Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
221 Cards in this Set
- Front
- Back
|
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
|
