Families Exam 4

**Which of the following statements by the parent indicates an understanding of the potential long-term complications of bacterial meningitis? Select the 2 statements that indicate an understanding. "I may notice behavioral issues when my infant gets older." "My baby will probably have chronic renal failure as they get older." "My baby could develop vision loss." "Even though my baby had a seizure, this will not lead to a seizure disorder." "This could cause learning difficulties."

"I may notice behavioral issues when my infant gets older." "This could cause learning difficulties." Bacterial meningitis can potentially cause neurodevelopmental sequelae including behavioral issues, learning difficulties, hearing impairment, intractable epilepsy, or significant intellectual disability. Long-term complications can be reduced or prevented if bacterial meningitis is identified and treated promptly and effectively.

Treatment for Amblyopia (lazy eye)

- Cover the strong eye and force the brain to use the weaker eye and strength. - Can also treat with glasses if needed. - Might need surgery to cut or sow muscles are affected so eye can track.

Nursing care for depression in children and teens

- Plan care that is individualized. - Obtain health history and growth and development information. - Assess for substance use. - Assess for actual or potential risk to self (including a suicide plan, lethality of the plan, and the means to carry out the plan). - Assist with coping strategies. - Encourage peer group discussions, mentoring, and counseling. - Interview the child.

medications given for autism

- SSRIs can decrease aggression - antipsychotics and melatonin can help with insomnia

Expected findings for depression in children and teens

- Sad facial expressions - Tendency to remain alone - Withdrawn from family, friends, and activities - Fatigue - Tearful/crying - Ill feeling - Feelings of worthlessness - Weight loss or gain - Alterations in sleep - Lack of interest in school, drop in performance in school - Statements regarding low self-esteem - Hopelessness - Suicidal ideation - Constipation

Clinical manifestations of meningitis for 2+ years

- Seizures (often initial finding) - Nuchal rigidity - Fever and chills - Headache - Vomiting - Irritability and restlessness that can progress to drowsiness, delirium, stupor, and coma - Petechiae or purpuric-type rash (with meningococcal infection) - Involvement of joints (with meningococcal and Hib) - Chronic draining ear (with pneumococcal infection) Positive Brudzinski's sign (flexion of extremities occurring with deliberate flexion of the child's neck) -- indicates infection and inflammation of the meninges -- lay child prone, lift neck, knees lift in response Positive Kernig's sign (resistance to extension of the child's leg from a flexed position) -- indicates inflammation -- lay flat, lifting the knees 90* = painful

nursing care for hearing loss

- assess - promote speech development, lip reading, cued speech, hand gestures - encourage socialization - refer to community groups - use sign language or an interpreter - assess gait and balance - assist with developing cochlear implants

nursing care for autism spectrum disorder

- assess: checklist for autism in toddlers (CHAT) or pervasive developmental disorder screening test - refer to early intervention for physical, occupational, and speech therapy - behavioral modification -- promote postitive reinforcement -- teach social awareness -- teach verbal communication -- set realistic goals -- decreases unacceptable behaviors -- structure opportunities for small successes -- set clear rules - decrease environmental stimuli - introduce children to new situations slowly

expected findings for developmental dysplasia of the hip (DHD) in infants

- asymetry and unequal number of skin folds on the posterior thigh - limited hip abduction - shortened femur - widened perieum - positive ortolani test (hip reduced by abduction) - positive barlow test (hip is dislocated by adduction) - one leg shorter than the other - walking on toes on one foot - walking with a limp

expected findings for scoliosis

- asymmetry of scapula, ribs, shoulders, and hips - improperly fitting clothing - screen during preadolescence -- observe the child wearing only underwear from the back. have them bend at the waist with arms hanging -- measure spinal curvature with a scoliometer

complications for scoliosis

- breathing difficulties - spinal or nerve damage - lowered self-esteem - small bowel obstruction - infection following surgery

visual impairments

- can be partial sight (20/70 to 20/200) - can be legal blindness (20/200 or worse)

how to perform visual screening test

- choose which test is appropriate (HOTV, snellen, tumbling E) - place the child 10 feet away, with their heels on the 10 foot mark - child gets to wear their glasses - while covering one eye, the child reads each line on the chart, starting at the bottom, until he can pass a line. - the child needs to identify 4 of the 6 characters to pass - then the child is asked to start at the top, and go to the bottom, until they can no longer see - repeat with the other eye

scoliosis

- complex deformity of the spine that also affects the ribs - characterized by lateral curvature of the spine - idiopathic or structural scoloiosis is the most common - more common in females - ages 8-15 years - genetic

compartment syndrome

- compression of nerves, blood vessels, and muscles inside a confined space, resulting in neuromuscular ischemia; most commonly occurring in tibial fractures involving the forearm. - caused by tight casting, hemorrhage, burns, surgery, and massive IV infiltration

Scoliosis, Developmental dysplasia of the hip (DDH) - prednisone

- corticosteroid given for inflammation and pain. - given for childhood arthritis - given as an eye solution, orally, or IV - administer lowest effective dose as short term therapy and discontinue by tapering the dose - may cause weight gain (esp in face), alteration in growth, lowers immune system

expected findings in autism spectrum disorder

- delays in social interaction, social communication, or imaginative play prior to age 3 - distress when routines are changed - unusual attachment to objects - inability to start or maintain conversations - delayed or absent language - grunting or humming - inability to adjust gaze - withdrawn or liable mood - lack of empathy - decreased pain sensation - enjoys time alone - avoiding eye contact - heightened or lowered senses - short attention span - showing aggression - repetitive movements

Depression in children and adolescents

- difficult to detect and often overlooked because children have difficulty expressing their feelings - findings must be present for 1 year to diagnose

nursing care for casts

- elevate the cast above heart level during the first 24-48 hours to prevent swelling - apply ice for the first 24 hours - do neuro checks - turn and position pt every 2 hours - keep effected limb supported with pillow - assess for increased warmth, drainage, skin integrity, - report severe pain if not relieved by meds after 1hour - reinforce skin and cover with plastic - cleanse with damp cloth if it becomes soiled - after cast removed, soak limb in warm water and apply lotion

treatment for compartment syndrome

- first, loosen dressing - severe: Fasciotomy to relieve compartment pressure and prevent permanent neurologic damage.

interventions for ICP

- head midline - HOB elevated to 30* - avoid coughing/sneezing - dim lights/noise - monitor for gag, pupillary, and blink reflex - administer oxygen to greater than 95* - assess for CSF drainage from the nose and ears

attention-deficit/hyperactivity disorder (ADHD)

- inattentiveness and impulsiveness usually prior to 7 - common in childhood but can persist into adulthood - manifest between 4-18 years - social and academic impairment

preoperative nursing actions and education for spinal fusion with rod placement

- inform and assist autologous blood donation - type and cross match blood - inform adolescent and family about what to expect - NPO, NG tube, chest tubes, cathethers, PCA pumps

Nursing care for meningitis

- initiate droplet precautions ASAP -- for bacterial meningitis, need droplet precautions for 24 hrs after antibiotics have started -- private room, all guest need a mask - For infants, monitor bulging fontanels and head circumferences. - Monitor vital signs, urine output, fluid status, pain level, and neurologic status - If pt looses conciousness, put on NPO. advance to clear liquids as tolerated - decrease environmental stimuli. -- dim room, limit visitors, quiet, room cool - position the pt without a pillow, slightly elevate HOB, or side lying - seizure precautions

nursing interventions for major burns

- maintain airway - provide humidified 100% oxygen - monitor vitals - maintain cardiac output -- initiate IV access with 2 large bore catheters -- fluid replacement - manage pain, give analgesics before dressing changes - prevent infection with REVERSE ISOLATION - monitor for septic shock - need extra protein for tissue healing - provide psychological support

nursing care for traction devices

- maintain body alignment - notify MD if pt experiences severe pain or muscle spasms unrelieved by meds - assess vitals, neuros, and skin integrity - maintain weights - inspect pins regularly

post-operative nursing actions and education for spinal fusion with rod placement

- monitor in ICU - administer analgesics through PCA pump - frequent neuro checks - turn by log rolling - assess skin integrity - assess bowel sounds, NPO until bowel sounds return - give blood transfusions - ambulated by 2-3 days - assess for infection - perform ROM to uneffected extremities - encourage physical therapy

expected findings for infants with hearing loss

- no startle reflex - failure to respond to noise - absence of vocalization by 7 months - lack of response to spoken word - failure to localize sound by 6 months

nursing care for fractures in children

- obtain history how injury occurred - monitor vitals, neuros, and pain - stabilize the injured area - if pelvic fracture, monitor urine for blood and signs of hypovolemic shock - elevate the affected limb, and apply ice packs (under 20 mins) - give analgesics, immunizations, and antibiotics

expected findings for fractures

- pain - crepitus (crunching) - deformity - ecchymosis - warmth / redness - decrease use

nursing care during a seizure

- protect head from injury - maintain airway - prepare to suction oral secretions - side-lying position - loosen clothing - do not restrain - do not put anything in the childs mouth - remove glassess - note onset, duration, and characteristics

Methlyphenidate, Dextroamphetamine

- psychosocial stimulant which increases dopamine and norepinephrine levels Actions: - Increase dose until theraputic results - Give 30 mins before meals - Give last dose prior to 1800 - Give in the morning - Avoid caffine - Trycyclic antidepressants (TCA) used as adjunct therapy to treat insomnia - Store properly. Has potential for misuse by others. Adverse affects: - insomnia, anorexia, nervousness, hyper/hypotension, tachycardia, and anemia

Clinical manifestations of meningitis for 3 month olds - 2 years

- seizures - high pitched cry - fever - irritability - possible nuchal rigidity - poor feeding - vomiting - bulging fontanels - BRUDZINSKI'S AND KERNIG'S SIGNS NOT RELIABLE

nursing care after seizures

- side lying - check breathing, vitals, position of head and tongue - check body for injuries - perform neuro check - reorient and calm the patient - do not offer food or liquids until swallow reflex is back - try to assess a trigger

nursing interventions for minor burns

- stop burn with cool/tepid water -- do not use cold water, grease, lotions, because it locks heat in - cover with clean cloth - use mild soap and antimicrobial agent - keep protected/covered with clean dressing - give analgesics - check immunizations - may need tetanus - watch for infections

normal urine output for children - under 30kg - over 30kg

- under 30kg: 0.5-1mL/kg/hr - over 30kg: 30mL/hr

nursing care for attention-deficit/hyperactivity disorder (ADHD)

- use calm, firm, respectful approach with the child - use modeling to demonstrate acceptable behavior - set clear limit - be consistent on rules - plan physical activities for the child to exert energy - focus on the childs strengths, not just behavior problems - give positive feedback - help with coping skills - age appropriate consequences - use a consistent study area - use steps when assigning chores - give regular breaks

expected findings for children with hearing loss

- use gestures rather than talking (by 15 months) - failure to understand speech by 24 months - yelling to express emotions - inability to gain attention - being shy or withdrawn - inattention - need for repeated conversations - speak loudly

education for isotretinoin / acutane

- used for severe cases - only prescribed by dermatologist adverse effects: - dry skin, dry eyes, dry mouth - decreased night vision - headaches - photosensitivity - elevated cholesterol - depression / suicidal thoughts - teratogenic -> MUST be on contraceptives

prevention of measles

-MMR vaccine contains live, attenuated measles virus that confers protection for up to 20 years. -Recommended for healthy children aged 12 - 15 months, with a booster before the child enters school (4-6 years)

3 medications given for (bacterial) meningitis

1. Antibiotics The length of therapy is determined by the client's condition and CSF results (normal blood glucose levels, negative culture). Therapy can last up to 10 days. 2. Corticosteroids: dexamethasone -- only for bacterial meningitis -- Assists with initial management of increased ICP, but might not be effective for long-term complications. -- Most effective for reducing neurologic complications in children who have infections caused by Hib 3. Analgesics: acetaminophen with codine Nursing Actions: Assess for allergies. Provide support for the client and family. Educate the family about the need to complete the entire course of medication

types of vision tests

1. HOTV test (3-5 yo) - picture chart, used for preschoolers 2. tumbling E (3-5 yo) 3. Snellen chart - letters, used for older children

3 treatments for developmental dysplasia of the hip (DHD) before 6 months

1. Pavlik harness: Scotish Right hospital video - Chest harness that abducts the legs - Prior to 6 months of age - Maintain harness for 12 weeks - Check straps every 1-2 weeks for adjustment - Perform neuro and skin integrity - PT CANNOT ADJUST STRAPS - Use an undershirt, - Wear socks underneath - Gently massage skin under straps to promote circulation - Avoid lotion and powders, place diaper under straps 2. Hip spica casts - purple casting video - maintains external rotation of the hip Trendelenburg sign - rotation of one hip further in front than the other. - assess temperature of toes every hour for at least 24 hours - inspect the inside edges of cast to look for extra pieces of cast material - perform neuro checks & ROM exercies - provide regular sponge baths - assess skin integrity (diaper) - assess for signs of redness/irritation 3. Bryant's traction - skin traction - hips flexed at 90* angle with buttock raised off the bed - neuro checks - maintain tractions

hearing impairments - 3 types 1. conductive loss 2. sensorineural loss 3. central auditory imperception

1. conductive loss - loss that results from ear infections, foreign bodies, or excessive ear wax 2. sensorineural loss - loss that results from disruption in nerve pathways, congenital defects, infection, medication, noise 3. central auditory imprecation - loss related to natural causes (aphasia, agnosia-damage to brain)

6 neuro checks for fractures

1. sensation - assess for numbness and tingling (nerve damage) 2. skin temperature 3. skin color - check distal to the injury and look for changes in pigmentation 4. capillary refill - should be under 3 seconds. 5. pulses - should be palpable and strong 6. movement - should be able to move the joints distal to the injury (fingers and toes)

5 medications that can be taken for acne

1. tretinion - topical med applied at night 20-30 mins after washing the face - avoid sun exposure, wear sun screen 2. benzyl peroxide - antibacterial agent 3. topical and oral antibiotics - clindamycin, azelaic acid, dapsone - photosensitivity 4. oral contraceptives - hormone control 5. isotretinoin

parkland formula for a child who weights 77lbs and is burned over 27% of their body

77 lbs / 2.2 = 35 kg 4mL x BSA% x kg - 4 x 27 x 35 = 3780 mL half in first 8 hours - 3780/2 = 1890mL / 8 hours -- 1890/8 = 236

interpretation of CSF for... viral meningitis: bacterial meningitis:

Bacterial Meningitis: - Cloudy color - Elevated WBC count - Elevated protein content - Decreased glucose content - Positive Gram stain Viral Meningitis: - Clear color - Slightly elevated WBC count - Normal or slightly elevated protein content - Normal glucose content - Negative Gram stain - Usually not contagious

diagnostics for seizures

EEG -- records electrical activity and identify the origin of seizure activity MRI -- detects tumors, cortical dysplasia, tumors lumbar puncture -- assess for infection CT -- detects hemorrhage, infarction, or malformations

developmental dysplasia of the hip (DHD)

Hip dysplasia risk factors include: breech delivery, family history of hip dysplasia, large infant for delivery, and multiple births. 3 big signs of hip dysplasia: 1) extra gluteal and thigh folds 2) shortened leg 3) a click that may be heard or felt when the affected hip is abducted as the femoral head slips in and out of the hip socket. - acetabular: an abnormally shallow hip socket that leads to uncovering of the femoral head and excessive pressure on the rim of the hip socket (delay in acetabular development) - subluxation: your ball joint has shifted partially out of its socket, but not all the way out (incomplete dislocation) - dislocation: femoral head not intact with acetabulum

MRSA

Methicillin-Resistant Staphylococcus Aureus; an infectious disease caused by a pathogen that is resistant to many antibiotics - treated with moist compress, topical and systemic antibiotics - need contact isolation -> gown and gloves

parkland formula

Method of calculating fluid repletion in burn patients. 4mL x BSA(%) x weight (kg) - give half over first 8 hours - give second half over 16 hours

Signs of increased intracranial pressure in: Newborns and infants: Children: Late findings: Flexion and Extension posturing:

Newborns and infants: -- bulging fontanel, separation of cranial sutures, irritability, bradycardia, restlessness, increased sleeping, high-pitched cry, poor feeding, setting-sun sign, distended scalp veins Children: -- nausea, headache, forceful vomiting, blurred vision, increased sleeping, inability to follow simple commands, decline in school performance, seizures Late findings: -- Alterations in pupillary response, posturing (flexion and extension), bradycardia, decreased motor response, decreased response to painful stimuli, Cheyne-Stokes respirations, optic disc swelling, decreased consciousness, coma Flexion posturing: --(severe dysfunction of the cerebral cortex): Demonstrates the arms, wrists, elbows, and fingers flexed and bent inward onto the chest and the legs extended and rotated internally. Extension posturing: --(severe dysfunction at the level of the midbrain): Demonstrates a backward arching of the legs and arms, flexed wrists and fingers, extended neck, clenched jaw, and possibly an arched back

Atomoxetine

Selective norepinephrine reuptake inhibitor used for ADHD to increase attention span. - Gradual increase in dose to reach therapeutic results. - Monitor for adverse effects (suicidal ideation)

Lumbar Puncture Procedure with Nursing Actions

This is the definitive diagnostic test for meningitis. The provider inserts a spinal needle into the subarachnoid space between L3 and L4, or L4 and L5 vertebral spaces. Measures spinal fluid pressure and collects CSF for analysis. Nursing Actions: -- Have the client void prior to the procedure. -- Assist the provider with the procedure. -- A topical anesthetic cream (lidocaine and prilocaine) can be applied over the biopsy area 45 min to 1 hr prior to the procedure. -- Place the client in the side-lying position with the head flexed and knees drawn up toward the chest, and assist in maintaining the position. Use distraction methods as necessary. -- The client can be sedated with fentanyl and midazolam (versed). -- The provider cleans the skin and injects a local anesthetic. -- The provider takes pressure readings and collects 3-5 test tubes of CSF. -- Pressure and an elastic bandage are applied to the puncture site after the needle is removed. -- Label specimens appropriately, and deliver them to the laboratory. -- Monitor the site for bleeding, hematoma, or infection

2 immunizations that can help prevent bacterial meningitis

Two vaccines given to infants: 1. PCV pneumococcal 2. Heamophilus influenza type b (Hib) -- recieved at 2, 4, and 6 months, and again at 12-15 months Meningococcal vaccine given to students living in dorms.

halo traction (cervical traction)

Uses a halo-type bar that encircles the head. screws are inserted into the outer skull. The halo is attached to either bed traction or rods that are secured to a vest worn by the client.

Clinical manifestations of meningitis in infants

Usually no illness present at birth, but symptoms progress within the first few days. Manifestations are vague and difficult to diagnose. --poor suck --refuses feeding --poor muscle tone --weak cry --vomiting or diarrhea --possible fever or hypothermia --neck is supple without nuchal rigidity. Bulging fontanels are a late finding

VP shunt

Ventriculoperitoneal shunt: used to treat swelling of the brain due to excess buildup of cerebrospinal fluid by draining fluid into the peritoneal cavity. - monitor for changes in LOC, fever, etc

Viral meningitis vs Bacterial meningitis

Viral: usually requires supportive care for recovery -- aka aseptic meningitis -- usually requires supportive care for recovery -- usually not contagious -- caused by many viral illnesses Bacterial: is a contagious infection. Prognosis depends on how quickly care is initiated. -- aka septic meningitis -- a contagious infection. -- caused by neisseria meningitidis (meningococcal), streptococcus pneumoniae (pneumococcal), heamophilus influenza type b (Hib). -- bacterial meningitis has decreased in all age groups except infants under 2 months since the introduction of the Hib and pneumococcal conjugate vaccines (PCV). -- risk is increased in crowded living condition, skull fractures

Impetigo contagiosa - what is it? - symptoms? - management? - teaching?

What is it? - Impetigo is a bacterial (skin) infection of the skin caused by staphylococci or streptococci bacteria. - Reddish macules that become vesicular with crusting - Honey colored - Moist erosions on the skin form honey colored crusts --Spread by peripheral or direct contact. Management? - treated with topical bactericidal or triple antibiotic ointment - oral or parenteral antibiotics for severe cases Teaching? --Spread via direct contact and is highly contagious from the time of initial appearance of lesions until all lesions have healed. --Impetigo does not cause the formation of antibodies that prevent reinfection. Therefore, the child can get impetigo again in the future. --Wash the crusts each day with water and soap to promote healing. --No sharing towels --Wash linens in hot water --Hand washing before and after contact

When is the varicella vaccine given?

at 12-15 months and 4-6 years of age. - CONTRAINDICATED IN PREGNANCY

treatment for scoliosis

bracing: customized baces slow the progression of the curve. - need to be fitted - assess skin - promote positive self image - wear brace for 23hr/day. only remove for showering.

measles (rubeola) virus - clinical manifestations? - nursing interventions?

clinical manifestations? - 1-4 days before rash appears, pt will have fever, conjunctivitis, fatigue, cough, runny nose, red eyes, sore throat - RASH: -- koplik spots - small white dots that appear in the mouth 2 days before rash -- red rash that starts on face and spreads downward -- spike in fever with rash nursing interventions? - antipyretics / analgesics (no aspirin) - rest and fluids

erythema infectiosum (fifths disease) - clinical manifestations - nursing interventions

clinical manifestations? - BEFORE RASH: -- fever, runny nose, headache - AFTER RASH: -- "slapped cheek" rash on the face appears around day 1-4 -- maculopapular red spots on limbs -- secondary itchy rash on the rest of body and soles of the feet -- sore throat, fatigue, malaise, upset stomach, headache, itching nursing interventions? - rest, fluids, stay home, etc

varicella zoster virus - clinical manifestations? - nursing interventions?

clinical manifestations? - fever - fatigue - loss of appetite - headache - rash --- macules start in center of trunk, spreading to the face and extremities --- progress from macules, to papules, to vesicles, and crusts --- scabs appear in 1 week nursing interventions? - antipyretics / analgesics (no aspirin) - rest and fluids - keep nails short and clean (no itch) - can go back to school after lesions crust over

mononucleosis (epstein-barr virus) - clinical manifestations? - nursing interventions?

clinical manifestations? - fever, lethargy, sore throat, swollen lymph nodes, loss of appetite, headache, increased WBCs, splenomegally, hepatic involvement - some people get a mono rash nursing interventions? - rest and fluids - avoid activity (spleen rupture) - antipyretics - no kissing or sharing drinks

autism spectrum disorder

complex neurodevlopmental disorder with spectrum of behaviors affecting ones ability to communicate and interact with others in social settings - genetic link - exact cause unknown

3 types of traumatic brain injuries: concussion/mild: moderate: severe:

concussion/mild: - mild, persistent headache, slow thinking/reading/memory, loss of balance, fatigue, light sensitivity, easily irritated. moderate: - GCS 9-12, posttraumatic amnesia 1-24 hrs, LOC severe: - GCS 8 or less, amnesia >24 hrs, coma, IICP

fourth degree burns - damage - appearance - sensation/healing

damage - deep full thickness burns - damage to all layers of skin, muscle, fascia, and bones - ligaments, tendons, and bones visible appearance - variable in color - dull and dry - charring present sensation/healing - no pain present - heals within weeks to months - scarring is present - grafting required - possible amputation

third degree burns - damage - appearance - sensation/healing

damage - full thickness loss - damage to entire epidermis and dermis and possible damage to the subcutaneous tissue - nerve endings, hair follicles, and sweat glands destroyed appearance - red, tan, black, brown - waxy / leathery - no blanching sensation/healing - initially may or may not be painful, more pain with healing - scarring is present - autographting

second degree burns - damage - appearance - sensation/healing

damage - superficial partial thickness or deep partial thickness - damage to entire epidermis, parts of dermis are damaged - sweat glands and hair follicles remain appearance - painful, moist, red/white, blisters, mild/moderate edema, blanches with pressure sensation/healing - PAINFUL - heals in 21+ days - scaring - sensitive to temperature, air, and light touch

first degree burns - damage - appearance - sensation/healing

damage - superficial, damage to epidermis appearance - pink/red - no blisters - blanches with pressure sensation/healing - painful - heals within 3-7 days - generally heals with no scars

expected findings for attention-deficit/hyperactivity disorder (ADHD)

inattention - cannot pay attention to details - careless mistakes - blocking incoming stimuli - trouble listening - trouble following instructions - losing things - easily distracted - forgetfulness hyperactivity - fidgeting - failing to remain seated - inappropriate running - cannot engage in quiet play - seems busy all the time - talks excessively impulsivity - blurting out responses - difficulty waiting turns - interrupting often - striking out, biting, shouting

Meningitis

inflammation of the meninges of the brain and spinal cord caused by an infection - bacterial, viral, or fungal

types of visual impairments: myopia: hyperopia: astigmatism: amblyopia: cataracts: glaucoma:

myopia: - nearsightedness - sees objects close clearly, objects in distance is blurry hyperopia: - farsightedness - sees distant objects clearly, but not close up astigmatism: - uneven vision amblyopia: - lazy eye, with reduced visual acuity cataracts: - gray opacity of the lens which prevents light from entering the eye glaucoma: - increased ocular pressure - loss of peripheral vision

expected ICP for children, and which number requires intervention

norm: 1-10 greater than 15 = interventions

acute otitis media - nursing interventions - medication

nursing interventions - comfort measures - pain meds, antipyretics, diversional activities - place child in upright position medication - antibiotics = amoxicillin or azithromycin (PO 10-14 days) OR ceftriaxone IM - antibiotics recommended for children over 6 months with severe manifestations (temp 102 or higher for 2 days) - benzocaine or lidocaine drops to relieve pain

hydrocephalus

obstruction of CSF flow or impaired reabsorption causing increased ICP

child abuse

physical, emotional, or sexual mistreatment of a child.

types of fractures: plastic deformation (bend): buckle (torus): greenstick: transverse: oblique: spiral: physeal: stress: complete: incomplete: closed / simple: open / compound: complicated: commuted:

plastic deformation (bend): - bend 45* or less without breakage buckle (torus): - compression of bone resulting in a bulge at the fracture site greenstick: - incomplete fracture, doesnt go all the way through the bone transverse: - straight across the bone oblique: - breaks diagonally around the bone spiral: - break spirals around the bone physeal: - injury to the growth plate stress: - small fractures/cracks in the bones from repeated muscle contractions complete: - bone fragments are separated incomplete: - bone fragments are still attached closed / simple: - no break in the skin open / compound: - breaks through the skin complicated: - fracture results in injury to other organs and tissues commuted: - small fragments of bone lie in surrounding tissues

status epilepticus

prolonged seizure lasting 30 minutes or longer, or continuous seizure activity. - administer large dose of diazepam or lorazepam. buccal, rectal, or nasal meds can be given until IV access can be established.

seizure vs epilepsy

seizure: - abnormal, involuntary, excessive electrical discharge of neurons within the brain - caused by cerebral edema, ICP, infection, brain tumors, anoxia, toxins or drugs, lead poisoning. epilepsy: - two unprovoked seizures at least 24 hours apart, or if a single unprovoked seizure occurs during a time period of 10 years following two unprovoked seizures

surgical treatment for scoliosis

spinal fusion with rod placement - used for curvatures over 45*

treatment for developmental dysplasia of the hip (DHD) for children ages 6 months - 2 years

surgical closed reduction with placement of hip spica cast

phases of tonic-clonic seizures (grandmal)

tonic phase: last 10-20 seconds - eyes roll up - tonic contractions of body with arms flexed, legs head and neck extended - mouth shuts (tongue bitten?) - thoracic and abdominal muscles contract - possible cry - flushing - loss of swallow reflex and increased salivation - apnea and cyanosis clonic phase: last 30-50 seconds, or up to 30 mins - violent jerking - rhythmic contractions - foaming of the mouth - incontinence postical state: 30 mins - semiconscious - confusion - lack of coordination - possible vomiting, headache, speech impairments - sore muscles - sleep - no memory of seizures

traction care

use of pulling force to reduce a fracture, maintain alignment, and provide muscle rest. types of tractions used depends on fractures, age, and associated injuries

skin traction

uses a pulling force that is applied by weights. using tap and straps applied to the skin along with boots and cuffs. weights are attached by a rope to the extremity. - bucks, russel, bryand

skeletal traction

uses of continuous pulling force that is applied directly to the skeletal structure or bone. used when more pulling force is needed than skin traction. a pin or rod is inserted through or into the bone. weights are never removed by the nurse.

lyme disease - what is it? - symptoms? - management? - teaching?

what is it? - Tick-borne disease caused by the spirochete Borrelia burgdorferi. symptoms? - stage 1: 3-30 days after bite, red bullseye appearance, pain, chills, fever, itching, headache, fainting, stiff neck, muscle weakness - stage 2: 3-10 weeks after bite. paralysis/weakness in the face, muscle pain, swollen joints, fever, fatigue, splenomegaly - stage 3: 2-12 months after bite. musculoskeltal pain, arthritis, deafness, cardiac complications, encephalopathy, abnormal muscle movements, numbness, tingling, speech problems. management? - antibiotics 2-3 week course for pts with confirmed case teaching? - if bitten by a tick, pul straight up with tweezers. remove any remaining parts with sterile needle, cleanse site with soap and disinfectant - report tick bites

acute otitis media - what is it? - symptoms?

what is it? - acute ear infection caused by a viral or bacterial infection, allergies, enlarged adenoids symptoms? - recent infection - changes in behavior - crying / fussiness - tugging at the ear - ear pain - N/V - fever - feelings of fullness in the ear - lethargy - bulging red or yellow tympatic membrane

pediculosis capitis - what is it? - symptoms? - management? - teaching?

what is it? - aka head lice symptoms? - intense itching - small red bumps on scalp - nits (white specks) on hair shaft management? - use 1% permethrin shampoo - spinosad 0.9% topical suspension for children 4+, and benzyl alcohol 5% for 6 months+ - use fine tooth comb to remove nits teaching? - repeat shampoo and comb 7 days later - wash all clothing and bedding in HOT water, or hot dryer for 20 mins - DO NOT share hair products, combs, brushes, hair ties, etc - lice do not JUMP from head to head, they are transferd by bedding or hair products

diaper dermatitis - what is it? - symptoms? - management? - teaching?

what is it? - diaper rash - caused by detergents, soap, soiled diapers, chemicals, or candida albicans symptoms? - bright red rash - firey red scaly areas on the scrotum, penis, and labia - pimples, blisters, ulcers, large bumps, or pus-filled sores management? - apply skin barrier = Petrolatum ointment, zinc oxide ointment, aluminum acetate solution. - prescribed ointment - nystatin teaching? - promptly remove soiled diapers - clean with non-irritating cleanser - expose area to air - do not wash off skin barrier during diaper change

Candidiasis - what is it? - symptoms? - management?

what is it? - fungal skin infection (candida albicans) symptoms? - most commonly found in the mouth (oral thrush) - found in moist areas of the skin - white exudate, peeling inflammed areas that bleed easily, pruritic. management? - topical antifungals = nystatin, miconazole - oral antifungals for oropharyngeal or intestinal = nystatin

measles (rubeola) virus - what is it? - how is it spread? - how long is it contagious?

what is it? - highly contagious, serous, viral disease that can cause blindness and brain damage how is it spread? - direct contact - droplet (airborne) - spread when infected person sneezes and coughs, breathing, touching near mouth and nose. how long is it contagious? - 4 days before rash appears - 5 days after rash disappears.

acne - what is it? - symptoms? - management?

what is it? - most common skin conditions in teens - self limiting, not life threatening, but has a negative impact on self-esteem - more common in males, has a genetic link. - linked to sugar and fat heavy diets symptoms? - lesions (comedones) are either open (blackheads) or closed (whiteheads) management? - gently wash affected area - avoid scrubbing or abrasive cleaners - severe cases can be treated with medications

mononucleosis (epstein-barr virus) - what is it? - how is it spread? - how long is it contagious?

what is it? - viral illness that causes abnormally high number of mononuclear leukocytes in the blood how is it spread? - spread through saliva - kissing, sharing drinks, etc how long is it contagious? - healthy people can transmit for a lifetime

erythema infectiosum (fifths disease) - what is it? - how is it spread? - how long is it contagious?

what is it? - viral infection that causes flu like symptoms that last about 2 weeks how is it spread? - spread through respiratory droplets and blood how long is it contagious? - 4-21 days

varicella zoster virus - what is it? - how is it spread? - how long is it contagious?

what is it? - virus that causes chicken pox how is it spread? - direct / contact - droplet (airborne) - contaminated objects how long is it contagious? - 1-2 days before lesions appear - contagious until lesions crust over

osteomyelitis what is it? what are the symptoms? nursing actions?

what is it? - infection within the bone secondary to a bacterial infection from an outside source (usually from an open fracture) or a bloodborn bacterial source symptoms? -irritability, fever, edema, pain is constant and increased with movement, unuse of extremity. - site is tender, swollen, and warm to touch. actions? - obtain skin, blood, and bone cultures - assist in joint or bone biopsy - give antibiotics - monitor liver and kidney function - immobilize and elevate limb - limit movement to not **** up growth plates