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82 Cards in this Set

  • Front
  • Back
What is talipes varus?
What is talipes varus?

- Congenital clubfoot with inversion of feet, toes pointed toward midline.

- Talipes equinovarus (most common) is plantar flexion, where feet are bent inward
S/S of scoliosis?
S/S of scoliosis?
- Scoliosis is characterized by a lateral curvature of the spine and spinal rotation that causes rib asymmetry
- Idiopathic or structural scoliosis is the most common form of scoliosis
- Idiopathic scoliosis can be congenital, idiopathic, or acquired (result of neuromuscular disorders)
- Idiopathic scoliosis may be present at birth or occur in early childhood. Onset usually occurs during the preadolescent growth spurt.
- Idiopathic scoliosis may have a genetic link
- Asymmetry of scapula, ribs, flanks, shoulders and hips.
- Improperly fitting clothing (one leg shorter than the other)
- Preadolescence screening for boys and girls
- Observe the child, who should be wearing only underwear, from the back.
- Have the child bend over at the waist with arms hanging down and observe for asymmetry of ribs and flank
- Diagnosis is made using x-rays of the child in a standing position from the neck to the groin and determining the angle of curvature using the Cobb technique with a scoliometer
How is scoliosis treated?
How is scoliosis treated?
- Mild scoliosis (curvature of 10 to 20 degrees) is treated with bracing and exercise to maintain strength and to maintain muscles of the abdomen and spine.
- Monitor for signs of skin breakdown in the child wearing a brace.
- Monitor adherence to therapy.
- Reinforce that the brace will not correct the curve but will help to stabilize it until growth is completed.
- Suggest decorating the brace to encourage acceptance by adolescents
- Instruct the child and family about the importance of adherence. Instruct the child to wear the brace 23 out of 24 hours a day.
- Reinforce the need to exercise along with the use of the brace.
- Reinforce the need to assess skin for breakdown.
- Educate the child and/or family to have the child wear a cotton t-shirt under the brace and to avoid the use of powders and lotions
- Surgery is generally needed for curves greater than 40 degrees
- A type of internal fixation system (Harrington, Dwyer, Zielke) may be used to straighten and realign the spine along with a bony fusion to stabilize the correction.
- Repair is performed from either an anterior and/or posterior approach.
- May need blood during procedure
- The goal of repair is to achieve maximal correction and maximal mobility with minimal complications
- Tx for mild (10-20 degrees) is bracing and exercises. Curves greater than 40 degrees may require surgery with internal fixation devices.
Psychosocial issues with girls who have scoliosis?
Psychosocial issues with girls who have scoliosis?
- Disturbed body image as most braces worn are too bulky to hide under clothes
- Body image – Self esteem
Describe the use of the Milwaukee Brace?
Describe the use of the Milwaukee Brace?

- A scoliosis brace worn that is full torso and extends from the pelvis to the base of the skull with a neck ring
- The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children. It is a full-torso brace that extends from the pelvis to the base of the skull.
- This brace is normally used with growing adolescents to hold a 25° to 40° advancing curve. The brace is intended to minimize the progression to an acceptable level, not to correct the curvature. For corrective measures, special exercises or physical activities are used. If the curvature continues despite the brace, surgery may be required.
- The Milwaukee brace is often prescribed to be worn 23 hours a day for several years, or in some cases, permanently.
- A related brace is the Boston brace (underarm brace, also known as a thoraco-lumbo-sacral orthosis, or TLSO), which is more commonly used for scoliosis. That brace does not have a neck ring and is more easily concealed under clothing, thus more acceptable to patients. However, it is not suitable for high thoracic or cervical spinal curvatures.
How do you treat a sprain?
How do you treat a sprain?

- Rest (no weight on affected part), Ice, Compress with ace bandage (check circulation), Elevate for 1st 24-48 hours and Analgesics and Anti-Inflammatory meds
- RICE
What is the Barlow's Test?
What is the Barlow's Test?
- Used to test for DDH. (Developmental dysplasia of hip)
- The Barlow maneuver dislocates a dislocatable hip posteriorly. (used with DDH)
- The hip is flexed and the thigh is brought into an adducted position
- From that position the femoral head drops out of the acetabulum or can be gently pushed out of the socket.
- The Ortolani maneuver reduces a posteriorly dislocated hip
- The thigh is flexed and then adducted while pushing up with the fingers located over the trochanter posteriorly.
- The femoral head is lifted anteriorly into the acetabulum
- Positive Ortolani – A clunk and a palpable jerk are felt as the femoral head is re-located
- A mild clicking sound is not a positive sign
- Most often positive in the first 1-2 months of age.
- Used on age group newborn – 3 months.
- Ortolani Barlow Maneuver used on infants (birth - 3mo) to check for hip dysplasia
- Best done on a non-crying infant.
- A clunk and a palpable jerk are felt as the femoral head is re-located
For which age group is the Ortolani Barlow Maneuver used?
For which age group is the Ortolani Barlow Maneuver used?
- For infants from birth to 3 months of age, the provider performs the Barlow and Ortolani tests
What is DDH?
What is DDH?
- Developmental dysplasia of the hip (DDH) is broad term used to describe a variety of disorders resulting in abnormal development of the hip structures
- DDH may be identified during prenatal or postnatal periods or early in childhood
- DDH may be affected by family history, gender, birth order, intrauterine position, and/or laxity of a joint
- Predisposing factors include intrauterine placement, mechanical situations (size of infant, multiple births, breech presentation), and genetic factors.
How is DDH positively diagnosed?
How is DDH positively diagnosed?
- For infants from birth to 3 months of age, the provider performs the Barlow and Ortolani tests.
- Developmental Dysplasia of the Hip. Can be identified prenatally or early childhood via ultrasound. After 4mo old can use an xray to dx.
What are the S/S of DDH?
What are the S/S of DDH?
- Asymmetrical gluteal and thigh folds
- Limited abduction of hips
- One knee that appears shorter when the infant is supine with thighs flexed at 90 degrees towards the abdomen (Alli’s sign)
- For infants from birth to 3 months of age, the provider performs the Barlow and Ortolani tests
- For children able to walk, observe postural gait
- Abnormal downward tilting of pelvis on the unaffected side when bearing weight on the affected side (Trendelenburg sign)
- Waddling gait or abnormal lordosis of spine if bilateral dislocation
- S/S are asymmetrical gluteal and thigh folds, limited hip abduction, one knee shorter than the other when supine and knees are bent to 90 degrees (Alli's Sign). Also a waddling gait.
How does the nurse do a neurovascular assessment?
How does the nurse do a neurovascular assessment?
- Pain – Assess pain level, location, and frequency, use an age-appropriate rating scale and have the child describe the pain
- Sensation – Assess for numbness or a tingling sensation, loss of sensation may indicate nerve damage
- Skin temperature – Assess the extremity for temperature-should be warm, not cool, to touch
- Skin Color – Assess the color, check distal to the injury and look for changes in pigmentation
- Capillary refill – Press the nail beds of the affected extremity until blanching occurs (3 seconds)
- Pulses – Pulses should be palpable and strong. Pulses should be equal to the pulses of the unaffected extremity.
- Movement – The child should be able to move the affected extremity in passive motion
- Assess for Pain, Sensation, Skin Temp, Skin Color, Cap Refill, Pulses and Movement. CMST
What is muscular dystrophy?
What is muscular dystrophy?
- The largest group of diseases that affects muscle function in children
- Loss of muscular strength is progressive
- Developmental milestones are likely to be met until the onset of the disease
- Onset of disease, progression, and muscle group affected depend on the type of MD
- Duchenne (pseudohypertrophic) muscular dystrophy (DMD) is the most common form of MD
- Inherited as an X-linked trait, DMD has an onset between 3 and 7 years of age
- Life expectancy with current technology for DMD reaches into early adulthood
- Management of DMD is symptomatic to assist with maintaining the highest level of mobility and preventing complications as the disease progresses
- Progressive loss of muscular strength. Duchenne (pseudohypertrophic) is most common. It is an inherited X link trait. Its onset is between 3-7 years old.
How is MD diagnosed?
How is MD diagnosed?
- Muscle tissue biopsy
- DNA analysis using peripheral blood, serum polymerase chain reaction (PCR) for the dystrophin gene mutation
- Serum creatine phosphokinase (CK) is elevated
- Electromyography (EMG)
- DX by DNA blood test for PCR (polymerase chain reaction) for dystrophic gene mutation.
What are the S/S of MD?
What are the S/S of MD?
- Muscular weakness in lower extremities
- Muscular hypertrophy, especially in calves
- Mild delay in motor skill development
- Decreased general muscle strength
- Unsteady wide-based gait; loss walking by age 12
- Difficulty riding tricycle (age 3), running, rising from seated position
- 30% with mental delay/learning disabilities
- Heart and respiratory muscles affected late
- Classic symptom: Positive Gower’s Maneuver
- Waddling gait, frequent falls, Gower sign (way a child gets up = walk up body – uses upper arms to “walk” up legs, very distinct movement)
- Lordosis (exaggerated curvature of lumbar of spine)
- Enlarged muscles, especially thighs and upper arms (hypertrophy of upper muscles)
- Progound muscular atrophy in later stages
- S/S = delay in walking, change in gait (waddling), difficulty running, climbing stairs and riding a bike. Also difficulty rising from a sitting position.
What type of diet is recommended for MD?
What type of diet is recommended for MD?
- Low calorie, high protein, high fiber diet
- Diet for MD? Adequate fluids and low fat diet. may progress to require tube feedings
Explain Vaso-occlusive crisis?
Explain Vaso-occlusive crisis?
- Diminished levels of oxygen lead to sickle shape, they become rigid causing obstruction of capillary blood flow, which leads to congestion and tissue hypoxia and additional sickling and infarctions
- Acute Vaso-occlusive Crises – Severe pain, usually in bones, joints, and abdomen, swollen joints, hands, and feet
- Anorexia, vomiting, and fever, hematuria, obstructive jaundice, visual disturbances
- Chronic Vaso-occlusive crises – Increased risk of respiratory infections and/or osteomyelitis
- Retinal detachment and blindness, systolic murmus, Renal failure and enuresis, liver failure
- Diminished levels of O2 lead to sickle shape. they become rigid and obstruct capillary blood flow. tissues are hypoxic leading to more sickling and infarctions. Can be acute or chronic.
What is Hodgkin’s disease?
What is Hodgkin’s disease?
- Malignancy of lymphoid system first identified by Dr. Thomas Hodgkin in 1832.
- S/S: firm, painless lymph nodes – neck, underarm, groin, and chest
- anorexia, fever, weight loss, malaise/fatigue, lethargy, night sweats and fever
- Goals include: control spread cancer cells, maintain airway patency, promote oxygenation, assess pain and treat, prevent infection, provide optimal G&D, prevent complications, provide adequate teaching
What is leukemia?
What is leukemia?
- Group of malignancies that affects bone marrow and lymphatic system
- Caner of blood forming tissue
- Leukemia is classified by the type of WBCs that becomes neoplastic
- Leukemia causes bone marrow dysfunction leading to anemia and neutropenia
- Leukemia causes increased production of immature WBC’s, infiltrating of organs and tissues
- Bone marrow infiltration leads to crowding of cells that would normally produce RBC’s, platelets, and mature WBC’s
- Deficient RBCs leads to anemia
- Deficient mature WBCs (neutropenia) increases the risk for infection
- Defecient platelets (thrombocytopenia) leads to bleeding and bruising
- Malignancies that affect bone marrow and lymphatic system. Cancer of blood forming tissues. When WBC's become neoplastic.
- Bone marrow aspiration or biopsy analysis-most definitive diagnostic procedure
What are the S/S of Leukemia?
What are the S/S of Leukemia?
- S/S of leukemia? Early = low grade fever, pallor, listlessness, unsteady gait, increased bruising and petechiae, enlarged liver, lymphs nodes and joints, abdominal, leg, and joint pain, constipation, headache, vomiting and anorexia.
- Late = Pain, hematuria, mouth ulcerations, enlarged kidneys and testicles and signs of increased ICP
What are the Types of Leukemia?
What are the Types of Leukemia?
- ALL (Acute Lymphoid Leukemia) *best prognosis and the most common
- AML (Acute Myelogenous)
- ANLL (Nonlymphoid Leukemia)
What are the nursing considerations/priorities when taking care of a child with leukemia?
What are the nursing considerations/priorities when taking care of a child with leukemia?
- Adequate hydration/electrolytes,
- nutritional support
- manage bleeding, pain
- transfuse platelets, RBC’s, other blood products
- oral and skin care
- protect from infection
- monitor LOC, prepare child for hair loss, Monitor for bleeding, infection,
- protect from injury, rest periods (cluster care), adequate nutrition, oral care.
- Treat side effects and prevent symptoms
What are the Nursing concerns/interventions for patient undergoing Chemo?
What are the Nursing concerns/interventions for patient undergoing Chemo?
- Hydration, Nutrition, manage pain and bleeding, transfuse platelets and other blood products, oral and skin care, prevent infection, monitor LOC and prepare for hair loss.
- SE’s of chemo – Mucosal ulceration, skin breakdown, neuropathy, loss of appetite, hemorrhage cystitis, alopecia
What is Sickle Cell Anemia?
What is Sickle Cell Anemia?
- Sickle cell disease (SCD) is a group of diseases in which there is abnormal sickle hemoglobin S (HbS).
- Manifestations and complications of sickle cell anemia are the result of RBC sickling, which leads to increased blood viscosity, obstruction of blood flow, and tissue hypoxia
- The RBCs have the ability to develop a sickled shape. This is usually precipitated by increased oxygen demands (infection, emotional stress, pain) or decreased levels of oxygen (pulmonary infections, high altitude)
- Tissue hypoxia causes tissue ischemia, which results in pain
- Increased destruction of RBCs also occurs
- Sickle cell crisis is the exacerbation of sickle cell anemia
- Sickle cell anemia is usually diagnosed soon after birth. If not, toddlers or preschoolers will present in crisis following an infection of the respiratory or GI tract
- SCA is found primarily in blacks.
- SCA is an autosomal recessive genetic disorder in which normal hemoglobin A (HbA) is partially or completely replaced with HbS
- Children with sickle cell trait do not manifest the disease but can pass the trait to their offspring.
- Abnormal sickle shaped Hgb and RBC's which leads to increased viscosity, obstruction and tissue hypoxia. It is an autosomal recessive genetic disorder (both parents).
What are the S/S of SCA?
What are the S/S of SCA?
- Family history of SCA or sickle cell trait, reports of pain, crisis, and management
- SOB, fatigue
- Tachycardia, pallor or jaundice, nail bed deformities
- Lethargy, irritability, and muscle weakness
- Impaired healing, loss of skin elasticity, and thinning of hair
- Ab pain, N/V, and loss of appetite, low-grade fever
- Systolic heart murmur and heart failure, crisis manifestations
- Hand-Foot syndrome
- family history, pain, SOB and fatigue, tachycardia, pallor or jaundice, nail bed deformities and muscle weakness. Impaired healing, think hair, ab pain, anorexia, low grade fever.
How is SCA DX?
How is SCA DX?
- Hgb electrophoresis- Separates the various forms of Hgb and is the definitive diagnosis of sickle cell anemia
- Hgb electrophoresis and Sickledex and CBC and Transcranial Doppler
What is the TX for SCA?
What is the TX for SCA?
- Promote rest to decrease oxygen consumption of the tissue
- administer O2 as prescribed if hypoxia is present
- maintain fluids and electrolyte balance (monitor I&O, give oral fluids, administer IV fluids with electrolyte replacement
- Pain Management - treat mild to moderate pain with Tylenol or Ibuprofen
- administer blood products, usually packed RBCs, and exchange transfusions per facility protocol. Observe for signs of hypovolemia and transfusion reaction
- Treat and prevent infection – (administer ABX, perform frequent hand hygiene, give oral prophylactic penicillin, administer immunizations to include pneumococcal vaccine (PVC), meningococcal vaccine (MCV4), and yearly seasonal influenza vaccine.
- Encourage passive ROM exercises to prevent venous stasis.
What ways can we teach parents of children with SCA to prevent infections?
What ways can we teach parents of children with SCA to prevent infections?
- Treat and prevent infection – (administer ABX, perform frequent hand hygiene, give oral prophylactic penicillin, administer immunizations to include pneumococcal vaccine (PVC), meningococcal vaccine (MCV4), and yearly seasonal influenza vaccine.
- Admin antibiotics, hand hygiene, prophylactic penicillin and immunizations of PVC, MCV4 and influeza. Teach kids to drink plenty of fluids and get lots of rest.
What is “Transposition of great arteries”?
What is “Transposition of great arteries”?
- Pulmonary arteries are supplied by left ventricle and aorta is supplied by right ventricle.
- Right to Left shunting, backwards
- Not compatible with life
- Immediate survival dependent on shunt from left heart to right heart
- 25% have VSD. 33% have abnormal coronary arteries
- S/S: murmur; severe cyanosis quickly; cardiomegaly; heart failure
- Tx: Prostaglandin E1 to maintain open ductus arteriosus, corrective surgery, prophylactic ABX, Promote nutrition
What kind of Lab testresults would you expect in a child with hemophilia?
What kind of Lab testresults would you expect in a child with hemophilia?
- PTT = increased (Normal – 42-54 seconds)
- PT = normal
- Bleeding time = normal
- Platelet count = normal
- Thrombin clotting time
- Factor VIII and IX assays
- Prolonged PT (Normal - 11-15 sec)
How is bleeding treated in hemophiliac patient?
How is bleeding treated in hemophiliac patient?
- Apply direct pressure for at least 5-15 minutes
- Elevate and apply ice to the affected joints
- Administer IV factor VIII and DDAVP
- Avoid taking temp rectally and avoid unnecessary skin punctures and use surgical aseptic technique
- Encourage the child to rest and immobilize the affected joints
- Admin factor (VIII) replacement to deep tissue, organs and joint spaces. Observe for s/e of h/a, flushing, low sodium and alterations in bp and hr. elevate and ice. rest and immobilize joints
What is Iron deficiency anemia?
What is Iron deficiency anemia?
- RBCs with decreased Hgb levels have decreased capacity to carry oxygen to tissue
- The production of Hgb requires iron. Iron deficiency will result in decreased Hgb levels in RBCs
- Iron deficiency anemia usually results from an inadequate dietary supply of iron
- Prolonges anemia can lead to: growth retardation and developmental delays
- Most common in kids 6mo - 2yrs and 12-20 y/o. The RBC's have decreased Hgb to carry the O2 to tissues.
- Risk Factors: Excessive intake of cow’s milk in toddlers (Milk not a good source of iron and milk takes place of iron-rich solid foods), premature birth (decreased iron stores), chronic bleeding (females with menorrhagia, poor intake of iron, periods of rapid growth (teenager), diarrhea (malabsorption), infection, chronic conditions (SCA, hemophilia)
How is iron deficiency anemia TX?
How is iron deficiency anemia TX?
- Give 1 hour before or 2 hours after milk or antacid to prevent decreased absorption
- Monitor for GI S/E’s (constipation, nausea, diarrhea)
- Give on empty stomach
- Give with Vitamin C to increase absorption
- Use a straw with liquid preparations, rinse with water
- Evenly distribute doses through out the day
- Use z-track for deep muscle admin. Do not massage
- Educate family to expect stools to be black
- Provide iron supplements for preterm or low birth weight infants
- Encourage breast feeding for infants < 6 months
- Iron fortified formula for non breastfed infants
- Include high iron, vitamin C, and protein foods
- Restrict milk intake in toddlers (Limit to 32oz (950mL) per day, avoid giving milk until after a meal, do not allow toddlers to carry bottles or cups of milk)
- Allow frequent rest periods
- Increase fiber and fluids to prevent constipation
- with iron supplements and foods with iron in them, including breast milk
- NC= Restrict milk intake in toddlers to 950ml a day, dont give milk after a meal, allow frequent rest periods
What is Kawasaki's disease?
What is Kawasaki's disease?
- A febrile multi-system disorder resulting in inflammation of blood vessels (vasculitis)
- Also called mucocutaneous lymph node syndrome
- Usually occurs in children under 5 years old
- Most prevalent in Japanese dissent
- Ask about 3 phases (acute, subacute, convalescent)
What are the S/S of Kawasaki’s disease?
What are the S/S of Kawasaki’s disease?
- Fever
- Strawberry tongue
- Cracked dry lips
- Oral mucus membranes
- Edema of hands and feet, erythema
- Rash (perineal area)
- Swollen lymph nodes
- Pain
- Elevated ESR
- Anemia
- Bilateral Conjunctivitis
- Significantly increased platelet count, Dysrythmias, CHF, MI
- Coronary artery disease leading to aneurysms
What is the Tx for Kawasaki disease?
What is the Tx for Kawasaki disease?
- Anti-inflammatory medications
- Aspirin 80-100 mg/kg/day
- Gamma Globulin (IVIG)
- Nursing – (frequent, gental oral care, promote comfort, cool baths, small frequent feedings, encourage fluids, skin care, passive ROM)
- IV Gamma Globulin
- Base-line echocardiogram to assess coronary artery status
What are the complications of Kawasaki disease?
What are the complications of Kawasaki disease?
- Aneurysms
- SE’s of ASA therapy: bleeding, GI upset
- SE’s of IVIG therapy: increased BP, facial flushing, tightness in chest
- Monitor Temp, eyes for conjunctivitis
What are the complications of Kawasaki disease?
What are the complications of Kawasaki disease?
- Aneurysms
- SE’s of ASA therapy: bleeding, GI upset
- SE’s of IVIG therapy: increased BP, facial flushing, tightness in chest
- Monitor Temp, eyes for conjunctivitis
What are some of the nursing interventions used when caring for a small child with congestive heart failure?
What are some of the nursing interventions used when caring for a small child with congestive heart failure?
- Keep child well hydrated, conserve child’s energy (frequent rest periods, cluster care, small frequent meals, bathing prn, crying to a minimum), daily weights, I&O, monitor BP, HR and electrolytes, renal function, and promote developmental growth
- Administer meds for improved cardiac function
- Maintain fluid and electrolyte balance
- Decrease workload of the heart
- Bed rest
- Car seat at 45 degree angle; semi-Fowler’s or Fowler’s while awake
- Provide adequate nutrition
- Feed every 3 hours after having rested
- Soft nipple or enlarged opening/holding semi-upright
- Use gavage feeds, prn
- Increase caloric density of formula up to 30 kcal/oz
What is cardiac catheterization?
What is cardiac catheterization?
- Invasive test used for diagnosing cardiac defect, repairing some defects, and evaluating some dysrhythmias.
- Check for allergies to iodine and shellfish
- NPO 4-6 hours before procedure
- Baseline VS, including O2 sat
- Locate and mark dorsalis pedis and posterior tibial pulses.
What are the nursing considerations post cardiac catheterization?
What are the nursing considerations post cardiac catheterization?
- Monitor for bleeding, hematoma, thrombus, assess pulses, temp, and color
- Check distal pulses and bleeding
- Pressure dressing for 6 hours
- Continuous cardiac monitoring, O2 sat
- Monitor for dysrhythmias, infection, urinary output
- VS, neurovascular checks insertion extremity
- Maintain bed rest for 4-8 hours; keep extremity straight
- Encourage oral intake (rid dye from body)
- Check insertion site
Why might a cardiac catheterization be done?
Why might a cardiac catheterization be done?
- Invasive test used for diagnosing cardiac defect, repairing some defects, and evaluating some dysrhythmias.
What is an appropriate meal for a child with iron deficiency anemia?
What is an appropriate meal for a child with iron deficiency anemia? Give Examples.
- Infants: Cereal and iron-fortified formula, and breastmilk
- Older children: Dried legumes; dried fruits; nuts; green leafy vegetables, iron-fortified breads; iron-fortified flour; poultry; and red meat, egg yolks, fruit, organ meats, fish
What symptoms would you see in a patient with decreased cardiac output?
What symptoms would you see in a patient with decreased cardiac output?
- Diminished pulses
- Reduced blood flow to the lungs
- Reduced SaO2 in circulation-low sats
- Cyanosis-baby appears blue (lips/skin)
- Increased RV pressure
- Deficient oxygen in tissues leads to acidosis
What are the nursing interventions for a child in traction?
What are the nursing interventions for a child in traction?
- Maintain body alignment
- Manage of pain and muscle spasms
- Assess and monitor neurovascular status
- Monitor the child’s skin integrity
- Assess pin sites for pain, redness, swelling, drainage, or odor. Provide pin care
- Monitor for infection, CMST, Tingling and numbness
- Traction – countertraction, and friction to align, immobilize, and reduce muscle spasms
- Skin traction (Buck’s traction, Russell’s)
- Skeletal traction (pins and rods)
- Halo traction (head and neck)
What is a VP shunt? List interventions used to provide post-op care?
What is a VP shunt? List interventions used to provide post-op care?
- Small tubing is placed inside the brain’s ventricle and tunneled underneath the skin to the peritoneum, drains CSF fluid
- Post-op care – Measuring head circumference, monitor for symptoms of increased ICP, support the head when transferring the infant to avoid strain on neck muscles, handle gently, prevent skin breakdown on the cranium, to reduce vomiting, feeding should be frequent small amounts
What is hydrocephalus?
What is hydrocephalus?
- Results from increased production, decreased absorption, or blockage of the flow of CSF
- Blockages can be caused by: infections, ventricular hemorrhages, tumors, cysts, or malformations
- Spinal fluid collects causing swelling and brain damage
What are the S/S of hydrocephalus?
What are the S/S of hydrocephalus?
- Classic: > than normal head circumference
- Disproportionate forehead
- Bulging anterior fontanel
- “Sun set” eyes
- Irritability
- Lethargy
- Nausea and vomiting
- Increased ICP
- Bulging fontanels, split sutures, increasing head circumference, prominent scalp veins, sunset eyes, irritability, poor feed, the older child will complain of HA
What are the S/S of increased ICP in a neonate, infant , and older child?
What are the S/S of increased ICP in a neonate, infant , and older child?
- Infants: High-pitched cry, poor feeding, lethargy, anorexia, vomiting, irritability
- Tense, bulging fontanel; increased head circumference; separation of cranial sutures
- Children: Anorexia, N/V, irritability, or lethargy
- Headache, blurred vision, papilledema
- Separation of cranial sutures
- Late signs: Altered LOC, Pupil dilation and sluggish response to light, tachycardia then bradycardia
- Altered respiratory rate then apnea
- Elevation in BP, increased pulse pressure, unstable temperature
What is cerebral palsy?
What is cerebral palsy?
- Cerebral palsy (CP) is a non-progressive impairment of motor function, muscle control, coordination, and posture
- CP is the most common permanent physical disability in children
- CP may cause abnormal perception and sensation; visual, hearing, and speech impairments; seizures; and cognitive disabilities
- CP manifests differently in each child
- Developmental outcomes vary and are dependent on the severity of the injury. Many children with CP are able to perform most, if not all, developmental tasks, and more than half will be able to work outside the home as adults. Others will require complete care for their entire lives.
What causes Cerebral Palsy?
What causes Cerebral Palsy?
- Brain anomalies, cerebral infections, head trauma (shaken baby syndrome), anoxia to the brain
- Premature birth, multiple births
- Extremely low or very low birth weights
- Inability of the placenta to provide the developing fetus with oxygen and nutrients
- Decreased oxygen delivery to the fetus during birth
- Kernicterus (high levels of bilirubin) in the neonatal period
- Head trauma
What are the goals of care for a child with rheumatic fever who is admitted to the hospital?
What are the goals of care for a child with rheumatic fever who is admitted to the hospital?
- Overview – Rheumatic fever is an inflammatory disease that occurs as a reaction to Group A B-hemolytic streptococcus (GABHS) infection of the throat, lasts up to 3 months and is self limiting)
- Bed rest, warmth to joints
- Reinforce with the child and family the importance of completing the entire 10-14 day course of antibiotics as prescribed, even if the child starts to feel better after a few doses.
- Promote rest and adequate nutrition to prevent heart damage
- Provide info and reassurance related to the development of chorea (involuntary jerking movements) and its self-limiting nature
What is Sydenham’s chorea?
What is Sydenham’s chorea?
- Sydenham's chorea or Chorea minor (historically referred to as Saint Vitus' Dance)[1] is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands. Sydenham's chorea (SC) results from childhood infection with Group A beta-hemolytic Streptococci [2] and is reported to occur in 20-30% of patients with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of RF. SC is more common in females than males and most patients are children, below 18 years of age. Adult onset of SC is comparatively rare and most of the adult cases are associated with exacerbation of chorea following childhood SC.
- Involuntary twitching
What is Jones’s Criteria?
What is Jones’s Criteria?
- Is how rheumatic fever is diagnosed. 2 majors or 1 major and 2 minors
- Major Criteria-Jones
- Polyarthritis: inflammation in many joints, especially knees, elbows, wrists
- Carditis (new murmur, ECG changes, tachycardia)
- Chorea (CNS)
- Erythema marginatum: macular rash trunk, proximal limbs
- Subcutaneous nodules
- Minor Criteria
- Fever, arthralgia, elevated WBC, ESR, CRP, decreased RBC
- Prolonged P_R and /or Q_T interval on ECG
Which blood test is most helpful in confirming diagnosis of rheumatic fever?
Which blood test is most helpful in confirming diagnosis of rheumatic fever?
- Elevated or rising serum antistreptolysin-O (ASO) titer – most reliable (Positive test)
- Elevated C-reactive protein (CRP) or sedimentation rate – in response to an inflammatory reaction
What are the complications of rheumatic fever?
What are the complications of rheumatic fever?
- Damage to mitral and aortic heart valves (Permanent)
- Initial Tx with 10-day course penicillin
- Monitoring of heart rate, murmurs
- Prepare child for valve replacement
- Restrict activity if carditis present
- Prophylactic antibiotic regimen
- Medical follow-up at least 5 years
- Bacterial Endocarditis
What are the S/S of bacterial meningitis? How is it treated?
What are the S/S of bacterial meningitis? How is it treated?
- An acute inflammation of the meninges of the brain
- Bacterial, or septic, meningitis is a contagious infection. The prognosis depends on how quickly care is initiated
- Newborns:
- No illness is present at birth, but it progresses within a few days
- Clinical signs may be vague and difficult to diagnose
- Poor muscle tone, weak cry, and poor feeding
- Fever or hypothermia
- Nuchal rigidity is NOT usually present
- NO headache
- Bulging fontanels are a late sign
- 2 months to 2 years:
- Seizures with a high-pitched cry
- Fever and irritability
- Bulging fontanels
- Possible nuchal rigidity
- Poor feeding
- Vomiting
- Brudzinski’s and Kernig’s sign do not assist with the diagnosis.
2 years through adolescence:
- Seizures (often initial sign)
- Nuchal rigidity
- Positive Brudzinski’s sign (flexion of extremities occurring with deliberate flexion of the child’s neck)
- Positive Kernig’s sign (resistance to extension of the child’s leg from a flexed position)
- Fever and chills
The S/S of bacterial meningitis depends on which factor?
The S/S of bacterial meningitis depends on which factor?
- It depends on the child’s age
- Newborns:
- No illness is present at birth, but it progresses within a few days
- Clinical signs may be vague and difficult to diagnose
- Poor muscle tone, weak cry, and poor feeding
- Fever or hypothermia
- Nuchal rigidity is NOT usually present
- NO headache
- Bulging fontanels are a late sign
- 2 months to 2 years:
- Seizures with a high-pitched cry
- Fever and irritability
- Bulging fontanels
- Possible nuchal rigidity
- Poor feeding
- Vomiting
- Brudzinski’s and Kernig’s sign do not assist with the diagnosis.
2 years through adolescence:
- Seizures (often initial sign)
- Nuchal rigidity
- Positive Brudzinski’s sign (flexion of extremities occurring with deliberate flexion of the child’s neck)
- Positive Kernig’s sign (resistance to extension of the child’s leg from a flexed position)
- Fever and chills
What is Reye’s syndrome?
What is Reye’s syndrome?
- An acute and potentially fatal childhood disease. A complication of viral infection. An acute encephalitis with onset of symptoms 1-3 weeks after viral infection
- Etiology is unknown, associated with aspirin
What is Reye’s syndrome?
What is Reye’s syndrome?
- An acute and potentially fatal childhood disease. A complication of viral infection. An acute encephalitis with onset of symptoms 1-3 weeks after viral infection
- Etiology is unknown, associated with aspirin
How is Reye’s syndrome Treated?
How is Reye’s syndrome Treated?
- Maintain hydration:
- Administer IV fluids as prescribed, maintain accurate I&O, insert indwelling urinary catheter as ordered
- Position the child:
- Avoid extreme flexion, extension, or rotation, Maintain the head in a midline neutral position
- Keep the HOB elevated 30 degrees
- Monitor appropriateness of coagulation:
- Note unexplained or prolonged bleeding
- Apply pressure after procedures
- Prepare to administer Vitmain K
- Meds – Osmotic diuretic – Mannitol (Osmitrol)
- To decrease cerebral swelling, administer as prescribed, monitor the child for increased ICP
- Insulin – Administer to increase glucose metabolism
- Monitor blood glucose levels prior to insulin administration and periodically
- Monitor pain status and response to painful stimuli. Administer pain meds when appropriate
- Barbiturates, sedatives, and diuretics
- Teach parents to avoid giving salicylates for pain or fever in children
- Teach parents to read labels of OTC meds to check for the presence of salicylates (Pepto-Bismol, Triaminicin, Coricidin, and Alka-Seltzer)
What is Juvenile Rheumatoid Arthritis?
What is Juvenile Rheumatoid Arthritis?
- Classifications of JRA include systemic arthritis, oligoarthritis, and polyarthritis with or without rheumatoid factor
- No definitive diagnosis, onset <16 years of age, and symptoms occur in one or more joints and last for 6 weeks or longer with no other cause identified
- Peak incidence is between 1 and 3 years of age or (2-5)?
- JRA is rarely life-threatening, may subside over time, but can result in residual joint deformities and altered joint function
- Risk factors – Susceptible individuals who have an autoimmune response to internal or external triggers
- A generalized systemic disease of the entire musculoskeletal system
- An auto immune inflammatory disease
What are the S/S or JRA?
What are the S/S or JRA?
- Joint swelling, stiffness, redness, and warmth
- Mobility limitations
- Fever
- Rash
- Nodules under the skin
- Delayed growth and development
- Enlarged lymph nodes
- Visual changes and uveitis (inflammation in the anterior chamber of the eye)
How is JRA treated?
How is JRA treated?
- NSAIDS: Naproxen (Naprelan), ibuprofen (Motrin), and tolmetin sodium (Tolectin)
- NSAIDS control pain and inflammation
- Should be taken with food to minimize gastric irritation
- Report changes in stool and GI discomfort or increase in bruising immediately
- Aspirin
- Methotrexate (Rheumatrex): A cytotoxic disease modifying antirheumatic drug (DMARD) that slows joint degeneration and progression of rheumatoid arthritis when NSAIDS do not work alone
- Monitor liver function tests and CBC regularly
- Corticosteroids: Relief of inflammation and pain
- Reserved for life threatening complications, severe arthritis, and uveitis
- Administer as eye solution, orally, or IV
- Encourage warm baths
- Encourage full ROM exercises when pain and inflammation have subsided
- Apply heat or warm moist packs to the child’s affected joints prior to exercise
- Encourage a well-balanced diet that is high in fiber and contains adequate fluids to prevent constipation from immobility
- Use of splints at bedtime
What is the difference between strabismus and amblyopia? How are they treated?
What is the difference between strabismus and amblyopia? How are they treated?
- Strabismus (misaligned eyes): failure of the eyes to direct and focus on the same object at the same time. (deviation of one eye) (cross eyed)
- Frowning or squinting, difficulty seeing print clearly, one eye closed to enable better vision, head tilted to one side, HA, dizziness, diplopia, photophobia, and crossed eyes
- Amblyopia (lazy eye): reduced visual acuity (clarity of sight) in one eye which cannot be corrected by glasses or contact lenses. Eyes are unable to focus and work together. Blindness may occur in the weaker eye if left untreated
- Tx of Strabismus – Patching of the unaffected eye to increase visual stimulation of the weaker eye. Glasses and exercised may help improve vision. Surgery to correct muscle defects, especially when conservative Tx is ineffective
- Tx of Amblyopia – Patching the unaffected eye. The child is forced to use and focus the weaker eye. Best time to treat is during early childhood
What is Hemophilia?
What is Hemophilia?
- Hemophilia is a disorder that results in an impaired ability to control bleeding.
- Bleeding time is extended due to lack of clotting factors. Bleeding may be internal or external
- Manifestations may be present early in infancy but may not be evident until infants begins teething, sitting up, or crawling
- Parents may observe excessive bruising with minor falls or contact
- Hemophilia has different levels of severity depending on the % of clotting factor a child’s body contains. For example, a child with mild hemophilia may have up to 49% of the normal factor VIII in his body, while a person with severe hemophilia has very little factor VIII.
- Both hemophilia A and B are X-linked recessive disorders
What are the S/S of Hemophilia?
What are the S/S of Hemophilia?
- Episodes of bleeding, excessive bleeding, reports of joint pain and stiffness, impaired mobility, and activity intolerance
- Active bleeding, which includes bleeding gums, epistaxis, hematuria, and/or tarry stools
- Hematomas and/or bruising
- Hemarthrosis as evidenced by joint pain, stiffness, warmth, swelling, redness, loss of ROM, and deformities
- Headache, slurred speech, and a decreased LOC
What are the S/S of Hemophilia?
What are the S/S of Hemophilia?
- Episodes of bleeding, excessive bleeding, reports of joint pain and stiffness, impaired mobility, and activity intolerance
- Active bleeding, which includes bleeding gums, epistaxis, hematuria, and/or tarry stools
- Hematomas and/or bruising
- Hemarthrosis as evidenced by joint pain, stiffness, warmth, swelling, redness, loss of ROM, and deformities
- Headache, slurred speech, and a decreased LOC
What is Tetralogy of Fallot? List the four disorders that compose this disorder.
What is Tetralogy of Fallot? List the four disorders that compose this disorder.
- Most common cyanotic defect
- Occurs in about 2 out of every 10,000 births
- Approximately 10% of all CHD
- Four related defects:
- Pulmonary stenosis
- VSD
- Overriding Aorta (the aorta is positioned directly over a ventricular septal, instead of over the left ventricle)
- Right ventricular hypertrophy (RVH)
What are the S/S of Tetralogy of Fallot?
What are the S/S of Tetralogy of Fallot?
- Murmur, cyanosis, severe dyspnea, clubbing of fingers, hypercyanotic spells, acidosis; polycythemia, clot formation; squatting position, FTT
- Reduced blood flow to the lungs
- Right to left shunt
- Reduced SaO2 in circulation- low sats
- Cyanosis – baby appears blue (lips/skin)
- Increased RV pressure
- Deficient oxygen in tissues leads to acidosis
- Hypercyanosis (TET spells) where there are transient periods when there is an increase in right to left shunting
What is Myelomeningocele?
What is Myelomeningocele?
- A type of neural tube birth defect (spina bifida cystica) in which a protrusion of a meningeal sac that contains CSF, a portion of the spinal cord, and nerves through a vertebral defect
- The sac includes meninges, spinal fluid, and nerves
What are the nursing considerations regarding the care of a patient born with Myelomeningocele?
What are the nursing considerations regarding the care of a patient born with Myelomeningocele?
- Prone position, get them to surgery
- Closure of a myelomeningocele sac done as soon as possible to prevent complications of injury and infection.
- Preoperative
- Cover the exposed sac with a sterile, moist (with 0.9% sodium chloride), non-adherent dressing until surgery
- Place the newborn in a prone position until surgery to protect the sac
- Teach the parents about what to expect postoperatively
- Teach the parents proper positioning techniques
- Teach the parents to avoid touching the sac
What is a VSD?
What is a VSD?
- Hole between the two ventricles
- Left to right shunt – majority, due to higher pressure in left ventricle
- Dilated right heart – too much blood to lungs – increase in pulmonary pressure
- Smaller defects can close spontaneously
- S/S: Loud harsh murmur; heart failure, FTT
How do you care for a child having seizures?
How do you care for a child having seizures?
- Protect the child from injury (move furniture away, hold head in lap if on the floor)
- Position the child to provide a patent airway
- Be prepared to suction oral secretions
- Turn the child to the side (decreases risk of aspiration)
- Loosen restrictive clothing
- Do not attempt to restrain the child
- Do not attempt to open the jaw or insert an airway during seizure activity (this may damage teeth, lips, or tongue). Do not use padded tongue blades.
- Post Seizure: - maintain the child in a side-lying position to prevent aspiration and to facilitate drainage of oral secretions, check VS, Assess for injuries, perform neurologic checks, Allow the child to rest if necessary, reorient and calm the child (she may be agitated or confused), institute seizure precautions, including placing the bed in the lowest position and padding the side rails to prevent future injury, encourage the child to describe the period before, during, and after the seizure activity, determine if the child experiencing an aura, which may indicate the origin of seizure in the brain, try to determine the possible trigger, such as fatigue or stress, document onset and duration of seizure and client findings/observation prior to, during, and following the seizure (LOC, apnea, cyanosis, motor activity, incontinence)
Precipitating factors contributing to sickle cell crisis? (Select all that apply)
Precipitating factors contributing to sickle cell crisis? (Select all that apply)
- Fever, Dehydration, altitude, extremes in temperature
- Infection, stress
- Vomiting
- Emotional distress
- Fatigue
- Alcohol consumption
- Pregnancy
- Elevated Hgb levels
- Elevated reticulocyte counts
- Excessive exercise or physical activity
- Acidosis
Treatment for sprained ankle? (Select all that apply)
Treatment for sprained ankle? (Select all that apply)
- RICE
- Rest, Ice, Compression, Elevate first 24-48 hours
Leukemia undergoing chemotherapy, nursing interventions? (Select all that apply)
Leukemia undergoing chemotherapy, nursing interventions? (Select all that apply)
- Adequate hydration/electrolytes,
- nutritional support
- manage bleeding, pain
- transfuse platelets, RBC’s, other blood products
- oral and skin care
- protect from infection
- monitor LOC, prepare child for hair loss, Monitor for bleeding, infection,
- protect from injury, rest periods (cluster care), adequate nutrition, oral care.
- Treat side effects and prevent symptoms
- Hydration, Nutrition, manage pain and bleeding, transfuse platelets and other blood products, oral and skin care, prevent infection, monitor LOC and prepare for hair loss.
- SE’s of chemo – Mucosal ulceration, skin breakdown, neuropathy, loss of appetite, hemorrhage cystitis, alopecia
- LFT’s – Determine baseline function for chemo
When is Cerebral Palsy diagnosed?
When is Cerebral Palsy diagnosed?
- Usually birth until 2
Rheumatic fever complication?
Rheumatic fever complication?
- Heart problem (tachycardia, carditis – inflammation of heart), can be permanent
S/S of left-to-right shunts
S/S of left-to-right shunts
- Murmur
- DOE
- Growth retardation
- FTT
- Diaphoresis
- RVH
- Right-sided heart failure
- Loud click on auscultation and cyanosis (truncus arteriosus)
S/S of Right-to-left shunts
S/S of Right-to-left shunts
- Murmur, DOE
- Cyanosis
- FTT, LVH
- Pulmonary edema
- Tachypnea
- Left-sided Heart failure
Select all of the correct responses related to iron-deficiency anemia.

A. It is the most common anemia in children
B. There is a decrease in the size and number of red blood cells
C. It can result in severe hemorrhage in children
D. It results in decreased oxygen-carrying capacity of the blood
E. It is caused by a nutritional deficiency
Select all of the correct responses related to iron-deficiency anemia.
**A. It is the most common anemia in children
**B. There is a decrease in the size and number of red blood cells
C. It can result in severe hemorrhage in children
**D. It results in decreased oxygen-carrying capacity of the blood
**E. It is caused by a nutritional deficiency