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PAEDS > paeds lect 3 > Flashcards

paeds lect 3 Flashcards

1
Q

At what week do the cerebrum & cerebellum develop?

A

Week 8-12

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2
Q

Primitive reflexes disappear by?

A

By the time infant is 12 months old

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3
Q

Which cranial nerves are non-myelinated at infant stage?

A

Optic & olfactory nerves

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4
Q

Which is not an increased intracranial pressure condition?

  • craniocerebral trauma
  • hydrocephalus
  • brain tumour
  • meningitis or encephalitis
  • spontaneous intracranial hypotension
  • intracerebral haemorrhage
A
  • spontaneous intracranial hypotension
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5
Q

In focal/partial seizure, abnormal discharge occurs in 2 areas of the brain. T/F?

A

FALSE.

only occurs in 1 area of the brain

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6
Q

Neonatal seizures symptoms

A
  • sucking, lip smacking or other oral-buccal-lingual movement
  • bicycling or pedaling movement
  • rhythmic ocular movements eg. horizontal eye deviation
  • occasionally apneic spells
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7
Q

Neonatal seizures’ causes

A
  • infection
  • electrolyte derangement
  • metabolic abnormalities
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8
Q

Cause of febrile seizures

A

when a child’s temperature rises to 38.5 degrees celsius or more

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9
Q

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 _________
A
  • 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
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10
Q

Cause of congenital hydrocephalus

A

a defect such as Chiari’s malformation, also associated with spinal bifida

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11
Q

Cause of acquired hydrocephalus

A

space-occupying lesion:

  • haemorrhage
  • intracranial infection
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12
Q

Treatment of hydrocephalus

A
  1. Direct removal of obstruction
  2. and insertion of ventriculoperitoneal shunts

to provide pri drainage of CSF to an extracranial compartment, usually peritoneum

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13
Q

Cerebral palsy is the most common PERMANENT disability of children. T/F?

A

True

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14
Q

4 classifications of cerebral palsy

A
  • 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%)
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15
Q

Characteristics of neuromuscular disease

A
  • hypotonia (↓ muscle tone)
  • weakness
  • ↓ deep tendon reflexes
  • may involve the anterior horn cells, peripheral nerve neuromuscular junction or muscles
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16
Q

Definition of muscular dystrophy. What could it lead to?

A
  • Progressive degeneration and weakness of skeletal muscles from infection or cardiopulmonary failure
  • could lead to death, usually in adolescence
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17
Q

What is absent in muscular dystrophy?

A

Absence of dystrophin (protein) in the muscle

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18
Q

Nursing interventions of muscular dystrophy (at least 5)

  • prevent ________ (________)
  • prevent ________ (use ________________)
  • promote ________
  • assess for signs of ________and ________
  • adequate ________ & ________
  • meds: ________, ________ & ________
  • promote optimal ________, support ________
A
  • 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
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19
Q

Characteristic of type 1 DM and what DM results from.

A
  • results from a partial/complete deficiency of insulin

- type 1 is characterised by pancreatic beta cell destruction hence leading to absolute insulin deficiency

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20
Q

If there is persistent blood glucose level >10mmol/L, what does it result in?

A

Results in glycosuria → osmotic diuresis with polyuria (body makes more pee than normal) & polydipsia (excessive thirst)

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21
Q

Excessive ketone production causes ____. And what are the characteristics?

A

Causes diabetic ketoacidosis (DKA).

Characterised by marked hyperglycemia, metabolic acidosis, dehydration and altered level of consciousness ranging from lethargy to coma

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22
Q

Sign and symptoms of DM Type 1 + signs of DKA

A
  • polydipsia
  • polyuria
  • polyphagia (excessive hunger or increased appetite)
  • fatigue
  • weight loss
  • dry skin
  • blurred vision
  • signs of DKA: hyperglycemia, acidosis, glycosuria, ketonuria
23
Q

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
A
  • 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
24
Q

Age appropriate blood glucose lvl (0-6yo, 6-12 & >12 yo) premeals and postmeals!!

A

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

25
Q

Ethiology of DM Type 2. What is the significant risk factor?

A
  • social, behavioral & environment risk factors
  • heredity is a strong component
  • obesity is a significant risk factor
26
Q

Children with type 2 DM will develop ____.

What can occur in type 2 DM?

A

insulin resistance

Velvety hyperpigmented patches in intertriginous area, hypertension and lipid disorders can occur.

27
Q

Nursing management of type 2 DM

A
  • 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)
28
Q

Name of a cancer depends on its cell origin:
1) Sarcoma
2) Carcinoma
Describe both

A

Sarcoma: connective tissue, muscle, bone

Carcinoma: epithelial tissue (glands, hollow organs, outer layer of skin that lines with the blood vessels)

29
Q

Most common cancer in children

A

Leukaemia

30
Q

For long term chemo:

Catheter tip is often placed at the _______.

A

superior vena cava

31
Q 
Side effects of chemo
Hematopoietic: 
GI: 
Hepatic: 
Renal: 
Integumentary: 
Reproductive:
A

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)

32
Q

S&S of acute lymphocytic leukaemia (At least 5)

A
  • fatigue
  • pallor
  • low-grade fever
  • bone & joint pain
  • petechiae & bruising
  • purpura
  • lymph nodes may be enlarged
33
Q

Investigation of acute lymphocytic leukemia

A
  • WBC (<5000/mm3)

- presence of abnormal blast cells in bone marrow: indication of leukaemia

34
Q

Treatment of acute lymphocytic leukemia (3 phases)

A
  • 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)
35
Q

Management of acute lymphocytic leukemia

A
  • prevent infection
  • prevent bleeding & injury
  • reducing pain
  • promoting energy conservation
  • relieving anxiety
  • promoting normal growth & development
36
Q

What type of infection is Sepsis? When does it usually occur?

A

bacterial infection;

occur in the 1st month of life

37
Q

Risk factors of sepsis

A
  • prematurity
  • invasive procedure
  • steroid use for chronic condition
  • nosocomial exposure (infections that develop as a result of a stay in hospital) to pathogens
38
Q

Clinical manifestations of sepsis (infants)

A
  • poor sucking
  • feeding lethargy
  • weak cry
  • irritability
39
Q

Subsequent s&s of sepsis

A
  • tachycardia
  • increased or irregular respiration
  • mottling (blotchy, red-purplish marbling of the skin)
  • GI disturbances
  • temperature instability
  • dehydration
  • hypotension
40
Q

Common causes of meningitis ( in neonates & children)

A
  • In neonates: E.coli and Group B streptococcus

- Infants & children: Neisseria meningitidis, Step. Pneumoniae & Group B Strep

41
Q

S&S of meningitis of children <2 yo

A
  • poor feeding
  • irritability
  • lethargy
  • high-pitched cry
  • bulging fontantel
  • hyperextension of neck & spine
42
Q

S&S of meningitis of older children (>2yo)

A
  • 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
43
Q

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 _______)
A
  • 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)
44
Q

Causative agent of hand foot mouth disease (HFMD)

A

Enteroviruses

45
Q

Mode of transmission of HFMD

A

direct contact

46
Q

S&S of HFMD

A
  • vesiculo-popular rash over palms, soles & butt
  • fever
  • pharyngitis
  • mouth ulcers
47
Q

Management of HFMD

  • _______ in single room
  • _______ for fever (avoid _______)
  • _______ to maintain hydration
  • monitor for complications: _______, _______, _______
A
  • isolate patient in single room
  • paracetemol for fever (avoid NSAIDs)
  • strict I/O to maintain hydration
  • monitor for complications: seizures, hyper/hypotension, tachycardia
48
Q

Causative agent of dengue

A

Flavirus

49
Q

S&S of dengue

A
  • maculopapular rash, flushing or petechiae
  • headache
  • retro-orbital pain
  • myalgia (muscle aches and pain)
  • arthralgia (joint stiffness)
50
Q

Management of dengue

  • ________ for fever (avoid _______)
  • ________ to maintain ________
  • IV plug
  • monitor for complications: ________ and ________
  • prevent ________________

Thrombocytopenia precaution:

  • ________
  • no ________
  • no ________
  • ________ & ________
A
  • 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
51
Q

All seizures are caused by fever. T/F?

A

False

52
Q

What is hydrocephalus

A

the build up of fluid in the cavity/ventricles deep in the vein

53
Q

Major complications of hydrocephalus

A

infections & malfunction

54
Q

What is the most common endocrine disease of paeds?

A

Type 1 DM aka juvenile diabetes

PAEDS (6 decks)

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