Exam 1 test review (02/04) Flashcards
1
Q
What is the normal heart rate range for infants (0-12 months)?
A
100-160 beats per minute
2
Q
Normal systolic for infants (approx)
A
> 60 or strong pulses
3
Q
Normal systolic for Preschooler (approx)
A
> 75
4
Q
Normal systolic for School age (approx)
A
> 80
5
Q
True or False: The normal respiratory rate for toddlers (1-3 years) is 20-30 breaths per minute.
A
False. Its 24-40
6
Q
What is the typical temperature range for children?
A
97°F to 100.4°F (36.1°C to 38°C)
7
Q
What is the normal respiratory rate for adolescents (13-18 years)?
A
12-20 breaths per minute
8
Q
What is the normal heart rate for a toddler?
A
90-150
9
Q
Fill in the blank: The normal resp rate for a newborn is typically _____
A
30-60
10
Q
What is the normal temperature range for infants?
A
97°F to 100.4°F (36.1°C to 38°C)
11
Q
What is the normal systolic blood pressure for adolescents?
A
> 90
12
Q
What is the normal respiratory rate for school age
A
18-30
13
Q
What is the normal heart rate for a school-aged child (6-12 years)?
A
70-120 beats per minute
14
Q
Fill in the blank: The normal respiratory rate for Preschool children aged 4-5 years is _____ breaths per minute.
A
22-34
15
Q
Multiple choice: Which age group typically has a respiratory rate of 30-60 breaths per minute? A) Infants B) Toddlers C) Adolescents
A
A) Infants
16
Q
What is the normal temperature for adolescents?
A
97°F to 100.4°F (36.1°C to 38°C)
17
Q
Fill in the blank: The normal systolic blood pressure for toddlers is approximately _____ mmHg.
A
> 70 or strong pulse
18
Q
What is the first stage of Erik Erikson’s psychosocial development?
A
Trust vs Mistrust
19
Q
During which age range does the Trust vs Mistrust stage occur?
A
Infancy, approximately 0-1 year
20
Q
True or False: Successful resolution of the Trust vs Mistrust stage leads to a sense of security.
A
True
21
Q
What is the second stage of Erik Erikson’s psychosocial development?
A
Autonomy vs Shame and Doubt
22
Q
At what age does the Autonomy vs Shame and Doubt stage typically occur?
A
Early childhood, approximately 1-3 years
23
Q
Fill in the blank: Successful resolution of the Autonomy vs Shame and Doubt stage results in a sense of _______.
A
independence
24
Q
What is the third stage of Erik Erikson’s psychosocial development?
A
Initiative vs Guilt
25
During which age range does the Initiative vs Guilt stage take place?
Preschool age, approximately 3-6 years
26
True or False: Initiative vs Guilt involves children Developing a sense of purpose and a desire to plan and undertake activities on their own.
True
27
What can happen if a child does not successfully navigate the Initiative vs Guilt stage?
They may develop feelings of guilt, hesitance, or inhibition.
## Footnote
where children grapple with the conflict of asserting their independence and taking initiative while also learning to manage potential feelings of guilt if they overstep boundaries or make mistakes
28
Fill in the blank: The outcome of the Initiative vs Guilt stage can lead to a sense of _______.
purpose
29
What is a potential negative outcome of unresolved issues during the Trust vs Mistrust stage?
Fear and suspicion towards the world
30
True or False: The stage of identity vs. confusion occurs during adolescence.
True
31
Fill in the blank: In the industry vs. inferiority stage, children learn to work with others and develop skills in __________.
various tasks and activities
## Footnote
Children learn new skills, build confidence, and figure out what they're good at
32
What are the two outcomes of the identity vs. confusion stage?
The outcomes are a strong sense of identity or role confusion.
33
Multiple Choice: At what age range does the industry vs. inferiority stage typically occur? A) 0-2 years B) 3-5 years C) 6-12 years D) 13-18 years
C) 6-12 years
34
What is a key factor that influences the development of identity during the identity vs. confusion stage?
Exploration of different roles and experiences.
| "Who am I?
35
True or False: Success in the industry vs. inferiority stage leads to feelings of self-worth.
True
36
What is the main challenge adolescents face during the identity vs. confusion stage?
Finding a personal identity and sense of self.
37
Fill in the blank: Failure to develop a sense of competence in the industry vs. inferiority stage can lead to feelings of __________.
inferiority
38
How do stages of development affect how we help patients with procedures?
-Toddler
Have child sit on their parents laps.
Allow them a little contol like keeping their shoes on.
39
How do stages of development affect how we help patients with procedures?
-Preschooler
Fear of pain "No needles"
Fear of mutilation
They love bandaids
avoid asking them to make a choice
40
How do stages of development affect how we help patients with procedures?
-School age
Fear of death
Fear of pain
Secondary gains
-involve them in their care
show necessary equipment
41
How do stages of development affect how we help patients with procedures?
-Teenager
worried about scars or visible signs they have to explain to peers.
Body image important
Loss of control and independence
| Listen, be honest and open
42
Stages of development (9 months)
* Physical Growth: Weight and length, gaining at a slower pace and growing slow and steady
*Fine Motor: Bangs objects together, crude pincer (3 fingers), waved ‘bye-bye’; holds an object in each hand; claps hands
*Gross Motor: Crawls, abdomen off of the floor, sits up unassisted, may
start to pull self up and may start walking.
*Cognitive Ability/Language: ‘Ma-ma’, ‘Da-da’, combines consonants and
vowels, object permanence, separation anxiety
43
Stages of development (6 months)
* Birth weight is doubles
Fine Motor: Releases objects I hand to take another
*Gross Motor: Sits in Tripod Position; Rolling over in both directions
- begins to sit unsupported
*Cognitive Ability/Language: Babbling, imitating sounds, belly laugh/giggle
-Examines objects, play mobiles, their toes
-Starts to respond to their name
44
Stages of development (10 months)
uses pincher grasp
45
What stage could ritualistic behaviors when a hospitalization difficult?
Going to bed at the same time? same bedtime routine? stuffed toys or blankets from home?
46
What toys would be appropriate for an infant? Which toys would be inappropriate?
| up to 4 months
playmat with toys overhead, mobile, mirror, soft rattle, teething toy would not be appropriate until at least 4 months
47
What toys would be appropriate/inappropriate for a toddler? 30-36months
push and pull toys, bigger puzzles, books, toys that are musical, nesting toys, bright building blocks
48
What toys would be appropriate/inappropriate for preschool aged children?
coloring/arts and crafts, start of imaginative play – dress up, play kitchen, tricycle, scooter
49
What toys would be appropriate/inappropriate for school aged children?
– sports equipment, science kits, arts and crafts, bicycles, scooter, skate board, books, or board games
50
Piaget’s Pre-Operational Stage
Piaget's pre-operational stage is a phase of cognitive development that occurs roughly between the ages of 2 and 7 years.
- During this stage, children acquire symbolic thinking and language skills but still lack the ability to perform operations:
-- which are reversible mental actions (meaning that they can occur in more than one way, or direction.
-- Adding (3 + 3 = 6) and subtracting (6 − 3 = 3) are examples of reversible actions, frozen ice cubes can return to thawed state and still be same volume)
Pre-operational is also when a child will draw stick figures
51
What stage of Piaget's growth and development will children draw stick figures?
Preoperational stage
52
Piagets Formal operational stage
Piaget's formal operational stage is the fourth and final stage
- which typically begins around adolescence (around 11 years old) and continues into adulthood.
During this stage, individuals develop the ability to think abstractly, engage in hypothetical reasoning, and use logical thinking to solve problems.
53
Think through different types of emergencies: Prevent bodily harm
Use age-appropriate car seats and seat belts
Supervise children during playtime
Keep sharp objects and tools out of reach
Teach children to use playground equipment safely
54
How will risk associated to various age groups impact nursing teaching?
Prevent infants for falling from high surfaces
Supervise children during playtime and while using stairs
Use safety gates at the top and bottom of stairs
Keep furniture away from windows
Use window guards on upper floors
55
How will risk associated to various age groups impact nursing teaching?
| SIDS risk factors and Prevention –Back to sleep
* ensure the crib is properly assembled
* *always place baby on their back to sleep*
* keep a smoke-free zone around baby
* remove everything other than the mattress and sheet from crib when baby is sleeping
* use a blanket sleep; never loose blankets
* once breastfeeding established, pacifier after
* keep baby in mom’s room, but in a separate sleeping area
* use a firm mattress with no more than two fingers width between crib and mattress
* do not over-clothe baby while sleeping; baby should not be hot to the touch
* there should not be more than a soda can width between bars
56
How will risk associated to various age groups impact nursing teaching?
Prevention of toddler poisoning
Where/how should families store cleaning products or medications?
Discard empty containers?
Have poison control number posted?
What is a poison?
What are acceptable levels and when is care escalated
Keep medicines, cleaning products, and chemicals out of reach
Store toxic substances in locked cabinets
Use child-resistant packaging
Teach children not to eat or drink anything unless given by a trusted adult
- poison can be anything
57
How will risk associated to various age groups impact nursing teaching?
-Prevent drowning
Never leave children unattended near water
Teach children to swim at an early age
Use appropriate safety equipment such as life jackets
Install fences around pools and secure pool covers
58
How will risk associated to various age groups impact nursing teaching?
-Preventing Burns
set home's water heater at a maximum of 120 F
- fill tub prior to child getting in and test temperature (never more than 104F)
- never let child touch the faucet
- turn the hot water on LAST and off FIRST
- faucet covers for safety
- stove covers
*Keep hot liquids and foods out of reach
Use stove guards and oven locks
Check water temperature before placing child in bath
Install smoke alarms and carbon monoxide detectors
59
How will risk associated to various age groups impact nursing teaching?
-Assess teenage risk behavior
MVAs
60
Postictal State of Tonic-Clonic Seizures
lasts about 30 minutes
- remains semiconscious but arouses with difficulty
- impairment of fine motor movements
- possible headache, vomiting, visual or speech difficulties
- confused for several hours
- lack of coordination
- sleeps for several hours, feels tired, may complain of sore muscles
- no recollection of the seizure
61
What are the key differences between infantile spasms and other seizures?
Infantile spasms (West Syndrome)
- peak: 3-7 months
- sudden, brief, symmetric muscle contractions
- flexed head, extended arms drawn up
- possible nystagmus or eye deviation
- possible LOC
- treatment: adrenocorticotropic hormone (ACTH)
exam:
- chaotic brain activity on EEG
- poor development
- not meeting milestones
62
What are the most important actions for the nurse or parent during a seizure?
Nurse:
- protect from injury
- position: maintain airway
- watch the clock
- note onset, time, and characteristics of seizure
- side-lying to prevent aspiration
- do not restrain child
- loosen restrictive clothing
- do not attempt to put anything in the child's mouth
- prepare for oxygenation
- remove glasses
- remain calm and stay with the child
63
Key features of tonic-clonic seizure
Is a generalized motor seizure
previously called grand-mal
most prevalent
consists of sudden stiffness (tonic) and repetitive jerking (clonic)
- *muscle stiffness: rhythmic pattern of contraction and relaxation of muscles*
Onset: without warning
- Tonic (10-20 seconds)
-- Loss of consciousness
-- Eyes roll upward
-- tonic contraction of the entire body with arms flexed, legs and head extended
-- possible piercing cry
-- thoracic and abdominal muscles contract
-- mouth snaps shut and tongue can be bitten
-- flushing
-- loss of swallowing reflux
-- increased salivation
-- apnea leading to cyanosis
- Clonic (30-50 seconds)
-- violent jerky movements of the body
-- can have foaming in the mouth
-- trunk and extremities experience rhythmic contraction and relaxation
-- can be incontinent of urine or feces
-- gradual slowing of the movements until cessation
64
Key features of absence seizure
Onset: 4-12 and ceases by teenage years
- day dream appearance
- staring off
65
What are key nursing interventions for a child with a concussion?
ABCs
may have brief LOC, tonic posturing with clonic movements
immediate treatment:
– cervical spine stabilization until neuro-assessment of all 4 limbs and no reported neck pain or cervical tenderness
symptoms may not appear until several hours after concussive episode
athletes may not report symptoms for fear of losing playing time
monitor ICP, GCS
oxygen as prescribed
assess for CSF leakage
monitor for fluid overload
66
What is nuchal rigidity and relation to meningitis?
Online response: Nuchal rigidity refers to a stiff neck, where the neck muscles resist bending forward, and is considered a key clinical sign that can indicate the presence of meningitis, a serious infection of the membranes surrounding the brain and spinal cord; essentially, when someone has meningitis, their neck muscles become tight and painful, preventing them from fully flexing their neck forward due to inflammation of the meninges.
67
What are physical exam signs of meningitis?
nuchal rigidity
kernig sign
brudzinski sign
68
What are the symptoms of meningitis in infants vs other age groups
| (break into different flashcards)
Newborn:
- no illness at birth
- vague and difficult to diagnose
- poor muscle tone
- weak cry
- poor suck
- refuses feeding
- vomiting, diarrhea
- possible fever or hypothermia
- no nuchal rigidity
- late sign: bulging fontanel
3 months - 2 years
- bulging fontanels
- seizures
- high pitched cry
- purpuric/petechial rash
- fever
- irritability
- poor feeding/vomiting
- possible nuchal rigidity
2 years - adolescence:
- initial finding: nuchal rigidity
- fever/chills
- severe headache
- vomiting
- positive Kernig’s sign
- positive Brudzinski’s sign
- petechial/purpuric rash
- photophobia and irritability
- progresses to drowsiness, delirium, coma
- involvement of the joints (meningococcal and Hib)
- chronic draining ear (pneumococcal)
69
Key features of febrile seizure
- associated with a sudden spike in temperature: 38.9-40 (102-104)
- 15-20 seconds
Treatment:
- acetaminophen or ibuprofen
- dress in light clothing
- administer tepid sponge baths
70
What is second impact syndrome? How to prevent?
second hit before first concussion has resolved
more long term deficits
prevent second impact syndrome (SIS), you can avoid returning to play after a concussion until you are fully healed and cleared by a doctor
71
What is Reye Syndrome?
- life-threatening disorder
- primarily affects the liver and brain
-- liver dysfunction
-- cerebral edema
- peak incidence occurs when influenza is common
- prognosis is best with early recognition and treatment
72
What are key lab results indicative of Reye Syndrome?
elevated liver enzymes (ALT, AST, bilirubin)
- elevated blood ammonia level
- blood electrolytes
- extended coagulation times
73
What is the reason for administering mannitol in certain conditions? in Reye syndrome?
osmotic diuretic; decrease intracranial pressure
reduce cerebral edema in Reye Syndrome
helps prevent seizures
74
What are preventative strategies for Sudden Infant Death Syndrome (SIDS)?
- ensure the crib is properly assembled
- *always place baby on their back to sleep*
- keep a smoke-free zone around baby
- remove everything other than the mattress and sheet from crib when baby is sleeping
- use a blanket sleep; never loose blankets
- once breastfeeding established, pacifier after
- keep baby in mom's room, but in a separate sleeping area
- use a firm mattress with no more than two fingers width between crib and mattress
- do not over-clothe baby while sleeping; baby should not be hot to the touch
- there should not be more than a soda can width between bars
75
What are key nursing care interventions following a tonsillectomy?
Post-Op Care:
- assessment for excessive bleeding
– vital signs:
— tachycardia
— increased or decreased BP
— increased RR
- assess pallor
- frequent clearing of the throat or swallowing
- watch vomiting bright red blood
- restlessness
- blood on inspection of the throat
76
What is the Brudzinski sign?
child laying flat and pull head up, their knees will come up too
77
What is the Kernig sign?
when bending knee, head will pull up
78
At what age do most girls begin to experience puberty?
Most girls begin to experience puberty between ages 8 and 13.
79
True or False: Puberty starts earlier in boys than in girls.
False
80
Fill in the blank: The average age for boys to start puberty is around ____ years old.
9 to 14
81
What are the primary physical changes that occur during puberty?
Growth spurts, development of secondary sexual characteristics, and changes in body composition.
82
What is the primary method for assessing pain in infants?
The primary method for assessing pain in infants is through behavioral observations, such as facial expressions, crying, and body movements.
FLACC
83
Fill in the blank: The ______ scale is commonly used for assessing pain in children aged 3 to 7 years.
Wong-Baker FACES Pain Rating Scale
84
What method do we use to measure pain in 3-12 year olds
| look up
OUCHER
## Footnote
I believe the difference here from the FACES scale is that this uses real faces versus cartoon faces
85
At what age do children typically begin to understand the concept of pain and can use a numeric scale to rate it?
Children typically begin to understand the concept of pain and can use a numeric scale to rate it around 8 years of age.
86
Communicating with a hospitalized child
INFANT
crying
Be soft, cuddle, rock, eye contact
Safety
87
Communicating with a hospitalized child
TODDLER
“control” - imitates parents
Short clear instructions
Give choices
Approach positively-praise after activity
Explain all procedures, objects, equipment
Comfort-cuddle, rock, drink
Uses expressive jargons-pointing
88
Communicating with a hospitalized child
PRESCHOOLER
Literal meanings
Utilize concrete visual aids
Handle equipment
Teach in several short sessions
Strong imagination
89
Communicating with a hospitalized child
SCHOOL AGE
Increased vocabulary
Respects authority-learns rules
Privacy
Hospitalization used for secondary gains
90
Communicating with a hospitalized chil
-Adolescents
Slang is common
Acting out
Privacy
Sexuality information
Injury prevention
Body image control
Seeks independence
Peer Influenced
91
What are the ages that have the highest hospitalization with RSV?
children under 1
92
What are the risk factors for RSV?
- male gender
- birth within 6 months of RSV season
- multiple birth (often are premature if multiples)
- young mothers
- young mothers who smoke during pregnancy or after
- non-breast fed babies
- low socioeconomic status and education
- living in crowded conditions
- older family can transmit infection, even if they have a cold
- preterm birth
- chronic lung disease
- congenital heart disease
- immunodeficiency
- neuromuscular disease
93
How is RSV transmitted?
Direct/indirect contact
Need frequent handwashing
highly contagious; transmitted from direct respiratory secretions
- can live on objects for hours
- can live on skin for 30 minutes
94
Home care vs hospital care with RSV (I feel like this needs to be more specific)
apnea, hypoxia, dehydration
online:
home
- Encourage fluids to prevent dehydration
- Use a cool-mist humidifier to ease breathing
- Gently remove mucus from the nose with a bulb syringe
- Give acetaminophen or ibuprofen to reduce fever and pain
- Keep the room warm but not overheated
Hospital care
- Intravenous (IV) fluids
- Humidified oxygen
- A breathing machine (mechanical ventilation), in rare cases
- Antiviral medications
95
What assessment do you never complete on a child with possible epiglottitis?
do not do a throat exam
96
What are signs and symptoms of epiglottitis?
*difficulty swallowing, drooling, high fever, stridor, tripod position, looking sick*
ppt:
- appears sicker than clinical findings
- drooling
- tripod position
- fever
- irritable, anxious, restless
- retractions
- thickened or muffled voice
- throat is red and inflamed (don't do throat inspection)
97
Does epiglottitis have a rapid or slow onset?
onset is abrupt
- rapid
- usually goes to bed asymptomatic and awakens with sore throat and painful swallowing
is a medical emergency - can rapidly progress to severe respiratory distress
usually 2-6 y/o
high fever
severe dysphagia
98
Signs and symptoms of pneumonia
*Tachypnea with retractions*
Bacterial:
- fever
- difficulty breathing
- chest pain
- tachypnea
Viral:
- seen more in children with viral URIs
99
Treatment for pneumonia
Bacterial: antipyretics, IVF, antibiotics
Viral: treatment is symptomatic
- keep nose clear
- humidifiers
- nasal saline
- reduce fever
- hydration
- rest
100
Home care vs hospital care of pneumonia
Home care:
- supportive
-- rest, hydration, humidifier, keeping nose clear, administering medications - antipyretics
Hospital:
- IVF
- antibiotics
101
What are signs and symptoms of croup?
barky cough, inspiratory stridor
- varying degrees of inspiratory stridor
- varying degrees of respiratory distress
-- resulting from obstruction in the larynx
-- resulting from swelling
- may affect the trachea, larynx, bronchi
laryngeal involvement often dominates the clinical picture
- worse at night and with crying
usually 6 months - 3 years
gradual onset
low-grade fever
102
Treatment for croup
Hospital:
- PO or IV fluids
- high humidity with cool mist (mist tent)
- nebulized treatments (racemic epinephrine)
- corticosteroids (dexamethasone)
Home:
- humidification (cool mist; outdoors, freezer)
- warm mist from hot running water in a closed bathroom
103
What is the first intervention done with croup
cold air for 15 minutes
104
Home care for croup
- warm mist from hot running water in a closed bathroom
- humidification: cool mist
-- outdoors
- open freezer door
10-15 minutes, stridor can resolve
105
What is posturing with head injuries?
Flexion:
- *severe dysfunction of the cerebral cortex*
- demonstrates the arms, wrists, elbows, and fingers flexed and bent inward onto the chest
- legs extended and rotated internally
Extension (more severe):
- *severe dysfunction at the level of the midbrain*
- demonstrated a backward arching of the legs and arms, flexed wrists and fingers, extended neck, clenched jaw, possibly arched back
(pretty sure this is just decorticate vs decerebrate -- flexion = decorticate; extension = decerebrate)
106
What is the Glasgow Coma Scale - head injuries?
need to monitor this along with VS, LOC, neuro, ICP
The Glasgow Coma Scale (GCS) is a scoring system that measures a person's level of consciousness. It's used to assess the severity of brain injuries.
- lowest is 3
- highest is 15
107
Complications of a tonsillectomy
Complications:
- hemorrhage
- dehydration
- chronic infection
108
Bacterial vs viral meningitis
Viral: aseptic
- supportive care
- causative agents: viral illness
-- CMV, HSV, enterovirus, HIV, abrovirus
- most common
- acute headache, fever, stiffness, N/V
- usually self-limiting with good prognosis
Bacterial: septic
- contagious
- prognosis depends on how quickly care is initiated; is serious
- causative agents: bacterial
-- neisseria meningitidis, Hib, e. coli
-- injuries --> CSF
109
Treatment for meningitis: bacterial vs viral
Antibiotics: broad spectrum (bacterial)
Corticosteroids: can control cerebral swelling (bacterial)
- not indicated for viral
Analgesics:
- acetaminophen
- acetaminophen with codeine
110
Meningitis: Nursing intervention - how do you help your patient with a headache?
- dim lights
- decrease environmental stimuli
- provide comfort measures
- analgesics
111
What is the most important responsibility of a nurse with seizures?
Time!!!!
Record what you see
112
When should a parent seek emergency help during a seizure?
- when lasting longer than 5 minutes
- after administering rectal diastat the family should call 911
113
Seizures: Complex partial - features and characteristics
- unaware
- repetitive motor movements such as lip smacking
- partial so focal
114
What is gynecomastia? Is it normal?
yes; it is normal in early puberty development in boys
- short period: have an imbalance of estrogen and testosterone
early-mid puberty: can have more estrogen, leading to breast development
- seen more frequently in boys that are overweight
- are genetic disorders and medications
- alcohol and marijuana can cause breast development
about 50% of boys will have breast development during ages of 11-14 y/o
- will take 6 months to 2 years but will resolve
115
What are key s/s of pneumonia?
From online (Fever: May be mild or high, with chills and sweating
Rapid breathing: Nostrils flare and muscles between the ribs strain
Cough: Loud cough with phlegm
Chest pain: Sharp or stabbing pain that worsens when breathing deeply or coughing
Loss of appetite: In older children, or poor feeding in infants)
116
How do stages of development affect assessment: infant?
place on exam table and have the parent visible to the infant
117
How do stages of development affect assessment: toddler?
have child sit on parent's lap
118
How do stages of development affect assessment: preschooler?
allow them a little control, like keeping their shoes on
119
How do stages of development affect assessment: adolescent?
ask if they want their parent present
120
Why do toddlers resist directions from others?
Because they are in the autonomy vs shame/doubt stage - they are trying to set their own autonomy
121
When should an infant weight double their birth weight?
at 6 months
(length is rapid)
122
When should an infant weigh triple their birth weight?
at 12 months
(length has increased by 50%)
123
When should the posterior fontanel close by?
6 weeks (2 months)
124
When should the anterior fontanel close by?
18 months (2 years)
125
When should an infant be able to roll over by?
6 months
126
Hospital care for croup
- PO or IV fluids
- high humidity with cool mist
-- mist tents
- nebulized treatments
-- racemic epinephrine
- corticosteroids
-- dexamethasone
127
Treatment for RSV
- mostly supportive care
- pharmacological treatment
-- ribavirin (anti-viral)
-- synagis (monoclonal antibody used for prevention)
128
Expected findings of meningitis
- photophobia (light sensitivity)
- irritability
- vomiting
- headache
129
Meningitis physical assessment findings: newborns
Newborn:
- no illness at birth
- vague and difficult to diagnose
- poor muscle tone
- weak cry
- poor suck
- refuses feeding
- vomiting, diarrhea
- possible fever or hypothermia
- no nuchal rigidity
- late sign: bulging fontanel
130
Meningitis physical assessment findings: 3 months - 2 years
3 months - 2 years
- bulging fontanels
- seizures
- high pitched cry
- purpuric/petechial rash
- fever
- irritability
- poor feeding/vomiting
- possible nuchal rigidity
131
Meningitis physical assessment findings: 2 years - adolescence
2 years - adolescence:
- initial finding: nuchal rigidity
- fever/chills
- severe headache
- vomiting
- positive Kernig’s sign
- positive Brudzinski’s sign
- petechial/purpuric rash
- photophobia and irritability
- progresses to drowsiness, delirium, coma
- involvement of the joints (meningococcal and Hib)
- chronic draining ear (pneumococcal)
132
Bacterial vs viral meningitis lab tests for spinal fluid
Bacterial:
- cloudy
- elevated WBC
- elevated protein
- decreased glucose
- POSITIVE gram stain
Viral:
- clear color
- slightly elevated WBC
- normal or slightly elevated protein
- normal glucose content
- NEGATIVE gram stain
133
Increased ICP signs in newborns
- bulging or tense fontanels
- high-pitched cry
- increased head circumference
- distended scalp veins
- irritability
- respiratory changes
- bradycardia
134
Increased ICP signs in children
- increased irritability
- N/V
- headache
- diplopia
- seizures
- bradycardia
- respiratory changes
