Peds Neuro Flashcards
drowning
only takes enough water to cover nose and mouth
near drowning / submersion injury
aspirated water damaging lung surfactant causing lung damage
**leads to hypoxia
drowning physical concern
hypoxia –> anoxia –> cerebral edema –> concern
what happens when drowning…
panic –> sporadic motion –> aspiration –> laryngospasm –> hypoxia
laryngospasms
causes bronchoconstriction limiting further aspiration
**when pulled out earlier it causes less fluid overload
hypothermia
occurs faster in water than in air , need to know the amount of time in the water
hypothermia s/s
depend on temp of water
length of time submerged
initial scene treatment
what to do when finding drowning victim on scene…
immediate CPR w/o pulse or breathing
**those in water for only 5-10 min have a better prognosis
what to do for drowning victim in hospital….
- airway
- HYPERoxygenation
- rewarming
passive external rewarming
take off wet clothes
blankets
increase room temp
active external rewarming
warm blanket
heating pads
radiant heat
warm bath
forced warm air
active internal warming
endovascular rewarming
peritoneal / pleural irrigation
drowning prevention education
constant observation - includes bathtime
fencing, pool alarm, floaties
ripcurrents
adult drinking @ beach / pool
swim lessons
normal intracranial pressure
15-20 mmHg
early increased intracranial pressure s/s
poor feeding
vomiting
irritability
lethargy
headache
sunsetting eyes!!
visual disturbance
dizziness / vertigo
IICP in infants
irritability
bulging fontanelle!!
wide sutures
dilated scalp veins
high pitch cry
**has early signs PLUS this
IICP late signs
significant decrease in LOC
seizures
fixed / dilated pupils, papilledema
cushing’s triad
cushing’s triad
increased systolic BP and wide pulse pressure
bradycardia
irregular respirations
IICP traumatic
MVA
GSW
anoxia
abuse : causing swelling and bleeding - shaking baby
IICP autonomic
hydrocephalus
tumors
infection
seizures
hypoxia
avoid these with IICP…
lumbar punctures may lead to herniation
hydrocephalus / IICP tx
VP shunt : drains excess CSF to belly
-monitor ICP, pain level, LOC, behavior, vitals
hydrocephalus shunt education
infection
failure
malfunction
DO NOT press on shunt post op
sutures come out follow up appointment
VP shunt failure s/s
rapid onset of vomiting
severe headache
irritability
lethargy
HA
seizures
bloating
over-draining s/s
nausea, dizziness, HA
Spinal cord injuries
-complete vs incomplete
-compression / shearing
-inflammation cause
complete spinal cord injury
irreversible loss of all sensory, motor, autonomic fxn below level of injury
incomplete spinal cord injury
varying degree of sensory, motor, autonomic fxn below level of injury
compression injury
loss of reflexes or movement
inflammation causes
ischemia in area –> necrosis
number one cause of peds spinal injuries…
MVC accidents
-not wearing seatbelts
-wrong car seat size
spinal cord complications
-impaired respirations : diaphragm paralysis
-autonomic dysreflexia
-scoliosis
-DVT
-pressure ulcer
-hip instability!!!
autonomic dysreflexia
increased BP
flushed face
HA
distended neck veins
decrease HR
sweating
why does autonomic dysreflexia typically occur…
distended bladder
constipation
pressure ulcer
**tx includes fixing the cause
spinal cord nursing care
- airway : O2, trach, intubate
- nutrition : TPN, G-tube, NG tube
- bowel / bladder : stool softener, straight cath, routine
- skin : early ambulation, repositioning
- promote independence
cerebral palsy
- congenital = brain damage before birth
- acquired = brain damage after birth
**muscle growth is limited d/t spasticity affecting bone growth, has varying degrees of contractures
spastic CP
difficulty moving just one side, just legs, or all limbs
**most common
athetoid CP
difficulty controlling movements
ataxic CP
problems with balance / coordination
mixed CP
can include any or all of the types of CP
congenital CP risks
- maternal infections
- placental abnormalities
- multiples
- LBW
- asphyxia at birth
- meconium aspiration
acquired CP risks
- bacterial meningitis
- severe jaundice
- anoxic injury after brith
CP development…
delayed in physical development
-sitting
-rolling
-walking
-speech
-crawling
CP clinical care
supportive therapies
-sustain fxn of where they are
-airway support - cannot expand diaphragm well
-nutrition - feed however we can
muscular dystrophy
muscular weakness and decrease in muscle tone overtime
**progressive degeneration of skeletal muscle
becker MD
around age 12
-progressive weakness in pelvis and legs
fascioscapulohumeral MD
weakness of shoulders and face muscles
-LEAST debilitating
-occurs later in life
duchenne MD
most rapid form
-dx before 6 yrs
-death in 20s d/t cardiac or resp failure
duchenne MD patho
passed from mother –> male
-lack of dystrophin (muscle protein)
-Gower’s sign
Gower’s sign
child uses hands to push on legs and stand
dystrophin
muscle protein located on skeletal muscle and X chromosome, when we don’t have enough = muscle deconstruction
osteogenesis imperfecta
“brittle bone disease”
-genetic defect in collagen produced in bones
osteogenesis imperfecta s/s
-multiple frequent fractures
-blue sclera!!
-short stature
-thin, soft skin
-weak muscles
-altered joint flexibility
-delayed walking
osteogenesis imperfecta dx
US - dx in utero
DEXA- bone density scan
X-rays
**can be mistaken for abuse with multiple fracture hx
osteogenesis imperfecta care
maximize independence
maximize mobility
minimize fractures
osteogenesis imperfecta diet
needs to be high in vitamin C, D, calcium
surgical stabilization osteogenesis imperfecta
used to prevent bowing of legs during growth
what is something to think about for BP and osteogenesis imperfecta…
take them manually!!
**prevents overinflation of cuff and breaking of bones
juvenile arthritis
begins as early as 2 yrs
genetic
**ankle, knees, hips affected
**typically bilateral pain
juvenile arthritis labs
CBC
rheumatoid panels
CRP - inflammation indicator
juvenile arthritis care
pain control
-aleve, naproxen, methotrexate
nutrition
uveitis - inflammation of iris
delayed puberty
child abuse risks
- young parents
- domestic violence
- parental mental health
- substance abuse
- families w/ premature or chronically ill pts
- ODD / ADHD parents
- sexual abuse from parental figure
unintentional abuse
could be from lack of education
ex : neglect
intentional abuse
physical abuse, typically seen to late, sexual abuse
**strong alliance to abuser
physical abuse s/s
-accident prone
-inconsistency w/ story
-redirecting blame on sibling / visitor
-delay in seeking medical tx
-uncommon injury sites
-hypervigilance
sexual abuse
-genital complaints
-difficulty walking / sitting
-stained clothing
-inappropriate sexual behavior
-excessive / public masturbation
-drawing sexual actions
most common fracture in physical abuse
spiral fracture of femur = twisting motion
**every spiral fracture needs to be looked at as abuse
non-specific behaviors
change in appetite, demeanor, mood, sleep are common
neglect behaviors
-poor hygiene
-clothes do not match weather
-developmental lag
-hunger and fatigue
-unattended medical needs
