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74 Cards in this Set
- Front
- Back
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Follow up mgmt of hydrocephalus/VP shunt
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• Post-op: placed on unoperated side (to prevent pressure). Kept flat. Pain management. OBSERVE FOR S&S OF ICP!!! Neuro assessments. Blood pressure. Observe for abdominal distention. May be NPO. ASSESS FOR S&S OF INFECTION!!!! Diaper off the suture line. Antibiotics as ordered. Meticulous skin care.
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Hydrocephalus teaching points for parents
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• Education: recognize S&S that indicate shunt malfunction or infection & how to pump the shunt if necessary.
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• S/sx of dehydration and fluid volume deficit
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• S&S: Fewer wet diapers than usual. No tears when crying. Mouth dry & sticky. Irritability. High-pitched cry. Difficulty in awakening. Increased respiratory rate or difficulty breathing. Sunken fontanel, sunken eyes with dark circles. Abnormal skin color, temp, or dryness. Slow capillary refill. Decreased turgor . Weight loss. Changing LOC. Non or slow response to stimuli. Shock, tachycardia and low blood pressure are signs of severe depletion of ECF volume.
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• S/sx of increased intracranial pressure
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• Widening of sutures & fontanels, lethargy, poor feeding, vomiting, irritability, dilated scalp veins, high-pitched, shrill cry, “Setting sun” sign, budging anterior fontanel, Increased head circumference.
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s/sx of brain tumor
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• S&S: HEADACHE & WOMITING UPON WAKING!!!!!
• Recurrent vomiting not related to feeding. Ataxia. Visual disturbances. Signs of increased ICP. Personality changes. |
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Osteomyelitis
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• Infectious process ( Staph or MRSA) in the bone metaphysis leads to local bone destruction and abscess formation
• S&S: CHILD LOOKS “SICK”! !!! Irritability. Fever. Tachycardia. Tenderness, warmth, edema over involved bone. Pain. Decreased ROM. • Tx: Aggressive IV therapy (PICC 4-6 weeks). Bed rest. Immobilization of extremity (prevent spread of infection) • Management: Monitor vital signs. Pain relief. Maintain IV for antibiotic tx |
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Legg-Calve-Perthes Dz
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• Avasular necrosis of the femoral head
• Disturbance of the circulation to the femoral capital epiphysis produces an ischemic necrosis of the femoral head • S&S: limp or hip pain first, joint dysfunction & limited ROM, weakness, & muscle wasting • TX: prevent weight bearing (traction then bracing) or Surgical (normal activity 3-4 months) • Management: Helping children cope. Activities & play important (in industry vs. inferiority. Educate about corrective devices. |
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Epiglottitis
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• EMERGENCY!!!!
• Inflammation of muscosa lining the larynx & trachea • BACTERIAL (H. Influenzae) • S&S: ABSENSE OF SPONTANEOUS COUGH. DROOLING. TRIPOD POSITION. Agitation. Abrupt onset (often preceded by core throat), fever. Dysphagia. “sick” appearance, Refusal to lie down. Cheery red lips & tongue |
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Epiglottitis (con't)
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• Medication: analgesics (fever). Antibiotics. HIB immunization.
• Tx: Oxygen. Room humidifier. Trach or NG tube incubation (severe). • Management: DO NOT INSPECT THE THROAT UNLESS EMERGENCY & PERSONEL AVAILABLE! REFRAIN FROM MAKING PATINENT MORE AGITATED (do IV later & let them stay in position they want) |
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Croup (Laryngotracheobronchitis)
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• Inflammation of mucosa lining the larynx & trachea usually developing over several days
• S&S: HOARSENESS. BARKY COUGH. STRIDOR (inspiration). Respiratory distress. Suprasternal retractions. Low fever. • VIRAL!!! • Management: Educate cough will get worse at night. Discourage crying. Take child outside (cold air). Take child in the shower (warm arm). Hold child upright. Encourage drinking. |
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Asthma
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• S&S: Cough. Increased mucus. Shortness of breath. Expiratory wheeze. Co2 retention. Prolonged expiratory. Retractions
• Maintenance inhaler: Long acting β antagonist & Inhaled steroids (GOLD STANDARD!) • Rescue Inhaler: Short acting β2 agonists & Albuterol • Acute exacerbations: oral steroids |
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Peak Expiratory flow rates
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a child’s personal best is established: record 2x a day
-green (80-100%)= continue current treatment -yellow(59-79%)=implement plan ordered by physician -red (Below 50%)= MEDICAL ALERT !!!! give short acting bronchodilator and call md if no improvement!!! |
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Bronchiolitis
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• Bronchiolitis is an acute viral infection of the lower respiratory tract with maximum effect at the bronchiolar level.
• Mostly caused by RSV, infection occurs in winter/spring. Usually occurs in kids 2-12 mos. Rare after 2 yo. |
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Bronchiolitis (cont)
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• S/Sx: Labored respirations, poor feeding, cough, tachypnea, retractions/flaring nares, emphysema, ^ nasal mucus, wheezing, fever.
• Tx: supplemental ox if sat < 90%, • bronchodialtors (optional), Racemic epi shows modest improvement • suction nasopharynx, ^ fluids, • Cool, humidified oxygen; maintain oxygenation. Routine chest physical Therapy is NOT recommended. • Fluids by mouth may be contraindicated d/t tachypnea, weakness, fatigue. IV fluids preferred. • Decrease airway inflammation and promote adequate fluid intake. • Corticosteroids/Antihistamines not effective. ABX not used d/t viral infection. |
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Nephrotic Syndrome
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• S&S: Weight gain over that expected based on previous pattern. Parent observation that the child’s clothes fit tightly. Decreased urine output. Pallor. Fatigue. Puffiness of face. Abdominal swelling. Blood pressure normal. Ankle/leg swelling.
• Diagnosistic: proteinuria, hypoalbuminemia, hyperlipidemia • ABSENSE OF HEMATURIA & HYPERTENSION • Management: 4-8 weeks of steroids. Dietary restrictions. |
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Glomerulonephritis
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• Primary event or manifestation of a systemic disorder than can range from minimal to severe
• S&S: Edema. HYPERTENSION. Anoriexia. Pallor. Irritability. “Sick appearance”. Etc. • Diagnostics: Step within 10 days-2 wks. HEMATURIA & PROTINENURIA. • Management: restrict sodium & fluid intake. Hypertension management. Antibiotic therapy. Strict I&O. |
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Congenital Heart Disease
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-left to right shunting lesions - ASD, VSD, PDA
-Right side is normally low pressure and left side is normally high pressure Blood flows from left to right thru the the defect -volume overload exists in the right heart and pulmonary artery. If flow into the right side becomes excessive CHF can develop. |
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Ductus arteriosus
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connects the pulmonary artery to the aorta, bypassing the lungs.
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Congenital Heart Disease: Atrial Septal Defect (ASD)
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• Abnormal opening between the atria, allowing blood from the higher-pressure L. atrium into the lower-pressure R. atrium.
• S&S: Usually tolerated well & may be apsymptomatic. Rarely develop CHF. Risk for atrial dysrhythmias and emboli formation in later life if unrepaired. • TX: may be closed in cardiac cath procedure; surgical repair w/ patch—usually before age 6 |
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Congenital Heart Disease: Venticular Septal Defect (VSD)
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• Small to moderated defects may close spontaneously within first yr of life
• R Ventricle becomes enlarged (hypertrophied); over time the R atria may also become distended • S&S: Characteristic Murmur; CHF is common; risk of Bact endocarditis; risk of pulmonary vascular obstructive disease • Tx: Surgical repair w/ bypass; Pulmonary artery banding (if not too large) or patch |
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Congenital Heart Disease: Patent ductus artious
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• Ductus SHOULD close by about age 15 hours after birth
• Often corrects self within first 2 months • Blood pumped out by LV →some of it flows back into the pulmonary art due to lower pressure → increased pressure in the pulmonary artery over time • S&S: BOUNDING Peripheral pulses. Widened Pulse Pressure (>25). Murmur (“machinery murmur”). Murmur audible throughout cardiac cycle • Management : -Preterm kids= INDOMETHICIN to close PDA’s -surgical ligation if meds fail -Surgery → between age 1-2 yrs |
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Congenital Heart Disease: Coarctation
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• Narrowing near the insertion of the ductus arteriosus
• S&S: BONDING PULSES IN ARMS. WEAK/ABSENT FEMORAL PULSES. Cool lower extremities. Signs of CHF in kids. • Tx: Non-surgical (balloon angioplasty) or Surgical |
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Tetralogy - Clinical manifestations
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-polycythemia- due to the body’s response to low oxygen.
The body is trying to compensate by making more cells to carry 02. -poor feeding, failure to thrive -marked cyanosis -clubbing -squatting postion - attempt to imprvoe hypoxia -poor perfusion -murmurs |
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Tetrology of Fallot
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– overriding aorta enlarged arises from left and right ventricle
4 defects; VSD that is high in the septum and unusually large An over-riding aorta that straddles the VSD Pulmonary stenosis RV hypertrophy |
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Polycythemia
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• Blood condition in which the bone marrow makes excess blood cells, primarily red blood cells, but also platelets and white blood cells
• The extra cells cause a thickening of the blood, which increases the risk of blood clotting, in turn potentially causing strokes, heart attacks, and other complications • S&S: reddened face, bleeding of the gums, dizziness, and itchiness |
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Sickle Cell Disease
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• Normal Hgb is replaced with sickled Hgb
• Crisis can be cause by: Infection. Dehydration. High altitudes. Hypoxia. Stress. • S&S: Pale. Jaudice due to breakdown of cell volume. Fatigue. Renal dysfunction. Liver/Spleen enlargement. PAIN! • Vaso-occulsive: pain & stroke • Aplastic: failure to make new RBC • Management: HYDRATION. OXYGEN. PAIN. Blood transfusion. Antibiotics |
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Kawasaki Disease
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• Acute systemic vasculitits of unknown cause
• Inflammation of the arterioles, venioles, & capillaries • S&S: Fever over 102.2 degrees (5+ days). STRAWBERRY TONGUE! Red lips. Bilateral conjunctival redness. POLYMORPHOUS RASH (blanching & raised) . Cervical lymphadenopathy ( one lymph node larger than other), Skin peeling. Peripheral edema. Lethargy & Irritability. -self limiting |
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Kawasaki Disease (cont)
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• Management: I.V.I.G (reduces incidence of coronary artery abnormalities). Aspirin therapy (controls fever & prevents blood clots). LOW DOSE ASPIRIN INDEFINITLY OF CORONARY ABNORMS EXIST. I&O & daily weights. Hydration. Assess cardiac status. Assess for S&S CHF. Cool cloths, unscented lotion, loose/soft clothing, mouth care, chap stick. Clear liquids and soft foods. Quiet environment. Educate parent not to be embarrassed by child’s irritability
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ITP (Idiopathic Thombocytopenic Purpura)
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• Excessive destruction of platelets (below 22,000)
• S&S: PETECHIAE & PURPURA • Tx: steroids, IVIG, splenectomy (reserved for patient with ITP lasting over a year) • Management: No sports. No rectal temp’s. No ASA or NSAIDS |
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• Cerebral Palsy
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• A group of permanent disorders of the development of movement & posture, causing activity limitation
• NON PROGRESSIVE/STATIC! (Injury before/during birth) • NOT ALL PATIENTS HAVE MENTAL DISCREPCENIES • Management: Maximum independence. Adequate nutrition. Promote physical mobility. Educate that disease will not get worse. |
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Muscular dystrophy
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• Group of progressively degenerative, inherited, causing weakness/wasting
• PROGRESSIVE!!! (usually wheelchair by 12) • S&S: Gower’s Maneuver (walking on hands to get up). Lordosis.Moderate obesity. Cardiomyopathy. Pseudohypertrophy. Decreased I/Q. • Management: Preserve function as long as possible. Hospice care. HELP COPE! |
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Seizures
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• Malfunction of the brain’s electrical system
• Epilepsy: chronic seizure disorder with recurrent & unprovoked seizures • Absence seizures: stop talking then being again after a few seconds • Management: observe & describe event. Protect from injury (don’t attempt to restrain, don’t force objects into the mouth). REMAIN WITH PATIENT until full recovery. Ease the child to the floor. • CALL EMS: seizure lasts more than 5 minutes. First seizure. Unequal pupils after. Persistent vomiting for 30+ minutes. Child stops breathing. • Status Epilepticus: seizure lasting 30+ minutes → EMERGENCY → IV diazepam, Ativan or Phenobarbital |
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Rheumatic Fever
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• Inflammatory disorder of connective tissue (joints, skin, brain & heart)
• Follows group A strep (1-3 weeks untreated) • S&S: -Joints (Migratory polyarthritis) -O (carditits) -Nodules (painless on joints) -Erythema marginatum: a long lasting rash -Sydenhams chorea: rapid movements without purpose • Dx: JONES critera • Management: PREVENTION!!! Prophylatic antibiotic therapy before dental/invasive. Monitor vital signs. Educate on antibiotic therapy for 5 years. |
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Mononucleosis
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• Early S&S: headache, malaise, fatigue, chills, low grade fever, loss of appetite, puffy eyes.
• Acute S&S: (cardinal features) fever, sore throat, cervical adenopathy • Common features: splenomegaly ( may persist for several months) palatine, petechiae, macular eruption (especially on truck). Exudate on pharyngitis/tonsillitis |
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Mononucleosis (cont)
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Management: There is no specific treatment for mononucleosis. Supportive measures (bed rest, fluids, and pain relievers). Antiviral and antibacterial drugs are not effective pain relievers (for fever/pain) , oral steroids (swelling of throat)
• SPLEEN RUPTURE IS A GREAT CONCERN! |
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Ewing’s Sarcoma
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• Bone tumor
• S&S: Pain. Soft tissue swelling around affected bone. Fever. • Tx: chemo → radiation → maybe resection • Management: related to chemo/radiation |
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Scoliosis
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• Congenital: during fetal development
• Idiopathic: no apparent cause (most noticeable during growth spurt/preadolescent) • Dx: Adam’s test • Tx: bracing (halts progression). Surgery for severe (>45). • Management Surgery: Blood loss. Log roll post-op. Ambulate the next day. PT asap. Neuro checks= PARALYSIS. Mesenteric artery ischemia ( abdominal pain & vomiting from supine) |
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Burn Managment
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• 24-48 hours FLUID REPLACEMENT is most important
• Management (acute): Monitor vital signs, output, fluid infusion, & respiratory status. IV INFUSION immediately! Assess LOC. Help patients cope. • Management (later): Monitor vital signs. Pain management. Cleansing, debridement, and topical medications. |
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Leukemia -
Neutropenia (Low WBC): |
Concern =Risk for infection
- Private room. Restriction of all visitors & health professionals w/ active infections. HANDWASHING w/ antiseptic. DO NOT give leukemia pt’s immunizations. Evaluate temperature. IV antibiotics. Good nutrition! |
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Leukemia -
Thrombocytopenia (Low platelet): |
): Concern= Hemorrhage
- Administration of platelet rich plasma. Skin punctures avoided whenever possible. No rectal temperatures. Meticulous mouth care. Avoid dangerous activities |
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Leukemia-
Anemia (Low RBC) |
Concern= low hemoglobin (low O2)
-Packed red blood cells.Give oxygen if needed. |
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Diabetes
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• Type I: body does not produce insulin
• S&S: Weight loss. Polydysia. Polyphagia. Polyuria. Fatigue. Blurred vision. • Hypoglycemia: low blood sugar < 70 - 10-15 grams simple carbs. If patient is vomiting or unconscious call EMS to give IV glucose - MORE CONCERNING!!! |
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Diabetes (cont)
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• Hyperglycemia: high blood sugar > 120
- Flu-like symptoms - Give recommended amount of insulin • Ketoacidosis: Severe Hyperglycemia > 330 - Fruity breath, ketouria, signs of dehydration, abdominal pain - Regular IV insulin, replace fluids (slowly!), k replacement (only if voiding) • IF YOU DO NOT KNOW IF PATIENT IS IN STATE OF HYPER OR HYPO → TREAT HYPO |
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Hirshprung’s Disease
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• congenital aganglionic megacolon.
• It is a mechanical obstruction caused by inadequate motility of part of the intestine. • S&S newborns: FAILURE TO PASS MECONIUM w/in24-48 hrs after birth. Refusal to feed. BILIOUS VOMITING. Abdominal distention |
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Hirshprung’s Disease (cont)
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• S&S infants: Growth failure. CONSTIPATION. Abdominal distention. Episodes of vomiting and diarrhea. Signs of enterocolitis. EXPLOSIVE watery diarrhea. Fever. Appears significantly ill
• S/S Childhood: CONSTIPATION. Ribbonlike foul smelling stools. Abdominal distention. VISIBLE PERISTALSIS. Easily PALPABLE FECAL MASS. Undernourished anemic appearance • Tx: remove aganglionic portion |
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Hodgkin’s Disease
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• Cancer of the lymph nodes
• S&S: ENLARGED SUPRACLAVICULAR LYMPH NODES! Persistent cough. Fever. Night sweats. Weight loss. Splenomegaly (enlarged). • Dx: biopsy (presence of Reed-Sternberg cells) • Tx: Chemo & radiation • Management: sperm banking? Chemo/radiation care |
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Puberty
Pre Pubertal Pubteral Post Pubertal |
Puberty = maturational, hormonal and growth that occurs as reproductive begin to function.
Pre = 2 years before. Most physical changes occur during this time. Pub = sexual maturity is achieved Post = period following skeletal growth complete and reproductive fx fairly well established. |
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Thelarche
Menarche |
=the beginning of breast development.
=beginning of menstruation |
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• What is the Erickson’s stage for adolescents?
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Identity vs. Role Confusion
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What is their major task?
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to develop a sense of personal identity and to view themselves as unique individuals.
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What is their cognitive development stage?
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Piaget: Formal Operations-Cognitive Stage
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What type of thinking should they be able to do?
Do they understand the consequences of their actions? |
Culminates with the capacity for abstract thinking. They are no longer restricted to the real
and actual thought, they are also able to think beyond the present. Think about college, relationships, jobs etc. Consequences of their actions Amounts of money per educational status or lack of. |
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Are they able to think logically?
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Use logical principles as well as personal experiences to draw conclusions and make decisions.
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Do parents play an important role in their social development?
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Although peers are taking over adolescent's, parent is still most important influence.
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What is their moral development level?
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Question moral codes and their relevance.
Develop an internal set of moral values Teens must develop an internalized personal moral code which is unique to themselves. Will question existing moral codes especially if they see adults doing one thing and saying another. |
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What is the best way to communicate with an adolescent?
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-Dont push aside emotional volatility; let it dissipate
-Acknowledge feeling and their right to have them. -Dont respond to 'shock' statements -Lack of response doesnt mean they havent heard you. -use open ended questions. |
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• What is an adolescent in danger of nutritionally? Do their nutritional needs increase or decrease?
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Rapid growth >>> increased nutritional requirements. r/t ^ in growth/body mass. Need ^ calories and protein.
If intake continues at same rate after growth has stopped will lead to obesity. Not a gland problem! Don’t take in enough protein if they snack all day. *** Need ^ calcium iron ( muscle mass and blood volume) and zinc ( skeletal and bone tissue) Need calcium, iron ( muscle mass and blood volume) and zinc ( skeletal and bone tissue) Calcium stored during adolescence>> to prevent osteo. Eventual bone mass = bone laid down in adol vs amt lost with aging. Also due to genetic and environmental factors ( nut/exercise) |
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• What teaching points would be important regarding sex education?
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Teaching birth control vs. abstinence
Sexual orientation STD's Teen pregnancy. |
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• What is the leading cause of death in teens? What is the most likely abused drug in the adolescent population?
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-motor vehicle crash: leading cause of death in teens
-Safety - firearms, sports, risk taking activities, water safety, bullying/violence -Alcohol is most highly abused drug |
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• What are the most common signs/symptoms of Brain Tumor?
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• Increase head size due to spinal fluid obstruction in younger children
• In older children: HEADACHE, ESPECIALLY ON AWAKENING o VOMITING NOT RELATED TO FEEDING o BUT SYMPTOMS ARE REALLY VAGUE AND EASILY OVERLOOKED (HISTORY TAKING IS REALLY IMPORTANT) |
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What type of cells will be present in a lymph node biopsy for Hodgkin's?
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• Dx: biopsy (presence of Reed-Sternberg cells)
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Osteogenic Sarcoma (Osteosarcoma)
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o Is the most common bone cancer in children
Most primary tumor sites are in the metaphysic of LONG BONES, ESPECIALLY IN LOWER EXTREMITIES (FEMUR, HUMERUS, TIBIA, PELVIS, JAW AND PHALANGES) S/SX BONE TUMORS: • Pain in the affected site (severe or dull), they might think is a growing pain MGMT: o SURGERY AND CHEMO |
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ERWING’S SARCOMA
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• Second most common bone cancer in childhood
• Long bones most affected • Tipycally less traumatic than osteosarcoma. Surgical amputation is not routinely recommended • Intensive radiation is preferred combined with chemo |
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S/Sx of ICP - Infants
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* Acute increased ICP
o Irritability o Poor feeding or emesis o Split sutures (especially lambdoid) o Bulging fontanelle o Altered mental status o Seizures o Parinaud sign (upgaze paresis) * Chronic increased ICP o Irritability o Poor feeding or emesis o Increased head circumference o Bulging fontanelle o Split sutures (especially lambdoid) o Apparent developmental arrest or regression o Parinaud sign (upgaze paresis) |
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S/Sx of ICP - Children
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* Acute increased ICP
o Severe, acute headache o Seizures o Emesis o Rapidly deteriorating mental status o Decerebrate or decorticate posture o Focal neurologic deficits o Papilledema o Pupillary abnormalities o Autonomic dysfunction (Cushing triad) * Chronic increased ICP o Chronic, progressive headache o Seizures o Early morning emesis o Change in school performance o Altered mental status o Cranial neuropathy (eg, sixth cranial nerve palsy) o Focal neurologic deficits o Papilledema o Visual changes |
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animism
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Giving life like qualities to inanimate objects: ie: scold stairs for
making child fall down |
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egocentrism
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Piaget's term for inability to consider another person's point of view.
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Conservation
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Piaget's term for awareness that two objects that are equal according to a
certain measure remain equal in the face of perceptual alteration so long as nothing has been added to or taken away from either object. |
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Mononucleosis
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• Early S&S: headache, malaise, fatigue, chills, low grade fever, loss of appetite, puffy eyes.
• Acute S&S: (cardinal features) fever, sore throat, cervical adenopathy • Common features: splenomegaly ( may persist for several months) palatine, petechiae, macular eruption (especially on truck). Exudate on pharyngitis/tonsillitis |
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Mononucleosis (cont)
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• Management: There is no specific treatment for mononucleosis. Supportive measures (bed rest, fluids, and pain relievers). Antiviral and antibacterial drugs are not effective pain relievers (for fever/pain) , oral steroids (swelling of throat)
• SPLEEN RUPTURE IS A GREAT CONCERN! |
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Acne
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• Most common problem during pt’s adolescence
• Caused by testosterone that increase during puberty • Sebaceous glands are enlarge, produce oil and plug the pores • Peak incidence in middle late adolescence (16-17 girls; 17-18 in boys) • More common in boys • Factors: hereditary, premenstrual, stress,cosmetics) |
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Acne mgmt
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• MGMT
• GENERAL HEALTH PROMOTION (ADEQUATE REST, EXERCISE, A WELL BALANCED DIET, REDUCTION OF STRESS, ELIMINATION OF FOCI OF INFECTION) • Gentle cleansing with a mild cleaner once or twice daily is enough • Antibacterial soaps may be too drying on skin when is use in combination with topical acne meds. • Hygiene of the hair and scalp (brush the hair away from the forehead) too improve condition |
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Acne nursing mgmt
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• Assess adolescent level of distress and management
• Discussed basic skin info give written instruction • Avoid too vigorous scrubbing • Don’t pick, squeeze the comedone • Avoid vinyl helmets |
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Acne meds
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Retin A, Benzoil peroxide, antibacterial agents, Oral contraception
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