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Exam 3 Flashcards

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1
Q

Physical Cues of Cerebral Palsy

A

Nonprogressive impairment of motor function, especially muscle control, coordination and posture

Can cause abnormal perception and sensation, visual, hearing and speech impairments; Seizures and Cognitive disabilities

Exact cause is unknown; associated with several prenatal, perinatal and postnatal factors with the majority of causes (80%) occurring before delivery

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2
Q

6 Cerebral Palsy Priority Care

A

Oxygenation/Ventilation – positioning, suctioning, incentive spirometry, aspiration prevention

Pain management – management of muscle spasms
Adequate nutrition – oral & enteral (tailored to ability), monitor ht & wt. Can use Baclofen, botulinum toxin A (botox), and carbidopa

Skin care – repositioning, monitoring skin under splints/braces

Communication – electronic devices, picture boards, touch screen computers

Psychosocial – promote independence & positive self-image; support family

Developmental – monitor developmental milestones, interact based on developmental level rather than chronological age

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3
Q

5 Complication of Cerebral Palsy

A

Complications:
Seizures
Delayed G&D
Hydrocephalus
Aspiration
Injury r/t limited mobility

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4
Q

Cues of Muscular Dystrophy

A

Absence of dystrophin that causes progressive weakness of voluntary muscle of hips, thighs, pelvis, and shoulders initially
+ Gower’s sign

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5
Q

3 Lab/Diagnostics of Muscular Dystrophy

A

Electromyography (EMG): reveals nerve/muscle dysfunction

Muscle BX: Definitive DX showing absence of dystrophin

DNA Testing: Positive for dystrophin gene mutation

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6
Q

Nursing Priorities of Muscular Dystrophy

A

Primary goal is to promote mobility, maintain cardiopulmonary function, prevent complications, and maximize quality of life

Optimize physical function – ROM, strength & muscle training

Oxygenation/Ventilation – breathing exercises, suctioning, O2, cough devices, Assess WOB

Adequate Nutrition – low calorie, high protein & fiber

Skin Care – repositioning, monitoring

Psychosocial – support groups, respite care/palliative, End-of-life care

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7
Q

Cues of Dysplasia of the Hip

A

Incomplete dislocation of the hip with intact femoral head

Asymmetry of gluteal folds in prone position

Unequal number of skin folds on posterior thigh

Shorter affected limb, walk with limp (older child)

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8
Q

Priority Care/assessment of Dysplasia of Hip

A

Neurovascular assessment
Skin care
Parent teaching

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9
Q

Parent teaching of Pavlik Harness

A

Do not take off and adjustment by provider only 24/7 for a week or longer

Skin care

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10
Q

Cues of Scoliosis

A

Lateral curvature of the spine exceeding 10° and spinal rotation that causes rib asymmetry, idiopathic being the most common cause

Asymmetry in shoulder height, prominence of one scapula, uneven curve of waistline, or rib hump on one side

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11
Q

Management of Scoliosis

A

Moderate curves (25-45°) usually treated with thoracolumbosacral (TLSO) bracing and exercise

Surgical Intervention if curve >45° or progresses despite bracing or if cardiac/respiratory compromise

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12
Q

Scoliosis Post-Op Care

A

Frequent NV assessment of extremities with VS; TC&DB; Hemovac; Foley care; PRBCs (severe blood loss anticipated)

Log-rolling only to prevent damage to hardware

Pre-medicate for pain prior to moving, and slow ambulation to avoid orthostasis; PCA pump

Operative site assessment

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13
Q

What is Meningocele?

A

Less serious form of spina bifida cystica (only has CSF in sac)

Visible defect with saclike protrusion of meninges through defect in vertebrae

Usually minor or no neurological deficits

Requires surgical correction

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14
Q

Priority care of Meningocele (Sac Care)

A

Surgery can be delayed if normal neurological function and sac intact

Report any leakage -> infection

Prone positioning

Monitor head circumference(↑ICP)

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15
Q

What is Myelomeningocele?

A

Most serious form of spina bifida cystica (sac contains CSF, nerves leading to degrees of neuromuscular, limb, and sensory deficits)

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16
Q

Nursing Action for Myelomeningocele

A

NS moistened dressings to keep sac moist

Report leaking of sac

Prone position

Avoid swaddling and blankets (keep in isolette/warmer)

Atraumatic care

Avoid Latex and post-op contamination from pee and poo

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17
Q

Result most frequently from accidental trauma and are the

2nd most common injury in child physical abuse

A

Fractures

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18
Q

What are the neural assessment for fractures?

A

Sensation
Skin temperature
Skin color
Spontaneous movement
Capillary refill
Pulses
***It is similar to the 5 Ps (pain, paresthesia, pulselessness, pallor, and paralysis)

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19
Q

What are the complications of fractures?

A

Compartment syndrome (5Ps) and osteomyelitis (irritability, fever, tachy, edema, constant pain, and tenderness )

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20
Q

What are the nursing priorities of care for fractures?

A

Promote & monitor tissue perfusion – NV assessment on a regular schedule; skin assessment

Pain management – use age-appropriate pain tool; provide both pharmacological & nonpharmacological interventions

Infection prevention & monitoring
Promote mobility – proper alignment; ROM of fingers, toes & unaffected extremities

Pt/family support & education – activity restrictions; cast application & care; proper crutch use; signs to report

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21
Q

What is hydrocephalus?

A

Not a specific brain disorder but caused by an underlying condition

Accumulation of excessive CSF within the cerebral ventricles and/or subarachnoid spaces = ventricular dilation & IICP

Prognosis depends on cause and whether brain damage has occurred

Increased risk for developmental disabilities, visual problems, abnormalities in memory, and reduced intelligence

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22
Q

What are physical Cues of hydrocephalus?

A

They are the same as increased ICP

S/S vary by age
◘Baby: bulging fontanelles, sunken eyes, prominent sutures
◘Older children: HA (headache)

Common Signs: irritability, lethargy, poor feeding, vomiting, complaint of HA (older children), altered, diminished, or change in LOC

Physical: Wide, open, bulging fontanels; Large head or recent change in HC; Thin, shiny scalp w/ prominent, visible scalp veins; Sun-set eyes; Seizures

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23
Q

What is the most common complication of VP shunts?

A

Most common complication of blockage/obstruction and infection

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24
Q

What is VP shunt used for?

A

Therapeutic management of hydrocephalus

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25
What are the s/s cues of VP blockage/obstruction?
Increased ICP Vomiting, drowsiness, and HA typically r/t shunt malfunction
26
What to do for a Shunt infection?
Shunt infection treated with IV antibiotics; if persistent, shunt is removed and external ventricular drain (EVD) placed until CSF is sterile ​
27
When do most shunt infection happen?
Shunt infection most common 1-2 months after placement (can occur any time as well)​
28
Early Sign of Increased ICP
HA Vomiting, possibly projectile Blurred vision, double vision (diplopia) Dizziness Decreased pulse and respiration
29
Late signs of increase ICP
Lowered LOC Decreased motor and sensory response Bradycardia Irregular respiration (cheyne-strokes respiration) Decerebrate or decorticate posturing Fixed and dilated pupils
30
What characterizes Cushing Triad
Irregular breathing HTN Bradycardia
31
Intervention to decrease ICP
Head midline with 30° on bed Decrease stimuli Avoid suctioning/blowing nose/coughing Use stool softeners Fever management ICP monitoring Careful fluid regulation (I/Os) Sedation and analgesia Mannitol or hypertonic saline Seizure treatment/prophylaxis
32
Labs for Bacterial Meningitis
Increased WBCs and Protein Decrease Glucose Cloudy in color
33
Sudden s/s onset of meningitis
HX of URI or sore throat Fever, chills, HA, vomiting Photophobia Stiff neck Rash Irritability, drowsiness, lethargy Muscle rigidity or SZ
34
Bacterial Meningitis Management
PICU admission with strict droplet precaution until 24H of antibiotics IV broad-spectrum antibiotic after all CXs Measures to reduce ICP
35
What are S/S of Reye syndrome
Severe and persistent vomiting, lethargy, positive Babinski, sluggish pupils, and hepatomegaly
36
Priorities of Care for Reye syndrome
Measures decrease ICP Supportive care for the sequalae r/t to liver failure
37
Reye Syndrome Management
Hyperammonemia may be treated with Lactulose (osmotic laxative) but may require hemodialysis if level greater than 500mcg/dl.​ ​ Coagulopathy may be treated (especially before invasive procedures or with clinically significant bleeding) using fresh frozen plasma (FFP) or Vit.K.​ Hypoglycemia may be treated with dextrose-containing fluids (D50, D10, D5) with a serum glucose goal of 100-120mg/dl.​
38
What to do during a seizure?
Protection from injurie, do not attempt to restrain; loosen restrictive clothing Patent airway - position, oral suction, O2 and side-lying Do not attempt to open jaw or insert airway Stay with the patient
39
What to do after a Seizure
Maintain side-lying position Monitor breathing/VS/ head position, tongue Assess for injuries (head, tongue, body) Neuro checks Swallow reflex before food/fluid
40
Seizure precations
Padding of side rails and other hard objects Side rails raised on bed at all times when child is in bed Oxygen and suction at bedside Supervision, especially during bathing, ambulation, or other potentially hazardous activities Bracelet
41
Febrile Seizures
Most common type of seizure in children <5 and peak incidence between 12-18 months​ SZ lasting 15-20 seconds once in a 24 hr period​ Brief postictal period​
42
Tonic-clonic seizure
Most common of all seizure types​ Starts with phase where body & limbs stiffen; piercing cry & loss of swallowing reflex to phase with violent jerking of body; incontinence​ Long postictal period
43
Absence seizures
Motionless, blank stare with minimal change in behavior; resembles daydreaming​ SZ lasting 5-10 seconds; may lip smack or twitch eyelids/face​ Immediately resumes previous activities/no postictal period​
44
Seizure Management​
Phenytoin (IV and PO; IM is contraindicated) Fosphenytoin (IM or IV only)
45
Phenytoin Vs Fosphenytoin
Phenytoin can be administered PO/IV and Fos can be administed IV/IM Phenytoin has more adverse effect (gingival hyperplasia, etc), you also need to monitor for adequate intake of Vit D, mg, calcium, folate, and vitamin B levels Phenytoin HAS TO BE GIVEN WITH NORMAL SALINE Fosphenytoin does not cause local irritation, but is more expensive drug. faster and easire administration and does not precipitate
46
Lab/diagnostics for Seizures
Glucose, Electrolytes, Ca+: Rule out ↓ BS and ↓ Ca+​ LP: Rule out meningitis or encephalitis​ Skull XR: Rule out FX or trauma​ CT/MRI: Identify abnormality, bleeds, tumors​ EEG: Evaluate SZ type; “normal” does not rule out epilepsy​ Video EEG: Evaluate behavior and “catch a SZ” (Requires admission to hospital)​
47
Decerebrate
Rigid Extension Damage to brainstem and extrapyramidal tracts = rigid extension and pronation of arms/legs, flexed wrists and fingers, clenched jaw, extended neck, and possibly arched back
48
Decorticate
Rigid Flexion Damage to cerebral cortex or lesion to corticospinal tracts above brainstem = rigid flexion of arms held tightly to body, flexed elbows/wrists/fingers, plantar flexed feet, legs extended and internally rotated, and possibly fine tremors or intense stiffness​
49
Opisthotonos
Abnormal posturing caused by muscle spasms due to immature nervous
50
Pupils Indication
Pinpoint: poison, brainstem dysfunction, and opiate use Dilated (reactive): after seizures Dilated (fixed): brain stem herniation increased ICP Anisocoria: naturally different sized pupils Sunset eyes: increased ICP/hydrocephalus Unilateral sudden dilation: intracranial mass
51
Level of Consciousness
Full consciousness (AxOx4, playful) Confusion: disorientation, may not respond appropriately to questions Obtunded: limited responses and fall asleep unless stimulated Stupor: response to vigorous stimulation Coma: cannot be aroused, even with painful stimuli
52
What are physical cues of a child with Growth Hormone Deficiency?
Large/prominent forehead; under-developed jaw​ High-pitched voice​ Delayed sexual maturation​ Delayed dentition/skeletal maturation​ Decreased muscle mass​
53
How is Growth Hormone Deficiency Diagnosed?
Skeletal Survey: 2+ SD < normal in bone age​ CT/MRI: Rule out tumors/other abnormalities​ Pituitary Function Test to confirm​ Growth Chart deviations​
54
How is it treated?
SOMATROPIN​ SUBQUTANEOUS​ GIVEN DAILY ​ ​0.18-0.30 mEQL/Kg/Wk
55
Physical Cues of Congenital Hypothyroidism
Poor sucking, hypothermia, constipation, lethargy, hypotonia, periorbital puffiness, cool/dry/scaly skiing, bradycardia, RR distress, large fontanelles and delayed closures Macroglossia and coarse facial features
56
Medication for Hypothyroidism? Medication management and teaching?
Thyroid hormone replacement (Levothyroxine) Mush be crushed Never use in whole bottle of feeding Give in a small amount of formula Medication absorption is affected by soy-based formulas, fiver, calcium, iron preparation, and antacids Reduce L-thyroxine effects Missed doses may lead to developmental delay/poor growth
57
Diagnosis/Labs for Congenital Hypothyroidism
Thyroid function test done at 2 nd day of life Free T4: 0.8-2.4 ng/dL TSH: 0-10 mu/L T4 low and TSH high
58
Teaching for Levothyroxine
If untreated can cause intellectual disability, delayed physical maturation, short stature, and growth failure Medication education
59
What is Diabetic Ketoacidosis?
An acute life-threatening condition characterized by glucosuria & breakdown of body fat for energy.​
60
What are expected Lab findings for DKA?
Main ones: Hyperkalemia, Metabolic Acidosis, Glucosuria, Ketonuria Blood glucose > 300 Decrease serum bicarb Acidic pH Increased creatine decrease sodium increased potassium increase hemo-A1c increased WBC Urinalysis (+ketones)
61
KDA management
PICU admission Hourly blood glucose monitoring to prevent BS falling more than 100 mg/dL/hr (can cause cerebral edema) IVFs to treat dehydration, correct Na+ and K+, and improve peripheral perfusion IV regular insulin via titrated infusion based on protocol sliding scale
62
DM diagnostics
BS >200 mg/dL Fasting Glucose (>126 mg/dL) Oral GTT (>200 mg/dL at 2 hrs) HgbA1C: >6.5%
63
DM Labs
Chem Panel: Evaluate BUN/Creatinine, Ca+, Mg+, PO4-, Na+, K CBC; UA C-Peptide: After glucose challenge to verify endogenous insulin secretion
64
Hypoglycemia management
If child coherent: feels S/S of hypoglycemia and glucose monitor shows low BS: -Give glucose paste/tablets or 10-15 g of simple carbohydrate (OJ or milk); Followed with complex carbohydrates (peanut butter and crackers) to maintain glucose level If incoherent: Glucagon Sub-Q or IM: Under 20kg - give 0.5mg Over 20kg - give 1mg D50: IV PRN
65
Down Syndrome (Trisomy 21) Complications
#1 PREVENTING COMPLICATIONS Aspiration: (Due to small mouth, large tongue, poor suck/tone, increased nasal stuffiness -Use of bulb syringe & humidification -Chin/neck support Hypothyroidism: Thyroid testing at 6 months, 12 months, then annually Atlantoaxial instability: Cervical XR at age 3-5 yr to screen: Report changes in gait or continence or weakness in head, neck Cardiopulmonary issues Hearing/Vision Impairments: screen regularly (cataract, OM)
66
How to promote nutrition for trisomy 21 patients
Plot length, weight, head circumference on Down Syndrome growth charts only; grow more slowly FTT: Poor suck/tone, nasal stuffiness, cardiac issues -Altered feeding positions Monitor GI conditions (celiac disease, constipation, Hirschsprung disease, imperforate anus) Routine dental care every six months and daily teeth brushing Regular diet and exercise
67
Name insulins and their generic names
Rapid acting

Peds (4 decks)

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