unit 4 Flashcards
respiratory insufficiency
increased work of breathing
respiratory failure
can’t maintain adequate oxygenation
respiratory apnea
no breathing for over 20 sec
respiratory arrest
complete cessation of breathing
away obstruction
blockage/aspiration of foreign body
asphyxiation
drowning/covering a child’s head with a plastic bag
signs of respiratory distress
nasal flaring
retractions
wheezing
bradycardia/pnea
decr LOC
cyanosis
indicators of choking
universal choking sign
weak, ineffective cough
high-pitched sound
dyspnea
cyanosis
respiratory nursing care
maintain airway
respiratory support
suction
CPR/RRT
asphyxiation (drowning)
submersion injury
drowning (at least 1” of water)
prevention is key
BRUE
(Brief Resolved Unexplained Event)
sudden event where infant has apnea, color change, muscle change, altered LOC
if BRUE occurs
prep for additional testing
monitor for recurrence
encourage CPR
BRUE labs/diagnostics?
blood culture, urine culture
CBC, glucose, electrolytes
EKG, EEG, MRI, sleep study
poisoning
ingestion/exposure to toxic substance
substances causing poisoning?
acetaminophen
aspirin (acetylsalicylic acid)
supplemental iron
hydrocarbons
corrosives
lead
foreign body ingestion
risk factors for poisoning?
under 6yr
improperly stored substances
exposure to toxins
lead ingestion
what do you need to know about poisons?
name and location
amount ingested
time of ingestion
labs to look at for poison?
CBC
ABGs
electrolytes
toxicology screening
poisoning problems?
N/V/D
respiratory distress
pain
burns around mouth
nursing care for poisoning?
notify poison control
continuous monitoring
antidotes
antidote for acetaminophen
N-acetycystenine
antidote for aspirin
activated charcoal
gastric lavage
sodium bicarb
vit K
oxygen
antidote for iron
emesis/lavage
chelation therapy
antidote for hydrocarbon
DONT induce vomiting
treat chemical pneumonia
intubation before gastric decontamination
antidote for corrosives
DONT induce vomiting
airway maintenance
analgesics
antidote for lead
chelation therapy
antidote for foreign body
imaging
scope out
pass through stool
causes of lead poisoning
ingestion
inhalation
placental transfer
what does lead poisoning cause
hematologic (anemia)
neurological (behavior changes)
blood levels with lead poisoning
WNL = <5 (education)
>45 (chelation therapy)
complications due to lead poisoning
developmental delays
learning disabilities
decrease growth
fatigue
seizure
Reyes syndrome
swelling of the brain and liver
(acute encephalopathy + organ involvement)
reyes syndrome risk factors
small children
use of aspirin
treatment for Reyes syndrome
intubation
neuro/seizure precautions
bleeding precautions
assess liver
prevention of childhood poisoning
proper hygiene
child proof home
avoid taking meds/calling meds any infront of children
non-mercury thermometers
no food in lead based containers
no lead paint
when should infant reflexes disappear?
moro: 4-6mo
Babinski: 12mo
Tonic: 3-4mo
protective: 3-5mo
neuro assessment
cranial nerves
LOC
VS
pupils
motor function
posture
reflexes
Cushing’s triad
bradycardia
HTN
irregular respirations
(late sign of ICP=potential brainstem herniation)
interventions for increased intracranial pressure
head to midline(reduce jugular compression)
minimize suction (gag reflex)
elevate HOB
VS
LOC
cluster care
medications
symptoms of increased intracranial pressure in infants
bulging fontanel
separated sutures
Mac Ewen sign (hollow sound when tapping= extra fluid)
symptoms of increased intracranial pressure in children
N/V
HA
seizures
sleeping lethargy
inability to follow commands
what is the Glasgow Coma Scale
determine LOC
(lower score=deeper coma)
causes of head injury/trauma in children
falls
motor vehicle accident
bicycle/sports
Pathology of head injuries
most common/mild of traumatic brain injury
concussion
alteration of neuro/cognitive function (with or without LOC) after injury
-confusion & amnesia
-sport related
contusion/laceration
bruising/tearing of vertebral tissue (CT/MRI)
-weakness
-prolong unconsciousness
-paralysis
permanet scaring/disability
skull fracture monitoring
-CSF leak
-CNS infection
-incr ICP
-nose/ear bleeding
-glucose changes
skull fracture assessments
-tissue swelling
-hematoma (boggy)
-raccoon eyes
-skin laceration
skull fracture nursing interventions
-airway support
-bed rest
-HOB elevated
-head in midline position
-side rails up
-seizure precaution
-pad hard surfaces
-restraints
no nare suction, could go into brain
what should be done after a head injury
stabilize Childs spine till spinal cord injury is rules out
epidural hemorrhage
hemorrhage between dura and skull
less likely in kids under 2
arterial blood
epidural hemorrhage monitoring
dangerous symptom free period, then rapid decline
-opposite side affected
-decr DTR, and weakness
-brain herniation/death
Subdural hemorrhage
hemorrhage where dura still attached to skull
venous blood
under 2yr
occurs slowly then spreads
-irritability
-vomiting
-bulging frontal
-seizure
cerebral edema
occur with all craniocerebral traumas
-peak 24-72hr
monitor for ICP 1-2days
brain herniation
downward shift of brain through foramen magnum
-cushing triad (HTN<bradycardia)
Hydrocephalus
imbalance of production/absorption of CFS
-increased CFS in brain
causes of hydrocephalus
defects
sunset eyes
bulging fontanel
dilated scalp veins
Macewen sign
treatment of hydrocephalus
removal of obstruction
VP shunt (lateral ventral to peritoneal cavity)
nursing care of hydrocephalus
daily head circumference
s/s of ICP
neuro assessment
assess for infection
occult tube defects
dark hair
dark birth mark over spinal cord
dimpling
meningocele tube defects
covering of spinal cord affected
myelomeningocele tube defects
everything involved
neuro problems
laminectomy
removal of vertebral arch & closure of defect
seizure
abnormal excessive neuro activity in the brain
Partial seizure
part of the brain affected
(one sided)
-simple seizure
-complex seizure
generalized seizure
whole brain affected
(both sides)
-absence (sensory, smell something others dont)
-tonic-clonic (jerking)
-myoclonic
-atonic
seizure brain damage
over 30 min
call 911 after 5min
diastat
rectal/intranasal
stop/prevent seizure
ketogenic diet
75% fat
20% protein
5% carbs
status epilepticus
seizure over 30 min
not recovered baseline LOC
phenobarbital
phenytoin
receive via D and folic acid
deficiencies
phenobarbital
drop IQ
phenytoin
gum hyperplasia
febril seizure
tonic-clonic with fever > 100.4
resolve within 15 min
