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Peds Exam 3 > Neuro/ Respiratory > Flashcards

Flashcards in Neuro/ Respiratory Deck (106):
1

What is one of the first body system to form in uterus?

Nervous system-neural tube

2

How much CSF do infants have?

50 mL

3

Does the brain continue to grow throughout childhood?

Yes

4

Are the pediatric brain and peripheral nerves fully developed at birth?

No

5

Neurological Alterations

-IICP
-head injury
-hydrocephalus
-seizure disorders
-spina bifida
- cerebral palsy
-Reyes syndrome

6

Causes of IICP

Space-occupying lesion- brain tumor, hematoma
Swelling- head trauma, infection, hypoxic episode
Overproduction of fluid
Malabsorption of fluid
Communication problem w/in
Aneurysms w/in the brain
Acute liver failure

7

What is Hydrocephalus?

A condition in which fluid accumulates in the brain
Typically I young children
Enlarging the head
Sometimes causing brain damage

8

What is Spina Bifida

A congenital neural tube defect(NTD)
Incomplete closure of the vertebrae and neural tube during fetal development

9

What is Cerebral Palsy?

A chronic, non progressive disorder of posture and movement

Difficulty in controlling the muscles b/c of an abnormality in the extrapyramidal or pyramidal motor system

10

What is Reye Syndrome

Exposure to a viral agent or toxin in at-risk children leads to liver cell damage w/rising serum ammonia levels

The toxic ammonia levels result in cerebral dysfunction (encephalopathy, cerebral edema), fluid and electrolyte and acid base imbalances, and coagulopathies

May be related to giving aspirin to children w/a viral disease

11

Diagnostic testing for neurological alterations

CT-SCAN
MRI
Nuclear brain scan
Angiography
Echopencephalography (EEG)
Lumbar puncture

12

Lumbar puncture RN intervention

Keep child still (side-lying, knees to chin)

Monitor cardiorespiratory status

Help parents comfort child

13

Lumbar puncture teaching points

EMLA cream used to numb the area(only form of pain management

Site will be cleansed w/cool antiseptic solution

Collection of CSF takes several minutes

Lie flat after procedure and encourage fluids

14

S/S IICP infants

Bulging fontanel
High- pitched cry
Increased head circumference
Eyes deviating downward(sun-setting)
Altered response to pain(increased or decreased)
Poor feeding/ vomiting
Irritability
Lethargy

15

S/S of IICP in child

Headache
Altered LOC
Vomiting(esp. morning due to rising from laying position= shift in pressure)
Mood swings
Slurred speech
Changes in normal behavior(not acting like themselves)

16

IICP nursing interventions

Elevate bed to 30 degrees
Medication: osmotic diuretic(mannitol), sedation, analgesics
Avoid aggressive use of passive ventilation (wind)
Monitor intraventricular catheter, if placed
Monitor LOC

17

Posturing- DECORTICATE

Flexor

Arms are like a C

Moved inward (on chest)

PROBLEMS W/ CERVICAL SPINAL TRACT OR CEREBRAL HEMISPHERE

18

Posturing- DECEREBRATE

Extensor

Arms are like E

Outward

PROBLEMS W/IN MIDBRAIN OR PONS

19

Head injury- infant signs of skull fracture/trauma are...

Scalp hematoma and seizures

20

Head injury assess

Airway

Respiratory function

Neurologic status

Other injuries

21

Head injury nursing interventions

Maintain vital functions (adequate Oxygenation/perfusion)

Frequent neurological checks monitor for IICP

Encourage rest-NO SCHOOL OR TV OR VIDEO GAMES JUST SLEEP

22

Mild head injury S/S EXPECTED

-Periods of confusion
-Behavior changes
-Irritability
-Vomiting
-Headache
-Sleepy

23

Severe head injury S/S

CALL HCP

-Seizures
-Severe headache
-Severe/constant vomiting
-Blurred vision
-CSF (watery) or blood from ears/nose
-Hard to wake (decreased LOC)
-Slurred speech
-Unequal pupils or crossed-eyes

24

Hydrocephalus infant early S/S

-Born w/ large head
-Rapid head growth
-Bulging anterior fontanel
-Irritability
-Poor feeding

25

Hydrocephalus infant late S/S

“Setting sun” sign
Vomiting
Difficulty feeding/swallowing
Increased BP
Decrease HR
Altered respiratory pattern
Shrill/high-pitched cry
Sluggish or unequal pupillary response to light

26

Hydrocephalus early S/S in children 12-18 months

Strabismus (cross-eyed appearance)
Morning frontal headache relieved by vomiting or sitting upright
Behavior/personality changes
Irritability
Sluggish or unequal pupillary response to light
Confusion
Lethargy

27

Hydrocephalus late S/S in children 12-18 months

-Seizures
-DECEREBRATE posturing and rigidity
-Increased BP
-Decreased HR
-Altered respiratory pattern
-Blindness (vision issues)

28

Causes of hydrocephalus

Head injury

Meningitis

Congenital defect

Tumor

Spina Bifida

29

Hydrocephalus nursing intervention

Monitoring the shunt to prevent further CSF accumulation and reducing disability and death

30

Hydrocephalus treatment

VP shunt (ventricular peritoneal shunt)

Permanent shunt from ventricle in brain to peritoneum

Drains CSF into abdomen where extra CSF can be absorbed, decreasing ICP

Internal system

31

Seizure disorder-febrile

-Children under 5 years old
-Caused by high and rapidly elevating temps
-Child at risk for additional febrile seizures
-Usually harmless and doesn’t cause other health problems
-ONLY TREATMENT IS GIVE ANTIPYRETICS

32

Neonatal seizure disorder

Birth to 4 weeks old (first month of life)

Subtle signs of seizures b/c immaturity of neonates nervous system

33

Neonatal seizure disorder causes

Underlying pathological process
-Drug withdrawal
-Hyperthermia
-Hypoglycemia
-IICP
-Intracranial hemorrhage

34

Neonatal seizure subtle signs of seizure activity

Staring

Rapid eye blinking

Rapid/constant lip smacking or sucking

35

Neonatal seizure disorder treatment

Medications during seizure activity and daily for 3-6 months

36

What is Epilepsy

Recurrent seizure activity that does not occur in association w/acute illness

37

Epilepsy treatment

Maintenance medication

For seizures lasting more than 5 minutes- give Dilantin (phenytoin) rescue drug RECTALLY AND KEEP THIS MEDICATION AT THE BEDSIDE

Ketogenic diet if medication doesn’t work! LAST RESORT (high fat, low/no carbs)

38

Seizure rn interventions

Place child on soft surface
Remove furniture/ objects from area
Turn gently to the side
Protect head
Stay w/child
Time and observe seizure
Do not restrain or put anything inside mouth
May need ketogenic diet if medications fail (high fat, low/no carbs)

39

Spina Bifida -occulta

Mild

Open vertebrae, nothing protruding

likely asymptomatic

40

Spina Bifida- cystica: meningocele

Moderate

Saclike protrusion containing meninges and CSF

41

Spina Bifida- cystica: myelomeningocele

Severe

-Saclike protrusion containing CSF, meninges, nerve roots and spinal cord
-Bowel/ bladder involvement
-Flaccid muscle tone
-respiratory issues
-paralysis of lower extremities

42

Treatment for Spina Bifida

-VP shunt
-Straight cath
-Leg braces
-Wheelchairs
-intrapartum-utero surgery

43

Complications of a VP shunt

Infection

Clog

Outgrow w/age

Migration

Breakage

44

Spina Bifida pts are at risk for...

Hydrocephalus and IICP
Cerebellum protrudes down top of spine causing CSF blockage-causing hydrocephalus
Respiratory apnea/cyanosis
GI dysfunction
Paralysis in lower extremities
Bowel ants bladder dysfunction
Club feet

45

Spina Bifida assessment

Lesion on back (dimple, hair tuft, saclike protrusion)
Flaccid lower extremities
Decreased sensation
Bowel/bladder incontinence
Improper positioning of hip, knee, plantar

46

Spina Bifida RN interventions

Prone position

Cover defect w/sterile, moist dressing prior to surgery

Latex precautions from birth due to repeated exposure to latex

Life long management of neurologic, orthopedic, and urinary problems

47

What is cerebral palsy?

-Chronic, non-progressive disorder of posture and movement.
-characterized by difficulty in controlling the muscles
-abnormality in the extrapyramidal or pyramidal motor system

48

Cerebral palsy co-mobidities

-cognitive impairments
-hearing impairments
-speech impairments
-visual impairments
-seizures

49

Risk factors

- being in a hot car
- shaking baby syndrome
-brain not going w/o oxygen during birth
-brain trauma
-maternal drug use intra-utero

50

How do we maximize a child with cerebral palsy’s abilities?

Early recognition and intervention

OT/PT

51

What is the main test for a lumbar puncture?

Meningitis

52

Strabismus

Cross-eyed appearance

53

Cerebral palsy assessment

-delayed gross motor development
-spastic or uncontrolled movements in extremities
-gait disturbances
-seizures
-sensory impairment
-primitive reflexes
-abnormal muscle tone
-lack of progression thru developmental milestones
-speech and swallowing impairments

54

How to prevent Reye syndrome?

Vaccinations of MMR, VARICELLA,FLU...

don’t give aspirin

55

S/S of Reye Syndrome

-prior viral infection
-progressive neurological decline
-malaise
-N/V
-elevated ammonia levels
-liver dysfunction
-low blood sugar
-bleeding issues
-IICP w/ respiratory dysfunctions

56

What two organs does Reye syndrome attack?

Liver

Brain

57

Monitoring w/ Reye syndrome

-Neurological status
-IICP
-hydration
-acid-base balance
-cardiorespiratory status

58

Treatment for Reye syndrome

-manage symptoms caused by virus

-IV Fluid to regulate glucose and electrolyte levels

-mannitol or IICP

59

Considerations for Reye syndrome

-Can cause permanent neurological damage (brain damage)
-can’t be fatal w/in days if not treated

60

What is Otitis Media?

Fluid or infection in the middle ear

61

What risk factors for otitis media

-Infants and small children d/t their Eustachian tube is not as slanted and is shorter
-daycare
-smoking in home
-supine position while being bottle fed
-pacifier users
-6-24 months

62

S/S of otitis media

-bulging, red,opaque tympanic membrane(MD)
-earache,pulling ears
-fever
-V/D
-sleep disturbances
-hearing & speech problems
-yellow/green foul smelling drainage(indicates perforated tympanic membrane (not common)

63

Treatment of otitis media

-watch and wait 3-4 days to see if it resolves itself before giving antibiotics
-antibiotics
-tympanostomy tubes

64

What is tympanostomy tubes?

-surgical placement on tubes into the ear canal

-treatment of otitis media

65

What is croup

-Viral infection

-upper airway

-let it run its course

66

S/S of croup

-sore throat
-INSPIRATORY STRIDOR
-RESPIRATORY DISTRESS
-fever
-BARKY COUGH (worse at night)

67

Croup treatment

-COOL MIST/ HUMIDIFICATION (#1)
-apply oxygen depends on vitals
-breathing treatments (respiratory therapy)
-manage symptoms
-may be treated at home or in the hospital

68

What is Pharyngitis

Inflammation or infection of the throat
(Usually strep)

69

S/S of pharyngitis & treatment

-sore throat
-redness/inflammation -throat
-fever
-cough
-runny nose
-hoarseness voice

TREATMENT-antibiotics, pain/ symptoms managed

70

S/S of tonsillitis

-Sore throat
-redness/inflammation of tonsils
-difficulty swallowing
-decreased appetite
-decreased thirst
-WHITE EXUDATE ON TONSILS
-fever
-UNPLEASANT MOUTH ODOR
-often present w/ pharyngitis

71

Treatment of tonsillitis

-antibiotics
-tonsillectomy if recurrent

72

RN interventions for tonsillitis

ASSESS FOR BLEEDING
-excessive swallowing
-bloody drainage
-bloody vomitus
-restlessness associated w/ pain
-high/low BP
-high HR
MAINTAIN HYDRATION
SCHEDULED PAIN MEDS
FLUIDS ORALLY

73

Epiglottis is

Inflammation of the flat that closes the opening of the windpipe when swollen.

EMERGENCY SITUATION!!!!!

74

S/S of epiglottis

-abrupt onset and gets worse very quickly
- the 4 D’S
-drooling
-dysphasia
-dyphonia
-distressed inspiratory efforts
(trouble breathing)
-tripod position
-HIGH FEVER
-Gasping for air

75

Treatment for epiglottis

-Antibiotics (IV until extubated)
-antipyretics (IV or rectal)
-USUALLY INTUBATED/ maintain patent airway

76

What vaccine can prevent epiglottis

HIB

77

RN intervention for epiglottis

-stay w/ child
-continually assess for respiratory distress
-have intubation equipment at the bedside
-radiographs at the bedside
-keep child and parents calm and quiet

78

What is the most important intervention for a pt w/ epiglottis

DO NOT PUT ANYTHING IN PTS MOUTH

DO NOT SWAB THROAT UNTIL READY W/ INTUBATION EQUIPMENT

SWABBING WILL INCREASE IRRITATION AND INFLAMMATION CAUSING COMPLETE AIRWAY OBSTRUCTION

79

What is Bronchiolitis

Inflammation and edema causing constriction of the bronchioles (lower airway)

CAUSED BY THE VIRUS RSV

80

S/S of bronchiolitis

-Sneezing
-A LOT OF CLEAR NASAL DRAINAGE
-ALTERED LUNG SOUNDS(crackles,wheezes, rhonchi)
-respiratory distress
-LOW GRADE FEVER

81

When to suction a pt w/ bronchiolitis(RSV)

Hospital or home

ESPECIALLY BEFORE FEEDING AND AT BEDTIME

82

When can a pt go home with bronchiolitis

When secretions can be controlled with a bulb suction

83

RN interventions for bronchiolitis

-suction
-apply cool humidified O2
-respiratory therapy
-IV fluids if necessary
-MAINTAIN HOB 30-40 degrees w/ Neck slightly extended
-TEACHING RSV PREVENTION IS MOST IMPORTANT

84

What is asthma?

Spasms in the bronchi of the lungs causing difficulty breathing

Usually caused by allergic reaction or hypersensitivity to stimulus

85

S/S of asthma

-Retraction
-nonproductive cough
-stridor
-respiratory distress
-apprehension, restlessness, diaphoresis
-abdominal pain
-SOB
-chest tightness followed by dry cough, wheezing, and suspend
-symptoms worsening at night

86

Triggers for asthma attack

-pet dander
-mold
-dust
-perfumes
-air fresheners
-tobacco smoke

87

How to treat asthma

- remove carper/curtains
-avoid allergens
-inhalers and nose spray SPACERS OR FACE MASKS ARE BETTER FOR KIDS TO INHALE MEDICATION
- rescue inhaler

88

What is cystic fibrosis

Chronic, genetic, multi system disorder affecting exocrine glands (bronchioles, small interesting, pancreatic and bile ducts) produces abnormally thick mucous causing obstruction of small passageways

89

What organs are affected w/ cystic fibrosis?

-Sinuses
-lungs (thick, sticky, mucus buildup, pneumonia, widened airway)
-skin(salty sweat)
-liver(blocked bile ducts)
-pancreas(blocked pancreatic ducts)
-intestines (cannot absorb nutrients)
-reproductive organs

90

How is cystic fibrosis dx

Newborn screening

Sweat test

91

First sign of cystic fibrosis?

Lack of meconium (meconium ileum)

Difficult for infant to have their first poop

92

What system does cystic fibrosis affect first

Digestive!

Then the respiratory develop later

93

S/S of cystic fibrosis

-Lack of meconium
-loose, bulky, fat stool
-diminished lung sounds
-hoarse voice
-wheezing(b/c of mucus)
-recurrent infection (like pneumonia)
-they are thin/ small for their age due to malabsorption

94

Treatment for cystic fibrosis

-give pancreatic enzymes w/food to aid in nutrient digestion and absorption
-chest percussion therapy (usually a vest)
-breathing treatments
-medications
-lung transplant is an option but not for all kids.

95

What is Apnea

The absence of breathing for 20 seconds or longer

Or

shorter period but w/ bradycardia or cyanosis present

96

S/S of apnea

Absence of breathing

Low HR

Cyanosis

Low O2 sat

97

What’s is important to observe ina pt w/ apnea

Observe for cause!!!

Like sleeping or feeding or pooping

98

RN interventions for apnea

-Monitor HR and respiratory continuously
-keep resuscitative equipment available at all times
-record time, duration, color change, HR, O2 sat during an episode
-what the pt was doing during the episode

99

What to do during an episode of apnea

Rub their
-back
-feet
-chest

100

What is most important for parents and care givers to do for apnea pts

CPR training!

101

What is SIDS

Sudden infant death syndrome

Sudden and unexplained death in infants

102

What age are they no longer at risk usually

6- 12 months depending if they can roll then the risk decreases

103

Risk factors for SIDS

-male gender
-prematurity
-prenatal exposure to alcohol or smoke

104

S/S of SIDS

Death

Child may be found in ANY POSITION AND MAY BE CLUTCHING BEDDING

105

Diagnosis of SIDS

Autopsy

106

Interventions or avoid SIDS

-no bed sharing! Sleep alone
-used ONLY firm mattress
-no loose bedding blankets or bumpers
-use sleepwear designed to keep baby warm
-do not put baby in car seat, carrier, or swing to sleep
-remove cigarette smoke