NUR328 Exam 3

A mother asks to hold her infant during a lumbar puncture. The nurse's best response It is best that the infant lays prone and remains untouched during this procedure." "I will hold the baby. You can offer the pacifier while the procedure is performed." "Yes, you can hold. Let me demonstrate the proper way first." "You must wait outside the room while this procedure is performed."

"I will hold the baby. You can offer the pacifier while the procedure is performed."

Peak ages of Juvenile Idiopathic Arthritis (JIA):

1 to 3 years and 8 to 10 years

Foreign Body Aspiration most common in ages

1-3 years

at ____ years, the cranial sutures cannot separate (can cause increase ICP)

12

Peak incidence of Hyperthyroidism

12-14 years old

Manifestation of Intermediate Spinal Muscular Atrophy

2 and 12 months of age

Bone Healing and Remodeling: neonatal period

2 to 3 weeks

Symptoms of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) decrease when

ADH is decreased

Therapeutic management of Foreign Body Aspiration

Abdominal thrusts -children > 1 year old Back blows and chest thrusts-children < 1 years old Removal via Endoscopy

Brief loss of consciousness (for 5 to 10 seconds) Minimal or no change in muscle tone (Lip smacking, staring spell, twitching) Sudden onset; up to 20 events or more per day Often misdiagnosed as attention-deficit/hyperactivity disorder (ADHD), inattention, or school difficulty

Absence Seizures

Pediatric Glasgow Coma Scale: Scoring <8

Accepted as definition of coma

Mildest form; osseous hypoplasia of the acetabular roof Femoral head remains in the acetabulum

Acetabular dysplasia (preluxation)

Three degrees of Developmental dysplasia of the hip (DDH)

Acetabular dysplasia (preluxation) Subluxation Dislocation

Result of neoplasm, inflammatory disease, dietary deficiency (but rarely in children), or increased secretion of pituitary TSH Low intake of dietary iodine

Acquired Goiter

Hydrocephalus is acquired after delivery

Acquired Hydrocephalus

Pituitary hyperfunction after the closure of the epiphyseal plate is called Graves disease Acromegaly Addison's disease Cushing syndrome

Acromegaly

Adrenal crisis-not enough cortisol

Acute Adrenocortical Insufficiency

Observable inflammation of middle ear, s/sx of infection

Acute Otitis Media

Cause: direct injury or systemic insult

Acute Respiratory Distress Syndrome (ARDS)

Causes: paroxysmal attacks of laryngeal obstruction Triggered by allergies or hypersensitivities

Acute Spasmodic Laryngitis

Clinical Manifestations of Developmental dysplasia of the hip (DDH): in older infant and child

Affected leg is shorter than the unaffected leg Waddling gait if bilateral dislocations

In a head injury, damage to the cerebrum is caused by njury from secondary swelling Injury at point of initial impact (coup) Injury at point of rebound impact (contra coup) All of the above

All of the above

Function of islets of Langerhans

Alpha cells produce glucagon Beta cells produce insulin Delta cells produce somatostatin

Varying states of unconsciousness that may be momentary or last a few hours, days, indefinitely

Altered States of Consciousness

Types of Skeletal Limb Deficiency

Amelia Meromelia Phocomelia Prenatal

Both cerebral hemispheres absent Incompatible with life

Anencephaly

_____________ pituitary gland is the "master gland"

Anterior

Medications for CP

Antispasmodics; Botox Analgesia Antiepileptics

Treatment of thyroid storm (Thyrotoxicosis)

Antithyroid drugs Propranolol

Treatment of Graves Disease

Antithyroid drugs (propylthiouracil [PTU] and methimazole) Subtotal thyroidectomy Ablation with radioiodine

Clinical Manifestations of Pseudohypoparathyroidism

Anxiety Mental depression Muscle spasms: Trousseau sign, tetany, Chvostek sign

The nurse's priority consideration for a patient with Guillain-Barre syndrome is Ambulating the patient 2x per day Maintaining strict airborne precautions Assessing respiratory status Monitoring strict I/O

Assessing respiratory status

RSV within 1st year of life will usually result in _______ later in life

Asthma

Sudden momentary loss of muscle tone May or may not have loss of consciousness Sudden fall to the ground, often on the face

Atonic Seizures

Stages of Coma Recovery: Level 7

Automatic, appropriate

Management of febrile seizures

Avoid tepid baths Long-term antipyretics are ineffective as preventive medicines Protect the child from injury during the seizure Call 911 if the seizure lasts longer than 5 minutes

Three Main causes of Intracranial Infections

Bacterial or pyogenic Viral or aseptic, caused by wide variety of viral agents Tuberculosis, caused by tuberculin bacillis

Signs and Symptoms of Pertussis (Whooping Cough):

Barking/hoarse/congested cough Apnea common in infants <6 month

involves bones at base of the skull in either the posterior or anterior region.

Basilar Fracture

Clinical Features of Osteogenesis Imperfecta (OI)

Bone fragility, deformity, fracture Blue sclera (due to the underlying choroidal veins which show through. This is due to the sclera being thinner than normal) Hearing loss Dentinogenesis

Food poisoning resulting from ingestion of the toxin produced by the anaerobic bacillus Clostridium botulinum

Botulism

Bone tumors are most common in

Boys, during accelerate growth rate

Late signs of increasing ICP:

Bradycardia Decreased LOC Decreased motor response to commands Decreased sensory response to painful stimuli Alterations in pupil size and reactivity Papilledema Flexion or extension posturing Cheyne-Stokes respirations

collection of pus anywhere within the brain

Brain abscess

Lower Respiratory tract Illnesses include:

Bronchitis Bronchiolitis RSV Pneumonias

Legs flexed at 90 degrees, hips and buttocks slightly off bed

Bryant Traction

Traction in which the legs are flexed at 90 degrees with the hips and buttocks slightly off the bed is called Buck extension traction Russell traction Cervical traction Bryant traction

Bryant traction

Legs extended Used for short term immobilization

Buck Extension Traction

Disorder of posture and movement from static brain injury perinatally or postnatally; limits activity

Cerebral Palsy

As neck muscles fatigue, vertebral bodies gradually separate so the spinal cord is no longer pinched between the vertebrae Inserted through burr holes in the skull with weights attached to the hyperextended head

Cervical Traction

Signs and symptoms of Seizures

Change in LOC Involuntary movements Posturing Changes in perception, behaviors, or sensations

Nursing Considerations for Thyrotoxicosis

Child needs a quiet environment and rest periods Dietary requirements to meet the child's increased metabolic rate

Not enough cortisol

Chronic Adrenocortical Insufficiency: Addison Disease

Secondary disease of Hyperparathyroidism

Chronic renal disease; congenital anomalies of the urinary tract

Bony abnormality almost always requiring surgical intervention

Classification of Clubfoot: Congenital idiopathic or true clubfoot

May correct spontaneously or require passive exercise or serial casting

Classification of Clubfoot: Mild or postural

Associated with other congenital anomalies Usually requires surgical correction and has a high incidence of recurrence

Classification of Clubfoot: Teratologic

______________ is the most frequently broken bone in childhood, especially in those younger than 10 years old

Clavicle

state of unconsciousness from which cannot be aroused, even with painful stimuli

Coma

Viral intracranial infections are best treated with Tuberculin medications Antibiotics Aspirin Comfort measures

Comfort measures

Multiple associated linear fractures (intense impact)

Comminuted Fracture

CSF flows out of the fourth ventricle and flows through the ventricular system, but can not be absorbed through the arachnoid granulations May occur after hemorrhage or infection

Communicating Hydrocephalus

Results from compression of nerves, blood vessels, and muscle inside a closed space

Compartment Syndrome:

Divides bone fragments

Complete Fracture

Transient neuronal dysfunction resulting in instantaneous loss of awareness and responsiveness following head trauma

Concussion

Stages of Coma Recovery: Level 4

Confused, agitated

Stages of Coma Recovery: Level 6

Confused, appropriate

Stages of Coma Recovery: Level 5

Confused, inappropriate

Hallmarks of concussions

Confusion and amnesia

Deformity of foot and ankle Most common: Talipes equinovarus-foot pointed down and inward

Congenital Clubfoot

Usually results from maternal ingestion of antithyroid drugs during pregnancy Common when mother is taking a thyroid medication

Congenital Goiter

Hydrocephalus present at birth or develops soon after birth

Congenital Hydrocephalus

Deficient production of PTH Aplasia or hypoplasia of the gland

Congenital hypoparathyroidism

Therapeutic Management of Acute Spasmodic Laryngitis

Cool mist- Inhaled medications

bruising at a site far removed from the point of impact

Countercoup

Backward force provided by body weight Increase by elevating the foot of the bed

Countertraction

bruising at the point of impact

Coup injury

Too much cortisol, can be caused by given too much steriods A characteristic group of manifestations caused by excessive circulating free cortisol

Cushing Syndrome

Irregular respirations, Bradycardia, Hypertension

Cushing's Triad

Exocrine gland dysfunction that produces multisystem involvement Increased viscosity of mucus gland secretions results in mechanical obstruction Thick mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts

Cystic Fibrosis (CF)

vaccination of Pertussis (Whooping Cough)

DTaP

Nursing Management of a Shunt

Daily head circumference (HC) measurements Monitoring for increased ICP and malfunction

Clinical Manifestations of Juvenile Hypothyroidism:

Decelerated growth Myxedematous skin changes Constipation Sleepiness Mental decline

Pediatric Glasgow Coma Scale: Scoring 3

Deep coma or death (lowest possible score) Extremely decreased LOC

Bone is locally broken, usually into several fragments that are pushed inward

Depressed Fracture

Therapeutic Management of Croup Syndromes:

Dexamethasone or prednisolone Racemic epinephrin

Results from hyposecretion of antidiuretic hormone (ADH) Produces uncontrolled diuresis

Diabetes Insipidus (DI)

Characterized by a total or partial deficiency of the hormone insulin The most common endocrine disorder of childhood

Diabetes Mellitus (DM)

How does Pediatric Anatomy Increase Risk of Respiratory Infection:

Diameter of airways is smaller Distance between structures is shorter, allowing organisms to rapidly move down Short and open eustachian tubes

femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly; ligaments are elongated and taut

Discloation

Therapeutic Management of Developmental dysplasia of the hip (DDH): Age 6 to 24 months

Dislocation is unrecognized until the child begins to stand and walk; use traction and cast immobilization (spica)

Occur when force of stress on a ligament is sufficient to displace the normal position of opposing bone ends or bone ends to socket

Dislocations

Cerebral Palsy is often accompanied by

Disturbances of sensation, perception, communication, cognition, and social behavior Secondary musculoskeletal problems

Death from asphyxia while submerged

Drowning

Therapeutic Management: Epilepsy

Drug therapy Ketogenic diet Vagus nerve stimulation Surgical therapy

etiology of neural tube defects

Drug, chemical, or radiation exposure Maternal malnutrition; low folate levels Genetic mutation in folate pathways Pre-pregnancy maternal obesity Maternal diabetes mellitus, low maternal vitamin B12 status, maternal hyperthermia

Therapeutic management of meningitis

Drugs (antibiotics as soon as possible)

Most severe and most common of the muscular dystrophies in childhood Also known as pseudohypertrophic muscular dystrophy X-linked inheritance pattern; one third are fresh mutations

Duchenne Muscular Dystrophy (DMD)

4 D's of epiglottitis

Dysphagia Dysphonia Drooling Distress

difficulty in expressing words as symbols of communication

Dysphasia

difficulty producing sounds

Dysphonia

difficulty in the rhythm, accents, inflections

Dysprosody

Goal for treatment of Reyes syndrome

Early diagnosis; aggressive supportive therapy

Patient teaching for a child with type I diabetes include Medications can be given to increase insulin production by the pancreas Eat a snack prior to exercise Oral insulin can be given to avoid needlesticks Strict calorie counting is required

Eat a snack prior to exercise

Signs and Symptoms of Tonsillitis

Edema, erythema Difficulty swallowing/breathing Snoring White or yellow patches on tonsils

Diagnosis of Hyperparathyroidism

Elevated calcium and decreased phosphorus

Inflammation of the CNS secondary to direct invasion by a virus or postinfectious disease after a viral illness Can be gradual or onset

Encephalitis

Clinical Manifestations of Lymphocytic Thyroiditis

Enlarged thyroid Tracheal compression Hyperthyroidism possible

A child is having a seizure. The nurse's priority is to Ensure the siderails are padded Administer IV morphine Monitor blood pressure continuously during the seizure Place a device in the child's mouth to ensure the tongue is not swallowed

Ensure the siderails are padded

Head Injuries can result in

Epidural hematoma Subdural hematoma Cerebral edema Sequelae of traumatic brain injury

Definition is two or more unprovoked seizures

Epilepsy

Arises in marrow, especially in Femur, tibia, ulna, humerus Vertebrae, pelvis, scapula, ribs, skull

Ewing Sarcoma

Appearance of Cushing Syndrome

Excessive hair growth Moon face, red cheeks Weight gain Pendulous abdomen with red striae Poor wound healing Ecchymosis Short stature (cortisol inhibits action of GH)

Possible Behavioral Signs of CP

Excessive irritability No smiling by age 3 months Feeding difficulties Persistent tongue thrusting Frequent gagging or choking with feedings

Infectious agent invades bone following a penetrating wound, open fracture, contamination in surgery, or secondary extension from abscess or burn

Exogenous Osteomyelitis

Pediatric Glasgow Coma Scale: includes

Eye opening Verbal response Motor response

Seizure associated with febrile illness in absence of CNS infection

Febrile Seizures

Symptoms of Reye's syndrome

Fever Profuse vomiting Neurologic impairment Disordered hepatic function

Signs and Symptoms of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Fluid retention hypotonicity Anorexia nausea and vomiting Neurologic signs (irritability, personality changes, Stupor, Seizures)

Signs and Symptoms of Influenza

Flushed face myalgia lack of energy fever, chills congestion n/v

With or without impaired awareness; generalize

Focal seizures (formerly partial seizures)

Cause: small children like to put things in their mouth

Foreign Body Aspiration

the line of the break in a broken bone

Fracture Line

Treatment for Increased ICP:

Frequent VS and neurological assessments Stabilization of CABs and spine Treatment of shock

Provided by patient's contact with the bed

Frictional force

Stages of Coma Recovery: Level 2

Generalized response

Tonic-clonic; absence; atonic; myoclonic; tonic; clonic

Generalized seizures:

Nursing considerations of Cushing Syndrome

Give steroids in the morning to maintain diurnal pattern of cortisol secretion Withdrawal of cortisol can produce shock-like symptoms

adrenal cortex steroids and hormones

Glucocorticoids (cortisol, corticosterone) Mineralocorticoids (aldosterone) Sex steroids (androgens, estrogens, progestins)

Therapeutic Management of Lymphocytic Thyroiditis

Goiter may be transient, asymptomatic May resolve spontaneously within 1 to 2 years Oral TH often decreases the goiter significantly Surgery contraindicated for this disorder

Manifestations of Muscular Dystrophies

Gradual degeneration of the muscle fibers Progressive weakness Wasting of the skeletal muscles

Most common cause of hyperthyroidism

Graves disease

A fracture in which the compressed side of the bone bends and the tension side breaks causing an incomplete fracture is called Comminuted Greenstick Compound Complicated

Greenstick

Bone is angulated beyond limits of bending

Greenstick Fracture

Possible hormone replacements needed in Growth Hormone (GH) Deficiency

Growth Hormone Thyroid extract Cortisone Testosterone or estrogens and progesterone

Hypothalamus does not secrete enough GhRH to trigger the AP, causes an absence or low levels of GH

Growth Hormone (GH) Deficiency

Weakest point of the long bones is the cartilage growth plate (epiphyseal plate) Frequent site of damage during trauma May affect future bone growth

Growth Plate Injuries

Acute demyelinating polyneuropathy with progressive paralysis Also known as infectious polyneuritis

Guillain-Barre Syndrome

Types of Osteomyelitis

Hematogenous Exogenous

Preexisting infection spreads to bone Infective emboli travel to arteries in the bone metaphysis, causing abscess formation and bone destruction

Hematogenous Osteomyelitis

Information to know for test about Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

High ADH Fluid Overload Oliguria Low Sodium Low Serum Osmolarity Weight Gain Risk for seizures

When taking a Neurological exam, let the _________ dictate the exam

History

Clinical Manifestations of Croup Syndromes:

Hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress

Therapeutic management of Bacterial Tracheitis

Humidified oxygen Antipyretics Antibiotics

Treatment of Status Asthmaticus

Humidified oxygen Bronchodilators, anti-inflammatories, muscle relaxant

Excessive accumulation of cerebrospinal fluid (CSF) within the ventricular system of the brain. Imbalance in the production and absorption of cerebrospinal fluid in the ventricular system

Hydrocephalus

Cause appears to be an autoimmune response to TSH receptors, but there is no specific etiology

Hyperthyroidism

Thyroid secretes too much TH Enlarged thyroid gland and exophthalmos

Hyperthyroidism

Hormone Pathway of Puberty Development

Hypothalamus secretes GnRH to the Anterior Pituitary which stimulates release of FSH/LH to either Testes or Ovaries. In Testes this stimulates development of androgens; in Ovaries this stimulates estrogren/progesterone which leads to puberty development

Hormone pathway of Growth

Hypothalamus send GnRH to Anterior Pituitary which sends GH to the liver which creates IGF which stimulates growth

Hormone Pathway of Water regulation

Hypothalamus stimulates ADH to the posterior pituitary which stimulates ADH to kidneys which leas to water regulation

Hormonal Pathway of Adrenal Cortex

Hypothalamus stimulates release of CRH to the anterior pituitary which releases ACTH to the adrenal glands which stimulates release of Glucocorticoids, Mineral Corticoids, and Sex Steroids

Results of Submersion Injury/Drowning

Hypoxia Aspiration Hypothermia

Medications for Status Epilepticus

IV diazepam or lorazepam Fosphenytoin followed by phenobarbital

Developmental dysplasia of the hip (DDH) types

Idiopathic Teratologic

Increased pressure in the skull from either an increase in blood volume or CSF, or brain tissue edema, results in less arterial blood entering the high pressure area in the brain s&s severe headache, vomiting, papilledema

Increased Intracranial Pressure (ICP):

Low ADH

Increases urine production

Cause is possibly a disturbance of the central neurotransmitter regulator at a specific phase of brain development Head and neck flex forward; knees are drawn up (jackknife position) May or may not have loss of consciousness No postictal drowsiness Usually associated with some degree of cognitive impairment, cerebral anomalies, or a congenital metabolic defect

Infantile Spasma

Causes of Acquired Hydrocephalus

Infection Neoplasm Vascular (IVH) Trauma

Croup syndromes include

Infections of the epiglottis or larynx

Causes: most common is Epstein-Barr virus Appear after 30-50 day incubation period

Infectious Mononucleosis

Long term control of Asthma

Inhaled corticosteroids Anti-inflammatories Flovent, Pulmicort Leukotriene modifiers Inhibit leukotriene production Singulair

First, weakness of the arms and legs; later, generalized weakness Prominent pectus excavatum Movements are absent during relaxation and sleep

Intermediate Spinal Muscular Atrophy

Causes of Congenital Hydrocephalus

Intrauterine Infection Toxoplasmosis Cytomegalovirus Rubella

Etiology of Cerebral Palsy

Intrauterine hypoxia or asphyxia Maternal exposure or trauma Preterm or post-term birth (after 42 weeks) Postnatal Maternal Infection Preexisting prenatal brain abnormality

Manifestations of Diabetes Insipidus (DI) in infants

Irritability is relieved with feedings of water but not milk

Clinical Manifestations of Increased ICP in Infants:

Irritability; poor feeding High-pitched cry Fontanels are tense and bulging Cranial sutures are separated Eyes have the setting-sun sign Scalp veins are distended Increased occipitofrontal circumference

Signs and Symptoms of Septic Arthrits

Joint is warm, tender, painful, and swollen Fever, leukocytosis, and increased sedimentation rate Neisseria gonorrhoeae (sexually active)

Thyroid does not secrete enough TH

Juvenile Hypothyroidism

Also known as Kugelberg-Welander Syndrome Pattern of muscular weakness (proximal muscle weakness mainly in lower limbs)

Juvenile Spinal Muscular Atrophy

When glucose is unavailable for cellular metabolism, the body breaks down alternate sources of energy

Ketoacidosis

in the blood are strong acids that lower the serum pH and produce ketoacidosis

Ketones

Hyperventilation characteristic of metabolic acidosis, resulting from the respiratory system's attempt to eliminate excess CO2 by increased depth and rate

Kussmaul Respirations

Abnormally increased convex angulation in the curvature of the thoracic spine Most common form is postural

Kyphosis

An increase in ICP = a decrease in

LOC

Scoliosis spinal deformity in three planes

Lateral curvature Spinal rotation causing rib asymmetry Thoracic hypokyphosis

Self-limiting, idiopathic, occurs age 3 to 12 years, more common in males age 4 to 8 years, and Caucasian 10 times more than African American Avascular necrosis of the femoral head Femoral head does not receive nutrients it needs and will lack ability to be mobile. Usually effects one side of hip

Legg-Calve-Perthes Disease:

Single fracture line that starts at the point of maximum impact. Does not cross suture lines.

Linear Fractures

Stages of Coma Recovery: Level 3

Localized response

A single seizure is not generally treated with __________ like epilepsy

Long-term medications

Accentuation of the cervical or lumbar curvature beyond physiologic limits May be an idiopathic or secondary complication of trauma May occur with flexion contractures of the hip, congenital dislocated hip

Lordosis

Information to know for test about Diabetes Insipidus (DI)

Low ADH Fluid Deficit Polyuria High Sodium High Serum Osmolarity Dehydrations/weight loss Risk for Hypovolemic shock

Also known as Hashimoto disease or chronic autoimmune thyroiditis Most common cause of thyroid disease in children and adolescents Accounts for the largest percentage of cases of juvenile hypothyroidism

Lymphocytic Thyroiditis

Therapeutic Management of Acute Laryngotracheobronchitis (LTB)

Maintain airway High humidity, cool mist Inhaled medications: steroids for inflammation, vasoconstrictors to reduce edema

Patient teaching for a child with osteogenesis imperfecta includes Strict adherence to medication regimen cure the condition Lift by the ankles when diapering the child Limit child interaction with other children Maintain regular dental checkups

Maintain regular dental checkups

Therapeutic management of Status Epilepticus

Maintain the airway and monitor for apnea Safety of the patient Establish IV access Medications

Clinical Manifestations of Encephalitis: Onset or Gradual

Malaise and fever Headache and dizziness Stiff neck Nausea and vomiting Ataxia Speech difficulties

Genetic Causes of Congenital Hydrocephalus

Maldevelopment of the Aqueduct of Sylvius Spina Bifida Vein of Galen anomaly Malformed posterior fossa Arachnoid Cyst Dandy-Walker Syndrome

is applied to a body part by the hand placed distally to the fracture site

Manual Traction

Nursing Considerations for Cystic Fibrosis (CF)

Medication: bronchodilators, abx for infections Forced expiration Replacement of pancreatic enzymes High-protein, high-calorie diet Reduction of rectal prolapse

acute inflammation of the meninges and CSF secondary to viral or bacterial infection Abrupt onset of illness including fever, chills, HA, and vomiting (Viral may develop slower & include GI symp.)

Meningitis

Sac contains meninges and spinal fluid but no neural elements No neurologic deficits

Meningocele

Neurological Examination includes

Mental status Content of speech Facial movements- symmetric or asymmetric Eye movements- conjugate gaze, blinking, eyelid position Posture and involuntary movements Swallowing, breathing, and articulation

Endocrine system controls and regulates

Metabolic processes Energy production Growth Fluid and electrolyte balance Stress response

Most common congenital foot deformity Often results from abnormal position in the uterus; usually evident at birth Angulation at the tarsometatarsal joint Pigeon-toed gait Treatment is physical therapy and orthotics

Metatarsus Adductus:

Occipitofrontal circumference is more than 2 standard deviations (SDs) below the mean for age and sex

Microcephaly

Nursing Considerations of Tonsillitis

Minimize activities that precipitate bleeding Soft to liquid diet Ice collar Watch for continuous swallowing

Treatment of Tuberculosis

Minimum of 6 months of drug therapy Can force patients to take medications

Nursing Management of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Monitor I&O Observe for signs of fluid overload Seizure precautions

Treatment of choice for seizures in pediatric patients

Monotherapy

Clinical Manifestations of Duchenne Muscular Dystrophy (DMD):

Muscle weakness appears during 3-7 years Difficulty running, riding bicycle, climbing stairs Gower sign

Therapeutic management of Myelomeningocele

Musculoskeletal considerations Management of genitourinary function Bowel control

Nursing care management of Osteogenesis Imperfecta (OI)

Must let school know if OI is present. Will be suspicion of child abuse

Nursing considerations of Epiglottitis

Must protect airway! Only inspect throat if immediate intubation is possible Antibiotic therapy if cause is bacterial High probability of intubation Never use tongue depressor or take throat culture Hib vaccine

Sac contains meninges, spinal fluid, and nerves Neural tube fails to close Location and magnitude of the defect determine the nature and extent of impairment

Myelomeningocele

Sudden brief contractions of a muscle group May be single or repetitive No loss of consciousness Often occur with falling asleep May be a nonspecific symptom in many CNS disorders May be mistaken for an exaggerated startle reflex

Myoclonic Seizures

Examples of Upper Respiratory tract infections

Nasopharyngitis Influenza Pharyngitis Tonsillitis Otitis Media Infectious Mononucleosis

Survival for at least 24 hours after submersion

Near Drowning

Failure of neural tube closure

Neural Tube Defects

A child is found unresponsive at home and is brought to the emergency department. The child is noted to have posturing on physical examination. This is an indication of involvement of which system? Neurological Endocrine Musculoskeletal Respiratory

Neurological

Nursing Considerations: Foreign Body Aspiration

Never do blind sweep Teach prevention: food shape, contraindicated foods, toys

Stages of Coma Recovery: Level 1

No response

Causative agents are principally viruses Arbovirus, herpes simplex virus, cytomegalovirus, human immunodeficiency virus, and adenovirus Diagnosis is based upon CSF findings Onset is abrupt or gradual Manifestations include headache, fever, malaise Treatment is primarily symptomatic

Nonbacterial Meningitis (Aseptic Meningitis)

Clinical manifestations of Growth Hormone (GH) Deficiency:

Normal growth in the first year then a slowed growth curve below the third percentile Obesity due to stunted height Crowded/malpositioned teeth

Upper respiratory tract includes

Nose, pharynx, larynx, upper trachea

Mental Status Examination

Note general appearance and behavior Stream of talk Mood and affect Content of thought Intellectual capacity Sensorium

Subluxation or partial dislocation of the radial head Ex: adult tugging on an uncooperative child or by swinging the child by the arms during play.

Nursemaid's elbow

Flow of CSF out of the ventricular system is impaired. May occur in aqueductal stenosis or tumors.

Obstructive Hydrocephalus

Arouses with stimulation

Obtundation

Signs and Symptoms of Acute Spasmodic Laryngitis

Occurs mostly at night (also called midnight croup) Child wakes up with barking cough, is well the next day

Signs and symptoms of Pharyngitis

Onset often abrupt Pharyngitis, headache, fever, and abdominal pain. Tonsils & pharynx may be inflamed with exudate Tongue appear edematous and red (strawberry tongue) Fine sandpaper rash on trunk, axillae, elbow, and groin (scarlet fever/group A Strep) Uvula edematous and red Anterior cervical lymphadenopathy

Communication between skull and scalp

Open Fracture

Potential Sites of Rhabdomyosarcoma:

Orbit Nasopharynx Paranasal sinuses Middle ear Retroperitoneal area Perineum

Physiological effects of immobilization on the cardiovascular system include Skin breakdown Orthostatic hypotension Urinary stasis Negative nitrogen balance

Orthostatic hypotension

A group of heterogeneous inherited disorders of connective tissue Characterized by excessive fragility (bone fractures) and bone defects (deformities)

Osteogenesis Imperfecta (OI)

Inflammation and infection of bony tissue Signs and symptoms begin abruptly; resemble the symptoms of arthritis and leukemia

Osteomyelitis

Most primary tumor sites are in the metaphyses (thickest part of bone) of the long bones, especially the legs

Osteosarcoma

Main types of Bone tumors

Osteosarcoma and Ewing sarcoma

Cause: growth of pathogen in the middle ear. Usually preceded by a viral respiratory infection (ie. RSV and influenza)

Otitis Media

fluid in middle ear space, feeling of fullness in ear

Otitis Media with Effusion

Manifestations of Acromegaly

Overgrowth of the head, lips, nose, tongue, jaw, and paranasal and mastoid sinuses Separation and malocclusion of the teeth Disproportion of the face to cerebral division of the skull Increased facial hair Thickened, deeply creased skin

6 Ps

Pain Pulse Pallor Paresthesia Paralysis Pressure

4 pea size glands on the underside of the thyroid help control calcium levels in the blood

Parathyroid Glands

Acquired Juvenile Hypothyroidism:

Partial or complete thyroidectomy for CA or thyrotoxicosis Following radiation for Hodgkin or other malignancy

Therapeutic Management of Developmental dysplasia of the hip (DDH): Newborn to age 6 months

Pavlik harness for abduction of the hip

Objective measure of child's LOC by assigning numerical values to the presence of developmentally appropriate clues (eye-opening, verbal response, and motor response).

Pediatric Glasgow Coma Scale

Permanent loss cerebral cortex function

Persistent Vegetative State

Possible Motor Signs of Cerebral Palsy (CP):

Persistent primitive reflexes Poor head control after age 3 months Stiff or rigid limbs Arching back; pushing away Floppy tone Unable to sit without support at age 8 months Clenched fists after age 3 months

Clinical manifestations of infant developmental hip dysplasia include all of the following EXCEPT Positive Barlow test Unequal gluteal folds Petechia on the affected extremity Shortened limb on the affected side

Petechia on the affected extremity

Adrenal tumor that secretes catecholamines (epinephrine, norepinephrine and dopamine)

Pheochromocytoma

Anterior Pituitary secretes too much GH which causes high levels of GH

Pituitary Hyperfunction

Excess GH before epiphyseal closure

Pituitary Hyperfunction

Bone is bent but not broken Child's flexible bone can be bent 45 degrees or more before breaking

Plastic deformation fracture

_______________ treatment may be used if seizures cannot be controlled with one drug

Polypharmacologic

Manifestations of Diabetes Insipidus (DI)

Polyuria and polydipsia Dehydration

Causes of Clubfoot

Positional Syndromic Congenital/idiopathic

The thigh is adducted and light pressure is applied to see if the femoral head can be felt to slip posteriorly out of the acetabulum

Positive Barlow test

Abducting the thighs and placing anterior pressure at the hip to see if the femoral head slips forward into the acetabulum

Positive Ortolani test

Clinical Manifestations of Developmental dysplasia of the hip (DDH): Infant

Positive Ortolani test Positive Barlow test

The principal cause of Diabetes Insipidus (DI) is

Posterior Pituitary

Hypothalamus begins secreting GnRH too early

Precocious Puberty

Nursing Interventions for treatment of Rabies

Prepare the child and family for multiple vaccine injections to complete therapy Vaccine consists of four doses IM days 0, 3, 7, 14 Can be stopped if animal remains healthy throughout 10 day observation period

Four requirements for developing tetanus:

Presence of tetanus spores or vegetative forms of the bacillus Injury to tissues Wound conditions encourage multiplication of the organism Susceptible host

Migraine, tension-type, trigeminal autonomic cephalalgia

Primary headache:

Clinical manifestations of Tetanus

Progressive stiffness, tenderness of neck and jaw muscles Progressive, opisthotonos, difficulty swallowing, laryngospasm, and tetany of respiratory muscles Rigidity of abdominal and limb muscles

Nursing Care Management of Duchenne Muscular Dystrophy (DMD):

Promote mobility, independence, and growth Prevent complications and isolation

Therapeutic Management of Limb Deficiencies:

Prosthetics as early as possible to maximize exploration and development of infant

Care for the child in a cast includes all of the following EXCEPT Providing a medically approved scratching tool to reduce infection risk Keeping the cast dry Monitoring pain and pulses Soaking the affected limb in warm water after cast removal

Providing a medically approved scratching tool to reduce infection risk

Production of PTH is increased, but end organs are unresponsive to the hormone Thought to be inherited as an X-linked dominant trait with variable expressivity

Pseudohypoparathyroidism

Stages of Coma Recovery: Level 8

Purposeful

Treatment for a soft tissue injury includes TOBY RICE RACE PASS

RICE

______ the most frequent cause of hospitalization in children <1 year

RSV

Nursing Considerations of Bronchiolitis and RSV

RSV requires droplet precautions Education Prophylaxis- Synagis-given monthly to high-risk patients November-March

An acute infection of the CNS Caused by a virus and transmitted by the saliva of an infected animal Virus multiplies in muscles; the disease is fatal if untreated

Rabies

Diagnosis of Pituitary Hyperfunction and Acromegaly

Radiologic studies-looking for cause, usually a pituitary adenoma (tumor)

Physical Findings of Hydrocephalus in the Neonate:

Rapidly increasing head circumference Full or bulging anterior fontanelle Wide suture lines May have palpable fluid

Treatment of Cushing Syndrome and Nursing Considerations:

Replacement of GH, ADH, TH, gonadotropins, and steroids

Therapeutic Management of Acute Adrenocortical Insufficiency:

Replacement of cortisol Fluid replacement IV hydrocortisone (solu-cortef)

Therapeutic management of Addison Disease

Replacement of glucocorticoids (cortisol) and mineralocorticoids (aldosterone). Some children able to control with only oral supplements of cortisol + liberal intake of salt.

When a child is experiencing a cardiac event, ___________ will go first which will cause _____________

Respiratory Cardiac Event (opposite from adults)

inability to maintain adequate gas exchange

Respiratory Failure

complete cessation of respiration

Respiratory arrest

Children exposed to smoke have increased

Respiratory illnesses. Acute otitis media, otitis media with effusion Asthma SIDS

Therapeutic Management of Soft Tissue Injuries: RICE and ICES

Rest Ice Compression Elevation Ice Compression Evaluation Support

A disorder defined as toxic encephalopathy associated with other characteristic organ involvements

Reye Syndrome (RS)

Malignant neoplasm originating from undifferentiated mesenchymal cells in muscle, tendon, bursa, and fascia or in fibrous, connective, lymphatic, or vascular tissue

Rhabdomyosarcoma

Immobilizes hip and knee in flexed position Two lines of pull

Russell Traction

Skin Indicators of Spina Bifida Occulta

Sacral dimple Sacral angioma or port wine nevus Sacral tufts of dark hair Sacral lipoma

Infectious Mononucleosis transmitted through

Saliva

Most common spinal deformity Complex spinal deformity in three planes: Lateral curvature, Spinal rotation causing rib asymmetry, and Thoracic hypokyphosis

Scoliosis

Malfunctions of the brain's electrical system Most common neurologic dysfunctionin children

Seizure Disorders

Etiology of Febrile Seizures

Seizure occurs with temperatures rapidly increases higher than 38.8°C (101.8°F)

Transient occurrence of signs symptoms due to abnormal excessive, synchronous neuronal brain activity

Seizures

are an indispensable characteristic of epilepsy

Seizures

Bacterial infection of the joint May result from extension of soft tissue infection May involve any joint but is most common in the hip, knee, or shoulder Usually involves only one joint

Septic Arthritis

Treatment for congenital clubfoot includes Amputation Botox injections Serial casting Traction

Serial casting

A system to divert or shunt CSF out of the skull in an effort to stabilize the pressure within the head. A silastic tube is placed into the ventricle and connected to a reservoir on the surface of the skull. Another silastic tube is connected to the reservoir, and then threaded under the skin to the peritoneum, gall bladder, or superior vena cava.

Shunt

Also known as congenital limb or reduction malformations Most are primary defects of development May have prenatal destruction of the limb from constriction of the amniotic band

Skeletal Limb Deficiency

is absence of an entire extremity

Skeletal Limb Deficiency: Amelia

is partial absence of an extremity

Skeletal Limb Deficiency: Meromelia

is deficiency of the long bones with relatively good development of the hands and feet attached at or near the shoulder or hip (seal limbs)

Skeletal Limb Deficiency: Phocomelia

is amniotic band syndrome (full or partial amputation of a limb in utero)

Skeletal Limb Deficiency: Prenatal

Tubercular infection of bones and joints caused by lymphohematogenous Common sites are the fingers and toes (tubercular dactylitis); spinal erosion (Pott disease)

Skeletal Tuberculosis (TB)

Diagnosis of Growth Hormone (GH) Deficiency

Skeletal survey in children younger than 3 years of age

is applied directly to the skeletal structure by a pin, wire, or tongs inserted into or through the diameter of the bone distal to the fracture

Skeletal traction

involves pulling mechanisms that are attached to the skin with adhesive material or an elastic bandage

Skin Traction

Spontaneous displacement of the femoral head 10-16 y.o. obese children

Slipped Capital Femoral Epiphysis

uncontrolled contractions of skeletal muscles, causing stiff and awkward movements (resembles spasm)

Spastic

Motor Abnormalities commonly seen in Cerebral Palsy

Spastic, dyskinetic, ataxic, mixed

severe damage to the spinal cord that impairs the function of the spinal cord

Spinal Cord Injuries

Also known as Werdnig-Hoffmann diseaseMost common paralytic form of floppy infant syndrome (congenital hypotonia)

Spinal Muscular Atrophy Type 1

Trauma to a joint from a ligament partially or completely torn or stretched by force - may hear "pop" or "snap"

Sprains

How does Cystic Fibrosis (CF) affect the Respiratory system

Stagnation of mucus and bacterial colonization result in destruction of lung tissue Tenacious secretions are difficult to expectorate, obstruct bronchi and bronchioles Decreased O2-CO2 exchange Results in hypoxia, hypercapnia, acidosis

THIS IS A MEDICAL EMERGENCY! Continued respiratory distress despite vigorous therapeutic measures Usually precipitated by an infection

Status Asthmaticus

seizure(s) lasting more than 30 minutes or a series of seizures in which the patient does not regain a premorbid level of consciousness

Status Epilepticus

Impaired digestion and absorption of fat

Steatorrhea

Posterior Pituitary _________ hormones and then _________

Stores hormones Sends it out the the organ

Microscopic tears to a musculotendinous unit Swollen and painful to the touch

Strains

Responsive to vigorous & repeated stimulation

Stupor

Bleeding between the arachnoid mater and the dura mater

Subdural hematoma

incomplete dislocation of the hip

Subluxation

Major cause of unintentional injury/death in children older than 1 year Death occurs from asphyxia while the child is submerged Can occur in even a small quantity of water (e.g., a pail of water, toilet, or bathtub)

Submersion Injury

CP Treatment:

Surgical Braces and supportive devices Medications

Therapeutic management of Pheochromocytoma

Surgical removal of tumor(s) May require bilateral adrenalectomy and lifelong glucocorticoid and mineralocorticoid therapy

Therapeutic Management of Hyperparathyroidism

Surgical removal or treatment of underlying cause

Therapeutic Management of Pituitary Hyperfunction and Acromegaly

Surgical treatment to remove the tumor Irradiation and radioactive implants Hormone replacement therapy after surgery in some cases

Diagnosis of Cystic Fibrosis (CF)

Sweat chloride test Chest X-ray Stool fat and

Anti-viral drugs used for Influenza

Symmetrel, Ramantadine, Zanamivir, Tamiflu

Produced by hypersecretion of the posterior pituitary (increased ADH)

Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Chronic multisystem autoimmune disease of connective tissue and blood vessels characterized by inflammation

Systemic Lupus Erthematosus (SLE):

Hyperthyroidism is diagnosed based on increased levels of which hormone(s)? T3, T4 ADH LH, FSH TSH

T3, T4

in Addison Disease, patients can be overly stress due to

Taking cortisol increases sugar and causes stress

Characterized by muscle rigidity involving the masseter and neck muscles

Tetanus

Abnormal adhesion to a bony or fixed structure Puts traction on the cord

Tethered spinal cord

A child with hydrocephalus has a cerebral shunt. Which of the following signs are indicative of a shunt malfunction? The parents report that the child is "not acting like himself" Dependent edema Continuous sneezing Bruising on the trunk

The parents report that the child is "not acting like himself"

The principal cause of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is

The poster Pituitary

How does Cystic Fibrosis (CF) affect the GI tract

Thick secretions block ducts Food does not get digestive as quickly Decrease in bile production Prevents pancreatic enzymes from reaching duodenum steatorrhea azotorrhea Impaired salivation

Therapeutic Management of Rabies:

Thorough cleansing of the wound Administer rabies vaccine Administer rabies immunoglobulin Need to know if dog was familiar to unfamiliar

regulates the basal metabolic rate (BMR)

Thyroid Hormone

May occur from sudden release of thyroid hormones May be precipitated by infection, surgery, or discontinuation of antithyroid therapy Also called Thyroid Storm

Thyrotoxicosis

Thyroid hormones include

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

Therapeutic Management of Osteosarcoma:

Traditional approach: radical surgical resection or amputation of affected area Limb-salvage procedures: resection of bone with prosthetic replacement of affected area Chemotherapy accompanying surgical treatment

Injuries are the leading cause of death in children >1 year of age

Trauma

Soft tissue injury includes injuries to muscles, ligaments, and tendons

Traumatic Injury

Inflammation following TB infection => from the lungs migrates to neural form Prevalent in immuno-compromised ppl very RARE in non-immunocompromised ppl

Tuberculosis meningitis

Causes of increased intracranial pressure:

Tumors or space-occupying lesion Fluid accumulation Bleeding Edema of cerebral tissues

believed to occur because of an autoimmune disease, arising when a person with a genetic predisposition is exposed to a precipitating event such as a viral infection

Type 1 DM

occurs in conjunction with obesity and sedentary lifestyle

Type 2 DM

3 Categories of Respiratory Illness:

Upper respiratory tract infections Croup syndromes Lower Respiratory tract illness

In Ketoacidosis, Ketones are released and excess ketones are eliminated in the

Urine (Ketouria) Lungs (Acetone Breath)

(antidiuretic hormone) hormone released by posterior pituitary; raises blood pressure and enables kidneys to conserve water

Vasopressin

Psychologic Effects of Immobilization: Cardiovascular system

Venous stasis (DVT, pulmonary emboli) Dependent edema

A reservoir that is punctured to remove CSE from the brain. Can be placed if a child is too small to receive a shunt when diagnosed with Hydrocephalus

Ventricular reservoir

Manifestations of Pituitary Hyperfunction

Vertical growth with rapid and increased muscle development Weight is generally in proportion to height

Etiology of Reye Syndrome

Viruses, drugs, toxins, or genetic Potential association between aspirin and varicella/influenza in kids Related to salicylates

Nursing Considerations of Pharyngitis

Warm saline gargles Cool liquids or ice chips Children considered infectious to others up to 24 hours after initiation of antibiotics. Discard toothbrushes Stay away from milk based products Can go back to school after 24 hours of no fever (without Tylenol)

Clinical Manifestations of Asthma:

Wheezing Coughing Symptoms associated with a trigger Diagnosis of exclusion

When to Discontinue Pharmacologic Management for Children with Seizures

When the child has been seizure free for 2 years When the EEG is normal Avoid during puberty (abrupt growth) Recurrence of seizures is possible within the first year following cessation of treatment

CNS Symptoms of Botulism appear

abruptly 12 to 36 hours after ingestion

Definitive Diagnosis of Growth Hormone (GH) Deficiency is based on the

absence of or subnormal reserves of pituitary GH

a head injury typical of a car crash in which the head comes to a sudden stop, but the brain continues to move back and forth inside the skull, resulting in bruising to the brain

acceleration-deceleration (shearing) injuries

Excess GH after epiphyseal closure

acromegaly

Cause of Cushing Syndrome: Latogenic

administration of excessive steroids

Infectious Mononucleosis most common in

adolescents

Cushing Syndrome may be caused by

adrenal tumor excessive or prolonged steroid therapy Abrupt withdrawal of steroids

Onset of Atonic Seizures

age 2 to 5 years

When does Lymphocytic Thyroiditis occur

age 6 years

Onset of Febrile Seizures

ages 6 and 60 months Rare after age 5 years

Nursing Intervention for cervical traction

always know where the key to unlock the device is; In case of CPR

Types of Neural Tube Defects

anencephaly and spina bifida

When assessing a child for headaches,

assess history and pattern of headaches (Acute, acute recurrent, chronic progressive, chronic nonprogressive)

An irregular , unpredictable respiratory rate and tidal volume.

ataxic

Impaired digestion and absorption of protein

azotorrhea

Associated damage to ________________ in sprains

blood vessels, muscles, tendons, and nerves

TH (T3, T4) regulates

body temperature, Heart Rate, Metabolism

Treatment of Ewing Sarcoma:

chemo, surgery, radiation

bruises on ________; sign of child abuse

core

Signs and Symptoms of Bronchitis

cough that worsens at night Starts out non-productive then becomes productive after 2-3 days

Signs and Symptoms of Aspiration Pneumonia:

cough, fever, foul smelling sputum, decreased oxygenation

Beginning symptoms of Bronchiolitis and RSV:

coughing, sneezing ear/eye drainage, rhinorrhea, pharyngitis, fever

In Diabetes Insipidus (DI), the posterior pituitary...

does not secrete enough ADH

difficulty articulating

dysarthria

inability to control muscle movement

dyskinetic

With a deficiency of insulin, glucose is unable to

enter a cell and remains in the blood, causing hyperglycemia

First sign of Diabetes Insipidus (DI)

enuresis accompanied by insatiable thirst

Bleeding between the dura mater and the skull

epidural hematoma

Children with febrile seizures do not have

epilepsy or neurologic damage

what causes black and blue discoloration in contusion

escape of blood into the tissue (ecchymosis)

Cause of Cushing Syndrome: Pituitary

excess of adrenocorticotropic hormone (ACTH)

Cause of Cushing Syndrome: Ectopic

extra pituitary neoplasm

Most common types of seizures in children

febrile seizures

Systemic Lupus Erthematosus (SLE) is most common in

females ages 10-19

Initial Presentation symptoms of Tuberculosis

fever, malaise, weight loss, progressive cough, pain/tightness in chest

onset of infantile spasms

first 6 to 8 months of life

Prevention of neural tube defects

folic acid

Precocious Puberty occurs most frequently in ______ between ages _______

girls 9-11

Cells break down protein for conversion to glucose by the liver

glucogenesis

When serum glucose levels exceed the renal threshold, glucose spills into the urine

glycosuria

Hypertrophy of the thyroid gland

goiter

Intracranial contents are damaged in head trauma injuries because the force is

greater than the amount of support provided by the skull

How does Age Factor into Pediatric Respiratory Illness: toddlers and preschoolers

have a high rate of viral infections

Etiologic factors of Acute Adrenocortical Insufficiency:

hemorrhage into the gland from trauma fulminating infections abrupt withdrawal of exogenous cortisone failure to increase cortisone during times of stress

Possible triggers for Systemic Lupus Erthematosus (SLE)

hormonal imbalance immune disorders environmental exposure to drugs infection stress chemical agents

Therapeutic management of adrenocortical insufficiency includes fluid restriction ativan hydrocortisone estrogen

hydrocortisone

Common factor of Hyperparathyroidism

hypercalcemia

Cause of Cushing Syndrome: Adrenal

hypersecretion of glucocorticoids

The Anterior and Posterior Pituitary Glands are controlled by the

hypothalamus

in Growth Hormone (GH) Deficiency, primary site of dysfunction appears in the

hypothalamus

Hormone pathway for Thyroid Production

hypothalamus stimulates release of TRH to the anterior Pituitary which releases TSH to the thyroid where TH (T3, T4) and Calcitonin are released

Complications of Trauma

hypoxia, edema, increased ICP

Nursing care management of Osteogenesis Imperfecta (OI): Diapering

includes two nurses, lift baby up from butt and then place diaper under

As a child grows, we need to __________ if they have seizures

increase dose of medications

___________ immunity develops with age

increased

Progressive symptoms of Tuberculosis

increased RR, diminished breath sounds, fever, anemia, weight loss, hemoptysis

Progressive symptoms of Bronchiolitis and RSV

increased coughing/wheezing, tachypnea and cyanosis

Diagnosis of Hyperthyroidism

increased levels of T4 and T3

How does Age Factor into Pediatric Respiratory Illness: 3-6 months

infection rate increases

Glucocorticoids control

inflammation and cellular use of sugar/fat

signs and symptoms of Acute Laryngotracheobronchitis (LTB)

inspiratory stridor, barking or seal-like cough Suprasternal retractions respiratory distress and hypoxia (can lead to respiratory failure and death)

Signs and Symptoms of Hyperthyroidism

intolerance to heat fine straight hair bulging eyes enlarged thyroid tachycardia increase systolic BP breast enlargement weight loss muscle wasting localized edema menstrual changes (Amenorrhea) increase diarrhea tremors finger clubbing

Severe cases of pneumonia result in

intubation or chest tube

Goal range of Blood sugar in Type 1 DM

less than 126 mg/dl

Slows prepubertal growth to normal rates Treatment is discontinued at the age at which normal pubertal changes would resume

leuprolide acetate (Lupron Depot)

diagnosis of reyes syndrome

liver biopsy

consist of anterior horn cells and spinal and peripheral nerves

lower motor neurons

Diagnosis of meningitis

lumbar puncture

Function of PTH is to

maintain serum calcium levels by working in conjunction with calcitonin

infantile spasms are more common in

males

Nursing Management for Thyroid enlargement at birth

may compromise newborn's artery

Therapeutic Management: Acute Respiratory Distress Syndrome (ARDS)

mechanical ventilation

The spinal cord extends from the _____ to _____.

medulla oblongata to L1-L2

Fracture on the underside of the skull can tear the _________ artery, causing severe _____________

meningeal hemorrhage with hypovolemic hypotension

two types of spina bifida cystica

meningocele and myelomeningocele

any malformation of spinal canal or cord

myelodysplasia

The neural tube defect in which there is a saclike protrusion containing spinal fluid and neural elements is meningocele spina bifida occulta myelomeningocele anencephaly

myelomeningocele

Where are bruises common on children

on the head

Excess GH before closure of epiphyseal shafts results in

overgrowth of the long bones Reach heights of 8 feet or more

Patients die from respiratory disease because they cannot

perfuse the oxygen being given

Signs and symptoms of SIADH include all of the following except fluid volume overload low serum osmolality weight gain polyuria

polyuria

3 P's of Diabetes

polyuria, polydipsia, polyphagia

At 8 weeks, the _________ fontanel closes

posterior

Patient teaching for a child with precocious puberty includes breast reductions can be performed prior to the age of puberty to avoid embarrassment treatment will last the entirety of the lifespan there is no treatment for precocious puberty preparing the child for regular injections

preparing the child for regular injections

Epiglottitis common in what ages

preschool aged

Clinical manifestations of spinal muscular atrophy include progressive wasting of musculature dairy intolerance hydrocephalus seizures

progressive wasting of musculature

Infected Rabies wild animals are most commonly

raccoons, skunks, foxes, and bats

Treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

restrict fluids ADH antagonizing Medications

Cranial sutures include

saggital, coronal, metopic, lambdoid

Mineral Corticoids regulate

salt/water

In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), the posterior pituitary...

secrete too much ADH

Goal for therapy of Graves disease is to

slow down rate of hormone secretion

Believed to regulate insulin and glucagon

somatostatin

Failure of the osseous spine to close

spina bifida

Visible defect with external saclike protrusion

spina bifida cystica

Therapeutic management of Bronchitis

symptomatic treatment (antipyretics, analgesics, humidity, cough suppressants)

Patient teaching for a child with spina bifida includes sleep only in the supine position there is an increased risk of allergies to bananas bladder continence is restored with age graduation from high school is unlikely

there is an increased risk of allergies to bananas

If a child is experiencing an issue with their growth hormone...

they are usually experiencing an issue with another hormone

Meconium characteristics if Cystic Fibrosis (CF) is present

thick mucus in stool making it hard for them to pass

Cystic Fibrosis (CF) creates _________ across all organs

thick, full mucus

Diagnosis of Pharyngitis

throat culture

Diagnosis of Tonsillitis

throat culture

Delay in fontanel closure common in pituitary hyperfunction due to

to enlargement of the head circumference

Arises because of insulin resistance

type 2 diabetes

In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), the kidneys are

unable to reabsorb water

Motor signs of cerebral palsy include all of the following EXCEPT persistent primitive reflexes floppy tone unable to sit without support at 4 months stiff limbs

unable to sit without support at 4 months

Treatment of Diabetes Insipidus (DI)

vasopressin or DDAVP

Temporary Treatments of Hydrocephalus:

ventricular punctures to directly access the ventricles through the anterior fontanelle and remove CSF

Bacterial Tracheitis common at what ages

5-7

Precocious Puberty defined as before age _ in African-American girls

6

Bone Healing and Remodeling: later childhood

6-8 weeks

Interventions for the Unconscious Child:

ABC's Stabilize the spine Treat for shock if applicable Reduce ICP Monitor temperature

Croup Syndromes Includes:

Acute epiglottitis Acute Laryngotracheobronchitis Acute spasmodic laryngitis Bacterial Tracheitis

Primary disease of Hyperparathyroidism

Adenoma of the gland

Quick relief of Asthma

Albuterol Bronchodilator Can be given via metered dose inhaler or nebulizer ProAir, Xopenex, DuoNeb

Cause: food, secretions, liquids or other materials enter the lungs causing inflammation

Aspiration Pneumonia

Chronic inflammatory disorder of airways

Asthma

Infants: Reflexes stepping disappears

Before walking

Compression of the porous bone Appears as raised or bulging projection at fracture site

Buckle Fracture

Etiology of Hydrocephalus

Chiari I and II malformations

Complications of Duchenne Muscular Dystrophy (DMD):

Contractures scoliosis disuse atrophy infections obesity cardiopulmonary complications

Goals of medication and therapy of Epilepsy

Control seizures Reduce the frequency and severity of seizures Discover and correct the cause Help the child live as normally as possible Promote normal growth and development

Contusion (bruise) is damage to soft tissue, subcutaneous tissue, and muscle

Contusions

Diagnostic Evaluation of Duchenne Muscular Dystrophy (DMD):

DNA analysis or biopsy

Purpose of Traction is to

Fatigue muscles to allow bone alignment Reduce muscle spasm Align bone Immobilize site Prevent or improve deformity

Signs and Symptoms of Infectious Mononucleosis

General symptoms of infection: fever, aches, sore throat, fatigue

Involves both hemispheres of the brain from onset

Generalized Seizures

Clinical Manifestations of Increased ICP in Children:

Headache Vomiting Motor weakness Diplopia and blurred vision Irritability Sleep alterations Personality changes Headache Seizures Lethargy/Sleepiness

Thyroid hormone (TH) replacement is necessary for the treatment of

Hypothyroidism

Cause of Cushing Syndrome: Food-dependent

Inappropriate adrenal response to the secretion of polypeptide

Clinical symptoms of Acute Adrenocortical Insufficiency:

Increased irritability, headache, abdominal pain, weakness, nausea & vomiting, diarrhea

Inflammation can affect the meninges (meningitis) or brain (encephalitis)

Intracranial Infections

Chronic inflammation of the synovium with joint effusion, destruction of cartilage, and ankylosis of the joints as the disease progresses

Juvenile Idiopathic Arthritis (JIA):

Lower Respiratory tract includes

Lower trachea, bronchi and bronchioles, alveoli

Febrile Seizures more common in

Males

Nursing considerations of Bronchitis

May become chronic Cough suppressants can interfere with clearance of secretions Adolescents with chronic bronchitis should be screened for tobacco or marijuana use

Therapeutic Management and Nursing Care of Osteomyelitis:

May have subacute presentation with a walled-off abscess rather than spreading infection Prompt, vigorous intravenous (IV) antibiotics for an extended period (3 to 4 weeks or up to several months)

first sign of Cystic Fibrosis (CF)

Meconium Ileus

Top five common childhood conditions

Migraine Headaches

Most common etiology of Spinal Cord Injuries

Motor vehicle collision is most common

Local onset and involve a relatively small location in the brain

Partial Seizures

Ways to reduce ICP

Provide quiet, dimly lit environment HOB at 15-30 degrees, ensure head is midline Correct if hyperthermia with antipyretics & cooling blanket Medicate for pain Monitor I & O closely ventricular drain

Sex steroids regulare

Sex differentiation, secondary sex characteristics, and sex drive

Usually lumbosacral, at L5 to S1

Spina Bifida Occulta

Forward force produced by attaching weight to a distal bone fragment Adjust by adding or subtracting weights

Traction

Types of Fracture lines

Transverse Oblique Spiral

Characterized by autoimmune destruction of beta cells, usually leading to an absolute insulin deficiency

Type 1 Diabetes

Pediatric Glasgow Coma Scale: Scoring 15

Unaltered LOC (highest possible score)

depressed cerebral function; inability to respond to sensory stimuli

Unconsciousness

West syndrome; Lennox-Gastaut Syndrome

Unknown onset epileptic seizures:

from cerebral centers to cells in spinal column

Upper motor neurons

Prognosis of meningitis

Variable hydrocephalus & hearing loss

Etiology of Addison Disease

a lesion of adrenal gland idiopathic

At 18 months, the _________ fontanel closes

anterior

two lobes of the pituitary gland

anterior and posterior

Therapeutic Management of Pharyngitis

antibiotics of bacterial

Treatment for CP includes which of the following antispasmodics and antiepileptics home schooling cp is untreatable bed rest

antispasmodics and antiepileptics

Signs and Symptoms of Bacterial Tracheitis

barking cough inflammation of airway purulent secretions fever respiratory

______ is usually caused by RSV

bronchiolitis

Infants: Reflexes Babinski's disappears

by 24 months

Pheochromocytoma increases production of

catecholamines (fight or flight hormones)

Adrenal medulla secretes

catecholamines epinephrine and norepinephrine

Hydrocephalus types

communicating and non-communicating obstructive and non-obstructive

Congenital Juvenile Hypothyroidism:

congenital hypoplastic thyroid gland

Anterior Pituitary ___________ hormones and then ____________

creates a hormone sends it out to the organ

Signs and Symptoms of Otitis Media

crying fussiness restlessness irritability rolling head from side to side pulling on ears loss of appetite

High ADH

decreases urine production

Diagnosis of Foreign Body Aspiration

endoscopy, bronchoscopy

Bacterial Tracheitis = high risk for

intubation

In Myelomeningocele, there is a high risk for

latex allergy or hypersensitivity

Main treatment of Precocious Puberty

leuprolide acetate (Lupron Depot)

How does Age Factor into Pediatric Respiratory Illness: >3 months

maternal antibodies offer protection

Largest group of muscular diseases in children

muscular dystrophies

Developmental dysplasia of the hip (DDH) type Terotologic is a defect in the

neuromuscular

two types of spina bifida

occulta and cystica

Parathyroid glands secrete

parathyroid hormone (PTH)

Inflammation of pulmonary parenchyma

pneumonia

Classifications of headaches

primary and secondary

Onset of Epiglottitis

rapid

How does Age Factor into Pediatric Respiratory Illness: 5+

see an increase in GABHS and Mycoplasma pneumoniae infections

Caclitonin regulates

serum calcium

treatment of hydrocephalus

shunt

Number one cause of Ear infections

smoke exposure

Pheochromocytoma signs and symptoms

tachycardia constipation headache increased metabolism hyperglycemia nervousness

Signs and Symptoms of Acute Respiratory Distress Syndrome (ARDS):

tachypnea, elevated RR, cyanosis, hypoxia within 1 week of injury, surgery, or illness

Severe symptoms of Bronchiolitis and RSV

tachypnea, listlessness, apnea, diminished breath sounds

Treatment for diabetes insipidus includes insulin vasopressin diuretics thyroxine

vasopressin

A parent calls the pediatrician's office after the child is bitten by a dog. What question is a priority for the nurse to ask? "Has the child stooled since the bite?" "How many children are in the home?" "Is the child in school?" "Do you know the dog?"

"Do you know the dog?"

Deep tendon reflexes Scale

0- No response 1- Low Normal response 2- Normal response 3- Brisk 4- Hyperreflexive with clonus

MUSCLE STRENGTH SCALE

0- Paralysis 1-2 Severe weakness 3- Moderate weakness 4- Minimal weakness 5- Normal

Infants: Reflexes moro disappears

1-4 months

Infants: Reflexes Sucking disappears

10-12 months

Peak incidence of Diabetes Mellitus (DM):

10-15 years or early adolescents

How many types of Influenza viruses are there

3

Infants: Reflexes Palmar Grasps disappears

3-4 months

Infants: Reflexes Rooting disappears

3-4 months

Bone Healing and Remodeling: early childhood

4 weeks

Onset of Absence Seizures

4-12 years of age

Normal Pupil size and response to light is

4-5mm

Infants: Reflexes Tonic neck disappears

4-6 months

A1C should be between ____ and _____ in DM depending on age

6.5-8%

Precocious Puberty defined as before age _ years in Caucasian girls

7

Life span for Intermediate Spinal Muscular Atrophy

7 months to 7 years

Infants: Reflexes Plantar Grasps disappears

8-10 months

Bone Healing and Remodeling: adolescence

8-12 weeks

Precocious Puberty defined as before age _ years in boys

9

Normal intracranial pressure

<15 mmHg

Acute Laryngotracheobronchitis (LTB) most common in what ages

<5 years