EXAM #3 Flashcards
(202 cards)
1
Q
When should solid foods be initiated?
A
4 months
2
Q
Dehydration clinical manifestations:
A
-Tachycardia
-Hypotension
-Decreased tears
-Weight loss
-Thirst
-Irritability
-Sunken eyes & fontanels
3
Q
Management of dehydration:
A
-Fluid replacement
-Electrolyte monitoring & replacement
-Safety considerations
4
Q
What electrolytes should we monitor in dehydration?
A
Na and K
5
Q
Which electrolytes are major extracellular?
A
-Na
-Cl
-HCO3 bicarbonates
6
Q
Which electrolytes are major intracellular?
A
-K
-PO42 phosphate
-Mg
7
Q
What is the intake to maintain fluids?
A
-0-10kg 100ml/kg of body weight
-11-20kg 1000ml/kg
->20kg 1500ml + 20ml/kg
8
Q
What should hourly output for an infant be?
A
2-3ml
9
Q
What should hourly output for a toddler/preschoolers?
A
2ml
10
Q
What should hourly output for a school-aged child?
A
1-2ml
11
Q
What should hourly output for an adolescent?
A
0.5-1ml
12
Q
Risk factors for cleft lip/palate
A
-Males and native americans
13
Q
Clinical manifestations of cleft lip/palate
A
-Unilateral or bilateral cleft lip
-With or without hard soft palate
-Uvula
-Poor feeding/suck
14
Q
Nursing/other Management of cleft lip or palate:
A
-CL & no palate abnormality: Longer nipple but can take breast (after surgical repair) or bottle
-CP: shorter nipple
-Promote bonding
-Speech therapy
-Dentistry
-Audiology
-Dietician
15
Q
Surgical management for CP/CL:
A
Multiple surgeries
-CL at 3 months
-CP before 18 months
-Site care
-Elbow splints
-Pain control
16
Q
Anorectal types:
A
Rectal atresia: closure of the rectal passage
Rectal stenosis: constriction/narrowing of the rectal passage
Imperforate anus: Absence of a rectal opening. Can have fistulas
17
Q
Rectal stenosis clinical manifestations:
A
Vomiting, abdominal distention, difficulty passing stool, ribbon-like or narrow stool.
18
Q
How to dx anorectal malformations:
A
physcial exam, X-ray, US, MRI, IV pyelogram, rectal biopsy
19
Q
Nursing care for anorectal malformation (surgical):
A
-NPO & IV fluids before surgery.
-Pain control
Post op:
-I & Os
-fluids
-v/s
-pain control
20
Q
Surgical care for anorectal malformations:
A
Manual dilation
&
Two stage repair:
-step 1: Resection and creation of temporary ostomy
-step 2: closing ostomy and connecting the blind pouch to the anus
21
Q
Education/discharge info for anorectal malformations:
A
Colostomy care, wound care and anal dilation
-Fiber, fluids, bulking agents
22
Q
Pyloric stenosis clinical manifestations:
A
-Insatiable appetite
-Projectile vomiting
-Weight loss
-Dehydration
-Olive-shaped mass
-Constipation
23
Q
How to diagnose pyloric stenosis:
A
-US
-Palpatation
-X-ray
-Upper GI series
24
Q
Nursing care for pyloric stenosis (include pre & post-op):
A
-Monitor skin turgor, mucous membranes, depressed fontanels, absence of tears, UO, weight loss and vs
-Before surgery: NPO, NG tube, give fluids and elctrolytes.
-After: Pain control, vs, infection, feedings 6 hours after surgery, fluids if theres vomiting, measure diapers, monitor for dehydration
25
Surgical management for pyloric stenosis:
Pyloromyotomy
26
Post-op feeding protocol for Pyloromyotomy
Give food 6 hours after
-increase fluid volume for every 2 successful feeds
-if the baby vomits, baby will stay at that level for 2 consecutive feeds until they are tolerated
27
Education for pyloric stenosis:
-Incision care
-Infection
-report vomiting 48 hours after surgery
28
Clinical manifestations for intussusception:
-Acute abdominal pain waxes and wanes (paroxysmal)
-Pain goes away once the abdomen relaxes
-Pulls legs towards abdomen
-Vomiting ( may or may not be projectile)
-Fever
-Dehydration
-Abdominal distention
-Lethargy
-Currant jelly stool
-Sausage-shaped mass
-Grunting
29
Diagnosis of intussusception:
-Hx
-Sausage-shaped mass
-Barium enema
-US
30
Nursing care: complications for pre & post-op intussusception:
NPO, NG tube, IV fluids
-Monitor for perforation (rigid, N/V, tachycardia, fever, confusion, and decreased urinary output), peritonitis, shock & pain
-Record stools passed
31
Medical care: How can barium/air enema help with intussusception and what should the nurse educate on?
Helps dx and can cure it.
Will stay at the hospital for 24 hours as it can occur again and will require surgery
32
Surgical care for intussusception:
Repair or removal of bowels.
33
Education/discharge instructions for intussusception:
Care for incision, signs of infection, educate on feedings, dehydration and pain management.
34
Clinical manifestations for appendicitis:
-Starts with periumbilical pain
-Right lower quadrant pain
-Vomiting
-Anorexia
-Stool changes (low in volume & mucus-like)
-High fever with perforation but will otherwise be afribrile or have a low grade fever
35
How to Dx appendicitis:
-Elevated WBCs
-Abdominal radiograph
-CT
36
Post-op nursing care for appendicitis:
-I & O
-Wound care
-Pain control
-NPO for 24 hours
-May or may not have drains
-Perforated: IV antibiotics
37
Education/discharge instruction for appendicitis:
Wound care, infection, pain management, progessively resume normal activity and nutritional intake as tolerated
38
Acute diarrhea etiology:
-Diet or food allergies
-Toxic substances
-Infections
-Medications (antibiotics)
39
How to dx acute diarrhea:
-Hx of recent family illness, ingestion of chemicals, diet & last normal BM
-Physical exam: abdomen & perineum (rash)
-Blood work
-C&S
40
Preventing acute & chronic diarrhea:
Hand hygiene & food handling
41
Nursing care for acute & chronic diarrhea:
-Monitor fluid intake and output & electrolytes
-Observe for dehydration
-Skin integrity of perineum
-Daily weights & diapers
-BRAT diet
-No dairy only yogurt
42
What medication do we give for bacterial acute diarrhea
Metronidazole (flagyl)
43
Education & discharge instructions for acute & chronic diarrhea:
-Prevention (hygiene)
44
Chronic diarrhea definition:
3 + stools passed per day for 14 days +
45
Chronic diarrhea clinical manifestations:
-Abdominal distention
-Hyperactive bowel sounds
-Weight loss
-Dehydration
-Perineal irritation
-Blood in stool
46
How to diagnose chronic diarrhea:
-Stool for C&S
-Occult blood test
47
GERD pathophysiology:
-Transfer of gastric contents into the esophagus
48
Clinical manifestations of GERD:
-Irritability and fussiness
-Dysphagia or refusal to feed
-Choking
-Chronic cough
-Wheezing
-Apnea
-Weight loss
-Respiratory infections
-Bloody vomit
-Sore throat
-Halitosis
-Chronic sinusitis
49
Diagnosis of GERD:
-H&P
-GI series
-pH monitoring
-Barrium swallow
-Endoscopy
50
Prevention of GERD:
-Proper formula preparation, feeding and position
51
Nursing care for GERD:
-Manage reflux through positioning & frequent burping
52
What medication do we give for GERD?
proton-pump inhibitor
53
Surgical intervention for GERD:
-Nissen fundoplication
-Feedings jejunostomy
54
Education/ discharge instructions for GERD:
-Diet modifications
-Positioning
-Medication as prescribed
-Burping
-Avoid: chocolate, caffeine, citrus, tomatoes)
-Avoid playing after eating
-Thickened feedings with an enlarged nipple hole
55
What is Hirschsprung's Disease?
-Absence of ganglion cells (tells us to release stool) in the colon.
-Mechanical obstruction from inadequate motility of intestine
56
Clinical manifestations of Hirschsprung's Disease?
-Failure to pass meconium w/in 1st 48hr of life
-FTT
-Poor feeding
-Chronic constipation
-Vomiting
-Abdominal obstruction
-Diarrhea, explosive
-Ribbon-like stools in older children
57
What is a complication of Hirschsprung's Disease?
Enterocolitis
-Abrupt foul-smelling diarrhea, abdominal distention, and fever.
58
How to dx Hirschsprung's Disease:
-Intestinal biopsy
-Radiographic studies
-Barium enema
59
Pre-op nursing care for Hirschsprung's Disease:
-NPO
-NG tube
-IV fluid and electrolytes
-I&O
60
Surgical management of Hirschsprung's Disease:
Resection & temporary colostomy
61
Post-op nursing care for Hirschsprung's Disease:
-Assess bowel sounds and distention
-NPO
-Pain management
-Wound care
-fluids
-Patency of NG tube
62
Education/discharge instructions for Hirschsprung's Disease:
-Colostomy care until surgical repair heals
-Community resources
63
Failure to thrive patho
Failure of the infant to meet age-appropriate weight gain
64
How to dx FTT:
-Trackin growth rate demonstrates lack of adequate progress
-Lack of cognitive and emotional development
-Physical exam
-Chemistry panel
-CBC
-Iron
65
Clinical manifestations of FTT:
-D/V/constipation
-Recurring infection
-Abdominal distention
-Loss of SQ fat
-General wasting
-dehydration
-Evidence of abuse of neglect
-scaling skin
-edema
-alopecia
-spoon-shaped nails
-labial fissures
-inability to be comforted-lack of preference
66
Celiac disease patho:
Proximal small bowel mucosa is damaged as a result of dietary exposure to gluten, leading to permanent intolerance to gluten.
67
Clinical manifestations of celiac disease:
-D/V/constipation
-Abdominal distention and bloating
-Steatorrhea
-Abdominal pain
-Anorexia
68
How to dx celiac disease:
Clinical symptoms, serial markers, small bowel biopsy (atophy of the villi & deep crypts)
69
What should a patient with celiac avoid in their diet?
Wheat, rye, barley, and oat
70
What can a patient with celiac have in their diet?
Corn, rice, and millet
71
Education/discharge instructions for celiac disease:
-Avoid processed foods with thickening agents, cookies, ice creams, soups, and lunch meats
-Recommend normal amounts of fats
-Supplement calories, vitamins and minerals in acute phase
72
UTI clinical manifestations:
-Poor feeder
-V/D
-fever
-malodorous urine
-dribbling urine
-abdominal pain
-malaise
-enuresis
-dysuria
-flank pain
73
How to dx a UTI:
-Urine C&S
-US
-VCUG
74
How to prevent UTIs
-Handwashing
-Wiping front to back
-Cotton underwear
-Loose fitting clothes
-Avoid bubble baths
-Avoid sittin in wet clothes for extended periods of time
-Prevent constipation
75
Nursing care for UTIs
-Assess perineal area (irritation, pinworms, sexual abuse or trauma, edema, discharge, vaginitis & urine stream)
76
What medication is given for UTIs?
Antibiotics depending on the culture
77
Education/discharge instructions for UTIs:
-Handwashing
-Constipation and soiled diapers
-Perineal care
78
Vesicouretera reflux patho:
Urine backflows from the bladder to the utreters and possibly the kidneys
-Primary: Valvular defect causing backflow. May resolve on its own
-Secondary: Obstruction from abnormal tissue fold within the urethra may cause backflow causing hydronephrosis (distention of the kidney)
79
Clinical manifestations of Vesicouretera reflux:
-UTI symptoms
-Flank or abdominal pain
-Enuresis
-Fever
-N/V
-Enlarged kidneys
80
How dx Vesicouretera reflux:
VCUG radiograph & IVP
81
How to prevent Vesicouretera reflux:
Preventing and treating UTIs & pyelonephritis
82
medical mangement for Vesicouretera reflux:
-Urine culture every 2/3 months
-Depends on the grade but child will need to see nephrologist and urologist
83
Medications for Vesicouretera reflux:
Prophylatic daily low dose antibiotics until the child is infection-free
84
Surgical care for Vesicouretera reflux:
Deflux: sugar gel that goes in the ureter to stop urine from refluxing
-Nurse should monitor I&Os and pain
85
Education/discharge instructions for Vesicouretera reflux:
-S/S of UTIs
-medication adherence
86
What is an early sign of kidney problems?
Hypertension
87
Acute Glomerulonephritis patho:
-Imflammation of the glomeruli interferes with filtering waste products from the blood
-Glomeruli become edematous and infiltrated
with leukocytes, occlude capillaries
-Decrease in urine filtration-water accumulates and retention of sodium leading to circulatory congestion, hypertension and edema, primarily periorbital and peripheal
88
What pathogen causes Acute Glomerulonephritis?
Streptococcal infection
89
Signs and symptoms of Acute Glomerulonephritis:
* Gross hematuria (tea or red-colored urine)
* Periorbital edema
* Hypertension
* Headache
* Possible ascites
90
How to Diagnose Acute Glomerulonephritis:
* ASO titer
-Monitor Creatinine and BUN
91
Prevention of Acute Glomerulonephritis:
Handwashing and preventing and managing infection.
92
Nursing care for Acute Glomerulonephritis:
-Monitor for HTN
-Monitor urine output & gross hematuria
-All 3 of these s/s, the patient will have to be hospitalized due to risk of acute renal failure
* Strict I&O
* Daily weights
* Dietary restrictions
* BP monitoring every 4 hours
93
Medications for Acute Glomerulonephritis:
* Antibiotics
* Diuretics
-Corticosteroids and plasma in severe cases
94
Hemolytic Uremic Syndrome patho:
Associated with ingesting beef with E. Coli or other bacteria
95
Hemolytic Uremic Syndrome clinical manifestations:
* Gastroenteritis (abdominal pain, vomiting, bloody diarrhea)
* Upper respiratory infection
* Hematuria
* Proteinuria
* Pallor
* Lethargy/Irritability
* Decreasing urine output
* Hepatosplenomegaly
* Dehydration
* Seizures
* Consciousness alteration
96
Prevention of Hemolytic Uremic Syndrome:
* Ensure ground beef is fully cooked
* Clean fruits and veggies
* Pasteurized products
97
Diagnosis Hemolytic Uremic Syndrome:
* Elevated BUN and creatinine
* Elevated Potassium levels
* Serum glucose levels
* Calcium decreases
* phosphorus increases
* Platelet count (reticulocyte count rises)
98
Nursing care for Hemolytic Uremic Syndrome:
* Monitor LOC & signs of increased ICP
* Monitor for signs of CHF (lung sounds)
* bleeding
* HTN
* Tachycardia
* Strict I&O (4hr or 1hr)
* Daily weights & edema
* Electrolytes (Na, K, Cl & bicarb)
* ABG’s
* ECG/EKG, cardiac monitor
99
Patient education for Hemolytic Uremic Syndrome:
- Avoid unpasturized foods
-Avoid pools when the child has diarrhea
-Wash hands
-Proper food handling
-Cook beef to 106 degrees
100
Acute Kidney Injury Pathophysiology
* Treatable condition
* Life threatening
* Sudden decreased capacity of the kidneys
to eliminate waste products, resulting in an
inability to maintain fluid and electrolyte or
acid-base balance
101
Causes of acute kidney injury
* Pre-renal: dehydration, hemorrhage, sepsis
* Intrarenal (intrinsic): Glomulonephritis
* Post-renal (obstruction): tumors & congenital malformations
102
How to diagnose AKI
* Determine cause, history, physical examination
* Nursing physical assessment
* Lab work evaluation: uranalysis, blood chemistry, BUN, Creatinine, pH
* Renal biopsy
103
Therapeutic Management of AKI
* Analyze category
* Monitor labs and hemodilution
* Increase renal perfusion, prevent fluid, electrolyte and acid base imbalances
* Renal replacement therapy
* Monitor weight, BMI
* Monitor intake, collaborate with dietitian
104
Education/Discharge AKI
* Nephrologist referral
* Renal replacement therapy
* Holistic care: family support and education, nutrition, I&O, VS, dietician counseling
105
Medications for AKI
*steroids
*diuretics
*antibiotics
Monitor peak and trough times
106
Chronic Kidney Disease patho:
Greater than 2 years of age, glomerular
filtration rate may progressively deteriorate in 4 stages
107
What are patients at risk for with CKD?
At risk for End-Stage Renal Disease (ESRD)
108
What are complications of CKD?
* Hypertension
* Anemia
* Metabolic Bone Disease
* Growth Failure
109
How to prevent CKD:
* Nutrition/good prenatal care
* Monitor growth
* Early assessment
110
Clinical manifestations of CKD:
* Failure to thrive or anorexia
* Nausea/vomiting/loss of appetite
* Lethargy
* Headaches
* High blood pressure
* Reduced urine output
* Polyuria and polydipsia
* Bed wetting
111
How to diagnose CKD:
* Urinalysis
* Review of systems
* Fluid, electrolyte, and acid-base abnormalities
* Radiographs, bone films, renal ultrasounds, electrocardiogram
112
Nursing management for CKD:
Consults to dietitian & pastoral care
113
What 2 diseases are treated with renal replacement therapy?
ESRD and AKI/CKD-stage 4
114
What is the criteria to get renal replacement therapy?
Volume overload, hyperkalemia, metabolic acidosis, BUN, neurological symptoms, calcium and phosphorus imbalance, dialyzable toxin or poison, uremic induced mental changes, neuropath, pericarditis
115
What is peritoneal dialysis?
Uses peritoneal membrane to filter blood.
-Dialysis solution is inserted into the abdomen throught catheter.
-Osmotic process
-Drains
116
What are complications of peritoneal dialysis?
* Peritonitis
* Catheter dysfunction and obstruction
* Pain
* Pulmonary complications
* Fluid and electrolyte imbalance
117
Prevention of complications from peritoneal dialysis
* Determine if safe to start the PD
* I and O
* lab work
* VS
118
Nursing care for peritoneal dialysis:
-Monitor catheter for signs of infection & returning dialysate
-Monitor pain
-Weigh the patient before and after
-Sterile procedure
119
What is hemodialysis?
* Prevent accumulation of fluid and toxins; extracorporeal circulation through a dialyzer
* Vascular Access
* Time frame is 3x/week
120
Criteria for hemodialysis
* GFR
* Intractable complications of AKI
121
Complications of hemodialysis
* Hypotension, hypovolemia, anemia, infection, muscle cramps, bleeding, fluid shifts
122
How to prevent complications of hemodialysis
Monitor potassium, foods
123
Therapeutic Management of hemodialysis:
* Access clean and safe
* Fluid and dietary restrictions
124
What is hypospadias?
Urethral opening located behind glans penis or anywhere along ventral surface of penile shaft.
125
Signs and symptoms of hypospadias:
-Opening of the urethra below the tip of on the bottom side of the penis
-Incomplete foreskin
-Curvature of the penis during an erection
-Abnormal position of the scrotum in relation to the penis
126
What is Epispadias?
Urethral opening is located on dorsal surface of the penis
127
Signs and symptoms of epispadias:
-Opening of the urethra above the tip of the penis
-Curvature of the penis
-Urinary incontinence
128
Surgical management for Hypospadias/ Epispadias
-Surgery at 6-12 months before toilet training
-No circumcision
-Pain management
129
Education/discharge information for Hypospadias
/ Epispadias:
-Monitor for UTI (cloudy, foul smelling urine with blood)
130
Enuresis Pathophysiology:
* Involuntary discharge of urine
131
Clinical Manifestations of enuresis:
* Urgency, jiggling of legs
* Foul smelling urine odor
* Psychological stress
132
Therapeutic Management for enuresis:
* DDAVP: causes the kidneys to conserve body water and concentrate the urine, decreasing urine output during sleep
* Voidance of fluids
* Bed, bladder alarms
133
Pathophysiology/
Etiology of ICP
ICP is the pressure of the CSF in the subarachnoid space between the skulls and the brain.
134
Clinical manifestations of ICP in infants:
* Irritability, poor feeding
* High-pitched cry
* Fontanels: tense, bulging
* Cranial sutures: separated
* Eyes: setting-sun sign
* Scalp veins: distended
135
Clinical manifestations of ICP in children:
* Headache
* Vomiting: with or without nausea
* Seizures
* Diplopia, blurred vision
* Irritability, restlessness
* Drowsiness
* Memory Loss
* Papilledema
136
Nursing care for ICP:
* Monitor V/S, LOC, reflexes, & pupil reaction (Q15 min to 2hrs)
*Respiratory staus & trach care in needed
* Pediatric Glasgow Coma Scale
* Position HOB 15-30 degrees, head/neck midline
* Check for intact gag & swallow reflexes
* Caution with suctioning/overstimulation
* Avoid hypotonic IV solutions
* Monitor for fever and use hypothermic blanket if indicated
*Seizure precautions
137
What is a normal score for the pediatric Glascow Coma scale?
9-15
138
What meds are used to treat ICP?
-Sedatives (barbs, fentanyl, Ativan)
-Paralytics
-Antipyretics
-Anticonvulsants if at risk for seizure
-Pain meds (morphine)
139
Seizure patho:
* Electrical disturbance in brain
* Generalized or partial (focal)
140
Etiology of seizures:
* Genetics; traumatic brain injury, CNS infection, toxic ingestion, endocrine dysfunction, AV malformation, or an anoxic episode
* Febrile is the most common 1st time seizure in children
141
How to dx seizures:
-Neuro exam and testing
-CT/MRI, EEG, PET
scans
* New onset --> malignant
neoplasm possible
142
Clinical manifestations of seizures
* Loss of consciousness/loss of
awareness
* Motor signs
* Stiffing of body
143
Nursing care for seizures:
* History of antecedent events & characteristics of seizure
* Review of prenatal care and review of systems
* Seizure precautions
* Keto diet
144
Seizure precautions:
-Maintain airway, give oxygen
-Suction available
-Monitor O2
-Give meds IV (ativan, diazepam)
-Raise padded ride rails & turn lateal side
-Medical alert bracelet
145
What should be monitored with anti-epileptic drug therapy?
-Liver function
-Renal function
-Hematological function
-Anticonvulsant serum level q 3-6mths
146
Surgical intervention for seizures:
Excision of located seizure focus
147
Education/Discharge instructions for seizures:
* CPR & emergency procedures
* Medication education
* Day care/school fully informed
* Adolescents may drive (dependent on state law)
148
Patho of meningitis:
Inflammation of CSF & meninges due to infection
149
Etiology of meningitis:
* Septic/Bacterial
* Aseptic/Viral
150
Clinical manifestations of meningitis (general)
* Fever
* HA
* Stiff neck
* Lethargy
* N/V
* Decreased LOC
* photophobia
* irritability
* anorexia
* emesis
* seizures
151
Clinical manifestations of meningitis (infant to 18mths):
* Tense, bulging fontanelle
* increasing head circumference
* high- pitched cry
152
How to Dx meningitis: What does an infected csf look like?
Lumbar puncture: chemistry, cell counts, culture & gram stain.
* Infected CSF (bacterial) = cloudy, increased protein, decreased glucose, & increased CSF pressure
* Blood cultures
153
How is meningitits prevented?
Inmmunizations (children under 2 who are immunocompromized & under 21 who are not vaccinated)
154
Nursing care for meningitis:
-Assess neruo status q 2-4 hours
-monitor for s/s of increased ICP (go to MRI or CT)
-Keep room quiet & dark
-Seizure precautions
-NPO
155
Meds for meningitis:
-Antipyretics
-Anticonvulsants
-NSAIDS
-Bacterial: IV antibiotics
-Viral: self-limiting
156
Patho & etiology of encephalitis:
Inflammation of brain tissue most commonly caused by mosquito- borne viruses & herpes simplex type 1
157
Clinical Manifestations of Encephalitis:
* Confusion
* HA
* Nuchal rigidity
* High fever
* Photophobia
* Lethargy
* Seizures
* Coma
158
How to diagnose encephalitis:
* Hx: Exposure to possible sources: mosquitos, outdoors, unvaxed pets, meds, illnesses
* MRI/CT, CSF analysis, EEG, & lab work
* Definitive diagnosis: brain biopsy
159
Prevention of encephalitis
* Protection from vectors, bug spray
160
Nursing management for encephalitis:
-Seizure precautions
-Neuro assessments
161
Meds for encephalitis:
* Viral origin --> antiviral med (acyclovir)
* Bacterial origin --> narrow spectrum antibiotic
* Antipyretics, anticonvulsants, analgesics, & anti inflammatory
agents
162
Patho & etiology of Reyes syndrome:
* Results in an increase in ICP & accumulation of fat to internal organs
* Administration of acetylsalicylic acid (aspirin) during viral illnesses
* Primarily affects ages 4-14yo
163
Clinical manifestations of Reye's syndrome:
-Restlessness
-Vomiting
-Drowsiness
-Seizures
-Loss of consciousness
164
Diagnosis for Reye's syndrome:
* History of recent viral illness & use of acetylsalicylic acid (ASA)
* Liver biopsy
* Serum tests: liver enzymes, blood glucose, ammonia level & coagulation studies
165
Nursing interventions for Reye's syndrome
* Neuro assessment
* Seizure precautions
* Assess airway
* Administer & monitor oxygen
166
Parent education for Reye's syndrome
read all labels of over-the-counter medications/products; no ASA under 19 years old
167
Patho of Spinal Bifida:
Neural tube fails to close early in fetal development
168
Clinical Manifestations of Spina Bifida:
* Symptoms vary based on lesion location
* Dimple or tuft of hair on back “tethered cord”
* Meningocele: protruding sac with meninges & CSF
* Myelomeningocele: meninges, CSF, & spinal cord elements
* Neuro deficits
* Impaired bowel & bladder function
169
Diagnosis of Spina Bifida: Prenatal age & what is elevated?
* Prenatal diagnosis 12 –14 weeks gestation via US
* Elevated alpha-fetoprotein level
170
Nursing management of spina bifida:
-Measure and type of defect & birth
-Infection
-Cover with sterile gauzed moistened by sterile saline
-Lay baby in prone position
-No diaper (monitor for perineal & skin breakdown)
-Assess orthopedic function
-Bladder & bowel function
-Monitor for hydrocephalus
-Latex free
-Monitor pain
171
A baby with spina bifida must be delivered via...
C-section
172
What surgery will a patient with spina bifida have?
Laminectomy
173
Patho & etiology of hydroceohalus:
* Accumulation of cerebrospinal fluid in
intracranial vault & spinal cord
* Congenital anomalies & After surgical closure of myelomeningocele
174
Clinical Manifestations of hydrocephalus:
* Age, cause, & rate of hydrocephalus development
* Head enlargement
* Prominent forehead
* Difficulty holding the head upright
* Increased ICP s/s
175
How to dx hydrocephalus:
* Imaging: CT, MRI ,& US.
* Increasing head circumference
176
Nursing management for hydrocephalus:
* Head circumference assessment
* Monitor S/S increased ICP
* Shunt pre-operatively: Administer antibiotics
177
Post-operative Shunt neuro assessment: Hydrocephalus
* Assess for increased ICP
* Vital Signs
* Monitor Mead circumference
* Assess fontanelles
* Monitor for seizures, lethargy
* Position on non-operative side & elevate head no higher
than 30 degrees MD orders
* Monitor S/S infection
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Education/Discharge instructions for hydrocephalus:
* Teach recognition of infection & of shunt malfunction
* No contact sports
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What does a Ventriculoperitoneal Shunt do?
Relieves pressure on the brain by removing CSF from head and draining into abdomen
180
Clinical Manifestations of Shunt Malfunction:
* Headaches
* Vomiting
* Lethargy
* Irritability
* Swelling or redness along the shunt tract
* Decreased school performance
* Periods of confusion
* Seizures
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Treatment for shunt malfunction:
* Antibiotics
* Shunt removal
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Patho of cerebral palsy:
Most common physical disability due to brain injury before development is complete.
-Mild to severe physical & mental dysfunction
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Prenatal, Perinatal, & Postnatal risk factors of cerebral palsy:
* Prenatal risk factors: asphyxia, infections, hemorrhage, trauma.
* Perinatal risk factors: low birth weight, preterm, hemorrhage.
* Postnatal risk factors: encephalitis, meningitis, falls, abuse, crashes
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Ataxic cerebral palsy is characterized by:
Difficulties with balance & depth perception. Fine motor control and walking is poor
185
Athetoid CP is characterized by:
Uncontrolled movements of the limbs.
Drooling, speech, & grimacing in severe cases
186
Spastic CP is characterized by:
Increased muscle tone (contracture risks), poor posture, coordinated movement & balance
187
Mixed CP is characterized by:
two or more types
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Clinical Manifestations of cerebral palsy
* Vary, depending upon area of brain involved & extent of damage
* Muscle rigidity, muscle spasticity, poor control of posture, ataxia
* Speech difficulties
* Swallowing problems
* Breathing difficulties
* Bowel/bladder incontinence
* Vision & sensory impairments
* Learning disabilities, attention & behavior problems
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How to dx cerebral palsy:
* Based on clinical symptoms & developmental delay
* Imaging: CT, MRI, Cerebral US
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Nursing management for cerebral palsy:
* Splints & braces
* Assistive devices
* Frequent rest periods to reduce muscle spasm.
* Enroll in school
* Education for parents on maintaining a safe environment
* Feeding supervision & support actions based on individual needs
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Medications used to manage Cerebral palsy:
* Lioresal delivered intrathecally via implanted pump. Continuous & controlled relief
* Neurolytic agent nerve block injections
* Antianxiety medications
* Antiseizure medications
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Education/Discharge instructions for Cerebral palsy
* Expected growth & development
* Early detection of deterioration
* Symptoms of infection
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Clinical manifestations of TBIs
* Scalp laceration
* Altered LOC
* Seizures
194
How to Dx TBIs:
* Imaging: CT, MRI
* EEG
* ICP
* CPP
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Therapeutic Management for TBI
* Airway PRIORITY
* Assessment w/ Glasgow Coma Scale
* Palpate for fracture; associated symptoms
* No NG tubes/suction
* Quiet, non-stimulating environment
* Relief of high ICP
* Seizure meds
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Abusive Brain Trauma Pathophysiology:
* “Shaken baby syndrome” (non-accidental)
* Prognosis depends on
severity of injury & response
to therapy
* Neuromotor &/or visual
impairment & developmental delays
* High incidence of death
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Clinical manifestation of abusive brain trauma: Severe and less severe
* Severe: Seizures, apnea, buldging fontanelles, coma, hemorrhage, bradycardia.
*Less severe: Vomiting, FTT, Hypothermia, Increased sleeping, lethargy, irritability, difficult to arouse
198
Diagnosis of abusive brain trauma:
* Imaging: CT, MRI
* Ocular funduscopic exam: retinal hemorrhage (classic sign)
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Nursing management of Abusive brain trauma:
* Initiate respiratory & cardiovascular support
* Assess increased intracranial pressure
* Gather health Hx & gather information of event. DOCUMENT.
* Skin and pressure ulcer prevention
* Seizure monitoring/prevention; seizure meds
*NG tube or OG tube
* Adequate fluid & nutritional intake.
200
What is the gold standard for intussiception?
Barium enema
201
True or False. Gross Hematuria is not common in epispadias repair or enlargement of the kidneys.
True
202
Obesity is in what percentile?
95th
