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221 Cards in this Set

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Describe an isolated seizure?
a seizure that must have and immediately follows a precipitating factor such as a car accident, etc
How are the causes of seizure disorders categorized?
by idiopathic and acquired
Which category, idiopathic or acquired, encompasses most of the seizures?
idiopathic
Explain an idiopathic cause of a seizure
over 3 year, no known cause, strong genetic component
Explain an acquired cause of a seizure
Less then 2 years, highest incidence time in childhood, birth injuries, hypoxia, hemorrhage, congenital defects, acute infections
Explain a partial seizure
a seizure that effect only one part of the brain
explain what is happening during a tonic clonic seizure
LOC, no memory of seizure, stiffening phase, jerking phase, and ictal phase
explain an absence seizure
not hearing, not aware of surrounding (daydreaming look for example) Usually happens between the ages of 4 and 14
explain an atonic seizure
just falls to the ground with no warning
explain a myoclonic seizure
small amount of seizure on one side
During a partial seizure, how will your pt. react?
it depends on the area of the brain that is affected
What is happening to the pt. during a simple partial seizure?
the patient does not lose consciousness, has a memory of the event
What is happening to the pt. during a complex partial seizure?
pt. loses consciousness, has no memory of the event
explain a myoclonic jerk
sudden brief contracture of a muscle group, no postical state
What is the most common age for febrile seizures?
18 months
Are antipyretics helpful in prevention of seizures?
NO
Why are seizure medications not recommended?
because the harmful side effects outweigh the positive effects
Why is it important to have a developmental assessment on your seizure patient?
because many of the seizures are related to a poor cognitive outcome
What type of neurologic exam should you perform?
deep tendon reflexes
What is the most common seizure trigger?
failure to take medication
Are antipyretics helpful in prevention of seizures?
NO
What are some common seizure triggers?
stress, lack of sleep, illness or fever, fatigue
What are some common side effects of seizure medications?
drowsiness, irritability, nausea, clumsiness, rash, learning disabilities, organ effects (liver) over time
Why are seizure medications not recommended?
because the harmful side effects outweigh the positive effects
What are some types of therapeutic management for seizures?
medication, vagal nerve stimulation, ketogenic diet
If your pt. is having a seizure what position should you place them in?
on their side to help prevent an ineffective breathing pattern
Why is it important to have a developmental assessment on your seizure patient?
because many of the seizures are related to a poor cognitive outcome
What is status epilepticus?
one seizure lasting 30 minutes or a series of seizures from which the child does not regain consciousness
What type of neurologic exam should you perform?
deep tendon reflexes
What is the most common seizure trigger?
failure to take medication
What are some common seizure triggers?
stress, lack of sleep, illness or fever, fatigue
What are some common side effects of seizure medications?
drowsiness, irritability, nausea, clumsiness, rash, learning disabilities, organ effects (liver) over time
What are some types of therapeutic management for seizures?
medication, vagal nerve stimulation, ketogenic diet
If your pt. is having a seizure what position should you place them in?
on their side to help prevent an ineffective breathing pattern
What is status epilepticus?
one seizure lasting 30 minutes or a series of seizures from which the child does not regain consciousness
Which has a better prognosis: decerebrate or decorticate?
decorticate
What does it mean if your pt has fixed pupils for greater than 5 minutes?
mean brain dysfunction and is a neurological emergency
What would you be observing if your patient has a visible CSF leak?
fluid will be coming out of the ears
If your infant pt. is experiencing increased cranial pressure what type of s/s might you observe?
tense or bulging fontanel, separated sutures, incr. head circumference, high pitched cry, distended scalp veins, irritability, "setting sun eyes"
What are some LATE signs of increased intracranial pressure?
decreased LOC, fixed, dilated pupils, papilledema, Posturing, irregular respirations, incr. systolic blood pressure with wide pulse pressure, bradycardia
What is Cushing's Triad?
sign of brain herniation (increased pressure area to a decreased pressure area)
What is a concussion?
a mild brain injury resulting from a direct blow to the head resulting in physiological changes in brain function
How long can a concussion last?
minutes to hours
What can a concussion possibly be followed by?
amnesia and confusion about the injury and time after it, vomiting, sleepiness, racoon eyes
How long after a concussion could your pt. experience bleeding complications?
up to 48 hours later
What can happen if someone experienced a second concussion before complete recovery from the first?
acute brain swelling, cognitive impairment, death
What is meningitis?
inflammation of the meninges and spinal nerves
What can meningeal inflammation cause?
headaches, cerebral edema, incr. intracranial pressure
What can spinal nerve inflammation cause?
stiff neck (meningismus)
How are newborns infected by bacterial meningitis?
vertically - through the birth canal during birth
Horizontally - nursery personnel or home caregivers
At what age do most cases of meningitis occur and why?
in children under 5 years old because they have a lowered immune system (haven't rec. vaccines yet)
What are some of the s/s of bacterial meningitis?
abrupt onset of fever, chills, headache, vomiting, stiff neck, Kernig and Brudzinski signs, cyanotic extremities, stupor, seizures, coma, concurrent pneumonia, petechiae and/or purpuric rash, arthritis
What is a Kernig sign?
inability to straighten leg/hip to 90 degrees
What is a Brudzinski sign?
severe neck stiffness (when you raise head from bed/table the knees come up)
What is the causative agent for meningococcemia?
n. meningitidis
How is meningococcemia spread?
spread by droplet from nasopharynx whre it colonizes and then spreads to the bloodstream, then to joints, meninges or disseminates through the body
What things can increase a persons risk of becoming infected with meningococcemia?
kissing, smoking, close contact
What are the three presentations of N. Meningitidis?
meningitis, meningitis + meningococcemia and meningococcemia
What test is needed to confirm a diagnosis of meningitis?
lumbar puncture
Is most meningitis viral or bacterial?
viral, 90% of all meningitis is due to enteroviruses in the summer/fall months
What test are done to diagnose menengitis?
CSF - culture and gram stain
WBC count and differential
glucose and protein levels
blood culture
lumbar puncture
What are some interventions for your pt. with meningitis?
respiratory isolation
IV antibiotics
mannitol for cerebral edema
dexamethasone
anticonvulsants/sedatives
antipyretics
Why would the Dr. prescribe dexamethasone (steroid)?
to decrease inflammation caused by the breakdown of bacteria
When can you remove your pt. from respiratory isolation?
once meningitis is ruled out and/or after 48 hours of antibiotics
How would you position your meningitis pt. in order to prevent an increase of intracranial pressure?
30 degree elevation of HOB
What causes bacterial meningitis in neonates and what meds do we use to treat it?
group B strep, treated with ampicillin and cefotoxime
What causes bacterial meningitis in infants age 1-3 months and how is it treated?
s. pniemoniae - vancomycin
H. influenenzae type b - cefotaxime
n. meningitidis - ampicillin and cefriaxone
What is encephalitis?
inflammation of the brain tissue
What is a diagnosis of encephalitis based on?
Presence of brain dysfunction
generalized and/or focal clinical presentation
Clinical evidence of inflammation
fever, abnormal CSF or blood
If your encephalitis pt. also presents with meningeal signs what would you suspect?
that they also have meningoencephalitis
What does meningoencephalitis mean?
that there is meningeal and brain inflammation together
What is the most common cause of encephalitis?
herpes simplex and enteroviruses
Are most cases of encephalitis viral or bacterial?
viral
What is an example of a bacterial encephalitis?
Bordatella - cat scratch disease
What do you assume all encephalitis cases are until proven otherwise?q
caused by herpes simplex
How would you diagnose herpes encephalitis?
focal presentation (seizures), focal changes on MRI, CT and/or EEG, HSV cultured from CSF
As the nurse, what could you do for your pt with encephalitis?
help keep fluid and electrolyte balance maintained, elevate head of bed 30 degrees to help control ICP, Nursing care the same as for meningitis
What is the cause of poliomyelitis?
highly infectious poliovirus
How is poliomyelitis spread?
fecal-oral spread
Explain what happens when a person has poliomyelitis
the poliovirus multiplies in the intestines, incubates for 7 - 14 days and is then excreted in feces for up to 6 weeks
If your pt has poliomyelitis, what could happen within hours of the virus invading the CNS?
total paralysis
Explain the pathology of poliomyelitis
from the intestines the virus goes to the bloodstream to the CNS and is spread among the nerve fibers. It destroys the motor neurons (what makes muscles work) so the muscle can't function
Can motor neurons regenerate?
no
What does Bulbar polio effect?
the brain stem and breathing
What are rabies and how do you catch it?
an acute, deadly viral infection of the CNS
You catch it when you come in contact with the saliva of warm-blooded, rabid animals (bites, saliva through open cuts, close contact)
How is rabies treated?
With HRIG (human rabies immune globulin) followed by HDCV (huan diploid cell vaccine)
How must the rabies injection be given?
intramuscularly
What are some of the symptoms of rabies?
reslessness, dilated pupils, incr.salivation, hypersensitivity to certain stimuli, irrational excitement (1st week of s/s), hydrophobia
If your pt with rabies survives the excitement stage, what can you expect to happen?
progessive paralysis, paralysis from the legs upward
What is Reye syndrome?
a rare metabolic disorder characterized by hepatic dysfunction and encephalopathy including cerebral edema with incr. ICP and hyperammonemia
What is Reyes syndrome especially associated with?
aspirin therapy during influenza and chicken pox
What type of medication do you NOT give your pt with Reyes syndrome?
aspirin
If you have a pt. who requires chronic aspirin therapy what must your pt. have every year?
influenza vaccine
When is the difference between a meningocele and a myelomeningocele?
meningocele: only the meninges are protruding
myelomeningocele: meninges and the spinal cord are protruding
What are some co-morbidities of spina bifida?
hydrocephalus, spinal curvatures, skin breakdown, greatly increased risk for latex allergy, bladder and bowel dysfunction, renal involvement from urinary retention and sexual dysfunction
How is spina bifida diagnosed pre-natally?
maternal alpha-fetoprotein, U/S, amniocentesis
How is spina bifida diagnosed post natally?
U/S, MRI, CT of spinal column
How would you position your pt. who is preparing for surgery for spina bifida?
in warmer, prone position without diaper, legs abducted, hips flexed to decrease tension on sac, lesion covered with vaseline or sterile, wet gauze (dressing changes q2-4h)
How should you care for your pt who has just had surgery for spina bifida?
prone until wound heals, gentle range of motion exercises, assess for infection or meningitis, daily head circumference(hydrocephalus)
Which has a better prognosis, a pt. with decorticate or with decerebrate?
decorticate (arms inward towards the body)
What would be some s/s that an infant is experiencing Increased Intracranial pressure?
tense or bulging fontanel, separated sutures, incr. head circumference, high pitched cry, distended scalp veins, irritability, "setting-sun eyes"
What would be some s/s that a child is experiencing incr. ICP?
headache, vomiting, seizures, diplopia (double vision)
What are some LATE signs of incr. ICP?
decr. LOC, fixed, dilated pupils, papilledema, posturing, Cushings triad (irreg. respirations, incr. systolic blood pressure with wide pulse, bradycardia)
What is Cushing's Triad a sign of?
brain herniation
What are some main causes of head injuries in children?
falls, MVA, bicycle injuries, abuse, contact sports
What is a concussion?
a mild brain injury resulting from a direct blow to the head resulting in physiological changes in brain function
How long can a concussion last?
from minutes to hours
What is a concussion followed by?
amnesia and confusion abouth the injury and time after it, vomiting, sleepiness, raccoon eyes (dark circles)
If your pt. suffers from a concussion, how often should you advise the parents to monitor for neurological issues?
every two hours as progression of symptoms. Even through the night
What are some s/s of a UTI in children?
fever (could be the only sign), dysuria, frequency, urgency, flank pain, enuresis, incontinence, hematuria, proteinuria, glucosuria, casts, increased BP, edema
What are some s/s of an upper UTI?
abdominal pain, unexplained fever alone, sepsis, vomiting, maybe diarrhea, dysuria, frequency, incontinence, foul smelling urine
What does a fever with a UTI indicate in a child?
kidney involvement
What are some anatomic factors that could be a factor in getting a UTI?
short urethra in females, un-circumcisions in males
What are some causes of urinary stasis?
Holding urine in, constipation, neurogenic bladder, VUR
What happens when the pH in urine goes below 5?
it inhibits growth of bacteria
What is the primary cause of a UTI?
E. coli
What is vesicoureteral reflux?
abnormal retrograde flow of bladder urine into the ureters from the bladder
What is the #1 cause of renal scarring?
VUR with UTI
How do we treat a low grade VUR?
with daily low dose antibiotics
How would we treat a high grade VUR?
with surgery
What are some ways to help prevent a UTI?
voiding schedule, double voiding, wiping properly, control of contipation, liberal fluid intake
What is the most common type of nephrotic syndrome in children?
Minimal Change Nephrotic syndrome
Explain Hypoalbuminemia
causes fluids to shift from plasma to interstitial space causeing edema, and into body cavities causing ascites
How does the body correct hyperlipidemia?
the liver increases synthesis of lipoprotein to correct it
What does it mean when you detect casts in your pts urine?
indicates that there is kidney involvement
What are some management goals when it comes to Nephrotic syndrome?
decrease urinary excretion of protein, decr. fluid retention, prevent infection, minimize complications of treatment
What is the mainstay treatment for a pt with Nephrotic syndrome?
corticosteroids (prednisone)
If your pt is on corticosteriods for Nephrotic syndrome, what do you need to monitor for closely?
infection, cushingoid wt. gain and "moon face", GI bleeding, hypertension
If the corticosteroids are not working for your pt. with nephrotic syndrome, what is your next choice of treatment?
immunosuppressants
What is the best indicator of fluid retention?
daily weights
What is Acute Glomerulonephritis?
inflammation of the glomerular capillaries
What is the most common postinfectious cause of AGN?
Acute Post Streptococcal glomerulonephritis
What are some risk factors when it comes to AGN?
high protein, high sodium diets, nephrotoxic medications, DM
What type of disease is AGN?
an immune complex disease
If AGN is untreated, what can it lead to?
renal failure
Is AGN more common in boys or girls?
boys
What are some clinical symptoms of AGN?
Healthy with an abrupt onset, edema, SOB, dyspnea, basilar rales, acute hypertension (typical), H/A, encephalopathy, seizures can occur
In AGN, how does the edema manifest itself?
it starts in the periorbital/facial region in the AM and then to the extremities later in the day
What are some s/s of AGN?
gross hematuria, tea colored urine w/o bacteria, incr. BUN, incr. creatinine, decr. creatinine clearance, incr. WBC, incr. SED rate
What is the best way to diagnose APSGN?
ASO titer
What are some nursing interventions for your AGN pt?
decr. salt, fluid restiction if incr. BP or edema, decr. potassium with oliguria, strict I/O, vital signs q 4-6 hrs, daily weights
What is the most frequent casue of acquired acute renal failure in children?
Hemolytic-uremic syndrome
What is the most frequent cause of acquired acute renal failure in children?
Hemolytic Uremic syndrome
What are some of the ways that a child can get Hemolytic Uremic Syndrome?
Petting Zoo's, undercooked hamburger, alfalfa sprouts, lettuce, unpasteurized milk or apple juice
What bacteria is linked to Hemolytic Uremic Syndrome?
E. coli
What is the triad of symptoms used to diagnose Hemolytic Uremic Syndrome?
1. hemolytic anemia
2. thrombocytopenia
3. renal failure
When would they perform dialysis on a pt. with Hemolytic Uremic syndrome?
if the pt. goes 24 hours without urinating (anuria), if they have oliguria with uremia, hypertension or seizures
When a person is in renal failure it means that the kidneys are unable to......?
1. excrete waste
2. concentrate urine
3. conserve electrolytes
What is azotemia?
accumulation of nitrogenous waste in the blood without symptoms
What is uremia?
azotemia which produces toxic symptoms (anorexia and lethargy leading to altered mental status and coma
What is ACUTE renal failure?
SUDDENLY unable to regulate the volume and composition of urine appropriately
What are the principle signs of oliguria?
azotemia, metabolic acidosis, electrolyte disturbances
What lab test would you look at in a pt. with acute renal failure?
BUN, serum creatinine, pH, Na, K, Ca
What are some nursing interventions for your pt. with acute renal failure?
accurate I/O, frequent weights, frequent labs, electrolytes,montitor pH, BUN, creatinine
What complication from acute renal failure is the most immediate threat to your pt. life?
Hyperkalemia
What treatment might you give your pt. who is experiencing Hyperkalemia as a result of acute renal failure?
Kayexalate orally or rectally
What are some complications that can result from acute renal failure?
Hyperkalemia, Hypertension, anemia, seizures, cardiac failure
What complication of ARF is almost always associated with hypervolemia?
cardiac failure
Describe Chronic renal failure
destruction of renal mass with irreversible sclerosis and loss of nephrons leading to a progresive decline in GFR
What are some causes of CRF?
congenital renal or urinary tract malformations, vesicoureteral reflux w. recurrent UTI's, chronic pyelonephritis, systemic lupus erythmatous glomerulonephritis
What are some manifestations of CRF?
edema, anemia, hyperkalemia, incr. BUN/creatinine, metabolic acidosis, calcium and phosphorus disturbances, growth disturbances, renal osteodystrophy
What type of diet would you instruct your CRF pt. to follow?
one with sufficient calories and protein for growth without taxing the kidneys, RDA of protein ok as long as there is no increased phosphorus levels, low sodium if pt. has edema or high BP
Why would you be concerned if your CRF pt. has an increased phosphorus level?
because too much phosphorus prevents the absorbtion of calcium in the body
How would you manage your CRF pts. decreased production of erythropoietin in the kidneys?
with procrit or epogen three times a week until the pts. Hgb is greater than 12-13
What could happen to your CRF pt. if their Hgb becomes to high?
they could be at risk for a stroke
How would you control your CRF pts. hypertension?
limit fluids and salt, antihypertensives, diuretic medications as needed
What is osteogenesis imperfecta?
genetic defect affecting type 1 collagen formation
What are some clinical features of osteogenesis imperfecta?
bone fragility of varying degrees, blue sclera, congenital hearing loss, dentinogenesis imperfecta
What are some way that you can prevent a fracture in a child with osteogenesis imperfecta?
never hold by their ankles to change diapers, realistic activities based on degree severity, genetic counseling
One good sign that could help in your diagnosis of osteogenesis imperfecta would be?
there is a fx but no soft tissue damage
What is a contussion?
tearing of the tissues (soft tissue, subQ structures and muscles) and small blood vessels plus inflammation lead to bleeding, edema and pain
What are myositis?
deep contusions of muscles
What is a dislocation?
great stress on ligament so bone is displaced
What is the #1 injury in children less than 5 yrs. old?
nursemaids elbow - elbow dislocation caused by yanking the childs arm
What is a sprain?
ligament is stretched or torn, damage to blood vessels, muscles, tendons, nerves
What is a strain?
microscopic tear in the muscle/tendon
What are some of the s/s of a sprain?
with or without pain, swelling and disuse occur quickly, the more sever the sprain the more lax the effected joint will be
What does ICES stand for?
Ice, compression, elevation, support
What is the most common site for a fx in children under 10?
Why?
the clavical
- outstretch arm to break a fall
- large neonate, small maternal pelvis (sometimes the dr. must break the clavical to get the baby out)
Why is it a problem when a child fx the epiphyseal or physeal plate?
because this is where the bone grows, the "growth plate"
What observations would you be concerned about in your pt. who has just been placed in a cast?
pain, pallor, pulselessness, paresthesia(tingling, pin prick sensation), paralysis
What is idiopathic scoliosis?
lateral curvature of the spine with spinal rotation causing rib asymmetry and thoracic hypokyphosis
What are the s/s of LCP?
(can be constant or intermittent) limp on the effected side, pain or ache, soreness, stiffness or hip, Pain felt in the hip, thigh or knee
What test can give a definative diagosis of LCP?
MRI because it shows osteonecrosis
What is the primary goal of therapy for LCP?
keep the head of the femur contained in the acetabulum
What are some therapy options for a child with LCP?
wide abduction traction, ambulation, casting 4-6 weeks or bracing, surgery
Explain wide abduction traction
it relieves spasms, stretches contractures and restores hip motion
What are the two types of traction?
skin tractions and skeletal traction
What are some nursing considerations that you would have for your pt. in traction?
prevent skin breakdown and prevent complications
What are some ways that you can help to prevent complications for your pt. in traction?
have them use their incentive spirometor, check pulses of both extremities, check under bandages for sores, check color, sensation changes, swelling, new pain, report and chart neurovascular changes immediately
What is happening when your pt. has slipped femoral capital epiphysis?
the epiphysis of the femur slips off in a posterior direction
Who is more likely to have Slipped femoral capital epiphysis and at what age?
boys between 10-16 yrs.
What are some pre-operative treatment options for slipped femoral capital epiphysis?
bedrest, traction, crutches BUT NO WHEELCHAIR
How soon should a child have surgery following a diagnosis for slipped femoral capital epiphysis?
within 24-48 hours NO WAITING
What are some complications of slipped femoral capital epiphysis?
avascular necrosis of the femoral head, condrolysis (loss of joint cartilage in hip), stiff hip, permanent loss of motion of the hip, contractures, chronic pain
What is septic arthritis?
hematogenous (through blood) spread of bacteria to the joint
Who is more likely to get septic arthritis?
adolescent males but sometimes infants too.
What are some s/s of septic arthritis?
SUPERFICIAL JOINTS are swollen, warm and very painful to move
DEEP-SEATED JOINTS are less obvious but joint stiffness can be present after trauma with fever
What are some ways to help manage septic arthritis?
aspiration for drainage and culture and sensitivity, long term antibiotic therapy (3-6 weeks),
When is septic arthritis considered a medical emergency?
when it is in the hip - need to protect femoral head from decreased blood supply
What is osteomyelitis?
infection of the bone
Who does osteomyelitis usually effect?
younger children and elderly, boys more than girls
What are the risk factors of osteomyelitis?
only sickle cell disease
What are the most common sites for osteomyelitis?
tibia and femur
What is a common complication of septic arthritis?
osteomyelitis
How would you diagnose osteomyelitis?
pt. hx, lab tests, MRI over xray or CT
What are some therapy option for your pt. with osteomyelitis?
antibiotic therapy against Staph Aureus until cultures are known, surgery if indicated
What is some nursing care that you would administer during the acute phase of osteomyelitis?
support limb, minimixe its movement, no weight bearing, casting(maybe), pain control, frequent VS, antibiotic compatability, labs, if open wound put on contact isolation, assess for color, swelling,heat and tenderness
What is some nursing care that you would administer during the post acute phase of osteomyelitis?
con't no weight bearing to decr. risk of fx of affected bone, encourage activities, wheelchair, assist with physical therapy
What type of disease is Juvenile idiopathic arthritis (JIA)?
autoimmune inflammatory disease
What does JIA do?
chronic inflammation of the synovium with joint effusion -
causes joint and other tissue inflammation
What are the two peaks of onset for JIA?
1-3 years of age
8-10 years of age
Explain pauciarticular onset of JIA
it effects 4 or fewer joints and the pt. is more at risk for iridocyclitis (vision)
Explain polyarticular onset in JIA
effect more than 4 joints
Explain systemic onset in JIA
high fevers, rash, HSM, pericarditis, pleuritis, lymphadenopathy, variable arthritis
How is JIA diagnosed?
by exclusion
Criteria includes:
age of onset less than 16
arthritis in greater than/= to one joint for greater than/= 6 weeks
exclusion of other diseases
What are the goals of the treatment for JIA?
control pain
minimize effects of inflammation
preserve joint function and range of motion
promote normal growth and development
What are some medications used in the treatment of JIA?
NSAIDs (naproxen, ibuprofen, tolmectin), Methotrexate, corticosteroids (worse case scenerio only)
What medication for JIA would you use when NSAIDs don't work and what should you monitor your pt. for?
methotrexate

monitor liver function, CBC because this med can cause bone marrow suppression
What medication for JIA is used when Methotrexate fails?
Etanercept (enbrel)
What are some nursing considerations for your pt. with JIA?
pain control, use of HEAT, compliance (meds, visits, etc), promotion of general health