Peds 3rd Exam - Berch
diabetes insipidus is when Urine output _____________ intake
Exceeds
Type 1 was previously called
Juvenile Diabetes
What 3 signs and symptoms are decreased in DI patients
Osmolarity Specific Gravity Blood pressure Extracellular Fluid (Hypovolemia)
Main goals of Cerebral Palsy
PREVENT INJURY Goal: to maintain optimal development
What are the 3 Cardinal signs of Diabetes Insipidus
Polyuria Polydipsia CriticalDehydration "People Pleasing causes damage"
Cerebral Pasly (CP)
condition characterized by lack of muscle control and partial paralysis, caused by a brain defect or lesion present at birth or shortly after
What are symptoms of Hyperglycemia
extreme thirst, need to urinate often, dry skin, hungry, blurry vision, drowsy, slow healing wounds
Early signs of ICP
headache, Vomiting, blurred vision
Treatment for DKA
hydration NS or ½ NS, IV insulin, reverse acidosis, restore electrolyte balance
What causes Hyperglycemia
illness, corticosteroids, too much food, no meds, inactivity, emotional stress
Signs of ICP of infants
infants: * bulging fontanels*** *Cranial suture separation *high pitched cry
In Type 2 diabetes the body is not
insulin dependent
Malfunction is usually from
obstruction from tissue or exudate or thrombosis
times when child is more prone to becoming hyperglycemic
• Illness (Monitor BS and urinary ketones every 3 hours) • steroids • ate too much • not enough insulin• dehydration
Nursing Interventions for TYPE 1 DM
• Physical assessment • Correct and safe insulin administration - including verifying dose withsecond RN• Monitor daily weights • BS monitoring • Monitor for S &S of hypo/hyperglycemia
What 3 things are used to DX Type 1 DM
• Random BS value of 200 or more • A1C greater than 7 • Decrease in serum insulin levels
Presentation of seizures
•Convulsions, shaking fever
•Post-op care includes observation:
•Position on un-operated side to prevent pressure on the shunt •HOB flat to avoid complication resulting from too-rapid reduction of ICP •Pain management •Observe for S/S ICP (monitor for I & O) •Neuro assessment •Monitor for S/S infection
Increased Intracranial Pressure
* changes in LOC *Papilledema *Impaired eye movement decrease *vomiting * headache *pupillary changes * changes in vital signs HIGH BP LOW Pulse
Late signs of ICP
Bradycardia, Cheyne-Stokes breathing fixed pupils
Cushing's Triad
Bradycardia, widened pulse pressure irregular respirations
An adolescent client with type 1 diabetes mellitus is admitted to theemergency department for treatment of diabetic ketoacidosis. Whichassessment findings should the nurse expect to note?
4. Fruity breath odor and decreasing level ofconsciousness
What do we teach parents about Children dx with DI
ALWAYS HAVE ACCESS TO WATER • CARRY NASAL SPRAY• TREATMENT LIFELONG• PREPERATION AND PROCEDURE FOR INJECTABLE VASOPRESSIN PO or SQ• WEAR MEDICAL ALERT IDENTIFICATION • SCHOOL PERSONAL SHOULD BE AWARE OF CHILDS DIAGNOSIS
Intracranial Infections Clinical Manifestations in Child
Change in LOC, fever HA, N/V, photophobia stiff neck, stiff hamstrings, rashes, Cold hands and feet
Management of VP Shunt
Airway ManagementICP monitoringCluster nursing ActivitiesMonitor for PainMedicationStrict I and O'sThermoregulationHygiene (Mouth and Eye Care)SkinPositioningStimulation (Auditory)Familly Support
•The nurse notes that an infant with the diagnosis of hydrocephalus has a head that is heavier than that of the average infant. The nurse should determine that special safety precautions are needed when moving the infant with hydrocephalus. Which statement should the nurse plan to include in the discharge teaching with the parents to reflect this safety need?
"When picking up your infant, support the infant's neck and head with the open palm of your hand."
Mangement for a child with Meningitis
#1 Isolate #2 Lumbar Puncture #3 Antibiotics
Causes of Neurological and sensory disorders in children
#1 TB Infection Brain Tumor Hydrocephalus " Thats all In Berch's Head"
What to give child when Hypoglycemic
1 tbsp of sugar(orange juice) followed by milk or PB protein• Can give children glucose paste to gums (Equivalent to cake frosting) in times of hypoglycemia
How much urine does DI patients urinate a day
20 L
The mother of a 6-year-old child who has type 1 diabetes mellituscalls a clinic nurse and tells the nurse that the child has been sick. Themother reports that she checked the child's urine and it was positivefor ketones. The nurse should instruct the mother to take whichaction?
3. Encourage the child to drink liquids.
The nurse should implement which interventions for a child olderthan 2 years with type 1 diabetes mellitus who has a blood glucoselevel of 60 mg/dL (3.4 mmol/L)? Select all that apply.
3. Give the child a teaspoon of honey. 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
What two signs and symptoms are increased in DI Patients
Thirst and HeartRate
Why ROM in Cerebral Palsy
To decrease contractures
Reflexes
Tonic neck: Turn neck and same side extends means brain damage Babinski: Neuro issue if positive after 1 year
Assess what in DKA
Vital signs • Assess respiratory status: Kussmaul breathing • Strict I & Os hourly • Monitor Potassium because Insulin can lower potassium levels
Gillain-Barre' CSF WBC Glucose Protein
WBC 0-5 Glucose 40-70 Protein 45- 1000
normal CSF WBC Glucose Protein
WBC 0-5 Gluc 40-70 Protein <40
Viral meningitis CSF WBC Glucose Protein
WBC 100-1000 Glucose 40-70 Protein < 100
Tuberculosis meningitis CSF WBC Glucose Protein
WBC 5-1000 Glucose <10 Protein >250
Bacterial Meningitis CSF WBC Glucose Protein
WBC >1000 Gluc <40 Protein >250
Life threatening infections are common when
breathing muscles become more affected- usually leads to death by age 15-18
in DMD when is ambulation nearly impossible ?
by age 12
What causes Hypoglycemia
too much insulin or oral hypoglycemic agents; too little food; delayed time of eating, too much exercise
What are symptoms of Hypoglycemia
weakness, rapid heartbeat, sweating, anxiety, hunger, trembling, dizziness, headache hunger impaired vision
Changes in Vitals during a Neurological Assessment
•BP, Pulse, RR can be high, low, slow, fast. •Any variation from normal means there is an issue
Posturing
•DECORTICATE: (Flexor) CEREBRAL CORTEX - Problems with cervical spinal Tract or Cerebral Hemisphere • DECEREBRATE: MIDBRAIN OR BRAINSTEM Problems within midbrain or pons
•Eyes: Pupils PERRLA
•FIXED: BRAINSTEM •DILATED: MIDBRAIN •PINPOINT: BRAINSTEM OR POISONING OR OPIODS ***SUDDEN APPEARNACE OF FIXED OR DILATED IS EMERGENCY***
Treatment after a Seizure
•Identify the source of the fever for treatment •Give antipyretic to decrease fever •Cooling measures
Symptoms Dependent on Age
•Increase in head circumference •Vomiting •High pitched cry (Infants) •Lethargy •Seizures •Sunsetting eyes •Vision issues (older children)
Biggest Problem With VP Shunt
•Infection or malfunction biggest issue!
Treatment during a seizure
•Note time of onset, end, and characteristics •Turn to side •Do not put anything in mouth or restrain •Keep safe from injury •Have suction and oxygen ready
Treatment of hydrocephalus
•Supportive Care •Decrease ICP •VP shunt •ETV (Newer procedure) •Make a small opening in one of the ventricles, which relieves the pressure buildup by allowing fluid to flow again. The procedure is called an ETV, or "endoscopic third ventriculostomy."
•The nurse is caring for a newborn infant with spina bifida (myelomeningocele) who is scheduled for surgical closure of the sac. In the preoperative period, which is the priority problem?
1. Infection
•A child with cerebral palsy is in a management program to achieve maximum potential for locomotion, self-care, and socialization in school. The nurse works with the child to meet these goals by performing which action?
1. Placing the child on a wheeled scooter board
•Cerebral palsy (CP) is suspected in a child and the parents ask the nurse about the potential warning signs of CP. The nurse should provide which information? Select all that apply.
1. The infant's arms or legs are stiff or rigid. 2. A high risk factor for CP is very low birth weight. 5. The infant has feeding difficulties, such as poor sucking and swallowing. 6. If the infant is able to crawl, only one side is used to propel himself or herself.
•The nurse is monitoring a 7-year-old child who sustained a head injury in a motor vehicle crash for signs of increased intracranial pressure (ICP). The nurse should assess the child frequently for which early sign of increased ICP?
1.Nausea
An adolescent with diabetes receives 30 units of Humulin N insulin at7:00 a.m. The nurse would monitor for a hypoglycemic episode atwhat time?
2. Before supper
•The community health nurse is providing information to parents of children in a local school regarding the signs of meningitis. The nurse informs the parents that the classic signs/symptoms of meningitis include which findings?
3. Photophobia, fever, and confusion
•The parents of a child recently diagnosed with cerebral palsy ask the nurse about the limitations of the disorder. The nurse responds by explaining that the limitations occur as a result of which pathophysiological process?
3. A chronic disability characterized by impaired muscle movement and posture
•The nurse is creating a plan of care for a newborn infant with spina bifida (myelomeningocele type). The nurse includes assessment measures in the plan to monitor for increased intracranial pressure. Which assessment technique should be performed that will best detect the presence of an increase in intracranial pressure?
3. Assess anterior fontanel for bulging.
•A mother arrives at the emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected. The nurse checks the child's airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP?
4 Bradycardia
•The nurse is caring for an infant with spina bifida (myelomeningocele type) who had the sac on the back containing cerebrospinal fluid, the meninges, and the nerves (gibbus) surgically removed. The nursing plan of care for the postoperative period should include which action to maintain the infant's safety?
4. Elevating the head with the infant in the prone position
The Skull is made of:
80% brain 10% CSF 10% blood **Any change in these 3 parts can cause problems**
Medications for Cerebral Palsy
Botox Antiepileptic Diazepam (Muscle Spasms)
Nursing Considerations for DMD
Fatigue Mobility Frequent Infections Psychological Effects Maintain Function
Most popular sign for DMD
Gowers Sign Waddling Gait
Common Insulin injection sites
abdomen, thighs, back of arms
Type 2 Diabetes is diagnosed in _______________; and sometimes found in ________________.
adulthood ; Overweight children
Type 1 diabetes is Diagnosed in which two groups ?
children and youngadults
Early signs of DMD
clumsiness frequent falls difficulty climbing stairs, running, and riding tricycle ** History of Development Delay**
Drowning
major cause of death in children >1 year old Can occur in even small quantity of water (such as pail of water) Priority CPR ABC's
When does the onset of Duchenne's Muscular Dystrophy start? and what sex?
onset of 3-5 years primarily in males
In type 2 diabetes the body fails to do what
produce and properly use insulin
•The nurse is providing instructions to the parents of an infant with a ventriculoperitoneal shunt. The nurse should include which instruction?
3. Call the health care provider if the infant has a high-pitched cry.
•The nurse is monitoring an infant for signs of increased intracranial pressure. On assessment of the fontanelles, the nurse notes that the anterior fontanelle bulges when the infant is sleeping. Based on this finding, which is the priority nursing action?
3. Notify the health care provider.
•The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care?
4. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics.
Duchenne muscular dystrophy
A human genetic disease caused by a sex-linked recessive allele; characterized by progressive weakening and a loss of muscle tissue.
Intracranial Infections Clinical Manifestations
Bulging Fontanel, fever, poor feeding, irritable, rashes
Hydrocephalus
CSF collects on the surface of the brain
What to eat before exercise to prevent Hypoglycemia ?
Eat 10-15 grams of carbs before exercise Milk, bread or PB is best because it's a complex carbohydrate
A school-age child with type 1 diabetes mellitus has soccer practiceand the school nurse provides instructions regarding how to preventhypoglycemia during practice. Which should the school nurse tell thechild to do?
Eat a small box of raisins or drink a cup oforange juice before soccer practice.
assessment of hydrocephalus
General physical exam: Fontanels and sutures Developmental milestones Head measurement Neuro exam
diabetes insipidus Patients often have a history of
Head injury Pituitary Tumor Craniotomy
Why Monitor ICP in Spinal Bifida kids ?
Hydrocephalus may be present because of this malfunction of the spinal cord
Respiration Characteristics During Neurological Assessment
Hyperventilation could mean metabolic acidosis or issue in the medulla (Respiratory Center) Irregular breathing possible brainstem damage
When is it a good time to test for ketones in urine? - to prevent what ?
Illness; DKA
In Type 1 patients the body doesn't produce
Insulin
Type 1 patients are dependent on
Insulin
Pediatric response is different than the adult response because....
Intracranial contents are damaged because the force is greater than the amount of support provided by the skull and musculoligamentous system
Symptoms of DKA
Kussmaul respirations Dehydration- Thirsty fruity breath odor (acetone) High HR ; LOW BP High BS > 240 Polyuria Hyperkalemia
Symptoms of Cerebral Palsy
Lack of Motor skills/ Muscle coordination Stiff Muscles and spasms Bad Posture and Instability Difficulty walking Impaired Cognitive Ability Epilepsy
Nursing Care management for Seizures
Maintain patent airway Ensure safety Assessment, documentation Diazepam administration Support family
Nursing care for DI patients
Monitor and replace fluids Check Nero Status/ Vitals check mucus membranes
Duchenne muscular dystrophy symptoms
Muscle deterioration - heart problems, breathing problems, weak bones
DI management Consists of
NEURO ASSESSMENT • I&OS FLUID BALANCE• ELECTROLYTE WATCH
Do Children have symptoms of Type 2 Diabetes.
NO
VP Shunt
Objective: divert the flow of CSF from the brain to another part of the body usually the peritoneal space
How do you know if there is a problem with the Shunt
Onset of vomiting, severe headache, irritability, fever, and lethargy
#1 goal for any person during a seizure is to
Prevent them from injury
Times when a child is more prone to being hypoglycemic
• Exercise • not eating • too much insulin • before meals • insulin peaks • Diarrhea • Vomiting
Neurological Assessment for Neurological and sensory disorders
• Vital Signs • LOC • Skin • Eyes • Motor Function • Posturing • Reflexes • Head circumference "People should really listen more very early hours"
What type of assistance does a spinal bifida kid need?
•Neurosurgery •Neurology •PT, OT, ST •Child life specialist
How to protect Spinal Bifida Budge
•When born protect defect cover with sterile moist dressing lay prone on open diaper
