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Critical Care Pediatics > Peds Neuro > Flashcards

Peds Neuro Flashcards

1
Q

drowning

A

only takes enough water to cover nose and mouth

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2
Q

near drowning / submersion injury

A

aspirated water damaging lung surfactant causing lung damage

**leads to hypoxia

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3
Q

drowning physical concern

A

hypoxia –> anoxia –> cerebral edema –> concern

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4
Q

what happens when drowning…

A

panic –> sporadic motion –> aspiration –> laryngospasm –> hypoxia

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5
Q

laryngospasms

A

causes bronchoconstriction limiting further aspiration

**when pulled out earlier it causes less fluid overload

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6
Q

hypothermia

A

occurs faster in water than in air , need to know the amount of time in the water

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7
Q

hypothermia s/s

A

depend on temp of water
length of time submerged
initial scene treatment

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8
Q

what to do when finding drowning victim on scene…

A

immediate CPR w/o pulse or breathing

**those in water for only 5-10 min have a better prognosis

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9
Q

what to do for drowning victim in hospital….

A
  1. airway
  2. HYPERoxygenation
  3. rewarming
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10
Q

passive external rewarming

A

take off wet clothes
blankets
increase room temp

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11
Q

active external rewarming

A

warm blanket
heating pads
radiant heat
warm bath
forced warm air

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12
Q

active internal warming

A

endovascular rewarming
peritoneal / pleural irrigation

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13
Q

drowning prevention education

A

constant observation - includes bathtime
fencing, pool alarm, floaties
ripcurrents
adult drinking @ beach / pool
swim lessons

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14
Q

normal intracranial pressure

A

15-20 mmHg

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15
Q

early increased intracranial pressure s/s

A

poor feeding
vomiting
irritability
lethargy
headache
sunsetting eyes!!
visual disturbance
dizziness / vertigo

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16
Q

IICP in infants

A

irritability
bulging fontanelle!!
wide sutures
dilated scalp veins
high pitch cry

**has early signs PLUS this

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17
Q

IICP late signs

A

significant decrease in LOC
seizures
fixed / dilated pupils, papilledema
cushing’s triad

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18
Q

cushing’s triad

A

increased systolic BP and wide pulse pressure
bradycardia
irregular respirations

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19
Q

IICP traumatic

A

MVA
GSW
anoxia
abuse : causing swelling and bleeding - shaking baby

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20
Q

IICP autonomic

A

hydrocephalus
tumors
infection
seizures
hypoxia

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21
Q

avoid these with IICP…

A

lumbar punctures may lead to herniation

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22
Q

hydrocephalus / IICP tx

A

VP shunt : drains excess CSF to belly
-monitor ICP, pain level, LOC, behavior, vitals

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23
Q

hydrocephalus shunt education

A

infection
failure
malfunction
DO NOT press on shunt post op
sutures come out follow up appointment

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24
Q

VP shunt failure s/s

A

rapid onset of vomiting
severe headache
irritability
lethargy
HA
seizures
bloating

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25
Q

over-draining s/s

A

nausea, dizziness, HA

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26
Q

Spinal cord injuries

A

-complete vs incomplete
-compression / shearing
-inflammation cause

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27
Q

complete spinal cord injury

A

irreversible loss of all sensory, motor, autonomic fxn below level of injury

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28
Q

incomplete spinal cord injury

A

varying degree of sensory, motor, autonomic fxn below level of injury

29
Q

compression injury

A

loss of reflexes or movement

30
Q

inflammation causes

A

ischemia in area –> necrosis

31
Q

number one cause of peds spinal injuries…

A

MVC accidents
-not wearing seatbelts
-wrong car seat size

32
Q

spinal cord complications

A

-impaired respirations : diaphragm paralysis
-autonomic dysreflexia
-scoliosis
-DVT
-pressure ulcer
-hip instability!!!

33
Q

autonomic dysreflexia

A

increased BP
flushed face
HA
distended neck veins
decrease HR
sweating

34
Q

why does autonomic dysreflexia typically occur…

A

distended bladder
constipation
pressure ulcer

**tx includes fixing the cause

35
Q

spinal cord nursing care

A
  1. airway : O2, trach, intubate
  2. nutrition : TPN, G-tube, NG tube
  3. bowel / bladder : stool softener, straight cath, routine
  4. skin : early ambulation, repositioning
  5. promote independence
36
Q

cerebral palsy

A
  1. congenital = brain damage before birth
  2. acquired = brain damage after birth

**muscle growth is limited d/t spasticity affecting bone growth, has varying degrees of contractures

37
Q

spastic CP

A

difficulty moving just one side, just legs, or all limbs

**most common

38
Q

athetoid CP

A

difficulty controlling movements

39
Q

ataxic CP

A

problems with balance / coordination

40
Q

mixed CP

A

can include any or all of the types of CP

41
Q

congenital CP risks

A
  1. maternal infections
  2. placental abnormalities
  3. multiples
  4. LBW
  5. asphyxia at birth
  6. meconium aspiration
42
Q

acquired CP risks

A
  1. bacterial meningitis
  2. severe jaundice
  3. anoxic injury after brith
43
Q

CP development…

A

delayed in physical development

-sitting
-rolling
-walking
-speech
-crawling

44
Q

CP clinical care

A

supportive therapies
-sustain fxn of where they are
-airway support - cannot expand diaphragm well
-nutrition - feed however we can

45
Q

muscular dystrophy

A

muscular weakness and decrease in muscle tone overtime

**progressive degeneration of skeletal muscle

46
Q

becker MD

A

around age 12
-progressive weakness in pelvis and legs

47
Q

fascioscapulohumeral MD

A

weakness of shoulders and face muscles
-LEAST debilitating
-occurs later in life

48
Q

duchenne MD

A

most rapid form
-dx before 6 yrs
-death in 20s d/t cardiac or resp failure

49
Q

duchenne MD patho

A

passed from mother –> male
-lack of dystrophin (muscle protein)
-Gower’s sign

50
Q

Gower’s sign

A

child uses hands to push on legs and stand

51
Q

dystrophin

A

muscle protein located on skeletal muscle and X chromosome, when we don’t have enough = muscle deconstruction

52
Q

osteogenesis imperfecta

A

“brittle bone disease”
-genetic defect in collagen produced in bones

53
Q

osteogenesis imperfecta s/s

A

-multiple frequent fractures
-blue sclera!!
-short stature
-thin, soft skin
-weak muscles
-altered joint flexibility
-delayed walking

54
Q

osteogenesis imperfecta dx

A

US - dx in utero
DEXA- bone density scan
X-rays

**can be mistaken for abuse with multiple fracture hx

55
Q

osteogenesis imperfecta care

A

maximize independence
maximize mobility
minimize fractures

56
Q

osteogenesis imperfecta diet

A

needs to be high in vitamin C, D, calcium

57
Q

surgical stabilization osteogenesis imperfecta

A

used to prevent bowing of legs during growth

58
Q

what is something to think about for BP and osteogenesis imperfecta…

A

take them manually!!

**prevents overinflation of cuff and breaking of bones

59
Q

juvenile arthritis

A

begins as early as 2 yrs
genetic

**ankle, knees, hips affected

**typically bilateral pain

60
Q

juvenile arthritis labs

A

CBC
rheumatoid panels
CRP - inflammation indicator

61
Q

juvenile arthritis care

A

pain control
-aleve, naproxen, methotrexate

nutrition
uveitis - inflammation of iris
delayed puberty

62
Q

child abuse risks

A
  1. young parents
  2. domestic violence
  3. parental mental health
  4. substance abuse
  5. families w/ premature or chronically ill pts
  6. ODD / ADHD parents
  7. sexual abuse from parental figure
63
Q

unintentional abuse

A

could be from lack of education

ex : neglect

64
Q

intentional abuse

A

physical abuse, typically seen to late, sexual abuse

**strong alliance to abuser

65
Q

physical abuse s/s

A

-accident prone
-inconsistency w/ story
-redirecting blame on sibling / visitor
-delay in seeking medical tx
-uncommon injury sites
-hypervigilance

66
Q

sexual abuse

A

-genital complaints
-difficulty walking / sitting
-stained clothing
-inappropriate sexual behavior
-excessive / public masturbation
-drawing sexual actions

67
Q

most common fracture in physical abuse

A

spiral fracture of femur = twisting motion

**every spiral fracture needs to be looked at as abuse

68
Q

non-specific behaviors

A

change in appetite, demeanor, mood, sleep are common

69
Q

neglect behaviors

A

-poor hygiene
-clothes do not match weather
-developmental lag
-hunger and fatigue
-unattended medical needs

Critical Care Pediatics (4 decks)

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