Peds_Exam3_Notes Flashcards
1
Q
- 4 things you would assess in osteomyelitis
- Factors that associate iwth SCFE x3
- What would you find in assessment DDH
A
- unable to move extremity, severe pain, fever, redness/swelling
- obesity, hormonal changes, endocrine disorders
- asymmetry of gluteal and thigh folds
2
Q
- Osteosarcoma, side effects of neutropenia?
- Assessments for compartment syndrome
- Sprains involve
A
- risk for infection
- pain, pulses, cap refill, pain meds
- ligament/joint
3
Q
- Where does a sprain cause damage?
- What is a strain?
- MGMT of sprain/strains
A
- blood vessels, muscles, tendons nerves
- microscopic tear to the muscle, similar features to sprain
- Ice, 20 min q 2-3 hours for 1st 48 hrs., elevate
4
Q
- Medications for sprain/strain
- What is the maximum amount of meds for this you can take
- torus/buckle fractures are characterized by..
A
- motrin, advil (10mg/kg/dose),
- 600 mg every 6 hours, 2.4 gm/day
- bulging of the cortex
5
Q
- What does a torus fracture resemble?
- Where do the 5P’s occur in a fracture?
- Early signs of compartment syndrome?
A
- torus or base of a pillar
- distal to the site of the fracture
- edema, numbness, tingling, pain,
6
Q
- What is a late sign of compartment syndrome?
- Causes of compartment syndrome?
- Ischemia and compartmanet syndrome
A
- weak pulse
- tight casts, skin traction, hemorrhage, trauma, burns, surgery
- deformity, muscle fibrosis, contracture, paralysis
7
Q
- Traction where legs are in extended position, skin traction
- uses skin traction onthe lower leg, padded sling under the knee
- Golden rule of calling physician
A
- Buck’s
- Russell’s
- do assessment first
8
Q
- Complication of osteomyelitis
- What bones are affected with osteomyelitis
- Treatment for Avascular Necrosis
A
- infection can rupture thru cortex into the subperiosteal space, stripping loose periosteum and forming abscess
- Long bones (tibia, femur)
- Bone Graft, Total Joint Replacement
9
Q
- Symptoms of SCFE
- Restrictions of SCFE
- How do you Dx SCFE
A
- continuous, intermittent pain in the hip, groin, front of thigh or knee.
- Internal rotation on adduction and external deformity with loss of abduction
- X-ray
10
Q
- How will child lay with SCFE
- Tx for SCFE
- Is legg Valve bilateral or unilateral
A
- lower extremity flexed, abducted, externally rotated b/c of intense pain
- pinning, non weight bearing, rest, PCA, cruch walking
- both
11
Q
- Onset of SCFE
- This is a disturbance of circulation to the femoral capital epiphysis producing an ischemic aseptic necrosis of femoral head
- 4 Stages of Leg Calve
A
- continuous pain in the hip
- Leg Calve
- avascular, fragmentation, reparative, regenerative
12
Q
- Tx of LCP
- This is a spinal deformity that occurs in 3 planes
- What does scoliosis do to ribs?
A
- Abduction casts, pelvic/fem osteotomy, leather harness sling, traction, surgical reconstruction
- Scoliosis
- assymmetry
13
Q
- What does scoliosis do to the thoracic cage?
- When does scoliosis occur congenital
- When does scoliosis occur in infantile
A
- hypokyphosis
- fetal development
- birth - 3 years
14
Q
- When does juveline scoliosis occur
- When does scoliosis occur in adolescents
- What is the Adam’s Test?
A
- 4-10 years of age
- during growth spurt, MOST COMMON
- Scoliometer
15
Q
- Definitive Dx of Scoliosis
- Treatment of osteogenesis
- Juvenile idiopathic arthritis
A
- Xrays using Cobb technique
- bone marrow transpant, -dronate drugs, splints, rods, genetic counseling
- inflammation of synovium, fibrosis of cartilage, ankylosis of joints, adhesion btwn joints
16
Q
- Goals for JIA
- What are SAARDS used for?
- Diagnosis of DDH
A
- prevent deformity and preserve function
- Slower acting antirheumatoid drugs for JIA
- asymmetrical of the gluteal and thigh folds, limited hip abduction, ortolani/Barlow maneuvers, xrays, ultrasound
17
Q
- tx for DDH
- tx for club foot
- What is important to watch for club foot
A
- pavlik harness, spica casting
- serial casting after birth, surgery, pin fixations, achills tendon lengthening
- skin and circulation
18
Q
- tx for subluxation of radial head
- most common site for osteosarcoma
- MGMT of osteosarcoma
A
- applying firm pressure to the head of the radius
- femur
- surgery, foot salvage, chemo, amputation (body image)
19
Q
- obtunded
- Signs of hydrocephalus and ICP
- Febrile Seizure
A
- falling asleep, needs to be shaken to respond
- high pitched cry
- could have another one, acetominphen when ill, do not require seizure meds
20
Q
- First procedure for dx meningitis
- braind damage with closed head injury
- Where is lumbar puncture inserted
A
- send spinal fluid and blood cultures to the lab
- decreased perfusion to brain, increased metabolic needs to brain
- between 3rd and 4th lumbar vertebrae.
21
Q
- Neurological exam
- Unilateral fixed pupils
- Dilated/non reactive pupils
A
- LOC, Alert, Verbal Pain, Unresponsibe, Glascow Coma score, Pupils, Motor sensory, reflex, gait, cranial nerves
- lesion on the same side
- hypothermia, anoxia, ischemis, poisoning w/ atropine like sub
22
Q
- pinpoint pupils
- Widely dilated & reactive
- widely dilated fixed pupils
A
- brainstem dysfunction, poisoning (barbiturate or opiate)
- after a seizure, may be one sided
- paralysis of CN III, secondary from herniation thru tentorium
23
Q
- Bilateral fixed pupils
- Conjugate pupils
- Absent pupil response indicates
A
- brainstem damage if present more than 5 minutes
- movement of the eyes direction opposite the head rotation (doll’s head maneuver)
- dysfunction of brainstem or CNIII
24
Q
- Full consciousness
- Confusion
- Disorientation
A
- awake, alert, oriented to time, place person behavior appropriate for age
- impaired decision making
- confusion w/ time, place, decreased LOC
25
Q
- Lethargy
- obtundation
- stupor
A
- limited spontaneous movement, sluggish speech, drowsy, failling asleep
- arousable w/ stimulation
- deep sleep, slow response to stimulation, moaning
26
Q
- Coma
- PVS
- 3 components of glascow coma scale
A
- no motor or verbal response, extension posturing to painful stimuli
- permanent loss of of cerebral cortex
- eye opening, verbal response, motor response
27
Q
- Causes for ICP x3
- Signs of Increased ICP
- What Cushing’s triad?
A
- increased brain mass, increased cerebral blod volume, obstruction of CSF
- Cushing’s triad
- inc systolic BP, bradycardia, irregular respers (dec)
28
Q
- What is a risk for ICP
- prevention of ICP
- In hydrocephalus, where does impaired absorption of CSF occur
A
- brain herniation
- group activities, avoid crying or painful activity, place child in comfortable position, minimize noise, lights down, quiet music
- subarachnoid space,
29
Q
- Signs in the eyes of hydrocephalus
- What might you see in craniosyntosis
- What is a concussion
A
- setting sun eyes, unequal response to light, sluggish pupils
- papilledema, optic atrophy, blindness
- altered mental status after head injury (confusion, vomiting), diffuse axonal injury
30
Q
- What happens with brainstem herniation
- Brainstem and Medulla oblongata injuries
- Pediatric differencees in head injuries
A
- Cessation of life
- affect breathing/circulatory center, fixed pupils (vitals fluctuated)
- lg blood volume to the brain, small subdural spaces, soft/thin tissue, vulnerable to acceleration/decceleration injury
31
Q
- 3 Major causes of brain damage?
- Linear Skull fracture
- Depressed Skull fracture
A
- falls, motor vehicle accident, bikes
- do not cross suture lines
- fragments pushed inward, bone is broken locally
32
Q
- What is a comminuted skull fracture
- Open skull fracture
- The cervical plexus c1-c4 innervates?
A
- multiple associated linear fractures
- increased risk for CNS infection, communication w/ URI
- necka nd diaphragm
33
Q
- Brachial plexus c4-t1
- Lumbosacral plexus L1-s4
- Prognosis for spinal cord inury child vs adult
A
- shoulders, chest, arms
- Lower trunk and legs
- better in children b/c rapid healing, inc nervous sys regeneration
34
Q
- Nursing care SCI
- Causes for seizures
- What is an atonic seizure?
A
- Skin, PT, neurogenic bladder, bowel training, remobile
- head trauma, tumors, metabolic, infection, toxins
- loss of muscle tone, falls, drop attacks
35
Q
- Classification ofr a myoclonic seizure?
- Infantile Spasms?
- When does febrile seizure occur?
A
- Generalized
- generalized
- happens at Peak temp rather than the rapidity of temp elevation
36
Q
- What is the post ictal period
- What procedure is done with first seizure
- What are the demographics for migraine headaches?
A
- ialtered state of consciousness after epileptic seizure. Lasts between 5 and 30 minutes
- Lumbar Puncture
- boys, 10-14 years
37
Q
- What is a migraine headache
- Migrain with aura
A
- release polypeptides cause pain and vasodilation of cranial vessels
- visual, tingling of lips face, throbbing, N/V, photophobia
38
Q
- Migrain without aura
- Tx for migraines in ED
- Name some CNS infections
A
- personality change, appetite, thirst, N/V, pallor
- IV fluids, rest, toradol, zofran, benadryl
- Meningitis (bacterial, Aseptic), Encephalitis
39
Q
- What vaccination has alleviated bacterial meningitis
- Pathogens in bacterial meningitis
- Pathogen in neonatal meningitis
A
- HiB, Pneumococcoal.
- Streptococcus pneumoniae, neisseria meningidis
- Broup B Streptococci, gram negative bacilli
40
Q
- S/Sx of Meningitis in neonates?
- S/Sx of Meningitis in infants
- Children adolescents
A
- refuse feeding, poor sucking, Vomiting, diarrhea, poor tone, weak cry,, bulgin fontanel
- fever, nuchal rigidity, seizures,
- abrupt, agitation
41
Q
- Prognosis for Meningitis
- Outcomes of bacterial meningitis
- How is MENINGOCOCCEMIA spread?
A
- 10-15% of bacterial meningitis are fatal
- hearing loss, brain damage, learning disability
- oral or nasal droplet
42
Q
- Prognosis for meningococcemia?
- Incubation period
- Sx of on bacterial meningitis
A
- death can occur within hours
- 2-10days
- headache, fever, malaise, & GI