Care of the child Musculo-skeletal,Neuro,Sensory conditions Flashcards Preview

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Flashcards in Care of the child Musculo-skeletal,Neuro,Sensory conditions Deck (72):
1

Osteomyelitis

-inflammation of the bone
-staph aureus
-blood bone infection

s/s:
-fever
-pain
-psuedoparalysis(afraid to move)

Diagnosis
-leukocylosis
-elevated esr
+ blood culture

Treatment/Nursing care
-long term course of treatment(6-8weeks)
-bedrest
-iv antibiotics
-analgesic
-immobilization of limb

2

Duchenne Muscular Dystrophy(etiology)

-Hereditary sex linked recessive
-progressive neuromuscular disease, life expectancy, early 30s
-fatty infiltration of muscle cells tissue breakdown
-occur in males more

diagnosis:
-H&P
-serum enzymes
-muscle biopsy

3

Duchenne Muscular Dystrophy(signs n symptoms)

-incidious(comes on gradually)
-delayed walking
-decrease muscle strength
-increasing clumsiness
-lordosis(shoulders back,rounded abdomen)
-gowers sign(large muscles break down first, cant stand up straight)
-usually die from PNA, ulcer

4

Duchenne Muscular Dystrophy(Treatment/Nursing Care)

-poor prognosis, no cure
-life expectancy adolensence
-depititating-crutches w/ bedridden
-prevention of complication
-skin care
-PT/OT
-emotional support

5

COXA-PLANA Disease aka LEGG-CALVE-PERTHES Disease(Etiology)

-lack of circulation to femoral head
-4-8 years with limp cause unknown
-trauma of synovities prior

6

COXA-PLANA Disease aka LEGG-CALVE-PERTHES Disease(nursing care/treatment)

-Rest, allow child to repair itself
-Bucks traction-puls in one place keeping in alignment
-hip bracing
-maintain ROM
-limit activity during treatment
-prognosis is good for hip degeneration in later years

7

Bone Tumors

-Benign: causes deformity and pain
-malignant-development of abnormal cells

8

Bone Tumors(Ewing Sarcoma)

-growth in marrow of the long bones
-metastisis tp lungs and other bones

s/s: pain,possible mass at the site,possible fx
tx:chemo and radiation, good prognosis provided caught early

9

Bone Tumors(Osteosarcoma)

-primary malignant tumor of long bones
-metas to the lungs
s/s:pain,limited mobility,obvious tumor mass
TX:amputation and chemo
Nursing care: post op care,potential for infection,coping family support,phantom limb pain,prosthesis-P/T

10

Juvenilele Rheumatoid Arthritis(Stills Disease)(Etiology)

-most common form of arthritis
-systemtic fever x10days, invovle internal organs(liver,spleen enlargement)
-polyarticular=arthritis in 5 or more joints
-pauciarticular=arthritis in 4 or more joints
S/S:swollen joints,enlarged liver and spleen,anemeia,anorexia,rash,pericarditis,myocarditis,potential for
-uueitis=inflammation of anterior chamber of the eye, check eyes every year for blindness
Dx:ANA, no cure

11

Juvenilele Rheumatoid Arthritis(Stills Disease)(Treatment/nursing care)

-no cure, treat symptoms
-NSAIDs, ,anti-inflammatory-hepatoxcity,effect the Gi system, ROM exerxcies
-prevent ankylosis(deformity of the joints)
-PT/OT to decrease ankylosis
-heat packs and warm showers-increase blood supply and decrease swelling
-good nutrition
-immunization delay because immunity decreased because of the use of corticorsteroids
-prognosis: subsides over a few years

12

Scoliosis(Etiology)

-curvture of the spine
-common in females

Functional:poor posture, no treatment
Structural:congenital,neuromuscular,diopathic(just happens we dont know)

Screening:pt. bends over feel spine
Dx: X-ray

13

Scoliosis(Treatment & Nursing care)

-curves under 20degrees=observation,good posture,backpack safety
-curves 20-40degrees=boston brace,milwaukee brace,daily exercise
-curves greater than 40degrees=harrington rods,spinal fusion
patient education:
-wear brace 23 hrs a day
-tee shirt under brace(skin integrity)
-body image in adolescents
-surgery:pre-op teaching,post op care, potential for constipation,log rolls,physical therapy,going to be immobile after surgery,dehersereanants after surgery because skin tight in the back, physical therapy

14

Hydrocephalus(etiology)

-excessive fluid in head around the brain
-increase CSF in ventricles of the brain
-increase intracranial pressure
-increase head circumference
-congenital or acquired

15

Hydrcephalus(Sign and symptoms)

-lethargy
-shrill cry,poor muscle tone,poor appetite
-seizures
-bulging fontanels
-increase head circumfeence
-seperated cranial sutures(increase fluid pushed them apart)
-getting sun eyes

16

Hydrcephalus(assessment)

-head circumference
-transillumnation
-MRI,cat scan

17

Hydrcephalus(treatment)

-ventriculo-peritoneal shunt

18

Hydrcephalus(pre-op care prior to shunt placement)

-Temp and Pulse q2h
-support head
-quiet feeding/quiet environment,prone to vomitting and seizures
-check fontanels
-monitor head circumference

19

Hydrcephalus(post-op care vp shunt)

-position baby on unoperative side
-initally flat then gradually increase HOB
-observe signs of malfunction
-monitor fontanels,sunken or bulging,adjust position
-observe for s/s of infection,possible menigitis/peritonitis
-skin care
-nutrition and emotional support

20

Hydrcephalus(parent teaching for VP shunt)

-recognize signs of increase intercranial pressure,malfunction,infection
-importance of the flu care and need for shunt revision
-safety-child may have tendency to be unbalanced
-early intervention: PT/OT/SPEECH

21

Spina Bifida(etiology)

-congenital embryonic neutal tube defect
-imperfect closure of spinal vertebrae

prenatal diagnosis
-alfa-fetal protein(AFP) level at 3-15weeks
-amniocentesis is indicated
-folic acid decreases incidence

22

Spina Bifida(2 types)

1.Spina bifida Occulta
2.Spina Bifida Cystica

23

Spina Bifida Occulta

-minor varistion, opening in spinal column small and no protrusion of structures

s/s: -tuft of hair or small dimple
-occurs at L1 or S1
-no treatment unless symptomatic

24

Spina Bifida Cystica

-Meningocele: cyst containing meninges and CSF
-size varies
-usually no neuromuscular symptoms
-surgery needed

Myelomeningocele
-defect in bony canal meninges csf. and spinal cord
-S/S:
-visible sac
-B&B control poor
-leg paralysis
-hydrocephalus

25

Tx of Spina Bifidas

-intra-uterine surgery
-c-section and surgery within 24hrs
-repairs defect
-prevents hydrocephalus
-latex free environment

26

Nursing care Spina Bifida

Pre-OP
-moist saline dressing
-assesment of sack
-avoid pressure on sac
-neuro assessment
-skinn care(no diapering)
-help promotoe parent-infant relationship

Post-Op
-observe dressing
-monitor for ICP, VS,for infection,for leakage
-parent teaching/expectations
-intelligence/learning ability not effected
-independence is compromised
-long term family goals
-focus on childs accomplishments
-catherization procedures
-bowel control
-precautions of latex allergic reaction
-observe for s/s of complication of immobility

27

Reyes Syndrome

-viral infection
-hepatopathy: ammonia level, bleeding
-encephalopathy
-no aspirin
-neuro checks
-HIB vaccine

28

Meningitis(etiology)

-inflammation of the meninges
-may be viral or bacterial
-peak incidence 6 to 12 months
-droplet infection/resp infection
-HIB vaccine useful to decrease risk

29

Meningitis(s/s)

-severe headache
-stiff neck
-irritability
-fever
-restlessness
-petechiae
-vomiting
-nuchal rigidity

30

Lumbar puncture

-small amount of CSF is extracted
-CSF should be clear

31

Lumbar puncture(nursing care)

-place child in lateral position
- hold neck and thighs to make a curve in spine
-talk quietly to child for reassurance
-quiet environment
-iv fluids and iv antibiotics
-anticonvulsants
-comfort and safety measures post LP
-resp isolation-72 ABX
-monitor iv fluids I/O
-observe for signs of increase ICP
-neuro checks
-tylenol for fever
-immunizations

32

Encephalitis(defintion)

-inflammation of the brain
-usually viral

33

Encephalitis(s/s)

-headaches
-drowsiness
-change in mental status
-coma
-seizures

34

Encephalitis(Tx)

-supportive care
-oxygen
-sedatives
-antipyretics
-iv fluids
-antibiotics

35

Encephalitis(nursing care)

-neuro check
-v/s
-i&o
-T&P

36

Brain turmors

-2nd common childhood cancer
-s/s depend on site
-treatment: radiation,surgery,chemotherapy
nursing care:monitor vs,observe for increase ICP,emotional support

37

Neuroblastoma(eitology)

-develops in utero
-adrneal gland
-abdominal mass
-HTN-tachycardia
-resp depression

38

Neuroblastoma(Dx)

-palpated mass in abdomen
-ct scan
-biopsy

39

Neuroblastoma(Tx)

-surgery
-chemo
-radiation

40

Neuroblastoma(nursing care)

-poor prognosis, due to metastasis before discovery
-emotional support

41

Mental retardation

-below average mental functioning
-deficit in adaptive behavior
-onset before 18
-3 components: memory,mood,language
-early intervention
-emphasize strengths
-family support
-AHRC

42

Downs Syndrome(Trisomy 21)

mild-severe mental retardation
-

43

Downs Syndrome(Trisomy 21)(S/S)

-small head
-round face
-flat nose
-protruding tongue
-close set eyes
-simian crease
-short thick hands: congenital heart defects
-family counseling
-strive to potential
-self-actualization

44

Head Injuries(etiology)

-concussion/skull fx
-shaken baby syndrome

45

Head Injuries(s/s)

-increased ICP
-headache
-hypoxia
-change of LOC

46

Head Injuries(nursing care)

-observe for LOC- wake child if neccessary
-monitor for ICP
-observe for posturing
-decerebrate=all 4 limbs extended, hands flexed back
-decorticate=arms wrist fingers flexed up

47

Decerebrate

all 4 limbs extended, hands flexed back

48

Decorticate

arms wrist fingers flexed up

49

Otitis Media(etiology)

-inflammation of middle ear due 2 upper resp infection
-communicable disease complication
-haemophilius influenzae
-baby w/ bottle in bed
-second hand smoke

50

Otitis Media(s/s)

-pain in ear, pulling on ear
-irritability
-diminished hearing
-fever
-headache
-vomit and diarrhea
-potential for rupture of eardrum

51

Otitis Media(Tx)

-broad spectrum antibiotic if throat culture positive
-analgesics
-ear drops
-under 3yrs: pinna down n back
-over 3yrs-inna up an back
-no cotton in ears
-myringotomy

52

Otitis Media(Nursing care)

-meds as ordered-Ax and tylenol
-no cotton in ear
-place child on affected side if drum is ruptures
-cold compress for pain relief
-check temp
-avoid water in ears

53

Hearing Impairment(etiology)

-prenatal viral infection or german measels
-acquired deafness: measles, mumps, meningitis exposure to loud noise
-temporary due to wax build up
-chronic ear infections
-neurological deficit

54

Astigmitism

-irregular shaped cornea or lense
-causes blurring vision
-treated with corrective lenses

55

Amblyopia

-lazy eye
-decrease muscle
-vision reduction
-patch good eye(unpatch 2hrs/24)
-can occur up to 9yrs of age

56

Strabismus

-cross eyes-unable to focus both eyes at same time
-move head instead of just eyes
-glasses
-patch unaffected eye
-vision therapy

57

conjuctivitis

-conjuctiva inflamed
-redness,drainage
-transferable
-treated with eye drops or ointment
-handwashing
-keeping person items seperate

58

hyphema

etiology: bleeding into the anterior chamber of the eye usually cause by blunt or penetrating trauma
-tx: both eyes are patched, cbr to prvent increase intracranial pressure and allows the re-absorption of the blood

59

cataracts

-opaque lens
-congenital
-hereditary
-non-hereditary
-surgery

60

Retinoblastoma(etiology)

-malignant tumor
-chromosome 13

61

Retinoblastoma(s/s)

-yellow/white reflex
-cats eye

62

Retinoblastoma(tx)

-cyrosurgery-freezing by laser
-photocoagulation-destroys blood vessels by laser
-enucleation-removal of eye
-chemotherapy

63

Retinoblastoma(Nursing Care)

-pressure dressing
-elbow restraints
-eye prothesis
-emotional support

64

Cerebral Palsy(etiology)

-anoxia at bitrth(lack of o2 to brain)
-prenatal
-preinatal
-non pregressive
-intelligence not necessarily affected
*person responsible for american disability act had cp

65

Cerebral Palsy(nursing care)

-early intervention
-Rom
-socializaiton
-family support

66

Seizures(etiology)

-altered neurological impulse causing rapid muscle contraction
-causes unknown, fever, trauma,brain tumor
-tonic-clonic(gran mal)
-aura
-tonic/clonic
-postictal lethary

67

Status epilepticus

-prolonged seizures
-sudden stopping of medication

68

Epilepsy

-chronica medical condition causeing seizures

69

Absence(petit mal)

-twiching , facial tics,blinking of eyes

70

Febrile

-most common
-caused by rapidly increasing temp

71

myoclonic

-sligh short lasting seizures

72

infantile spasms

-seen in premies with under developed nerous systems
-child is very jumpy and twitching