NUR331 Exam 3b Flashcards
(48 cards)
1
Q
cerebral palsy
A
- def - group of permanent disorders of the development of movement and posture causing activity limitation that are because of nonprogressive disturbances that occurred in the development of the fetal brain
- nothing is wrong with the muscles, just the brain’s ability to use the muscles
- etiology - brain bleed, premature, shaken baby syndrome, stroke, umbilical cord wrapped around neck, infection during pregnancy, etc.
- classified by motor abnormalities, associated impairments, anatomic and radiologic findings, and timing
- patho - narrow gyri, wider sulci, anoxia causes natural death, or brain did not form properly
- congenital causes - maternal infections, jaundice, Rh incompatibility with mom, or disruption in first 2 years of life
2
Q
CP diagnosis, CM, motor abnormalities
A
- diagnosis - neuro exam, persistent primitive reflexes, failure to meet developmental milestones, imaging (CT, MRI, ultrasound, serum testing, EEG), rule out other brain lesions
- cannot be confirmed until 2 years of age
- CM - infant doesn’t reach developmental milestones, may not present until second half of first year of life, motor abnormalities, abnormal muscle tone, associated impairments, facial grimacing, writhing movements, ataxia
- gross motor abnormalities - cannot sit up by 8 months, floppy or limp posture, stiff arms and legs, uses one side of body to crawl
- behavioral abnormalities - failure to smile by 2 months, feeding difficulties, tongue thrust after 6 months, extreme irritability or crying
- hypotonic movements - up to 1 year
- hypertonic movements - resistance to passive ROM, increased DTR, hips higher than trunk when prone, spine deformities, contractures
- associated abnormalities - seizures, mental impairment, incontinence, ADHD, consequences of non-ambulatory status, feeding difficulties, affects chewing/swallowing/talking, respiratory problems, impaired hearing, oral disorders,
3
Q
types of CP movement disorders
A
- spastic - upper motor neuron muscular weakness, scissoring*
- dyskinetic - often have chorea (jerking movements that are involuntary and irregular), worm movement, writhing movement
- ataxic - unsteady shaking movements, wide based gait, poor balance and coordination
- mixed - combo of other types
4
Q
management of CP
A
- PT/OT/ST
- assistive mobility devices
- surgery
- meds to help associated symptoms - antiepileptics, stimulants, botox, Anti anxiolytics, bowel regimen
- prevent injury, side rails on bed, no scatter rugs
- NC - frequent rest periods, meet nutritional needs, routine skin assessment, immunizations, safety precautions
- respite care
5
Q
muscular dystrophy
A
- mom passes to male offspring or new mutation where mom is not a carrier
- mutation in the gene that encodes dystrophin (protein product in the muscles, absence leads to muscle degeneration)
- onset between 3-5 (have progressed normally until then), rapid progressive muscular degeneration after initial normal development
- signs - waddling gate, lordosis, positive gower’s sign (use legs to stand up)
6
Q
CM of MD
A
- pseudohypertrophy - fatty infiltration
- muscular atrophy - ability to ambulate is lost by 10-12
- facial and respiratory muscles atrophy
- cardiac or respiratory failure
- mild to moderate cognitive impairment
- median age is 27 with mechanical ventilation (ALS for kids)
7
Q
complications of MD
A
- contractures of the hips, knees, ankles, and spine
- atrophy of disuse caused by inactivity
- infections - respiratory from immobility
- obesity, may not decrease life expectancy
- cardiac manifestations occur in later stages
8
Q
dx of MD
A
- clinical manifestations with diagnostic evaluation
- serum enzymes
- muscle biopsy
- EMG
9
Q
treatment of MD
A
- primary goal - maintain function in unaffected muscles as long as possible
- treat complications - PT/OT, nutrition, respiratory failure, cardiac failure
- experimental treatments to slow progression - corticosteroids, CT GaINAc transferase, glutamine and creatine monohydrate
- palliative care
10
Q
spina bifida
A
- malformation in the spine in which the posterior portion of the lamina of vertebrae fails to close, failure of the neural plate to develop into a tubular structure
- could be due to inadequate consumption of B vitamin folic acid during first trimester
- neural tube fails to close during 4th week of pregnancy
- dx - mostly prenatally, diagnose based on imaging of meningeal sac, and neuro eval
11
Q
types of spina bifida
A
- spina bifida occulta - defect is only in vertebrae (spinal cord and meninges normal), generally have no neuro involvement, may see skin depression, dimple, or tuft hair in lumbosacral area of newborn
- spina bifida cystica - external sac encases meninges and spinal fluid, not associated with neuro deficit, OR encases meninges, spinal fluid, and nerves
12
Q
myelomeningecele
A
- CM - sac like protrusion evident at birth, hydrocephalus - (accumulation of fluid in ventricles), varying degree of sensory and neuro dysfunction, poor tone in bladder, poor muscle tone in rectum, flexion or extension contractures
- treatment - surgery, closure of sac within 24-72hrs
- nursing care - prevent infection in preop (sterile covering), avoid taking rectal temps
- NC - VS, weight, IO, assess pain, observe incision, prone, feed when awake/parents hold, ortho eval, treat urinary incontinence, treat bowel incontinence (antegrade continence enema procedure), accurate measurement of head circumference and fontanel, assess for s/s of infection, latex free environment*, promote normal development
13
Q
criteria for cognitive impairment
A
- at least 2 domains
- communication, self-care, home living, social skills, use of community resources, self-direction, health and safety, functional academics, leisure, work
- impairment is mild or severe
14
Q
NC for children with cognitive impairments
A
- identify early signs of CI (ex. - unable to maintain eye contact)
- work with school system to develop educational plan
- educate child and family - only give one or two tasks at a time, teach fading and shaping
- promote optimum development (communication, sexuality, play)
- promote independent self-help skills
15
Q
trisomy 21 (down syndrome) - definition, RF, and CM
A
- 3rd copy of 21st chromosome
- risk factor - maternal age over 35
- CM - inner epicanthel folds, depressed nasal bridge, small nose, excess skin on back of neck, high arched palate, large protruding tongue, wide space between first and second toe, decreased muscle tone, lower intelligence, social developmental delay, cognitive anomalies, sensory problems, reduced height and obesity, delayed sexual development
- associated illnesses - feeding difficulties, obesity, congenital heart disease, acute otitis media, leukemia, hypothyroidism, upper respiratory infections
16
Q
DS nursing care
A
family support, assist family in preventing physical problems, promote child’s developmental progress, assist with genetic counseling
17
Q
ASD - RF, CM criteria
A
- unknown cause
- RF - male
- CM - demonstrate core deficits in social interactions, communication, and behavior
18
Q
ASD social interaction deficits
A
- abnormal eye contact often earliest sign
- failure to smile
- failure to orient to name
- lack of imitation
- lack of interactive play
- lack of gesture use such as pointing or waving
19
Q
ASD - associated illnesses
A
- GI problems
- epilepsy
- feeding issues
- disrupted sleep
- ADHD
- anxiety
- depression
- OCD
- schizophrenia
- bipolar disorder
20
Q
ASD - communication deficits
A
- absent to delayed speech
- atypical language such as humming, grunting, laughing inappropriately, use of echolaia (repeat things that don’t make sense at inappropriate times, doesn’t fit in context)
21
Q
ASD - behavioral impairments
A
- repetitive, impulsive, restrictive, and obsessive behavior - rocking, flapping hands, head nodding, spinning, twirling, difficulty with change, self-injurious behaviors
22
Q
ASD nursing care
A
- therapy for multiple sources with the objective beings - provide positive reinforcement, increase social awareness, teach verbal communication skills, decrease unacceptable behavior
- structured routine is key*
- show skills on a trusted object before preforming on child
- use nonverbal communication
- few people with rounding
- use few words, don’t use figures of speech
23
Q
ADHD - definition, cause, dx, associated problems
A
- developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity in children 4-18
- cause of ADHD has only been theorized decreased dopamine, norepinephrine, or epinephrine
- diagnosis is based on activity in at least 2 different settings and present before age 7
- dx - H&P, multidisciplinary assessment
- associated problems - school or academic difficulties, greater risk for conduct disorders, oppositional defiant disorders, depression and anxiety, developmental disorders, learning disabilities
24
Q
ADHD treatment
A
- treatment - behavioral and psychotherapy must be first line treatment*
- meds - psychostimulants, antidepressants
- med side effects - weight loss and abdominal pain, decreased appetite, sleeplessness, high BP, high HR
- med admin - usually taken at breakfast and noon, give immediate release on an empty stomach, drug holidays are not recommended, need frequent reevaluations
25
NC of ADHD
- develop child's strengths
- environmental manipulation - consistency, organizational charts, decrease distractions during periods when needing to concentrate
26
developmental considerations for the GU system
- nephrons are immature and less efficient
- glomerular filtration rates are low because kidneys in newborns are immature
- decreased ability to concentrate urine and reabsorb amino acids
- loop of henle is shorter - reduces ability to absorb sodium
- more vulnerable to acidosis
- newborn bladder is more of an abdominal organ
- infants cannot concentrate urine until 1-3 months
- newborn kidneys are unable to adapt to deficiencies or excesses - vulnerable to FVE
27
newborn s/s of GU disease
- poor feeding
- respiratory distress
- poor urinary system
- jaundice
- seizures
- dehydration
- vomiting
28
infant s/s of GU disease
- poor feeding
- pallor
- fever
- failure to gain weight
- persistent diaper rash
- seizures
- dehydration
- vomiting
29
children s/s of GU disease
- frequent urination, bed wetting
- painful urination
- enlarged kidney or bladder
- excess thirst
- foul smelling urine
- poor appetite
- pallor
- fatigue
- enuresis
- edema
- hematuria
- abdominal of back pain
- HTN
- tetany
- growth failure - renal osteodystrophy
30
NC for children with GU disease
- accurate IO, BP, and weight
- prep child and parents for tests - likely painful
- collect specimens
31
What should a normal urinalysis look like?
- clear, yellow
- 1.010-1.030
- ph - 4.5-8.0
- negative for glucose, protein, ketones, nitrites
- RBCs - <1-2
- WBCs - <1-2
- casts - moderate clear protein
- volume - 1-2mL/kg/hr
32
GU physical assessement
- H&P
- family hx of HTN, renal disease, etc
- PA - abnormal rate and depth of respiration, HTN, fever, decreased growth, signs of circulatory congestion, abdominal distention, early signs of uremic encephalopathy, congenital abnormalities (hypospadias, ear abnormalities)
33
hypospadias
- urethral opening is on the ventral surface of the penis, may be a sign of ambiguous genitalia
- CM - increased risk of UTI, may interfere with procreation, body disturbance issues
- management - surgery in stages (ideal between 6-18mo)
- NC - examine every newborn male carefully, delay circumcision if any question, psych prep
- post op care - pressure dressing (do not change), catheter/stent care, double diaper, teach home care (no baths, hold carefully)
34
cryptorchidism
- condition in which one or both testicles fails to drop
- types: undescended, ectopic, retractile, absent
- therapeutic management - ultrasound or surgical exploration, recommend treatment before 1 year of age (orchiopexy), teaching - increased risk of testicular cancer
35
obstructive uropathy
- obstruction at any level of the urinary tract
- blockage of urine flow causes hydronephrosis
- CM - recurrent UTI, incontinence, fever, flank or abdominal pain, foul smelling urine, hematuria, dysuria, polyuria, polydipsia, FTT, nocturnal enuresis
- therapeutic management - surgical correction, monitor BP, prep parents and children for procedures, close observation for post-op complications, protect catheter
36
vesicoureteral reflux
- regurgitation from bladder all the way to kidneys, graded 1-5
- can lead to HTN, renal insufficiency, or failure
- usually familial and outgrown
- primary reflux - result of incompetent valve mechanism
- secondary reflux - result of condition
- recurrent UTI in females, single episode of UTI in males, family hx of VUR
- management - voiding cystourethrogram, abx, surgery when abx don't work
- NC preop - prevent infection (abx at bedtime), have siblings screened, age appropriate prep
- NC postop - care for catheters and stents, pain meds, antispasmotics, prophylactic abx
37
hernias
- protrusion of a portion of an organ through an abdominal opening
- dangers - constricted, circulation is impaired, interferes with function or development
38
congenital diaphragmatic hernia
- opening between thorax and abdominal cavity as a result of incomplete fetal development
- abdominal contents enter thoracic cavity
- s/s - often detected in utero, respiratory distress, cyanosis, scaphoid abdomen, impaired cardiac output
- needs immediate attention - intubation, GI decompression, IV fluids, will need surgery
- preop - monitor resp and fluid status, acidosis, thermoregulation, cardiac output, sedation, gastric decompression
- postop - monitor for acidosis, fluid status, GI decompression, thermoregulation, sedation, pain control, cardiac output, parental bonding
39
umbilical hernia
- incomplete fusion of umbilical ring
- usually self resolves, sometimes needs surgery
- teach parents to push on it, should feel squishy with air
40
inguinal hernia
- vaginalis persists allowing abdominal contents to be pushed through opening
- often asymptomatic and painless
- more visible with straining
- needs surgical correction, push on it
41
UTI
- urethritis, cystitis, pyelonephritis
- mainly e coli in females
- uncircumcised infants
- RF - constipation, use bubble bath, pinworms, dysfunctional voiding, decreased fluid intake, VUR, urologic abnormalities, indwelling catheter, neurogenic bladder, sexual abuse, sexual intercourse
- infant CM - fever, weight loss, FTT, vomiting, diarrhea, foul smelling urine
- children CM - dysuria, frequency, urgency, incontinence, foul smelling urine, hematuria, abdominal pain, fever
- urine culture
- NC - push fluids, comfort, follow up cultures, teach prevention
42
enuresis
- involuntary passage of urine by a child older than 5 - primary, secondary, diurnal, or nocturnal
- dx - H&P, urine sample
- treatment - most outgrow, retention exercises, drug therapy, moisture alarm, behavior modification
- NC - do not punish child, limit fluid intake after dinner, make sure to void before going to bed, limit intake of bladder irritants, bed pads, pull ups only with sleepovers
43
bladder capacity
age in years +2 oz
44
hemolytic uremic syndrome
- combination of hemolytic anemia and thrombocytopenia that occurs with acute renal failure
- watery diarrhea progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia
- etiology - mainly diarrhea, ingested undercooked meat
- RBC and platelets are destroyed as they move through partially occluded blood vessels
- s/s - vomit, marked pallor, oliguria, anuria, edema, fatigue, elevated BP, abdominal pain and tenderness, neuro changes
- urinalysis is positive for blood, protein, pus, and casts
- complications - renal failure, seizures and coma, pancreatitis, intussusception, rectal prolapse, cardiomyopathy, CHF, acute respiratory distress
- management - maintain fluid balance, correct HTN, acidosis, and electrolytes, replenish RBC, provide dialysis
- NC - contact prec*, close attention to fluid volume, encourage nutrition, monitor for bleeding, teach prevention
45
nephrotic syndrome
- massive proteinuria, hypoproteinemia, HL, and edema
- results from increased basement permeability which allows loss of protein in urine
- idiopathic, secondary, congenital
- CM - massive proteinuria, rapid weight gain, edema, PE, decreased urine output, diarrhea, anorexia, pallor, muehrcke lines, low BP, frequent infections, hypoalbuminemia, HL, mild hematuria
- dx - urinalysis, serology, renal biopsy
- management - bed rest during edema, no added salt*, steroids, immunosuppressant therapy, loop diuretics, albumin
- NC - manual BP Q4, may need albumin, potential for infection/skin integrity/altered nutrition, activity intolerance, ineffective breathing pattern
46
acute glomerulonephritis
- immune processes injure glomeruli, can range from minimal to severe
- CM - fever, lethargy, weakness, h/a, anorexia, vomiting, puffy face, discolored and decreased volume of urine, edema, weight gain, flank or abdominal pain, HTN, FVE
- dx - urinalysis, culture (neg), serology (normal electrolytes, elevated BUN, creatinine, sed rate, and RBC may be low)
- management - bed rest during acute phase, no added salt*, control HTN, abx, isolation from other kids with infection, increase in UOP means improvement
- NC - FVE considerations, monitor BP, risk for injury, knowledge deficit
47
acute renal failure
- sudden reversible decline in renal function that results in accumulation of toxins as well as fluid and electrolyte imbalance
- etio - poor perfusion, dehydration, vancomycin out of range, nephrotoxic drugs
- CM - oliguria, n/v/d, edema, HTN, drowsiness, lethargy, circulatory congestion, cardiac arrhythmias
- complications - hyponatremia, hyperkalemia, HTN, anemia, seizures, cardiac failure
- management - prevetnion, treat underlying cause, manage F/E balance, decrease BP, mannitol/albumin/furosemide
- NC - v/s, IO, regulate fluids, nutrition, diuresis may be significant when output is restored
48
chronic renal failure
- reduction in renal function that occurs over time in response to irreversible damage to nephrons
- slow gradual process
- etio - glomerular disease, DM, glomerulonephritis, developmental abnormalities, heredity renal disease
- CM - loss of energy, decreased appetite, HTN, h/s, cramps, nausea, urine output increased or decreased, edema, dental defects, sallow skin, bone or joint pain
- supportive therapy - diet, vitamins, prevent osteodystrophy
- need to decrease phos and increase calc
- dialysis
- renal transplant
- NC - FE imbalance, unrestricted activity, nutrition, prevent osteodystrophy, fleets enemas are contraindicated
