Unit 5: Nursing care of High-Risk Infant Flashcards
Condition with inappropriate degree of inattention, impulsiveness, and hyperactivity
ADHD
Average age of ADHD onset
7 years old
2 Criteria for Diagnosing ADHD
6 or more symptoms of (1) Hyperactivity-Impulsiveness
present for at least 6 months or
(2) Inattention present for at least 6 months
to an extent that is disruptive and
inappropriate for developmental level.
Does not like quiet activities Fidgets and Squirms Unlimited Talking Constant motion Cannot Sit Still Dashes and Touches Everything
These are symptoms of _________
Hyperactivity
Blurts Inappropriate Comments Acts without thinking of consequences No emotional restraint Difficulty waiting Aggressive/Unruly Interrupts Conversations...Impatient
Are Symptoms of ________
Impulsivity
Forgetful Easily Distracted Looses important things Avoids Effort Not following instructions Does not listen
Are Symptoms of________
Inattention
2 Types of ADHD
Predominantly Inattentive Type
Predominantly Hyperactive-Impulsive Type
Aka Rabbit Type ADHD
Predominantly Hyperactive-Impulsive Type
Aka Pooh Type ADHD
Predominantly Inattentive Type
The client has poor impulse control, difficulty sitting still, and is fidgeting or squirming. What is the type of ADHD?
Predominantly Hyperactive-Impulsive Type
or
Rabbit Type
The client is inattentive, sluggish, slow-moving, unmotivated, daydreamer
Predominantly Inattentive Type
or
Pooh Type
Behavior Disorder
Antisocial Disorder
Developmental Disorder
Disruptive Behavior Disorder
Oppositional Defiant Disorder
Conduct Disorder
6 Classifications of ____
ADHD
Preservatives Artificial Food Coloring Genetics Environment Sugar and Coffee
Are etiologies for ____
ADHD
Wellbutrin
Effexor
Tricyclic Depressants
Pamelor
Intuniv
Catapres/Tenex
Strattera
7 Drugs for Treating______
ADHD
Few Simple Rules/Firm Limits
Avoid Fatigue/Overstimulation
REgular Daily Routine
Structured Environment
Treatment Plan for _____
ADHD
1st Line of treatment for ADHD
Methlyphenidate (Ritalin)
Stimulant used to treat for ADHD and Narcolepsy
A group of Disorders with common disabilities in (1) Social awareness (2) Communication Skills (3) Imaginative Play
Autism Spectrum Disorder (ASD)
Withdrawal of the child into the self and into the fantasy world of his creation
Imaginative Play
Autism appears in the first __ years of life
3
No medical detection
No known cure
Autism affects the brain’s normal development of ___ and _____ skills
Social
Communication
Autism happens in ____ out of every ___ children
1…110
More common than pediatric cancer, AIDS, and Diabetes combined
Autism is ___ times as many in boys than girls
4
Parents over ___ years old can have a child with autism
40
Have distinctive abilities in art, music, mathematics or memory
Autistic Savants
1% of the population
7x as many as people as classic autism; average to higher IQ
Asperger’s Syndrome
A pervasive developmental disorder defined by same social impairments and restricted stereotyped behaviors seen in autistic disorder but no LANGUAGE and COGNITIVE delays involved
Asperger’s Disorder
Type of Autism: Severely to mildly handicapped in cognition and intellect
Classic or Kanner Autism
Classic Autism is ____ times more common in boys than in girls
4
Unusual distress in changing routines
Repeated body movements
Unusual attachment to objects
Sensitive Senses
Are Signs or Symptoms of ____
Autism
Main problem of ADHD
Decreased Attention Span
Refers to Autistic behavior wherein one gets stuck on a single topic or
task
Perseveration
During Play, a child with Autism does not _______
Imitate the actions of others
A complication of Autism wherein a child has a developmental problem including learning disabilities & cognitive impairment.
Fragile X Syndrome
Growth of numerous
noncancerous benign tumors in many parts of the
body( Kidney tumors ) - life threatening
Tuberous Sclerosis
3 Medications for Autism
Methylphenidate chloride (stimulant) Opiate blockers (naltrexone/ReVia) Antidepressants (fluvoxamine/Luvox)
Described by John Langdon Down in 1866: a group
of children with common traits that differed
from other children with mental retardation.
Down’s Syndrome or Trisomy 21
aka mongoloid
Most common chromosomal abnormality affecting
children today
Down’s Syndrome or Trisomy 21
Down’s Syndrome occurs from the presence of ___ copies of _____rather than the normal ___
3…chromosome 21…2
What age category/gender is at risk of giving birth to babies with Trisomy 21
Older women
51% over age 35 of individuals with Trisomy 21 presented with _______
Dementia
What gender lives longer in clients with Trisomy 21?
Males
Why is Caffeine or Sugar not allowed for clients with ADHD?
Because of drug interactions
Why is Autism more common in boys?
Due to x chromosome mutation
A client may have autism if he/she is unable to (4)
Gesture (12 months)
Babble (12 months)
Say a word (16 months)
Say two words (24 months)
Teaches a specific and comprehensive system of autism treatment & education designed to help families and caregivers enable their children to dramatically improve in all areas of learning, development, communication and skill acquisition.
Son-Rise Program
2 Nursing Management for Children with autism
Parents should be around as much as possible
Allow objects the client is attached to
The most common form of chromosomal translocation in humans. It means that two chromosomes, the structures that make up a person’s DNA, join together in an abnormal way.
Robertsonian Translocation
3 Types of Down Syndrome
Trisomy 21 Mosaicism
Trisomy 21
Robertsonian Translocation
Difference between Trisomy 21 and Robertsonian Translocation in terms of Maternal Aging
Trisomy 21 - frequency of trisomy
increases with increasing maternal age
Robertsonian translocation- not related
to maternal age
Inherited Robertsonian Translocation can result in (4):
Monosomy
Normal Chromosomes
Trisomy
Carrier of the Translocation
Protruding Tongue is a clinical feature of ______
Down’s Syndrome
Children with Down’s Syndrome Sit, creep, and Walk approximately at the age _____ the normal age
Twice
Typical Heart Disease in Down’s Syndrome
AV Septal Defect
50% of those with DS have heart disease
4 Common eye problems with Down’s Syndrome
Strabismus
Refractory Error
Glaucoma
Cataract
In Down’s Syndrome which occurs more frequently? Hypothyroidism
Hyperthyroidism
Hypothryoidism
People with Down’s Syndrome are at an increased risk of excessive mobility of atlas (C1) and the axis (C2), which may lead to spinal cord compression injury, this is called ______
Atlantoaxial
instability
Due to Atlantoaxial
instability what should nurses say to the parents of children with Down’s Syndrome?
Avoid participation in contact sports
Common Sleep Disorder in Down’s Syndrome
Sleep Apnea
Palmoplantar hyperkeratosis Seborreic dermatitis Fissured tongue Cutis marmorata Xerosis ...are skin disorders common in clients with \_\_\_\_\_\_
Down’s Syndrome
Prenatal screening (amniocentesis, chorionic villus sampling (CVS), or percutaneous umbilical cord blood sampling, ultrasound) are diagnosis methods for\_\_\_\_\_\_\_
Down’s Syndrome
Growth Measurements for children with Down’s Syndrome will help in the prevention of _______ and early diagnosis of ______ and _______.
Obesity…Celiac Disease…Hypothyroidism
An eye exam should be
performed in the newborn period or at least
before____ of age to detect ______
and ______.
6 months…strabismus…cataracts
Hearing Screening should be done in the newborn
period, every ____ until ____of age and then
____
6 months…3 yrs…annually
Thyroid Function assessment should be done in newborn period and should be repeated at ___ and ___months , and then _____
6…12…annually
Celiac Disease
Screening should begin at ___
yrs. Repeat screening if signs/Sx develop.
2
Is inadequate growth resulting from inability
to obtain or use calories required for growth
Failure to Thrive (FTT)
Described as a condition rather than a
specific disease.
For FTT, measurements drop more than ____percentiles from baseline
2
For FTT weight and height persistently falls below the ____ to ____percentile on a standard growth
chart
3rd…5th
Type of FTT where weight is below standard
Acute FTT
Type of FTT where Weight, Height, and Length are below standard
Chronic FTT
Types of FTT
Acute FTT
Chronic FTT
_____ is the single most common cause
of FTT that results from___ and___
Under feeding…parental poverty…ignorance.
2 Categories for FTT Etiology
Organic causes
Inorganic causes
Cardiac Disease, celiac, chron’s, hepatic, etc. are what type of FTT cause?
Organic cause
Disturbance in the parent-child
relationship resulting in maternal role
insufficiency is what type of FTT cause?
Inorganic cause
4 FTT Pathophysiology Classifications
- Inadequate caloric intake
- Inadequate absorption
- Increased metabolism
- Defective utilization of calories
Premature birth Maternal Vices Mechanical problems Poor appetite Inadequate Intake Metabolic Abnormalities Poor Food Absorption Increased Nutrient Loss
…are what type of FTT cause
Organic cause
Causes due to caregiver’s actions are what type of FTT cause?
Inorganic Cause
The most common cause of FTT
Malnutrition
Prenatal factors such as Prematurity,
Exposure in utero to toxic agents,
and Intrauterine growth restriction from any cause may result to ________
FTT
Postnatal factors such as: Inadequate caloric intake Inadequate absorption Increased caloric requirement Defective utilization of calories ..may cause \_\_\_\_\_\_
FTT
During FTT, weight is lower than the _____ percentile
3rd
History Taking for FTT include______ or history of _______ in a 3-5 day period.
24h dietary recall…Food consumption
The _____ was devised to provide a simple method of screening for evidences of slow development in infants and preschool children
Denver Developmental Screening Test (DDST)
Assess the Degree of FTT:
Weight 75-90%
Mild
Assess the Degree of FTT:
Weight 60-74%
Moderate
Assess the Degree of FTT:
Weight <60%
Severe
Assess the Degree of FTT:
Height 90-95%
Mild
Assess the Degree of FTT:
Height 85-89%
Moderate
Assess the Degree of FTT:
Height <60%
Severe
Assess the Degree of FTT:
Wt/Ht ratio 81-90%
Mild
Assess the Degree of FTT:
Wt/Ht ratio 70-80%
Moderate
Assess the Degree of FTT:
Wt/Ht ratio <70%
Severe
Catch up growth for FTT is _ to _ times greater the
expected rate for age.
2..3
For FTT management Feeding interval should not be greater than __ hours and a maximum time allowed for
sucking should be_____ minutes
4.. 20
For FTT management ,older and young children meals should last for ___, solid foods should be offered
before liquid.
30 mins
For FTT what liquids should be avoided in excess?
Fruit juice
-Occur between the age of 6 and
60 months
-Temperature of 38C or higher
-Not the result of CNS infection or any metabolic
imbalance
-Occur in the absence of a history of prior afebrile seizures.
Febrile seizure
Febrile seizure is not the result of ___ infection
CNS
Febrile Seizures mostly resolves within ___ hours & require no treatment.
24
Is a fit that can happen when a child has a fever.
Febrile seizure
Febrile seizure is aka ____
Febrile convulsions
Relatively common and, in most cases, aren’t
serious
Age< 1 yr old
-is a ___risk factor for febrile seizure recurrence
Major
Duration of fever < 24hr
-is a ___risk factor for febrile seizure recurrence
Major
Fever 38-39 C
-is a ___risk factor for febrile seizure recurrence
Major
Family history of febrile seizures
-is a ___risk factor for febrile seizure recurrence
Minor
Family history of epilepsy
-is a ___risk factor for febrile seizure recurrence
Minor
Complex febrile seizure
-is a ___risk factor for febrile seizure recurrence
Minor
Male gender
-is a ___risk factor for febrile seizure recurrence
Minor
Lower serum sodium
-is a ___risk factor for febrile seizure recurrence
Minor
3 Types of febrile seizure
Simple febrile seizure
Complex febrile seizure
Febrile status epilepticus
The most common type of febrile seizure
Simple febrile seizure
8 out of 10 cases
Simple febrile seizure is a fit that: is a\_\_\_\_ seizure lasts \_\_\_\_\_\_ minutes doesn't reoccur within \_\_\_or the period in which the child has an illness
tonic clonic…less than 15…24 hours
The stiffening of muscles
Tonic
During _____ seizures , the mouth snap shuts, tongue may be injured… and there is increased salivation
Tonic
Type of simple febrile seizure that lasts 10-30 seconds
Tonic seizures
upward rolling of eye balls loss of consciousness may fall when standing cyanotic ..are due to \_\_\_
Tonic seizures
Rigidity is replaced by intense jerking
movements
Clonic
Type of Simple febrile seizure where there is a generalized contraction of entire body
Tonic seizure
Type of Simple febrile seizure where there is Uncontrolled oral secretions
Clonic Seizure
Simple Febrile Seizures that last 30-50 seconds
Clonic Seizures
Trunk and extremities undergo rhythmic
contraction & relaxation
Incontinence of urine and feces
is due to ______
Clonic Seizures
______ seizures cause a stiffening of muscles while ____ seizures are characterized by jerking or twitching
Tonic…clonic
Type of Seizure where it lasts longer than 15 minutes
Complex Febrile Seizure
Type of Seizure where the child only has symptoms in one part of their body
Complex Febrile Seizure
aka Partial or focal seizure
Type of Seizure where the child has another seizure within 24 hours of the first seizure,
or during the same period of illness
Complex Febrile Seizure
Type of Seizure where the child doesn’t fully recover from the seizure within one hour
Complex Febrile Seizure
Type of Seizure:
Less common
2 out of 10 cases
Complex Febrile Seizure
Type of Febrile Seizure that is
Rare and is Continuous or in series
Febrile status epilepticus
Type of Febrile Seizure that Lasts longer than 30minutes
Febrile status epilepticus
Type of Febrile Seizure where the child does not regain premorbid Level of Consciousness
Febrile status epilepticus
Treatment should begin within 5 minutes
The main symptom of a febrile seizure is _____that occurs while a child has a fever.
a Fit
Febrile seizures often occur during the ___
day of a fever, which is defined as a high
temperature of ____ or above.
1st…38C (100.4F)
Simple Febrile Seizures usually lasts _____ minutes
Less than 5
Type of seizure that tend to last longer than 15 minutes, only affect one area of the child’s
body, and recurs within 24 hours or
during the period in which the child is ill.
Complex Febrile Seizure
Exact cause of Febrile Seizure
Unknown
2 First Aid Medications for Febrile Seizures
Diazepam
Midazolam
Recommended in children less than 12mo of age after
their first febrile seizure to rule out meningitis
Lumbar Puncture
Why is it important to consider if the child has
received prior antibiotics before Lumbar Puncture
It would mask the clinical symptoms of Meningitis
The presence of an identified source of fever , such as
otitis media , does not eliminate the possibility of
_____
Meningitis
_____are the major sign of meningitis in 13-15% of
children
Seizures
In drawing CSF samples _____ is sent to the chemistry laboratory for glucose and
protein.
Tube 1
In drawing CSF samples _____ is sent to the hematology laboratory for cell count
with differential.
Tube 2
In drawing CSF samples _____ is sent to the microbiology and immunology
laboratory
Tube 3
In drawing CSF samples _____is held for repeat cell count with differential; if needed for other subsequent studies, not initially ordered.
Tube 4
For Meningitis, EEG should be generally restricted to special cases
if what is highly suspected?
Epilepsy
EEG need not be performed as part of the
evaluation even though the child is presenting with his or her first simple febrile seizure if he/she is ______
Neurologically healthy
__ or __ is not recommended during neuroimaging for Febrile Seizures
CT…MRI
Blood glucose should be determined only in
children with prolonged______ _____ _____
Poor oral intake
Patients with febrile status epilepticus have been reported to have swelling of their ____ acutely and subsequent long term hippocampal atrophy
Hippocampus
______ therapy , continuous or
intermittent, is not recommended for children
with one or more simple febrile seizures.
Antiepileptic
If the febrile seizure lasts >5mins, then acute treatment
with ____ ______ or _______ is needed
Diazepem
Lorazepam
Midazolam
(Anti-convulsants )
Rectal _____ is often prescribed to be given
at the time of recurrence of febrile seizure lasting
> 5 min
Diazepam
Buccal or intranasal ____
may be used and is often preferred by parents for treatment of febrile seizure
Midazolam
___ can decrease the discomfort of the
child but do not reduce the risk of having a
recurrent febrile seizure
Antipyretics
_______therapy may be
considered for children with high risk for later
epilepsy.
Chronic Anti-Epileptic
IV benzodiazepines
Phenobarbital
Phenytoin
Valproate
4 Medications for ______
febrile status epilepticus
Attempts to _____ will not prevent
seizures
Lower temperature
Tepid sponge bath is _____ for febrile seizures
Not recommended
Shivering effect _____metabolic output
Increases
Cooling effect causes ______ in febrile seizures
Discomfort
During seizures what position should the client be placed?
Side-Lying
Parents should call the physician if it is the ____ seizure or when it lasts for longer than ___ minutes
1st…5
Colic aka
Infant Colic
Infantile Colic
3-month Colic
Abdominal pain or cramping manifested by
loud cry, and drawing of legs up to abdomen.
Colic
Colic:
common to in younger infants under age
___months than in older infants
3
Colic is Self limiting resolves at ____months
3-4
Colic is common among ____ and ___ babies
Bottlefed
Breastfed
Crying inreases. during late afternoon to evening is aka _____
Witching hour
Colic is manifested by unexplained fussing/crying lasting more than___
hours a day, at least ___ times per week within a ____
month period.
3…3…3
Pediatricians often use the ______to diagnose colic
“Rule of
Three”
Intense and prolonged crying
Sleeplessness, irritability and fussiness
Exhaustion
Abdominal bloating
are symptoms of _____
Passage of excessive flatus
Colic
Immature digestive system
Lack of Probiotics
Allergens passed via breastmilk
Swallowing Air during Crying
4 possible causes of ______
Colic
Baby cries suddenly and often after a feeding.
Cries continuously and louder.
Face gets flushed/re
Abdomen becomes distended, legs
alternating between flexion &extension, and
the hands get clenched , mostly evening.
…is indicative of ____
Colic
Moaning Shrill Cry Vomiting Stool Change Fussy eater
Abnormal temperature Irritability Lethargy Soft Head Bulge Poor Weight Gain
are 10 red flag symptoms of ____
Colic
Infection Intestinal Pain Trouble breathing Increased Brain Pressure Skin Pain
Mouth Pain Kidney Pain Eye Pain Overdose Others
are medical problems to consider for babies with red flag symptoms of _______
Colic
Both parents having colic
Overfeeding in attempt to lessen crying
Feeding certain foods especially those with
high sugar content ( undiluted juices)
Presence of excessive anger, fear, anxiety,
excitement in the family
…are factors that ___ colic
Worsen
Antispasmodics
Antihistamines
Antiflatulents
Medications for _____
Colic
*won’t completely resolve
2 Milk choices for colic
Hydrolyzed Milk
Soy Milk
3 Examples of Hydrolyzed Milk
Nutramigen
Alimentum
Pregestimil
During breastfeeding a colicky infant what foods should the mother try eliminating for 7 days to see if improvement occurs. (6)
Cow Milk Orange Juice Peanuts Cabbage family Onions Chocolates
Hirschsprung disease aka
Congenital Aganglionic Megacolon
Is a congenital anomaly that results in mechanical
obstruction from inadequate motility of part of the
intestine.
Hirschsprung Disease
Is a congenital anomaly resulting to the absence of aganglionic cells in the distal colon
resulting in a functional obstruction.
Hirschsprung Disease
Hirschsprung Disease is 4 times more common in what gender?
Males
______ - 80% of Hirschsprung Disease that involves rectum to portion of distal colon
Short-segment disease
_______- 15% of Hirschsprung Disease 15% that involves entire colon or small part of small intestines
Long-segment disease
Hirschsprung Disease is more frequent in what gender?
Males
Long Segment Disease is more common in what gender?
Females
Hirschsprung Disease is associated with ______
Down’s Syndrome
Classic Symptom of Hirschsprung Disease
Ribbon-like Stool
2 Classic Signs of Hirschsprung Disease
Newborn with delayed passage of meconium
Obstinate constipation (inability to pass stool w/o softeners& laxatives)
Foul smelly stool Bowel obstruction &Abdominal distention Poor feeding Failure to thrive About 10% diarrhea
…are clinical presentations of ____
Hirschsprung Disease
Colonic perforation Sepsis Vomiting Visible peristalsis, Palpable fecal mass ---are clinical presentations of\_\_\_\_
Hirschsprung Disease
Distended abdomen
Inability to release flatus
An empty rectum on digital rectal
examination
…are physical presentations of _____
Hirschsprung Disease
Rectal impaction
Rapid expulsion of feces after rectal
examination
…are physical presentations of _____
Hirchsprung Disease
A _____ _____ _____ with potential ___
is the classic finding of Hirschsprung.
narrowed distal colon…dilation
Failure to pass meconium within 24-48h
after birth is indicative of ______
Hirchsprung Disease
Balloon is attached to rectum
The test records reflex pressure response of anal
sphincter to distension of balloon
Anorectal Manometry
In Hirschsprung Disease the _____ is normal but _____fails to relax thus no bowel movement leading obstruction
External Sphincter
Internal Sphincter
Normally Internal S. relaxes followed by contraction
of External S.
Confirmatory test that indicates an absence of ganglion cells
Rectal biopsy
Histologic test for absence of ganglion cells
Simple suction rectal biopsy
IV hydration
Nasogastric decompression
IV antibiotics
3 Cornerstones of initial medical management of ______
Hirschsprung Disease
In 1949, Swenson described the first consistent
definitive procedure for Hirschsprung - ____ _____ ____
Rectosigmoidectomy with coloanal
anastomosis
At the time of diagnosis of Hirschsprung Disease diverting _____ is performed; once the child grows and weighs more than _____ , the definitive repair is performed.
Colostomy…10kg
The 3 most commonly performed definitive
repairs for Hirschsprung Disease are:
- Swenson
- Duhamel
- Soave procedure The Pull through
Procedure)
Type of surgical repair for Hirschsprung Disease wherein residual pouch of aganglionic bowel is left intact with the healthy bowel attached behind
Duhamel procedure
Type of surgical repair for Hirschsprung Disease wherein the outer layer of the aganglionic bowel is left in place (muscular cuff)
Soave procedure
Type of surgical repair for Hirschsprung Disease wherein all of the aganglionic bowel is removed
Swenson procedure
It is the original pull through procedure used to
treat Hirschsprung disease.
Swenson procedure
Was first described in 1956 as a modification to
the Swenson’s procedure.
Duhamel procedure
Key points are that a retrorectal approach is used
and a significant portion of aganglionic rectum is
retained
Duhamel procedure
Was introduced in the 1960”s
Consists of removing the mucosa and submucosa
and the rectum and pulling the ganglionic bowel
through the aganglionic muscular cuff of the
rectum.
Soave (endorectal) procedure
For children (and occasionally adults) with ultra short segment Hirschsprung disease.
Anorectal myomectomy
The surgeon removes a 1 cm wide strip of
extramucosal rectal wall, beginning
immediately proximal to the dentate line and
extending to the normal ganglionic rectum
Anorectal myomectomy
______ colostomy also indicates that a future
surgery will be done to close it. So the capabilities
of the parent to afford it at that time need to be
seen.
Temporary
The rule of 8 6 4 2 is followed in bowel preparation for surgery. What is it?
8hrs before surgery no solid
6hrs before no formula
4hrs before no breastfeeding
2hrs before, nothing at all
\_\_\_\_\_ diet may optimize post op bowel function for client with Hirschsprung Disease
High fiber
Hirschsprung Disease management where the abdomen is measured by a paper tape measure at the largest diameter, usually at
the level of umbilicus.
Abdominal girth monitoring
Postop management for Hirschsprung Disease include accurate recording of stool ( number, freq.)
____ ______ ______ and ______
consistency
color
odor
shape
No rectal temp. taking for taking temp
Spontaneous telescoping of one portion of
the intestine into another leading to
mechanical obstruction.
Intussusception
A _____is a lesion or variation in the intestine
that is trapped by peristalsis and dragged into a
distal segment of the intestine, causing
intussusception.
Lead point
______is the most common cause of
intestinal obstruction in patients aged 5months
to 3 years .
Intussusception
______ is caused by part of the intestine
being pulled inward into itself. This can block the
passage of food through the intestine. If the blood
supply is cut off, the segment of intestine pulled
inside can die.
Intussusception
The cause of intussusception is ______
Unknown
Although viral infections may be responsible in
some cases. Sometimes a lymph node, polyp, or
tumor can trigger the problem. The older the
child, the more likely such a trigger will be found.
Intussusception Occurs most often near the: (4)
ileocecal junction
jejuno jejunal
jejunoileal
colo colic.
The _______, a proximal segment of
bowel, telescopes into the ______ , a
distal segment, dragging the associated
mesentery with it.
Intussusception…Intussuscepens
In Intussusception, there maybe a palpable ______mass
“sausage shaped”
(often in the right upper quadrant).
The absence of bowel in the right
lower quadrant
Dance’s sign
In Intussusception, there is a mucoid and bloody ______stools.
“redcurrant
jelly”
For patients with Intussusception, with a _____ _____ (sudden
onset of intermittent severe abdominal pain
with or without rectal bleeding ) or
characteristic findings on radiography, may
proceed directly to ____ ______
using hydrostatic (contrast or saline) or
pneumatic (air) enema, performed under
either sonographic or fluoroscopic guidance.
typical presentation…nonoperative reduction
For Unclear presentation of Intussusception: initial work up may
include:
Abdominal ultrasound -
Abdominal plain films -
doughnut or target sign
meniscus or crescent sign
Tests for Intussusception include:
Abdominal x ray
Air or contrast enema
CT scan
Utrasound
Crescent shaped gas in the bowel lumen
Meniscus Sign
For managing Intussusception
The child will first be ____
Stabilized
A tube will be passed
into the stomach through the nose ( nasogastric
tube). An intravenous (IV) line will be placed in the
arm, and fluids will be given to prevent dehydration.
Hydrocephalus Pathophysiology
Csf flows through the aqueduct of ____ into
the fourth ventricle, where fluid is formed;
Leaves the 4 th ventricle through foramen ____
and midline of foramen ______
Flows to ___
To cerebral and cerebellar subarachnoid space for
absorption
Large portion is absorbed by ____
Slyvius
Luschka
Magendie
Cristena magna
Arachnoid villi
Origin of CSF in Hydrocephalus is due to an _____ __ ____ that enters the basal
side of the choroid epithelium and by active
metabolism , it is transformed into CSF and
secreted at the apical or ventricular side of the
epithelium.
ultrafiltrate of plasma
Possible sites of origin of CSF in Hydrocephalus include the _____ the parenchyma (20%), and the ependyma
Choroid plexus
(80%),
The formation rate of CSF is about ____ or ____ in adults and children
20mL/hr…500mL/day
The total CSF volume in the ventricles and subarachnoid space is age-dependent but reaches the adult volume of ____ by age 5 years
5 mL
Intracranial Pressure for Infants
5-10 mmHg
Intracranial Pressure for Children
15 mmHg
Hydocephalus is a condition resulting from imbalance in CSF
____ and ____
Production…absorption
Hydrocephaly occurs in 80-85% children born with _____
meningomyelocele
Hydrocephaly is common in what gender?
Both male and female
____ -when the lower cerebellum extends
below the foramen magnum and into the
spinal canal
Chiari
Does not cause hydrocephalus
Herniation of cerebrum, medulla, pons and 4th ventricle into cervical spinal canal through enlarged foramen magnum resulting on obstruction of CSF flow
Type 2 Chiari Malformation
Commonly associated with meningomyelocele
Cystic expansion of 4th ventricle, partial/complete absence of cerebral vermis and subsequent obstruction of CSF flow
Dandy Walker Malformation
Occurs when the CSF flows out of the ventricles and into
the spinal canal, but it is not reabsorbed normally by the
subarachnoid space surrounding the brain and spinal
cord.
Communicating hydrocephalus/Non obstructive
Sometimes this type of hydrocephalus corrects
itself
Communicating hydrocephalus/Non obstructive
Occurs when the CSF does not flow properly between or
out of the brain ventricles because of an obstruction,
such as from a malformation or narrowing
Non communicating hydrocephalus/Obstructive
2 Classifications of Hydrocephaly
Communicating hydrocephalus/Non obstructive
Non communicating hydrocephalus/Obstructive
Hydrocephalus present at birth
Congenital Hydrocephalus
Hydrocephalus caused by physical problems with CSF flow, infections/trauma during fetal development, or teratogens
Congenital Hydrocephalus
Hydrocephalus caused by infections such as meningitis, bleeding, injury, or tumor
Acquired Hydrocephalus
Refers to a condition of brain volume loss that may be present at birth
Ex vacuo hydrocephalus
In ______ ventricles become large to fill the space where there is absence of brain tissue; may result of failure in fetal development of brain
Ex vacuo hydrocephalus
Cracked pot sound on percussion of skull near the junction of the frontal, temporal, and parietal bones
Macewen Sign
Physical presentation when the third ventricle dilates (upgaze palsy with a normal vertical Doll response)
Parinaud Syndrome
A Parinaud syndrome with lid retraction and increased tonic downgaze
Setting sun sign
4 Signs for Diagnosis of Hydrocephalus (Infant’s head)
Head enlargement
Dysjunction of Sutures
Dilated Scalp Veins
Tense Fontanelle, anterior fontanelle bulging
Head circumference enlargement for Hydrocephalus occur at ____ per ___ in first ____months
2 cm…month…6
In older children developing a large head due to Hydrocephaly, ___ are closed. but chronic increased ICP will lead to progressive _____
Sutures…macrocephaly
Process done where translucency assessed extending beyond 2.5 cm in frontal area or 2 cm in occipital area indicates abnormality
Transillumination
Characteristic of ICP in infants where ocular globes are deviated downward, upper lids are retracted, and white sclera is visible above the iris
Setting-sun Sign
If the raised iCP is not treated, this can lead to optic atrophy and vision loss
Papilledema
Is secondary to increased ICP
Unilateral or Bilateral 6th Nerve Palsy (Abducens)
Sign of hydrocephaly in infants where periventricular pyramidal tract fibers are stretched
Increased Limb Tone
Spasticity affects lower limbs
Sign of Hydrocephalus in children related to spasticity in the lower extremities
Unsteady gait
3 Drug groups for treating Hydrocephaly
Diuretics
Anticonvulsants
Antibiotics
2 Diuretics for treating Hydrocephaly
Acetazolamide
Furosemide
A short term solution to Hydrocephalus
External Ventricular Drain
Diverts fluid from the brain and allows for monitoring of intracranial pressure
External Ventricular Drain
The most common treatment for hydrocephalus is
the surgical insertion of drainage a drainage system called a/an ____
Shunt
3 Types of Shunts
Ventriculoperitoneal (VP) shunt
Ventriculoatrial (VA) shunt
Lumboperitoneal (LP) shunt
______shunt should be replaced periodically as the child grows and the
tubing becomes too short.
Ventriculoperitoneal
Shunts will generally consists of three
components:
Inflow catheter
Valve mechanism
Outflow catheter
Part of shunt that drains the CSF from the ventricles
Inflow catheter
Part of shunt that regulates the pressure control through the shunt tubing
Valve mechanism
Part of shunt that Runs under the skin and moves the CSF from the valve to the peritoneal cavity, heart or other
drainage site.
Outflow catheter
Shunt infection usually occurs within___
____months of insertion.
2…3
High Pitched cry /Irritability Restlessness Sleeping more than usual Nausea Bulging anterior fontanel Vomiting Has poor appetite and does not eat
Signs of _______ in infants
increased ICP
Layers of tissue that separate the skull and the brain
Meninges
-Haemophilus influenzae serogroup B
-Neisseria meningitidis serogroups B and C
-Klebsiella
pneumoniae
-Steptococcus pneumoniae
-Two types
of Escherichia coli
5 Major
causative agents of _____
bacterial meningitis
Most cases of meningitis both viral and bacterial result from infections that are contagious, spread via
______ from the throat and nose of
someone who is infected.
tiny drops of fluid
Bacterial meningitis is aka
Septic meningitis
2 Common Bacterial meningitis in newborns
Group B streptococcus
Escherichia coli
…and
less commonly, Listeria monocytogenes
Meningitis caused by Mycobacterium tuberculi
TB meningitis
Infection of this bacterium usually begins in
the lungs.
Unlike other types of meningitis TB meningitis
progresses _____ and symptoms are
vague
very slowly
Viral Meningitis is aka
Aseptic meningitis
More common than bacterial form and
usually less serious.
Meningitis that is less likely to have permanent brain damage
after the infection resolves.
Viral Meningitis
Treatment for Viral Meningitis
NO specific treatment
Most patients recover completely on their
own
If the cause of meningitis is a ______, there’s an antiviral medication
available
Herpes
virus
Enterovirus (Coxsackie virus and poliovirus) Adenovirus Arbovirus Measles virus Herpes simplex virus Varicella
6 Causative agents of ____
Viral Meningitis
___ is much less common than the other two
meningeal infections.
Fungal Meningitis
_____ meningitis is rare in healthy people but it is more likely
in persons who have impaired immune
system.
Fungal Meningitis
Happens when severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees
Kernig’s Sign
Happens when severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
Brudzinski’s Neck Sign
Fever + Stiffness of Neck
\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_may be a sign of meningitis or alternatively, may be seen in an infant who is attempting to compensate for airway edema or stridor.
Opisthotonic positioning
For spinal tap, the needle is inserted between _____ and ____ ______ vertebrae
3rd…4th…lumbar
_______ is done to collect a
sample of spinal fluid. This test will show any signs
of inflammation and whether a virus or bacteria is
causing the infection.
Lumbar puncture or spinal tap
For CSF analysis, Elevated WBC count and Increased
neutrophils is _______ meningitis
Bacterial
For CSF analysis, Slightly elevated WBC count and increased lympocytes is _______ meningitis
Viral
For CSF analysis, Elevated Protein
content is _______ meningitis
Bacterial
For CSF analysis, Normal or slightly
inc. Protein
content is _______ meningitis
Viral
For CSF analysis, Decreased Glucose
Content is _______ meningitis
Bacterial
For CSF analysis, Normal Glucose
Content is _______ meningitis
Viral
For CSF analysis, Positive Gram stain is _______ meningitis
Bacterial
For CSF analysis, Gram Negative gram stain; bacteria
culture is _______ meningitis
Viral
For CSF analysis, Turbid or cloudy Color is _______ meningitis
Bacterial
For CSF analysis, Elevated Opening
Pressure is _______ meningitis
Bacterial
For CSF analysis, Normal Opening
Pressure is _______ meningitis
Viral
For CSF analysis, Clear or slightly cloudy Color is _______ meningitis
Viral
Third generation cephalosporin such as
Cefotaxime or ceftriaxone
Vancomycin is added in the regimen in case of
resistance
Dexamethasone
Dehydration and shock can be treated with fluid
therapy.
Phenytoin for seizure management
is medical management for ______meningitis
Bacterial
ATT medications are started:
Isoniazid, Rifampicin, Pyrazinamide, and
Streptomycin
Second line drugs:
Aminoglycosides
Fluoroquinolones
Conventional therapy is given for 6 9 months
In children, BCG vaccine offers (approximately 64%)
protective effect
Is medical management for ___ meningitis
TB
Treatment is mostly supportive and no medicines
are prescribed
Seizure prophylaxis:
Lorazepam or Phenytoin or Barbiturate
Increased ICP
IV Mannitol 1g/kg followed by 0.25 0.5g/kg Q6H
or/and dexamethasone
Rest is advised
is medical management for ___ meningitis
Viral
A malformation of spine, in which posterior
portion of lamina of vertebra fail to close with or
without defective development of spinal cord.
Spina Bifida
Spina bifida, which literally means ___ ____
is characterized by the incomplete development
of the brain, spinal cord, and/or meninges
“cleft spine”
2 Classifications of Spina Bifida
- Spina bifida occulta
2. Spina bifida cystica
2 Types of Spina bifida cystica
Meningocele
Myelomeningocele
is the mildest and most common form of Spina Bifida in
which one or more vertebrae are malformed.
Spina bifida occulta
The name “ occulta ,” which means ____
indicates that the malformation, or opening
in the spine, is covered by a layer of skin.
“hidden”
This form of spina bifida rarely causes
disability or symptoms.
Spina bifida occulta
A spina bifida defect which result from failure of formation of bony
arch around the spinal cord, but the spinal cord and
meninges are normal. It is not visible externally and is
aymptomatic
Spina bifida occulta
A spina bifida defect wherein the closure of posterior vertebral arch
with protrusion of spinal cord and meninges
through the defect.
Spina bifida cystica
It is a sac like herniation through the bony
malformation, containing meninges and CSF
Meningocele
It is a sac like protrusion of spinal cord , CSF and
meninges through spinal cleft.
Myelomeningocele
It is mostly found in lumbar or lumbosacral region.
It occurs due to defect in the orderly closure of vertebral
column and formation of spinal cord during 4th or 6th weeks
of gestation.
Spina bifida cystica
Spina bifida ______are asymptomatic , the
only features seen are:
Dimple in the skin or growth of hair over
malformed vertebra
As the child grows, he may develop foot weakness
or disturbances of bladder and bowel sphincter
Occulta
External cystic defect
Weakness of leg or lack of sphincter control
is a clinical feature of ______
Meningocele
… in Spina bifida cystica
Herniated mass in lumbosacral region
Hydrocephalus
Loss of motor control
Congenital skeletal anomalies
is a clinical feature of ______
Myelomeningocele
…… in Spina bifida cystica
Folic acid deficiency doses:
For 1 month before
pregnancy with History
_____
For negative History
____
4mg/day …0.4mg/day
For spina bifida cystica, surgery is required .
_____and closure of the defect is
done within 24-48hours of birth.
Laminectomy
Management depends on the nature and extent of
defect. Usually no intervention is required for
spina bifida ______.
Occulta
Common complication of Spina Bifida
Loss of bladder and bowel control
For prevention of Spina Bifida
Folic acid supplements
Dosage:
400 micrograms/ day
Foods high in _____include dark green
vegetables, egg yolks, and some fruits.
Folic acid
This inflammation often begins with infections
that cause sore throats, colds or other
respiratory problems, and spreads to the middle
ear.
Otitis media
It is the second most common clinical problem in
children after upper respiratory tract infection
Otitis media
___otitis media is typically associated with fluid
accumulation in the middle ear together with signs
or symptoms of ear infection
Acute
A bulging eardrum usually accompanied by pain,
A perforated eardrum, often with drainage of purulent material (pus).
Fever can be present.
are symptoms of ______
Ear infection
Chronic Otitis Media
is a persistent inflammation of the middle ear, typically
for a minimum of___
1 month
_____otitis media may develop after a prolonged
period of time with fluid ( or negative pressure
behind the eardrum (tympanic membrane)
Chronic
_____otitis media often starts painlessly without
fever
Chronic
____otitis media can cause ongoing damage to
the middle ear and eardrum and there may be
continuing drainage through a hole in the eardrum
Chronic
Most prevalent disease in childhood after respiratory
tract infections.
Otitis media
Otitis media Occurs in frequently in what gender?
Males
Higher incidences of Otitis Media are seen in children with ___ _____
Cleft
palate
Otitis media mainly deals with ______ ______
dysfunction.
Eustachian tube
Ear pain
Otalgia
2 Treatments for Otitis Media (Include Dosage)
Amoxicillin 20-40mg/kg/day 3x a day for 10-14days
Augmentin
45mg/kg/day 3x a Day for 10-14days
For Otitis media, What secondary agents are used if the primary
antibiotic has failed after 10 days and the
symptoms persists.
Cefprozil
Erythromycin/sulfisoxazole
Trimethoprim/sulfamethoxazole
“Blue drum syndrome”
Cholesterol granuloma
For Nursing Intervention in Otitis Media …Position infants as ___ as possible during
feeding to avoid reflux of formula into
Eustachian tube.
Upright
\_\_\_ \_\_\_ causes middle ear effusion by enhancing attachment of pathogens, cause otitis in middle ear space, prolonging the inflammatory response and impending drainage through the Eustachian tube(Kerschner & Precadio, 2016).
Passive smoking
The main problem of ADHD
Decreased Attention Span
