peds unit 3 exam

An infant with a femur fracture is placed in Bryant traction. What would the nurse include in the infant's plan of care?

keeping the buttocks slightly elevated.

rapid acting insulin

lispro, aspart, glulisine onset: 15 minutes peak: 1 hour duration: 2 - 4 hours *do not delay eating

creatine kinase

male: 55-170 female: 30-145 elevated = muscle damage

anticonvulsants

medications that antagonize folic acid

head injury

mild s/s: headache, confusion, dizziness, lethargy severe s/s: increased ICP, decreased LoC, pupil abnormalities, seizures dx: CT or MRI concussion: self-resolving in 1-3 weeks, rest, gradual return to activities complications: -fixed dilated pupils, decreased LoC, abnormal respirations and posturing, hematoma, hydrocephalus tx: mannitol: rapidly decreases ICP phenobarbital: induce coma and decrease metabolic demands opioid analgesics anticonvulsants mechanical ventilation ICP monitoring nursing: -simultaneously stabilize spine and maintain patent airway -v/s -avoid suctioning -elevate HoB 30 degrees -keep head midline

fat embolism

monitor after bone fracture: increased RR, change mental status

A nursing instructor is preparing a class presentation about tibia vara. What would the instructor include as a risk factor?

obesity

oblique fracture

occurs at an angle across the bone

transverse fracture

occurs straight across the bone

greenstick fracture

one in which the bone is bent and only partially broken incomplete

biphosphonate

prevents bone loss

intracranial arteriovenous malformation

rare congenital disorder caused by abnormal development of blood vessels and can occur in the brain, brain stem, or spinal cord Monitor for changes in neuro status, noting any seizure activity, monitor for signs of ICP and hemorrhage

febrile seizures

risk factors: 6 mo-5 yrs s/s: LoC, uncontrollable shaking arms and legs rule out meningitis tx not always necessary educate family to call 911 if lasts more than 5 mins

myxedema

severe hypothyroidism

myxedema coma

severe hypothyroidism hypoxia, dec cardiac output, bradycardia, hypothermia

A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as:

significant bending without actual breaking.

hydrocephalus teaching

-s/s of vp shunt infection: elevated v/s, poor feeding, vomiting, decreased LOC, local inflammation along vp shunt tract -infection usually occurs 1-2 months after shunt placement -s/s of vp shunt malfunction: vomiting, drowsiness, headache if external ventricular drainage (EVD) system used: -sterile dressing at entry point -clamp before any movement -will require lifelong treatment, including hospitalizations and surgeries, early recognition of neuro changes, possible delayed development

Viral (aseptic) meningitis

-same symptoms as bacterial meningitis -usually requires only supportive care for recovery, can be managed at home -3-10 days -rest, water -acetaminophen for pain/fever -hand hygiene (enteroviral) -isolation not necessary -lumbar puncture CSF: clear, normal glucose, increase protein, increase WBC, negative Gram stain

botulin toxic (botox)

-substance prod by clostridium botulinum -paralyzes muscle fibers -used for severe migraines

cerebral angiography

-x-ray imaging of the arterial blood vessels in the brain after injection of contrast material -help child keep still -allow parent to accompnay -push fluids after to flush out contrast medium

Upon assessment of an infant the nurse suspects the child has positional plagiocephaly. What questions should the nurse ask the parents to help confirm if this is correct?

"How much tummy time do you plan each day for your infant?" "Besides transporting your infant in the car, how much time do you place your infant in the car seat every day?" "Do you follow the recommended guidelines of placing your infant on the back to sleep rather than the abdomen?"

During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?

"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."

The nurse is caring for a school-age child diagnosed with juvenile arthritis (JA). Currently, the child's hips and knees are inflamed and painful. What statement by the parent would indicate a need for further education?

"I will keep my child home from school when there is a flare up to help reduce the amount of time my child is in pain."

The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur?

"My child measures their own medication but sometimes doesn't administer the correct amount."

SIADH nursing diagnoses

1. Fluid volume excess r/t increased water reabsorption secondary to increased ADH secretion 2. Decreased cardiac output r/t fluid overload 3. High risk for injury r/t cerebral edema and CNS dysfunction 4. Knowledge deficit r/t required fluid restriction 5. Imbalanced nutrition r/t nausea and vomiting (hyponatremia)

breath holding

-benign behavior of childhood -usually seen in children 6 mo-6 yr old -episodes in which child starts crying, stops breathing, hyperventilates, passes out, and may turn bluish -usually lasts 30-60 seconds -usually triggered by anger, stress, fear, pain, or being startled -association with iron deficiency anemia -parents should not try to stop episode but just keep safe by placing in side-lying and manage child's stress

bone fracture treatment

-bone reduction: pulls the bone back into original position closed: manually: casts open: surgically

scolosis brace care

-brace worn 18 hrs day -no moisture -check skin and brace daily -wear cotton tshirt underneath for comfort -back-strengthening exercises -seek medical attention for any breathing/cardiac problems -promote positive body image in teens, wearing baggy clothes

post cast removal care

-cast cutter makes loud noise but doesn't hurt and will cause vibration or warmth -brown, flaky skin normal -soak daily -skin may be tender -lotion

clubfoot teaching

-casting and bracing ASAP -surgical repair if not repaired by 6-12 wks -foot immobile 12 wks in cast post op -weekly then biweekly cast changes -cast care: CMS (circulation/color, movement, sensation) -sponge baths

nursing management for fractures

-check ABCs -observe fracture -splint above and below to immobilize -stop bleeding by applying pressure -if open: cover w/ sterile dressing -elevate extremity -ice -NPO til seen by provider -pain management meds -monitor for compartment syndrome: no pain relief (early sign), severe pain with passive movement -frequent neurovascular checks: 6 Ps

cerebral palsy

-developmental disorder of progressive muscle weakness leading to impaired movement causes: -fetal brain injury 24-26 weeks -forceps use during delivery -genetics s/s: -Muscle weakness -Spasticity -Ataxia: clumsiness tx: -botox -intrathecal baclofen -phys/occ/speech therapy -orthopedic devices teaching: -buckle in wheelchair

positional plagiocephaly

-flattening of one side of an infant's head from prolonged lying in one position -reposition/tummy time -molding helmet

CN IX

-glossopharyngeal -assess mouth for taste -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech

hip dysplasia

-head of femur slips out of acetabulum s/s: -uneven gluteal folds - + Trendelenburg sign (hip drops) -uneven knee height tx/management: -<6 mo infant: Pavlik harness 24h/day, 3 months -> 6 mo: surgical reduction -both: followed by cast 12 wks then brace -follow-ups until skeletal development complete (25 yrs)

hyperparathyroidism

-hypersecretion of the parathyroid glands, usually caused by a tumor -hypercalcemia -hypophosphotemia -neuromuscular dysfunction: clumsy, weakness -cognitive issues -flank pain - renal calculi -diuretics/fluids to flush out calcium/prevent calculi -juice to lower pH -oral phosphate -restrict calcium -prevent falls

neurogenic bladder

-impairment of bladder control as a result of brain, spinal cord, or nerve damage management: -clean intermittent catheterization -oxybutynin chloride: improves bladder capacity

bacterial meningitis

-inflammation of meninges of brain and spinal cord -occurs most often in children 1-5 mo and 15-24 yr risk factors: crowds (dorms, daycare), travel, immunosuppresion -birth-3 months causes: e coli, listeria, strep -3 mo-6 yr: strep, h. influenzae, neisseria -secondary to ear/throat/sinus infections -high fever -change in loc -headache (subjective, can't confirm in infant) -photophobia -irritability -bulging fontanels -weak cry -vomiting -nuchal (neck) rigidity -positive kernig sign: inability to extend knee when on back -positive brudiznski sign: pain when flexing neck while lying on back, flexes in knees and hips -elevated WBCs -hearing loss (CN VIII) -opisthotonic position (head and neck hyperextended) -monitor for abrupt red or purplish rash - indicates meningococcemia (systemic infection) -diagnosed w/ lumbar puncture -CSF: cloudy, decreased glucose, increased protein, increased WBC, positive Gram stain -treat with IV antibiotics -corticosteroids -acetaminophen -*droplet precautions first 24h antibiotic therapy -anticonvulsants if seizure is a concern -seizure precautions -quiet, dim room -neuro checks -elevate HoB 30 degrees -keep head midline -minimize suctioning -hib and pneumococcal vaccines at 2 mo -meningococcal vaccine at 11-12 yr, booster at 16

ICP monitoring

-keep HOB elevated -reduce stimulation

A and P differences in children

-large head to body mass ratio (prone to head injuries) -brain highly vascular, increased risk for hemorrhage -cranial bones not developed or fused -large tongue (airway obstruction) -trachea is short, more anterior (increase aspiration) -smaller airway diameter (increase RR in infants) -weak neck muscles -myelinization: proceeds in cephalocaudal direction (head and trunk then extremities)

head injury risk factors in children

-large head to body proportion with higher center of gravity -high activity level -curiosity -incomplete motor development -lack of knowledge and judgement -not using helmets, car seats, or seatbelts

compartment syndrome management

-monitor 6 Ps -keep limb at heart level -loosen clothing -notify MD -bivalve cast (split) -decrease weight on traction -severe: fasciotomy

cast mangement

-monitor compartment syndrome, temp, foul odor -elevate above heart and ice 48 hours -use palms to handle immediately after placement (fingertips cause dents, pressure ulcers) -plaster: dries in 24-48h -fiberglass: dries in mins, causes warm feeling inside -turn cast every 2 hr during drying period -hair dryer w/ cool setting can be used to help dry, or for itching -cast petaling with tape on plaster casts: prevents skin breakdown -keep dry -don't insert anything inside -don't use lotions or powders -plastic bag over when showering

intraventricular hemorrhage is commonly seen in preterm infants due to:

-more and fragile capillaries in periventricular area -immature cerebral vascular development -poorly supported vascular bed -the smaller and more premature, the higher the risk

diabetic ketoacidosis

-more common w/ type 1 extremely high BG >250, ketones present in urine, metabolic acidosis, and hyperkalemia s/s: 3 Ps, fruity breath, Kusmal respirations, N/V, dehydration treat underlying cause, IV fluids, Q1 vitals, monitor potassium, BG

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

-oversecretion of ADH s/s: Edema Headache hypertension weight gain n/v irritability high urine specific gravity hyponatremia management: -daily weights, strict I&Os, safety -declomycin: inhibits ADH, promotes diuresis *don't give with calcium-containing foods loop diuretics: watch for hypokalemia Spread fluids throughout day Restrict fluids hypertonic saline solution (3%): draws fluid out of cells

6 P's of compartment syndrome

-pain -pallor -paralysis -paresthesia -pulselessness: late sign -poikilothermia: difference in temperature on affected extremity

hyperglycemic signs

-polyuria -polyphagia -polydipsia -ketonuria -weight loss -weakness -blurred vision -HA -N/V -abdominal cramping -elevated blood glucose

craniosynostosis

-premature closure of cranial sutures -can cause skull deformities, brain growth inhibition, increased ICP -surgical correction for cosmetic reasons -monitor hemoglobin and hematocrit -monitor for pain, fever, hemorrhage, infection, swelling -surgery can cause facial swelling and inability to open eyes for a few days postop -encourage parents to provide support and comfort

anticonvulsants

-prevent or control seizures (clonazepam, phenytoin, gabapentin) -don't stop taking abruptly -can cause decreased RR -monitor serum levels -phenytoin known to cause gingival hyperplasia -phenobarbital c/i w/ valproic acid

electroencephalogram (EEG)

-record of the electrical activity of the brain to diagnose seizures -hold morning anticonvulsant

nursing interventions for near-drowning incidents

-resuscitate -promote oxygenation -monitor for infection from water aspiration -teach: swimming skills at early age, pool fence, adult supervision, empty water from all containers after use, always use personal flotation device when near water

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?

Do not mix this insulin with other insulins. Glargine is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

glascow coma scale

EYE OPENING 4 - spontaneous 3 - open to speech 2 - open to pain 1 - no response VERBAL 5 - alert and oriented 4 - disoriented conversation 3 - inappropriate words 2 - nonsensical sounds 1 - no response MOTOR 6 - spontaneous 5 - localizes pain 4 - withdraws to pain 3 - decorticate posturing 2 - decerebrate posturing 1 - no movement

A child who has been having seizures is admitted to the hospital for diagnostic testing. The child has had laboratory testing and an EEG, and is scheduled for a lumbar puncture. The parents voice concern to the nurse stating, "I don't understand why our child had to have a lumbar puncture since the EEG was negative." What is the best response by the nurse?

"The lumbar puncture can help rule out any infection in fluid surrounding the brain and spinal cord as the cause of the seizures."

hypoglycemia signs

(TIRED) Tachycardia Irritability Restlessness Excessive hunger depression and diaphoresis

cerebral palsy nursing diagnoses

- impaired communication - impaired physical mobility - risk for injury: falls/seizures - impaired/altered comfort

nursing interventions for adequate fluid balance

-IV fluids when NPO -encourage fluids -I&O -avoid overhydration when cerebral edema is a concern -monitor urine specific gravity (1.005-1.030)

plaster cast

-Inexpensive -easy to manipulate and handle when applying -strong, and rigid -Disadvantage: -Not waterproof, breakdown of material can lead to reapplication.

fiberglass cast

-Stronger than plaster -achieves weight-bearing, strength faster than plaster -waterproof (but must get dried after getting wet) -durable and lightweight -Disadvantage: $$$$

PKU (phenylketonuria)

-a condition that makes it impossible for babies to metabolize certain proteins -can lead to brain damage -newborn screening -s/s: dev delay along w/ vomiting -avoid proteins such as meat and breastmilk

scoliosis

-abnormal lateral curvature of the spine -can be anterior or posterior or both -curves between 25-45 degrees repaired w/ brace -curve angle needs to be >45 degrees to require surgical repair -postop: turn using log-roll technique to avoid back flexion

growth hormone deficiency

-absence or deficiency of growth hormone produced by the pituitary gland to stimulate the body to grow dx: -confirmed by pituitary function test: peak GH levels <7-10 x2 tests -delayed bone age - hand/wrist xray -CT or MRI to rule out tumors -outside 5-95th percentile management: -give injections at bedtime -therapy stopped after epiphyseal plates fused -measure height and weight twice goal: -3-5 in first year therapy

traction care

-aligns bone w/ steady pulling action -pad bony prominences with cotton padding before applying -apply adhesive before traction tape -let weights hang freely, never on floor -never remove weights w/out order -overhead trapeze bar to help w/ movement -treat pin sites as surgical wounds -massage back and sacrum with lotion to promote circulation -avoid bumping into or moving bed suddenly -neurovasc checks (6 Ps) -diazepam for muscle spasm

galactosemia

-an inborn error of metabolism that makes infants unable to process galactose, resulting in a variety of physical problems in addition to intellectual disabilities; dietary intervention reduces potential for problems -requires antibiotics due to it causing sepsis

deceberate

-arched back -straight, tense arms at side -flexed wrists that look like "e's" -curled fingers -rigid, extended legs -pointed, turned in toes

decorticate

-arms flexed toward center of body -curled wrist and balled hands against chest -rigid, extended legs -pointed, turned in toes

nursing interventinos for increased ICP

-assess neuro status: decreased LOC, irritability, lethargy, decreased pupillary response -monitor V/S: decreased HR and RR, increased BP/pulse pressure -measure head circumference -elevate HOB -reduce stimuli, noise, and pain -have emergency cardiac and respiratory equipment available

hyperthyroidism

-autoimmune disorder, excessive activity of the thyroid gland -peaks at 12-14 yrs - + Chovstek's -weight loss -widening BP -tachy -sweating, heat intolerance management: -propylthiouracil - can cause agranulocytosis, notify if fever or sore throat -methimazole -radiodine not safe for children

medications used to treat increased ICP in children

-barbituates: decrease ICP by decreasing cerebral metabolic rate e.g. pentobarbitone -diuretics: acetazolamide, furosemide -corticosteroids -anticonvulsant: topiramate -analgesics

folic acid intake for pregnant women

400 mcg/day

The nurse is reviewing the recommended diet with the parents and child who was diagnosed with type 2 diabetes. The nurse determines that the parents and child understand the information when they identify that they will restrict carbohydrate intake to which amount at each of the three main meals?

45 grams

A 9-year-old boy is suffering from headaches but has no signs of physical or neurologic illness. Which intervention would be most appropriate?

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

neonatal thyrotoxicosis

A baby born to a mother w/ Graves has poor weight gain, irritability, warm&flushed skin... TSH receptor antibodies from Mother can cross placenta. Tx: Methimazole and a Beta blocker for several weeks Resolves spontaneously :) Note: Like real thyroid hormone, levothyroxine does not cross placenta and its safe in pregnancy.

Inborn Errors of Metabolism (IEM)

A group of congenital conditions that cause either accumulation of toxins or disorders of energy metabolism in the neonate. These conditions are characterized by an infant's failure to thrive and by vague signs such as poor feeding. -PKU, maple syrup urine disease, trimethylaminuria, tyrosinemia -previously healthy baby starts to deteriorate -labs: ꜛ glucose, ꜛ ammonia, abnormal blood gases

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?

A simple blood test to diagnose hypothyroidism is required in most states.

bone fractures s/s

BROKEN: -bruising and swelling -reduced movement (immobilize affected bone) -odd appearance -krackling sound -edema, erythema -neurovascular impairment

epilepsy risk factors

Birth trauma (lack of oxygen to babies brain) Asphyxia neonatorum (before birth) Head injuries Infections Toxicities Fever Circulatory problems Metabolic disorders-HYPOGLYCEMIA Drug/Alcohol intoxication Cardiovascular dysfunctions Hemorrhage

A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse?

Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.

CN XII

Hypoglossal (tongue movement)

absence seizure

LoC for few seconds, resembles daydreaming blank staring, lip smacking, picking at clothes

short-acting insulin

Onset 30-60 minutes Peak 2-4 hours Duration 5-8 hours regular

intermediate acting insulin

Onset: 1.5-4 hr Peak: 4-12 hr Duration: 12-18 hr NPH

long acting insulin

Onset: 2 hours Peak: NONE Duration: 24 hours glargine, detemir

Chovstek's sign

Sign of hypocalcemia or hypomagnesemia; abnormal functioning of the facial nerve causes a twitch on the same side of the face

spinal injury management

Skin integrity Make temp cooler (loss of sensation) Change positions 1-2 h Incontinence

Chiari malformation

Type I: Sublinical Type II-IV: herniation of cerebellar tonsils through the foramen magnum Presentation: - hydrocephalus - syringomyelia: crossing spinothalamic => "capelike" loss of pain and temp, hand weakness - meningiomyelocele

Pavlik harness care

Used for management of DDH Do not adjust the straps without checking with the provider It must be used continuously until the provider instructs you to take the harness off for a period of time each day. Change diaper while in the harness. Place your baby to sleep on back. Check skin folds for redness. Keep these areas clean and dry. Once the baby is permitted to be out of the harness for a short period, you may bathe your baby while the harness is off. Long knee socks and an undershirt are recommended to prevent rubbing of the skin against the brace. Note location of the markings on the straps for appropriate placement of the harness. Call the provider if: Your baby's feet are swollen or bluish. The harness appears too small. Skin is raw or a rash develops. Your baby is unable to actively kick his or her legs.

periosteum

___ is stronger, thicker, and flexible in pediatrics, decreasing bone fracture recovery time

closed or simple fracture

a broken bone in which the bone does not break through the skin

encephalocele

a congenital herniation of brain tissue through a gap in the skull

spiral fracture

a fracture in which the bone has been twisted apart

status epilepticus

a prolonged seizure lasting 5 or more minutes or situation when a person suffers two or more convulsive seizures without regaining full consciousness medical emergency

myelography

a radiographic study of the spinal cord after the injection of a contrast medium through a lumbar puncture

microcephaly

abnormally small head, can be congenital defect or occur later due to early malnutrition, perinatal infection, or anoxia

tonic clonic seizures

aka generalized tonic: stiffening of muscles and LoC clonic: 1-2 mins rhythmic jerking of extremities postictal phase: confusion, sleepiness, possible agitation

Graves disease

an autoimmune disorder in which immune system produces thyroid stimulating immunoglobulin (TSI) which mimics TSH and causes a enlarged thyroid gland/goiter and/or exophthalmos

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect s/s: sipping and pissing dehydration - dry mucous membranes, poor skin turgor hypotension, shock low urine specific gravity hypernatremia management: -daily weights, strict I&Os, safety -chlorpropamide: increases ADH, *monitor for hypoglycemia, *avoid sunlight -vasopressin: constricts blood vessels to raise BP (lifetime) -diaper count -calm infant w/ water, not milk -labs: urine specific gravity, HCT

comminuted fracture

bone breaks into many fragments (≥3)

open or compound fracture

bone breaks through the skin

3-12 weeks

bone fracture healing time?

complete fracture

bone is broken all the way through

incomplete fracture

bone is not broken all the way through

myoclonic seizure

brief jerking or stiffening of extremities

acquired hypothyroidism

causes: -Hashimoto thyroiditis -more common in girls in adolescence -iodine deficiency s/s: -slow or arrested growth rate -increased weight -goiter -sluggish DTRs -edema of face, eyes, and hands

leaking CSF sign

clear fluid leaking from ears and nose and tests positive for glucose

management of myelomeningocele

closure withn 24-48 hours of life via surgery. PRE OP: cover sac with sterile, moist gauze, prone position, no diapering, isolation precautions - infection risk, slow feedings POST OP: supine or prone, neuro checks, assess for s/s ICP, catheter for urinary retention, hip abduction LONG TERM: bracing, assistive devices, neurogenic bladder (catheter needed, educate parents and eventually patient on how to, educate on how to prevent infection, DITROPAN as muscle relaxer for bladder), fecal impactions common (use of stool softeners BID, enemas)

anencephaly

defect in closure of the cephalic portion of the neural tube that results in incomplete development of the brain and bones of the skull; the most drastic neural tube defect usually results in a stillbirth

hypothyroidism

deficient levels of thyroid hormone low T3/T4, high TSH everything is low, slows down monitor cholesterol: low T3/T4 causes increased triglycerides/cholesterol

A nurse is preparing a class on neural tube disorders to present to a community group. What information regarding prevention is most important for the nurse to include in the teaching?

dietary considerations

The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child:

draws up the short-acting insulin into the syringe first.

diabetes

dx: 2 abnormal test results: casual BG >200 fasting BG >126 BG >200 w/ oral glucose tolerance test HbA1c over 6.5% when sick: measure BG Q2-3h ketone checks Q4h regular insulin dosing notify MD of fever or ketones

epilepsy

dx: 2 or more unprovoked seizures, EEG risk factors: fever (most common), cerebral infection, toxins, hypoxia, hypoglycemia, brain tumor tx: anticonvulsant: valproic acid, carbomezapine, phenytoin

A 6-week-old infant has been diagnosed with congenital hypothyroidism. Once the level of medication has been determined, in order to maintain the proper dosing of thyroid hormone, the nurse instructs the parents to have the baby's levels tested how often during the first year?

every 1 to 3 months

The nurse is assessing a child with spastic cerebral palsy. What findings would the nurse expect to assess? Select all that apply.

exaggerated deep tendon reflexes hemiplegia poor control of balance hypertonicity

spina bifida

fetal neural tube defect types: occulta (can't see affected area, covered by tuft of hair or dimple) meningocele: protruding sac or cyst over spinal cord containing CSF, meninges myelomeningocele: protruding sac or cyst over spinal cord containing CSF, meninges, AND spinal cord risk factors: -folic acid deficiency (<400 mcg/day) -increased alpha fetoprotein (range 10-150) tx: surgical closure of defect (possibly in utero) complications: -hydrocephalus -allergies to latex → also to bananas, kiwi, avocado, strawberry, tomato -inc risk pressure injuries and burns due to loss of sensation -bladder dysfunction - intermittent cath

5 states of consciousness

full consciousness confusion: may be alert but responds inappropriately obtunded: limited response, falls asleep unless stimulated stupor: only responds to vigorous stimuli coma

HbA1c

goal: <7.5% measures BG over 2-3 months best way to determine treatment compliance

The nurse caring for a child who has issues with the anterior pituitary gland would expect the child to have issues with which hormone?

growth hormone

Cushing's

hyper adrenal corticoids Hypertension, hyperglycemia, etc Hypopotassium Widened pulse pressure

Addison's

hypo adrenal corticoids Low BP, low BG Hypotension hypoglycemia Hyponatremia Hyperkalemia Confusion, apathy Bronze pigment of skin Tx: "add a sone" cortisone

hypoglycemic episode

if conscious: provide 15 g carbs recheck BG in 15 mins if normal, have protein snack if unconscious: administer IV glucagon

ICP range for children

infants: 1.5-6 young children: 3-7

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles extreme swelling severe pain severe crying Loss of sensation must intervene before 6 hours or irreversible damage

A nurse is reviewing the results of a lumbar puncture of a child. The nurse identifies which results as being abnormal? Select all that apply.

specific gravity of 1.011 cloudy in color granulocytes are present Normal appearance of cerebrospinal fluid (CSF) is clear and colorless. The presence of granulocytes suggests a cerebrospinal fluid infection. Normal specific gravity is 1.004 to 1.008. Trace amounts of protein, glucose, lymphocytes, and body salts are normal.

atonic seizure

sudden loss of muscle tone resulting in falling

When assessing a neonate for seizures, what would the nurse expect to find? Select all that apply.

tachycardia elevated blood pressure jitteriness ocular deviation

levothyroxine

thyroid replacement for hypothyroidism give 1 hr before meals w/ full glass of water

muscular dystrophy

types: Duchenne's: -most common -fatal, no cure, palliative care -age 7-12 lose ability to walk - wheelchair FT age 12 -short life span, death usually occurs in 20s -affects cardiac muscles as well -x-linked disease (recessive, males more likely to have it) Becker's: -age 2-16 yrs -less severe/fatal dx: ECG (to determine muscular, not nervous), creatine kinase, muscle biopsy, DNA testing (confirm) s/s: -muscle weakness -delayed motor movement - elevated creatine kinase (early) - + Gower's sign (falling forward, climbing) -waddling gait -walking on toes or balls of feet -calf pseudo-hypertrophy -early childhood: 3-6 yrs -late: respiratory failure, dilated cardiomyopathy, arrhythmias, swallowing difficulties -decreased self-esteem, depression, isolation treatment (palliative): -glucocorticoids: side effects weight gain, high blood sugar, osteoporosis -physical therapy to improve QoL -beta blockers, ACE inhibitors -calcium and vitamin D to prevent osteoporosis -antidepressants management: -minimal weight bearing to promote circulation, healthier bones, straight spine -passive stretching or strengthening exercises -standing walker -schedule activities when has most energy -deep breathing, coughing -encourage modified activity -respite care -genetic counseling

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions?

urine output

ADH

vasopressin aka regulates water balance constricts blood vessels

The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin?

within 15 to 30 minutes