paeds lect 3 Flashcards
At what week do the cerebrum & cerebellum develop?
Week 8-12
Primitive reflexes disappear by?
By the time infant is 12 months old
Which cranial nerves are non-myelinated at infant stage?
Optic & olfactory nerves
Which is not an increased intracranial pressure condition?
- craniocerebral trauma
- hydrocephalus
- brain tumour
- meningitis or encephalitis
- spontaneous intracranial hypotension
- intracerebral haemorrhage
- spontaneous intracranial hypotension
In focal/partial seizure, abnormal discharge occurs in 2 areas of the brain. T/F?
FALSE.
only occurs in 1 area of the brain
Neonatal seizures symptoms
- sucking, lip smacking or other oral-buccal-lingual movement
- bicycling or pedaling movement
- rhythmic ocular movements eg. horizontal eye deviation
- occasionally apneic spells
Neonatal seizures’ causes
- infection
- electrolyte derangement
- metabolic abnormalities
Cause of febrile seizures
when a child’s temperature rises to 38.5 degrees celsius or more
Positioning of child to abort seizures
- avoid__________________ (increases ICP)
- _________ of bed _________ to facilitate _________ of the brain
- ensure availability of _________ eg. _________
- during seizure: remove_________ , _________ , position child on_________ to allow _________
- avoid prone, neck flexion (increases ICP)
- raise head of bed 35-45 degrees to facilitate venous drainage of the brain
- ensure availability of equipment eg. O2 and suction
- during seizure: remove harmful objects, extend neck to maintain airway, position child on side to allow flow of secretions
Cause of congenital hydrocephalus
a defect such as Chiari’s malformation, also associated with spinal bifida
Cause of acquired hydrocephalus
space-occupying lesion:
- haemorrhage
- intracranial infection
Treatment of hydrocephalus
- Direct removal of obstruction
- and insertion of ventriculoperitoneal shunts
to provide pri drainage of CSF to an extracranial compartment, usually peritoneum
Cerebral palsy is the most common PERMANENT disability of children. T/F?
True
4 classifications of cerebral palsy
- Spastic CP (70%) – abnormal patter of posture and/or movement, increased tone, pathological reflexes
- Dyskinetic CP (10%)– recurring involuntary stereotyped movement
- Ataxic type (10%)– rapid repetitve movement
- Mixed/Dytonic (10%)
Characteristics of neuromuscular disease
- hypotonia (↓ muscle tone)
- weakness
- ↓ deep tendon reflexes
- may involve the anterior horn cells, peripheral nerve neuromuscular junction or muscles
Definition of muscular dystrophy. What could it lead to?
- Progressive degeneration and weakness of skeletal muscles from infection or cardiopulmonary failure
- could lead to death, usually in adolescence
What is absent in muscular dystrophy?
Absence of dystrophin (protein) in the muscle
Nursing interventions of muscular dystrophy (at least 5)
- prevent ________ (________)
- prevent ________ (use ________________)
- promote ________
- assess for signs of ________and ________
- adequate ________ & ________
- meds: ________, ________ & ________
- promote optimal ________, support ________
- prevent physical injury (safe env, protective gear)
- prevent physical deformity (use prescribed braces/other devices, ROM exercise)
- promote mobility
- assess for signs of disorder progression and complication
- adequate fluid & nutritional intake
- meds: sedative, muscle relaxant & anticonvulsant
- promote optimal family function, support child’s need
Characteristic of type 1 DM and what DM results from.
- results from a partial/complete deficiency of insulin
- type 1 is characterised by pancreatic beta cell destruction hence leading to absolute insulin deficiency
If there is persistent blood glucose level >10mmol/L, what does it result in?
Results in glycosuria → osmotic diuresis with polyuria (body makes more pee than normal) & polydipsia (excessive thirst)
Excessive ketone production causes ____. And what are the characteristics?
Causes diabetic ketoacidosis (DKA).
Characterised by marked hyperglycemia, metabolic acidosis, dehydration and altered level of consciousness ranging from lethargy to coma
Sign and symptoms of DM Type 1 + signs of DKA
- polydipsia
- polyuria
- polyphagia (excessive hunger or increased appetite)
- fatigue
- weight loss
- dry skin
- blurred vision
- signs of DKA: hyperglycemia, acidosis, glycosuria, ketonuria
Nursing intervention for DM Type 1 (At least 5)
- assess child for signs of ________, ________ & their complications
- provide ________ during________, such as ________
- monitor ________ status, ________, ________
- monitor level of ________ (a lower than normal potassium level in your bloodstream)
- promote ________ by maintaining accurate & careful record of IV infusion blood glucose lvl, intake & output & urine specific gravity
- test ________ for ________ every ___hrs when child is ill and whenever blood sugar level > ________
- administer ________ to ________ ________ blood glucose lvl
- assess child for signs of hypoglycemia, hyperglycemia & their complications
- provide care during acute phase, such as DKA
- monitor neurologic status, vital signs, blood glucose lvl
- monitor level of hypokalemia (a lower than normal potassium level in your bloodstream)
- promote adequate fluid vol. by maintaining accurate & careful record of IV infusion blood glucose lvl, intake & output & urine specific gravity
- test urine for ketones every 3hrs when child is ill and whenever blood sugar level > 15mmol/L
- administer insulin to decrease elevated blood glucose lvl
Age appropriate blood glucose lvl (0-6yo, 6-12 & >12 yo) premeals and postmeals!!
Premeals:
0-6 yo: 5-12mmol/L
6-12 yo: 4-10 mmol/L
>12 yo: 4-8 mmol/L
Post meals:
<12 mmol/L
<10 mmol/L
<8 mmol/L
Ethiology of DM Type 2. What is the significant risk factor?
- social, behavioral & environment risk factors
- heredity is a strong component
- obesity is a significant risk factor
Children with type 2 DM will develop ____.
What can occur in type 2 DM?
insulin resistance
Velvety hyperpigmented patches in intertriginous area, hypertension and lipid disorders can occur.
Nursing management of type 2 DM
- Metformin (1st line treatment)
- insulin & oral anti-diabetic usually added to diet & exercise regime to improve blood glucose control
- calorie-restricted diet
- promote lifestyle change (increase physical activity & decrease sedentary activity)
Name of a cancer depends on its cell origin:
1) Sarcoma
2) Carcinoma
Describe both
Sarcoma: connective tissue, muscle, bone
Carcinoma: epithelial tissue (glands, hollow organs, outer layer of skin that lines with the blood vessels)
Most common cancer in children
Leukaemia
For long term chemo:
Catheter tip is often placed at the _______.
superior vena cava
Side effects of chemo Hematopoietic: GI: Hepatic: Renal: Integumentary: Reproductive:
Hematopoietic: myelosuppression, anaemia, thrombocytopenia, neutropenia
GI: mucositis
Hepatic: liver toxicity
Renal: renal toxicity
Integumentary: alopecia (an autoimmune disorder that causes your hair to come out)
Reproductive: oligomenorrhea ( infrequent menstrual periods)
S&S of acute lymphocytic leukaemia (At least 5)
- fatigue
- pallor
- low-grade fever
- bone & joint pain
- petechiae & bruising
- purpura
- lymph nodes may be enlarged
Investigation of acute lymphocytic leukemia
- WBC (<5000/mm3)
- presence of abnormal blast cells in bone marrow: indication of leukaemia
Treatment of acute lymphocytic leukemia (3 phases)
- induction phase (4 weeks to remission) (IV Vincristine, L-asparaginase, Prednisolone)
- consolidation phase (high-dose chemo, IT/radiation therapy is CNS is involved)
- maintenance phase (chemo agents by oral, IV or IM route)
Management of acute lymphocytic leukemia
- prevent infection
- prevent bleeding & injury
- reducing pain
- promoting energy conservation
- relieving anxiety
- promoting normal growth & development
What type of infection is Sepsis? When does it usually occur?
bacterial infection;
occur in the 1st month of life
Risk factors of sepsis
- prematurity
- invasive procedure
- steroid use for chronic condition
- nosocomial exposure (infections that develop as a result of a stay in hospital) to pathogens
Clinical manifestations of sepsis (infants)
- poor sucking
- feeding lethargy
- weak cry
- irritability
Subsequent s&s of sepsis
- tachycardia
- increased or irregular respiration
- mottling (blotchy, red-purplish marbling of the skin)
- GI disturbances
- temperature instability
- dehydration
- hypotension
Common causes of meningitis ( in neonates & children)
- In neonates: E.coli and Group B streptococcus
- Infants & children: Neisseria meningitidis, Step. Pneumoniae & Group B Strep
S&S of meningitis of children <2 yo
- poor feeding
- irritability
- lethargy
- high-pitched cry
- bulging fontantel
- hyperextension of neck & spine
S&S of meningitis of older children (>2yo)
- respiratory or GI problem
- stiff neck
- headache
- tripod posture
- Kernig signs: pain to knee extension when on supine position
- Brudzinski’s sign: flexion of knees & hips when neck is flexed when on supine position
Management of meningitis
- Monitor _______
- Monitor_______, _______ & _______(maintain IV therapy, _______ is avoided to prevent SIADH)
- assess signs of _______
- administer_______, _______ or _______ to relieve cerebral oedema
- provide supportive intervention (_______ to decrease _______)
- Monitor vital signs
- Monitor I/O, fluid & electrolyte balance (maintain IV therapy, overhydration is avoided to prevent SIADH)
- assess signs of raise ICP
- administer antibiotic, anticonvulsant or steroids to relieve cerebral oedema
- provide supportive intervention (quiet room to decrease env. stimuli)
Causative agent of hand foot mouth disease (HFMD)
Enteroviruses
Mode of transmission of HFMD
direct contact
S&S of HFMD
- vesiculo-popular rash over palms, soles & butt
- fever
- pharyngitis
- mouth ulcers
Management of HFMD
- _______ in single room
- _______ for fever (avoid _______)
- _______ to maintain hydration
- monitor for complications: _______, _______, _______
- isolate patient in single room
- paracetemol for fever (avoid NSAIDs)
- strict I/O to maintain hydration
- monitor for complications: seizures, hyper/hypotension, tachycardia
Causative agent of dengue
Flavirus
S&S of dengue
- maculopapular rash, flushing or petechiae
- headache
- retro-orbital pain
- myalgia (muscle aches and pain)
- arthralgia (joint stiffness)
Management of dengue
- ________ for fever (avoid _______)
- ________ to maintain ________
- IV plug
- monitor for complications: ________ and ________
- prevent ________________
Thrombocytopenia precaution:
- ________
- no ________
- no ________
- ________ & ________
- paracetemol for fever (avoid NSAIDs)
- strict I/O to maintain hydration
- IV plug
- monitor for complications: hypovolemia and bleeding
- prevent dengue haemorrhagic fever
Thrombocytopenia precaution:
- CRIB
- no IM injection
- no brushing teeth
- daily platelet count & haematocrit
All seizures are caused by fever. T/F?
False
What is hydrocephalus
the build up of fluid in the cavity/ventricles deep in the vein
Major complications of hydrocephalus
infections & malfunction
What is the most common endocrine disease of paeds?
Type 1 DM aka juvenile diabetes
