2 years, verbal response-2-5 years)
More conscious you are- 15 is the sum
0-5 years old
Level of alertness
Alert-
Lethargy-
obundation,
stupor,
coma
Alert- when patient answers questions appropriately
Lethargy-opens eyes, appears drowsy, answers questions appropriate but falls asleep and needs reminders to answer
obundation, - can open eyes but appears confused - overall alertness is decreased
stupor, - only responds to painful stimuli , verbal responses are absent or slow
coma - do not respond to internal or external stimuli and remain in unaroused state with eyes closed
The space in between the brain and skull create intercrainial pressure s/s such as?
Infants?
Seizures Decreased eye contact Building fontanels HTN (pushing triad)? Bradycardia Irregular resp
LOC, papilledema , pupil changes, impaired eye movement, decerebrate, decorticate, and flaccid posture, change in motor ability , speech, headache
Infants - bulging fontanels, cranial suture separation, increases head circumference, high pitched cry
intercrainial cranial pressure s/s in ER or nicu - what to do?
Overall goal?
Closely monitor pt
Address changing of vitals
Assess neuro status
- ask what there normal state of being is from there parents
Provide care and prevent harm?
Important observation in infants to asses for intercranial pressure and dehydration
Anterior closes at 18 months of age
Things that can impacts intercrainal pressure /fluid In head
Growing tumor
Electrical disturbance activity in the brain resulting in motor dysfunction , alterations and sometimes sensation
Seizure
Classified?
Seizures can result from?
Traumatic brain injury
Toxic ingestion of chemicals
Endocrine dysfunction
Anoxic(low oxygen) episodes
Etiology of seizures (why it happens may be )
Unknown
Mom who has continuous late decelerations and progresses in labor may do what to the child
Decreased or absent variability
Anoxic (low oxygen) episodes and may cause seizures
What is a partial seizure
A seizure that affects only one part of the brain. Affects a single limb (hands , lips, wrist, arm, face)
LOC onset
What is a simple partial seizure ?
No LOC
Spread to other parts of body
Buzzing sounds
Flashing lights
Anxiety of unknown
Five minutes
Don’t remember
Complete partial
Complete LOC and awareness
Behavior changes, lip smacking, inappropriate mannerisms , confusion followed by a seizure
Generalized seizure aka ?
S/s
Phases
Other types
How it begins?
Tonic clonic (grand mal)- most common
Unconsciousness , onset with out warning
Other types- Mytonic , atonic, absent seizure
Begin with dyspnea on the limb= tonic phase
Breathing may decrease or stop, cyanotic on lips , mucus membranes,nail beds, and face in tonic phase
Followed by Jerking of limbs and face= clonic phase , breathing may return here but irregular, lasts less than a minute , some people may only experience this phase
Incontinent may occur , may have bit tongue (blood present) , raspy and labored breathing after
Care for one having a seizure
Be sure they are safe- do not hit anything surrounding them (head)
Get them on floor
Loosen tight constricting clothing around neck (bib, tie, scarf)
Care after seizure
Put them on their side
Get vomit out of mouth so they do not aspiriate
(Airway and repositioning)
When to call 911 during a seizure
Time the length of lasts longer than 5 minutes - call 911
The person does not have epilepsy
A second one occurs before patient is fully recovered
Regular breathing does not return after ending
Seizure occurs in water
Pt is pregnant
Pt has diabetes
Injury occurs during seizure
Do NOT do what?
Do not put anything in mouth or restrain patient
How to protect seizure pt from injury
Place something soft under head and remove dangerous objects out of the way
Roll onto side after seizure subsides
As seizure of ending pt may have bowel or bladder incontinence and excess saliva during
Stay with pt until full awareness returns
Pt may be tired , Talk softly after
Viral infection that occurs with an acute febrile illness characterized by cerebral edema and infection surrounding mengengies ?
Encephalitis
Most common cause of viral encephalitis is caused by?
Mosquito or herpes simplex virus type 1
May also be caused by rabies , mononucleosis, or Poliomyelitis
Swelling around the meninges causes what s/s of encephalitis?
Confusion Headache High fever Photophobia Lethargy Nuchal ridgity (stiff neck) seizures Coma
When someone come into ER with cerebral edema or encephalitis s/s what to go?
Initiate seizure precautions
Head to toe assessment/ neuro exam
Vital signs
Draw labs - CBC and kem panel?
Position to avoid neck and vein compression
Monitor fluid and electrolytes and monitor or syndrome if innappopriate anti diuretic hormone
Inflammation of the structures of the central nervous system caused by infection
Meningitis
Meningitis Can be caused by
streptococcus pnemona
Meningitis
Influenza type b
Bacteria or viral
Meningitis that is deadly , spreads fast
Signs
Bacterial
Brudzinki (bend neck and hips and knees flex laying supine) and kernig sign (supine- knees can not extend due to pain when hip flexed 90 degrees) ** know?
Bacterial infection indications - opposite to viral
Cloudy spinal fluid -spinal tap
Elevated WBC count
Grams stain Positive
Decreased glucose levels
Protein content elevated
What to watch for after spinal tap
Headache that is more intense than previous headache
Liver and brain damage caused by aspirin to pt age 4-14
Reye’s syndrome
Meningitis s/s?
Interventions
Fever, headache, Steph Nik, lethargic, irritability, nausea, vomiting
Assess neurological status every 2 to 4 hours
Seizure precautions at all times
calm and quiet room
S/s of ryes syndrome
Tx and interventions
Restlessness, vomiting, drowsiness, seizures, loss of consciousness
ABCs , resp status
Head to toe vital signs
Seizure precautions for ICP
IV hydration - make sure they contain glucose and correct hypoglycemia and correct potassium , sodium electrolyte imbalances
Corticosteroids - decrease cerebral edema and inflammation
Insulin- increase glucose metabolism
Diuretics - increase fluid elimination - decrease edema/ICP
Vitamin K/ plasma
What does ryes syndrome primarily affect in children
Brain
But can affect all systems
2 part
Abusive head trauma aka
Why and how it happens
S/s -
Shaking baby syndrome (non accident)
emotional response - shake until quit crying
6 months or younger - not moving by self yet to injure self - ***
seizure activity , apnea , bulging of fontanels, coma , bradycardia, Hemorrhage, vomiting, poor feeding , lethargy, irritability ,failure to thrive
Nursing care for abusive head trauma
Progress for child depends on?
May result in?
—Recognize hallmark signs -
Maintain respiratory and cardiovascular support, assess for ICP and visible injury, prevent complications due to long-term impairment such as infections contractures decrease muscle tone and pressure ulcers, may need gastrostomy or tracheostomy tube
Inconsistency of what your assessing and what your being told by parents
Inconsistency in stories of each parent
- severity of injury and timing of care after injury
- Visual or neurological impairments , developmental delays
Why are children prone to head injuries?
Have larger head then body
Unstable gait
Soft cerebral tissue
Occurs when a joke or hit to the head disrupts the normal function of the brain
Trumatic brain injury
Traumatic brain injury nursing care?
Maintain airway
Give oxygen as needed
Assess pupils and reactivity
Asses reflexes
Assess skull fractures - palpate CSF fluid from ear or nose
Assess for blood in middle ear, mastoid bruising and periorbital bruising (raccoon eyes)
Warning signs of head injury?
Change in LOC, Drowsiness, confusion, difficult to arouse, seizures, bleeding or watery drainage from nose or ears, slurred speech, vomiting, blurred vision, loss of sensation to extremities, people slow to react or unequal
Common Reasons why children are seen in ER
What is anticipatory guidance (Education) to client and parent?
Motor vehicle accidents
Bicycle accidents
Sports trauma
Violence at home or school
Falls
- wear knee pads , helmet, seatbelt , following safety rules
Spinal cord injures when most often seen
In summer
Spinal cord injuries have been associated with what
Traumatic births
Fighting with guns and knifes
S/s of spinal cord injuries
How they occur
Depends on severity of injury
Injury to cervical, thoracic, lumbar or sacral
Caused by direct or indirect force and damage which results in loss of sensation or paralysis below the level of injury
Cervical injury-
Thoracic -
Lumbar-
Sacrum-
Quadriplegia (all fours)
Paraplegic(legs and butt)
Paraplegia - (below waist)
Coccyx
Common through childhood and classified as primary or secondary
Headaches
Triggers for primary headaches
Lack of sleep
Stress
Exercise
Hunger
Loud noises
Persistent loud noises
Weather changes
Hormonal changes during mensuration
Triggers of secondary headaches
Trauma
Vascular disease
Infectious processes
Substance abuse
Psycho genic issues
Headache
●Associated with stress
●Dull to moderate pain located in the back head at the base of the skull
Radiate bilaterally or just above neck and shoulders
Sleep is affected , loss of vision, photophobia, nausea, auditory sensation
Tension headache
very common
Starts presenting during preschool and school age children
Family hx is usual
●Moderate to severe radiating pain located on one side of the head with throbbing or pulsating quality
Aura may be associated
Not easily remedied
Migraine headache
●Series of headaches that occurs over a period of weeks or months that vary in intensity
●Unilateral pain, behind one eye, causing ptosis and pupil constriction
Rhinorrhea and edema , URI
Cluster headache
Nursing care for headaches
●Nursing Care
●Maintain calm and quiet environment
●Promote relaxation techniques
●Use pharmacological techniques
Identify triggers and avoid triggers
Educate family about Rest and calm environment
Eye sensory disorders
When are they commonly diagnosed?
Hyperopia (farsighted)
•myopia (nearsighted)
Color blindness - first three can be identified in elementary school screening
- Astigmatism
- strabismus (visual lines cross)
- nystagmus (rapid, irregular eye movements)
- cataracts (cloudy or hazy corneal lens)
- glaucoma (thin, cloudy cornea)
- retinoblastoma (malignant tumor of retina)
Eye screening in elementary school
Tx for eye exams
Corrective lenses, patching of stronger eye to force weaker eye to work independently (strabismus), extraocular surgery (nystagmus), increase lighting (cataracts), fall assessment, preop/postop teaching
Children eye test- what is it and how to do?
Snellen test
Stand 10 feet away
Cover one eye, then cover the other and read and then read with both , wear glasses or contacts if have corrected vision
is one of the most common sensory disorders in the us
Early detection is important to improve and maximize outcomes
Caused by?
Hearing loss
Genetic / non genetic
Meningitis, maternal torch, infection during pregnancy, idiopathic (unknown cause)
S/s of hearing loss
Classified how?
Classification – normal, slight, mild, moderate, moderate/severe, severe, profound loss
- Signs and symptoms:
- lack of startle reflex,
- child does not turn toward sounds
- child does not follow verbal directions or respond when called by name
- child has delayed speech or is difficult to understand
- child has difficulty with articulation
When is the first hearing test done?
Newborn in hospital
Child hearing loss signs?
May not turn to sound or follow direction , speech delay and pronunciation, articulation
Speech in children
2 years old-
2 word sentences - understand 50% of time
3- 3 word sentence-understand 75%
4- 4 word sentence- understand 100% of time
●Difficulty understanding what others are saying
●Problems following directions that are verbally given to them
●Difficulty organizing thoughts
Receptive speech disorder
●Difficulty forming sentences
●Trouble finding the correct words when speaking
●Decreased vocabulary when compared with other children of the same age
Expressive speech disorder
Nursing care for speech disorders
●Recognize and monitor for further speech and developmental delays
●Document milestone
●Recognize areas of difficulty
Listen to parents and what they tell you about any developmental issues during clinic visits
Understanding their growth and development and where it should be at each ***age milestones
“It must be difficult you.”
is a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21.
●Decreased or poor muscle tone.
●Short neck, with excess skin at the back of the neck.
●Flattened facial profile and nose.
●Small head, ears, and mouth.
●Upward slanting eyes, often with a skin fold that comes out from the upper eyelid and covers the inner corner of the eye.
Down syndrome
What does the integumentary system do?
Barrier to protect against outside
Waterproof, prevent water loss , protects deeper tissues, regulates body temp, excretes waste , helps with vitamin D synthesis
Bacterial Infection
●Reddish macule, vesicular
●Erupts, leaving skin moist, cursts
●Spreads peripherally and direct contact
●Treatment with topical antibiotic
●Others skin infections: folliculitits, furuncle, carbuncle, cellulitis, staphyloccal
Impetigo Contagiosa
Viral skin infections
How to treat and what is can cause or caused from
Warts
Herpes type 1/2
Shingles
Warts - hand, planter (burnt with dry ice)
Shingles - from herpes zoster virus - caused by varicella virus (only can develop if you have had chicken pox)
Herpes simplex 1- fever blister
Herpes simplex type 2- antiviral - aceclovyir tx
Fungal infections
Ring worm types? Who is it common in?
Jock itch types?
Athletes foot - tx ?
Tinea capitits (on scalp) ring-like
Tinea coporis- on body
Common in people who play close contact sports (wrestling) educate parents on head to toe skin assessments and good body hygiene
Tinea cruris- dark coloration near groin
Tinea pedis - dry scaley skin between toes - treat with antifungals -clotrimazole cream
Education on burns in children to parents
Home safety
What burns are the most common
Thermal burns
(type of burn resulting from making contact with heated objects, such as boiling water, steam, hot cooking oil, fire, and hot objects.
Burns occur from the ignition of combustible materials and contact with fire, fireworks, candles, and campfires.
Flame burns
burns are caused by explosions, especially with combustible fuels like gasoline, kerosene, charcoal lighter, and fireworks or hairspray.
Common in?
Flash burns
Young men population
Burns occur when hot liquid is spilled on them
Common in?
Scald burns
Young children from pot handles not being turned in
Burns that occur when exposure to hot object
Commonly from what?
Contact burn
Water heater should be set no higher than 120 degrees F , check before putting child in
occur when the skin of the child comes in contact with radiofrequency or ionizing agents.
●Sunburn
●radiation burn (cancer treatment)
●radioactive material
Education ?
●Radiation burns
Wear sunscreen , glasses and hats
●burns occur when the skin comes in contact with a chemical agent that is corrosive to the skin.
●Acids like sulfuric acid and muriatic acid are caustic to the skin.
●Alkaline agents like lye, lime, ammonia, and household cleaning agents are also caustic to the skin and cause injury.
Agents that are corrosive to the skin in the home
CHEMICAL burns
occur when electricity passes through or around the body as it seeks the fastest path of least resistance to the ground.
●Household current of 110 volts can cause a full-thickness burn injury to the corner of the mouth.
●Electrical lines that carry electricity throughout towns and cities typically carry 14,800 volts.
●High-tension wires can carry as much as 150,000 volts.
●ightning can have between 10 and 100 million volts.
Education?
Electrical burns
Plug ins have caps over them in home , don’t chew on electrical cords
Partial thickness injury burn involves the epidermis
minor Heat , sun, or friction exposure
First degree burn
Superficial partial thickness injury
Thin walled fluid filled blisters that develop within minutes of exposure- blisters may weep , painful, bleed easily
Or Deep partial thickness, injury involve the entire dermis, appears waxy, white, and is surrounded by superficial partial thickness injury- dermis is pale , blisters do not weep,painful , 9 weeks to heal and scaring
Severe Sunburn , heat or friction burns
2nd degree burn
Full thickness injury , destruction of the epidermis and subcutaneous tissue. Bone and muscle may also be destroyed
Escher is visible and may damage nerves , bones and muscles
Dry and leathery
Severe heat or friction exposure
3rd degree burn
When burn pt comes in to hospital what to do first?
Primary- # 1 Fluid resuscitation -formula -most important - Make sure airway is patent completely (inhalation burn) , ventilation used for 2-4th degree burns
Second - head to to examine, history
Determine if it is due to abusive or neglectful - involve social services
Rule of nines (no need to know for his test)
When to intubate burn pt
If inflation injury is present
How to treat burn wounds
Debridement sand dressing changes
Hydrotherapy and dressing changes
What percent is intentional and unintentional poisoning
80% unintentional
10-20 intentional
1 most common medication poisoning
●Nausea, vomiting, sweating, pallor (initial symptoms)
●Pain in RUQ, confusion, stupor, jaundice, coagulation issues (36 hours to 7 days)
●Treatment: N-acetylcysteine orally
Poisoning:
Acetaminophen
●Acute: nausea, vomiting, tachypnea, disorientation
●Chronic: Bleeding dehydration, seizures
●Treatment: Intubation ●Activated Charcoal ●Gastric lavage ●Sodium Bicarbonate ●Vitamin K ●Hemodialysis (severe)
Poisoning: Aspirin (acetylsalicylic acid)
●Gagging, choking, nausea, vomiting, coughing, lethargy, weakness, tachypnea, cyanosis, grunting, retractions
●Treatment:
●Do not induce vomiting
●Intubation w/cuff prior gastric decontamination/lavage (pulled out of body)
Poisoning:
Hydrocarbons
●Pain, burning in mouth, swollen mouth, vomiting, cyanosis, drooling, anxiety/ doom
●Treatment:
●Airway support
●NPO
●Do not neutralize substance
Address pain
Poisoning:
Corrosives
Children poisoning occurs most often due to exploratory behaviors
Age 5 and below
Ages that have increased finger to mouth activity and PICA = increased risk of accidental ingestion
1-4
Guidance / education with chemicals and family with young children
Most common ingested agents ?
Lock cabinets
Put chemicals away
Crawl on hands and knees to see what children can see
Cleaning agents and laundry detergent
Evaluation with poisoned child
Eval of ABCs - asses airway, breathing, circulation
Resuscitation and stabilization
If unstable, hx with be done along with resuscitation
Most common approach in the poisoned child who had decreased level of consciousness or abnormal vitals is to do what?
Address causes of symptoms presented
Many common malignancies arise from primitive a embryonic tissue in which there is a strong environmental link related to what?
Guideline
The development of cancer
Why should childhood cancer survivors have their height measured regularly
Guideline
Complications from chemo and radiation
What should pre pubertal girls with cancer be monitored for ?
Guideline
Signs of early onset puberty
What to do for cancer patients who have impaired fertility
Guideline
Referred to specialist for ongoing assessment
What is essential in cancer patients pertaining to growth and development
●Good nutrition is essential
●The nurse should promote good oral hygiene
to prevent complications of pharmacological therapies. Enteral and parenteral nutrition should be implemented when needed
●nurse should encourage activity and play
while allowing for adequate periods of rest
because the child with cancer may fatigue easily
●Quiet activities should be encouraged
when the child has low levels of energy
●nurse should encourage the child to attend school, or see peers when unable to attend school, to avoid social isolation
●Rare kidney cancer, AKA nephroblastoma
●Symptoms:
●Parents notice a firm lump, average 1 pound at diagnosis
●Nausea, stomach pain, loss of appetite, fever, blood in urine
●Diagnosis/Treatment:
●Ultrasound,* CT, MRI
●Removal, chemotherapy*
Painless palpable abd mass often with increased abd girth - parents often find with diaper changes
Hematuria - microscopic may be present
Overall symptoms are decreased appetite and stomach pain
Wilms tumor
Most common type of cancer in children
75-80% of all childhood leukemia’s
Acute lymphocytic leukemia
Acute lymphocytic leukemia s/s
Diagnosis
Fever Fatigue Lethargy Anemia Pale Anorexia Bone or joint pain Limp Refuse to walk due to pain
CBC, WBC , platelets , liver, kidney function , lumbar puncture
Nursing care for ALL
Medical care
Without therapy and nursing care, it is fatal
Once remission is achieved most children relapse within a few months if treatment is stopped
- Chemotherapy, bone marrow transplant, hormone therapy
This cancer appears to be an arrest (stop)? in the differentiation pathway of myeloid progenitors or precursor rather than abnormal growth kinetics
Acute myelogenois leukemia
Acute myelogenois leukemia s/s and diagnosis ?
Flulike symptoms, fever, infections, decreased RBCs, decreased O2 levels, pale, fatigue, headache, dizziness, “blueberry muffin” lesions (subcutaneous nodules) - nodules instead of joint pain
Bone marrow aspiration and analysis
Acute myelogenois leukemia nursing care
Medical care
Treatment begins promptly especially to control any copresenting symptomatology (presenting problem)
Medical- cytarabine (Ara-C) and daunorubicin (mycin)
Chronic myelogenous leukemia
Clonal disorder of the hematopoietic tissue (formation of blood cells ) that accounts for 2% to 3% cases of leukemia in children
Chronic myelogenous leukemia s/s
Fever , fatigue , weight loss, anorexia
Chronic myelogenous leukemia
Diagnosis
Increased numbers of myeloid cells With the differentiation to mature forms in the peripheral blood smear and bone marrow
Chronic myelogenous leukemia
Nursing care
Medical care
Primary Care revolves around post bone marrow or transplant interventions such as..
(pain management, hand hygiene , good nutrition, infection control, alternative care therapies - talk to provider first to see if beneficial for disease)
Medical care: hydroxyurea (medication)
Tumor of nerve tissue that develops an infant and children
It develops from the tissues that form the sympathetic nervous system
Neuroblastoma
Neuroblastoma signs and symptoms
Hard, painless mass tumor palpated on midline and neck or abdomen
Neuroblastoma diagnosis
MRI, CT, catecholamines in urine
Nursing care for neuroblastoma
Complete nursing assessment is vital to ensure that the child does not have an infection
And his or her condition remains stable
Placed emphasis on the child’s discomfort and alleviating pain
Medical care for neuroblastoma
Surgical resection, chemotherapy,Radiation, bone marrow transplant
Most common pediatric soft tissue sarcoma
8% of childhood cancers
Most often found in the neck and head and genitourinary tract, extremities and trunk
2 types - embryonic and alveolar
Survival rate is about 65%
Rhabdomyosarcoma
Rhabdomyosarcoma s/s
Orbital or eyelid tumors may cause proptosis(a downward displacement of the eyeball) and may impair vision, headache, vomiting, urinary obstruction, erythema, and tenderness
Diagnosis of Rhabdomyosarcoma
Biopsy of lesions , physical examination, CT, MRI, X-ray
Nursing care Rhabdomyosarcoma
monitoring of the surgical site is vital or if chemo is needed , initiate standard nursing care
Medical care for Rhabdomyosarcoma
Chemo or surgery if possible
Malignant tumor that arises from the retina at the back of the eye during fetal life or early childhood
It can grow rapidly or slow
Retinoblastoma
Retinoblastoma s/s
Red painful eyes, blindness is the last sign because of retina, visual impairment, abnormal appearance of the eye,Unilaterally or bilaterally (one or both)
Retinoblastoma diagnosis
Examination under anesthesia using ophthalmoscope , orbital ultrasound, CT , MRI
Retinoblastoma nursing care
Show parents a photograph of another child who has had this type of surgery to show parents and child up there and parents will be nearly normal
Retinoblastoma medical care
Primary enucleation (removal of the eye) Is usually performed if there is no potential for useful vision
Retinoblastoma education
Child is usually discharged in 3 to 4 days after surgery.
The nurse Teacher’s parents about care of the eye socket by showing them gentle irrigation of the area with the prescribe solution and then applying a thin coating of the prescribed antibiotic ointment.
Eye gauze pads are applied until the wound has completely healed.
Enforce good hand washing for the entire family
Nursing care for cancer
Neutropenia diet
Decrease infection- infection control, hand washing
Chemo/ radiation - educate negative effects
Pain management - morphine,
Psychosocial support,
asses safety interventions,
care for nausea and vomiting,
address hair loss, (alopecia)
assess for exervasion(chemo meds fall into tissue and can cause death)**
assess for mucositis-pain in mucus membrane - can use chlorahexidate oral swish or nystatin or sodium bicarbonate to keep oral mucosa pain free to be able to absorb nutrients *
Address any loose stools or constipation - electrolytes
Care for anemia
Understand thrombocytopenia (low platelet count ) Side effect
Neutropenia is side effect
Chemotherapy nursing action
Stay with individuals
Monitor side effects - can happen within 20 minutes
Baseline vital sign and continued vital signs
