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Nursing 250-255 > PEDS test 2 -again ! > Flashcards

PEDS test 2 -again ! Flashcards

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1
Q

MRI is used with Cerebral palsy (CP) why?

A

to look for structral abnormalities in the brain, this is preferred to a CT.

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2
Q

Do all people with CP have a lowered IQ?

A

NO

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3
Q

Drugs for spasticity and how they are given

A

Dantrolen sodium, baclofen [Lioresal], and diazepam [valium] - given orally or through NG (if child has one)

Botulinum toxin A (Botox) is injected into a selected muscle ( commonly the qudriceps, gastrocnemius, or medial hamstrings)

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4
Q

When assessing a 6 month old for CP, what would you look for?

A

failure to meet any developemental milestones such as rolling over, raising head, sitting up, crawling

presisten primitive reflexes such as moro, atonic neck

poor head control (head lag( and clenched fists

pushing away or arching back; stiff posture

floppy or limp body posture, especially when sleeping

using only one side ofbody, or only arms to crawl

feeding difficulties

extereme irritability or crying

failure to smile

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5
Q

Diagnostics for menigits

A

Lumbar puncture for testing of the CSF - the pressure is measure and samples are obtained for cututre, gram stain, blood count, and determination of glucose and protein

the fluid will be cloudy if +

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6
Q

Vaccine for menigits

A

Menigocococcal polysaccharide for children 2 and older

quad meningococcal conjugate for ages 11-55

HIB for all children starting at 2 months.

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7
Q

How is bacterial menigits spread?

A

Droplet/airborne

need to be in isolation

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8
Q

You will see petechiae in what menigits?

A

Classic- menigococchal

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9
Q

How do you rate pain with hydrocephalus pts?

A

FLACC

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10
Q

How do you know a VP shunt is failing?

A

If there is an obstruction the child will usually present with increased ICP, usually with worsening neurologic status.

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11
Q

clinical signs of hydrocephalus in an infant

A

EARLY- rapid head growth, bulding fontanels, dilated scalp veins, seperated sutures, thinning skull bones

GENERAL- irritablity, lethary, infant is more calmwhen not being held, normal expected responses fail to appear

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12
Q

untreated hydrocephalus

A

frontal enlargemnt, or bossing

depressed eyes

setting-sun sign (sclera visible above the iris)

pupils sluggish, with unequal response to light

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13
Q

what is measure with myelomeingocele?

A

head circumference

at risk for hydrocephalus

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14
Q

How to prevent infection pre-op with myelomeningocele?

A

protect the sac- infant does not wear any clothes or covers laying in prone position, legs are kept in sbduction with a pad between knees to counteract hip subluxation, and a small roll is placed under the ankles to maintain a neutral foot position

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15
Q

what kind of bladder is associated with myelomeningocele?

A

neurogenic - retain their urine.

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16
Q

how can myelomeningocele be prevent? and how is it detected intrauterine?

A

If mothers take folic acid before they concieve and during pregnancy.

It occurs with 1st month

can be picked up on US

or by elevated alpha-fetoprotein

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17
Q

with myelmeningocele, the higher the defect the….. and the lower the defect the…

A

greater problems there will be

less problems there will be

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18
Q

There is a latex allergy seen in spina bifida (myelomeningocele) pts, why?

A

because of repeated exposure to it during surgiers and mutliple catherizations (due to the common s.e of neurogenic bladder)

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19
Q

allergic reactions to latex range from..

A

urticaria, wheezing, watery eyes, and rashes to anaphlactic shock,

need a LATEX FREE environment

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20
Q

non-communication or obstructive hydrocephalus

A

due to obstruction to the flow of CSF through ventricle system (tumor or clot)

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21
Q

communication or nonobstructive hydrocephalus

A

no blockage but CSF stillnot draining properly

usually due to obliteration of the subarachnoid cisterns or malfunction of the arachnoid villi

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22
Q

excessive secretions hydrocephalus

A

rarely, a tumor of choroid plexuz causes increased CSF secreations.

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23
Q

Ventriculoperitoneal (VP) shunt for hydroceph

A

placement of a shut that provides primary drainage of the CSF from the ventribles to an extracranial compartment, usually the peritoneum.

most have a ventricular catheter, a flush pump, a unidirected flow valve, and a distal catheter.

All valves are designed to open at a perdetermined intraventricle pressue and close whne the pressure falls below that level.

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24
Q

VA shunt

A

not as commone, can cause dysrrythmias, heart problems, stroke –it goes right to cardio system

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25
hypotonicity with down's
need to be swaddled when feeding, it will take 2-3x longer to feed them due to protruding tongue.
26
characteristics of downs children
lows set ears, flat bridge of nose, square hands and feet, straight lines on palms, square head, flat footed can't cough due hypotonicity - risk for aspiration
27
preop for cardio surgery
teaching usually done at home or in clinic setting, may include a tour or ICU younger children should be prepared close in time to the event, older children and adolescents may benefit from teaching several weeks in advance info-techniques - verbal and written info, hosp tours, peoperative classes, picture books, or videos Let them know what they will see (monitors, many people , lots of equip), hear (beepings noises, alrams, voices), and feel (lines and dressings, tape, discomfort, thirst) after the procedure.
28
post op cardio surgery
VS and BP done frequently until stable heart rate and resps done for a full min and compared to monitor observe cardiac rhythm, report any irregularites at least hourly, ausculate lungs for breath sounds. diminished or absent may indicate atelactasis, pleural effusion or pneumothorax. temp changes are common and may go to 100(37,7) in first 24-48 hours, and increase after that time is most likely a sign of infection, need immediate attention.
29
signs of Dig toxicity
nausea, vomiting, anorexia, bradycardia, dysrhythmias
30
esophageal atresia(EA) with tracheoesophageal fistula (TEF)
rare malformation that results from failed seperation of esophagus and trachea by the 4th week of gestation
31
Clinical signs of TEF
Couging, Choking, Cyanosis = 3 C's apnea, increased resp distress after feedings, abd distention, excessive salvation and drooling.
32
EA is a surgical emergency
maintain airways, prevent pneumonia, gastric or blind ouch decompressiong and surgical repair
33
When EA/TEF are suspect in infant
take off oral intake, start and IV, place in position least likely to cause aspiration of either mouth or stomach secreations. removal of secreations from the mouth and upper pouch require frequent or continuous suction. often put on a broad spectrum ABX
34
hypercyanotic spells, blue spells, or Tet spells
infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasms decreases pulmonary blood flow and increases right- to- left shunting. occur suddenly, often in the mornging and may be preceded be feeding, crying, defecation, or stressful procedures
35
treating tet spells
place infant in knee-chest position employ calm, comforting approach admin 100% oxygen by blow-by give morphine subQ or through exisiting IV line begin IV fluid replacement and volume expansion if needed repeat morhpine admin
36
rheumatic fever occurs after
beta-hemolytic streptococcal pharyngitis
37
most significant complication of rheumatic fever
cardiac valve damange most commonly the mitral valve may need valve replacement later on in life
38
Jones Critera
suggests that the presence of two major manifestations or one major and two minor manigestations, such as fever and arthralgia, with supportive evidence of recent strep infection, indicates a high probability of RF
39
Carditis (jones criteria)
tachycardia out of proportion to degree of fever cardiomegaly new murmurs or change in preexisting murmurs muffled heart sounds pericardial friction rub chest pain changes in electrocardiogram ( prolonged PR interval)
40
What titer is elevated with RF?
antistreptolysin O (ASO or ASLO)
41
Is use of ASA (aspirin) okay for RF?
yes, for joint pain
42
Kawasaki is treated with?
IVIG and Aspirin, high does at first, then the dose lowers at risk for cardiac problems - coronary artery aneurysms
43
Defects with decreased Pulmonary blood flow
pressure on the right side increases, exceeding left-sided pressure. desaturated blood shunts right to left. causing desaturation in the left side of the heart in systemic circulation Tetralogy of fallot, tricuspid atresia are the common anomalies
44
Tetralogy of fallot
includes 4 defects: VSD, pulmonic stenosis, overriding aorta, and right ventricular hypertropy may have tet spells at risk for emboli, seixures, and loss of consciousness or sudden death following an anoxic spell
45
Defects with increased pulmonary blood flow
left side has a higher pressure then the right side left to right shunting ASD and patent ductus arterious are typical anomalies
46
Obstructive defects
blood exiting heart meets and area of stenosis, causing obstruction to blood flow coarctation of the aorta (narrowing of the aortic arch), aortic stenosis, and pulmonic stenosis are typical defects exhibit signs of CHF
47
mixed defects
hemodynamically, fully saturated systemic blood flow mixes with the desaturated pulmonary blood flow, causing a relative desaturation of the system blood flow **transportation of great vessels,** total anomalous pulmonary venous connection, truncus arteriosus, hypoplastic left heart syndrome
48
most commone type of hemophilia
antihemophilic factor(AHF) - deficiency of factor VIII - classic - hemophilia A the less AHF found, the more serious the disease.
49
RICE for hemophilia
Rest, Ice, Compression, and Elevation. teach to parents and children so that can start treatment immediately when bleeding occurs
50
If bleeding in the joints (hemarhrosis) occurs too often, what can occur?
limitation of motion, bone and muscle changes occur that result in flexion contractures and joint fixation Teach to do ROM after that bleeding episode Diet control - being over weight can cause strain on the joints, calories need to be supplied in accordance with energy requirments.
51
what kind of sports should hemophiliacs be involved in\>
noncontact sports - swimming, walking, jogging, tennis, golf, fishing, and bowling. use of protective equipment (padding, helmets) is important.
52
With RF and \<3 problems you should do what before dentist?
pre-medicate, always inform dentist of health history
53
What do you do for phototherapy?
cover their eyes, have them nude with just a diaper, count stools, feed q2-3 (remove eye shields when feeding), reposition frequently to expose all body surfaces, check bilirubin q6-12 hrs, laps should be no less then 18in away from infant.
54
when is a cardiac cath contraindiacted?
if there is severe diaper rash (usually go through femoral) or rhinitits - watch for signs of infection - dont do it there is one.
55
characteristics of a child in the acute phase of kawasaki
high fever that is unresponsive to ABX and anitpyretics, the child is very irritable, signs of CHF start to appear
56
what is abnormal to find on the dressing after a cardiac cath?
bleeding
57
Children with downs..
will be floppy, are prone to congenital heart disease, have an xtra chromosome intervene as soon as possible when downs is suspected.
58
Its important to check what about the toys of a cognitively impaired child?
saftey of the toys toys should be approriate for their development age sensorimotor skills toys - musical mobiles, stuffed toys, water play, floating toys, a rocking chair or horse, a swing, bells, and ratlles - sensorimotor play may last longer then usual. encourage outings with them to develop social skills
59
Patent ductous arterious
left to right shunt increase vascular congestion machinery-like murmur, widened pulse pressure and bounding pulse result from runoff of blood from the aorta to the pulmonary artery.
60
Drugs for heart failure
Dig and lasix watch for dig tox - nasuea, vomit, bradycardia
61
pre-op heart defect surgery
patient is sent home to await surgery, teaching is done mostly outside of hospital. parents taught to watch for tachycardia and dyspnea
62
Diet for AGN ?
low sodium corn on cob, chicken, apple, milk
63
common food allergies
wheat, milk, eggs
64
what is a sign of poor oxygenation
clubbing, cyanosis
65
pre and post op myelomeningocele
pre - cover with saline soaked, nonadherent dressing post - pain (flacc), I&O and head circumferenc at risk for hydrocepalus and neurogenic bladder
66
use what kind of pain scale for a 3 year old?
faces scale - wong/baker
67
what med for RF?
penicillin ask mom about recent sore throat
68
signs of nephrotic syndrome
child is well but steadlidy gaining weight, appearing edematous, and then becoming anorexic, irritable, and less active
69
child with nephrotic syndrome should be roomed with what kind a patient?
A patient that is well - so a femur break
70
nursing priority for menigits
admin ABX as prescribed 24 hours after intital dose, not infectious anymore, can be out of isolation.
71
s/s of nonbacterial (aseptic) meningitis
headache, fever, malaise, and GI symptoms
72
how phototherapy works
the flourescent light promotes bilirubin excretion by photoisomerization. which alters the structure of bilirubin to a soluble form (lumirubin) for easier secretion
73
how to know if mom understood d.c teaching for child with DM?
can she proper admin insulin and take blood glucose does she know to watch for infections and eye problems know to taek glocuse source when travel
74
how do toddlers perceive death?
as being temporary
75
how to demonstrate bone marrow aspiration with a 5 year old..
show the procedure on a doll

Nursing 250-255 (6 decks)

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