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
