paeds lect 3 Flashcards
(54 cards)
1
Q
At what week do the cerebrum & cerebellum develop?
A
Week 8-12
2
Q
Primitive reflexes disappear by?
A
By the time infant is 12 months old
3
Q
Which cranial nerves are non-myelinated at infant stage?
A
Optic & olfactory nerves
4
Q
Which is not an increased intracranial pressure condition?
- craniocerebral trauma
- hydrocephalus
- brain tumour
- meningitis or encephalitis
- spontaneous intracranial hypotension
- intracerebral haemorrhage
A
- spontaneous intracranial hypotension
5
Q
In focal/partial seizure, abnormal discharge occurs in 2 areas of the brain. T/F?
A
FALSE.
only occurs in 1 area of the brain
6
Q
Neonatal seizures symptoms
A
- sucking, lip smacking or other oral-buccal-lingual movement
- bicycling or pedaling movement
- rhythmic ocular movements eg. horizontal eye deviation
- occasionally apneic spells
7
Q
Neonatal seizures’ causes
A
- infection
- electrolyte derangement
- metabolic abnormalities
8
Q
Cause of febrile seizures
A
when a child’s temperature rises to 38.5 degrees celsius or more
9
Q
Positioning of child to abort seizures
- avoid__________________ (increases ICP)
- _________ of bed _________ to facilitate _________ of the brain
- ensure availability of _________ eg. _________
- during seizure: remove_________ , _________ , position child on_________ to allow _________
A
- avoid prone, neck flexion (increases ICP)
- raise head of bed 35-45 degrees to facilitate venous drainage of the brain
- ensure availability of equipment eg. O2 and suction
- during seizure: remove harmful objects, extend neck to maintain airway, position child on side to allow flow of secretions
10
Q
Cause of congenital hydrocephalus
A
a defect such as Chiari’s malformation, also associated with spinal bifida
11
Q
Cause of acquired hydrocephalus
A
space-occupying lesion:
- haemorrhage
- intracranial infection
12
Q
Treatment of hydrocephalus
A
- Direct removal of obstruction
- and insertion of ventriculoperitoneal shunts
to provide pri drainage of CSF to an extracranial compartment, usually peritoneum
13
Q
Cerebral palsy is the most common PERMANENT disability of children. T/F?
A
True
14
Q
4 classifications of cerebral palsy
A
- Spastic CP (70%) – abnormal patter of posture and/or movement, increased tone, pathological reflexes
- Dyskinetic CP (10%)– recurring involuntary stereotyped movement
- Ataxic type (10%)– rapid repetitve movement
- Mixed/Dytonic (10%)
15
Q
Characteristics of neuromuscular disease
A
- hypotonia (↓ muscle tone)
- weakness
- ↓ deep tendon reflexes
- may involve the anterior horn cells, peripheral nerve neuromuscular junction or muscles
16
Q
Definition of muscular dystrophy. What could it lead to?
A
- Progressive degeneration and weakness of skeletal muscles from infection or cardiopulmonary failure
- could lead to death, usually in adolescence
17
Q
What is absent in muscular dystrophy?
A
Absence of dystrophin (protein) in the muscle
18
Q
Nursing interventions of muscular dystrophy (at least 5)
- prevent ________ (________)
- prevent ________ (use ________________)
- promote ________
- assess for signs of ________and ________
- adequate ________ & ________
- meds: ________, ________ & ________
- promote optimal ________, support ________
A
- prevent physical injury (safe env, protective gear)
- prevent physical deformity (use prescribed braces/other devices, ROM exercise)
- promote mobility
- assess for signs of disorder progression and complication
- adequate fluid & nutritional intake
- meds: sedative, muscle relaxant & anticonvulsant
- promote optimal family function, support child’s need
19
Q
Characteristic of type 1 DM and what DM results from.
A
- results from a partial/complete deficiency of insulin
- type 1 is characterised by pancreatic beta cell destruction hence leading to absolute insulin deficiency
20
Q
If there is persistent blood glucose level >10mmol/L, what does it result in?
A
Results in glycosuria → osmotic diuresis with polyuria (body makes more pee than normal) & polydipsia (excessive thirst)
21
Q
Excessive ketone production causes ____. And what are the characteristics?
A
Causes diabetic ketoacidosis (DKA).
Characterised by marked hyperglycemia, metabolic acidosis, dehydration and altered level of consciousness ranging from lethargy to coma
22
Q
Sign and symptoms of DM Type 1 + signs of DKA
A
- polydipsia
- polyuria
- polyphagia (excessive hunger or increased appetite)
- fatigue
- weight loss
- dry skin
- blurred vision
- signs of DKA: hyperglycemia, acidosis, glycosuria, ketonuria
23
Q
Nursing intervention for DM Type 1 (At least 5)
- assess child for signs of ________, ________ & their complications
- provide ________ during________, such as ________
- monitor ________ status, ________, ________
- monitor level of ________ (a lower than normal potassium level in your bloodstream)
- promote ________ by maintaining accurate & careful record of IV infusion blood glucose lvl, intake & output & urine specific gravity
- test ________ for ________ every ___hrs when child is ill and whenever blood sugar level > ________
- administer ________ to ________ ________ blood glucose lvl
A
- assess child for signs of hypoglycemia, hyperglycemia & their complications
- provide care during acute phase, such as DKA
- monitor neurologic status, vital signs, blood glucose lvl
- monitor level of hypokalemia (a lower than normal potassium level in your bloodstream)
- promote adequate fluid vol. by maintaining accurate & careful record of IV infusion blood glucose lvl, intake & output & urine specific gravity
- test urine for ketones every 3hrs when child is ill and whenever blood sugar level > 15mmol/L
- administer insulin to decrease elevated blood glucose lvl
24
Q
Age appropriate blood glucose lvl (0-6yo, 6-12 & >12 yo) premeals and postmeals!!
A
Premeals:
0-6 yo: 5-12mmol/L
6-12 yo: 4-10 mmol/L
>12 yo: 4-8 mmol/L
Post meals:
<12 mmol/L
<10 mmol/L
<8 mmol/L
25
Ethiology of DM Type 2. What is the significant risk factor?
- social, behavioral & environment risk factors
- heredity is a strong component
- obesity is a significant risk factor
26
Children with type 2 DM will develop ____.
| What can occur in type 2 DM?
insulin resistance
Velvety hyperpigmented patches in intertriginous area, hypertension and lipid disorders can occur.
27
Nursing management of type 2 DM
- Metformin (1st line treatment)
- insulin & oral anti-diabetic usually added to diet & exercise regime to improve blood glucose control
- calorie-restricted diet
- promote lifestyle change (increase physical activity & decrease sedentary activity)
28
Name of a cancer depends on its cell origin:
1) Sarcoma
2) Carcinoma
Describe both
Sarcoma: connective tissue, muscle, bone
Carcinoma: epithelial tissue (glands, hollow organs, outer layer of skin that lines with the blood vessels)
29
Most common cancer in children
Leukaemia
30
For long term chemo:
| Catheter tip is often placed at the _______.
superior vena cava
31
```
Side effects of chemo
Hematopoietic:
GI:
Hepatic:
Renal:
Integumentary:
Reproductive:
```
Hematopoietic: myelosuppression, anaemia, thrombocytopenia, neutropenia
GI: mucositis
Hepatic: liver toxicity
Renal: renal toxicity
Integumentary: alopecia (an autoimmune disorder that causes your hair to come out)
Reproductive: oligomenorrhea ( infrequent menstrual periods)
32
S&S of acute lymphocytic leukaemia (At least 5)
- fatigue
- pallor
- low-grade fever
- bone & joint pain
- petechiae & bruising
- purpura
- lymph nodes may be enlarged
33
Investigation of acute lymphocytic leukemia
- WBC (<5000/mm3)
| - presence of abnormal blast cells in bone marrow: indication of leukaemia
34
Treatment of acute lymphocytic leukemia (3 phases)
- induction phase (4 weeks to remission) (IV Vincristine, L-asparaginase, Prednisolone)
- consolidation phase (high-dose chemo, IT/radiation therapy is CNS is involved)
- maintenance phase (chemo agents by oral, IV or IM route)
35
Management of acute lymphocytic leukemia
- prevent infection
- prevent bleeding & injury
- reducing pain
- promoting energy conservation
- relieving anxiety
- promoting normal growth & development
36
What type of infection is Sepsis? When does it usually occur?
bacterial infection;
| occur in the 1st month of life
37
Risk factors of sepsis
- prematurity
- invasive procedure
- steroid use for chronic condition
- nosocomial exposure (infections that develop as a result of a stay in hospital) to pathogens
38
Clinical manifestations of sepsis (infants)
- poor sucking
- feeding lethargy
- weak cry
- irritability
39
Subsequent s&s of sepsis
- tachycardia
- increased or irregular respiration
- mottling (blotchy, red-purplish marbling of the skin)
- GI disturbances
- temperature instability
- dehydration
- hypotension
40
Common causes of meningitis ( in neonates & children)
- In neonates: E.coli and Group B streptococcus
| - Infants & children: Neisseria meningitidis, Step. Pneumoniae & Group B Strep
41
S&S of meningitis of children <2 yo
- poor feeding
- irritability
- lethargy
- high-pitched cry
- bulging fontantel
- hyperextension of neck & spine
42
S&S of meningitis of older children (>2yo)
- respiratory or GI problem
- stiff neck
- headache
- tripod posture
- Kernig signs: pain to knee extension when on supine position
- Brudzinski's sign: flexion of knees & hips when neck is flexed when on supine position
43
Management of meningitis
- Monitor _______
- Monitor_______, _______ & _______(maintain IV therapy, _______ is avoided to prevent SIADH)
- assess signs of _______
- administer_______, _______ or _______ to relieve cerebral oedema
- provide supportive intervention (_______ to decrease _______)
- Monitor vital signs
- Monitor I/O, fluid & electrolyte balance (maintain IV therapy, overhydration is avoided to prevent SIADH)
- assess signs of raise ICP
- administer antibiotic, anticonvulsant or steroids to relieve cerebral oedema
- provide supportive intervention (quiet room to decrease env. stimuli)
44
Causative agent of hand foot mouth disease (HFMD)
Enteroviruses
45
Mode of transmission of HFMD
direct contact
46
S&S of HFMD
- vesiculo-popular rash over palms, soles & butt
- fever
- pharyngitis
- mouth ulcers
47
Management of HFMD
- _______ in single room
- _______ for fever (avoid _______)
- _______ to maintain hydration
- monitor for complications: _______, _______, _______
- isolate patient in single room
- paracetemol for fever (avoid NSAIDs)
- strict I/O to maintain hydration
- monitor for complications: seizures, hyper/hypotension, tachycardia
48
Causative agent of dengue
Flavirus
49
S&S of dengue
- maculopapular rash, flushing or petechiae
- headache
- retro-orbital pain
- myalgia (muscle aches and pain)
- arthralgia (joint stiffness)
50
Management of dengue
- ________ for fever (avoid _______)
- ________ to maintain ________
- IV plug
- monitor for complications: ________ and ________
- prevent ________________
Thrombocytopenia precaution:
- ________
- no ________
- no ________
- ________ & ________
- paracetemol for fever (avoid NSAIDs)
- strict I/O to maintain hydration
- IV plug
- monitor for complications: hypovolemia and bleeding
- prevent dengue haemorrhagic fever
Thrombocytopenia precaution:
- CRIB
- no IM injection
- no brushing teeth
- daily platelet count & haematocrit
51
All seizures are caused by fever. T/F?
False
52
What is hydrocephalus
the build up of fluid in the cavity/ventricles deep in the vein
53
Major complications of hydrocephalus
infections & malfunction
54
What is the most common endocrine disease of paeds?
Type 1 DM aka juvenile diabetes
