Peds Final (New information) Flashcards
What is meningitis and what can cause it
inflammation of the meninges. can be caused by bacteria, viruses, or fungi in cerebral spinal fluid
Viral meningitis is caused by…
cytomegalovirus, herpes simplex virus. enterovirus, HIV, arbovirus
Bacterial meningitis can be caused by…
Neisseria meningitis, streptococcus pneumonia. hemophilia influenza type b, E.Coli
Risk factors for meningitis
-a big concern for infants under 2 months
-crowded living conditions
-+ GBS mother during pregnancy
Expected findings for meningitis newborn
-typically won’t see any illness at birth but present within a few days
-hard to diagnose
-Baby will be inconsolable, high pitch cry, move head from side to side, squinted eyes, nuchal rigidity
-LATE FINDINGS: bulging fontanel
Expected findings for meningitis 3 months - 2 years
-seizures with a high pitch cry
-bulging fontanels
-possible nuchal rigidity
-Brudzinski’s ( lift head while lying down will involuntarily flex legs) and Kernig’s (flex hips at 90 and then straighten legs it will be painful) signs are not reliable for diagnosis
Expected findings for meningitis 2 years - adolescence
- # 1 findings seizures-+ Brudzinskis sign, kernigs sign
labs for meningitis
- lumbar puncture ( they will observe for coloring (milky) , elevated WBC count, Elevated protein, glucose should be normal or lower , +gram stain)
Meningitis diagnoses
-lumbar puncture is a definitive diagnosis
-MRI & Ct scan determines Intracranial pressure
Meninigits Nursing considerations
-make sure the client voids before the procedure
-apply a topical anesthetic cream
- position the client side-lying with the head flexed and knees drawn up (the nurse will help hold the child)
- apply pressure and an elastic bandage to the puncture site after needle removal
-label specimens and deliver them to the lab
-monitor for site for bleeding, hematoma, or infection
Medications and education for meningitis
-*administer IV antibiotics for bacterial infections
-corticosteroids -dexamethasone- (NOT for viral meningitis)
-analgesics
Education
-assess for allergies
-educate the family about the need to complete the entire course of medication
-assess temperature prior to administering acetaminophen or ibuprofen (which can mask a fever)
-monitor resp. status
-monitor LOC *are they more confused etc?
Possible complications for meningitis & nursing actions
increased intracranial pressure
-could lead to neurologic dysfunction
Nursing actions
-monitor for manifestations of increased ICP
-Newborns & Infants: bulging or tense fontanels, increased head circumference, high-pitched cry, distended scalp veins, bradycardia, respiratory changes
-Children: increased irritability, headache, N/V, diplopia, seizures, bradycardia, and resp. changes - provide interventions to reduce ICP (positioning; avoidance of coughing and straining)
Reyes Syndrome
-can be when aspirin is given to a child after a viral illness. The body’s immune system processes the aspirin through the liver, and it starts affecting the liver and the brain, causing metabolic changes.
Expected findings Reyes syndrome
- lethargy, irritability, *combativeness, delirium
Reyes labs & diagnostic
Labs: liver enzymes (High AST), blood ammonia levels (high), blood electrolytes, coagulation times can be longer
Diagnostics: liver biopsy, CSF analysis
Reyes syndrome treatment & patient education
Medications: Osmotic diuretic (mannitol) - decrease cerebral swelling, monitor for increased ICP
Patient education: should not receive aspirin, read medication labels make sure no presence of salicylates, liver function can be regained but neurologic deficits might persist
Reyes syndrome nursing care & complications
Nursing Care
-maintain hydration , I&O, catheter, coagulation and prevent bleeding
-implement seizure precautions
Complications
Neurologic sequelae: speech or hearing impairments and developmental delays
Nursing actions: explain the client’s condition to the family, help the familywith home care support services
Death:
What is epilepsy
a diagnosis of epilepsy is made if a client has two unprovoked seizures at least 24 hours apart. or if a single unprovoked seizure occurs during a period of 10 years following two unprovoked seizures
Etiology of partial (focal) seizures and generalized seizures
Partial (focal): involves one area of the brain
Generalized: involves the entire brain
Risk factors for seizures and epilepsy
Seizures: febrile (High fever episode), cerebral edema, infection or pressure intracranial, tumors cyst etc., drugs, lead poisoning, tetanus, shigella, salmonella, sodium being off
Epilepsy: trauma, hemorrhage, low glucose, congenital defects, migraines, uremia, cardiac dysfunctions
Expected findings absence (petit mal)
-Onset ages 4-12 usually stops by teenage years
-loss of consciousness lasts 5-10 seconds
-minimal change, resembles daydreaming
-may have lip smacking or twitching
-return to normal activities afterwards
Expected findings Myoclonic
-Variety of seizure episodes
-symmetric or asymmetric involvement
-brief contractions of muscle or groups of muscle
-no postictal state
-might not lose consciousness
Expected findings Atonic or Akinetic
-known as drop attacks
-onset ages 2-5
-muscle tone lost for a few seconds causes a fall
-followed by a period of confusion
-if it happens frequently child should wear a helmet to prevent injury
Expected findings partial/ focal Simple
Simple
Motor manifestation:
-Aversive seizure: most common type eyes and head turn away from the focus, may or may not involve loc
-Rolandic(sylvan seizure): tonic- clinic movements of the face, salivation, and usually occurs during sleep
Sensory Manifestations:
- tingling, numbness, pain in one area, pain spreads, may include visual sensations and motor development changes (hypertonia or posturing)
Expected findings partial/ focal Complex
(psychomotor seizure)
-altered behavior and inability to respond to the environment, impaired consciousness lasting less than 5 minutes
-confusion and inability to recall event
Expected Findings and treatment Febrile’s seizure
-Associated with a sudden spike in temperature as high as 38.9-40 Celsius (103-104 Fahrenheit)
-duration 15-20 seconds
treatment
-administer acetaminophen or ibuprofen when they have a fever
-dress the child in light clothing
-tepid sponge bath
Unclassified seizures expected findings/treatments
West syndrome (infantile seizures)
-treated with adrenocorticotropic hormone ACTH
Lennox- Gastaut syndrome
-a mixture of different seizures in children with cognitive deficits
Labs and Diagnostics for seizures
Labs: lead level, WBC, Blood glucose, Metabolic panel, Chromosoml analysis, toxicology screening
Diagnostic: EEG, MRI, LB, CT
Education/ preparation for EEG
-Quiet, Caffeine-free, clean hair, awake (for children), painless
Nursing Care during a Seizure
During a seizure
Safety: protect, side-lying, loosen clothing
Airway: suction, no objects in mouth, oxygen
Observe: onset, duration, characteristics
Support: Calm, reassure caregivers
Post seizure
-positioning and safety
-monitoring and assessment
-postictal care
-communication
Medications, Nursing & Patient Teaching for seizures
Medications: decreases incidence and severity of seizures
-monitor for seizure control
-Assess for allergies
-monitor for adverse effects
-check therapeutic blood levels for required medications
*IV diazepam should not be mixed with any solution other than 0.% sodium chloride to prevent precipitation
Patient Teaching
- Consistency, Interactions, adverse effects, growth
Types of head injury
Concussion: traumatic injury to the brain that alters the way the brain functions
Contusion: bruising of cerebral tissue
Laceration: tearing of cerebral tissue
Skull fractures: direct trauma to the skull
Head injuries expected findings minor and progression
Minor Injury
-possible LOC
-temporary period of confusion
-vomiting
-pallor
-irritability
Progression of Injury
-marked changes in vital signs heart rate is often one of the first vitals that changes
-AMS
-Focal neurologic deficits
-Increase in agitation
Head injury severe injury expected findings
severe injury increased ICP
Infants: bulging fontanels, irritability, restlessness, sleepiness, poor feeding, setting- sun sign- child’s eyes look downward, distention in scalp veins,
Children: N/V, Headache, blurred vision, sleepiness, seizure precautions*
Head injury expected findings severe injury- skull fractures
Depressed skull fracture: misshapen skull (broken bone fragments are pushed inwards)
Basilar skull fracture: blood & CSF leakage (involves those at the anterior or posterior base of the skull)spinal headache*
Open skull fracture: laceration & CSF leakage (involve a break in the scalp or mucosa of the respiratory tract -> can lead to osteomyelitis
Growing skull fracture: skull defect & delayed neuro changes ( when a fracture worsens due to pressure from the brain herniation, dilated ventricles or a cyst
Head injury Nursing consideration
*Therapeutic cooling for ICP management(helps regulate body temperature)**
-keep head midline and elevate the bed to 30 for venous drainage
-monitor fluid and electrolytes
-low stimulation envrioenemtn
-seizure precautions
-monitor for bleeding or CSF leakage
-
A nurse is assessing an adolescent with a closed head injury. Which of the following findings may indicate an increase in intracranial pressure (ICP)? (Select all that apply.)
A. Complaints of headache
B. Changes in pupillary response
C. Heightened motor response
D. Increased drowsinessE. Heightened sensory response
A,B,D
Brain tumors expected findings, post-op
second most common form of cancer and the most solid kind of cancer in children
Expected findings: increased ICP, Headache *, vision changes/ papilledema, vomiting, enlarged head circumference, lethargy & projective vomiting= late signs
Post-op: monitor for safety, suction, no fluid or foods till gag reflex is checked, make sure no excessive bleeding on the dressings, frequent vitals, look for edema, position child opposite to surgical site
Cerebral Palsy and expected findings
affects movement and coordination due to brain damage. It can also lead to issues with perception, sensation, vision,hearing, speech, seizures, & cognitive functions
-developmental delays
-Feeding difficulties
-+ babinski reflex
-Gait: crouched legs with scissoring ffet plantar flexed
-muscle tightness and increased reflexes
-poor control of motion, balance, and posture
Spina Bifida Nursing Consideration
neural tube defect present at birth characterized by failure of the osseous spine to close with CNS effects
-Assess infant-parent attachment: observe bonding between infant & parent
-*Assess sac: size, integrity, infection, leakage
-do not take rectal temperature due to rectal prolapse
-Asses bowels might have to do frequent catheterization q4
-assess head circumference & fontanels
Spina Bifida education
-assess head circumfrence
-assess skin integrity
-assess allergies
-Asses for signs of UTI
-Asses bladder and bowel function **very likely will perform intermittent catheterization q4
Osteosarcoma Nursing consideration and treatment
Treatment
-most commonly amputation
-can be followed with chemo or radiation
consideration
-phantom limb pain
-infection prevention
-physical and emotional care preop and postop
Idiopathic scoliosis pre and post op
Pre
-reinforce teaching (incentive spirometer, turning, coughing, deep breathing) to prevent complications
-educate family and adolescent on promoting cooperation & participation in recovery
-demonstrate log rolling
-demonstrate use of pca pump
post
-pain management
-emphasize the importance of physical therapy
-emphasize follow-up care
-emphasize independence in adolescents
Types of fractures
Plastic deformation (bending of a long bone that results in no fracture)
Buckle (Torus) -(stress from opposing forces causes the bone to bulge out
Greenstick (incomplete fracture in a bone that causes the bone to slightly bend , often in young children)
Transverse (break straight across the bone (perpendicular break in the bone that goes completely through
Oblique (fracture that occurs at an angle of the bone)
Spiral (twisting force that causes a spiral-like fracture)
Physeal (break in growth plate)
Nursing care for fractures (ER care at time of injury)
-obtain history
-ABC (CAB-sometimes circulation first
-monitor vs
-assess neurovascular status
-positioning/elevate extremities (reduce swelling)
-remove jewelry and constricting objects
-splint/ stabilize injured area
Fractures Nursing Interventions
assess, use, monitor, maintain, ROM, Increase
-assess pain frequently
-use appropriate pain management
-monitor neurovascular status
-maintain proper alignment
-promote range of motion to prevent complications
-increase calcium intake
Halo traction, nursing considerations, education
Considerations
-wrench for rod release, CPR, Move client as a unit, monitor pins for infection, skin integrity
Education
-provide proper hydration, utilize stool softeners as necessary, teach how to provide pin site care
-report manifestations of compartment syndrome
-powder is to not be used under the halo vest
Fractures complications
osteomyelitis
-superinfection
-ototoxicity
-hepatic dysfucntion
-renal dysfunction
Compartment syndrome (treatment -fasciotomy)
-Volkmann contracture
-deformity
-infection
-paralysis
-edema
Down syndrome complications and nursing interventions
Complications
-Respiratory complication: due to enlarged tounge, shorter & broader neck
Nursing Interventions
-Tongue protrusion locks the child airway (promote use of incentive spirometer, educate caregiver about staying up to date with immunizations, reposition the child raise the HOB)
-Aspirate nasal secretions, promote fluid intake,, cool, humidifier air
-educate a child to rinse mouth to prevent dryness, educate caregivers about child’s risk for respiratory infection
Down syndrome patient education & nursing care
largest concern is resp. isues
those with downsyndrom have a smaller nose as well as depressed nasal bridge. more prone to GI issues due to hypotonia
-ensure there is regular secretions of aspirations, ensure proper positioning for clear airway
-parents: incentive spirometer, proper vaccinations, humidifier
-proper skin care, proper diet (high fiber & high fluid
Nursing Care
-monitor growth, & weight, promote proper feeding
Expected findings for autism spectrum disorder
they would have delays in at least one of the following
-social interaction & communication
-imaginative play before 3 years old
-distress when routines change
-attachments to objects
-using gestures rather than words
-delayed or absent language development
-inability to adjust gaze
Autism specrum disorder nursing considerations (referrals & support)
Screening tools: can show where on the spectrum someone with ASD might fall
Therapy referrals: nurses responsible for making sure they have all the resources in place
Bhevaioral support, communication and social skill (speech therapy)
Family support and nutritional and environmental needs
ADHD nursing considerations
Assessment & Approach
-set clear limits , provide positive feedback , consistent routine
Supporting the child & family
-help family with modification of child environment like charts o help with organization & decrease stimuli
behavioral strategies
-use positive reinforcement, reward for good behavior
School support
-allow more time for testing
-have consistent rules
-small classroom settings
ADHD Nursing and caregiver education
-utilize positive reinforcement
-allow them to be in charge when possible
-encourage family therapy
-charts & visual organization
-reduce distractions in environment
-keep daily environment consistent
-perform the hardest task in the morning
