Peds Exam 2 Flashcards
What are the S x S of FTT?
- < 3-5% weight
- Development can be delayed
- Muscle mass can ⬇
- Abdominal distention
- Behavior
What is an important feeding approach to remember w/ a FTT child?
Be persistent when offering to eat.
- Add new foods slowly
What are some criteria in concerns to FTT feeding approaches?
- Vitamin & mineral supplements
- High calorie formula (24 kcal/oz versus reg. 20kcal/oz
When can a cleft lip be surgically repaired?
Between 3-6 months of age.
When can a cleft palate be surgically repaired?
Between 6-24 months of age.
- Early repair enables better feeding
What other medical occurrence is associated w/ cleft lip and palate?
Otitis media
What can be done after feeding to prevent the occurrence of Otitis Media?
Follow Feedings w/ water
What are some key points in concerns to cleft lip/palate post surgery?
- Monitor carefully to prevent aspiration
- Clean the suture line frequently
- May need to use syringe w/ rubber to feed
- Position upright during and after feedings
- Rinse mouth w- water after feedings
- Keep away pacifiers, straws…
- Do not brush teeth for 1-2 weeks
What is the definition of Gastroenteritis?
Acute inflammation of the stomach and intestines accompanied by vomiting and diarrhea.
What are the S x S of Gastroenteritis?
- Vomiting
- Diarrhea
- Irritability
- Nausea
- Electrolyte imbalance
What would a diagnostic test most likely reveal w/ Gastroenteritis?
Neutrophils and RBCs on stool specimen very indicative of bacterial gastroenteritis.
What is the most common cause of Gastroenteritis?
Rotovirus = vaccine available
What nursing assessments are performed w/ Gastroenteritis?
1) ⬆ fluid requirements w/ fever
2) Observe for S x S of dehydration
3) NO antidiarrheal for acute diarrhea
How would rehydration be handled in the event of dehydration caused by Gastroenteritis?
1) Oral Rehydration Therapy
2) IV fluids = LR or 0.9% NaCl
- -> after improved status:
- D5 0.45% NaCl twice the hourly maintenance rate
3) KCl replacement only after adequate urine output established
4) Food as soon as rehydrated and tolerating PO
- Avoid plain water not to cause hyponatremia.
What type of diets are preferable after Gastroenteritis?
1) ABCs Diet =
- Applesauce
- Bananas
- Carrots (strained)
2) BRAT Diet =
- Bananas
- Rice
- Applesauce
- Toast
What are the possible diagnostic tests for Lactose Intolerance?
- Clinitest of stool
- Breath hydrogen testing
What can be included in a lactose intolerant patient’s diet?
1) Enzyme replacement (LactAid, Dairy Ease)
2) High calcium content foods =
- egg yolks
- green leafy vegetables
- dried beans
- cauliflower
- molasses
What is the definition of Hirschsprung Disease? (Congenital Aganglionic Megacolon)
Hirschsprung disease is characterized by the absence of ganglion cells in segment of colon.
As a result =
- Stool accumulate proximal to the defect
- Bowel obstruction
- Potential Entercolitis
What are the S x S of Hirschsprung Disease?
- Constipation in 1st month
- Pellet like or ribbon foul smelling stools
- FTT
- Abdominal distention
- Palpable fecal mass
- Visible peristalsis
- -> Can result in:
- Chronic constipation
- Bowel obstruction
What are the S x S of a bowel obstruction secondary to Hirschsprung disease?
- Abdominal pain + distention
- Refusal to feed or suck
- Bile stained vomitus
- If presence of Entercolitis the S x S =
- explosive, watery diarrhea
- fever
- toxic
What assessments are performed pre-op for Hirschsprung’s?
- Weight loss/gain
- Nutritional intake & bowel habits
- High calorie w/ high proteins and low fiber
- Abdominal measurements
- Monitor fluid and electrolytes
- if severe NPO & TPN
What OR and post-op interventions are performed w/ Hischsprung’s?
- Bowel resection or temp colostomy
- NPO until NG to LIS
- No rectal temperatures
- Fluid and electrolyte monitoring
- Colostomy care
What is Hypertrophic Pyloric Stenosis?
The pyloric sphincter hypertrophies resulting in narrowing the pyloric canal.
- -> Obstructs gastric emptying
- -> Develops in the first few weeks
What are the S x S of Hypertrophic Pyloric Stenosis (HPS)?
1) Projectile vomiting (1/2 to 1h after eating)
2) Palpable olive-like mass in RUQ
3) Deep peristaltic waves in stomach
4) FTT
5) When severe = dehydration + metabolic alkalosis
- Vomit is non-bilious because content coming from stomach only
What is an Intussusception?
Proximal bowel segment telescopes into a more distal segment.
–> Can turn into necrosis = gangrene
What are the S x S of Intussusception?
1) Sudden acute abdominal pain (colicky)
2) Stools = Red currant jelly-like
3) Palpable sausage-shaped mass RUQ
4) Vomiting = bile-stained
- -> Can lead to Peritonitis if untreated
What are the treatments for Intussusception?
1) Hydrostatic reduction –> barium or air enema
2) Surgery =
- manual reduction
- resection of non viable areas of bowels
What is Gastroesophageal Reflux Disease (GERD)?
= Return of gastric contents I to the esophagus due to relaxation of the lower esophageal sphincter.
What patients are most at risk for GERD?
1) Premature babies
2) Bronchopulmonary dysplasia
3) TEF or EA repair
4) Scoliosis
5) Asthma
6) CF
7) CP
What are the 2 types of GERD?
- Physiologic
- Pathologic
What are the characteristics of physiologic GERD?
- Painless emesis after meals
- Rarely occurs during sleep
- No FTT
- -> pharmacologic + medical management
What are the characteristics of pathologic GERD?
- FTT
- Aspiration pneumonia, asthma
- Apnea, coughing + choking
- Frequent emesis
- -> may require surgery + pharmacologic tx
What are the S x S of GERD w/ infants?
1) Spitting up + forceful vomiting
2) Crying, stiffening
3) Weight changes (may ⬇ because of FTT)
4 Respiratory: cough + wheezes
5) Hematemesis + OM
6) Apnea or ALTE (Apparent Life Threatening Event)
What are the S x S of GERD w/ children?
1) Chronic cough
2) Heartburn
3) Abdominal pain
4) Non-cardiac chest pain
5) Dysphasia
6) Nocturnal asthma
7) Recurrent pneumonia
What interventions could help infants’ feeding w/ GERD?
- Thickened formula
- Small frequent meals
- Burp infant often
- HOB 30 *
What interventions could help toddler’s feeding w/ GERD?
- Feed solid foods first
- Follow w/ liquids
What is a particular sleeping recommendation for an child < 1 year old w/ GERD?
- Sleep in right side position
- -> may help stomach emptying
- HOB 30 *
What medications are recommended to manage GERD?
ANTACIDS
1) H2 Antagonists = ranitidine, cimetidine, famotidine
2) Mucosal protectants = sucralfate
3) Prokinetic Agents = metoclopramide
4) Proton Pump Inhibitors = omeprazole
What complications can occur if GERD is not well managed?
- Esophageal strictures
- Laryngitis
- Recurrent pneumonia
- Anemia
In what occurrences will a surgical intervention be necessary w/ GERD?
1) Recurrent pneumonia
2) Apnea
3) Esophagitis
4) FTT
5) Failed medical Tx
6) Nissen fundoplication = gastric fundus encircles the distal esophagus
What are the possible surgical complications w/ GERD?
- Breakdown of the wrap
- Gas-bloat syndrome
- Infection
- Retching
- Dumping syndrome
What are TEF and EA?
- Tracheoesophageal Fistula
- Esophageal Atresia
–> Can occur together or separately
What is the definition of TEF and EA?
Malformation that results in failure of the esophagus to develop as a continual tube during the 4th and 4th weeks of gestation.
- Higher incidence in =
- premature infants
- low birth weight
What is the most important nursing intervention w/ TEF and/or EA?
- Keep pt supine with HOB 30 degree + NPO
What are the S x S of TEF?
1) Excess saliva + drooling
2) Coughing
3) Choking
4) Cyanosis
5) Vomiting
6) ⬆ respiratory distress after feedings
7) Abdominal distention
What surgical interventions can be performed to treat TEF or EA?
1) Fistula ligation
2) Atresia anastomosis
What are some post-op considerations w/ surgical Tx of TEF or EA?
- Respiratory assessment
- Tubes = G-tube, NG, chest tubes
- Non-nutritive sucking (pacifier) = to keep stimulation
What is the definition of Meckel Diverticulum?
- A fibrous band connecting the small intestine to the umbilicus.
–> Most common GI anomaly
What are the S x S of Meckel Diverticulum?
1) Painless rectal bleeding
2) Abdominal pain
3) Intestinal obstruction signs
What causes Appendicitis?
–> located at McBurney’s point
- Hardened fecalith
- Swollen lymphoid tissue
- Parasite
What are the S x S of Appendicitis?
1) RLQ pain (starts before vomiting)
2) Fever
3) Rigid abdomen = guarding
4) ⬇ or absent bowel sounds
5) Vomiting = can have bile
6) Constipation or diarrhea
7) Anorexia
8) ⬆ pulse
9) ⬆ shallow respirations
10) Pallor
11) Lethargy
12) Irritability
13) Stooped posture
How can the RN assess for suspected Appendicitis?
1) Symptoms develop slowly (12 h)
2) Presence of pain, anorexia, or nausea + vomiting + fever
3) If pain precedes vomiting = suspect Appendicitis
If vomiting before pain = suspect Gastroenteritis
4) Pain may be generalized and focused on RLQ later
What is Rovsing’s sign in concerns to Appendicitis?
- When pushing on LLQ, pain will appear on RLQ.
What are some confirming diagnostic tests for Appendicitis?
- CT scan
- Ultrasound
- ⬆ WBCs
- CRP = C-reactive protein (> in 12 h of infection)
What are some nursing assessments in concerns to Appendicitis?
- Allow pt to assume a position of comfort
- Assessment for classic abdominal symptoms
- Pain
- If sudden spike of fever and relief of pain may indicate perforation.
What are the pre and post-op nursing interventions w/ Appendicitis?
1) Pre-op =
- Do not stimulate the bowels –> could cause perforation
2) Post-op =
- IV antibiotics
Non perforated –> Cefepime
Perforated –> Meropenem
What are the S x S of a post-op abscess w/ Appendicitis?
1) ⬆ pain
2) Restlessness
3) Irritability
4) ⬇ ambulation
What maintains the ICP (intracranial pressure)?
The balance of the following =
1) Brain tissue
2) Blood
3) Cerebrospinal fluid
What factors influence the ICP?
1) Pressures =
- Arterial
- Venous
- Intraabdominal (Valsava)
- Intrathoracic
2) Posture
3) Temperature
4) Blood gases (CO2 + O2 exchange)
How is the ICP regulated and maintained?
1) Normal compensatory adaptations:
- Alteration of CSF
- Displacement of CSF into subarachnoid space
2) Ability to compensate is limited:
- If volume ⬆ continues, ICP ⬆
What are the S x S of ICP?
1) Headache =
- often continuous (worst in am because flat supine)
- time exacerbates
2) Vomiting =
- not preceded by nausea
- projectile
3) LOC changes =
- irritability
- confusion
- ⬇ responsiveness
- difficulty following commands (wiggle toes, hold up 2 fingers)
4) Pupil changes (response to light)
5) Cushing’s triad (response) =
- bradycardia
- ⬆ BP
- abnormal respiratory pattern
6) ⬇ motor function + reflexes
7) Posturing =
- decorticate (extremities to core)
- decerebrate (extremities extended + pronated)
8) Flaccid response to pain (sternal rub)
9) Babinski sign
What can be assessed when suspecting ICP?
Glasgow Coma Scale (GCS)
- Eye 4
- Verbal 5
- Motor 6
- -> Score ranges from 3 to 15
What are the S x S noticed on infants w/ ICP?
1) Bulging fontanel
2) ⬆ head circumference
3) Cranial sutures
4) High pitched cry
5) Poor feeding
6) Vomiting
7) Irritability/ Restlessness
What are the S x S noticed on children w/ ICP?
1) Headache (worst in am)
2) Diplopia
3) Mood swings
4) Slurred speech
5) N/V (especially in am)
6) Altered LOC
7) Papilledema
What nursing interventions can be performed to relief ICP?
1) Adequate oxygenation =
- ABG analysis
- O2 therapy
- May require ventilator
2) Drug therapy =
- Mannitol (osmotic diuretic)
- Corticosteroids (inflammation)
- Barbiturates (anti-anxiety)
- Anti-seizure drugs
What is the definition of bacterial Meningitis?
1) Acute inflammation of meningeal tissue =
- Always arachnoid mater + cerebrospinal infection
2) Medical emergency =
- Untreated mortality rate near 100% (quick onset)
How is bacterial Meningitis contracted?
Organisms enter CNS from respiratory tract or bloodstream =
- through wounds of skull or fx sinuses
- often secondary to viral respiratory disease
What are the clinical manifestations of bacterial Meningitis?
1) Inflammation response ⬆ CSF production w/ moderate ⬆ ICP
2) Purulent secretions spread to other areas of brain through CSF
3) If concurrent encephalitis present –> ⬆ ICP becomes problematic
What are the S x S of bacterial Meningitis?
1) Fever
2) Severe headache
3) Nuchal rigidity (neck)
4) Nausea, vomiting
5) Positive Kernig’s sign
6) Brudzinski’s sign (flex neck –> hip flex)
7) Photophobia
8) ⬇ LOC
9) S x S of ⬆ ICP
10) Coma (poor prognosis)
11) Seizures (1/3 of cases)
- Kernig’s sign =
- Elevate + flex leg
- Extend leg
- If pain reported = positive sign
What are some possible complications w/ bacterial Meningitis?
- Acute ⬆ of ICP
- Residual neurological dysfunction (cranial nerves + hearing loss)
- Acute cerebral edema (–> brady❤, CN palsy, coma, death)
How can bacterial Meningitis be diagnosed?
1) Blood culture
2) Lumbar puncture (analysis of CSF)
3) X-rays of skull
4) CT scan
5) MRI
- No lumbar puncture if ICP is too high - Assess fundus of eyes first.
What are some nursing interventions performed w/ bacterial Meningitis?
- Vaccination against resp infections
- Early Tx of resp infections
- Prophylactic antibiotics
- Position of comfort
- Pain + seizure medications
- Antibiotics + steroids
- Darken room
- Cool cover for eyes
- Monitor hydration
What are the most common causes for viral Meningitis?
1) Enterovirus
2) HIV
3) HSV
What is Reye Syndrome (RS)?
Acute rapidly progressing encelophalopathy.
What are the clinical manifestations of Reye Syndrome?
1) Liver dysfunction
2) Cerebral edema + ⬆ ICP
3) Hypoglycemia
4) Shock
What is Reye Syndrome associated with?
- Influenza
- Chickenpox
- Aspirin + Salicylate intake w/ virus illness
How is Reye Syndrome possibly diagnosed?
1) Liver function tests
2) Liver biopsy
3) Lumbar puncture
4) Serum ammonia level (⬆)
5) Coagulation time
What are the S x S of Reye Syndrome?
1) Loss of neurological function
2) N/V
3) Cerebral edema
4) Liver dysfunction
What are the different stages of Reye Syndrome?
I = lethargic, confused, follows command II = stuperous, agitated, delirious III = unresponsive coma, decorticate posture IV = brain stem dysfunction - decerebrate posture V = flaccid, seizures, respiratory arrest
How is Reye Syndrome clinically managed?
- Mainly supportive care
- ⬆ ammonia levels = Neomycin
- ⬇ ICP = Mannitol, corticosteroids, HOB 15-30*
- Vitamin K
- Seizure precautions
What are the 3 different types of Spina Bifida?
1) Spina Bifida Occulta = Invisible, no S x S, defect in bony spine.
2) Menigocele = No neuro S x S, spinal defect, sac-like protrusion contains no spinal nerves.
3) Myolomenigocele = Neuro S x S, spinal defects, sac-like protrusion contains meninges, spinal fluid and spinal nerves.
What causes these different types of Spina Bifida?
1) Insufficient Folic acid in maternal diet
- 70% could be prevented if had taken a daily 400 mcg before and during pregnancy.
- 30% etiology unknown: possible genetics or environmental.
How is Spina Bifida diagnosed?
1) In utero = AFP, Amniocentesis
2) Physical exam
3) CT
4) MRI
What are the necessary assessments w/ a Spina Bifida patient?
1) Inspect sac at birth + determine if intact
2) Inspect lumbosacral area for dimpling
3) Assess head circumference + fontanel = hydrocephalus if ⬆ CSF
4) Assess extremity movement
5) Infection risk
What are the nursing interventions in concerns to Spina Bifida?
1) Cover sac w/ sterile (NS) nonadherent dressing until surgery
2) Protect sac from injury = keep infant in prone position w/ surveillance
What is the definition of Hydrocephalus?
Abnormal accumulation of CSF w/in the ventricles of the brain.
What are the causes of Hydrocephalus?
1) Spina Bifida = most common
2) Meningitis complications
3) Obstruction of CSF flow between the ventricles
What are the S x S of Hydrocephalus w/ infants?
1) Irritability, lethargy
2) ⬆ head circumference
3) Bulging fontanels
4) ⬆ suture lines
5) High pitched cry
What are the S x S of Hydrocephalus w/ children?
1) ⬇ LOC
2) Irritability
3) N/V
4) Headache = worst in am
5) Unequal pupil response
6) Seizures
7) Personality change
What are the characteristics of Ventriculoperitoneal Shunt?
- Shunt is inserted into ventricle
- Tubing is tunneled through skin to peritoneum
- Shunt valve opens at a predetermined ventricular pressure and it drains excess CSF from ventricle to peritoneum
- Shunt valve closes when pressure fails below the threshold level
What is the post-op care involved w/ a VP shunt?
1) Assess dressing for blood and CSF drainage
2) ICP assessment
3) Position on unoperated side
4) HOB position per MD order =
- facilitate CSF drainage
- avoid too rapid of drainage
5) Assess abdominal distention =
- peritonitis + Ileus
What are certain complications that could arise w/ a VP shunt?
1) Infection =
- ⬆ temp
- N/V
- poor feeding
- redness/ tenderness along shunt tract
2) Separation or migration of tubing
3) Obstruction resulting in ⬆ ICP
What is the definition of Cerebral Palsy?
A non progressive injury to the motor centers causing neuromuscular problems of spasticity or dyskinesia (involuntary movements).
What are the associated problems w/ Cerebral Palsy?
- Mental retardation
- Seizures
- Level of function varies widely
- Pts can be verbal but often non-verbal
What are the classifications of CP?
1) Spastic (most common) =
- hypertonic, poor posture, balance + coordination
- may involve 1 or both side
2) Dyskinetic/ Athetoid =
- abnormal involuntary movements
- early life: flaccid and limp
- later life: slow writhing motions
3) Ataxic =
- wide bases gait
- rapid repetitive movements + ⬇ fine motor control
What are the S x S of CP?
1) Persistent reflexes after 6 months
2) Developmentally delayed
3) Poor suck, tongue thrust
4) Spasticity
5) Scissoring of legs
6) Involuntary movements
7) Seizures
8) Sensory alterations: visual, hearing…
- If cannot communicate does not mean they do not understand!
What some nursing interventions involved w/ CP?
1) Prevent aspiration during feedings =
- position upright + support lower jaw
2) Medications to manage symptoms =
- anticonvulsants
- muscle relaxants (Baclofen)
3) Prevent and treat contractures
4) Assistive devices
What is the definition of a Urinary Tract Infection?
Infection of bacterial, viral, fungal origin that occurs in the urinary tract.
–> Females more prone due to short urethra
What are the S x S of a UTI in infants?
1) Fever or hypothermia
2) Irritability
3) Dysuria (crying when voiding)
4) Change in urine odor or color
5) Feeding difficulties
What are the S x S of a UTI in children?
1) Abdominal or suprapubic pain
2) Voiding frequency + urgency
3) Dysuria
4) New or ⬆ incidence of enuresis
5) Fever
What is the definition of Pyelonephritis?
Upper UTI that involves the ureters, renal pelvis and renal parynchema.
What are the S x S of Pyelonephritis?
Same as UTIs plus:
1) High fever, chills
2) Back pain
3) Costovertebral angle tenderness
4) N/V
5) Appears sick (toxic)
What are the diagnostic methods w/ urinary illnesses?
- Urinalysis
- Urine culture
- VCUG = voiding cystourethrogram
- Ultrasound or CT
What are the nursing interventions involved w/ UTIs?
- Assess fluid and electrolyte status
- Antibiotics = IV or PO
- Renal impairment = falsely low specific gravity
What is Vesicoureteral reflex?
The upper openings in the bladder coming from the kidneys do not properly shut when voiding. As a result, urine will flow back up toward the kidneys and create an infection.
What are the diagnostic tests for Vesicoureteral reflex?
1) Hx of UTIs
2) VCUG (Voiding Cystourethrogram) =
- Dye into bladder via catheter
- X-rays taken before, during and after voiding
- Visualize bladder, urethra reflux
How is Vesicoureteral reflex treated?
1) Most can be treated medically = Grades I- III
2) Low dose antibiotics
3) Frequent urine cultures
4) Surgically - Criteria =
- Grades IV and V
- Recurrent UTI (w/ AB Tx)
- Noncompliance w/ AB (antibiotics)
- Intolerance to AB
- VUR after puberty in females
What are the implications after surgical intervention w/ VUR?
1) Reimplant the ureters into bladder
2) Stents into ureters
3) Foley
4) Post-op antibiotics until normal VCUG =
- 3 months
- 1 year
- 3 years
What is the definition of Glomerulonephritis?
Inflammation of the glomeruli of the kidneys, usually in response to group A beta-hemolytic streptococcal infection of the skin or pharynx.
- If strep is not well treated => can turn into Glomerulonephritis
What are the clinical manifestations of Acute Postinfectious Glomerulonephritis (APG)?
1) Hematuria = mild-gross (tea color)
2) Periorbital and ankle edema = ⬆ in a.m
3) ⬇ urine output
4) Febrile/Lethargic
5) Abdominal pain
6) Headache
7) HTN
8) ⬆ protein in urine
9) > BUN + > Creatine
–> Risk for pulmonary edema
What are the different diagnostic tests available for APG?
1) ESR + lipid levels ⬆ in 40% of cases
2) Positive ASO titter confirms strep infection
How can APG be treated?
- Diuretics = Lasix
- Antihypertensives
- Antibiotics
What are some nursing interventions in concerns to APG?
- Daily weight + strict I & O
- Assess BP
- Respiratory assessment
- Prevent skin breakdown = edema ⬆ risk
- Low Na diet (or none)
- Limit fluid if ordered
- Encourage rest in acute phase
What is a characteristic of Nephrotic Syndrome (NS)?
It is an autoimmune process caused by a domino effect w/ liver stimulation.
What are the clinical manifestations of Nephrotic Syndrome?
1) Edema
2) Massive proteinuria (frothy urine)
3) Hypoalbuminemia
4) Hyperlipidemia
5) Fatigue + abdominal pain
6) Normal BP!
7) Anorexia
What are the proper treatment for Nephrotic Syndrome?
1) Corticosteroids = ⬆ dose to ⬇ proteinuria
2) Diuretics = ⬇ edema
3) Possible albumin administration
4) Antibiotics (prophylactic)
5) No added salt diet
6) Fluid restriction (if severe edema)
What are some patient teaching tips in concerns to the corticosteroids to treat the NS?
Common side effects =
- ⬆ appetite
- hyperglycemia
- ⬇ resistance to infection
Precaution =
Meticulous aseptic technique to prevent infection (Candidiasis)
What is Wilms Tumor?
Nephroblastoma = left embryonic tissue enclosed creating a tumor that can metastasize if untreated.
What are the S x S of Wilms Tumor?
1) Non-tender, firm, flank mass
2) Often asymptomatic
3) Abdominal pain (especially when felt)
4) Vomiting
5) Microscopic - gross hematuria
6) Anemia
7) HTN
What are the possible diagnostic tests in concerns to Wilms Tumor?
- Physical assessment I.D mass
- Abdominal ultrasound
- Evaluation for metastasis = CT + MRI
How is Wilms Tumor clinically managed?
- Don’t palpate flank or abdomen once felt once
- Surgery
- Chemotherapy
- Radiation
What are some characteristics of Wilms Tumor?
- Survival rate = > 90%
- Recurrence = 50%
What is the definition of Hypospadias?
It is a congenital defect that results in the urethral opening on ventral side of penis.
What are the S x S of Hypospadias?
1) Abnormal meatus placement
2) Altered voiding stream
3) Chordee = ventral curvature of penis
4) May occur w/ =
- Undescended testes
- Inguinal hernia
How is Hypospadias treated and clinically managed?
1) No circumcision (to save skin used later in surgery)
2) Surgical correction before 3 years of age
3) Post-op =
- Monitor urine output
- Catheters (Foley, suprapubic or urethral stent)
What is Developmental Dysplasia of Hip (DDH)?
Abnormality in the development of the proximal femur, acetabulum or both.
–> unknown cause + ⬆ risk w/ Caucasian females
What are the known risk factors w/ DDH?
- Family Hx
- First pregnancy
- Oligohydramnios
- Breech presentation
- Maternal hormones = relaxes baby joints
- Twins
- Large size
What are the diagnostic tests for DDH?
- Physical exam
- Ultrasound (2 weeks of age)
- X-rays (> 4 months)
What are the S x S of DDH?
1) Asymmetry of gluteal folds
2) Leg length discrepancy
3) Hip abduction limitation
4) Positive Ortolani sign (click w/ abduction)
5) Pain
6) Positive Trendelenberg sign = pelvis tilts down on side opposite to affected leg.
How is DDH clinically managed?
1) Between 0 and 6 months of age –> Pavlik harness =
- Wear 24 h/day
- Adjust straps w/ growth
- Assess for skin irritation (often)
2) > 6 months of age = closed or open reduction w/ hip spica cast application
What are the nursing interventions for post-op spica cast care?
1) Neurovascular assessment of extremities
2) Assess cast for drainage and bleeding
3) Assess respiratory system (cast constriction)
4) Pain management
5) Skin assessment
What is the definition of Clubfoot?
Congenital deformity of the foot that is twisted out of shape or position.
What are the 2 different types of Clubfoot?
1) Equinus = Bent downward
2) Varus = Bent inward w/ angulation towards the midline
What can be the causes of Clubfoot?
- Familial
- Crowding in uterus
- Maternal smoking during pregnancy
- Amniocentesis
- > risk in boys
- > risk in twins
How is Clubfoot clinically managed?
- Manipulation + serial casting (changed weekly)
- Corrective shoes + splints
- Surgery
- -> Outcome = foot may always be slightly smaller and stiffer
What is Scoliosis?
Lateral curve of the spine.
What are the known causes of Scoliosis?
1) Neuromuscular disease (Cerebral Palsy)
2) Trauma
3) Tumors
4) Vertebrae infections/disorders
What are the S x S of Scoliosis?
1) Hips at angle uneven w/ shoulder height
2) Pants/ skirts length discrepancy
3) Respiratory dysfunction (w/ severe curvature)
How is Scoliosis clinically managed?
1) Bracing: 25-35 degree =
- Milwaukee brace
- Wear 23 h/day
- Wear T-shirt under to prevent skin breakdown
- Assess skin frequently
2) Spinal fusion if > 40 degree angle
What is the proper nursing care for a spinal fusion (w/ Scoliosis)?
- Prepare pt for foley, NG, chest tubes
- Review pain management PCA
- Log-roll and avoid twisting trunk
- Neurovascular assessments (lower extremities)
- Assess incision site for blood and CSF
- Body jacket used when ambulating
What is Juvenile Rheumatoid Arthritis or Juvenile Idiopathic Arthritis?
Group of chronic autoimmune inflammatory diseases affecting joints and other tissues =
–> Wearing down and damage to the articulate cartilage
(> incidence w/ girls)
What are the S x S of JRA?
1) Joint swelling, stiffness, redness
2) Joint pain
3) Joints warm to touch
4) Mobility limitations
5) Fever, rash, malaise
6) Mild - severe in presentation
- -> Can lead to risk of Uveitis = Eye disorder (blindness)
What are the 3 different types of JRA?
1) Pauciarticular = 4 or fewer joints (greater risk for Uveitis)
2) Polyarticular = 5 or more joints
3) Systemis = any number of joints involved w/ high fever, rash, pericarditis, hepatosplenomegaly, lymphadenopathy.
- Poorest prognosis = Polyarticular and systemic
How is JRA clinically managed?
- NSAIDs (Ibuprofen, Naproxen)
- Cytotoxic drugs ( Methotrexate) when NSAIDs not effective alone
- Corticosteroids (Prednidone) = small dose
- Antirheumatic drugs
What is the proper nursing care when treating JRA?
1) Moist heat to joints before exercise
2) Rest acutely inflamed joints
3) Splint joints for sleep to ⬇ pain and prevent flexion deformities
4) Exercise heated pool (pace activity)
–> 60% can recover
40% still have symptoms
What is Muscular Dystrophy?
A group of inherited disorders w/ progressive degeneration of symmetric skeletal muscle groups.
–> Affects mostly boys (inherited from mom)
- Duchenne muscular dystrophy is the most common
What is the Duchenne Muscular Dystrophy life expectancy?
Between teen years and early 20’s
What are the S x S of Duchenne Muscular Dystrophy (DMD)?
1) Early onset (3-5 years)
2) By 9-11 years old = loss of independent ambulation
3) Progressive muscle weakness
4) Calf muscle hypertrophy
5) Waddling gait
6) Lordosis
7) Winged scapulae
8) Gowers sign =
- difficulty rising
- child walks up legs using hands to stand up
9) 30% mentally delayed
10) Respiratory + cardiac difficulties later in disease
- By age 10 = most are in wheel chairs
How is DMD clinically managed?
- Maintain muscle function as long as possible
- ROM keeps joints flexible
- Splints and braes to prevent contractions
- Encourage child to be independent
- Respiratory support = intermittent pressure ventilation
- Support groups for DMD
