PEDS test 2 -again ! Flashcards
MRI is used with Cerebral palsy (CP) why?
to look for structral abnormalities in the brain, this is preferred to a CT.
Do all people with CP have a lowered IQ?
NO
Drugs for spasticity and how they are given
Dantrolen sodium, baclofen [Lioresal], and diazepam [valium] - given orally or through NG (if child has one)
Botulinum toxin A (Botox) is injected into a selected muscle ( commonly the qudriceps, gastrocnemius, or medial hamstrings)
When assessing a 6 month old for CP, what would you look for?
failure to meet any developemental milestones such as rolling over, raising head, sitting up, crawling
presisten primitive reflexes such as moro, atonic neck
poor head control (head lag( and clenched fists
pushing away or arching back; stiff posture
floppy or limp body posture, especially when sleeping
using only one side ofbody, or only arms to crawl
feeding difficulties
extereme irritability or crying
failure to smile
Diagnostics for menigits
Lumbar puncture for testing of the CSF - the pressure is measure and samples are obtained for cututre, gram stain, blood count, and determination of glucose and protein
the fluid will be cloudy if +
Vaccine for menigits
Menigocococcal polysaccharide for children 2 and older
quad meningococcal conjugate for ages 11-55
HIB for all children starting at 2 months.
How is bacterial menigits spread?
Droplet/airborne
need to be in isolation
You will see petechiae in what menigits?
Classic- menigococchal
How do you rate pain with hydrocephalus pts?
FLACC
How do you know a VP shunt is failing?
If there is an obstruction the child will usually present with increased ICP, usually with worsening neurologic status.
clinical signs of hydrocephalus in an infant
EARLY- rapid head growth, bulding fontanels, dilated scalp veins, seperated sutures, thinning skull bones
GENERAL- irritablity, lethary, infant is more calmwhen not being held, normal expected responses fail to appear
untreated hydrocephalus
frontal enlargemnt, or bossing
depressed eyes
setting-sun sign (sclera visible above the iris)
pupils sluggish, with unequal response to light
what is measure with myelomeingocele?
head circumference
at risk for hydrocephalus
How to prevent infection pre-op with myelomeningocele?
protect the sac- infant does not wear any clothes or covers laying in prone position, legs are kept in sbduction with a pad between knees to counteract hip subluxation, and a small roll is placed under the ankles to maintain a neutral foot position
what kind of bladder is associated with myelomeningocele?
neurogenic - retain their urine.
how can myelomeningocele be prevent? and how is it detected intrauterine?
If mothers take folic acid before they concieve and during pregnancy.
It occurs with 1st month
can be picked up on US
or by elevated alpha-fetoprotein
with myelmeningocele, the higher the defect the….. and the lower the defect the…
greater problems there will be
less problems there will be
There is a latex allergy seen in spina bifida (myelomeningocele) pts, why?
because of repeated exposure to it during surgiers and mutliple catherizations (due to the common s.e of neurogenic bladder)
allergic reactions to latex range from..
urticaria, wheezing, watery eyes, and rashes to anaphlactic shock,
need a LATEX FREE environment
non-communication or obstructive hydrocephalus
due to obstruction to the flow of CSF through ventricle system (tumor or clot)
communication or nonobstructive hydrocephalus
no blockage but CSF stillnot draining properly
usually due to obliteration of the subarachnoid cisterns or malfunction of the arachnoid villi
excessive secretions hydrocephalus
rarely, a tumor of choroid plexuz causes increased CSF secreations.
Ventriculoperitoneal (VP) shunt for hydroceph
placement of a shut that provides primary drainage of the CSF from the ventribles to an extracranial compartment, usually the peritoneum.
most have a ventricular catheter, a flush pump, a unidirected flow valve, and a distal catheter.
All valves are designed to open at a perdetermined intraventricle pressue and close whne the pressure falls below that level.
VA shunt
not as commone, can cause dysrrythmias, heart problems, stroke –it goes right to cardio system
hypotonicity with down’s
need to be swaddled when feeding, it will take 2-3x longer to feed them due to protruding tongue.
characteristics of downs children
lows set ears, flat bridge of nose, square hands and feet, straight lines on palms, square head, flat footed
can’t cough due hypotonicity - risk for aspiration
preop for cardio surgery
teaching usually done at home or in clinic setting, may include a tour or ICU
younger children should be prepared close in time to the event, older children and adolescents may benefit from teaching several weeks in advance
info-techniques - verbal and written info, hosp tours, peoperative classes, picture books, or videos
Let them know what they will see (monitors, many people , lots of equip), hear (beepings noises, alrams, voices), and feel (lines and dressings, tape, discomfort, thirst) after the procedure.
post op cardio surgery
VS and BP done frequently until stable
heart rate and resps done for a full min and compared to monitor
observe cardiac rhythm, report any irregularites
at least hourly, ausculate lungs for breath sounds. diminished or absent may indicate atelactasis, pleural effusion or pneumothorax.
temp changes are common and may go to 100(37,7) in first 24-48 hours, and increase after that time is most likely a sign of infection, need immediate attention.
signs of Dig toxicity
nausea, vomiting, anorexia, bradycardia, dysrhythmias
esophageal atresia(EA) with tracheoesophageal fistula (TEF)
rare malformation that results from failed seperation of esophagus and trachea by the 4th week of gestation
Clinical signs of TEF
Couging, Choking, Cyanosis = 3 C’s
apnea, increased resp distress after feedings, abd distention, excessive salvation and drooling.
EA is a surgical emergency
maintain airways, prevent pneumonia, gastric or blind ouch decompressiong and surgical repair
When EA/TEF are suspect in infant
take off oral intake, start and IV, place in position least likely to cause aspiration of either mouth or stomach secreations.
removal of secreations from the mouth and upper pouch require frequent or continuous suction.
often put on a broad spectrum ABX
hypercyanotic spells, blue spells, or Tet spells
infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasms decreases pulmonary blood flow and increases right- to- left shunting.
occur suddenly, often in the mornging and may be preceded be feeding, crying, defecation, or stressful procedures
treating tet spells
place infant in knee-chest position
employ calm, comforting approach
admin 100% oxygen by blow-by
give morphine subQ or through exisiting IV line
begin IV fluid replacement and volume expansion if needed
repeat morhpine admin
rheumatic fever occurs after
beta-hemolytic streptococcal pharyngitis
most significant complication of rheumatic fever
cardiac valve damange
most commonly the mitral valve
may need valve replacement later on in life
Jones Critera
suggests that the presence of two major manifestations or one major and two minor manigestations, such as fever and arthralgia, with supportive evidence of recent strep infection, indicates a high probability of RF
Carditis (jones criteria)
tachycardia out of proportion to degree of fever
cardiomegaly
new murmurs or change in preexisting murmurs
muffled heart sounds
pericardial friction rub
chest pain
changes in electrocardiogram ( prolonged PR interval)
What titer is elevated with RF?
antistreptolysin O (ASO or ASLO)
Is use of ASA (aspirin) okay for RF?
yes, for joint pain
Kawasaki is treated with?
IVIG and Aspirin, high does at first, then the dose lowers
at risk for cardiac problems - coronary artery aneurysms
Defects with decreased Pulmonary blood flow
pressure on the right side increases, exceeding left-sided pressure.
desaturated blood shunts right to left. causing desaturation in the left side of the heart in systemic circulation
Tetralogy of fallot, tricuspid atresia are the common anomalies
Tetralogy of fallot
includes 4 defects: VSD, pulmonic stenosis, overriding aorta, and right ventricular hypertropy
may have tet spells
at risk for emboli, seixures, and loss of consciousness or sudden death following an anoxic spell
Defects with increased pulmonary blood flow
left side has a higher pressure then the right side
left to right shunting
ASD and patent ductus arterious are typical anomalies
Obstructive defects
blood exiting heart meets and area of stenosis, causing obstruction to blood flow
coarctation of the aorta (narrowing of the aortic arch), aortic stenosis, and pulmonic stenosis are typical defects
exhibit signs of CHF
mixed defects
hemodynamically, fully saturated systemic blood flow mixes with the desaturated pulmonary blood flow, causing a relative desaturation of the system blood flow
transportation of great vessels, total anomalous pulmonary venous connection, truncus arteriosus, hypoplastic left heart syndrome
most commone type of hemophilia
antihemophilic factor(AHF) - deficiency of factor VIII - classic - hemophilia A
the less AHF found, the more serious the disease.
RICE for hemophilia
Rest, Ice, Compression, and Elevation.
teach to parents and children so that can start treatment immediately when bleeding occurs
If bleeding in the joints (hemarhrosis) occurs too often, what can occur?
limitation of motion, bone and muscle changes occur that result in flexion contractures and joint fixation
Teach to do ROM after that bleeding episode
Diet control - being over weight can cause strain on the joints, calories need to be supplied in accordance with energy requirments.
what kind of sports should hemophiliacs be involved in>
noncontact sports - swimming, walking, jogging, tennis, golf, fishing, and bowling.
use of protective equipment (padding, helmets) is important.
With RF and <3 problems you should do what before dentist?
pre-medicate, always inform dentist of health history
What do you do for phototherapy?
cover their eyes, have them nude with just a diaper, count stools, feed q2-3 (remove eye shields when feeding), reposition frequently to expose all body surfaces, check bilirubin q6-12 hrs, laps should be no less then 18in away from infant.
when is a cardiac cath contraindiacted?
if there is severe diaper rash (usually go through femoral)
or rhinitits - watch for signs of infection - dont do it there is one.
characteristics of a child in the acute phase of kawasaki
high fever that is unresponsive to ABX and anitpyretics, the child is very irritable, signs of CHF start to appear
what is abnormal to find on the dressing after a cardiac cath?
bleeding
Children with downs..
will be floppy, are prone to congenital heart disease, have an xtra chromosome
intervene as soon as possible when downs is suspected.
Its important to check what about the toys of a cognitively impaired child?
saftey of the toys
toys should be approriate for their development age
sensorimotor skills toys - musical mobiles, stuffed toys, water play, floating toys, a rocking chair or horse, a swing, bells, and ratlles - sensorimotor play may last longer then usual.
encourage outings with them to develop social skills
Patent ductous arterious
left to right shunt
increase vascular congestion
machinery-like murmur, widened pulse pressure and bounding pulse result from runoff of blood from the aorta to the pulmonary artery.
Drugs for heart failure
Dig and lasix
watch for dig tox - nasuea, vomit, bradycardia
pre-op heart defect surgery
patient is sent home to await surgery, teaching is done mostly outside of hospital.
parents taught to watch for tachycardia and dyspnea
Diet for AGN ?
low sodium
corn on cob, chicken, apple, milk
common food allergies
wheat, milk, eggs
what is a sign of poor oxygenation
clubbing, cyanosis
pre and post op myelomeningocele
pre - cover with saline soaked, nonadherent dressing
post - pain (flacc), I&O and head circumferenc
at risk for hydrocepalus and neurogenic bladder
use what kind of pain scale for a 3 year old?
faces scale - wong/baker
what med for RF?
penicillin
ask mom about recent sore throat
signs of nephrotic syndrome
child is well but steadlidy gaining weight, appearing edematous, and then becoming anorexic, irritable, and less active
child with nephrotic syndrome should be roomed with what kind a patient?
A patient that is well - so a femur break
nursing priority for menigits
admin ABX as prescribed
24 hours after intital dose, not infectious anymore, can be out of isolation.
s/s of nonbacterial (aseptic) meningitis
headache, fever, malaise, and GI symptoms
how phototherapy works
the flourescent light promotes bilirubin excretion by photoisomerization. which alters the structure of bilirubin to a soluble form (lumirubin) for easier secretion
how to know if mom understood d.c teaching for child with DM?
can she proper admin insulin and take blood glucose
does she know to watch for infections and eye problems
know to taek glocuse source when travel
how do toddlers perceive death?
as being temporary
how to demonstrate bone marrow aspiration with a 5 year old..
show the procedure on a doll
