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Muscle relaxer for spastic CP
mechansim unknown
oral or intrathecally
central acting skeletal muscle relaxer for CP



Neurotoxin that blocks neuromuscular conduction
CP and torticollis
dry mouth



antiinflammatory and autoimmune
duchesne MD
Myasthenia gravis
Must taper it down



adjunct relief for skeletal muscle spasms for CP


1st line treatment for hyperthyroidism

methimazole (MTZ, Tapazole) or PTU propythlthiouracil

Adjuct therapy with inderal, a B-adrenergic blocker if marked symptoms


Cholinergic crisis

occurs from over meds of anticholinergic meds for myasthenia gravis

Severe muscle weakness (possible affecting respiratory), sweat, increase salivation, bradycardia, hypotension.

Wear medical alert bracelet


Autoimmune neuromuscular disorders

Dermatomyositis: muscles and tissues; often from virus or meds, genetics, more in girls 5-14

Guillain-Barre: peripheral nervous system is attacked, but doesn't affect brain or spinal cord. Inflammation and demyelinization of nerves. Triggered from flu like respiratory infection or acute gastroenteritis with fever. Paralysis, resp involvement, numbness and tingling, severe muscle weakness, quick onset, bottom to top, 2-4 week course. Plasma exchange, IVIG, corticosteroids

Myasthenia gravis: genetic, thru birth, in childhood. No cure. Progressive weakness and fatigue of skeletal muscle. Crisis is a medical emergency Sudden resp distress, dysphagia, dysarthria, ptosis, dipllopia, tachycardia, anxiety, rapid increasing muscle weakness. Too much anticholinergics may cause it. Prevent resp problems, promote nutrition, wear bracelet


3 types SMA spinal muscular atrophy

1: Werdnig-Hoffman: birth - 6 months, general weakness, can't sit, weak cry, poor suck, weak swallow and breathing. Progress to early death. Ventilators, enteral feeding

2. Intermediate: 6-18 months, proximal muscles more affected, resp muscles, scoliosis, slower progress, survive to adult with respiratory status being maintained

3: Kugelberg-Welander disease-juvenile SMA, after 18 months, taken at least 5 steps, weakness in shoulder, hip, thigh, upper back, resp may be involved, scoliosis, slow progression, walking usually maintained until adolescence.


Slipped capital femoral epiphysis

SCFE femoral head dislocates from the neck and shaft of femur at epiphyseal plate. males 11-16, African, obese
Acute: cant bear weight, pain sudden
Chronic: pain and limp
decreased ROM, external rotation of hip, DO NOT perform passive motion


Childhood FX

Plastic or bowing deformity, bone not broke
Buckle fx: compression,
Greenstick, incomplete, most common in childhood (wrist and forearm)
Complete: broke in two
Spiral: most common abuse fx (femur, humerus, rib)



infection bone and tissue
staph aureus
bacteria from blood invades bone or joints
aspiration and culture (4-6 wks of abx)
pain, swelling, warm joints, decreased ROM, possible fever


Septic Arthritis

bacteria invade the joints, usually hip and knee.
From blood, puncture, injection, venipuncture, wound, surgery, injury, staph aureus
Medical emergency: joint cartilage deteriorates, AVN,
Sudden onset of fever, moderate to severe pain

Predisposing factors: resp infection, otitis media, skin or tissue infection, traumatic puncture wounds, femoral venipuncture,



Poor feed, jittery, lethargy, high pitched weak cry, apnea, cyanosis, seizures, may by asymptomatic,

Newborn: rosy cheeks, ruddy skin, short neck, buffalo hump, massive shoulders, distended abdomen, Increased subQ fat, listless, hypotonia, apathy, poor feed, apnea, low O2, cyanosis, temp instable, pallor, sweat, tremors, irritable, seizures


Med for Diabetes Insipidus

DDAVP, vasopressin
Intranasal, PO, SubQ q8-12 hrs, dose depends on urine specific gravity 1.010, age and output, keep in fridge, clear nostrils, repeat if sneeze, overdose: confusion, headache, drowsy, rapid wt gain.

Maintain and monitor fluids, daily wt, monitor for dehydration, monitor BP close, notify doc if urine > 1000ml per hour twice in row, if fluids are stopped, could lead to hypernatremia and seizures


Precocious puberty

before age 9 for boys
before age 6 for african girls
before age 7 for white girls

If med is stopped, puberty will occur again
Treat child like age, not what they look like.
Slow it with Depo-provera injections, Cycrin tablets

Central puberty: most common, release of GnRH prematurly > release of LH and FSH > gonads release sex hormones.

Peripheral puberty is just early overproduction of sex hormones



heat intolerance
wt loss
smooth velvety skin
increased rate of growth



cold intolerance
wt gain
dry thick skin, edema of face
decreased growth


Rapid acting insulin

15; 30-90; 3-5 hrs



Short acting insulin

30-60; 2-4; 5-8

Regular-Humilin R, Novolin R


Intermediate acting insulin

1-3, 2-4, 10-16
NPH-Humilin N, Novolin N

Often mixed with regular


Long acting insulin

1-2; none; 6-24

Do not mix


Drugs through tracheal tube during emergency

Epinephrine - adreneric, increases HR and systemic vascular resistance
Atropine - anticholinergic, increases, CO, dries secretions
Naloxone - anagonist action of narcotics

follow by 5 ml of sterile saline and 5 positive pressure ventilations to deliver the drug.


Adult chain of survival

1. Hurriedly emergency medical system activation
2. Early cardiopulmonary resuscitation
3. Early defibrillation
4. Early access to advanced care
5. Integrated post cardiac arrest care


Pediatric chain of survival

1. Prevention of cardiac arrest and injuries
2. Early CPR
3. Early access to emergency response system
4. Early advanced care/pediatric advanced life support
5. Integrated post cardiac arrest care


Pals pneumonic DOPE for when intubated child deteriorates

Displacement of tracheal tube
Obstruction (mucus plug)
Pneumothorax- sudden change, decreased breath sounds and chest expansion, emphysema, drop in HR and BP
Equipment failure: disconnected O2, Leak, Power loss


CO2 monitoring for intubation

Purple-problem, little or no CO2 detected
Tan - think about a problem
Yellow-yes, CO is detected and tube is in trachea


Types of shock

Compensated shock: poor perfusion exists without a decrease in BP
Hypovolemic: most common in children, perfusion decreses and a result of inadequate vascular volume. Vomit, diarrhea, diuretics, heat stroke, blood loss from injury, burns third spacing

Septic: systemic inflammation

Cardiogenic: ineffective pump, the heart, decrease in stroke volume. Heart defects

Distributive: loss in the SVT. neurogenic, anaphylaxis,

Toxic ingestions


S&S of shock

Respiratory distress, grunting, gasping, nasal flaring, tachypnea, increased work of breathing, dark cool extremities, Decreased elasticity, decreased urinary output. Always evaluate the ABCs, initiate CPR if pulseless, 100% O2 via mask

Vascular access
Peripheral IV, cental IV, saphenous vein, intraosseous
Restore fluid volume with isotonic (RL, NS). DO NOT USE DEXTROSE SOLUTIONS > osmotic diuresis, hypokalemia, hyperglycemia, ischemic brain injury. Fluid is replaced quickly 100-200ml/kg in initial hours. Goal urine output is 1-2ml/kg/hour

Vasoactive meds: improve CO, dobutamine, epinephrine, dopamine,


Repiratory arrest in children

Upper airway causes: Burnings, croup, epiglottitis, foreign body aspiration, reflux, strangulation, tracheomalacia, vascular ring

Respiratory failure leads to cardiopulmonary arrest. Children are at greater risk than adults because they have smaller airways and underdeveloped immune system, the diminished ability to combat serious respiratory illnesses. They lack coordination, they are susceptible to choking on food and objects, SIDS.


Emergency treatment for respiratory distress

Maintain a patent airway (jaw thrust), provide supplemental oxygen, monitor for changes, assist with ventilation and or intubation, offer support to Child and family.

1 breath every 3-5 seconds, 12-20 per minute


Toxic ingestion

If a child deteriorates quickly without a known cause, suspect toxic ingestion.

ABCs, supportive care, gastric lavage, bowel irrigation, dialysis, charcoal (not for iron overdose)


Respiratory distress syndrome

From a lack of alveolar surfactant and immaturity of the respiratory control center. Premature birth is a risk factor. Grunting, nasil flaring, retractions, seesaw respirations, cyanosis, tachycardia over 150 to 180, crackles, tachypnea over 60, x-rays show ground glass.

Silverman-Anderson 10 is most critical


Postterm newborn

Over 42 weeks gestation
Dry cracked peeling wrinkled skin.
Vernix caesosa and lanugo are limited or absent.
Long thin extremities.
Creases that covers the entire soles of the feet.
Wide-eyed and alert expression.
Abundant hair.
Thin umbilical cord.
Meconium stained skin in fingernails with long nails.


LGA with hypoglycemia

Blood glucose should be greater than 40. Listlessness, hypotonia, apathy, poor feeding, apnea, decrease in 02, cyanosis, temperature instability, pallor and sweating, tremors, irritability, seizures, jittery, lethargy, high-pitched week cry


SGA nursing priority action

Anticipate the need to provide resuscitation as indicated by the condition. Perform frequent blood glucose measurements and give IV glucose if necessary. Obtain weight, length, head circumference. Monitor vitals. Be alert for respiratory changes. Neutral thermal environment. Frequent and early feeding


Common problems associated with preterm birth

Before 37 weeks. Respiratory distress syndrome. Periventricular or intraventricular hemorrhage. Bronchopulmonary dysplasia. Retinopathy of prematurity. Hyperbilirubinemia, anemia, necrotizing enterocolitis, hypoglycemia, mental and motor delays


Perinatal asphyxia

Newborn fails to establish adequate sustained respirations afterbirth. It results in hypoxia, hypercarbia, in metabolic acidosis.
Early ID is a must. review prenatal hx. Immediate resusciatation is a must. Resuscitate for 10 minutes. Continue until pulse > 100, good cry, good breathing, pink tongue (O2 to brain).

Therapeutic hypothermia may help perinatal encephalopathy after asphyxia.



listlessness, hypotonia, apathy, poor feed, apnia, cyanosis, temp instability, pallor and sweating, tremors, irritable, seizures, high pitched weak cry,

*4yo tachycardia, slurred speech, diaphoresis*

BG checks every hour for 4 hrs, then every 3 hrs til stable.
Feed every 2-3 hrs
Neutral thermo
Rest to decrease energy


Neonatal abstinence syndrome

Tremors, regurgitation, shrills, high-pitched cry

Cocaine: fussy, irritable, inconsolable, poor suck and swallow

Trt: provide comfort, relieve symptoms, improve feeding and weight gain, prevent seizures, promote mom interactions, reduce mortality and abnormal development


Necrotizing enterocolitis

Enteral antibiotics, parenteral fluids, milk feedings, corticosteroids, probiotics, slow drip feedings.

S&S: BILIOUS VOMITTING Feeding intolerance, abdominal distention, bloody stools, septic shock, diarrhea, temp instability, lethargy, apnea, hypotesnion,

Trt: bowel rest, antibiotics, possible ostomy, gastric decompression,


Bladder exstrophy

The bladder is open and exposed to the outside of the abdomen. It requires surgical repair. Protect the bladder and prevent infection. Place infant in supine position, keep bladder moist and cover with a sterile plastic bag. Change soiled diapers immediately, sponge bathe, apply barrier cream


Cycle of violence

Tension building is the longest phase. When the partner may try to calm down the user to prevent abuse.
Acute battery phase is the violence.
The honeymoon phase is the calm and loving behavior phase.
The goal of intimate partner violence is to encourage the woman to regain control of her life. Offer safety plan and shelter info


Battered Pregnant Women

At higher risk for violence. Intimate partner violence usually lasts longer if the woman has children. Pregnant women are vulnerable during this time. Poor mental health, depression, PTSD

Establish rapport and trust, consistent and direct approach, safety assessment, emotional support


ABC's of caring for abused women

A is for reassuring the woman that she is not alone. People can help her

B expressing the belief that violence is not acceptable and it is not her fault. Believe her story

C Confidentiality, interview alone, assure her you will not tell others

D Documentation includes a quoted statement, accurate descriptions of injuries and their history, information on the first, worst, and most recent abuse. Photos of the injuries with consent

E Education about the cycle of violence and that it will escalate. Offer community support and referrals. Display posters and brochures. Educate about the abuse.

S Safety is the most important aspect of intervention. See that the woman has resources and a plan of action when she decides to leave


Rape Recovery - 4 phases

1. Acute phase-disorganization: shock, fear, disbelief, anger, shame, guilt, unclean, insomnia, nightmares, sobbing

2. Outward adjustmant-denial: composed, returns to work-school, denies counseling

3. Reorganizaion: life adjustments, moves, changes jobs, uses distance to cope

4. Integration and Recovery: feels safe, trusts, advocate for others


Date rape drugs

Also called club drugs.

Rohypnol (roofies, forget pills, drop drug) 10x valium, memory loss for 8 hrs

Gamma hydroxybutyrate (GHB, liquid ecstasy, easy lay): euphoria, out of body, sleepy, increased sex drive, memory loss. Unconcious, coma, depression

Ketamine (special K, Vitamin K, superacid): separates perception and sensation, fatal with other drugs



Intrusion is reexperiencing the trauma, nightmares, flashbacks, recurrent thoughts.

Avoidance avoiding the trauma stimuli, social withdrawal, emotional numbing.

Hyperarousal increased emotional arousal, exaggerated startle response, irritable.

Symptoms usually start within three months and must last longer than 1 month


Risk factors for intimate partner violence in men

Individual factors: young, heavy drinker, personality disorder, depression, low academics, seeing or experiencing violence as a child

Relationship factors: marital conflict or instability, economic stress, dysfunctional family, male dominance, cohabitation, outside sexual partners

Community factors: week sanctions against violence, poverty, low social capital

Societal factors: traditional gender or social norms supportive of violence.


PEA Pulseless electrical activity

Asystole, no cardiac electrical activity, straight line on ECG.

PEA has some rhythm on ECG, but no pulses.

Ventricular tachycardia may also present as pulseless. Wide QRS, no P
Ventricular fibrillation chaotic, no P, No QRS, no T

Although these have rhythm, they are pulseless and must receive compressions