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test 3 Flashcards

1
Q

general difficulty or deficiency

A

cognitive impairment ot intellectual disability

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2
Q

how to dx cognitive impairments

A

must have 2 functional impairments

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3
Q

nursing care for impaired cognitive function

A

early intervention
teach child self care skills
promote optimal development
encourage play and exercise
establish discipline
strict sexual code of conduct in adolescents

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4
Q

down syndrome statistics

A

age 35: risk 1 in 350 births
age 40: risk 1 in 100 births

trisomy 21 in 95% cases

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5
Q

clinical manifestations of down syndrome

A

small head with upward slant eyes
flat nasal bridge
protruding tongue
hypotonia muscles
low set ears

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6
Q

physical problems with down syndrome

A

congenital heart disease
hypothyroidism
leukemia

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7
Q

therapeutic management for down syndrome

A

surgery to correct congenital anomalies
evaluation of hearing and sight
testing for thyroid function periodically
preventing of AAI- instability of cervical spine
ear infections common, greater risk for resp infections due to shorter tubes

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8
Q

Fragile X syndrome

A

second most common genetic cause of cognitive impairment

caused by abnormal gene on the lower end of the long arm of the X chromosome

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9
Q

fragile X manifestations

A

large head circumfence
long narrow face with prominent jaw
protrude ears
large testicles
cognitive impairment
hyperactivity
hypersensitivity to taste, sounds, touch
aggressive behaviors
autistic like behaviors

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10
Q

Fragile X ther management

A

tegretol/prozac for behaivoral control
stimulants for hyperactivity
early intervention

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11
Q

turner syndrome

A

only affects girls
missing a portion or all of the X chromosome

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12
Q

turner syndrome manifestations

A

short stature
difficulty with PO intake, reflux
webbed neck
low set hairline
heart defects (coartion of aorta)
renal and endocrine dysfunction
nonfunctional ovaries

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13
Q

nursing interventions for turner syndrome

A

baseline EKG
estrogen for puberty development
growth hormone for growth
nutrional guidance

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14
Q

common ototoxic drug

A

lasix

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15
Q

hearing impairment manifestations in infancy

A

lack of startle reflux
absence of reaction to auditory stimuli
absence of well formed syllables by age 11 months
general indifference to sounds
lack of response to spoken word

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16
Q

hearing impairment manifestation in childhood

A

deafness is likely to be dx in infancy but if not then when entry into school

abnormalities in speech development
learning disabilities

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17
Q

promoting communication for hearing impairments

A

lip reading - make sure you face them when speaking
cued speech
sign language
speech language therapy
socialization
hearing aids
cochlear implants
surgery

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18
Q

what hearing loss can cochlear implants be used in

A

sensory neural

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19
Q

common disorders causing visual impairments

A

sickle cell disease
juvenile rheumatoid arthritis
tay-sachs disease

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20
Q

myopia

A

nearsightedness

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21
Q

hyperopia

A

farsightedness

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22
Q

strabismus

A

Crossed eye or eye deviation

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23
Q

amblyopia

A

Lazy eye. One eye is worse than other

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24
Q

vision impairment management

A

provide a safe environment
orient child to surroundings
encourage independence

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25
Q

preventing visual impairments

A

rubella vaccine
prevent eye injuries
screen all children

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26
Q

autism spectrum disorders (ASDs)

A

complex neurodevelopment disorders accompanied by social and communication alterations

many different types

more common in boys

caused by not immunizing, and genetics

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27
Q

ASDs manifestations and dx

A

peculiar and bizarre characteristics primarily in specific areas:
socialization
communication
behavior
difficulty with eye and body contact
language delay

dx usually around 2-3 years

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28
Q

ASDs care management

A

no cure for autism

provide structured environment
use some improvements with language skills
decrease unacceptable behaivor

resource for family= autism society of america

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29
Q

common first sign of increased ICP

A

change in LOC

Pay attention to the early signs so you can intervene quickly and prevent any neurological compromise.

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30
Q

manifestations of increased ICP in babies

A

remember they cant tell you how they feel

setting sub sign- looks like the sun setting, bulging eyes
tense, bulging fontanelles
distended scalp veins
suture may be separated in skull
irritabiliy
poor feeding
difficult to soothe, cry

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31
Q

manifestations of increased ICP in children

A

headache
forceful vomiting
seizures
dizziness, lethargy
diminished physical activity
inability to follow simple commands

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32
Q

late signs of increasing ICP

A

vital sign changes- bradycardia
decreased motor response
decreased sensory response to painful stimuli
alterations in pupil size and reactivity
extension/flexion posture
decreased consciousness
coma

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33
Q

positions you may see after a head injury or infection that was not treated quickly

A

Decorticate posturing
Decerebrate posturing

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33
Q

glasgow coma

A

The Glascow Coma Assessment is a 3-part assessment focusing on eye opening, verbal response, and motor response.
The highest score attainable is 15.
A score of 8 usually signifies a coma, and a 3 is the worst possible score.

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34
Q

Decorticate posturing

A

arms flexed inwards, feet plantar flexed

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35
Q

Decerebrate posturing

A

wrist flexed outward

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36
Q

DX for increased ICP

A

cultures/lab test to find the issue
EEG to assess seizures
lumbar punctures for CSF
CT for concussions, MRI for bleeds/clots, Xray for skull fractures
evoked potentials

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37
Q

emergency management of unconscious child

A
  1. airway
  2. reduction of ICP
  3. treatment of shock
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38
Q

pain in comatose child

A

Pain is exhibited by agitation and rigidity in the comatose child, so we may give analgesics prn.
Remember that ICP can increase due to pain–this is why it’s important to keep pain under control.

vitals may change in response to pain. Pay attention to the vitals as part of your pain assessment.
- increase in HR, RR, BP
-decrease in o2

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39
Q

indications for ICP

A

glasgow coma scale score of less than 8
TBI with abnormal CT scan
deteriorating neuro condition
subjective judgement regarding clinical appearance and response

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40
Q

preventing ICP

A

prevent anything that would irritate a person
avoid neck vein compression
provide alternation pressure mattress
elevate HOB at 30 degrees
only suction if needed

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41
Q

meds for increased ICP

A

ABX for infections
corticosteroids for inflammation
sedatives, anti-seizures, paralytics

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42
Q

concussion

A

alteration in neuro or cognitive function with or without loss of consciousness

short lived and reversible. typically resolves in a week

generally followed by amnesia and confusion

dx with CT

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43
Q

contrecoup

A

bruising at a site far removed from point of impact in brain

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44
Q

basilar fracture

A

most concerning fracture
Some kind of fracture in base of skull. Worried about infection, meningitis. Give abx for prophylaxis

s/s
battle sign- bruising behind ears
raccoon eyes
CSF leak

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45
Q

head trauma for ER

A

severe injuries
loss of consciousness
prolonged/continues seizures

Nothing admin orally at first in case of surgery and aspiration risk

hematoma s/s can take 24 hours to develop. wake child up frequently to assess

assess vitals, pupils, nuero status, LOC

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46
Q

submersion injury (near drowning)

A

Typically hospitalize for 24 hours even if they seem fine

CPR at scene
hypoxia, aspiration, hypothermia common

frequent complication is aspiration pneumonia

prognosis <5 mins is best predictor

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47
Q

bacterial meningitis

A

more concerning than viral

acute inflammation of meninges and CSF

DROPLET PRECAUTIONS

decreased incidence of Hib and PCV vaccine. MCV vax at age 11/12 and before college

most commonly caused by: neisseria meningitis

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48
Q

symptoms, dx, tx of bacterial meningitis

A

fever, headache, nuchal rigidity

dx by lumbar puncture

treated by isolation IV ABX, isolation precuation, control temp and seizures, restrict hydration

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49
Q

aspetic/viral meningits

A

dx by CSF

onset may be abrupt or gradual

manifestations- headache, fever, malaise

tx is symptomatic

give ABX until we know for sure its not bacterial

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50
Q

what can cause seizures

A

underlying disease such as tumor, brain injury, etc

if unknown- epilepsy

51
Q

partial seizure

A

local onset
small part of brain

52
Q

general seizure

A

involves both hemispheres without local onset
full body jerking

53
Q

absence seizures

A

abrupt onset
“day dreaming”

54
Q

management of seizures

A

goal- control seizures or reduce frequency
correct the cause

management- drug therapy
ketogenic diet- no carbs
vagus nerve stimulation
surgery as last resort

time them
nothing in mouth
side laying position

5 mins or longer give meds

55
Q

seizure precautions

A

padding, o2, suction, HOB raised

56
Q

hydrocephalus

A

caused by imbalance in the production and absorption of CSF

treatment- ventriculoperitoneal shunt
this stays in forever

57
Q

causes of hydrocephalus

A

result of developmental defects
often associated with myelomeningocele

other causes neoplasms, infection and trauma

58
Q

shunt infection

A

greatest risk 1-2 months after shunt placement

treated by massive dose abx or shunt removal

can do external ventricular drain instead (EVD)

59
Q

external ventricular drain (EVD)

A

External shunt needs monitored hourly and needs to be at ear level
Abx can be directly put in head if infection

60
Q

reticulocytes

A

immature red blood cells. If retic count is increasing, we are increasing RBC, key marker in sickle cell, as well as hemolytic

61
Q

how does RBC work in body

A

RBC carry oxygenated hemoglobin to body and deoxygenated blood back to lungs. Production of RBC stimulated by erythropoietin and tissue hypoxia

62
Q

what is anemia defined by

A

low RBC/low hbg

this is a symptom, not a diagnosis on its own

63
Q

three classifications of anemia

A

decreased RBC production
Increased RBC loss
Increased RBC destruction

64
Q

what may cause decreased RBC production

A

nutritional deficiency
bone marrow failure

65
Q

what may cause increased RBC loss

A

acute blood loss

66
Q

what may cause increased RBC destruction

A

intracorpuscular
extracorpusclar

67
Q

consequences of anemia

A

in mild cases, children usually adapt.

hemodilution
decreased peripheral resistance
increased cardiac circularion and turbulence
cyanosis
growth retardation

68
Q

hemodilution

A

Occurs when there is less RBC when there should be. Body needs to work harder to ensure circulation, increasing cardiac workload can produce a murmur

69
Q

iron deficiency anemia

A

caused by inadequate dietary supplement of iron

more prevalant in premies, milk babies/toddlers, or multi fetal babies

treated by increasing iron consumption

can use iron drops in between meals- but they could stain teeth

70
Q

what drug can cause a drug induced anemia

A

cephalosporins

71
Q

sickle cell anemia

A

abnormal hemoglobin S, making it difficult to hold on to oxygen. it is an autosomal recessive disorder, common in areas where malaria is common

there are multiple types. the worst is hbgSS

Sickled cells block blood flow, they are hard. They increase inflammation and cause Vaso inclusion, causing local hypoxia and tissue death over time

dx by newborn blood smear

72
Q

complications of sickle cell

A

*acute chest syndrome
*Vaso inclusive crisis
*CVA
*Splenic sequestration
pain
abdominal pain
hematuria
hepatomegaly
avascular necrosis
retinopathy
death

73
Q

acute chest syndrome

A

clustering in chest, pulmonary infiltrate. Similar to pneumonia symptoms. Pts will need O2, fluids. Use incentive spirometer. Treat with analgesics

74
Q

vaso inclusive crisis

A

mild to severe pain from sickling. Most common in arms, legs, chest, or flank area. Most commonly occurs when dehydrated. Priority is bolus fluids and pain meds.

75
Q

splenic sequestration

A

too many sickled cells get trapped in spleen causing splenomegaly. Damage is caused to spleen. This is a medical emergency. These patients typically get there spleen out by 6 if this constantly occurs

76
Q

sickle cell management

A

prevent sickling, hydration, rest, analgesics, abx, blood replacement.

encourage vaccines.

penicillin used for prophylactic. monitor for bacterial infections

transcranial doppler yearly to assess stroke risk

if fever- treat asap, give abx

do not do blood transfusions unless hgb at 7 or 8

77
Q

Why do we not want to constantly do blood transfusions in SCD

A

risk for reaction

78
Q

exchange transfusions for SCD

A

replacing bad sickle cells with normal RBC

79
Q

What is the only possible cure for SCD

A

stem cell trasnplant, but there are a ton of complications so its not done often

80
Q

hydroxyurea for SCD

A

a chemotherapy that reduces bone marrow production but in recovery we found it increases production of hemoglobin F (fetal), which is less likely to sickle. This drug has caused a significant reduction in mortality, acute chest syndrome, vasoinclusive. Does come with a increase risk of leukemia and bone marrow suppression. Oral chemo, allows for much better quality of life overall

81
Q

Hemophillia

A

a group of hereditary bleeding disorders that result from deficiencies of specific clotting factors. It could be type A or B

usually it is X linked recessive, so it is more common in boys.

treated by replacing missing clotting factors, using damopressin, and aminocaproic acid.
severe cases will have scheduled factor replacements

avoid NSAIDs in these kids

82
Q

hemophillia dx

A

history of bleeding episodes

low levels of factor VIII or IX
prolonged PTT

platelet count is normal. This is not a platelet issue.

83
Q

hemophillia management

A

Want kids to stay active and strengthen muscles around joints, but also prevent any bleeding
avoid contact sports
genetic counseling

84
Q

immune thrombocytopenia

A

immune system mistakenly attacks the platelets.
this could be acute or chronic, but its typically acute

it typically follows upper resp infections or other infections

85
Q

clinical manifestations of immune thrombocytopenia

A

platelets under 20,000
petechiae, ecchymoses, bleeding, hemathoris, hemataemesis

normal bone marrow with increased number of immature platelets or eosinophils

make sure to rule out other disorders where thrombocytopenia is preset, like leukemia, lymphoma

86
Q

management of immune thrombocytopenia

A

primary supportive
Often started on prednisone and IVIG which helps recovery time

if becomes chronic and body doesn’t response well to treatment, spleen may need removed

87
Q

IVIG vs anti D for immune thrombocytopenia

A

IVIG- liquid concentrate of antibodies from the plasma of healthy blood donors. Which will help overwhelm spleen and increase platelets. Premed them with Tylenol and Benadryl as we would with a normal blood product

Anti D antibody may be used instead of IVIG because it is cheaper. It does help increase platelet count by targeting RH factor on RBC, so the spleen focuses on RBC not platelets. We cant use this on RH- blood type

88
Q

epistaxis

A

nose bleeds
common in childhood
could be due to underlying disease

bleeding usually stops within 10 minutes after nasal pressure. apply pressure to soft lower part of nose and lean forward.

keep child calm. agitation causes increased BP which could create more blood flow

89
Q

HIV/AIDS transmission prevention

A

can be transmitted by risky behavior or from mother to child

HAART therapy prevents perinatal transmission

90
Q

pediatric HIV/AIDS manifestations

A

lymphadenopathy, oral candidiasis, hepatosplenomegaly, diarrhea, FTT, developmental delay

91
Q

severe combined immunodeficiency disease (SCID)

A

AKA bubble boy infection

absence of immunity. body is constantly ill

treated with donor bone marrow, IVIG, prophylaxis

key is to prevent infections.

Without a bone marrow or stem cell transplant, this is a poor prognosis

92
Q

what to do for blood transfusions

A

Frequent vitals. Done before blood products, then 15 mins in.
Any reaction needs product to be stopped, or slowed down

Will be given in a pump on floor so its given safely

give tylenol and benadryl each time to prevent reactions

93
Q

early signs of cancer

A

unusal mass/swelling
unexplained loss of energy and pallor
bruising
pain
fever prolonged
headaches with vomiting
vision changes
weight loss

94
Q

what does lumbar puncture look at

A

looks for anything that metastasizes in CNS

95
Q

cancer dx

A

labs- CBC, LFTs, coagulation, urinalysis

lumbar puncture, bone marrow aspiration/biopsy

CT, MRI, PET

surgery

96
Q

how do children get chemo

A

thru central lines

We can not due it in peripheral lines because it will burn there tissues, peripheral IVs don’t last as long as central lines

97
Q

3 phases of therapy (primarily for leukemia)

A

induction
intensification
maintence therapy

98
Q

induction chemo

A

4-5 weeks, begins immediatly
We want to get them less than 5% of those bad cells, once they do, they are in remission and move to intensification

we want to see how chemo is responding before we proceed more

99
Q

intensification therapy

A

chemo periodically over 6 months

high doses, lots of side effects

100
Q

maintence therapy chemo

A

to perserve remission
weekly or monthly CBCs needed
treatment usually stops after 2-3 years
monitor for relapse

lower dose, less side effects

goal is for a 5 year remission for cure

101
Q

biggest chemo concern

A

infection

Look at ANC count. We want it to be at least 500. if lower, use protective precautions. Use masks, hand washing, etc.
monitor for fevers, septic shock

102
Q

what to do if chemo kid has fever

A

drawl blood cultures immediately, start broad spectrum Abx. One good one is vancomycin- but it has a lot of side effects

102
Q

neutropenia precautions

A

avoid fresh fruits/veggies unless they can be pealed. No flowers in room

103
Q

chemo side effects

A

hemorrhage due to low platelets
anemia
nausea and vomitting
altered nutrition
mouth ulceration
constipation
hemorrhagic cystitis
alopecia
foot drop
jaw pain

104
Q

chemo side effect care

A

no platelet transfusion unless actively bleeding
no blood transfusion unless hgb under 7
zofran, benadryl or ativan for n/v
let them eat whatever they want- lots of calories, protein, fat
use stool softeners
keep shoes on to prevent foot drop
analgesics for any pain
increase fluids
dont give bladder toxic chemo at night

105
Q

what NSAID do we not use in oncology kids

A

ibuprofen- bleed risk

106
Q

graft vs host disease (GVHD)

A

most common complication of stem cell transplant

The new graft rejects the old host, presents as rash. We like to see a little of this as it means the graft can fight, but sometimes the graft gets too aggressive and attacks the GI tract. Monitor liver labs, it can cause severe liver damage. We have meds to treat and prevent this

107
Q

cancer health promotion

A

still need basic health care aside from oncologist
no live vacccines, only inactivated
get varicella immune globulin instead of vax

108
Q

leukemia

A

unrestrcited proliferation of immature WBC. these WBC dont fight anything.

ALL is most common

most common in toddler white boys

s/s- fever, pallor, fatigue, anorexia, hemorrhage, bone and joint pain.

leads to infection, anemia, bleeding

dx by peripheral blood smear, lumbar puncture, bone marrow aspiration/biospy

109
Q

what to do if cancer is over blood brain barrier

A

Chemo does not pass blood brain barrier. If the cancer has, then they need intrathecal chemo

110
Q

when is CNS prophylactic therapy used

A

in high risk children to reduce the risk of leukemic cells taking over the CNS

111
Q

what leukemia can a bone marrow transplant help

A

ALL
AML

112
Q

what male body part is resistant to chemo and could lead to relapse

A

testes

113
Q

hodgkin disease

A

Nodules on lymph nodes. Found quicker, better success rates

presence of abnormal reed-sternberg lymphocyte cell

more prevalent in children age 15-19

typically painless
may have enlarged cervical or supraclavicular lymphadenopathy
cough, abdominal discomfort, anorexia may be present

accurate staging is basis for tx and prognosis

114
Q

non hodgkin disease

A

reed sternburg cell not present
more prevalant in children under 14

Lower success rate as its harder to diagnose. No nodules, typically metastasizes.
Symptoms similar to those of TB: fever, anorexia, weight loss, night sweats

115
Q

brain tumor

A

most common solid tumor in chlidren

s/s depends on location
may be headache, hydrocephalus, vomiting, nystagmus, ataxia, dysarthia, DI, growth failure

116
Q

brain tumor management

A

We don’t know how bad the brain tumor is until we go to surgery. Imaging doesn’t show what its pressing on. We do surgery quickly then do chemo

Don’t lay the child on side of head where surgery is- brain damage could be caused

do frequent nuero checks

117
Q

neuroblastoma

A

IN ADRENAL GLAND. develops from embroyonic nerual crest cells (these help in the womb)
commonly dx in infancy

most common extracranial solid tumor

diagnosis is often made after metastais occurs

surgery needed to remove as much as possible, chemo

younger age=better survival rate

118
Q

neuroblastoma s/s

A

firm, non tender mass that goes across abdomen, resp obstruction, paralysis, periorbital edema, supraorbital ecchymosis, neuro impairment

119
Q

osteosarcoma

A

most common bone tumor

common in lower extremites on growth plate

peak age: 15 year male

surgery to for biopsy and to save or amputate limb
chemo to decrease tumor size

120
Q

osteosarcoma management

A

We don’t know how bad it is until we get in there. We must tell them prior to surgery about the potential of amputation

goal is to save bone

121
Q

wilms tumor

A

kidney tumor.
s/s- painless nontender swelling/mass on one side, deep in flank area

common in toddler/preschool age

dx by ultrasound, CT, MRI, CBC, UA

122
Q

wilms tumor management

A

1 nursing priority before surgery is to not palpate this mass

You can do ultrasound, but if you do firm palpation you could release the cancer cells throughout body

chemo is done for a year after surgery. this cancer has a great outcome and short treatment plan

surgery will be done soon after cancer found

123
Q

rhabsomyosarcoma

A

cancer of soft tissue sarcoma.
can be in any soft tissue- muscle, organs, etc

s/s depends on site of tumor

dx by PET/CT, MRI, biopsies, LP

multimodal therapy demonstrates high survival in nonmetastatic disease

124
Q

retinoblastoma

A

cancer arises in retina

s/s- white glow in pupil, strabismus, blindness

concern for secondary tumor

goal is to avoid loss of vision in eye

management- chemo, surgical implantation iodine for radiation, photocoagulation, cryotherapy

peds (4 decks)

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