The Pediatric Patient v2 Flashcards
Hydrocephalus
Characterized by an increase in cerebrospinal fluid (CSF) within the ventricles of the brain:
Causes pressure changes in the brain
Increase in head size
Results from an imbalance between production and absorption of CSF or improper formation of ventricles
Patient with Hydrocephalus Most commonly acquired by
An obstruction (such as a tumor, or as a sequela of infections (encephalitis or meningitis))
A sequelae of infection
Perinatal hemorrhage
Symptoms depend on
Site of obstruction
Age at which it develops
Hydrocephalus classification are….
Noncommunicating
Communicating
Communicating
CSF is not obstructed in the ventricles but is inadequately reabsorbed in the subarachnoid space
Noncommunicating
Obstruction of CSF flow from the ventricles of the brain to the subarachnoid space
Diagnosis
of Hydrocephalus
Transillumination (the inspection of a cavity or an organ by passing a light through its walls – is a simple diagnostic procedure useful in visualizing fluid. A flashlight with a sponge rubber collar is held tightly against the infant’s head in a dark room. The examiner observes for areas of increased luminosity. A small ring of light is normal, but a large halo effect is not. The child’s head is measured daily.)
Echoencephalography (computed tomography (CT) scanning, and magnetic resonance imaging (MRI) are used to visualize the enlarged ventricles and to identify the area of obstruction.)
CT scan
MRI
Ventricular tap or puncture (A ventricular tap or puncture may be performed, using a sterile technique, to determine the pressure and to drain CSF. The equipment needed is the same as that for a lumbar puncture. A specimen is labeled and sent to the laboratory for analysis.)
Treatment of
Hydrocephalus
Medications to reduce production of CSF
Surgery to place a shunt : Ventriculoperitoneal Shunt
Shunt acts as a focal spot for infection and may need to be removed if infections persist
The use of acetazolamide and furosemide reduces the production of CSF and may provide some relief, but most often surgery is indicated
Manifestations of Hydrocephalus
Increase in size of head- classical sign
Cranial sutures separate to accommodate enlarging mass
Scalp is shiny
Preoperative
nursing care of hydrocephalus
Frequent head position changes to prevent skin breakdown; head must be supported
Head must be supported at all times while being fed.
Measure head circumference along with other vital signs
Postoperative care nursing care of hydrocephalus
Assess for signs of increased intracranial pressure.
Protect from infection.
Depress shunt “pump” as ordered by surgeon.
Position dependent on multiple factors.
Assess and provide for pain control.
Parent Education of hydrocephalus
Teach signs that indicate shunt malfunction may be occurring and when to “pump” the shunt by pressing against the valve behind the ear, and the need for multidisciplinary follow-up care.
Signs of shunt malfunction in an older child can include:
- Headache
- Lethargy
- Changes in LOC
Intracranial Hemorrhage
Most common type of birth injury May result from trauma or anoxia Occurs more often in preterm infants Whose blood vessels are fragile May also occur during precipitate delivery or prolonged labor
SX/S of intracranial hemorrhage
Signs and symptoms vary depending on severity:
- poor muscle tone
- lethargy
- poor sucking reflex
- respiratory distress
- cyanosis
- twitching
- forceful vomiting
- high-pitched, shrill cry
- convulsions
manifestation of intracranial hemorrhage
Possible Location: Subdural Subarachnoid Intraventricular The fontanelle may be tense and under pressure rather than soft and compressible. The pupil of one eye is likely to be small (constricted) and the other large (dilated). If the symptoms are mild, most patients have a good chance of complete recovery. Death results if there is a massive hemorrhage.
The infant who survives an extensive hemorrhage may suffer residual effects, such as intellectual impairment or cerebral palsy.
Intracranial Hemorrhage Diagnostic Testing
History of the deliver CT scan MRI Evidence of an increase in ICP symptoms and course of the disease.
Intracranial Hemorrhage Treatment
Incubator Environment Elevate Head Consider Vitamin K Phenobarbital Prophylactic antibiotics Vitamins Feeds stable Sucking reflex May Vomit easily
Intracranial Hemorrhage Nursing Interventions
Perform Neuro checks Monitor: VS Increased ICP Convulsions Measurement of HC (head circumference) Palpating Fontanelles Assist with procedures Lumbar punctures Aspiration of subdural hemorrhage
Meconium aspiration syndrome (MAS) manifestation
-prolonged labor post term fetal hypoxia decreased fetal movement slowing of FHR, weak, irregular decrease in short term variability meconium stained fluid low Apgar scores
magnesium toxicity antidote
calcium gluconate
Meconium aspiration syndrome (MAS)
In utero
Fetus expels meconium into amniotic fluid.
Cord compression or other condition interrupts fetal circulation.
If asphyxia or acidosis occurs, fetus may have gasping movements that cause meconium-stained amniotic fluid to be drawn into the lungs.
At delivery
Can occur if newborn inhales before nose and mouth have been suctioned
Respiratory Distress secondary to MAS
PE Findings Tachypnea Nasal flaring Expiratory Grunting Retractions Labored breathing with prolonged expiration Cyanosis Decreased breath sounds
Nursing Interventions
of Meconium Aspiration Syndrome (MAS)
Nursing Interventions
Maintain adequate oxygenation Chest X-ray Provide mouth and skin care Prepare for antibiotics only as indicated Suction only as needed gently Remember neonates are obligate breathers
Infant of Diabetic Mother
Large amounts of glucose are transferred to fetus
Causes fetus to become hyperglycemic
Fetal pancreas produces large amount of fetal insulin
Leads to hyperinsulinism along with excess production of protein and fatty acids; often results in an LGA newborn weighing 9 lb (4082 g) or more (macrosomia)
