Pediatrics Nursing Flashcards
What are the EARLY signs of increased ICP?
INFANT: high pitch cry/ Shill cry
CHILD: Aggitation
ADULT: Restlessness
GERIA: Confusion
SIGNS of Increased ICP in Infants:
Increased head circumference
Bulging Fontanelles
Headache
Diplopia (double vision)
Pupillary Changes
Sunset Eyes
Anorexia, Nausea, Weight loss
Seizures
When is the time Anterior and Posterior Fontanelles closes?
A. Fontanelle: DIAMOND 12-18 mos
P. Fontanelle: TRIANGLE 2-3 mos
INITIAL SIGN of increased ICP?
HEADACHE
One pupil is dilated the other is constricted? (O.o)
Anisocoria = brain Damage
What may be the cause of both dilated pupils?
SHOCK
What may be the cause of both constricted pupils?
Narcotic OD
What happens to the eye because of Increased ICP?
Sunken Eyes (PUPILS are lower)
Contraindicated meds for pedia’s w/ increased ICP?
OPIATES AND SEDATIVES
(Further increases ICP)
Mngt for increased ICP (pedia)?
Semi fowlers
Coughing/sneezing avoided
limit fluid intake (1200-1500 a day)
Med Management for increased ICP (pedia)?
Diuretics
Steroids(dexamerthasone) - prevent cerebral edema
anticonvulsants
anticoagulants - prevent clumping of blood in the brain
antacids - prevent GI irritation
Med Management for increased ICP (pedia)?
Diuretics
Steroids(dexamerthasone) - prevent cerebral edema
anticonvulsants
anticoagulants - prevent clumping of blood in the brain
antacids - prevent GI irritation
Antidote for HEPARIN and WARFARIN?
HEPARIN: Protamine Sulfate
WARFARIN: Vit. K
Infection of the Meninges
Bacterial Meningitis
Diagnostics for Bacterial Meningitis?
Lumbar Puncture
CSF Analysis
what vertebrae is accessed in Lumbar Puncture?
L3, L4. L5,
Position for Lumbar Puncture?
C- shape, fetal, kneechest/genopectoral
CSF Analynsis:
Normal color of CSF?
Clear
CLOUDY = Infection
- Elevated WBC
- Elevated protein
Causative agent of bacterial meningitis?
neisseria Meningitides
S/SX
KERNIG’S
BRUZINKI’s
KERNIG’S: Knee -> flex -> (+) pain in the hamstring
BRUDZINKI’S: Batok -> flex-> (+) pain in the neck and back
Other S/SX of bacterial meningitis
Nuchal Rigidity: body moves as one unit
Opisthotonus: arching of the back
Difference between Concussion and Contusion
Concussion: Jarring of the brain (BAGOK)
Contusion: Bruising; structural alteration due to extravasation of blood (BUKOL)
INFANT CAR SEAT
<3 y/o = rear facing (Protect the spine)
>3y/o = front/forward facing; booster seat
An erratic transmission of electrical impulse in the brain
Seizure
TYPE OF SEIZURE:
Known as generalized seizure
Grand Mal
TYPE OF SEIZURE:
“Absent Seizure” ; blank facial expression
- automatism
- lip smaking
Petite Mal
Tonic-clonic of a group of muscle which can lead to grand mal
Jacksonian
TYPE OF SEIZURE:
- Mental clouding and intoxication
- not common in children
Psychomotor
TYPE OF SEIZURE:
- Temperature increasing from 35c to 40c
- common in children
Febrile Seizure
TYPE OF SEIZURE:
- brain damage can occur
- can last to up to 30 mins.
Status Epilepticus
Management of Seizure
1st choice: Medication
2nd Choice: Surgery
Medical Management of Seizure:
- Phenytoin
- Benzodiazepines
- Carbamazepines
- Valporic acid
Phenytoin precautions
WOF: Gingival hyperplasia
- use soft bristled toothbrush
- meticulous oral care
- inform patient about pinkish/red urine
Valporic Acid precautions
- use as last resort
- hepatotoxic
- never given in pregnancy - can cause neural tube defects
Surgical Management of Seizure
Neurectomy - surgical resection of cranial nerve involved in the seizure.
CARDIOVASCULAR DISORDERS (PEDIA)
LAYERS of the HEART
Endocardium: innermost
Myocardium: Muscle > Contraction; Middle
Pericardium: Outermost
- Ductus arteriosus is still present after delivery
- acyanotic
Patent Ductus Arteriosus
Pathognomonic Sign of PDA
Machine-like murmurs
DOC for PDA
Indomethacin - Prostaglandin inhibitor
What maintains the patency of ductus arteriosus
Prostaglandins
- A congenital disease
- a hole in the septum of the heart
- acyanotic
Atrial Septal Defect
Ventricular Septal Defect
Management of ASD/VSD
- Surgery by suture
- Dacron Patch
2 types of Dacron Patch
- Tissue/Cardiac tissue - low rejection rate (most preferred)
- Plastic - high rejection rate
- Narrowing of the aorta
- specifically in the descending aorta
Coarctation of the Aorta
What are the VS in the L. extremities and U. extremities?
UE - high VS
LE - low vs
UE - BP high; Pulse bounding
LE - BP low; Pulse weak/absent
Compensation made by the heart cause by the narrowed aorta
Rib notching -> rib deformity
Management of CoA
Balloon angioplasty w/ coronary stenth
CoA
type of permanent stent used in this surgery
Mesh
- A congenital heart disease caused by 4 defects in the heart?
- Cyanotic
Tetralogy of Fallot
the 4 problems of Tof
- Pulmonary Stenosis
- R. Ventricular hypertrophy
- overriding of the aorta
- VSD
Primary problem in ToF?
Pulmonary Stenosis
ToF:
What is the compensatory mechanism in ToF?
R. Ventricular Hypertrophy
ToF:
What allows the mixing of blood?
overriding of the aorta
ToF:
What keeps the patient alive in ToF?
VSD - relieves the pressure on the Right Ventricle
ToF:
A sign in which there is decreased venous -> decreased cardiac output which lead to cardiac rest?
Squatting
TRIAD of ToF
TET SPELLS
- irritability
- pallor
- blackout/convulsions
other signs and symptoms of ToF
- cardiomegaly
- clubbing of nails (naumbok)
- pan systolic murmurs
- Boot shaped heart via 2D echo
Palliative surgical mngt of ToF
Blalock-Taussig Shunt
- relieves s/sx
- goal: oxy>deoxy
- anastamosis (pagdugtungin) of PA and Aorta using subclavian artery
- Aorta is connected in the RV
- PA is connected in the LV
- cyanotic
Transposition of the Great Arteries (ToGA)
S/Sx of ToGA
- Severe Respi depression
- Failure to thrive
- no murmurs heard due to weak contractions
ToGA:
What is needed to be maintained for the patient to be alive?
Patent Ductus Arteriosus
ToGA:
Medical Management:
Prostaglandin E
Surgical Management of ToGA
Jatane Switch/ Arterial Switch
- must be done during the 1st week of life of the newborn
Surgical Management of ToGA
Jatane Switch/ Arterial Switch
- must be done during the 1st week of life of the newborn
An autoimmune disease caused by GABHS
Rheumatic Fever
Rheumatic Fever:
Signs/Symptoms
Inflammation of:
- heart
- joints
- blood vessels
- brain
Sore throat which can lead to acute glomerulonephritis
Rheumatic Fever:
Criteria used to diagnose RF
Jones Criteria
MAJOR:
-Joint pain
- Carditis
- Nodules - Subq
- Erythema Marginatum - trunk
- Sydenham Chorea
MINOR:
- increased TEMP
- 950 - titer - antistreptolysin
- ESR + CRP - inflammatory marker
Rheumatic Fever:
JONES CRITERiA
2 MAJOR or
1 MAJOR + 2 MINOR
Rheumatic Fever:
Medical Management:
- Penicillin
- Aspirin
- Steroids/NSAIDs
- Phenobarbital/Diazepam
2 Types of heart failure:
RSHF: Systemic Manifestations
LSHF: Pulmonary Manifestations
2 Types of heart failure:
RSHF: Systemic Manifestations
LSHF: Pulmonary Manifestations
HEART FAILURE:
Diagnostics
- Chest X-RAY
- 2d ECHO
- Pulse OX
- PWCP for LSHF
- CVP for RSHF
HEART FAILURE:
Management
- Fowler’s Position
- O2 Therapy
- Inotropics: Increases Cardiac Output
- LANOXIN/DIGOXIN
HEART FAILURE:
DIGOXIN WOF
- Nausea
- Anorexia
- Visual Disturbance
- Diarrhea
- Abdominal cramps
HEART FAILURE:
DIGOXIN ANTIDOTE
DIGIBIND
HEART FAILURE:
Nursing Responsibilities
- Monitor IO
- Record daily weight > same time, clothes and scale
- administer diuretics
An autoimmune disease that has generalized vasculitis and it is called as acute febrile syndrome
KAWASAKI’S DISEASE
KAWASAKI:
S/SX
- Fever for 5 days
- eyes w/o exudates
- lips > edema; peeling
- **strawberry tongue
- lymphadenopathy
- trunk - rashes
- palms/soles - red, edema, peeling
- blood test - increased uric and platelet
KAWASAKI:
MANAGEMENT
- IV Ig Stat (w/in 7-10 days)
- Aspirin for fever and thrombus formation
- Echocardiogram
- Vaccine must be delayed
inflammation of the stomach and intestine which is caused by an infection that leads to vomiting and diarrhea
Acute Gastroenteritis
type of infection in AGE
Viral Infection (self-limiting)
AGE:
SIGNS of Dehydration
- Fontanelle sunken
- eyes sunken
- poor skin turgor (< 1 sec; abdomen)
AGE:
Management of vomiting (Alkalosis)
- SFF
- ORS
- Antiemetic
- Pedialyte
- IVF D5NS (if severe)
AGE:
Management of Diarrhea (Acidosis)
- ORS
- IVF D5NS
- IV Ca
- IV K (diluted, incorporated, infused slowly)
Ensure if voided
Narrowing of the pyloric sphincter valve
Pyloric stenosis
PYLORIC STENOSIS:
S/SX
- vomiting immediately after feeding
- projectile vomiting
- dehydration
- olive-shaped lump
- no bile in vomitus
- sour smelling vomitus
PYLORIC STENOSIS:
MANAGEMENT
PYLOROMYOTOMY - widen the lumen
PYLORIC STENOSIS:
POST OP
- NPO w/ pacifier
- IVF
- 4-6 hrs: ORS na
- ORS + milk
- milk
position: right SL
report: vomiting
normal: diarrhea dumping syndrome
An idiopathic disease in which distal part of the ileum invaginated the proximal colon
Intussusception
INTUSSUSCEPTION:
S/Sx
- severe pain
- distended abdomen
- reappearing pain
- red currant jelly stool/ bloody mucoid stool
INTUSSUSCEPTION:
MANAGEMENT
Surgical emergency:
- Instillation
- Water Soluble Enema
- Air Insufflation
- Barium Enema - Delayed Repeated Enema (24hrs monitor)
- Reduction Surgery
Characterized as a distended sigmoid colon with the absence of muscle curvatures of the ganglions
Hirschsprung Disease
Characterized as a distended sigmoid colon with the absence of muscle curvatures of the ganglions
Hirschsprung Disease
Hirschsprung disease:
S/Sx
- Megacolon
- aganglionic
- ribbon- like stools
- chronic constipation
Hirschsprung disease:
Diagnostics
- rectal exam
- balloon catheter - anorectal
- manometry - barium enema w/ contrast
w/ caution - Biopsy
Hirschsprung disease:
Diagnostics
- rectal exam
- balloon catheter - anorectal
- manometry - barium enema w/ contrast
w/ caution - Biopsy
Hirschsprung disease:
Management:
Pull through operation
1. temporary colostomy
2. 12-16 months: Bowel repair
3. Permanent Colostomy
Increase in size of a structure orderly and predictable, but not even; it follows a cyclical pattern
Growth
Maturation of physiologic and psychosocial systems to more complex state. Qualitative
Development
Development or evolution of a species or group
Phylogeny
Development of an individual within a species
Ontogeny
growth and development is an ongoing process from conception to death Orderly
Continuous Process
follows a predictable sequence of growth and development
Orderly Sequence
head to toe
Cephalocaudal
trunk to periphery
Proximo-distal
simple to complex motor skills
Gross to Refined Skills
development occurs over a period rather than a certain point of time depending on the child’s ability.
Different Rates
Normally disappears eventually; indicates development and
maturation of nervous system
Absent Neonatal Reflexes
behavior and skill are learned by practice
Practice
PIAGET’S THEORY
COGNITIVE THEORY
Cognitive theory 2, 4, 7, 11, 15
Sensorimotor:
Pre conceptual:
Intuitive:
Concrete operations:
Formal operations:
Sensorimotor: ACTS, REFLEXES
Pre conceptual: EGOCENTRIC, SYMBOLS, MAGICAL THINKING
Intuitive: CAUSATION
Concrete operations: INDUCTIVE
Formal operations: ABSTRACT/DEDUCTIVE
