Test 3 Flashcards

1
Q

Basic Components of Neuro Assessment

A

LOC

pupil response (2-6)

motor function

VS’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GCS

A

Best response:

  • eye opening
  • verbal response
  • motor response (decoriate, decerebrate)

Minimum score is 3, max is 15, < or = 8 is coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

LOC

A
  • Full consciousness-Awake and oriented
  • Confusion
  • Disorientation
  • Lethargy
  • obtundation (arousable with stimulation)
  • stupor
  • persistent vegetative state=permanently loss funtion of the cerebral cortex, eyes follow objects by reflex, can withdraw from painful stimuli, hands show reflexive grasping, face can grimace, some food may be swallowed, my cry/grown, but no words
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Microcephaly

A
  • primary-genetic, autosomal recessive or chromosomal
  • secondary-not genetic…infection, trauma, etc., has neuro manifestations

not all children with microcephaly have cognitive delays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypoxic-Ischemic

Brain Injury

A

complication of prematurity

long term sequelae=

cognitive impairment

seizures

CP

Hypoxic-ischemic Encephalopathy-cellular damage from hypoxic-ischemic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Intraventricular Hemorrhage

(IVH)

A

extremely common in preterm infants, espcially ELBW and VLBW infants <32 weeks gestation

50% of preemies that die in first few days have hemorrhage

subsequent neurological handicap is not uncommon

  • etiology: BP flucts, mech vent, asphyxia, rapid infusion volume, NaHCO3 or hyperosmolar solns, coagulopathy, pneumothorax
  • S/S=sudden deterioration, brady, acidosis, fall in H/H, shock, hyperglycemia, tense anterior fontanel; or may be gradual

Later-tense, bulging fontanel, incr vent support, sz, apnea, coma

-hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nursing procedures that increase ICP

A
  • ET suctioning
  • head positioning (lowest when head is midline and elevated 30 degrees)
  • crying, cough, sneeze, strain, shivering
  • normal is 80-110 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Plagiocephaly

A

asymmetric head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Craniosynostosis

(Craniostenosis)

A
  • premature closure at birth of one or more cranial sutures (usually sagital suture–results in elongation of skull in anterior-posterior direction)
  • increased ICP-with or without mental retardation; progressive papilledema, optic atrophy, eventual blindness
  • Sx correction at 6-9 months (post-op observe for hemorrhage and infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Increased ICP

A
  • S/S-increased BP, decreased pulse (opposited of shock)
  • diminishes cerbral perfusion, leads to brain ischemia and infarction=poor prognosis
  • if sustained-brainstem compression and herniation of cerebellum and brainstem…respiratory arrest
  • clinical manifestations: anterior fontanel bulging, absence of normal pulsations; increased OFC, HA (increased pain with valsalva), altered mental status (irritable, fatigued), vomiting, VS’s (brady is late sign), altered vision (diplopia, stting sun, restricted fields, papilledema), pupillary changes (normal…sluggish…fixed and dilated (blown)), altered LOC, high pitched cry
  • increased BP and decreased HR (opposite of shock)
  • increased temp increases O2 needs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Brain Tumor

A
  • most common solid tumor of childhood
  • manifestations: *HA on awakening, vomiting (with/without nausea, progressively more projectile, more severe in AM, relieved by position change), neuromuscular change (clumsiness, loss of balance, + Babinski, paralysis), behavioral change, cranial nerve neuropathy (head tilt, visual), VS disturbances (decreased pulse and respiration, increased BP, hypo/hyperthermia), seizures, cranial enlargement, bulging fontanel, nuchal rigidity, papilledema
  • surgery (VS and pupil checks q1h), infection-meningitis, drainage (colorless=CSF), do not position on side of tumor, fluid regulation, pain control (narcan available); DI and SIADH
  • radiotherapy
  • chemotherapy (intrathecal chemo, or resevoir in brain)
  • Later children may develop another CA, thyroid issues, cognitive changes, radiation somnolence syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Myelodysplasia

(spina bifida)

(neural tube defects)

A

Types:

  1. anencephaly-absence of brain tissue above rudimentary brainstem
  2. encephalocele-external mass/sac that may occur at any place above the skull
  3. spina bifida cystica-sac is present at some point along the spine. myelomeningocele-contains meninges, spinal fluid, neural tissue; spinal nerve roots may end at the sac, sensory/motor function end here; meningocele-contains meninges and CSF, less neuro involvement
  4. spina bifida occulta-may have no signs externally-defect of vertebrae only–bowel and bladder problems may occur

**ALWAYS screen for latex allergies**

  • prevention-folic acid
  • Associated-flaccid paralysis (no feeling below the defect), head circ no normal, hydrocephalus (90% of those with myleomeningocele), neurogenic bladder, poor anal sphincter tone, congenital dislocated hips, club feet, skin problems from anesthesia below defect, scoliosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Orthopedic Problems associated with NTDs

A
  • club feet
  • contractures
  • dislocated hips
  • scoliosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mitrofanoff Procedure

(NTDs)

A
  • appendix is used as route for intermittent catheterization
  • q4-5 h to prevent fluid stasis (microo’s)
  • if appendix won’t work-use Monti tube-part of the intestine, ileum or colon is used to create a conduit.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hydrocephalus

A
  • abnormal accumulation of CSFwithin the ventricles of the brain
  • most often associated with spina bifida; can be a complication of meningitis
  • communicating=impaired absorption of CSF within the subarachnoid space
  • non-communicating=obstruction to the flow of CSF through the ventricular system-usually developmental malformation, apparent at birth
  • S/S=head growth abnormal, bulging anterior fontanel, setting-sun sign, poor feeding, irritable, lethargy, changes in LOC, opisthotonos (arching=severe CNS irritablility), lower extremity spasticity
  • Tx-ventriculoperitoneal shunt (VP), rarely ventriculoatrial shunt; complications=malfunction (increased ICP, vomit, HA, irritability, pupillary response, increased BP, decreased HR, setting sun sign.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Meningitis

A
  • source-usually bacterial invasion of middle ear/nasopharynx, other sources=wounds including skull fx, lumbar punctures and shunts
  • LP shows increased WBCs, decreased glucose, increased protein, increased ICP, positive culture
  • peak incidence is between 6-12 months
  • S/S=infants & young children-fever, poor feeding, vomit, irritability, restless, sz, bulging fontanel, nuchal rigidity, + Brudzinski and Kernig; older child-sz, irritable, photophobia, nuchal rigidity, opisthotonis, + Brudzinski and Kernig, hyperactive reflexes, signs of cardiovascular collapse, petechiae or purpura
  • complications=obstructive hydrocephalus, subdural effusions, thrombosis in meningeal veins or venous sinuses, brain abcess, deafness, blindness, paralysis, Waterhouse-Friderichesen Syndrome (shock, DIC, massive bilateral adrenal hemorrhage, purpura), SIADH (90% of children with bacterial meningitis), seizures

Treatment-respiratory/droplet precautions for first 24h, antimicrobial therapy, hydration, ventilation, reduce ICP, control sz, temperature, anemia

Rifampin-orange urine

Hib vaccine!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Seizures

A
  • more common in children under the age of 2
  • causes=immaturity of CNS, fever, infection,neoplasms, cerebral anoxia, metabolic disorders
  • Partial (focal/local)=simple partial, complex partial
  • Generalized=absence, myoclonic, tonic, tonic-clonic, atonic
  • infantile spasms (infantile myoclonus)-more often in boys, no post-ictal drowsiness, poor outlook for intelligence, may or may not include loss of consciousness
  • Febrile-more in boys
  • status epilepticus-Ativan, Dliantin, Valium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Opisthotonos

A

Can result from tetnus or meningitis–The person is usually rigid and arches the back, with the head thrown backward.

19
Q

Compound Fracture

A

break in the skin around a broken bone

20
Q

Epidural Hematoma

A
  • child abuse, MVA
  • momentary unconsciousness…normal period…lethargy/coma (compression of brain)
  • Cushing’s triad=late sign…impending herniation
  • respiratory depression, apnea, brady, vomit
21
Q

Subdural Hematoma

A
  • much more common than epidural
  • child abuse
  • HA, loss of consciousness, focal sz, unilateral pupil (blown/fixed=neuro emergency), hemiparesis, agitiation, drowsiness/confusion, progressive slowed thinking
  • hypotension, fluid vol def d/t N/V-balance with IICP
  • decreased CO d/t hemorrhage
22
Q

Submersion Injury

A
  • most organ systems affected
  • all children admitted for observation (symptoms may not occur for 24 h)
  • hypoxia, asphyxiation
  • aspiration
  • hypothermia
23
Q

Absolute Neutrophil Count

(ANC)

A
  • total percentage of neutrophils (including bands and segs)
  • mult by WBC
  • *ANC<500 is bad

(at risk for spsis, malaise, dehydration, sz, secondary infection)

-Neupogen to create WBCs

24
Q

Meds for CA

A
  • allopurinol- lowers the amount of uric acid in blood, uric acid is released during cell breakdown; prevents TLS, maintenance
  • vincristine-used for induction; neurotoxic-foot drop, impaired physical mobility
  • prednisone/dexamethasone-induction
  • L-Aspariginase–for induction and intensification/consolidation–given by IM injection; may cause anaphylaxis

-Oral 6-mercaptopurine-intensif/consolidation-maintenance

  • methotrexate-intensif/consolidation & maintenance
  • Bactrim-ATB
25
Q

Myelosuppression

A
  • decreased ability of bone marrow to produce blood cells
  • common SE of chemotherapy
  • other SE of chemo=alopecia, diarrhea, dry skin, ulceration of mucosa
26
Q

Tumor Lysis Syndrome

A
  • hyperuricemia
  • hypocalcemia
  • hyperphosphatemia
  • hyperkalemia
  • uremia (uric acid crystals can lead to acute renal failure)
  • monitor serum electrolytes, urine pH
  • strict I&Os
  • aggressive fluids (to flush)
  • allopurinol to decrease uric acid production
27
Q

Wilm’s Tumor

(Nephroblastoma)

A
  • malignant neoplasms of kidney-most common in young children
  • associated with aniridia (no iris), hemihypertrophy, genitourinary anomalies
  • mass in abd (painless), hematuria, anemia, HTN (d/t increased renin releases), wt loss, fever
  • metastasis to lungs (dyspnea, cough, SOB, pain in chest)
  • Dx-xray/ultrasound, MRI, CT scan, bone marrow aspirate, hematological studies, urinalysis
  • Tx-Sx, chemo, radiation
  • observe for s/s tumor rupture=pain, hemorrhage
  • Post-op-monitor BP*, weight, HTN-bounding pulses, HA, irritability, flushing, prevent UTI’s
28
Q

Osteosarcoma

(Osteogenic Sarcoma)

A
  • osseous bone tumor in mesenchyme
  • most common malignant bone tumor
  • femur
  • mets to lungs, other bones, lymph system, liver
  • pathological fx
  • peak incidence 10-25 yo
  • amputation, chemo
  • prone to lymphoma/thyroid CA later
29
Q

Urinalysis

A
  • sp.gr. 1.015-1.0125 (1.001-1.018 <2yr)
  • pH 4.5-8 average 5-6
  • Negative for glu, ketones, blood, bilirubin, nitrates, leukocyte esterase, WBCs, RBCs, casts, crystals
30
Q

UTI

A

S/S=poor feeding, FTT, freq urination, crying with urination, dehydration, convulsions, fever, diaper rash, foul-smelling urine, vomiting, XS thirst, incontinence, dysuria, hematuria, fatigue, fever, CVA tenderness, pyuria (pus)

Urosepsis

urinary stasis, reflux, poor perineal hygiene, constipation, PG, tight clothes, bubble baths, sexual intercourse

trimethoprim-sulfamethoxazole (TMP-SMX), amoxicillin, cephalexin, gentamycin, pyridium (OTC)

31
Q

Vesicoureteral Reflux

(VUR)

A
  • Primary
  • Secondary
  • Manifestations: dysuria, frequency, urgency, hesitancy, retention, cloudy, dark or blood tinged, RBCs, pyuria
  • IVP, VCUG, cystoscopy
  • grades 1-5 (permanent kidney damage)
  • Tx=deflux injection (gel), or surgical
32
Q

Nephrotic Syndrome

A
  • Characterized by proteinuria, hypoalbuminemia, hyperlipidemia, altered immunity, edema
    1. MCNS 80% of cases-unknown etiology-Tx=steroids for 3 months, children generally relapse1-3x per year, may give albumin to pull fluids back. Diuresis indicates improvement
    2. Secondary Nephrotic Syndrome occurs after glomerular damage of known etiology (SLE, DM, SCD)

Increased permeability to protein

Fluid shift from intravascular space to interstitial space-ascites=THIRD SPACING-stimulates ADH to retain water in an attempt to increase intravascular volume

Manifestations: periorbital, pedal, scrotal edema…generalized edema, weight gain, decr urine output, pleural effusion, pallor, anorexia, fatigue, abd pain, diarrhea, resp distress, BP normal or decreased, altered immunity

Dx=proteinuria, hyaline casts, increased sp gr, low serum albumin

33
Q

Acute Glomerulonephritis

A
  • mostly post infectious (pneumococcal, streptococcal, viral) or systemic disorder (SLE, Sickle Cell)
  • HTN, pallor, fatigue, leth, periorbital and generalized edema, wt gain electorlyte imbalance, oliguria, hematuria (cola colored), CVA tenderness, anorexia, hyperkalemia
  • fluid goes intracellular►extracellular
  • urinalysis-RBCs, WBC’s, prtoein, eleveated serum BUN, creatinine, ESR, ASO

Acute Poststreptococcal Glomerulonephritis (APSG)=autoimmune, 6-7yo, uncommon <2yo

Tx-daily wt, abd girth, low sodium, low-moderate protein, restrict K-foods (ALWAYS for oliguria)

34
Q

Hypospadius

A
  • urethral opening located below glans penis or anywhere along the ventral surface of penile shaft
  • assoc’d with undescended testes, inguinalhernia
  • premature, afr amer
  • repaired surgically
35
Q

Acute Renal Failure

A
  • oliguria
  • azotemia, metabolic acidosis, electrolyte disturbances
  • most commonly due to severe dehydration
  • hyperkalemia, HTN, anemia, Sz, hypovolemia, cardiac failure with pulmonary edema

CHRONIC renal failure-

  • uremia
  • congenital, VUR with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis
  • restrict protein, restrict phosphorus (Ca), restrict Na and water, restrict K (if creatinine clearance is not WNL), ADEK will accumulate
  • HTN and sz
36
Q

DDH

(Developmental Dysplasia of the Hip)

A

4 F’s=female, first (birth order), family hx, feet first birth

  • unequal knee height, or leg length-Barlow test (hip dislocates), Ortoloni test (clunk), (Brazinski is for meningitis)
  • older children-limp, Trendelenburg’s Gait

Pavlik Harness-remove only for skin checks and bath, 3-5 months, check straps every 1-2 wk due to rapid growth

-Dx-ultrasound, X-ray (ossification of femoral head occurs bt 3-6 months)

37
Q

Osteomyelitis

A
  • fever, pain, erythema, heat ans swelling, decreased ROM
  • CBC with differential (WBCs and sed rate elevated)
  • aggressive tx for 4 wk min-PICC line
  • Staph-napcillin, clinamycin
  • MRSA-vanc
38
Q

Scoliosis

A
  • Brace (not for curve >40)-Boston or Wilmington
  • Milwaukee for kyphosis
  • TLSO
  • 16-23 hr/day
39
Q

CP

A
  • hypoxia at some point-esp ELBW, VLBW
  • not always cognitive defecit (50-60% normal IQ)
  • spastic is most common-hypotonia-quadriparesis (tetraparesis)=4 extremeties with disability, speech/swallow difficulties, tongue protrusion, labile emotions. diplegia, monoplegia, triplegia, paraplegia
  • S/s=poor head control after 3-4 months, stiff or rigid limbs, arching back, floppy tone, unable to sit wo support at 8 months, clenched fists after 3 months, XS irritable, no smile by 3 months, feeding difficulties, ADHD, Sz’s, dental problems
  • Tx=Botox, Baclofen (pump), dantrium, valium
40
Q

Hypotonia

A
  • floppy infant syndrome, head lag, poor suck
  • SMA Type 1 (infantile spinal muscular atrophy)=Werdnig-Hoffmann, autosomal recessive, most common (congenital hypotonia), progressive weakness and wasting of skeletal muscles, degeneration occurs in spinal cord and brainstem, earlier onset = poor prognosis
  • SMA Type 2-manifests bt 2-12 months
41
Q

Muscular Dystrophy

A
  • A form of muscular atrophy
  • Pseudohypertrophic Duchene MD (DMD) = most common, X-linked-only boys develop normally until 3-5 yo
  • ascending-starts lower legs, moves up to lungs
  • mutated gene that encodes dystrophin protein in skeletal muscle
  • calf muscle hypertrophies
42
Q

Talipes Equinovarus

(Club Foot)

A
  • unknown patho, strong familial tendency
  • Tx-3 stages: 1. correction of deformity 2. maintenance of correction 3. follow-up to prevent recurrence
  • serial casting, more severe=Sx
  • may be associated with NTDs
43
Q

Osteogenesis Imperfecta

A
  • 5 types (at least)
  • bone fragility, deformity, fx
  • blue sclerae
  • hearing loss
  • dentinogenesis imperfecta
  • mostly autosomal dominant; most severe=autosomal recessive