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Nursing 250-255 > PEDS test 2 -again ! > Flashcards

PEDS test 2 -again ! Flashcards

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1
Q

MRI is used with Cerebral palsy (CP) why?

A

to look for structral abnormalities in the brain, this is preferred to a CT.

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2
Q

Do all people with CP have a lowered IQ?

A

NO

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3
Q

Drugs for spasticity and how they are given

A

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)

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4
Q

When assessing a 6 month old for CP, what would you look for?

A

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

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5
Q

Diagnostics for menigits

A

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 +

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6
Q

Vaccine for menigits

A

Menigocococcal polysaccharide for children 2 and older

quad meningococcal conjugate for ages 11-55

HIB for all children starting at 2 months.

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7
Q

How is bacterial menigits spread?

A

Droplet/airborne

need to be in isolation

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8
Q

You will see petechiae in what menigits?

A

Classic- menigococchal

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9
Q

How do you rate pain with hydrocephalus pts?

A

FLACC

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10
Q

How do you know a VP shunt is failing?

A

If there is an obstruction the child will usually present with increased ICP, usually with worsening neurologic status.

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11
Q

clinical signs of hydrocephalus in an infant

A

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

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12
Q

untreated hydrocephalus

A

frontal enlargemnt, or bossing

depressed eyes

setting-sun sign (sclera visible above the iris)

pupils sluggish, with unequal response to light

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13
Q

what is measure with myelomeingocele?

A

head circumference

at risk for hydrocephalus

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14
Q

How to prevent infection pre-op with myelomeningocele?

A

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

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15
Q

what kind of bladder is associated with myelomeningocele?

A

neurogenic - retain their urine.

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16
Q

how can myelomeningocele be prevent? and how is it detected intrauterine?

A

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

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17
Q

with myelmeningocele, the higher the defect the….. and the lower the defect the…

A

greater problems there will be

less problems there will be

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18
Q

There is a latex allergy seen in spina bifida (myelomeningocele) pts, why?

A

because of repeated exposure to it during surgiers and mutliple catherizations (due to the common s.e of neurogenic bladder)

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19
Q

allergic reactions to latex range from..

A

urticaria, wheezing, watery eyes, and rashes to anaphlactic shock,

need a LATEX FREE environment

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20
Q

non-communication or obstructive hydrocephalus

A

due to obstruction to the flow of CSF through ventricle system (tumor or clot)

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21
Q

communication or nonobstructive hydrocephalus

A

no blockage but CSF stillnot draining properly

usually due to obliteration of the subarachnoid cisterns or malfunction of the arachnoid villi

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22
Q

excessive secretions hydrocephalus

A

rarely, a tumor of choroid plexuz causes increased CSF secreations.

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23
Q

Ventriculoperitoneal (VP) shunt for hydroceph

A

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.

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24
Q

VA shunt

A

not as commone, can cause dysrrythmias, heart problems, stroke –it goes right to cardio system

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25
Q

hypotonicity with down’s

A

need to be swaddled when feeding, it will take 2-3x longer to feed them due to protruding tongue.

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26
Q

characteristics of downs children

A

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

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27
Q

preop for cardio surgery

A

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.

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28
Q

post op cardio surgery

A

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.

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29
Q

signs of Dig toxicity

A

nausea, vomiting, anorexia, bradycardia, dysrhythmias

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30
Q

esophageal atresia(EA) with tracheoesophageal fistula (TEF)

A

rare malformation that results from failed seperation of esophagus and trachea by the 4th week of gestation

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31
Q

Clinical signs of TEF

A

Couging, Choking, Cyanosis = 3 C’s

apnea, increased resp distress after feedings, abd distention, excessive salvation and drooling.

32
Q

EA is a surgical emergency

A

maintain airways, prevent pneumonia, gastric or blind ouch decompressiong and surgical repair

33
Q

When EA/TEF are suspect in infant

A

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

34
Q

hypercyanotic spells, blue spells, or Tet spells

A

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

35
Q

treating tet spells

A

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

36
Q

rheumatic fever occurs after

A

beta-hemolytic streptococcal pharyngitis

37
Q

most significant complication of rheumatic fever

A

cardiac valve damange

most commonly the mitral valve

may need valve replacement later on in life

38
Q

Jones Critera

A

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

39
Q

Carditis (jones criteria)

A

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)

40
Q

What titer is elevated with RF?

A

antistreptolysin O (ASO or ASLO)

41
Q

Is use of ASA (aspirin) okay for RF?

A

yes, for joint pain

42
Q

Kawasaki is treated with?

A

IVIG and Aspirin, high does at first, then the dose lowers

at risk for cardiac problems - coronary artery aneurysms

43
Q

Defects with decreased Pulmonary blood flow

A

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

44
Q

Tetralogy of fallot

A

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

45
Q

Defects with increased pulmonary blood flow

A

left side has a higher pressure then the right side

left to right shunting

ASD and patent ductus arterious are typical anomalies

46
Q

Obstructive defects

A

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

47
Q

mixed defects

A

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

48
Q

most commone type of hemophilia

A

antihemophilic factor(AHF) - deficiency of factor VIII - classic - hemophilia A

the less AHF found, the more serious the disease.

49
Q

RICE for hemophilia

A

Rest, Ice, Compression, and Elevation.

teach to parents and children so that can start treatment immediately when bleeding occurs

50
Q

If bleeding in the joints (hemarhrosis) occurs too often, what can occur?

A

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.

51
Q

what kind of sports should hemophiliacs be involved in>

A

noncontact sports - swimming, walking, jogging, tennis, golf, fishing, and bowling.

use of protective equipment (padding, helmets) is important.

52
Q

With RF and <3 problems you should do what before dentist?

A

pre-medicate, always inform dentist of health history

53
Q

What do you do for phototherapy?

A

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.

54
Q

when is a cardiac cath contraindiacted?

A

if there is severe diaper rash (usually go through femoral)

or rhinitits - watch for signs of infection - dont do it there is one.

55
Q

characteristics of a child in the acute phase of kawasaki

A

high fever that is unresponsive to ABX and anitpyretics, the child is very irritable, signs of CHF start to appear

56
Q

what is abnormal to find on the dressing after a cardiac cath?

A

bleeding

57
Q

Children with downs..

A

will be floppy, are prone to congenital heart disease, have an xtra chromosome

intervene as soon as possible when downs is suspected.

58
Q

Its important to check what about the toys of a cognitively impaired child?

A

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

59
Q

Patent ductous arterious

A

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.

60
Q

Drugs for heart failure

A

Dig and lasix

watch for dig tox - nasuea, vomit, bradycardia

61
Q

pre-op heart defect surgery

A

patient is sent home to await surgery, teaching is done mostly outside of hospital.

parents taught to watch for tachycardia and dyspnea

62
Q

Diet for AGN ?

A

low sodium

corn on cob, chicken, apple, milk

63
Q

common food allergies

A

wheat, milk, eggs

64
Q

what is a sign of poor oxygenation

A

clubbing, cyanosis

65
Q

pre and post op myelomeningocele

A

pre - cover with saline soaked, nonadherent dressing

post - pain (flacc), I&O and head circumferenc

at risk for hydrocepalus and neurogenic bladder

66
Q

use what kind of pain scale for a 3 year old?

A

faces scale - wong/baker

67
Q

what med for RF?

A

penicillin

ask mom about recent sore throat

68
Q

signs of nephrotic syndrome

A

child is well but steadlidy gaining weight, appearing edematous, and then becoming anorexic, irritable, and less active

69
Q

child with nephrotic syndrome should be roomed with what kind a patient?

A

A patient that is well - so a femur break

70
Q

nursing priority for menigits

A

admin ABX as prescribed

24 hours after intital dose, not infectious anymore, can be out of isolation.

71
Q

s/s of nonbacterial (aseptic) meningitis

A

headache, fever, malaise, and GI symptoms

72
Q

how phototherapy works

A

the flourescent light promotes bilirubin excretion by photoisomerization. which alters the structure of bilirubin to a soluble form (lumirubin) for easier secretion

73
Q

how to know if mom understood d.c teaching for child with DM?

A

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

74
Q

how do toddlers perceive death?

A

as being temporary

75
Q

how to demonstrate bone marrow aspiration with a 5 year old..

A

show the procedure on a doll

Nursing 250-255 (6 decks)

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