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381 Cards in this Set
- Front
- Back
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what can cause sickle cells to sickle? (4)
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1. dehydration
2. acidosis 3. hypoxia 4. temp elevation |
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how to reverse sickling? (2)
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1. hydration
2. oxygenation |
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what are the s/s of sickle cell? (10)
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1. pain/hypoxia in areas
2. enlarged spleen (suspectible to infx now) 3. obstruction in liver, gallbladder, kidney causing hepato, gallstones, hematuria 4. marrow congestion 5. hyperplasia of bone/osteoporosis, bone suspectible to infx 6. cardiomegaly/murmurs 7. exercise intolerance 8. jaundice 9. anorexia 10. anemic |
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how is kidney affected by sickle cell?
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causes inability to concentrate urine and may progress to nephrotic (think damage and holes to glomero)
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name some sickle cell crises? (7) explain
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1. hand foot syndrome- migratory
2. sequestion crisis-blood buildup in liver or spleen 3. aplastic crisis-lo rbc 2ndary to virus 4. megaloblastic anemia-need folic and b12 5. hyperhemolytic anemia-lysing rbc so fast (jaundice) 6. chest syndrome-think venooccude like pneumonia 7. overwelming infx |
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name 3 diagnostics for sickle cell and which one is definitive to distinguish trait and disease
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1. stained blood smear
2. sickle turbidity test ***3. hgb electrophoresis |
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which diagnostic is definitive to distinguish sickle cell?
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hgb electrophoresis
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what are some medical mgmt of sickle cell? (2)
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1. hydroxurea and erythropoietin
2. bone marrow transplant |
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what is the symptomatic tx of sickle cell? (5)
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think O HEAT!
1. oxygen 2. hydration 3. electrolytes 4. analgesic 5. transfusion |
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what is beta thalassemia in medical and laymens term?
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it is a partial or complete deficiency of beta chain of hgb molecule
RBC don't work well and die fast |
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how will the blood workup be for beta thalassemia? (hgb/hct, color/shape of RBC) (2)
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1. low hct/hgb (anemia)
2. hypochromic and hypomacrocytic cells |
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what diagnosis for thalassemia?
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hgb electrophoresis
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what are the s/s of thalassemia? (10)
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1. pallor
2. poor feeding 3. hypoxia 4. ha 5. bone pain 6. exercise intolerance 7. small growth retardation 8. delayed sex maturation 9. freckled complexion 10. bronze skin |
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what is the tx for thalassemia? (2)
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1. transfusion for life-to keep bone marrow from overworking
-must be careful not to give too much hgb because can cause hemosiderosis 2. bone marrow transplant |
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hgb for thalessemia is adequate at what level? what happens if you go over?
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9.5g/dl hgb
-don't go over b/c can cause hemosiderous |
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if you get hemosiderous, what should you do? what is hemosiderous?
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hemosiderous-iron overload
need to do chelation caused desferal and oral vitamin C |
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hemosiderous (iron overload may cause____) if untreated with desferal chelation?
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organ damage from iron deposits
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classical hemophilia is from what factor?
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factor 8 (hemophylia A)
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christmas disease hemophilia b is from what factor?
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factor 9
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factor 8 and 9 are necessary for what?
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the formation of THROMBOPLASTIN in phase 1 of blood coagulation
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a person has mild hemophilia (5%) when would you expect them to bleed?
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bleed with severe trauma or surgery
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a person has moderate (1%-5%) hemophilia, when would you expect them to bleed?
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bleed with trauma
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a person has severe (1%) hemophilia, when would you expect them to bleed?
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spontaneous bleed WITHOUT TRAUMA
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how to diagnose hemophilia? (3)
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1. dna testing
2. test factor 8 and 9 3. PTT |
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s/s of hemophilia
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continuous bleeding internally or externally
hemoarthrosis may cause crippling |
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what is the medicine mgmt of hemophilia? (5)
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1. synthetic vasopressin (gives vonwillebrand factor)
2. human recombinant 3. protein-free recombinant 4. cryoprecipitate 5. FFP |
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what is the automatic action for hemophilia if don't have factor on hand? (4)
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RICE
1. rest 2. ice 3. compression 4. elevation |
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how to prevent serious injury of hemophilia?
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1. keeping track to keep factors above 1%
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amicar is given when and what is the MOA?
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given after a known a bleed
MOA-makes clot stay longer |
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what are 2 types of Child CA?
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1. hematological ca
2. solid tumors |
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most childhood ca come from what part of embryo? (2)
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1. mesoderm
2. ectoderm (inside) |
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what are some examples of ectoderm CA? (2)
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1. brain, spine, meninges
2. adrenal |
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what are some examples of mesoderm CA? (8)
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1. blood
2. lympha 3. bone 4. muscle 5. pleura 6. heart 7. kidneys 8. gonads |
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what is the most common CA in children?
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brain tumor
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wilm tumor is what kind of tumor?
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kidney
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what should you remember about wilms tumor?
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that it is a encapsulated tumor and that you should avoid touching it beacuse if capsule is maintained=high recovery
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what is the most classic s/s of brain tumor? (2)
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1. ha
2. vomitting |
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what s/e of chemo limits tx?
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neutropenia
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absolute neutrophil count of ca will be below?
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500
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how does neutropenia affect tx?
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limits the amount of drugs given
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how does CA affect adolescent?
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takes away their independence
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mucositis of chemo may cause what to happen? what is important to emphasize?
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may need to cut dose b/c of the mouth pain and impaired nutrition
emphasize nutrition |
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digoxin toxicity s/s are? (5)
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1. n/v
2. diarrhea 3. yellow vision 4. cardiac arrythmia 5. bradycardia |
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what are some ekg changes that digoxin over 2mcg can cause? (3)
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. 1. prolonged pr interval
2. heart block 3. atrial/ ventricular ectopy |
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if mother thinks she missed a dose of digoxin, what should the nurse tell her?
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don't administer it unless you are sure
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if the child is vomitting, what should the nurse do with the digoxin?
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do not administer, it may be a sign of digoxin toxicity
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when can you give the digoxin?
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on schedule (if missed less than 4 hr, can give). If it has been more than 4 hrs, omit dose (WAIT)
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mild stenosis is predominantly __ to ___ shunting? they will look like?
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L to R shunting (PINK TETS
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severe stenosis puts a lot of pressure on the ___
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right ventricle
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in severe stenosis, there is __to ___ shunting through ____ _____
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severe stenosis= right to left shunting. shunting through the overriding aorta
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tetralogy of fallot is a classic syndrome r/t what 4 defects? (4)
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1. right ventricular outflow tract obstruction
2. endocardial cushion defect with large ventricle septal defect 3. overriding aorta 4. right ventricle hypertrophy |
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the severity and direction of shunting is r/t what in tetralogy of fallot of the 4 defects? (2)
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1. the degree of right ventricle outflow tract obstruction
2. the degree of pulmonic stenosis |
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with mild stenosis (pink tets), there is an increase in what?
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pulmonary blood flow increase
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pink tets (mild stenosis) is linked to risk s of what 2 defects?
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1. chf
2. pulmonary venous hypertension |
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what is the severe stenosis (blue tets) r/t? (3)
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1. spasms of RVOT
2. decreased SVR 3. increased 02 requirements |
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what is the tx of TET spells? (4)
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think POMS
1. phenylephrine (to cause vasoconstriction) 2. oxygen 3. morphine 4. squatting |
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what is the goal of tet spells? (2)
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1. relax the RVOT spasm
2. increase SRV which reverses the shunt |
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why is squating or putting knee to chest good for tets spells?
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b/c it cuts circulation in the groin and pushes the blood back into the right side of the heart
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what are important nursing care for a child undergoing cardiac catheter care? (7)
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1. i/o
2. freq vs and co, and bp 3. manage tubes 4. titrate 02 5. pain mgmt 6. open communication 7. teaching |
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what are possible cardiac complications from cardiac catheter? (3)
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1. chf
2. dysrythmia 3. tamponade |
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what are possible pulm complications from cardiac catheter? (4)
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1. atelactasis
2. pneumothorax 3. effusion 4. pulmonary edema |
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what are some neuro complications that may arise from cardiac catheter? (4)
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1. seizures
2. stroke 3. cerebral edema 4. hypoxemia |
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what are some hematological complications that may arise from cardiac catheter (2)
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1. hemorrhage
2. failure to clot |
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how should you monitor cardiac catheter?
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1. check for bleeding
2. check pulses BELOW sites for equality and symmetry |
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patho of cyanosis?
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when blood shunts past the lungs and enters the systemic circulation without oxygenation
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if baby is cyanotic but gets pink after o2 administration, waht does that indicate?
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pulmonary problem
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if baby is cyanotic but does not get pink (stays blue), what should you think?
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cardiac problem
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what does crying do as far to right and left pressures of the heart
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increases pressure on the right side of the heart and decreses pulmonary blood flow
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what are some r/f for congenital heard disease?
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1. maternal drug use
2. maternal illness (like rubella, toxo, cmv, and diabetes) |
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what is the most common anomaly of CHD?
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ventricular septal defect
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some kids that have CHD are at risk for?
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other defects such as trisomy
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after prematurity, what is the major cause of death in a baby's first year of life?
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CHD
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what are the defining characteristics of blood flow? (4)
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1. increasd pulmonary blood flow
2. decreased pulmonary blood flow 3. obstruction to blood flow 4. mixed blood flwo |
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acyanotic are r/t what 2 factors?
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1. increased blood flow in lungs (increased pulmonary blood flow)
2. obstruction of blood flow from ventricles |
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cyanosis is r/t what 2 factors?
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1. decreased pulmonary blood flow
2. mixed blood flow |
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For CHD with increased pulmonary blood flow, what kind of shunt will you have?
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L to R shunt
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how will L to R shunt manifest in turns of blood flow? e.g right side, pulmonary flow, and systemic blood flow
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-increased volume in R side (b/c blood is shunting from left to right)
-increased pulmonary flow (because blood from L side is backflowing into lungs again -decreased systemic flow (b/c blood is not going from L side to body |
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when is cyanosis present (at what hgb and o2 sats)?
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Visible when deoxygenated hemoglobin at least 5 mg/dl
O2 sats of 75%-85% |
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obstructed left heart may progress to?
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CHF
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obstructed right heart may progess to?
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cyanosis
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mixed blood may cause? (2)
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1. cyanosis
2. CHF it depends |
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what are 3 examples of CHD with increased pulmonary blood flow?
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1. ASD
2. VSD 3. PDA |
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what are 2 examples of CHD with DECREASED pulmonary blood flow?
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1. pulmonic stenosis
2. tricuspid atresia |
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explain how increased pulmonary blood flow is diff vs decreased blood flow in terms of the LOCATION OF DEFECT?
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increased PBF= septum/pda
decreased PBF=valvular/arteries |
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right to left shunt will show up as? (3)
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1. decreased oxygenated systemic
2. CYANOSIS 3. possibly incompatible with life |
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how to identify an obstructive heart defect?
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take the bp (upper body will have INCREASED bp and lower body will have low bp
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what are 3 obstructive heart defects (why?)
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1. aortic stenosis
2. pulmonic stenosis 3. coarctation of the aorta (notice how they are all between the ventricles to atrium===obstruction from the ventricles to |
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coarctation of the aorta is what kind of CHD?
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obstructive
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septum defects are r/t ___heart defects and will manifest?
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acyanotic (L to right shunting)
may not be blue |
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coarcation, aortic stenosis, and pulmonic stenosis will manifest (cyanotic vs acyanotic?)
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acyanotic
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tetralogy of fallot and tricuspid atresia is linked to __heart defect?
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cyanotic (usually blue TETS)
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what are 3 examples of mixed blood heart defects?
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1. transposition of great arteries
2. total anomalous pulmonary venous return 3. hypoplastic left heart syndrome |
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what happens in mixed defects?
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mixed deoxy/oxy systemic blood flow= depends, probably CYANOSIS
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what are nursing considerations when dealing with a kid who underwent cardiac shunt? (2)
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1. do not take bp on that side
2. do not put filter on that side |
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how to take care of a kid with a R to L shunt? (3) Basic goal
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basic goal=prevent stroke
1. no air in IV 2. use filter 3. prevent blood from sludging |
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if there is increased PBF (septum defect/pda) r/t L to R shunting, how do you be careful to adminster 02?
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GIve no more than 40% o2....kids with these defects can tolerate oxygen stats in the 80%
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kawasaki mainly affects what age group?
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toddlers and school children
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what is kawasaki?
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an acute systemic vasculitis of unknown origin WITH damge of blood vessel
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what are s/s of kawasaki? (9)
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1. high fever not responsive to antipyretics
2. infalmmation of the eyes and mucosa 3. rash 4. edema and erythema of hands and feet 5. cervical adenopathy 6. thrombocytosis 7. hypercoag (risk for clotting) 8. myocarditis 9. strawberry tongue |
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what is important to get for a kid with kawasaki syndrome? why
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baseline EKG, ECHO of heart
why: b/c at risk of coronary artery aneurysm |
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what is the medicinal tx for kawasaki? (2)
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1. IVIG
2. ASA |
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what is important to monitor (assess) in kawasaki? why?
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monitor fluid and cardiac b/c at risk for myocarditis
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what age are girls and guys indciated as a precoscious puberty?
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before 9yo boys
6-7yo girls (more common) |
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what is the cause of precocious puberty?
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poss disorder in gonad, adrenal, or hypothalamic-pituitary-gonadal axis,
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what can you tell parents about precocious puberty prognosis
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is a benign disease and children will have a normal puberty cycle
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how are precocious puberty kids mentally?
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Mental age congruent with chronological age
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how is the viability and order of sexual maturation
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Maturation of gonads & secondary sexual characteristics proceed in usual order
is fertile |
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what should be considered emotionally wtih kids that are in precocious puberty?
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Most difficult time -they may get teased a lot
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diabetes instipidus is a d/o from where?
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posterior pituitary HYPOFUNCTION (think posterior=adh, not enuff adh=duresis
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diabetes insipidus is ____ of what hormone?
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Hyposecretion of antidiuretic hormone (vasopressin)
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what are 2 primary causes of diabetes insipidus
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familial or idiopathic
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what are 3 secondary causes of diabetes insipidus
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Trauma, tumor, infx
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what are cardinal s/s of diabetes insipidus (2)
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polydipsia and polyuria
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how is the s/s of diabetes inspidus different in an infant versus a older child?
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may be irritable. INSIST on drinking water, not milk
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infants with diabetes insipidus are at risk for?
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electrolyte problems
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how to diagnose diabetes insipidus?
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Restrict fluids & watch for changes in urine volume & concentration
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what to do if you find out pt has diabetes insipidus?
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give test dose of injected aqueous vasopressin
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what are some other diagnostic tests indicated for kids with diabetes insipidus? why? (2)
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1. skull x-ray (to check for tumor)
2. kidney test and electrolyte (to test for kidney failure |
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what are 3 ways to tx diabetes insipidus? how long does it last?
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1. vasopressin injection in peanut oil mix well, lasts 2-3 days
2. Nasal spray of aqueous lysine vasopressin, last 8-12hr 3. intranasal Desmopressin acetate with flexible tube 2x/day |
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what is SIADH?
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too much ADH
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where is the problem in the brain with SIADH?
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too much (hypersecretion) of posterior pituiray ADH hormone
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which pituitary (anterior or posterior) is SIADH from? along with what other hormone?
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posterior
along with oxytocin |
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what conditions is SIADH commonly seen with? (4)
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1. infx
2. tumor 3 CNS disease 4 trauma |
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what 2 s/s of SIADH?
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fluid retention & hypotonicity
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how are the labs in SIADH? (serum osmolarity, urine osmolarity, serum sodium)
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↓ Serum osmolality
↑ Urine osmolality (more concentrated) ↓ Serum Na levels below 1.020 |
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low levels of sodium in the blood in SIADH can cause?
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water intox/manifested by stupor and convulsions
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if you notice your child have anorexia, n/v, cramps, irritability, personality changes
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water intoxication secondary to hyponatremia
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if there is impending stupor and convulsions with SIADH, what should you do as the nurse?
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RESTRICT FLUID TO ¼ TO ½ MAINTENANCE
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what is nursing care for a pt with SIADH?
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think A DOSE
1. accurate i/o 2. daily wt 3. observe for fluid overload 4. seizure precaution 5. explain fluid restriction to client and family |
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what is important to teach a pt with SIADH?
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explain the importance of fluid restriction to client and family
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what are 2 r/f for congenital hypothyroidism
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1. girl
2. down syndrome |
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what is the best prognosis for congenital hypothyroidism?
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early dx and tx
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infants may not exhibit s/s of congenital hypothyroidism. Why?
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d/t prenatal hormones or breast feeding
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what are subtle s/s of congenital hypothyroidism in newborns? (7)
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1. Poor feeding
2. lethargy 3. prolonged jaundice 4. cyanosis 5. constipation 6. large fontanels 7. bradycardia |
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what are the typical facial features of congenital hypothyroidism? (4)
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1. depressed nasal bridge,
2. short forehead 3. puffy eyelids 4. lg tongue |
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how do congenital hypothyroid babies feel?
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cold to touch (mottled)
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typical features of congenital hypothyroidism appear when?
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after 6 wks after birth
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how are congential hypothyroid in GI, mentally, nervous syst?
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Infant difficulty feeding
GI: Decreased gastric motility Mentally: Severe mental retardation Other nervous system: slow awkward movements |
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what is the most serious problem of congenital hypothyroidism?
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mental retardation
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hypothyroidism screening is mandated in?
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all states
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what must be evaluated with kids who have congenital hypothyroidism?
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Measurement of t4 levels and bone age surveys
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what is the medicinal tx of congential hypothyroid?
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synthroid or levothyroid
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what can you tell the parents of the congential hypothyroid baby that they can expect in life if tx early?
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they can have normal physical growth and intelligience
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what is the most cause of inadqueate tx?
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noncompliance
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what are the KEY findings of congenital hypothyroidism? (LOC, reflexes, physical assesmsnt, temp/condition of skin)
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Lethargy
Hypotonia Short, thick neck Cool body & skin temp Dry, scaly skin |
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in congenital hypothyroidism, what will be increased, what will be decreased in hormones?
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↑ TSH level with ↓ T3 & T4 levels
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what are the s/s of synthroid overdose for tx of congenital hypothyroidism? (6)
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1. Tachycardia
2. dyspnea 3. irritability 4. insomnia 5. fever/sweating 6. decreased wt |
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what are some s/s of inadequate tx of hypothyroid (thru synthroid)
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Fatigue, sleepiness, decreased appetite and constipation
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what are the s/s of GH deficiency? (5) think looks and sexual organs
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1. Short stature
2. Well-nourished 3. Skeletal proportions NL for age 4. Appear younger than chronological age 5. Sexual development slightly delayed |
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GH deficiency may be at risk for?
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Premature aging later in life
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how is the bone in GH deficiency (includes teeth)
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Bone age retarded but close to ht age
Eruption of permanent teeth delayed |
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how is the intelligience and emotions in GH deficiency?
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Normal intelligence
Emotional problems common |
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how to diagnose GH deficiency? (3)
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1. Family hx
2. Hx of child’s growth patterns /physical exam 3. X-rays such as skeletal surveys <3, hand and wrist survey, skull series, carotidangiogram |
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Endocrine Function Study measures what?
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measures effect of hormone
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Radioimmunoassay measures what?
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measures minute quantity of hormone
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tests (2) to diagnose endocrine problems are?
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1. endocrine function study
2. radioimmunoassay |
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what is the tx for GH deficiency? how often is it adminstered?
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everyday subcut injection of biosyth GH until they reach their target height
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what kind of emotions may child and parents of GH deficiency have? what is important to do?
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may have anger and guilt
need to support family and child |
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when is it BEST time to give GH for GH deficiency?
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night time
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how is immobilization hard on child and family? (2)
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1. b/c growth and develop is affected
2. hard on child, family, staff |
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what is immobilization?
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forced restriction on movement to aid in recovery or injury
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what are 3 physiologic effect of immbolization?
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1. loss of muscle strength, endurance, and muscle mass
2. bone demineralization 3. loss of joint mobility and contractiures |
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immobilization affects what body syst?
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all
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what are the psychologic effects of immoblizxation? (5)
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1. may be bored
2. language delay in young child due to low exposure 3. anxiety/depression/regression/anger/hostility 4. may believe they are getting punished 5. response may be active or passive |
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immobilization may make a young child feel like?
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they are getting punished
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how does immobilization strain the family? (4)
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1. money strain/take off work
2. neglect of other family members 3. difficulty accepting altered body image 4. guilt/difficulty coping |
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what are some mobilization devices for immobile kids?
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orthotic: braces
prosethic: artificial limbs |
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ossification begins when? fx lecture
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at embryo 18/21
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explain diaphysis and the direction it grows
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mid section of bone progresses OUTWARD
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what is and where does the epiphysis end?
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epiphysis is the rounded ends of the long bone
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what is epiphyseal plate/ where is it?
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the plate is in the diaphysis (shaft) and epiphysis AND is responsible for LONGITUDINAL GROWTH.
Therefore it allows up to grow taller |
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what is the periosteum? what does it contain
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the tough covering of the bone that contain blood vessels
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what are 10 types of fx? explain some
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think 4C i TOSS
1. comminuted: shattered but intach 2. complicated 3. compound: open fx 4. complete : all the way 5. incomplete 6. transverse 7. oblique: at an angle 8. spiral: uneven angle 9. simple 10. green stick: partial/half tx |
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where is a freq site of damage in trauma?
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at the epiphyseal
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if little damage to epiphyseal, what happens
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generally heals promptly
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whay is epiphyseal injuries bad? (2)
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1. detection is difficult
2. may affect bone growth |
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what is the medical mgmt of epiphyseal injuries?
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open reduction AND internal fixation
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what are s/s of a fx? (4 visual)
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1. swelling
2. pain/tenderness 3. decreased use of affected part 4. possible bruising |
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if there is vascular damage, whawt are the s/s of a fx? (5)
|
think 5 P's
1. pain 2. pallor 3. paresthesia 4. paralysis 5. pulselessness |
|
|
what are the goals of fx mgmt? (4)
|
1. regain alignment and length of bony fragments
2. retain alighnment and length 3. restore function of injured part 4. prevent further injury |
|
|
what are some examples of how to fix a fx? (4)
|
1. closed manip and casting (outpt)
2. traction 3. internal and external fixation 4. open reduction |
|
|
explain the bone healing stages in a fx? (5)
|
stage 1: hematoma formation
stage 2: celluar prolif stage 3: callus formation stage 4: ossification stage 5: consolidation and remodeling |
|
|
the amount of extremity to be in a cast is influenced by? (3)
|
1. completeness of fx
2. type of bone 3. how much wt is placed on the limb |
|
|
what is immobilized when a child has a fx? why?
|
at joints above or below fx b/c they want to avoid displacement at fx site
|
|
|
what are 4 categories of cast? (4)
|
1. upper extremity
2. lower extremity (like ankle/knee) 3. spinal/cervical (spine/neck) 4. spica |
|
|
who are light weight cast more likely to be used in? Give 2 examples of lightwt casts?
|
used more often in young children
1. fibroglass 2. polyurthane |
|
|
what is the nurse suppose to do when a cast is JUST put on?
|
allow it to dry
|
|
|
how long would you expect fibroglass cast to dry? plaster?
|
plaster takes 1-2 days to dry
fibroglass takes minutes to dry |
|
|
explain the care of a cast? (7)
|
1. keep uncovered
2. turn child q2h 3. use a cool fan/hair dryer to dry it 4. handle with palms of hands (gentle) 5. elevate cast on first day 6. check CMS 7. check for s/s of infx |
|
|
what might kids do to their cast? (3)
|
1. like to hide things in cast =oh no!
2. may like to scratch in it 3. may put things in it |
|
|
how can you relieve itching w/ a kid in a cast (2)
|
1. medication
2. ice pack |
|
|
if a child is incontinent, what are ways to keep cast dry?
|
protect with waterproof tape and plastic
|
|
|
what might you want to do to avoid irritation at the edges of the cast?
|
pad edges
|
|
|
when a chld is in a cast, what is important to tell them/encourage them during the first 1-3 days
|
emphasize rest for the first few days,
elevate their cast area on the first day |
|
|
what are some consideration for a kid with a hip spica cast? (4)
|
1. may need SPECIAL car speat
2. put them on their stomach when self feeding 3. use small bedpans or special pads for elimination 4. have altern. was for sitting |
|
|
how would you position a kid/infant if self feeding when they have a hip spica cast?
|
prone
|
|
|
why is traction not used as much anymore? (3)
|
1. b/c more people are being tx in outpt (traction is a inpt thing)
2. newer surgical techniques 3. newer developmental considerations |
|
|
how might traction be good? (2)
|
puts bone in alignment to promote bone healing
|
|
|
traction must be ____. WHy?
|
continuous.
b/c a release will cause CONTRACTION and malposition |
|
|
what are 3 types of traction?
|
1. manual
2. skin 3. skeletal |
|
|
explain manual traction? when is it used?
|
hand is placed distal to fx and is often used during cast application
|
|
|
explain skin traction?
|
pull is applied to skin directly
is attached with adhesive/elastic bandage over soft foam adhesive traction straps |
|
|
explain skeletal traction?
|
pull is applied directly into/thru the bone distal to the fx from pins, wire, or tongs
|
|
|
explain 2 types of upper extremity traction? what is it usually used with?
|
1. overhead suspension
2. dunlop traction used with skin traction |
|
|
explain overhead suspension? where is traction applied?
|
arm is bent at elbow and suspended vertically by skin or skeletal attachment
traction is applied at distal end of humerus |
|
|
explain dunlop traction?
|
arm is suspended horizontally with skin or skeletal attachment
|
|
|
how is dunlop and overhead suspension traction different?
|
overhead is VERTICAL SUSPENSION
dunlop is HORIZONTAL SUSPENSION |
|
|
explain bryant traction?
|
low extremity traction that is PULLED only in ONE direction
not recommended |
|
|
explain bucks extension traction? what kind of traction is it? how long is it used for?
|
it is a SKIN traction with legs in extended position
used for SHORT TERM |
|
|
explain russell traction? what kid of traction is it? how will the lower extremity be?
|
it is a SKIN TRACTION on lower leg and padded sling under knee
has a longitudinal AND perpendicular pull hip and knee will be in a FLEXED position |
|
|
explain 90 to 90 degree traction? where is the pins
|
lower leg is in a boot cast OR supported in a sling
there is a PIN/wire in the DISTAL FRAGMENT OF THE FEMUR |
|
|
explain suspension traction? what is it used with? (what is the traction and where is it)
|
-may or may not have skin or skeletal traction
-no traction is exerted directly on body part |
|
|
other than traction, what is supporting in balance suspension traction and where does it support?
|
has thomas splint and person attachment in balanced suspension
-thomas splint extends from the groin to midair above foot -pearson attachments supports lower leg |
|
|
in balanced suspension, what positions are the lower extremities in relation to the others?
|
leg is suspended in flexed position to relax hip and hamstring
|
|
|
what is nursing care to maintain traction? (4)
|
1. check line of pull
2. check each component 3. check position of bed (should not be touching) 4. don't change traction |
|
|
how to care for skin traction? (2)
|
1. asess adhesive straps and elastic bandages
2. maintain traction IF changing |
|
|
how to care for skeletal traction? (2)
|
1. check, clean, and dress pin sites as need
2. cover end of pins to prevent injury |
|
|
how can you prevent complications of traction? (2)
|
1. check CMS
2. exercise unaffected joints |
|
|
what is the hugest complications of fx, what should you encourage?
|
pulmonary emboli
encourage IS |
|
|
explain the two types of scoliosis?
|
1. nonstructural, function, or postural: NONPROGRESSIVE c curvature
2. structural: a PROGRESSIVE S curve |
|
|
what are some causes of NONSTRUCTURAL scoliosis? (4)_
|
1. poor posture
2. discrepancy of leg lengths 3. paraspinal inflam 4. acute disk disease |
|
|
what are some causes of structural or progressive scoliosis? (3)
|
1. deformity of vertebral bodies
2. RIB changes 3. neuromusc changes (muscle wkness or paralysis |
|
|
what is essential for successful tx of scoliosis?
|
early detection and tx
|
|
|
what are the diagnostics for scoliosis called? (3)
|
1. adams forward bend test
2. x-ray in STANDING position 3. scoliometer |
|
|
what are some tx options for scoliosis pt? (3)
|
1. observation
2. bracing 3. spinal fusion |
|
|
what does the choice of tx depend on with scoliosis? (3)
|
1. magnitude, location, type of curve
2. age/skeletal maturity of child 3. underlying disease |
|
|
what is the major choice of tx for scoliosis?
|
bracing
|
|
|
what does bracing do AND how long should kids expect to wear it?
|
braces halts progression of curve
expect to wear it for 16-23 hours a day |
|
|
what kind of brace is HARDLY used for scoliosis?
|
milwaukee
|
|
|
explain the surgical option for scoliosis? (3)
|
1. only used for severe cases
2. has INTERNAL FIXATION and instrumentation with bony fusion of spine 3. has anterior or posterior approach |
|
|
explain 3 posterior approaches of surgery for scoliosis?
|
1. harrington
2. lugue semental spinal instrumentation 3. cotrel-dobousset approach |
|
|
explain harrington system for scoliosis surgery? (specif the post op)
|
1. post op kid is log rolled to prevent spinal motion
2. will use a molded jacket to stabilize spine when child is up |
|
|
explain the luque spinal instrumental post op for scoliosis postop
|
no postop immobilization needed
|
|
|
cotrel-dubousset approach surgery for scoliosis explain?
|
combines harrington and luque
|
|
|
what are 2 examples of anterior approach? what do these two things require
|
1. dwyer
2. zielke both require plastic jacket for immobilization |
|
|
what is CP?
|
a nonspecific term for a NONPROGRESSIVE d/o characterized by early onset and impaired movement and posture
|
|
|
when is CP expected to come about
|
early onset
|
|
|
what is the single most important determinant of CP?
|
preterm birth of low birth weight infant
|
|
|
what is the common s/s? (since CP s/s are variable? (7)
|
abnormal muscle tone and coordination
1. spastic 2. dyskinetic/athetoid 3. ataxic 4. mixed type/dystonic 5. reflex abnormalities 6. abnormal posture 7. abnormal gross motor development |
|
|
explain the spastic type of CP? (3)
|
1. most common type
2. hypertonic with poor control of posture, balance, coordination 3. includes may type of spastic CP; e.g. athetoid, ataxic, and mixed |
|
|
explain the dyskinetic.athetoid CP? (3)
|
1. abnomral INVOLUNTARY movement
2. slow, wormlike, writhing movement 3. drooling and poor speech |
|
|
explain the ataxic CP? (3)
|
1. wide based gait
2. rapid repetitive movemetns 3. upper extremities DISINTERGRATE |
|
|
the mixed/dystonic type of CP will most likely manifest as?
|
spastic
|
|
|
what are associative disabilities that CP kids may face? (6)
|
1. vision impairment
2. hearing impairment 3. communication and speech difficulties 4. Intellectual impairment 5. seziures 6. ADHD |
|
|
what kind of impairment may CP kids face? (4)
|
1. vision
2. hearing 3. intellectual (tho many are WNL) 4. communication/speech |
|
|
what are s/s of CP other than impairment? (6)
|
1. drooling
2. feeding problems and constipation 3. inadeaute gas exchange 4. orthopedic complications like scoliosis 5. dental problems (gingivitis and cavities) 6. seizures |
|
|
what are the diagnostics for CP?
|
1. care assessment at BIRTH
2. neuro exam 3. hx 4. supplemental diagnostics tests: eeg and serum electrolytes |
|
|
what are 2 supplemental diagnostics for CP?
|
eeg and serum electrolytes
|
|
|
what is CP tx based on (2) why?
|
based on symptoms and prevention
since it is a permenant disease |
|
|
who is essential for the tx of CP?
|
parents
|
|
|
what is the most important aim in CP child tx?
|
promoting socialization with non-cp and CP children
|
|
|
based on s/s of CP, what may be needed in the tx? (7)
|
1. PT/OT with mobilizing devices
2. surgery 3. medications like antianxiety b/c may be at risk for ADHD 4. Speech therapy/care of visual and auditory deficits w/ technical aids like hearing and speaking 5. education 6. recreation (promote socialization) 7. dental care b/c at risk for cavities |
|
|
what is the cause of DS?
|
unknown
|
|
|
what are the r/f of DS? (2)
|
1. AMA but major born from young women
2. paternal age is a factor |
|
|
how is the intelligience and social development of DS?
|
1. intellignece varies and social development is 2-3 years beyond mental age
|
|
|
what are the visual s/s of DS? (5)
|
1. flattened nose and face
2. upward slanted eyes 3. single palmar crease and pinkie curves in 4. many crease on foot with large gap between 2nd toe and big toe 5. usually HYPOTONIC |
|
|
what are things you should teach when parent has child with DS? (4)
|
1. safety
2. self care 3. family planning 4. activity suitable for child mental age |
|
|
DS kids are at risk for what type of problems? (9)
|
1. sensory problems (important to evaluate hearing and sight)
2. altered immunity 3. EARLY AGING 4. RR infx 5. leukemia 6. thyroid problems 7. decreased growth 8. delayed sexual development 9. congenital defects |
|
|
give me 4 examples of diseases that DS kids may have?
|
1. RR infx
2. leukemia 3. thyroid problems 4. ASD heart defect |
|
|
how is the growth in DS kids (ht, wt, sex)
|
ht: delayed
wt: delayed but more rapid than ht sex: delayed, incompete (DS boys are infertile, DS girls are fertile |
|
|
how does fertility differ with DS girls and DS boys
|
girls fertile , boy infertile
|
|
|
what is the tx for DS?
|
NO CURE
1. surgery to correct congenital defects like ASD 2. need reg checkups (esp important to evaluate signt and hearing) 3. use special growth charts |
|
|
when evaluating a DS kid (outpt) what are 2 things to remember?
|
1. use special growth charts
2. pay attention and evaluate to sight and hearing evals |
|
|
what does it mean to be:
-deaf -hard of hearing |
with deaf, even with a hearing aid, CAN"T HEAR
hard of hearing-can hear barely if have an hearing aid |
|
|
hearing impairment refers to?
|
varying degrees of hearing impairment, e.g. deaf and hard of hearing
|
|
|
how is hearing impairment classified? (3)
|
1. by cause
2. by pathology 3. by s/s severity |
|
|
what is the most common type of hearing impairment?
|
conductive
|
|
|
what is the cause of conducive hearing loss? how does it cause impairment?
|
from INTERFERENCE OF TRANSMISSION to the middle ear and mainly involves the interference of the LOUDNESS of the sound
|
|
|
which type of hear loss may occur from freq serous otitis media?
|
conductive hearing loss
|
|
|
what is the sensorineural hearing loss?
|
DAMAGE to the auditory nerve or INNER ear structure
|
|
|
what are 3 causes of sensorineural hearing loss?
|
1. congenital defects
2. acquired condition 3. exposure to excessive noise |
|
|
sensorineural hearing loss results in what to happen?
|
distortion of sound
|
|
|
a kid is exposed to constant loud noises b/c he lives near a construction site, what kind of hearing loss would you suspect?
|
sensorineural
|
|
|
if you said "flight" and the kid responds saying you said "mice" what hearing loss would you suspect? why?
|
sensorineural. B.c sensorineural causes a DISTORTION of the sound
|
|
|
think of janell and dad, connect the two with sensorineural and conducive?
|
janell: sensorineural (what you said mice when i heard you said dice?
dad: conducive (need loudness) |
|
|
what is the tx for conducive hearing loss?
|
1. medicine
2. surgery 3. hearing aid remember interference of the LOUDNESS |
|
|
what is the tx for sensorineural hearing loss?
|
need cochlear implants thru surgery
ONLY SURGERY CAN HELP, HEARING AID WILL NOT HELP |
|
|
which type of hearing loss will not benefit from a hearing aid?
|
sensorineural
|
|
|
when is it critical to identify hearing loss AND why is it important?
|
critical to evaluate hearing loss within THE FIRST 3-6 MONTHS OF AGE
-important: to increase language b/c hearing loss affects language |
|
|
who is at risk for hearing loss (parents report)
|
my child doesn't turn to sound
|
|
|
who do you screen for auditory function?
|
ALL CHILDREN
|
|
|
to promote communication in a deaf kid, what 4 things can you do?
|
1. teach LIP READING
2. provide HEARING AIDS 3. teach or use SIGN LANGUAGE 4. utilize SPEECH & LANGUAGE THERAPY |
|
|
what are measures to prevent hearing loss? (meaning what 2 things can you tell the parent?)
|
1. importance of tx EAR and RR infx EARLY
2. counsel pregnant women about the r/f and importance of early and freq checkups |
|
|
what are s/s of visual impairment? (6)
|
1. ha
2. squinting 3. fatigue 4. tilting head 5. rubbing eyes 6. double vision |
|
|
what is def of legal blindness
|
visual acuity of 20/200 or less or a visual field of 20 degrees or less in better eye
|
|
|
what is partially sighted def?
|
visual acuity of better than 20/200 but worse than 20/70 in better eye with correction
|
|
|
jonny can see 20/60, is he blind?
|
no, he is BETTER THAN PARTIALLY SIGHTED
|
|
|
what is the stop point for legal blindness?
|
less than 20/200
|
|
|
what is the stop point for partial sighted?
|
20/70 in better eye
|
|
|
what is the causes of visual impairment?
|
usually cause is UNKNOWN, linked to
a. genetic b prenatal c. postnatal factors |
|
|
what ist he most common cause of visual impairment?
|
refractive error
|
|
|
what is myobia?
|
near-sightedness (light falls in front of retina)
|
|
|
what is it when light falls IN FRONT of retina? how does it manifest?
|
myobia, will have NEAR sightedness
|
|
|
what is hyperopia?
|
far sighted (light falls behind retina)
|
|
|
if light falls behind retina, what is it called? how will it manifest?
|
hyperopia, will be FAR sighted
|
|
|
what is amblyopia?
|
lazy eye in ONE eye
|
|
|
what is strabismus?
|
cross eye ( in or outwards
|
|
|
what is cataracts?
|
opacity of lens THICKEN
|
|
|
what is glaucoma?
|
increased IOP
|
|
|
if glaucoma is not tx, what can happen?
|
blindness
|
|
|
give examples of what can cause visual impairment? (8)
|
1. myopia
2. hyperopia 3. amblyopia 4. strabismus 5. cataracts 6. glaucoma 7. trauma 8. infx |
|
|
why is important to indentify visual impairment?
|
to preven social, physical, and psychological harm to child
|
|
|
who do you screen for vision?
|
all children
|
|
|
what are nursing considerations for visually impaired children? (4)
|
1. increase parent-child attachment
2. support child and family 3. increase optimal development 4. care of child |
|
|
myleomeningocele's paralysis below the second lumbar vertebra causes (2)
|
1. flaccid paralysis of lower extremities
2. sensory deficits |
|
|
many myleomeningocele have what condition, what does it require?
|
many have hydrocepahalus
|
|
|
what cerebravascular disease has most neuro deficits?
|
myleomeningocele
|
|
|
what are the s/s of myleomeningocele? (5)
|
1. motor and sensory deficits below level of defect
2. neurogenic bladder and bowel problems 3. impaired peristalsis 4. deformities and contractures of lower extremities 5. cognitive deficits |
|
|
myleomeningocele are at risk for? name some nursing diagnosis (5)
|
1. impaired nutrition
2. bowel and bladder incontinence/retention 3. impaired consciousness (cognitive deficits) 4. constipation 5. impaired mobility (below level of defect) |
|
|
myleomeningocele: where is the sensory and motor deficits?
|
below the level of the defect
|
|
|
myleomeningocele is prone to? (4)
|
1. latex allergy
2. uti 2ndary to neurogenic 3. scoliosis 4. pneumonia |
|
|
in taking care of myleomeningocele IN A HOSPITAL, remember what?
|
DO NOT USE LATEX
|
|
|
what is the nursing care for child with myleomeningocele
|
1. maintain prone (to avoid injury to exposed spine)
2. protect airway 3. protect sac (prevent drying and infx) 4. support family (emphasize bonding) |
|
|
myleomeningocele is what kind of disease?
|
most serious form of spina bifilda
|
|
|
VP is used to tx what?
|
hydrocephalus
|
|
|
what are potential risk associated with VP shunt? (4)
|
1. infx
2. blockage or malfunction of valbes 3. kinked tubing 4. outgrowing of shunt |
|
|
why is peritoneal VP shunt used often?
|
b/c have rich mesenteric bed that can absorb fluid
|
|
|
explain VP shunt?
|
from lateral ventricle, runs subcut to peritoneal cavity
|
|
|
what do doctor do with VP shunt if young kid?
|
put extra tubing to allow kid to grow BUT one complication is an OUTGROWING of the shunt
|
|
|
what do you need to teach parents when kid has VP shunt? (4)
|
recognize s/s of increased ICP
1. increase in head circumference 2. LOC, irritability 3. vision changes 4. fever |
|
|
how is the G & D of kids with VP shunt?
|
may have normal cognitive function, more serious of motor deficit
|
|
|
what does a VP shunt do?
|
remove excess CSF pressure from the brain draining it to the abdomen
|
|
|
how are the VS in Increased ICP? (early vs late)
|
early: increase in BP, P, RR
late: cushing triad (bradycardia and wide pulse pressure, irreg breathing) |
|
|
what are the s/s of increased ICP in infants? what is the 2 biggest ones? (5)
|
1. INCREASED HEAD CIRCUMFERENCE
2. BULGING FONTANELS 3. high pitched cry 4. lethargy 5. poor feeding/vomitting |
|
|
s/s of increased ICP in older child? (9)
|
1. irritability
2. HA 3. vomitting 4. decreased LOC 5. seizures 6. positive babinski 7. blurred vision 8. cushing triad 9. memory loss |
|
|
what is decorticate?
|
think DEeper to the COre
pray with pointed feet |
|
|
what is decerebrate?
|
think cerebrate!! so i will fly
flying with arms low and outwards and inward rotation of foot but spaced out |
|
|
decorticate and decrebrate indicate?
|
increased iCP
|
|
|
what is the lowest glascow coma scale? highest? what does it indicate?
|
lowest: 3 (brain dead)
highest: 15 (healthy brain) |
|
|
how many pts do you give to open eyes, motor, and verbal in glascow?
|
eyes: 4
motor: 6 verbal: 5 |
|
|
what is the leading cause of head injury of 5 y.o?
|
falls
|
|
|
what does is coup to contracoup?
|
when injury occurs at point of impact then to opp
|
|
|
who is vulnerable to acceleration and deceleration injuries? why?
|
infants b/c have weak neck muscles and heavy head
|
|
|
explain the types of head injury (4)
|
1. concussion
2. contusions/lacerations 3. skull fx 4. hematomas |
|
|
concussion is manifested by? (2)
|
1. loss of awareness and responsiveness that last a minute to hours
2. followed by amnesia and confusion NO REAL DAMAGE |
|
|
what are contusions and lacerations?
|
bruising and teraing of brain tissue that may occur with coup and contracoup
|
|
|
how is linear skull fx and deprewssed skull fx different?
|
linera fx has no real deficits
depressed fx has neuro deficits |
|
|
what is epidura hematoma?
|
collection of blood aboce dura
|
|
|
if pt had an epidural hematoma, when would you see s/s?
|
may take several days (insiduous)
|
|
|
what does subdural hematomas involve?
|
rupture of veins or arteries
|
|
|
if a kid had acute subdural hematoma, what would you suspect? (4)
|
1. abuse
2. shaking 3. trauma 4. decel-accel damage |
|
|
shaking baby is a form of what kind of hematoma?
|
subdural (deeper)
|
|
|
what hematoma is more common in kids/
|
subdural
|
|
|
what is the medical mgmt of head injuries? (4)
|
1. reduce cerebral edema thru mannitol and HOB midline
2. manage pain and fever 3. promote brain o2 4. support normal growth |
|
|
how to prevent increased ICP?
|
1. pain assessment (increased pain=iicp)
2. fever (hypoxia=iicp) 3. hob midline 4. fluid mgmt/restriction 5. quiet environ (stress=iicp) |
|
|
people with head injuries may be at risk for?
|
aspiration and vomitting
|
|
|
when an infant has a head injury, it is important to assess for ICP by doing?
|
testing reflexes
|
|
|
head injuries can potentially cause? (6)
|
1. HIE (motor/intell deficit, vis/aud deficit, swallowing defi, seizures)
2. infx 3. seizures 4. hydrocephalus 5. mental retardation 6. PTSD |
|
|
what is meningitis?
|
acute inflammation of meninges surrounding CNS
|
|
|
how can meningitis be transmitted? (4)
|
1. droplet
2. airborne 3. extension of another infx 4. perinatal transmission |
|
|
when taking care of a meningitis kid, it is important to what? why?
|
wear a mask b/c it is droplet precaution
must be isolated |
|
|
what has decreased the incidence of meningitis?
|
vaccine (h-flu vaccine)
|
|
|
what are s/s of meningitis (7)
|
1. STIFF NECK
2. HA 3. fever 4. hypothermia 5. poor feeding 6. vomitting 7. pedechial rash |
|
|
if you have a kid with pedichial rash, what might you suspect? what should you do?
|
may mean meningitis
need to get abx started and get them isolated!!! |
|
|
what s/s may you see in an infant with meningitis? (4)
|
1. bulging fontanel
2. pedechial rash 3. stiff neck 4. kernig and brudzinki sign |
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what 2 nursing assessment test can be given to test meningitis. how to do it?
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1. kernigs: extend of lower leg
2. brudzinski: flex neck forward |
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what are positive sign of menigitis for the 2 tests?
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kernigs: kid will have back pain when you extend lower leg
brudzinski: kid will go into fetal position when flex their neck |
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how do you 4 diagnostics for meningitis?
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1. physical and neuro exam
2. lumbar puncture 3. CT/MRI 4. EEG |
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what are nursing measures to care for a kid with meningitis? (6)
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1. isolation precautions
2. speedy abx & antiviral 3. hydration/ventilation 4. interventions to decreased ICP (pain assessment, fever, position, I&0, quiet) 5. prevent seizure 6. freq neuro and sepsis assessment |
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what is the most important med mgmt for meningitis?
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abx/antiviral tx
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what are important nursing assessment for meningitis (5)
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1. head circumstance under 1.5 year old
2. LOC/IICP/seizure 3. VS 4. labs for potential sepsis 5. CAREFUL I/O (watch for SIADH and DI) |
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what are very important considerations for meningitis? (3)
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1. sepsis
2. isolation precaution 3. I/o with consideration of DECREASING ICP |
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unlike adults, children with increased ICP will have ____
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delayed manifestation of IICP
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in IICP, there is 3 components and what is the theory?
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brain, csf, and blood
if one component increases, the others need to decrease |
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pyloric stenosis is what?
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hypertrophy of pyloric sphnicter
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when is the s/s of pyloric stenosis appear?
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later. at birth, appears normal
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what are the 3 main s/s of pyloric stenosis?
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1. nonbilious vomitting projectile
2. olive shaped mass 3. metab alkalosis |
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what are nursing interventios for pyloric stenosis preop? (4)
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1. rehydrate
2. correct alkalosis 3. decompress stomach 4. pylomectomy |
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when is cleft palate repaired?
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1 y.o
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what is common among cleft palate kids?
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1. ear problem, otitis
2. speech problems |
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what may a kid with a cleft palate get?
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pressure equalizer to drain ear
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how to feed a preop cleft palate pt?
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upright with freq burping
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post op, how to feed cleft palate pt? (3)
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1.okay to put on stomach
2. may resume breast, bottle, cup 3. no hard stuff in mouth |
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what are some nursing diagnosis for pyloric stenosis? (3)
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1. risk for dehydration
2. FTT 3. metab alkalosis |
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how is the nurses rx to death?
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1. similar to family
2. nurses choose to be concerned 3. they worry about being detached 4. think DADA a. denial b. anger c. d d. anxiety |
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how can nurses help themselves when dealing with a loss of a pt? (6)
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1. becoming more educatied about terminal kids
2. base their practice on evidence and theory 3. distance/separate work 4. remember shared rituals 5. focus on positve 6. support, not do everything for family affected |
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a child rxn to chronic illness is based on what factors? (6)
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1. developmental age
2. temperment 3. intelligience 4. motor skill 5. age 6. type/duration of illness |
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how does mom rxn differ from father rxn of death of kid?
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more emotional while dad is more practical
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how do foster parents and siblings react to loss of family member?
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foster fmaily more prepared
sibling increase their caring |
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how may families react to a death
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1. assign a meaning
2. share burderns 3. empowerment 4. denial |
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what is the first rxn of death of a loved one? what will happen
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shock but then parents will reintegrate
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