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PEDS Unit 3 > 11th Hour Review > Flashcards

11th Hour Review Flashcards

1
Q

What are the key points to spinal fusion?

A
  • For curves >40%, braces are for < 40%
  • Anterior or posterior approach, or both
  • Most common: posterior spinal fusion w/ instrumentation and bone grafting
  • align first, then insert metal rods to keep everything in place
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2
Q

What are our post op concerns for spinal fusion?

A
  • Long recovery
  • Post op worried about resp status since we’ve adjusted spine
  • May need chest tube
  • Mobility will be limited, can’t bend, will need to do logroll in bed
  • Will get PCA so they can control the pain meds
  • When they’re done and healed, they’ll be completely ok
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3
Q

What are the nursing interventions for GU consequences of immobility?

A
  • I/Os
  • Stimulate bladder
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4
Q

What is our nursing care management for spinal cord injuries?

A
  • Acute Phase
    • Airway, Neuro checks, Neurogenic shock, UOP, temp
  • Stabilizing the mobility of neck
  • Neck brace care
  • Pain management
  • Spasticity management
  • Rehab phase
    • DVT and PE prevention.
    • Autonomic dysreflexia
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5
Q

What are the stages of bone healing?

A
  • Inflammatory
  • Callus
  • Bone
  • Remodeling
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6
Q

What are the six “P’s” that indicate possible compartment syndrome?

A
  1. Pain
  2. Pallor
  3. Pressure
  4. Paralysis
  5. Paresthesia
  6. Pulselessness
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7
Q

What are our nursing care issues regarding traction?

A
  • Know purpose/function of traction
  • Maintain traction
  • Not to be d/c’d without physician order
  • Do not lift up on weights or hold them for extended amounts of time
  • No knots in rope length, knots securing rope to weights/devices need to be secure
  • Ropes should move freely through pulleys
  • Maintain alignment
  • Prevent skin breakdown
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8
Q

How is the dx of osteomyelitis confirmed?

A
  • X-rays/bone scan
  • CRP, ESR
  • Blood culture
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9
Q

Med care of osteomyelitis?

A
  • abx
  • surgery
  • symptom management
  • No active range of motion
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10
Q

What is Duchenne Muscular Dystrophy?

A
  • Most severe and most common MD in childhood
  • Atrophy profound in later stages
  • This effects muscle cells!
  • Around 2 the s/s start
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11
Q

How is Duchenne Muscular Dystrophy dx’d?

A
  • Waddling gait, falls, lordosis/scoliosis
  • Muscle biopsy
    • fatty fibrous tissues have invaded muscle cells (indicates positive)
  • Blood enzymes
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12
Q

Key points for Progressive Infantile Spinal Muscular Atrophy (SMA)?

A
  • Autosomal recessive trait
  • Most common paralytic form of floppy infant syndrome (congenital hypotonia)
  • Degeneration in spinal cord and brainstem, resulting in atrophy of skeletal muscles, progressive weakness
  • Age of onset variable; earlier onset has poorest prognosis
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13
Q

How is Spinal Muscular Atrophy dx’d?

A
  • electromyography,
  • muscle biopsy
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14
Q

Nursing Care for SMA?

A
  • Coordination of care
  • Nutrition
  • Activities to promote mobility
  • Treatment is symptomatic
  • Prevent infection or treat infection
    • Respiratory is biggest concern
  • Family education and support
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15
Q

What is Baclofen

used for,

how is it administered

and why?

A
  • It is used to decrease muscle spasticity
  • It is administered interthecally via pump that provides a steady dose
  • The steady dose reduces possible sfx (over oral administration)
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16
Q

How does Baclofen work?

A

It blocks activity of nerves in the part of the brain that controls the contraction and relaxation of skeletal muscles to help them relax.

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17
Q

What is our post-op nursing care for a newborn with a myelomeningocele?

A
  • Prone or side-lying position
  • Same as any post-op
    • I/O
    • Monitor for infection - like a lot a lot
    • Pain ctrl
    • Neuro checks
    • Location of site will determine type of care needed
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18
Q

What are the long-term care issues to keep in mind for a child born w/ myelomeningocele?

A
  • Orthopedic Considerations
  • Management of Genitourinary Function
  • Bowel Control
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19
Q

What are the 6 steps for degeration of LOC?

A
  • Irritable but consolable
  • Irritable and inconsolable
  • Lethargic when left alone
  • Needs more stimulation to wake up
  • No response to touch
  • No response to pain
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20
Q

Re: LOC, define Lethargic

A
  • Drowsy but awakens with stimulation, slow to answer questions
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21
Q

Re: LOC, define Obtunded

A
  • Difficult to arouse, falls back to sleep in the absence of stimulation
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22
Q

What is “Cushing’s Triad”?

A
  • A response to increased ICP
    • Decreased HR
    • Increased BP
    • Irregular breathing
  • This is a really late sign
  • We want to catch it early
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23
Q

What are the early s/s of increased ICP in children?

A
  • Headache,
  • vomiting without nausea,
  • blurred vision,
  • seizures,
  • decreased LOC
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24
Q

What are the early s/s of increased ICP in infants?

A
  • Tense or bulging fontanel,
  • high-pitched cry,
  • changes in feeding,
  • vomiting,
  • irritability (which is a decrease in LOC)
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25
Q

What are the late s/s of increased ICP in infants and children?

A
  • Cushings Triad
    • Bradycardia,
    • irregular breathing,
    • widening pulse pressure,
  • alteration in pupil size or reactivity,
  • coma
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26
Q

Treatment for ICP?

A
  • Abx if bacterial cause of ICP
  • Antiseizure if they’re seizing
  • Corticosteroids to reduce cerebral edema
  • Diuretic to decrease fluid
    • Restrict fluid
    • Watch I/O fluids
  • Only hypertonic solutions
    • Hypotonic will cross blood/brain barrier and increase ICP
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27
Q

Nursing Care for a Child s/p VP Shunt Placement

A
  • Continually monitor LOC
  • Monitor for s/s infection
  • Incision site care
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28
Q

What are the considerations for Diastat use?

A
  • If seizure lasts more than 5 mins, then this is used to stop the seizure
  • If < then 5 and typical for the child, don’t use and family will keep track of episodes
  • Educate family to TAKE THE CAP off before they stick it up their kid’s ass!
  • If used, you’ll need to take kid to HCP for f/u
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29
Q

Treatment for febrile seizures, while in hospital?

A

Pt will be given IV or rectal diazepam

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30
Q

What are the long term complications of meningitis?

A
  • Deafness
  • Seizure disorder
  • Hydrocephalus
  • Cognitive Deficits
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31
Q

What is the tx for Viral (Aseptic) Meningitis?

A
  • Treatment is just manage s/s and sequelae
  • Sequelae = whatever happens after
  • Sometimes given anti-virals
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32
Q

What are some causes of encephalitis?

A

Rabies, HSV, ebstein barr, varicella, mesquito virus, measles/mumps

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33
Q

What is responsible for the dramatic decline of bacterial meningitis?

A

The Hib (Haemophilus influenzae type B) vaccine in 1990

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34
Q

What are two things that can be triggered when you have CNS trauma or illness and what are the key points of each?

A
  • SIADH
    • Oversecretion of ADH
    • Fluid retention and hypotonicity
    • Decreased sodium levels
  • Diabetes Insipidus
    • Posterior pituitary hypofunction
    • Under Secretion of ADH
    • Uncontrolled diuresis
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35
Q

What is Measles and how is it spread?

A
  • AKA Rubeola
  • Caused by Morbillivirus
  • It is airborne
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36
Q

What are the complications (conditions) that can arise from Measles?

A
  • Pneumonia (1:20 infected aquire it)
  • Encephalitis
  • Death
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37
Q

What is Mumps and how is it spread?

A
  • Epidemic parotitis caused by Mumps virus
  • It is droplet
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38
Q

What are the complications that can arise from a Mumps infection?

A
  • Meningitis (occurs in 1:10)
  • Encephalitis (causes deafness)
  • Testicular swelling (can cause permanent damage)
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39
Q

What is diphtheria and how is it transmitted?

A
  • an acute, highly contagious bacterial disease causing inflammation of the mucous membranes, formation of a false membrane in the throat that hinders breathing and swallowing, and potentially fatal heart and nerve damage by a bacterial toxin in the blood
  • contact, droplet transmission
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40
Q

S/S of Diphtheria

A
  • can be asymptomatic
  • sore throat,
  • fever,
  • difficulty swallowing
  • DEAD TISSUE ON TONSILS
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41
Q

What complications can arise from Diphtheria?

A
  • suffocation,
  • paralysis,
  • death,
  • endocarditis,
  • neuropathy
42
Q

How is Pertussis transmitted?

A
  • Contact, Droplet
43
Q

What are two potential complications of Pertussis?

A
  • Bacterial pneumonia
  • Neurological d/t hypoxia
44
Q

Treatment for Pertussis?

A
  • ABX (Erythromycin)
  • Supportive
  • Tx household contacts (family)
45
Q

What is the method of transmission for Polio?

A

Fecal-Oral

46
Q

S/S of Polio?

A
  • fever,
  • HA,
  • muscle spasm,
  • paralysis
47
Q

What precautions are put in place for a pt w/ meningococemia?

A

droplet

48
Q

How is Meningococemia treated and is it preventable?

A
  • Once dx’d, abx STAT
  • It can be prevented with a meningococcal vaccine, rec’d in adolescence
49
Q

True or False

Rotavirus does not have a vaccine and there is no partial immunity after infection.

A

False

There is a vaccine and there is partial immunity after infection

50
Q

Key points for Tuberculosis?

A
  • Airborne
  • Dx in Peds is difficult
    • Kids don’t cough up sputum like adults do
  • TB skin test is key indicator
51
Q

Key points for Covid in kids?

A
  • Occurs about 4 weeks after COVID-19 exposure, an immune response to the virus
    • Overactive immune response
  • Also called Pediatric Inflammatory Multisystem Syndrome (PIMS)
  • Treatable with anti-inflammatories to bring down the swelling and reduce negative fx, O2 supplementation, etc
52
Q

What are some contraindications to immunizations?

A
  • Severe febrile illness
  • Recent administration of immune globulin (IVIG)
  • Altered immunity
  • Severe pertussis reaction
  • Hypersensitivity to the immunization or preservative
53
Q

JIA dx key points?

A
  • Onset < 16 years old (peak onset is 1-3 years of age)
  • Lasts more than 6 weeks
  • No other causes of the inflammation
  • Arthritis in <4 joints in 50% of cases
54
Q

One of the tx for JIA is to suppress the immune system.

What are the key points to keep in mind here?

A
  • May increase the risk for infection as result
  • Latent TB may flare up
55
Q

What is Systemic Lupus Erythematosus (SLE)?

A
  • an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs.
  • It can affect the joints, skin, brain, lungs, kidneys, and blood vessels.
56
Q

S/S of SLE?

A
  • Fever
  • Fatigue
  • BUTTERFLY RASH ON FACE
57
Q

General SLE tx?

A
  • Supportive care for inflammation
  • Medications
  • Nutrition, rest, exercise
  • LIMIT UV LIGHT EXPOSURE
58
Q

What is the max amount of daily milk for toddlers and teens?

A
  • Toddlers = ≤ 32oz
  • Teens = ≤ 3 cups (24oz)
59
Q

What is the medical treatment for Aplastic anemia?

A
  • Immunosuppression if autoimmune cause is suspected
  • Bone marrow transplant
60
Q

What happens if you wait on a bone marrow transplant for aplastic anemia, what happens?

A
  • reduces survival right to 70% as the child would to the human leucocyte antigen (HLA)
  • body may now see it as “this isn’t me” and reject the new marrow
61
Q

Describe the vaso-occlusive crisis of SVA.

A
  • sickled cells cause blockages that result in a painful episode from hypoxia
  • Leads to
    • Acute Chest Syndrome (similar to pneumonia)
      • crisis clogs chest
      • leading cause for death in SCA
    • CVA (Cerbrovascular Accident - stroke)
      • Crisis clogs brain
    • Infection
62
Q

Pain is a huge issue with SCA. What are the key points regarding medication?

A
  • want to start meds as soon as possible,
  • give PCA if they’re old enough
  • want them to feel in control
  • nsaids, motrin, ibuprofen and opioid med is typical
63
Q

How is Beta Thalassemia, “Cooley’s Anemia” acquired?

A

inherited from parents

64
Q

What is happening in Beta Thalassemia?

A
  • Red blood cells hemolyze and become non-functional
  • Body makes more RBCs to compensate
    • Inside the bone marrow AND
    • Outside the bone marrow (extramedullary hemotopoiesis)
65
Q

Simply put, what is Beta Thalassemia and what does the process lead to?

A
  • Constant descruction and production of RBCs result in poor perfusion
  • Process leads to
    • Brittle bones, hepatosplenomegaly from the process
    • Delayed growth
    • Facial deformities
66
Q

What is Idiopathic Thrombocytopenic Purpura (ITP)?

A
  • An aquired hemorrhagic disorder that is characterized by:
    • Thrombocytopenia (destruction of of platelets - PLT<20K
    • Purpura (advanced peticea)
    • NORMAL bone marrow
67
Q

What is the treatment for ITP?

A
  • IVIG
  • Prednisone - to help body settle down and minimize platelet destruction
68
Q

All kids should be screened for lead poisoning by what age?

A

12mos

69
Q

What are five common diagnostic tests for cancer?

A
  • Bone marrow biopsy
  • Bone Scintigraphy
  • Gallium Scan
  • PET Scan
  • SPECT Scan
70
Q

How does a bone marrow biopsy help us diagnose cancer?

A
  • liquid marrow samples & a bone core segment
  • Uses:
    • Diagnosis
    • Evaluates DNA/Chromosomes
    • Prognosis/Risk
    • Treatment and response to therapy
71
Q

How does bone scintigraphy help us diagnose cancer?

A

We use it to ID areas of increased cellular turnover (rapid growth)

72
Q

How does a PET scan help us diagnose cancer?

A
  • IDs differences in metabolism in tissues
    • (tumor cells have faster metabolism)
73
Q

How does a SPECT scan help us diagnose cancer?

A
  • a nuclear medicine scan
  • examines the function of organs
  • looks at organs from different angles
74
Q

What is the nursing care after a bone marrow biopsy?

A
  • put on dressing (possibly pressure to stop in bleeding if present)
  • Monitor for bleeding, bruising, infection
  • Pain management
75
Q

When screening for Leukemia, what will x-rays and a CBC show?

A
  • X-Rays/Imaging
    • Show enlarged liver and spleen
      • abnormal cells are building up in liver/spleen
  • CBC
    • HIGH WBC (With greater % of blasts/immature cells)
      • Low WBC of healthy type
    • Low H&H
    • Low Platelet count (<50,000 admitted to hospital)
76
Q

What are the first steps taken for a pt w/ a new dx of Leukemia?

Briefly explain each

A
  • Symptom management
    • Get the stable
  • Bone marrow biopsy
    • confirm dx/type of Leukemia
  • Lumbar Puncture
    • to assess CSF involvement
  • Central line placement
    • prep for chemo
  • Chemo
    • prophylactic treatment in case CSF involvement
    • focused chemo later in tx
77
Q

A lumbar puncture is done to evaluate for leukemic presense in the CNS. Explain the process.

A
  • Patient will be side-lying with head flexed and knees drawn up
  • Patient may be sedated
  • Provider will take 3-4 vials of CSF
  • Pressure will be held and an elastic bandage placed to puncture site
  • Monitor site for Bleeding, Hematoma, & Infection
  • Child should remain in bed for 4-8 hours flat to prevent leakage, which can lead to spinal headache
78
Q

Explain the three phases of chemo therapy for Leukemia.

A
  • Chemotherapy: three phasesInduction therapy
    • 4 to 5 weeks
    • Goal: “remission”
  • Intensification/Consolidation
    • 6 months of “bursts” of treatment
    • Goal: make sure it doesn’t come back
  • Maintenance therapy
    • 2-3 years
    • Goal: To preserve remission
79
Q

What is worse, Hodgkins or non-Hodgkins lymphoma? Why?

A
  • Non-hodgkins
    • Because it can appear in the same places as Hodgkins as well as others and when it is discovered, it is usually at an advanced stage
  • Hodgkins has a 90% survival rate for ≥ 5yrs
80
Q

What is Wilms Tumor?

A
  • Tumor on the kidneys, usually unilateral
  • Most often diagnosed at 3-5 yrs of age
  • 90% survival rate
  • If untreated, the mass will block the vena cava/other organs and death will follow
81
Q

How is Wilms Tumor confirmed?

A
  • Intravenous pyelogram
    • dye is injected and observed
82
Q

What is our Nursing Care for Wilms Tumor?

A
  • Family education/support
  • Monitor central line
  • Post surgical/chemo care
83
Q

What are the dx tests for Neuroblastoma?

A
  • CT scan
  • Chest x-ray
  • Skeletal scintigraphy
  • Biopsy of tumor
84
Q

What is scintigraphy?

A

A technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning.

85
Q

What is the Medical tx for Neuroblastoma?

A
  • Surgery
  • Chemo
  • Radiation
  • BMT (Bone Marrow Transplant)
86
Q

What are the s/s of Neuroblastomas?

A
  • s/s are based on where it happens
    • If in spine, child may have leg weakness, balance issues
    • May have bowel and bladder issues not present before
  • If in face
    • May see bruising/swelling around the eyes
87
Q

True or False

Very commonly the kids will have metastastes somewhere else (bone marrow, lympnodes, bone or skin, etc) before they’re even dx’d w/ neuroblastoma

A

True

88
Q

What is the recovery rate for Neuroblastomas?

A
  • 30-90% recovery rate
    • Lower numbers are with metastasis at time of dx
    • Higher number is when its caught prior to any metastasis
89
Q

In addition to s/s due to location of Brain Tumor, what are some other manifestations to keep an eye out for?

A
  • Irritability
  • lethargy
  • increased head circumferance (infants),
  • headache
  • loss/delay of milestones (waking, crawling, etc)
90
Q

Dx tests for Brain Tumors?

A
  • MRI
  • CT Scan
  • PET (to eval tx)
  • LP
  • Biopsy
  • Labs
91
Q

What are three areas have common complications to chemo?

A
  • Hair
  • GI
  • GU
92
Q

What are the chemo complications for GI and how do we address them?

A
  • Nausea/vomiting
    • common but manageable w/ anti-emetics
    • give cool or bland foods
  • Change in appetite
    • some kids lose sense of taste
    • This was the storry about flaming hot cheetos being popular cause they can actually taste those
  • Mucositis- Mucosal irritation/Mouth sores
    • Provide good oral hygeine
    • “Magic mouthwash” - has benadryl, lydocane and an antacid - that helps them feel better for mouth care and inflammation and acids in stomach that add to pain
  • Constipation
    • stool softeners
93
Q

How does chemo effect the GU system?

A
  • Chemo is gonna be in bladder
  • Problem is it just sits there against the bladder tissue and can cause hemorrhagic cystitis
  • Will give lots of fluids, up to TWICE their proper maintenance dose - trying to flush that out
  • MESNA is med protects the bladder tissues
94
Q

How is radiation treatment delivered?

A
  • In divided treatments (about 5mins ea), every day, over weeks
  • Delivered to exact location of cancer cells (unlike chemo)
95
Q

SFX of radiation?

A
  • fatigue
  • skin damage
  • hair loss
  • n/v
  • low blood counts
96
Q

Key things to remember about pre-op care?

A
  • Consent/assent
  • Fam/Pt education on what’s about to happen
    • developmentally appropriate for kid
  • Parents stay with kid until the last second and parent brought back in for the wake up
97
Q

What is Tumor Lysis Syndrome?

A
  • It is when the tumor ruptures and its contents are spread throughout the body
  • Can cause metabolic abnormalities/electrolyte imbalances - ex. hyperkalemia, hypocalcemia
98
Q

How is Tumor Lysis Syndrome managed?

A
  • Hydration
  • Serial labs
  • Monitor I/Os
  • Meds for specfic abnromality/imbalance
    • ex. if hyperkalemia, reduce potassium
99
Q

To know the nadir, we need to know the Absolute Neutrophil Count.

What is its formula and what level triggers neutropenic precautions?

A
  • ANC = neutrophils X WBCs
  • or
  • ANC = (%segs + %bands) x WBCs
  • an ANC < 500 is the trigger point for neutropenic precautions
100
Q

What are neutropenic precautions?

A
  • Neutropenic precautions are steps you can take to prevent infections if you have moderate to severe neutropenia.
  • Neutropenia is a condition that causes you to have low neutrophils in your blood.

PEDS Unit 3 (9 decks)

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