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96 Cards in this Set
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s/s ICP
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Headache
Vomiting Mental status changes Irritability Fatigue |
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LOCs
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full
confusion (impaired decisions) disorientation lethargy obtundation (arousable w/ stim) stupor - remaining in deep sleep, slow or moaning response to vigorous stim. coma - no motor or verbal response or extension posturing to noxious stimuli PVS - perm. lost function of cerebral cortex. spastic limbs but can withdraw from painful stim. some groaning + crying, but no words. |
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when should medical attention be sought after head injury?
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if child loses consciousness or vomits more than 3 times.
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definition of concussion
+ 2 hallmarks |
an alteration in mental status with or without loss of consciousness, which occurs immediately after a head injury.
confusion and amnesia are hallmarks of concussion. |
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nursing management of closed head injury.
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ABCs
Observation Wake during night- vital signs,pupil checks Symptomatic treatment Fluid restriction, Hospitalization Pain management |
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the 3 major causes of brain damage in childhood
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falls
MVA bicycle injuries |
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3 stages of response to spinal cord injury
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1. spinal shock syndrome
Sudden disruption of central and autonomic pathways Flaccid paralysis below level of damage lasts 1-6 weeks 2. Spinal reflex activity returns Increased spasticity 3. Neurologic signs are stable. Can tell what has been lost Rehab stage |
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nursing/treatment of spinal cord injuries
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Stabilize the child to prevent further damage
-Traction -Neck collar -Steroids, initially -Respiratory -Cardiac -Temperature control -Skin care -Bladder/ bowel training -Education/ support -rehab |
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what is decerebrate posturing?
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Decerebrate posture is an abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly. This type of posturing usually means there has been severe damage to the brain.
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s/s bacterial meningitis
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Nuchal rigidity
Headache Fever Petechaie Photophobia Kernig/ brudzinski sign |
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what are kernig's sign and
brudzinski's sign? |
Kernig’s sign – hamstring stiffness – inability to straighten leg when hip is flexed 90 degrees.
Brudzinski sign – lifting of relaxed neck stimulates contraction of legs. |
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nursing considerations for bacterial meningitis
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Isolation room (droplet)
Monitor vital signs, urine output, neuro status, quiet environment, dim lighting Antibiotics, steroids, anticonvulsants, analgesics |
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nursing treatment of viral meningitis
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Symptomatic treatment
Neuro assessment Pain control |
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LP results in bacterial meningitis
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Bacterial meningitis:
High WBC count High neutrophils High protein Low glucose Clear color (normal color) |
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LP results in viral meningitis
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Viral Meningitis:
Normal to high WBC count High leukocytes Slightly high protein Normal glucose Clear or sl. cloudy |
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briefly describe encephalitis and common causes
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Inflammatory process of CNS
Caused by bacteria, fungi, viral, parasites Mumps, measles, varicella, herpes |
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s/s encephalitis
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Resembles meningitis (viral)
malaise Fever Headache Dizziness Lethargy Nuchal rigidity Seizures, disorientation, death |
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describe Reye Syndrome
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Metabolic encephalopathy
Fever, impaired consciousness, disordered liver function Follows viral illness (flu, varicella) Cerebral edema, liver changes Associated with aspirin therapy |
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nursing considerations for Reye syndrome
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Observation for signs of ICP
I & O Education/ support |
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describe epilepsy
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2 or more unprovoked seizures
Abnormal electrical discharge |
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causes of epilepsy
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Acute- head trauma, meningitis
Remote symptomatic- no immediate cause but previous brain insult Cryptogenic- no clear cause Idiopathic - can be genetic (these last two are synonyms) |
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what's the difference between simple partial and generalized seizures?
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Partial- local onset, small location in brain. No LOC, short duration. May not be noticed.
Generalized- involves both hemispheres. Tonic clonic. No warning LOC changes, eyes rolling, jerking movements |
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what is status epilepticus?
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a continuous seizure that lasts more than 30 min or a series of seizures from which the child does not regain a premorbid LOC.
risk of death - respiratory fail |
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3 possible causes of epilepsy
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birth trauma
infections idiopathic |
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describe complex partial seizures
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Over 3 years of age
Amnesia Inability to respond Impaired consciousness +/- aura |
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describe absence / petit mal seizures
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Ages 4-12
Girls> boys Brief LOC Abrupt onset Mistaken for daydreaming/ may go unrecognized |
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nursing management / treatment of seizure disorders
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ABCs
Medications Monitor/ safety Ketogenic diet (high fat, low carb) Vagus nerve stimulation (implantable device- over age 12, after med fails) Surgery (after med fails) |
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nursing care of myelomeningocele
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C-section delivery if possible
Surgical closure within 1-3 day after birth NS sterile dressings Positioning impt- prone pre surgery to minimize risk of trauma Diapering/ skin care issues |
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describe anencephaly
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Both cerebral hemispheres are absent
Incompatible with life Have some brain stem- die within hours or weeks |
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nursing care of hydrocephalus / vp shunt
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Observation/ monitoring
Head circumference Pre-op / post-op care Position on opposite side Flat lying Neuro assessment Abdominal distension Infection monitoring no contact sports. ever. sometimes helmet is worn. |
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#1 cause of pedi death?
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trauma
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childhood understanding of death by category:
infant toddler preschooler school-ager adolescent |
Infants: No understanding
Toddler: No understanding true concept Can’t separate temporary vs. permanent Preschooler: Magical thinking Bad thoughts cause death School-ager: Understands death is permanent Exaggerated concerns Adolescent: Better grasp of reality Sense of invincibility |
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barriers to quality care at the end of life.
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The realities of life limiting diseases
Lack of adequate training of professionals Delayed access to hospice/palliative care |
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definition of palliative care
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care that seeks to prevent, relieve, reduce, or soothe the symptoms produced by serious medical conditions or their treatment and to maintain patients’ quality of life.
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what is hospice?
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form of health care that provides palliative care across a variety of settings based on the philosophy that dying is a part of the normal life cycle.
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steps for breaking bad news (following MD talk)
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Find out what they know/want to know
Plan what to say/Use simple language Establish rapport Be sensitive/Respectful Control the environment Set aside time/Turn off pagers Overcome your own discomfort |
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euthanasia vs. assisted suicide
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Euthanasia – intentionally causing the death of a pt. for the purpose of relieving suffering. (active vs. passive)
Assisted suicide – pt. performs the act itself. |
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nursing interventions for death vigil
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Collaboration with physician/team
Reassurance and education Role model comforting Physical comforting Spiritual care; honor culture Rituals, memory making Decrease family interruptions |
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nursing care considerations following death
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Organ donor procedures
Other support (resources, organizations) Removal of tubes, equipment Bathing and dressing the child’s body Respect cultural preferences Compassionate/sensitive removal of the body Rigor mortis 2-4 hrs after death Special attention to siblings Assistance with calls, notifications Destroying medications Assisting with arrangements Initiating bereavement support Follow-up by HCPs Encourage to see child's doctor Follow-up phone calls Refer to support groups |
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most common type of birth defect?
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congenital heart disease
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3 perinatal circulatory changes
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Decreased pulmonary vascular resistance (PVR)
Vasodilation of pulmonary vessels Increased systemic vascular resistance (SVR) |
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3 shunt closures
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Ductus Venosus
Patent Foramen Ovale (PFO)- closes when pressure increases on left side of heart Patent Ductus Arteriosus (PDA)- closes with decreasing levels of prostaglandins and oxygen-filled blood flow |
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describe S1
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S1: closure of AV valves (tricuspid and mitral valves)
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describe S2
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S2: closure of semilunar values (aortic and pulmonic valves)
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describe gallop rhythm S3
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S3: ventricular gallop “Kentucky” heard right after S2, lower pitch
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describe gallop rhythm S4
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S4: atrial gallop “Tennessee” heard before S1
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incidence of murmurs in children
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almost 1/3 of children
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what kind of shunts are acyanotic?
what kind of shunts are cyanotic? |
left to right shunts are acyanotic.
right to left are cyanotic. |
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a shitload of congenital heart defect symptoms:
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Tachypnea
Tachycardia Cyanosis Clubbing Fatigue Murmur Ascites Diaphoresis Edema Pallor FTT Decreased/ Bounding pulses Hypoxemia Polycythemia |
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4 possible causes of HF
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1. Increased workload due to altered cardiac preload- too much volume returning to heart
2. Increased workload d/t altered cardiac afterload- too much resistance to blood leaving the heart 3. Impaired cardiac contractility or conduction- inefficient contraction 4. High cardiac output demands (fever, infection, prematurity, etc) |
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describe atrial septal defects
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- Hole in the atrial septum that
separates the right and left atria - Left to right shunt there are 3 types, differing in the location of the hole. - more common in girls. |
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describe VSD
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- Hole in the Ventricular Septum
- Left to right shunt - Most common form of CHD** (approximately 20% of cases) - VSD may be single or multiple and may occur in different parts of the ventricular septum. - Small holes usually close spontaneously in the first year or two of life. - Large holes almost always require surgical closure in the first year of life |
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2 symptoms of VSD
Medical treatment of VSD |
Symptoms:
- FTT - CHF Management: - Heart failure treatment until optimal timing for closure - Surgical closure (sutures or patch), PA band - Cardiac cath closure |
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Nursing care of VSD
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Increased metabolic needs (maximize calories, enteral feeds)
Maintain optimal fluid balance, diuretic therapy Diuretic management and fluid balance control |
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describe PDA
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Vessel connecting aorta to pulmonary artery in fetal circulation which remains open after birth allowing blood to flow from aorta into the pulmonary arteries
PDA is the failure of the ductus arteriosis to close within the first week(s) of life |
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2 possible symptoms of PDA
+ Medical Treatment of PDA |
Symptoms
Often loud, “machine-like” systolic murmur Can be asymptomatic - CHF symptoms Management - Medical closure: Indomethicin- a prostaglandin inhibitor Surgery: Ligation/division via thoracotomy or VATS Coil procedure in cardiac cath |
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Nursing Care of PDA
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Reduce non-cardiac energy requirement needs (environment, enteral feeds)
check apical pulse before giving digoxin. (don't want it to be less than 90-110) |
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which CHD is associated with Down's syndrome?
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atrioventricular canal.
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describe atrioventricular canal
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- Combination of defects involving malformations of the tricuspid and mitral valves allowing flow between all 4 chambers of the heart
- can also have additional defects like ASD and VSD |
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symptoms of AV Canal
Medical Treatment of AV Canal |
Symptoms
Murmur CHF symptoms (moderate to severe) Management: - PA banding (if <5kg or other comorbidities) - Surgery: valve repair or replacement and patch closures of ASD/VSD |
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2 nursing considerations for AV Canal
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Diuretic management
Feeding difficulties (trisomy) |
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describe coarctation of the aorta
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Obstructive defect (like stenosis)
Localized narrowing or shelf-like obstruction of aorta resulting in increased pressure proximal to defect and decreased pressure/blood flow distal to obstruction - Types: Pre-ductal (PDA supplies blood) and post-ductal (decreased blood flow to descending aorta) In some cases, the aortic valve (AV) is abnormally formed in this defect, with only two valve leaflets rather than the usual three (Bicuspid Aortic Valve). |
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s/s coarctation of the aorta
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Decreased pulses, BPs, temp in affected extremities
Bounding pulses and increased BPs in opposing extremities CHF symptoms May be hemodynamically unstable and deteriorate rapidly Older children may have dizziness, headaches, fainting |
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Medical Management of Coarctation of aorta
+ Nursing Considerations for Coarctation of aorta. |
Management
Surgery: Resection of defect with end-to-end anastamosis- usually recommended in first 1-2 years of life Cardiac cath: balloon angioplasty Nursing Considerations 4 extremity BPs and pulse checks Skin assessment Post-surgical care |
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describe tetralogy of Fallot
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Most common cyanotic heart defect
beyond infancy 4 defects (tetralogy) 1) Large VSD 2) A narrowing (stenosis) of the outflow tract from the RV into PA 3) Large and overriding aorta (sits above VSD) -right sided aortic arch is present in 4) Right ventricular Hypertrophy |
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symptoms of Tetralogy of Fallot
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Symptoms
Tet spells (acute hypoxia with syncope) Cyanosis (as PS worsens with age) FTT |
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medical treatment of TOF
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Management
Surgery within 1st year of life/ with increased symptoms: VSD closure and PS repair - TET/PA- palliative repairs |
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Nursing Treatment of TOF
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Tet spell management: morphine, oxygen, knee-to-chest position, calming
Reduce environmental stressors Post-operative care |
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tetralogy of fallot mnemonic
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IHOP
Interventricular septal defect (VSD) Hypertrophy of right ventricle Overriding aorta Pulmonary stenosis |
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describe transposition of greater arteries
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Aorta and pulmonary arteries are connected to the wrong chambers of the heart
More common among males, affecting 3 boys to every 1 girl This defect will require surgery usually in the first week of life side 3: symptoms and medical treatment Associated defects must be present to permit blood to enter systemic or pulmonary circulation (i.e. PDA, VSD) |
Symptoms:
Cyanosis (if minimal communication between ventricles) CHF (with large defects) Management: Prostaglandin E to keep PDA open (to maintain oxygenated blood) Balloon Atrial Septostomy (BAS) via cardiac cath Surgery: Arterial Switch Operation (ASO) |
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describe hypoplastic left heart syndrome
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Small and functionally inadequate left ventricle of the heart
Features: 1. Atretic or Stenotic Mitral Valve 2. Atretic or Stenotic Aortic Valve 3. Hypoplastic Left Ventricle 4. Hypoplastic Ascending Aorta 5. Coarctation of the Aorta 6. Atrial Septal Defect |
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symptoms and medical management of hypoplastic left heart syndrome
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Symptoms
CHF symptoms Cyanosis FTT Management Palliative surgeries (3) First one often in first weeks/days of life Often require heart transplants side 3: nursing considerations for hypoplastic left heart syndrome |
EDUCATION! Lifelong symptoms and surgical/medical management
CHF management Fluid balance (accurate weights/ I + Os) Nutrition needs Meeting coping/support needs |
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describe total anomalous pulmonary venous return (TAPVR)
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Pulmonary veins (PV), are "anomalous," or abnormal with respect to how they return to the heart. Varying forms
Red blood from the lungs being carried by the pulmonary veins back to the right side of the heart rather than to the left atrium (LA), To get to the body, blood must cross through an ASD In the most common form of this defect (shown in the diagram), the pulmonary veins (PV) are connected by a vessel to the superior vena cava |
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symptoms and medical management of TAPVR
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Symptoms
- Cyanosis (inversely r/t degree of pulmonary blood flow) - CHF r/t increased pulmonary blood flow Management - Surgery in infancy (ligate anomalous connection, close VSD, anastomosis of PV to left atrium snowman appearance on CXR |
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nursing care of the cardiac surgery pt.
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Fluid balance
Respiratory status Chest tube management Monitor for arrythmias Pain control Infection control Bowel regimen Wound care Nutrition (increased calories) Education (wound care, medications, warning sx) Distraction! Coping strategies, preparation |
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post-cardiac cath care
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Blood pressure monitoring
Frequent pulse checks Monitor for bleeding, clot Accurate I + Os Monitor mental status Pain control Wound care no bending at the waist. bedrest. |
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what 2 things should you know about giving digoxin?
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apical pulse for 1 min, don't give if outside parameters
digitalis toxicity - mental status changes, visual disturbances. |
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how does digoxin work for afib?
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By slowing down the conduction in the AV node and increasing its refractory period, digoxin can reduce the ventricular rate. The arrhythmia itself is not affected, but the pumping function of the heart improves owing to improved filling.
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symptoms of kawasaki's disease
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Fever
Bilateral conjunctivitis (very red) Erythematous rash Cervical lymphadenopathy Irritability Changes in peripheral extremities - reddening/peeling of palms and soles of feet, non-pitting edema Changes in mucous membranes - strawberry tongue, erythema/fissuring of lips |
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treatment of kawasaki's disease
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IV Ig - 2g/kg once
Salicylate (ASA) therapy: 80-100mg/kg/day while febrile, then 3-5mg/kg/day. Long term ASA therapy. side 3: nursing considerations |
Cool baths, skin/mouth care
Fever reduction Cardiac assessment, signs of CHF Fluid balance |
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describe kawasaki disease
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Kawasaki disease (KD), also known as Kawasaki syndrome, lymph node syndrome and mucocutaneous lymph node syndrome,[1] is an autoimmune disease in which the medium-sized blood vessels throughout the body become inflamed. It is largely seen in children under five years of age. It affects many organ systems, mainly those including the blood vessels, skin, mucous membranes and lymph nodes; however its rare but most serious effect is on the heart where it can cause fatal coronary artery aneurysms in untreated children. Without treatment, mortality may approach 1%, usually within six weeks of onset.
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describe rheumatic fever
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Inflammatory disease that may develop after an
infection with Streptococcus bacteria (such as strep throat or scarlet fever) It can affect the heart, joints, skin, and brain Mainly affects children ages 6 -15, and occurs approximately 20 days after strep throat or scarlet fever |
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s/s rheumatic fever
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Fever
Arthritis (mainly in large joints) Skin rash (erythema marginatum) Skin nodules Carditis- heart inflammation (50% of cases) Chorea: abnormal movements (rapid, jerky) |
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med treatment of rheumatic fever
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Antibiotics (effective for strep)
Anti-inflammatory medications (NSAIDS, corticosteroids) Management of cardiac symptoms Low-dose long-term antibiotic prophylaxis side 3: possible complications of rheumatic fever |
Arrhythmias
Damage to heart valves (in particular, mitral and aortic stenosis) Endocarditis or Pericarditis Heart failure |
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risk factors for leukemias
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Congenital anomalies (Down’s)
Immunodefienciency Hx of cancer/ treatment Chemical agents viruses |
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s/s childhood cancers
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Recurrent fever
Morning headache with vomiting Lump in neck White dot in eye or vision changes Swollen face and neck Mass in abdomen Pallor and fatigue Limping Bone pain Vaginal bleeding Weight Loss Loss of energy Bruise easily |
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def of neuroblastoma
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It is a neuroendocrine tumor, arising from any neural crest element of the sympathetic nervous system or SNS. It most frequently originates in one of the adrenal glands, but can also develop in nerve tissues in the neck, chest, abdomen, or pelvis.
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Rhabdomyosarcoma
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cancerous tumor of the muscle
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what is a wilm's tumor?
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cancer of the kidney
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2 types of leukemias
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Acute lymphocytic (ALL) & Acute Myelogenous (AML)
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s/s ALL
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Fatigue, pallor, tacycardia
Fever, bruising, bleeding, bone pain Lymphadenopathy Anorexia Dyspnea irritability |
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clinical findings of hodgkin's lymphoma
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Prolonged onset
50% with mediastinal mass Firm, non-tender lymph nodes Systemic: anorexia, night sweats, unexplained fevers, often a rash/itching |
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clinical findings of non-hodgkin's lymphoma
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Rapid presentation
35% with abdominal mass: cramping, distention, ascites, N/V 50-70% with mediastinal mass and pleural effusions: pain, dysphagia, dyspnea, swelling neck |
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clinical findings for wilm's tumor (nephroblastoma)
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Abdominal mass most common presenting symptom
Firm, non-tender Hematuria HTN, vomiting |
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s/s retinoblastoma
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Malignant congenital tumor of embryonic retina
80% diagnosed <3 years White spot on eye (leukocoria) Strabismus Esotropia (eyes turning in) Exotropia (eyes turning out) |
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treatment for stomatitis (+ what's in it)
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Magic mouthwash - Lidocaine, benadryl, maalox
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