Peds Exam 2 Flashcards
_____ urethras in peds gu system
shorter
renal system includes
kidneys, ureter, bladder, urethra
All nephrons present at birth but _____
immature
Less urine output per day but more ____
voids
Immature structure and function until _____
puberty
One of the most common pediatric infections, Bacteria enter urethra and ascend to bladder.
UTI
involves urethra or bladder
cytitis
kidney infection involving ureters, renal pelvis, or renal parenchyma
pyelonephritis
incomplete bladder emptying
stasis
factors that place children at risk for UTI’s
age, gender, hygiene, stasis (fluid retention)
Sexual intercourse in adolescents promotes “______” of bacteria from perineum and vagina
milking
upper urinary tract infections are located where
kidneys or ureter
what is the primary function of the renal system
maintain fluid balance
what should urine output of a normal child be
1-2ml/kg/hr (30ml/hr for adult)
the characteristics of urine are
color, odor, clarity
how do you measure urine output in a diaper wearing child
weigh the diaper before u put it on ad after it is soiled
what is a sensitive indicator of daily fluid loss and gain
weight/ girth
the amount of fluid retention makes a difference in
BP and HR
the amount of solute in urine is referred to as
specific gravity
the AMOUNT of solute in urine is:
1.016-1.022
2 things that help keep bacteria at bay in the urinary tract
acidity and flow
Incontinence of urine past the age of toilet training
Enuresis
diurnal
daytime
lower urinary tract infections are located where
bladder or urethra
upper urinary tract infections are located where
kidneys or ureter
factors that place children at risk for UTI’s
age, gender, hygiene, stasis
interruption of sleep to void
timed voiding
antidiuretic hormones
desmopressin
Tricyclic antidepressants
imipramine
Anticholinergics
oxybutynin
Fluid accumulation in the scrotal sac.
hydrocele
Transillumination of the scrotum to confirm ______ ______
fluid collection
If hydrocele persists beyond __ to __ months, likely noncommunicating and require surgical repair.
12 and 18
Testicle rotates and twists the spermatic cord, cutting off blood supply to the scrotum.
-Caused by excessive mobility of the testes, impact injury, vigorous activity, cold temp., growth spurt
EMERGENCY
testicular torsion
Bladder extrudes through lower abdominal wall, Displaces umbilicus and separates rectus muscles.
Bladder Exstrophy
Treat bladder spasms with ________.
antispasmodics
for bladder exstrophy: Cover exposed bladder with plastic wrap or sterile plastic bag to keep ____.
moist
Surgical intervention for bladder exstrophy __-__ hours after birth.
48-to-72
Retrograde flow (backflow) of bladder urine into one or both ureters during voiding
- Reflux occurs because the ureters are implanted in the bladder wall at an abnormal angle
Vesicoureteral Reflux (VUR)
Management of VUR
continuous antibiotic prophylaxis (CAP)
what age group is most effected by UTI
2-6
what gender is more effected by UTI
female
name a behavior symptom of a UTI in infant
crying more, especially during urination
fever, not eating, uninterested, diarrhea, urine characteristics are different
physiologic symptoms of UTI in infant
indicate damage to the glomeruli;
nephrotic syndrome
result in the release of too much protein from the body (albumin) into the urine;
nephrotic syndrome
lead to a fluid shift from the intravascular spaces to tissue (interstitial space).
nephrotic syndrome
urinary retention, urinary frequency, urinary urgency
signs and symptoms of UTI in a toddler
How can you help a UTI without meds
no iced tea/soda, cranberry juice (more with e.coli), cleanliness of genital area and keeping well hydrated
what is something that can cause a UTI that is internal
constipation
How can you prevent constipation
high fiber/fluid intake, exercise
wetting the bed
enuresis
when is wetting the bed considered abnormal
when it occurs past the age of bladder control (5+)
what are some requirements to be diagnosed with enuresis
2-3 times a week, 3+ months
enuresis occurs more in females or males?
males
What is considered a sufficient bladder volume to be able to hold all night
300-350 mL
psychological factors that can cause enuresis
divorce, hospitalization, family stress and tendencies (siblings such as twins)
how can enuresis be treated
medications, bladder training, fluid restriction in the evening, waking up in the middle of the night to urinate, or conditioned reflex response device
Inflammation and impairment of the glomeruli not caused by direct infection of the kidneys.
- followed by exposure to bacterial infection
Acute Poststreptococcal Glomerulonephritis
(APSGN)
what is the BEST form of treatment for enuresis that cures it in about 2-3 weeks
conditioned reflex response device (wired underwear)
what are some drugs used to treat enuresis
trofanil, oxybutrinine/ditropan (they use a bed pan), DDADP
abnormal defect where the urine flows backward due to misshaped entrance angle of the ureters to the bladder
vesicoureteral reflux (VUR)
diagnosis by cystourithrogram, long term antibiotics (grades 1-2) and surgical procedures (grades 4-5) for grade 3 you attempt to treat with antibiotics and if it doesn’t work surgery is needed
managing VUR
Symptoms include gross hematuria (cloudy, dark tea-
colored urine), periorbital edema, anorexia, proteinuria,
and hypertension.
Acute Poststreptococcal Glomerulonephritis
(APSGN)
what kind of drain do they often use after surgical intervention for VUR
jackson pratt
Acute renal disease characterized by thrombocytopenia,
hemolytic anemia, and acute kidney injury.
hemolytic uremic syndrome
Main cause of acute kidney injury in early childhood, usually caused by e. coli
hemolytic uremic syndrome
Presents with subtle onset with vomiting, abdominal pain,
anorexia, and ascites.
-toxins enter the bloodstream and destroy red blood cells
-Breakdown of red blood cells clog the kidneys
HUS
refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function.
renal failure
_____ infections are cause of majority
of acute illnesses in children
respiratory
Oronasopharynx, pharynx, larynx, and trachea
upper resp tract
Bronchi, bronchioles, and alveoli
lower resp tract
have protection due to maternal antibodies
infants under 3 months
infection rate increases at what months
3-6
high rate of viral infections; the incidence of these infections decreases by age __.
5
what are some airway obstruction risks in infants
the airway is very small
the airway is short in length so it has increased risk for infection and inflammation
infants have immunologic immaturity
infants can not support their head to open their airway when they can’t breath well
Older than __ years: increase in Mycoplasma pneumonia and beta-strep infections
5
it pushes down on their airway when they lay down and can impede breathing
problem with babies fat necks
Mycoplasmal infections more common in what seasons
fall and winter
Asthmatic bronchitis more frequent in ____ weather
cold
Respiratory syncytial virus (RSV) season considered to be
winter and spring
newborn resp. per min
30-55
1 year resp. per min
25-40
3 year resp. per min
20-30
7 year resp. per min
16-22
10 year resp. per min
16-20
17 year resp. per min
12-20
Tonsils become inflamed/reddened, Report of sore throat/difficulty swallowing
tonsilitis
why are babies not good coughers?
they have immature chest musculature
Caused by numerous viruses, common cold
Nasopharyngitis
nasopharyngitis symptoms
◦ Fever
◦ Nasal inflammation and secretions
◦ Irritability, restlessness*
◦ Decreased appetite and fluid intake
◦ Vomiting and diarrhea
“Strep throat” (bacterial)
-Group A beta-hemolytic streptococci (GABHS)
Streptococcal Pharyngitis
Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
-Affect larynx, trachea, and bronchi
croup syndromes
Most common croup disorder (viral)
-Low-grade fever, restlessness, hoarseness,
barky cough, dyspnea, inspiratory stridor,
retractions, fear and anxiety over dyspneic state
acute Laryngotracheobronchitis
(LTB)
infant symptoms of cute Laryngotracheobronchitis
(LTB)
nasal flaring, intercostal retractions,
tachypnea, and continuous stridor
Also called spasmodic croup, midnight croup
- Paroxysmal attacks of laryngeal obstruction
- Occurs chiefly at night, sudden; transient
acute spasmodic laryngitis
Serious obstructive, inflammatory process
-Potential for complete respiratory obstruction/failure – medical emergency! (Go to the ER!)
Bacterial Epiglottitis
Prevention of bacterial epiglottis
Hib vaccine
Predictive signs of bacterial epiglottis
Absence of cough, drooling, and agitation
diagnostic signs of bacterial epiglottis
Tripod position*, steeple sign
Also called tracheobronchitis
-Associated with an upper respiratory infection, usually viral, and inflammation of the trachea,
bronchi, and bronchioles
Bronchitis
bronchitis symptoms
Persistent dry, hacking cough as a result of inflammation; chest pain; thick sputum; may vomit
thick mucus
babies are ______ breathers
nose
what should be assessed to evaluate respiratory function in children
oxygenation
work of breathing
airway clearance ability
temperature
What can you use to assess oxygenation
cap refill, pulse ox, skin color, LOC, restlessness, anxiety, ABG
What can you look at to assess work of breathing
nasal flaring, accessory muscle use, are they grunting, head bobbing
How can you assess adequate airway clearance
can they cough (productive/nonproductive)
what do their lungs sound like
how often are they coughing
what causes obstructive emphysema
mucus build up in the alveoli
how long does nasopharyngitis typically last
10 days
what is a common cause of nasopharyngitis
viral: rhinovirus, respiratory syncytial virus, adenovirus
what is the treatment regimen for nasopharyngitis
fluid, rest, decongestants
Acute viral infection, affects infants
-Respiratory Syncytial Virus (RSV) or other viruses
RSV/Bronchiolitis
Caused by seasonal reaction to allergens most often
in the autumn or spring
allergic rhintis
what is the most common age for a Peds patient to get nasopharyngitis
under 5
what helps filter and protect the respiratory system and GI tract?
tonsils
Infection or inflammation in lower airways
bacterial pneumonia
requirements for tonsil removal are
at least 7 beta strep infections in one year or 5 infections in 2 years with really high fever; OR peritonsilar absess OR massive hypertrophy
If the tonsils are removed what does the nurse need to assess for after surgery
bleeding
when is a tonsillectomy patient at most risk for bleeding
right after surgery 7-10 days post-op
how can you tell if a tonsillectomy patient is bleeding
frequent swallowing, blood in vomit
ear pain
otalgia
The “flu” is a viral respiratory illness that is most
prevalent during fall and winter months
influenza A and B
whooping cough
Common cold manifestations: runny nose, congestion, sneezing, mild fever, mild cough
pertussis
what are the 3 types of croup syndromes
laryngotracheo-bronchitis, acute spasmodic croup, epiglottitis
how can laryngotracheo-bronchitis be treated
decadron, nebulized epinephrine ( both reduce airway edema)
very harsh cough that occurs mostly at night and is more likely in mid oct- mid april
acute spasmodic croup
Lung infection with acid-fast bacilli, spread by airborne droplets
tuberculosis
how can you provide short term relief for acute spasmodic croup
steamy shower or cold night air
helps keep alveoli open
grunting
assist with ventilation
retractions, head bobbing
increases diameter of air passages
nasal flaring
opens the airway
Hyperextension of head and neck
Type of respiratory failure
-Acute, diffuse, and inflammatory lung injury
-Allows fluid to leak into the lungs
acute resp. distress syndrome (ARDS)
the _____ swells and causes obstruction of the airway
epiglottis
what gender is epiglotitis more prevalent in
males
what does the cough of a epiglottitis patient sound like
frog like
When the lumens of the bronchioles fill with mucus and it can not be cleared. ends up resulting in obstructive emphysema.
bronchiolitis
what does the respiratory rate have to be for a baby to have tachypnea
80
what is the peak age for bronchiolitis
2-6 months
what can a nurse give to a patient with bronchiolitis to reduce inflammation
steroids/albuterol
what are the names of the 3 stages of pertussis
catarrhal, paroxysmal, convalescent (CPC)
pertussis stage that happens in the first 2 weeks and the child is most infectious
cattarhal
pertussis stage that involved a loud bark cough and can last 3-4 weeks
paroxysmal
pertussis stage when the child gradually begins to get better and cough decreases
convalescent
what are some stimuli that can trigger and asthma attack?
pollen, dust, pollution, weather changes, second hand smoke, dietary allergen, mold, pet dander
what gender is more likely to have asthma until adolescent stage
boys
what gender is more likely to have asthma after adolescent stage
girls
what accounts for the bronchial obstruction associated with asthma
mucus, inflammation, bronchospasm
what is an NSAID that can be helpful in the prevention management of asthma
singulair
Most common chronic condition
asthma
what is a common steroid given to children with asthma
decadron or albuterol
what is the most common lethal genetic illness among caucasians
cystic fibrosis
what is the avg life expectancy of someone with cystic fibrosis
31
what is unique about the chance of getting cystic fibrosis
it is a recessive gene so both parents must be a carrier and there is still only a 1/4 chance their child will get it
what are the major systems effected by cystic fibrosis
resp and GI
fat in the stool as a result of cystic fibrosis
steatorrhea
protein in the stool as a result of cystic fibrosis
azotorrhea
coughalator, nebulizers, chest PT, administering pancreatic enzyme (if not given they would have 6-7 loose stools a day)
nursing management for a cystic fibrosis patient
what are some side effects of nephrotic syndrome
proteinuria
hypoalbuminemia
hyperlipidemia
edema
what is a characteristic of urine unique of nephrotic syndrome
frothy like beer, still normal color
what usually precedes nephrotic syndrome
viral illnesses
edema that hangs out in the abdomen is called
ascites
what is the hallmark sign for peritonitis
rigid abdomen
what diseases put you at risk for UTI
diabetes and renal failure
why do epiglotitis patients drool so much
hurts to swallow
site for blood oxygenation
placenta
Umbilical vein carries __________ blood to
body
oxygenated
at birth, Pressures higher in the _____ ventricle than
_____
left than the right
Pressures higher in pulmonary artery than
_____
aorta
at birth, Alveoli expand reducing _______
pressure
pulmonary
Deoxygenated blood returns from body to
right side of the heart via RA, Transported to lungs via RV, Returns from the lungs to LA, LV pumps oxygenated blood to body
post-natal circulation
normal child urine output
1-2 mL/kg/hr
congestive heart failure consists of:
Decreased cardiac output, decreased tissue perfusion, activity intolerance
Decreased blood flow to organs results in
failure to meet ______ needs.
metabolic
Tachycardia, Gallop rhythm, Diaphoresis, Poor perfusion, Restlessness, Fatigue are signs of
impaired myocardial infarction in kids
tachypnea, dyspnea, accessory muscle use, nasal flaring, grunting noise, orthopnea are signs of
pulmonary congestion
in systemic venous congestion what side of the heart is weak?
right side
what is a nursing intervention for a child with systemic venous congestion
have them sit up at a 90 degree, especially if they are retaining fluid so the fluid doesn’t put pressure on their organs. fluid restriction
abnormal number of heart sounds (3-4 audible sounds)
gallop rhythm
difficulty breathing while laying down
orthopnea
what is the area of greatest pressure in the heart after birth
left ventricle
only vein in the post-birth body that carries oxygenated blood
pulmonary vein
what organs are affected by CHF
all of them - problems in the heart mean problems everywhere
the fetal heart structure that becomes a ligament. it connects the pulmonary artery with the aorta
ductus arteriosus
the fetal heart structure that connects the inferior vena cava with the umbilical vein
ductus venous
the fetal heart structure that is an opening between the right atrium and the left atrium
foramen ovale
what side of the heart has higher pressure while the baby is in utero
right side
what is different about a baby’s lungs while in utero
they are collapsed
how does a fetus receive oxygen
through umbilical veins
Hepatomegaly, Edema, Weight gain, Distended neck veins (only in older children) are signs of
Systemic Venous Congestion
meds improving cardiac fn
Digoxin, Angiotension-converting enzyme (ACE)
inhibitors (Capoten,Vasotec)
med that helps heart pump more blood
digoxin
Measure oxygen saturations and pressures
in chambers and great arteries, evaluate CO, or visualize defects in blood flow patterns
cardiac catheterization
how often should you check a patients vitals after they had a cardiac cath
every 15 mins for an hr then every 30 mins for 2 hrs
What are some things the nurse needs to repeatedly asses post cardiac cath
color of extremity distal to the site, pedal pulse, fluid intake , flexion restriction (straight legs for 4-6 hrs)
what kind of shunt is an atrial septal defect
left - right
the CHD where oxygenated blood returns from the lungs through the pulmonary artery and flows through the defect and then back to the lungs
atrial septal defect
what is a hallmark sign of atrial septal defect on an x-ray
increased pulmonary vascular marking
what type shunt is a ventricular septal defect
left - right
what is the most common defect
ventricular septal
what is unique about pressures in the heart of someone with ventricular septal defect
the entire left side of the heart has high pressure not just the ventricle
What is common with ventricular septal defects
CHF, murmurs
a channel is formed between the pulmonary artery and aorta
Patent Ductus Arteriosus
what can be done to close the patent ductus arterioles defect
prostoglandin inhibitors
surgical ligation
occlusion via cardiac cath
desaturated blood exits the heart without going to the lungs
right to left shunt
4 defects involved in Tetralogy of Fallot
ventricular septal defect
pulmonic stenosis
overriding aorta
right ventricular hypertrophy
blue spells (because they cause hypercyanosis)
-Pulmonary artery spasm shunting large
amounts of deoxygenated blood into the
circulation.
TET spells
treatment options for Tet spells
knee to chest
oxygen
morphine
IV fluids
what age group is rarely effected by tet spells
younger than 2 months
what are some implications of hypoxia in the tetrology of fallot
cyanosis
polycythemia
risk for CVA (stroke)
careful fluid management
what type of shunt is coarctation of the aorta
right-left
why type is shunt is tetrology of fallot
right-left
what does coarctation of the aorta put the child at risk for
neurological disorder because 50% of the brain is developed in the 1st year of life
Narrowing results in increased pressure
proximal to the defect and decreased
pressure distal to obstruction
coarctation of the aorta
what do kids typically complain of when they have CHF as a result of coarctation of the aorta
dizzy, headaches, nose bleeds
what should you assess for with chest tubes post-op cardiac surgery
drainage- not over 3ml/kg/hr for more than 3 hrs or more than 5-10ml/kg in any one hr
pulmonary changes that can happen post cardiac surgery
atelectasis, pneumothorax, pulmonary edema, pleural effusion
collapsed lung
atelectasis
what are most blot clots due to post cardiac surgery
heart/lung bypass machine
after surgery, ________ antibiotics need to be administered to prevent infection of open wound
prophylactic
systemic vascular disease that causes
inflammation of multiple small blood
vessels including the coronary arteries.
kawasaki disease
what age is kawasaki disease most prevalent
under 5, peak is toddlers
stage ? of kawasaki disease:
-high fever
-red eyes (conjunctivitis) with NO drainage
-inflamed oral mucosa/ pharynx (strawberry tongue)
-rash
-edema on hands/feet
-irritability
stage 1
how long does stage one of kawasaki disease last
4-5 days
stage ? of kawasaki disease:
-peeling fingers/toes
-arthritis
-afebrile
-irritability
stage 2
Gradual resolution of remaining symptoms
especially joint pain and irritability, Cardiac outcomes range from no damage to myocardial infarction and permanent cardiac damage.
convalescent stage of kawasaki
how can the nurse prevent cardiac damage of a kawasaki patient
High dose IV immunoglobulins, high dose aspirin, no MMR or VAR immunizations for a year after infection
What disease should the parents of a kawasaki patient immediately tell the doctor if it is acquired
chicken pox
signs of myocardial infarction in children
complaining of belly pain
vomiting
restlessness
inconsolable cry
pallor
shock
what age has the highest prevalence of rheumatic fever
5-14
cardiac valve damage, joint involvement, non-puritic rash, sub Q nodules, involuntary jerks (chorea) are signs of
rheumatic fever
if present this indicates a prior strep infection
Antistreptolysin
they take out the old heart and replace it with a new one
orthotopic heart transplant
the new heart is place along side the old one as a piggy back pump
heterotopic heart transplant
what type of heart transplant is very rarely done with children
heterotopic
what is the most common type of life threatening arrhythmia
hypertropic cardiomyopathy
what are some causes of CHF
volume overload - especially L-R shunts (most common)
pressure overload - resulting from obstruction
decreased contractility - myocardial ischemia
high cardiac demands -body needs more O2 than the heart can pump
When is cyanosis usually more apparent
<85%
what does dehydration in hypoxic kids increase the risk of ?
CVA
___ bones at birth that ossify to form ___ bones.
300, 206
Growth plates until early __, Bones are more porous and elastic and less ___.
20s, dense
Flat feet until __ years old.
6
Pigeon-toed gait until __ years old
8
“Knock-knees” until __ years old.
7
Congenital deformity; ribs and sternum grow inward, severity increases during growth spurts
Pectus Excavatum
No contact sports for 6 months and physical therapy, pain management, and breathing exercises postoperatively after which surgery?
Pectus Excavatum
for pectus excavatum, Surgery to reshape ____ and relieve pressure if pulmonary or cardiovascular effects.
sternum
in pectus excavatum surgery, Metal bars placed during surgery may be removed after __ years (when bones have healed and fused).
2
Extra digits on the hands and/or feet.
Polydactyly
Digits are fused and fail to separate (often
involves nerves and muscles).
Syndactyly
Genetic collagen disorder resulting in fragile bones
Osteogenesis Imperfecta (OI)
Protein of the body’s connective tissue that bones are
formed around.
collagen
t/f: females ossify bones first
true
t/f: When changing diapers, caregivers should lift
children with osteogenesis imperfecta by the hips.
true. do not pull on extremities!
Disorder of the tibial growth plate that causes inward
turning of the lower legs, which worsens with time, Also known as tibia vara or bowed legs.
blount disease
blount disease is suspected if leg alignment is not straightened by age __.
3
Treat blount disease with bracing if younger than __ years old.
4
Heel tilts in and down, forefoot turns in, and bottom of the foot faces inward or upward, can be bilateral or unilateral, more common in boys and have be genetic
Congenital Clubfoot
Shorter Achilles tendon and foot and calf on affected side.
Congenital Clubfoot
-Nonsurgical treatment using serial casting with long leg casts changed weekly (begin early before bones ossify).
-Percutaneous lengthening of Achilles tendon once casting is complete.
-Bracing for 2 to 4 years afterward to maintain correction.
congenital clubfoot
an infant is born with congenital clubfoot and the nurse
tells the mother that serial casting should be started
soon after birth. The mother asks why treatment must
start so early? Which response, if made by the nurse,
would best explain the need for early treatment?
“Early treatment allows the bone to be reformed
before it hardens.”
Inadequate coverage of the ball of the socket of the hip joint or dislocation of the ball from the socket.
Developmental Dysplasia of the Hip (DDH)
manifestations of Developmental Dysplasia of the Hip (DDH)
limited hip abduction, differing leg lengths,
uneven thigh skin folds, palpable and audible click as femoral head moves (Ortolani/Barlow test), and limping gait.
DDH Treatment: Before 6 months of age:
bracing (Pavlik harness)
DDH Treatment: 6 to 24 months:
closed-reduction surgery
DDH Treatment: after 24 months:
open-reduction surgery
Young bone fails to calcify due to vitamin D
deficiency.
rickets
Usually occurs in children with dark skin and limited
exposure to sunlight who are exclusively breastfed
and do not receive vitamin D supplementation.
rickets
treatment for rickets
vitamin D supplementation (or food), correction
of skeletal deformities. avoid magnesium
products
Ball at the head of the femur slips off the neck of the bone at the growth plate.
Slipped Capital Femoral Epiphysis (SCFE)
for SCFE, Treat with immediate surgical intervention to prevent _______ necrosis of the bone.
avascular
risk factors for SCFE
male gender, obesity, renal disease, thyroid disease, pituitary disorders, and family history.
Blood supply to the femoral head is disrupted, causing
necrosis and bone cell death.
Legg–Calvé–Perthes Disease (LCP)
Manifests with a limp; may or may not have pain, self limiting condition in kids <6, occurs with 4 stages and lasts years
Legg–Calvé–Perthes Disease (LCP)
treatment for Legg–Calvé–Perthes Disease (LCP)
-Surgery to reshape femoral head in older children (>8).
-Casting postoperatively for children >8 or to treat
without surgery for children 6 to 8.
inflammation of the bone secondary to bacterial
infection.
Osteomyelitis
Staphylococcus aureus is the most common bacterial
cause for _________
osteomyelitis
treat osteomyelitis with ______
antibiotics (obtain blood cultures before starting, IV first)
Progressive lateral curvature of the spine with rotation of the vertebrae, S shape of spine
scoliosis
manifestations of scoliosis
truncal asymmetry, uneven shoulders, raised
hips, and rib hump.
for scoliosis, Bracing prevents further curving and must be worn __ to __ hours per day and be properly fitted; avoid skin breakdown.
16 to 23
Stretched or torn muscle or tendon.
strain
Injury to a ligament.
sprain
Broken bones; varying types, _______ in the growth plate have higher risk for deformity and impaired healing.
fractures
Handle a wet cast with ____ _____
open palms
Elevate the cast above the level of the ____ and ice to
prevent swelling.
heart
Fascia are tight, non-stretching bands that divide the
muscle groups of the body, Swelling and pressure inside one of the muscle group sections (compartments) can impair tissue circulation and cause necrosis.
compartment syndrome
A child with a newly diagnosed ulnar fracture has a
short-arm cast applied. Which of the following
symptoms would be most concerning for the nurse?
uncontrolled, severe pain
indirect pulling on the skin
that puts traction on muscle and bone
skin traction
surgically placed pins through bone to apply pull
skeletal traction
Microtrauma damage to bone, muscle, or tendon from
repetitive stress without time to heal.
overuse injuries
__ pairs of cranial nerves (emerge from brain)
12
__ pairs of spinal nerves (emerge from spinal
cord)
31
Contract and relax to produce movement
muscular system
neuromuscular system is fully formed at birth but _______
immature
Gross and fine motor development of neuromuscular system over first __ years of life.
2
Reaction to noxious odor
CN I (olfactory):
Ability to regard a person’s face, maintain eye contact,
reach for an object, and pupillary response
CN II (optic):
Move a brightly colored toy through the visual fields to
assess tracking, corneal light reflex, and pupillary response
CN III (oculomotor):
Symmetric eye movements and corneal light reflex
CN IV (trochlear):
Response to light touch on face
CN V (trigeminal):
Same as trochlear (CN IV)
CN VI (abducens):
Facial symmetry during crying (motor) and response to salt solution on tongue (sensory)
CN VII (facial):
Ability to startle to loud noises and turn to a familiar voice
CN VIII (vestibulocochlear):
Observe strength and quality of cry, ability to suck and
swallow, and gag reflex
CN IX (glossopharyngeal): (same as CN X- vagus)
Ability to perform coordinated movements of neck and
shoulders
CN XI (accessory)
Symmetrical movements of tongue
CN XII (hypoglossal)
Complex, nonprogressive, and permanent disorder.
-Results from improper development or insult to
brain.
manifestations: increased or
decreased muscle tone, gross and fine motor delays,
feeding difficulties, seizures, and joint deformities.
Cerebral Palsy
includes brain and spinal cord, Congenital disorders that occur during development of the neural tube, typically 17 to 27 days after conception
neural tube defects
Most common neural tube defect, Failure for neural tube to fuse in the lower spinal area.
spina bifida
spina bifida 1 type with no obvious protrusion, intact skin, and hair tuft.
occulta
spina bifida 1 type with obvious protrusion involving the meninges only.
meningocele
spina bifida 1 type with meninges and spinal
cord in obvious protrusion.
myelomeningocele
Cesarean birth to protect the extruded sac
spina bifida 2
Skull fails to fuse during 3rd or 4th week of
gestation, Brain and cranial membranes protrude along midline of skull.
Encephalocele
Most common location is the base of the skull
encephalocele
failure of neural tube to close at cranial end, Function brainstem, but large portions of the skull
and brain are missing.
anencephaly
Inherited diseases characterized by muscle wasting and
progressive muscle weakness due to muscle fiber
degeneration.
Duchenne and Becker Muscular Dystrophy
- Loss of motor function throughout all muscles of the
body due to mutation in the survival motor neuron. - Degeneration of the motor neurons in the anterior
horn cells of the spinal cord. - Progressive, symmetrical weakness and atrophy of
the proximal muscles leading to premature death
spinal muscular atrophy
Damage to the spinal cord resulting in loss of
physical and/or sensory function.
spinal cord injury
life threatening medical emergency in pt with spinal cord injury that if delayed can cause seizures, stroke, retinal hemorrhage, cardiac arrest or death
autonomic dysreflexia
causes of autonomic dysrelfexia
bladder distention/ UTI, discomfort, bowel impaction, pressure sore or skin bones, fracture, ingrown toenails
symptoms of autonomic dysreflexia
increased BP, pounding headache, profuse sweating, nasal congestion, bradycardia, flushed clammy. and goosebumps
A child with a history of T3 spinal cord injury
presents to the emergency department with
headache, facial flushing, and cardiac dysrhythmias.
Which of the following conditions would the nurses
suspect?
Autonomic dysreflexia
Autoimmune response resulting in an attack on the peripheral nervous system and demyelination of the peripheral nerves, Triggered by recent bacterial or viral infections, acute inflammatory demyelinating
polyradiculoneuropathy
Guillain–Barré Syndrome
May require intubation and respiratory support if
diaphragm and respiratory muscles are impaired.
Guillain–Barré Syndrome Treatment
A child is admitted to the inpatient unit with Guillain
–Barré syndrome. Which assessment should the
nurse perform first?
Respiratory assessment
Neuroparalytic illness caused by toxins from Clostridium
botulinum bacteria, Symmetric descending flaccid paralysis of muscles under
autonomic and voluntary control.
botulism
decreased muscle tone
hypotonia
