Peds Test 3 (Final Exam)

Front 1

inflammation of the bladder

Back 1

cystitis

Front 2

inflammation of the urethra

Back 2

urethritis

Front 3

inflammation of the upper urinary tract and kidneys

Back 3

pyelonephritis

Front 4

Febrile UTI coexisting with systemic signs of bacterial illness; positive blood culture

Back 4

Urosepsis

Front 5

This common childhood illness affects mainly females. E. coli accounts for 80% of the cases. The urethra, bladder, and kidneys can be involved.

Back 5

Urinary tract infection

Front 6

What are some causes or factors that predispose children to UTIs?

Back 6

Girls have a short urethra

Urinary stasis (common in children b/c they don't take the time to go to the bathroom)

Vesicoureteral reflux

Altered urine and bladder chemistry (leads to overgrowth of bacteria)

Chronic constipation (stool applies pressure on the urethra, and urinary stasis can occur because child has trouble voiding completely).

Front 7

If there is a UTI in the lower urinart tract, what structures are involved?

Back 7

urethra
bladder

Front 8

If there is a UTI in the upper urinary tract, what structures are involved?

Back 8

ureters
kidney

Front 9

What part of the urinary tract is normally colonized with normal flora bacteria?

Back 9

distal 1/3 of urethra

Front 10

A urinalysis is done on a child suspected to have an UTI. What does the nurse suspect the UA to show?

Back 10

positive for nitrites, leukocytes, and blood

Front 11

What is an advantage of a urinalysis? Disadvantage?

Back 11

Advantage: it is fast

Disadvantage: not difinitive for UTI

Front 12

What tests can be ordered for a child to definitively diagnose a UTI?

Back 12

Urine culture (takes 2d, but is a dx test- be careful not to contaminate)

Suprapubic aspiration (not commonly used- but most sterile... needle inserted into bladder)

Front 13

How can a urine culture best be collected to avoid contamination?

Back 13

catheter

* clean catch can contaminate

Front 14

A nurse is preparing to collect a urine specimen from an unpottytrained child. How should she collect it?

Back 14

a urine collection bag

Front 15

A nurse expects the symptoms of a child age 1-24months with a UTI to include:

Back 15

poor feeding
poor weight gain
vomiting
fever
foul-smelling urine
dehydration
dysuria
polyuria
frequent wetting small amts of urine

Front 16

A nurse would expect that a child age 2-14 years with a UTI would have s/s including:

Back 16

simliar to adult s/s:

vomiting
dysuria
polyuria
fatigue
abd/back pain
edema
incontinence
polydipsia

Front 17

To manage a child with a UTI, the nurse knows to:

Back 17

ID and eliminate contributing factors (for ex. get rid of constipation)

prevent systemic spread of infection

preserve renal function

antibiotics are based on ID and sensitivity

do renal workup if in child <5y

Front 18

What antibiotics can be used to tx a UTI? How do you determine which to use?

Back 18

augmentin, bactrim, keflex, suprax, macrodantin

* physician will usually start antibiotics immediately, but may change to a different one once culture and sensitivity results are in.

Front 19

What is involved in a renal workup? When would a physician order a workup for a UTI?

Back 19

VCUG (insert catheter, inject dye, looks for vesicourethral reflux)

renal ultrasound (looks for obvious renal abnormalities)

* first time UTI in child <5 years will have a VCUG

Front 20

What are some prevention techniques to prevent a UTI?

Back 20

drink plenty of water
empty bladder q3-4h
avoid bubble baths
wear cotton underwear
avoid constipation
wipe front to back

Front 21

This is an acute or chronic upper UTI which involves the ureters, renal pelvis, and renal parynchema. Usually requires hospitalization

Back 21

pyelonephritis

Front 22

A child presents to the ED with systemic symptoms plus symptoms of a UTI: vomiting, dysuria, frequency, flank pain, high fever over 102, abdominal pain, decreased appetite, chills, and body aches. What should the nurse suspect?

Back 22

pyelonephritis

Front 23

What treatments should the nurse expect to implement for a patient with pyelonephritis?

Back 23

*Same as for UTI, but most likely will be hospitalized

IVF for dehydration
IV antibiotics
renal workup

Front 24

This is an abnormal flow of bladder urine into the ureters and back into the bladder. It is due to a defect in the valve between ureters and bladder.

Back 24

Vesicoureteral reflux

Front 25

How is the severity of vesicoureteral reflux graded?

Back 25

from least severe (grade 1) to most severe (grade 5)

*grade 5 will have reflux all the way to the kidneys
*area of scarring will depend on area reflux is in: for example, grade 5 may have scarring in ureters and kidneys.

Front 26

What treatments are used for vesicoureteral reflux?

Back 26

*prophylactic antibiotics
*surgery possible for severe cases (grade 4-5)
*may resolve itsef, especially if mild case (grades 1-3)

Front 27

This is a protrusion of abdominal contents through the inguinal canal into the scrotum. It is painless, and can be bilateral or unilateral. It is more obvious when child is crying or straining

Back 27

Inguinal hernia

Front 28

If an inguinal hernia becomes painful, what should be suspected

Back 28

Incarcerated abdominal contents- they may become necrotic. This is a surgical emergency!

Front 29

This is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. It can be unilateral or bilateral.

Back 29

hydrocele

Front 30

How is a hydrocele treated?

Back 30

will be repaired surgically if not resolved spontaneously by age 1 year

Front 31

how is a hydrocele diagnosed?

Back 31

a penlight is placed against the scrotum; it will illuminate the fluid

Front 32

This is a narrowing or stenosis of the preputial opening of the foreskin. Can be mild or severe

Back 32

phimosis

Front 33

What is the treatment for mild cases of phimosis?

Back 33

manual retraction of the foreskin and proper cleansing of the area (will retract a little more each day)

Front 34

What is the treatment for severe cases of phimosis?

Back 34

circumcision

*if the parents are against circumcision, can do vertical division and transverse suturing of the foreskin

Front 35

This is a condition where the urethral opening is located between the glans penis and anywhere along the ventral surface of the penile shaft?

Back 35

Hypospadias

Front 36

What is the treatment for hypospadias?

Back 36

Surgery- will use the foreskin in repair.

*DO NOT CIRCUMCISE!!!!!

Front 37

What is a ventral (downward) curvature of the penis called?

Back 37

Chordee

*often is associated with hypospadias. Is treated by surgical release of the fibrous band causing the deformity (usually when the hypospadias is repaired)

Front 38

This condition is where the meatal opening is located on the dorsal surface of the penis.

Back 38

Epispadias

*same tx as for hypospadias...no circumcision

Front 39

This is a failure of one or both testicals to descend normally through the inguinal canal.

Back 39

Cryptorchidism

Front 40

How is a cryptorchidism treated?

Back 40

administer human chorionic gonadotropin to older child

surgery- orchiopexy to surgically descend the testical

can manually maneuver testical downward in some cases if it is not far up in there.

Front 41

What is at risk if a cryptorchidism is not treated or if it is damaged before descent?

Back 41

tumors can form

Front 42

A female has male characteristics or a male has female characteristics

Back 42

ambiguous genitalia

*gender assignment based on predominant characteristics OR ultrasound
*sensitivity required- will be traumatic for parents!!!

Front 43

A child that is born with both ovaries and testes

Back 43

hermaphrodite

Front 44

Partial or complete closure of the external vaginal opening as a result of adhesions of the medial edges of the labia minora- they are fused together. Affects primarily infants but may persist into adolescence (may open after onset of adolescence due to hormones).

Back 44

Labial adhesions

Front 45

When should treatment be started for a child with labial adhesions?

Back 45

No treatment will be necessary unless child has recurrent UTIs

*to tx give topical estrogen cream- will open them.

*do not ever catheterize a child with labial adhesions!

Front 46

This is a primary, secondary, or congenital disease that is due to glomerular permeability to plasma protein (glomerular membrane is not normally supposed to be permeable to protein) which results in massive urinary protein loss. Also includes hypoalbuminemia, hyperlipidemia, and edema

Back 46

Nephrotic syndrome/nephrosis

Front 47

This syndrome mainly occurs between ages 2-7, is more common in males, and massive protein is lost in the urine. Edema, ascites, hypovolemia, hypoalbuminemia, hyperlipidema are common manifestations. The cause is unknown but often follows an upper respiratory tract infection, like bronchitis. May be metabolic, biochemical, or autoimmune related.

Back 47

nephrotic syndrome/ nephrosis

Front 48

Why do edema, ascites, and hypovolemia occur in nephrotic syndrome/ nephrosis?

Back 48

Loss of protein leads to change in osmotic pressure:

Fluid shifts into interstitial spaces:

this causes edema, ascites, and hypovolemia.

Front 49

Why does hyperlipidemia occur in nephrotic syndrome/ nephrosis?

Back 49

proteins normally help in the transport and breakdown of lipids.

With massive protein loss, lipids cannot be transported or broken down: hyperlipidemia

Liver increases production of lipoproteins to try and replace them. This also increases the amount of lipids.

Front 50

A child presents with:

weight gain
facial edema
ascites
fatigue
diarrhea
anorexia (secondary to intestinal mucosal swelling)
normal to slightly elevated BP
ankle and leg swelling
lethargy

What do you suspect?

Back 50

Nephrotic syndrome/ nephrosis

Front 51

A child with nephrotic syndrome/ nephrosis has just had blood work done, and you are going to check his serum protein, albumin, plasma lipids, sodium, platelets, and H&H. What do you expect to find for these levels?

Back 51

Serum protein, serum albumin, and sodium levels will all be decreased

Plasma lipids, platelets, and H&H will be elevated

Front 52

Why is sodium decreased in a child with nephrotic syndrome/nephrosis?

Back 52

due to increased extracellular fluid volume from fluid shift in interstitial spaces

Front 53

What are diagnostic evaluations a health care provider would make to confirm a diagnosis of nephrotic syndrome/nephrosis?

Back 53

*dx can be based on clinical manifestations
*urinalysis (>3+ protein on urine dipstick)
*blood tests for protein, albumin, lipids, sodium, platelets, H&H

Front 54

What are the objectives in managment for nephrotic syndrome/ nephrosis?

Back 54

1. reduce excretion of urinary protein
2. reduce fluid retention in tissues
3. prevent infection
4. minimize complications

Front 55

What are some treatments/ considerations for nephrotic syndrome/nephrosis?

Back 55

low salt, fluid restricted diet
diuretic therapy for edema
corticosteroids (if immune problem is the cause)
antibiotics (if it is a secondary infection)
monitor I&O, daily weight
frequent urinalysis to check protein
Edu on relapse recognition

Front 56

A school-aged child presents with oliguria, edema, hypertension, circulatory congestion, hematuria, and proteinuria. His urine is the color of cola, he has a headache and stomachache, and he is lethargic. He had a strep throat infection 3 weeks ago. What should the nurse suspect?

Back 56

glomerulonephritis

Front 57

What happens to the glomeruli in glomerulonephritis?

Back 57

Glomeruli become swollen and infiltrated with WBCs:

This occludes the capillary lumen:

Results in decrease in plasma filtration:

Water and sodium accumulate:

This expands plasma and interstitial fluid volumes.

Front 58

A nurse is performing a urinalysis on a client with glomerulonephritis. What should she expect to find?

Back 58

blood and protein in the urine

Front 59

What are some diagnostic evaluations that can be done for glomerulonephritis?

Back 59

50% of cases have increased BUN and creatinine
Urinalysis
Serum antistreptolysin O titer
CXR for cardiac enlargement, pulmonary congestion, and pulmonary effusion (from fluid retention)

Front 60

What are some treatments/considerations for glomerulonephritis?

Back 60

*supportive care
hospitalization if severe
Na & fluid-restricted diet for edema and hypertension
I&Os, daily weights
antihypertensive meds/diuretics as needed
antibiotics (used only for persistent strep infection)
steroids (if an autommune response is the cause)
monitor VS and fluid balance
neuro assessment/ seizure precautions

Front 61

This is the most common malignant renal and intraabdominal tumor of childhood

Back 61

Wilm's tumor

Front 62

Who is more commonly diagnosed with Wilm's tumor?

Back 62

males

children <5 (peak incidence at age 3)

Front 63

What is special about a Wilm's tumor?

Back 63

it is encapsulated (it has a capsule around it, like a shell, holding all cancerous cells)

Front 64

A child has a tumor that is limited to the kidney and the surgeon plans to completely remove it. What kind of tumor does this child have?

Back 64

Stage I Wilm's tumor

Front 65

A child has a tumor extending beyond the kidney, but the surgeon can completely remove it. What kind of tumor is this?

Back 65

Stage II Wilm's tumor

Front 66

A child has a residual nonhematogenous(not spread in blood) tumor confined to the abdomen. What kind of tumor is this?

Back 66

Stage III Wilm's tumor

Front 67

A child has a hematogenous tumor that has metastases, deposits are beyond the abdomen, in the lung, liver, and brain. What kind of tumor is this?

Back 67

Stage IV Wilm's tumor

Front 68

A child has a tumor with bilateral renal involvement. What kind of tumor is this?

Back 68

Stage V Wilm's tumor

Front 69

A child presents with abdominal swelling/mass, hematuria, fatigue, weight loss. What might this child have?

Back 69

Wilm's tumor

Front 70

What clinical manifestations might a child have with a stage IV Wilm's tumor?

Back 70

abdominal mass
hematuria
fatigue/malaise
weight loss

*fever, SOB, cough, CP, etc depending on where mets has occurred

Front 71

How is a Wilm's tumor diagnosed?

Back 71

ultrasound, CT
bloodwork H&H (polycythemia sometimes present if tumor secretes excess erythropoietin)
Urinalysis (tests for blood)
Bone marrow aspiration to r/o mets

Front 72

What happens if normal kidney function is not present on contralateral side to tumor?

Back 72

both kidneys are involved so need to do dialysis/transplant

Front 73

What are treatments for Wilm's tumor?

Back 73

surgery (remove tumor, affected kidney, and adrenal gland)
Do partial nephrectomy or transplant if both kidneys are involved
manage adrenal s/s
Radiation therapy for large tumors, mets, and recurrence
Chemotherapy

Front 74

What are some preoperative interventions for Wilm's tumor?

Back 74

DO NOT PALPATE TUMOR! can break capsule and release cancer cells.

handle carefully for same reason

Front 75

What are some postop interventions for Wilm's tumor?

Back 75

closely monitor:
BP
UOP
provide pulmonary hygiene
monitor for S/S infection

Front 76

This is an uncommon, acute renal disease occuring usually before age 5years. It is the most frequent cause of acute renal failure in children. IT presents as a prodromal illness (such as upper respiratory infection or acute gastroenteritis) but a sudden onset of hemolysis and renal failure occurs.

Back 76

Hemolytic-Uremic syndrome (HUS)

Front 77

What 3 things are needed to diagnose hemolytic-uremic syndrome? Why do they occur?

Back 77

1. Anemia
2. Thrombocytopenia
3.Renal failure

* arterioles and glomeruli become occluded with platelets:

RBCs become damaged trying to get through vessels:

Spleen tries to remove damaged RBCs- causes hemolytic anemia.

Platelet aggregation also occurrs

Front 78

An illness in a child progressed from a prodromal illness to sudden proteinuria, hematuria, vomiting, bruising, petechiae, hematochezia, oliguria, seizures, and coma. What does this child have?

Back 78

Hemolytic-Uremic Syndrome (HUS)

Front 79

What are treatmetns for hemolytic-uremic syndrome (HUS)?

Back 79

hemodialysis
peritoneal dialysis
blood transfusions (PRBCs, platelets, fresh frozen plasma)
control HTN
prenent complications (renal failure, hypertension, CNS disorders)

Front 80

What are some interventions by the nurse for hemolytic-uremic syndrome (HUS)?

Back 80

monitor I&Os, daily wt, VS
watch for behavior changes
watch for s/s infection
provide good family support

Front 81

This is an inability of the kidneys to excrete waste material, concentrate urine and conserve electrolytes.

Back 81

renal faulure

Front 82

accumulation of nitrogenous waste within the blood

Back 82

azotemia

*characteristic of renal failure

Front 83

retention of nitrogenous products produces toxic symptoms

Back 83

uremia

*characteristic of renal failure

Front 84

This is a sudden onset of oliguria, azotemia, metabolic acidosis nad electrolyte disturbances that is uncommon in childhood. In childhood it is normally a result of severe dehydration.

Back 84

Acute renal failure

Front 85

What are some causes of acute renal failure in children?

Back 85

severe dehydration
glomerulonephritis
HUS
poor renal perfusion
urinary tract obsruction
renal injury

Front 86

The patho of this disease includes a severe reduction in the glomerular filtration rate, and elevated BUN and creatinine, and a significant reduction in renal blood flow

Back 86

acute renal failure

Front 87

A child presents with oliguria, nausea, vomiting, drowsiness, edema, and hypertension. What does this child have?

Back 87

acute renal failure

Front 88

What is included in managing acute renal failure?

Back 88

find and treat precipitating disorder
Bloodwork (BUN, creatinine, pH, Na, K, Ca)
manage complications
diuretics
dialysis
correct electrolyte imbalances
restore volume
I&Os

Front 89

What are some complications of acute renal failure?

Back 89

water intoxication
hyponatremia
hypernatremia
hypertension
anemia
seizures
cardiac failure

Front 90

This is when the kidneys can no longer maintain the normal chemical structure of body fluids under normal conditions. Can be caused by congenital renal or urinary tract malformations, VUR with recurrent UTIs, chronic pyelonephritis, chronic glomerulonephritis

Back 90

Chronic renal failure

Front 91

What are some complications of chronic renal failure?

Back 91

retention of waste products
edema and vascular congestion (due to retention of Na and H2O)
hyperkalemia
metabolic acidosis
anemia
growth disturbances
calcium and phosphorus disturbances (altered bone metabolism)

Front 92

What are some early signs of chronic renal failure?

Back 92

fatigue
energy loss
HTN

Front 93

What are some later signs of chronic renal failure?

Back 93

N/V
bleeding tendenceis
deep respirations
HTN
CHF
pulmonary edema
uremic frost
neuro involvment

Front 94

What are some symptoms of chronic renal failure?

Back 94

weight loss
facial edema
maliase
growth retardation
bruising
itchy skin
bone/joint pain
amenorrhea

Front 95

What are the goals of managin chronic renal failure?

Back 95

1. promote maximal renal function
2. maintain body lfuid and electrolyte balance within safe chemical limits
3. to treat systemic complications
4. to promote as active and normal life as possible for the child for as long as possible

Front 96

abdominal cavity acts as a semipermeable membrane through which water and solutes move by osmosis and diffusino

Back 96

peritoneal dialysis

Front 97

blood is circulated outside the body through artificial membranes

Back 97

hemodialysis

Front 98

blood filtrate is circulated outside the body by hydrostatic pressure exerted across a semipermeable membrane (used more in acute)

Back 98

hemofiltration

Front 99

Who can be a donor for a kidney transplant?

Back 99

living related donor
cadaver donor

Front 100

What are some s/s of transplant rejection?

Back 100

fever
swelling and tenderness over graft area
decreased UOP
elevated BP

Front 101

This contagious skin disorder comon in ealry childhood, caused by Staph (sometimes MRSA), causes macules that turn into vesicles and rupture. It dires and forms honey-colored crusts.

Back 101

Impetigo

Front 102

What is tx for impetigo?

Back 102

topical bacteriocidal ointment

oral antibiotics for more extensive and severe causes

Front 103

What can scratching eczema lead to?

Back 103

impetigo

Front 104

This is an inflammation of the skin and subcutaneous tissues caused by strep, staph, and h. flu. It may even progress to form an abscess. What is this disorder of the skin called?

Back 104

cellulitis

Front 105

A child presents with intense redness, swelling, and firmness in an area of the skin. He also has fever and malaise. What does this child have?

Back 105

cellulitis

Front 106

How is cellulitis treated?

Back 106

oral or IV antibiotics

warm compresses

abscesses may require I&D

Front 107

This is an infection of a hair follicle

Back 107

folliculitis

(pimple)

Front 108

This is a larger lesion than that of folliculitis. It hs more redness and swelling at the hair follicle.

Back 108

Furuncle

(boil)

Front 109

How should folliculitis or a furuncle be treated?

Back 109

warm, moist compresses

topical/oral antibiotics

If severe, may need I&D

NEVER SQUEEZE! (can do more harm than good and introduce more bacteria)

Front 110

How would a child with community acquired MRSA (abscess or boils) need to be treated?

Back 110

vancomycin/ bactrim

bactriban- topical antibiotic

Front 111

This is a contagious skin condition characterized by well-circumscribed, grey-brown, elevated, firm papules with a roughened, finely papillomatous texture. It is caused by HPV

Back 111

Verruca (warts)

Front 112

What is the treatment for verruca (warts)?

Back 112

surgical removal
electrocautery
curettage
cryotherapy
laser
caustic solutions
Duck tape (a theory, but it usually works)
may spontaneously disappear after months-years.

Front 113

This is a reactivation of the varicella virus (after someone has had chickenpox and the virus can lay dormant)

Back 113

Varicella Zoster (shingles)

Front 114

A person presents with crops of pruritic, painful vesicles along a nerve tract. What is this condition?

Back 114

Varicella Zoster (shingles)

Front 115

What is used to treat Varicella Zoster? Is the person contagious?

Back 115

Oral Acyclovir
Vaccine now available for older adults (>65)

Other people can catch the chickenpox from someone with a shingles outbreak, so isolate them from non-immunized children or adults.

Front 116

This is a skin condition characterized by flesh-colored papules with a central caseous plug (seed) that is caused by a POX virus. It is contagious (if child picks at it) but is not pruritic or painful- only unsightly.

Back 116

Molluscum Contagiosum

Front 117

How is Molluscum Contagiosum treated?

Back 117

Should resolve spontaneously within 18m

If a large number of papules are present, can do curettage or cryotherapy

Front 118

This is a fungal infection characterized by lesions in the scalp/hairline. These scaly, circumscribed patches will have scaling areas of alopecia. It is contagious. It is AKA "ringworm of the scalp"

Back 118

Tinea Capitis

Front 119

A child has Tinea Capitis, and the lesions are becoming boggy and encrusted. What are these lesions called?

Back 119

kerions

Front 120

How is tinea capitis treated?

Back 120

With oral griseofulvin (given for 4w, but then must check LFT before continuing. check baseline LFT before starting.)

Selenium Sulfide shampoos (Nizoral)

Topical antifungals

Front 121

How should griseofulvin be administered?

Back 121

Orally, with high-fat foods for better absorption

*this medication is costic to the liver- do baseline and rechecks of LFT.
*this med is also expensive and tastes bad.

Front 122

This fungal infection is characterized by round or oval erythematous scaling patches that spread peripherally and clear centrally; it is usually from pet or animal origin. It is AKA ringworm.

Back 122

Tinea Corporis

Front 123

How is Tinea Corporis treated?

Back 123

topical antifungals

oral griseofulvin for severe cases

Front 124

This fungal infection is characterized by lesions in intertriginous areas (skin folds), such as between toes, or on the plantar surface of the feet. The lesions are fissuring, pruritic, vesicular patches that have drainage. Can be mild to severe, affecting one toe to the whole foot. This is AKA as athelete's foot

Back 124

Tinea Pedis

Front 125

What is the treatment for Tinea Pedis?

Back 125

topical antifungals (cream/powder)
Oral griseofulvan for severe cases
KEEP THE FEET DRY!!!

Front 126

This fungal infection grows in moist areas- common in diaper area, skin folds, orally, or vaginally. It is pruritic, with inflamed areas of white exudate, peeling and easily bleeding.

Back 126

Candidiasis (yeast)

Front 127

What is the treatment for candidiasis (yeast)?

Back 127

topical antifungals (lotrimin, nystatin)

nistatin PO

Front 128

This is an inflammatory reaction of the skin to chemical substances (natural or synthetic). It is characterized by sharp delineation between inflammed and normal skin (which may help determine the cause). Causes include wools, fur, dyes, metals, perfume, soaps.

Back 128

Contact Dermatiits

Front 129

What is the treatment for contact dermatiits?

Back 129

topical steroids
depending on the severity, may prescribe oral steroids

Front 130

These skin conditions are caused by urushiol oil from plants. The lesions will characterisically appear in a linear line. Sensitivity develops after 1-2 exposures. Smoke from burning plants may also cause a reaction. What are these conditions?

Back 130

Poison Ivy, Oak, and Sumac

Front 131

What is the treatment for poison ivy, oak, and sumac?

Back 131

topical or oral steroids, benadryl, and calamine lotion.

*flush the skin with cold water within 15m of known exposure

*The rash is not contagious- but scratching can cause a secondary infection

Front 132

this skin disorder is caused by a mite. A pregnant female mite burrows into the skin and deposits eggs and feces.

Back 132

Scabies

sarcoptes scabiei

Front 133

How does scabies appear in children

Back 133

Mainly on the hands and wrists: the rash is pruritic and appears as minute, gray-brown thread-like lesions. May be able to see black dots at the end of lesions (the actual mite).

Front 134

How does scabies appear in infants?

Back 134

as an eczematous eruption of prurutic lesions primarily on the feet and ankles

Front 135

What are predisposing factors to scabies?

Back 135

poor hygiene, low socioeconomic status

Front 136

What are some treatments for scabies?

Back 136

Permethrin 5% cream (elimite) is drug of choice

Lindane is another drug- is neurotoxic (causes seizures)

Treat all family members/close contacts

*Mites will be killed after 1 topical treatment, but itching lasts 2-3w

Front 137

This is an infestation of the scalp by pediculus humanus capitis common in school-age children. The female lays eggs (nits) at the base of the hair shaft, and eggs hatch in 7-10 days and cause itching.

Back 137

Lice (pediculosus capitus)

Front 138

What are some treatments for lice (pediculosus capitus)?

Back 138

Permetjerom 1% cream rinse (NIX) is drug of choice

RID and Ovide are also used

1/2 vinegar &1/2 water soln to scalp, wrap head with towel

*seal stuffed animals in ziploc bags for 14d, wash all sheets and towels in hot water, etc.

Front 139

This is a skin condition caused by prolonged and repetitive contact with an irritant, such as urine, soaps, stool, ointments, or friction. Causes red, excoriated, bleeding areas.

Back 139

Diaper Dermatitis

Front 140

This skin condition around the diaper area is caused by candida albicans, and presents as red, papular lesions that can be diffuse./

Back 140

Diaper Dermatitis

Front 141

How do you treat diaper dermatiis?

Back 141

frequent diaper changes
diaper rash cream (A&D, balmex, boudreaux's butt paste)
Nystatin, Lotrimin (if yeast)
d/c wipes for a time b/c alcohol burns skin
Air time! (lay down a trashbag, top with a towel, and let child lay with no diaper)

Front 142

This is a chronic skin condition of unknown origin, thought to be related to alterations in sweating, peripheral vascular function, and heat tolerance. It is worse in the fall and winter. Usually occurs in people with a family history of the disorder and also a history of asthma and allergies.

Back 142

Atopic Dermatitis (Eczema)

Front 143

A child presents with papules and papular patches, dry, hyperpigmentated, oozing, crusting, erythmetous, pruritic lesions behind the knees and in the antecubital spaces. Also the skin appears to have lichenification (leathery appearance). What does this child have?

Back 143

Atopic Dermatitis (Eczema)

Front 144

What are the goals of managing atopic dermatitis (eczema)?

Back 144

relieve pruritis
hydrate skin
reduce inflammation
prevent secondary infection

Front 145

How should a child with eczema/ atopic dermatitis be managed?

Back 145

mild soap
pat dry after baths
use lubricating lotion after bath (to seal in moisture)
oatmeal bath
topical steroid
topical non-steroids (for long-term use)
oral antihistamines (esp. at night to prevent scratching in sleep)
oral steroids for severe flare-ups

Front 146

This condition is seen in infants and young children- the sebaceous glands of the scalp produce too much oil, which turns to oily patches that dry and flake off (golden-colored scales).

Back 146

Seborrheic Dermatitis (cradle cap)

Front 147

How should cradle cap/ seborrheic dermatiits be treated?

Back 147

rub baby oil on scalp, scrub scales off with soft bristle brush, then wash off oil (or it will contribute to the problem)

Dandruff shampoo and Nizoral shampoo if severe

Front 148

These are vascular, capillary-filled lesions that are usually present at birth. They are benign, unless seen over underlying organs (nose, eyes, mouth).AKA strawberry mark. What is this called?

Back 148

Hemangiomas

Front 149

What is the treatment of a hemangioma?

Back 149

usually resolves itself- after the first year (rapid growth period) usually start involutional phase.

If lesion involves underlying organ(nose, eye, mouth) can do surgical correction

*teach them not to pick at it! Causes bleeding!

Front 150

This is a skin condition due to excessive sebum production. It occurrs mainly in adolescence. It is more common in males, but can commonly occur in girls with premenstrual flares.

Back 150

Acne

Front 151

What are some patho/teaching strategies for acne?

Back 151

cosmetics increase production

diet does not cause or aggravate acne

Comedogenesis- closed are whiteheads, and open are blackheads.

Inflammation from propinoibacterium acnes- results in papules, pustules, nodules, and cysts

Front 152

How is acne treated?

Back 152

rest, exercise, well-balanced diet, reduction of stress

Meds: retin-A, Benzoyl peroxide, topical antibiotic, Accutane (avoid sun!), Oral antibiotics, birth control pills

Topical cleansing of the ckin

Front 153

An example of this type of burn is a sunburn- it involves minimal tissue damage

Back 153

1st degree

Front 154

This is a partial-thickness burn involving the epidermis and varying degrees of the dermis- an example is a bad sunburn or scalding burn with blisters

Back 154

second-degree burn

Front 155

This type of burn involves the entire epidermis and dermis, and extends into subq tissues- nerve endings are destroyed.

Back 155

third degree burn

Front 156

In this kind of full-thickness burn, the muscle fascia and bone are involved

Back 156

fourth degree burn

Front 157

This type of injury often follows inhalation of heated gasses and toxic chemicals during combustion. It usually only damages the upper airway and does not damage below the vocal cords (they reflexively close to prevent full inhalation).

Back 157

inhalation injury

Front 158

What are some s/s of inhalation injury?

Back 158

burns to face and lips
singed nasal hair
laryngeal edema
wheezing
hoarseness
increasing secretions
wet crackles in lungs

Front 159

What are the steps in order to delivering emergency care to a burn victim?

Back 159

stop the burning process (remove them from source)
ABCs
cover the burn (prevent colonization- try to be as clean as possible)
transport to hospital
provide reassurance

Front 160

What are some indications for minor burns?

Back 160

clean w/ soap and water
debridement
antibiotic ointment
sterile dressing
follow-up visits
tetanus
watch for s/s infection

Front 161

What are some indications for Major burns?

Back 161

ABCs- may need to intubate
fluid replacement
adequate nutrition
medication
Primary excision, debridement, hyperbarics, and skin graft

Front 162

What is the Parkland Formula for 24h replacement therapy after a burn?

Back 162

4ml x kg x % burned BSA

*1/2 will be given in the first 8h
*last 1/2 will be given over the last 16h

Front 163

How are children <5y managed after a burn?

Back 163

calculated maintenance requirements should be added to the total volume (Parkland 24h replacement formula) to more accurately predict fluid needs.

Front 164

How should children with burns <15% of BSA be managed after a burn?

Back 164

usually do not have significant capillary rate and can be managed at 1.5 times the maintenance rate

Front 165

How should children <20kg with burns be managed?

Back 165

Are at risk of developing hypoglycemia and should have dextrose-containing fluid administered at a maintenance rate along with the calculated fluid volume (from parkland 24h replacement formula)

Front 166

What is the purpose of fluid replacement in major burns?

Back 166

to compensate for water and sodium loss, restore circulating volume, provide adequate perfision, correct acidosis, improve renal function.

Front 167

What medications can be used for major burns in children?

Back 167

sedatives
analgesics
antibiotics for secondary infection

Front 168

This disease is caused by Borrelia burgdorferi that enters the skin and bloodstream through the saliva and feces of ticks (esp. deer tick)

Back 168

Lyme disease

Front 169

What is the treatment of Lyme Disease?

Back 169

oral penicillin
amoxicillin
doxycycline
ceftin or rocephin

Front 170

A child presents to the clinc with erythema chronicum migrans (a "bullseye lesion") on his arm. What does the nurse suspect the child has?

Back 170

Lyme Disease

Front 171

What are the 3 stages of Lyme Disease?

Back 171

1. Tick bite followed in 3-32 days by the development of erythema chronicum migrans (a bullseye rash)
2. systemic involvement of neurologic, cardiac and musculoskeletal systems- appears several weeks after stage 1
3. musculoskeletal pain involving the tendons, bursae, muscles, and synovia

*blood tests available in later stages of the disease

Front 172

This disorder results from a deficient secretion of growth hormone. It is treated more frequently in boys. Causes include tumors, trauma, vascular abnormalities, hereditary disorders, and anorexia.

Back 172

hypopituitarism

Front 173

A child presents with short stature, inactivity, permanent teeth have not erupted yet (though all other children his age have permanent teeth), and delayed sexual development. What is the most likely cause of these s/s?

Back 173

hypopituitarism (GH deficiency)

*later in life child will have premature aging

*also causes early closure of the growth plates

Front 174

Why does a child w/ hypopituitarism/ GH deficiency have a delayed sexual development?

Back 174

b/c FSH and LH are also from the pituitary, and these are necessary for sexual development and growth spurt at puberty

Front 175

How is hypopituitarism (growth hormone deficiency) diagnosed in a child?

Back 175

will have progressive deviation from normal growth rate(slacking on growth curve)- seen as early as infancy

growth hormone levels below 10 after 2 tests (2 tests needed b/c GH is released in spurts)

Xray of hte hand and wrist for centers of ossification of bones

MRI to check entire pituitary

*check thyroid levels to r/o thryroid as cause

Front 176

How is growth hormone deficiency/hypopituitarism managed?

Back 176

-correct underlying problem (tumor, etc)
-replace GH- biosynthetic (injections) is successful in 80% of children...young, obese, and severely deficient children respond best.

Front 177

This is an excess GH secretion before the closure of the epiphyseal shfats. Long bones will grow until individual reaches 8 or more feet.

Back 177

Gigantism (pituitary hyperfunction)

Front 178

This is excess GH secretion after the epiphyseal shafts have closed.

Back 178

Acromegaly (pituitary hyperfunction)

Front 179

A child presents with overgrowth of the head, lips, nose, tongue, jaw, and sinuses. The teeth are separated and maloccluded in the jaw. The face appears disproportionate to the cerebral skull. He has increased facial hair and thick skin. His growth is described as "excessive."What does this child have?

Back 179

pituitary hyperfunction- gigantism

Front 180

How is gigantism or acromegally diagnosed?

Back 180

excessive growth, increased levels of GH, radiologic studies (may show tumor), normal bone age, enlargement of bones, possible excess of other hormones- (cortisol, sex hormones)

Front 181

How is pituitary hyperfunction managed?

Back 181

surgery to remove tumor

medications to reduce GH secretion

irradiation and radioactive implants to destroy pituitary tissue

hormone relacement for pituitary insufficiency (after tissue removed or destroyed)

Front 182

This is a manifestation of sexual development before age 8 in girls and before age 9 in boys

Back 182

precocious puberty

*more common in girls

Front 183

What is the difference in true and incomplete precocious puberty?

Back 183

*true- menarche or sperm release plus physical characteristics

*incomplete- just physical characteristics- no menarche, sex hormones, or sperm release

Front 184

A 7 year old girl presents with breast development, pubic hair growth, menstruation, behavioral chages, advanced bone age, acne, and accelerated linear growth. The nurse tells her mother that this is considered (normal or abnormal) development. Why?

Back 184

Abnormal- onset of sexual maturation before age 8 in girls is called precocious puberty.

Front 185

How is precocious puberty diagnosed?

Back 185

sex hormone studies (testosterone, estradiol, FSH, etc)

radiologic studies (checking for structural abnormalities)- pelvic ultrasound of uterus and ovaries, testicular ultrasound, skeletal age, MRI, CT

Front 186

How is precocious puberty managed?

Back 186

-tx based on cause
-monthly injections of luteinizing hormone releasing hormone (LHRH; lupron) to regulate pituitary secretions- take this until the normal time for puberty

Front 187

This is hyposecretion of antidiuretic hormone (ADH) that causes uncontrolled diuresis. Causes include heredity, tumors, trauma, infections (meningitis), or aneurism.

Back 187

diabetes insipidus

Front 188

A child presents with polyuria and polydipsia after a trauma. What disorder do you suspect?

Back 188

diabetes insipidus

Front 189

An infant presents with polyuria, irritability relieved by water instead of milk, dehydration, electrolyte imbalance (increased Na and decreased fluid vol), and hyperthermia. What do you suspect?

Back 189

diabetes insipidus

Front 190

How is diabetes insipidus diagnosed? What treatment will be initiated at dx?

Back 190

-restrict oral fluids- will have little or no effect on urine formation but causes wt loss from dehydration.

*if this is (+), aqueous vasopresssin (DDAVP) will be given via nasal spray or pill to alleviate polyuria and polydipsia. Watch for water intoxication signs

Front 191

This is hypersecretion of antidiuretic hormone. Causes include infection, tumor, and trauma. Increased ADH causes the kidneys to reabsorb water, which increases fluid volume and serum osmolality.

Back 191

SIADH- syndrome of inappropriate antidiuretic hormone

Front 192

In this disorder, decreased serum sodium causes anorexia, nausea, stomach cramping, irritability, behavior changes, and seizures.

Back 192

SIADH

Front 193

What is the tx for SIADH?

Back 193

restroct fluids and treat underlying cause

Also: closely monitor I&Os, daily wt, watch for fluid overload, seizure precautions, educate on fluid restriction

Front 194

Screening for this disorder occurs at birth (mandatory). There are decreased T3&4 levels but increased TSH level.

Back 194

congenital hypothyroidism

Front 195

An infant is not feeding well, has lethargy, constipation, bradycardia, hoarse cry, depressed nasal bridge, short forehead, puffy eyelids, large tongue, abdominal distention, an umbilical hernia, and his parents say he is "such a good baby, because he hardly ever cries." As a nurse you suspect the child has:

Back 195

hypothyroidism

*start child on TH preplacement promptly to promote brain growth- or can result in mental retardation!

Front 196

A child presents with decelerated growth, dry skin, puffiness of the eyes, sparse hair, constipation, sleepiness, and mental decline. What does this child have?

Back 196

juvenile hyperthyroidism

Front 197

This disease is caused by a serum thyroid-stimulating immunoglobulin, causing a increased T3 and t4 level. TSH is low or unmeasurable. This disease peaks at about 12-14y and is more common in girls.

Back 197

Graves disease (hyperthyroidism)

*may be present at birth if mother is thyrotoxic

Front 198

A mother brings her child to your office, saying that for the past 6 months the child has been slowly developing problems being restless, having problems in school, is fatigued all the time, and has a huge appetite with weight loss. She cannot stand to be in the heat, and developed a tremor. In your assessment, you find that she has very fine hair. what should you suspect?

Back 198

Graves disease (hyperthyroidism)

*exopthalmos is another s/s of graves disease

Front 199

How is Grave's disease treated?

Back 199

antithyroid drugs (to interfere with the synthesis of TH)

subtotal thyroidectomy

ablation with ratioiodine

Front 200

This is a rare disorder caused from trauma, meningococcemia, or abrupt withdrawal of sources of cortisone

Back 200

Acute Adrenocortical Insufficiency

*Trauma- hemorrhage into the gland... long, hard labor is a cause
*Meningococcemia- result in hemorrhage and necrosis of the adrenal gland
*Abrupt withdrawal of cortisone- must taper off the corticosteroid.

Front 201

A child presents with muscular weakness, mental fatigue, lethargy, dehydration, seizures, abd pain, electrolyte imbalance, headache, sweating, hunger, syncope, & hypotension. His mother says that all he wants to eat is salty food, but he can't keep weight on him. What is the suspected disorder, and what questions should the nurse ask to determine the cause?

Back 201

acute adrenocortical insufficiency

*Ask if he has had a trauma, or if he has stopped taking corticosteroids abruptly?

Front 202

How is adrenocortical insufficiency treated?

Back 202

-replace cortisol
-replace body fluids
-administer glucose for hypoglycemia
-blood transfusion if hemorrhage severe
-vasopressors for elevation of BP

Front 203

This is caused by a lesion or neoplasm(cancer) of the adrenal glands. S/S appear late: 90% of adrenal tissue is nonfunctional at manifestation of s/s.

Back 203

Chronic adrenocortical insufficiency (Addison's disease)

Front 204

What are the clinical manifestations of Addison's disease?

Back 204

Same as for acute adrenocortical insufficiency

Front 205

How is Addison's disease diagnosed?

Back 205

based on measurements of functional cortisol reserve

Front 206

How is Addison's disease managed?

Back 206

replace glucocorticoids (cortisol) and mineralcorticoids(aldosterone).

*dosage must be tripled during stressful situations (emotional, physical, surgery) to accomodate the body's increased need for glucocorticoids
*never suddenly stop treatment
*always have prefilled syringe of hydrocortisone available in emergencies, and teach importance of non-stressful environment

Front 207

This is a disease characterized by excessive circulating free cortisol. It has pituitary, adrenal, ectopic, and iatrogenic causes.

Back 207

Cushing syndrome

*pituitary- adrenal hyperplasia
*adrenal-adrenocortical neoplasms
*ectopic- extrapituitary neoplsms
*iatrogenic- administration of large amounts of exogenous corticosteroids

Front 208

A child appears to have centripetal fat distribution (w/ thin extremities), a moon face, red cheeks, hirsutism, and thin skin. She has had muscular wasting, poor wound healing, excessive bruising, hypertension, hypokalemia, a peptic ulcer, hyperglycemia, amenorrhea, and a deep voice. She seems depressed.

Back 208

cushing syndrome

Front 209

how is cushing disease diagnosed?

Back 209

-fasting glucose levels
-electrolyte levels (hypokalemia and alkalosis)
-X-rays (osteoporosis)
-administer cortisone (normally supresses ACTH, but cortisol levels remain high in cushing's)

Front 210

How is Cushing's disease managed?

Back 210

*bilateral adrenalectomy
*postop replacement of cortical hormones
*growth hormone, thyroid extract, ADH, steroids may be necessary for indefinate period (if origin of problem is pituitary)

Front 211

This is an inborn deficiency of various enzymes necessary for the biosynthesis of cortisol and aldosterone. There are low cortisol and low aldosterone levels, but high androgens. This results in increased ACTH production and hyperplasia of the adrenal gland.

Back 211

Congenital Adrenogenital hyperplasia (CAH)

*mandatory screening at birth
*low cortisol and aldosterone causes ACTH level to increase (ACTH is trying to get cortisol and aldosterone levels to rise).
*high ACTH levels cause increased androgen levels

Front 212

What are the causes of CAH?

Back 212

- inherited, autosomal recessive disorder
- or results from a tumor or maternal ingestion of steroids

Front 213

What are the 2 types of CAH?

Back 213

-salt-losing: most common, AKA "salt wasting". Decreased aldosterone and cortisol

-non salt-losing: decreased cortisol but normal aldosterone

Front 214

A female child presents with masclinized features, fusion of labia, enlarged clitoris, no breast development, amenorrhea, and infertility. What does this child have?

Back 214

CAH

*can also have ambiguous genitalia

Front 215

A male child presents wtih genital enlargment, frequent erections, and small testes. What does this child have?

Back 215

CAH

*can also have ambiguous genitalia

Front 216

How do you assign the sex to a newborn with ambiguous genitalia?

Back 216

-US to look for ovaries or testicles

-screening to dx CAH
*will have increased 17-ketosteroid levels and potassium, and decreased sodium and chloride levels

Front 217

What is therapeutic managment of CAH?

Back 217

-assign sex to the child
-administer cortisone to suppress the abnormally high secretions of ACTH
-increase cortisol during stress
-if salt-losing, also need aldosterone replacement and dietary salt
-plastic surgery if necessary

Front 218

These cells in the islets of langerhans produce glucagon which stimulate the liver and other cells to release stored glucose (glycogenolysis)

Back 218

Alpha cells

Front 219

These cells in the islets of langerhans produce insulin which facillitates the entrance of glucose into the cells for metabolism

Back 219

beta cells

Front 220

These cells in the islets of langerhans produce somatostatin which reugulate the release of insulin and glucagon

Back 220

delta cells

Front 221

This is the destruction of the pancreatic beta cells resulting in absolute insulin deficiency. Onset is usually in childhood/adolescence.

Back 221

Type I DM

Front 222

This disorder is due to insulin resistance in which the body fails to use insulin properly. Will have relative insulin deficiency.

Back 222

Type II DM

Front 223

Why do polyuria, polydipsia, and polyphagia develop in DM?

Back 223

decreased insulin leads to hyperglycemia

body fluid shifts from intracellular to extracellular spaces

This causes glycosuria and polyuria

Polydipsia develops

Polyphagia develops due to decreased carb metabolism.

Front 224

A child presents with weight loss, enuresis, iritability, fatigue, dry skin, poor wound healing, headache, frequent infections, hyperglycemia, glycosuria, dehydration, acidosis, kussmaul breathing, polyuria, is excessively hungry and thirsty. What does this child have?

Back 224

Diabetes

Front 225

How is diabetes diagnosed?

Back 225

-urinalysis for glucose
-fasting serum glucose >126 or random sample >200
-ABGs to determine acidosis

Front 226

How is diabetes managed?

Back 226

-insulin replacement (managed by endocrinologist)

Front 227

When is a urinalysis done in diabetes?

Back 227

-not routinely done anymore except in the presence of illness
-done every 3h during an illness and when blood glucose is >240

Front 228

What are some effects of immobilization on musculoskeletal system?

Back 228

decreased muscle tone
decreased strength
bone demineralization

Front 229

What are some effects of immobilization on metabolism?

Back 229

decreased metabolic rate

Front 230

What are some effects of immobilization on the cardiovascular system?

Back 230

dependent edema
orthostatic hypotension
decreased cardiac workload
venous stasis

Front 231

What are some effects of immobilizatio on the GI system?

Back 231

anorexia
abd distention
constipation

Front 232

What are some effects of immobilization on the respiratory system?

Back 232

decreased O2 need
loss of respiratory muscle strength

Front 233

What are some effects of immobilization on the urinary system?

Back 233

impaired ureteral peristalsis
difficulty voiding in prone position
infection
renal calculi

Front 234

what are some effects of immobilization on the integumentary system?

Back 234

tissue injury
decreased healing
difficulty w/ personal hygiene

Front 235

what are some psychological effects of immobilization?

Back 235

-delayed growth/development
-takes away mechanism for hild to deal with impulses/feelings
-takes away sensory stimuli
-isolation and boredom
-sluggish intellectual and psychomotor responses
-decreased communication skills
-increased fantasizing
-hallucinations and disorientation
-regress to earlier developmental behaviors to gain attention

Front 236

What are some effects of immobilizatin on the family?

Back 236

-life-altering changes
-encourage child to participate in care
-individual/group counseling
-financial burden

Front 237

damage to the soft tissue, subcutaneous structures, and muscle

Back 237

contusions

Front 238

Soft tissue injury where the force of stress on the ligament is so great that it displaces the normal position of the opposing bone ends or the bone end to the socket

Back 238

dislocations

Front 239

Soft tissue injury where ligament is partially or completely torn or stretched by the force created as a joint is twisted or wrenched

Back 239

sprain

Front 240

Soft tissue injury where there is a microscopic tear into the muscular unit- similar to sprain

Back 240

strain

Front 241

How are soft tissue injuries (contusion, dislocation, sprain, strain) managed?

Back 241

RICE!
(rest, ice, compression, elevation)

Front 242

A child has a spriral fracture. What should the nurse suspect might have caused this?

Back 242

child abuse

Front 243

A child refuses to walk or move the extremity. What might have caused this injury?

Back 243

fracture

Front 244

This kind of cast molds to body parts, and dry in up to 72h.

Back 244

plaster

Front 245

This kind of cast dries in 5-30m, is used more in children. It is water resistant, unable to mold to body, expensive, has rough surface, and comes in different colors.

Back 245

Synthetic cast

Front 246

What are some nursing considerations for children with fractures?

Back 246

-special car seats (hip or large casts)
-increase diaper size (to fit around cast
-petaling
-make sure small children don't put things in cast
-holding infant in spica cast: football hold for breastfeeding, for ex
-use of bedpans
-keep cast dry
-check for movement/sensation of visible extremity
-proper crutch use

Front 247

What are some uses for traction?

Back 247

-stabilize/align bone fragments
-provide rest for extremity
-prevent or improve contracture deformity
-correct deformity
-treat dislocation
-reduce muscle spasms
-provide immobilization
-allow positioning

Front 248

What are some nursing considerations for traction?

Back 248

-check ropes/pulleys/weights
-check bed position
-check after child moves
-maintain correct angles
-check pin sites
-prevent skin breakdown
-encourage deep breathing
-ROM for non-involved joints

Front 249

This is a hip that is subluxable, dislocateable, or reducible. Maternal secretion of relaxin and estrogen affects laxity of fetal joints. Breech position may cause. Family history of laxicity may contribute.

Back 249

Developmental dysplasia of the hip (congenital hip displacement)

*more common in Female, more common in L hip,LGA & twins more susceptible,
*#1 reason for malpractice lawsuits for pediatricians

Front 250

An infant is born with unequal leg lenghts, restricted abduction of one leg, unequal gluteal folds, and positive ortolani test. What does this infant have?

Back 250

DDH (developmental dysplasia of the hip)

Front 251

A child presents with one leg shorter than the other, marked lordosis, waddling gait, telescoping of the joint, and trendelenberg sign. what does this child have?

Back 251

DDH (developmental dysplasia of the hip)

Front 252

What are some diagnostic evaluations for a child with DDH (Developmental dysplasia of the hip)?

Back 252

- Barlow or Ortolani maneuver
- ultrasound until 4m
-X-ray after 4m
-tx most successful if dx before 2m (should have full walking ability)
-don't use skin folds as diagnostic tool

Front 253

How is DDH (developmental dysplasia of the hip) managed?

Back 253

-double diapering (done in the past but not done now according to book)
-pavlik harness (tx of choice) worn 3-6m
-skin traction- used when adduction contracture present
-spica cast used when difficulty maintaining stable reduction or after surgery
-surgery is difficult after age 4 and impossible after age 6

Front 254

Abnormality where the foot is pointed downward and inward in varying degrees of severity. A contracture of the calf and toe flexor muscles. Mal-alignment of the ankle and heel, and of the hindfoot and forefoot, occur.

Back 254

Congeinital clubfoot (AKA Talipes Equinovarus)

*unilateral is most common
*most common in boys
*detected easily on ultrasound or at birth

Front 255

How is congenital clubfoot managed?

Back 255

-correct deformity
-maintain the correction until normal muscle balance is regained
-serial casting done shortly after birth (gradually moves foot into better position- is changed frequently during first few weeks of life to allow for rapid growth)
-surgery (between 4m and 1y)
-care is same for child w/ any cast- observe circulation frequently b/c babies grow FAST!

Front 256

This is the most common congenital foot deformity. It is a result of abnormal intrauterine positioning. There is a medial adduction of the toes and forefoot- the heel and ankle is in a neutral position and there is no contracture present.

Back 256

Metatarsus adductus ("pigeon toed")

Front 257

How is Metatarsus adductus treated?

Back 257

stretching exercises- gently stretch muscles into normal position

Front 258

This is an abnormality where the forefoot is abducted and anlke is severely dorsiflexed to the tibia. It is a result of intra-uterine positioning. The plantar surface of the foot is flat.

Back 258

Calcaneovalgus foot

Front 259

How is calcaneovalgus foot treated?

Back 259

-usually resolves without treatment
-parents can do stretching exercises
-may need casting

Front 260

This is a group of inherited disorders characterized by abnormally fragile bones. It is AKA "brittle bone disease". Long bones are slender, with reduced thickness (problems with collagen production). Defective periosteal bone formation. Fractures decrease at puberty b/c hormones help strengthen bones temporarily.

Back 260

Osteogenesis Imperfecta

Front 261

A child has thin skin, lax ligaments, epistaxis, diaphoresis, bruising, hyperpyrexia, blue sclera, and fragile bones. What does this child have?

Back 261

osteogenesis imperfecta

Front 262

How is osteogenesis imperfecta treated?

Back 262

-supportive care
-lightweight braces and splints
-PT to strengthen muscles (and improve bone density)
-surgery to insert rods for recurrent fractures
-careful handling of children
-genetic counseling
-lifelong permanent dz

Front 263

This is a nonprogressive condition characterized by multiple joint contractures found throughout the body at birth. Can be caused by muscle defects, neurological defects, abnormal connective tissues or joints, decreased space in the womb. Life expectancy depends on severity and related CNS disorders. Child will have normal intelligence.

Back 263

Arthrogryphosis

Front 264

How is arthrogryphosis managed?

Back 264

-vigorous PT to stretch contractures
-splinting/casting/bracing
-feeding assistance
-surgery to try to get into better position of functioning

*contractures do not go away. stretching is not very effective.

Front 265

This acquired disease affects children 3-12 years of age. Boys 4-8 years of age are most commonly affected. It is a disturbance of circulation to the femoral head which produces an ischemic aseptic necrosis. This takes place over months to years. Trauma, inflammation, & coagulation defects are some of the causes

Back 265

Legg-Calve-Perthes Disease

Front 266

What are the stages of Legg-Calve-Perthes Disease?

Back 266

Stage I= avascular- (lose blood supply)
Stage II= revascularization (blood supply restored)
Stage III= reparative
Stage IV= Regenerative

* stages can occur over mos-years

Front 267

A school-age child presents with a limp, hip soreness/aches on one side, intermittent or constant hip stiffness, pain to thigh and knee, and limited ROM on that side. What do you suspect?

Back 267

Legg-Calve-Perthes Disease

*Dx made by X-ray

Front 268

How is Legg-Calve-Perthes Disease managed?

Back 268

- goal is to keep femoral head contained in the acetabulum
- rest and non-weight bearing helps reduce inflammation and restore motion
- PROM (passive ROM) and AROM (active ROM)
- bracing
-surgery (returns child to normal activity in 3-4m (instead of years if natural progression of dz occurs)
-conservative tx requires tx over 2-4y!

Front 269

This is the most common hip disorder of adolescence. Is considered an emergency. It occurs during a growth spurt. There is bilateral involvement in 40% of cases. Obesity, physeal architecture, and hormones play a role in it.

Back 269

Slipped femoral capital epiphysis

*proximal femoral epiphysis slips in a posterior and inferior direction
*Capital femoral epiphysis remains in the acetabulum, but the femoral neck slips, deforming the femoral head and stretching blood vessels to the epiphysis

Front 270

An adolescent presents with a limp, continuous or intermittent hip pain, knee pain, restricted internal rotation, shortening of lower extremity, and loss of abduction. What does this child have?

Back 270

slipped femoral capital epiphysis

*diagnosis is confirmed by X-ray

Front 271

How is slipped femoral capital epiphysis managed?

Back 271

-surgery (open reduction internal fixation)
-non-weight-bearing with crutches until painless ROM achieved
-considered an emergency!!! (child can lose lood supply and function)

Front 272

This is an increased convex angulation of the thoracic spine, causing a "hunchback" appearance. IT is common in adolescence due to slouching.

Back 272

Kyphosis

Front 273

How is kyphosis treated?

Back 273

-postural exercises to strengthen shoulder and abdominal muscles
-bracing for more marked deformity
-selected sports- weight lifting, tract, dancing, swimming

Front 274

This is an accentuation of the cervical or lumbar curvature beyond physical limits..."swayback" appearance. Can occur secondary to obesity, congenital hup dislocation, slipped femoral capital epiphysis, and hip contractures

Back 274

Lordosis

Front 275

How is Lordosis treated?

Back 275

-managing predisposing cause when possible
-postural exercises

Front 276

This is a lateral curvature of the spine, or spinal rotation causing rib asymmetry and thoracic hypokyphosis. It is most commonly seen in early adolescence. It can be congenital.

Back 276

Scoliosis

Front 277

How is scoliosis managed?

Back 277

- >7 ribs in a "hump" needs an orthopedic referral
- tx depends on severity, age and skeletal maturity of child, and associated s/s
- bracing- SLOWS progression
- surgery is reserved for severe cases only (>40 degrees)

Front 278

This is soreness and swelling of the tibial tuberosity due to inflammation (the tibial tuberosity is where the quadriceps muscle and tendons attach to the tibia). It peaks in adolescents who are physically active and in a growth spurt.

Back 278

Osgood Schlatters

Front 279

How is Osgood Schlatters treated?

Back 279

-best tx is rest!
- anti-inflammatories and corticosteroids (controversial)
- need good stretching exercises
- knee wraps and ice during/after activities

Front 280

This is an infectious process of the bone, usually caused by staph. It is most common between 5 and 14 years, and is twice as common in boys.

Back 280

Osteomyelitis

Front 281

What are predisposing factors for osteomyelitis?

Back 281

- twice as common in boys
- poor physical condition
- poor nutrition
- poor hygiene

Front 282

How is osteomyelitis caused?

Back 282

- exogenous: open fracture, burn, penetratin wound, contamination in surgery

-hematogenous: furuncles, abrasions, impetigo, URI, AOM, tonsillitis, abscessed teeth

Front 283

A school-aged boy presents with fever, restlessness, and appears ill. He had an injury to his arm recently and there is tenderness, warmth, edema, pain with movement, and the surrounding muscles are tense and restist movement. what is the likely cause?

Back 283

osteomyelitis

Front 284

How is osteomyelitis managed?

Back 284

-blood cultures
-agressive IV antibiotic therapy for 3-4w (PICC line)
-immobilization of affected extremity
-possible surger to move dead bone or drain abscess
-pain control
-good nutrition

Front 285

This is an infections process of the joint that is caused by staph aureus (&MRSA), group A strep, H. flu. It is usually hematogenous. The hip, knee, shoulder, and large joints are usually affected.

Back 285

Septic Arthritis

* more common in adolescent males, though in infancy incidence is equal in sexes

Front 286

A child presents with a warm, tender shoulder joint. He exibits pain on gentle pressure. There is edema over the joint, and he has fever, leukocytosis, and increased sedimentation rate. What does this child likely have?

Back 286

septic arthritis

Front 287

How is septic arthritis managed?

Back 287

-surgery (drainage of infections)
- repeated needle aspirations if necessary
- aggressive IV antibiotic
- pain relief
- immobilization of joint
- non-weight-bearing until healing complete (lower extremities)

Front 288

This is the most frequently encountered malignant bone cancer in children. It peaks at 10-25 years. Most primary tumor sites are the metaphyses of long bones (wider part of the shaft, next to the growth plate). It is most common in lower extremities (esp. femur). The humerous, tibia, pelvis, jaw, and phalanges are other common sites.

Back 288

Osteogenic sarcoma

Front 289

How is osteogenic sarcoma diagnosed?

Back 289

Definitive: CT scan, bone scan, needle/surgical biopsy

MRI looks at neruovascular structures, soft tissue extension, other bone involvement, etc... it is useful in limb-salvaging procedures.

Front 290

What are some s/s of osteogenic sarcoma?

Back 290

-severe to dull pain at site
- limp
- decreased physical activity due to pain
- unable to hold heavy objects

Front 291

How is osteogenic sarcoma managed?

Back 291

-radical surgical resenction or amputation of affected area
- antineoplastic drugs (methotrexate, adriamycin, cisplatin, ifosfamide) before and after surgery
-65-75% long-term survival rate
- prostetic limb

Front 292

This is the second most common malignant bone tumor in children. Is very lethal. It is a primitive neuroectodermal tumor. It occurs in the marrow spaces of the bone- femur, ulna, humerous, vertebrae, pelvis, scapula, ribs, scull.

Back 292

Ewing Sarcoma

Front 293

How is Ewing Sarcoma diagnosed?

Back 293

CT
Bone scan
Biopsy
MRI

Front 294

How is Ewing Sarcoma managed?

Back 294

-Tx of choice: radiation in involved area + chemotherapy
-surgical amputation not routinely done unless extremity is deformed/useless

Front 295

This is a soft tissue sarcoma; means striated muscle tumor. This is the fourth most common solid tumor in hcildren. It originates from the mesenchymal cells in muscle, tendons, fascia, or from fibrous, connective, lymphatic or vascular tissue. Usually occurs in children <5y. It can occur anywhere in the body because skeletal muscle is found almost anywhere.

Back 295

Rhabdomyosarcoma

*dx same as bone tumors

Front 296

What are some clinical manifestations of Rhabdomyosarcoma?

Back 296

-depends on tumor site. Could be:
loss of extraorbital movement
stuffy nose
nasal obstruction/epistaxis
sore throat/ear pain
palpable neck nodes
facial nerve palsy
bowel or bladder dysfunction
abdominal mass and pain

Front 297

How is Rhabdomyosarcoma managed?

Back 297

-HIGHLY malignant!- mets have usually already occurred by the time of dx
-surgical removal of tumor if possible
- radiation/chemo combo (vincristine, actinomycin-D, cyclophosphamide, cisplatin, ifosfamide)

Front 298

This is a chronic inflammation of thesynovium with joint effusion and eventual erosion, destruction, and fibrosis of the articular cartilage. Unknown cause. Onset peaks at 1-3y and 8-10y. It is more common in girls.

Back 298

Juvenile Rheumatoid Arthritis

Front 299

This type of juvenile rheumatoid arthritis involves 4 joints or less

Back 299

paurciarticular

Front 300

This type of juvenile rheumatoid arthritis involves 5 or mroe joints

Back 300

polyarticular

Front 301

This type of juvenile rheumatoid arthritis is characterized by variable arthritis, systemic features (fever, rash, enlarged spleen, pericarditis, lymphadenopathy).

Back 301

systemic

Front 302

how is juvenile rheumatoid arthritis diagnosed?

Back 302

- dx is based on how many joints are involved
- 90% of cases have a negative rheumatoid factor
-may or may not have elevated sed rate
-antinuclear antibodies common
- No definitive tests

-Dx based on criteria:
1. age of onset (<16y)
2.arthritis in 1 or more joints
3.duration of arthritis 6w or longer
4. exclusion of other forms of arthritis

Front 303

How is juvenile rheumatoid arthritis managed?

Back 303

-no cure!
-NSAIDS
-cytotoxic drugs (for severe arthritis who fail NSAIDS... low-dose methotrexate for ex)
-corticosteroids- used for life-threatening disease or if incapacitated
-antirheumatic drugs- used in combo w/ NSAIDS... hydroxycholoquine, gold
-PT
-well balanced diet

Front 304

This is a subluxation of the radial head.

Back 304

Nursemaid's elbow

Front 305

A young child presents with no history of trauma and suddenly refuses to use an arm. The child resists supination/pronation as well as flexion/extension of the forearm. What should the nurse expect?

Back 305

Nursemaid's Elbow

*the forearm is usually flexed 15-20 degrees at the elbow, and the forearm is partially pronated

Front 306

This type of pain is common in preschoolers and grade-shool aged children... it is leg pain of unknown cause, especially nighttime pain. What does the nurse suspect? What tx will be used?

Back 306

Growing Pains

*r/o disease of the bone/muscles
*massage, warm compress
*motrin/tylenol

Front 307

What are some signs of increased intercranial pressure in infants?

Back 307

bulging fontanel
separated cranial sutures
irritability
high pitched cry
distended scalp veins
increased head circumference
feeding changes
cries when held or rocked(they want to be still)

Front 308

What are some signs of increased intercranial pressure in children?

Back 308

headache
nausea
vomiting
diplopia
blurred vision
seizures

Front 309

What are some late signs of increased intercranial pressure in children?!

Back 309

lowered LOC
decreased motor response to command
decreased sensory response to pian
alterations in pupil size/ reactivity
posturing
cheyne-stokes respirations

Front 310

What are the 3 major causes of childhood brain damage?

Back 310

falls
MVA
bicycle injuries

Front 311

Children tolerate increased intercranial pressure (better/ worse) than adults because:

Back 311

better

*because of the cranium's ability to expand and b/c of a thin skull

Front 312

A child being ejected from a car, flying off a bicycle when it hits a curb, etc. are examples of what kind of head injury?

Back 312

acceleration

Front 313

A child getting a head injury from a sudden stop, i.e. rear-ending a vehicle, is an example of what kind of head injury?

Back 313

deceleration

Front 314

A traumatically induced alteration in mental status is what kind of head injury?

Back 314

concussion

Front 315

This kind of head injury results in brain tissue that is bruised and damaged in a local area.

What is the difference between coup and contrecoup

Back 315

contusions

*coup- occurs exactly where impact happens
*contrecoup- brain richochets and injury occurs opposite side to impact.

Front 316

This kind of head injury (fracture) involves suture lines

Back 316

diastatic

Front 317

What are clinical manifestations of minor head injury?

Back 317

(+) or (-) LOC
transient confusion
irritability
pallor
vomiting
somnolence

Front 318

If a child with a head injury vomits >__ times, see a MD!

Back 318

3

Front 319

What are signs of progression of a head injury?

Back 319

altered mental status
vital sign changes
mounting agitation
headache
vomiting (projectile)
fatigue
tiredness

Front 320

What are some clinical manifestations of severe head injury?

Back 320

signs of increased ICP
hemiparesis
retinal hemorrhage
elevated temperature (if involves hypothalamus)
unsteady gait
papilledema (swelling of optic nerve)

Front 321

In this type of head injury, blood accumulates between the dura and the skull to form a hematoma.

Back 321

Epidural Hemorrhage

Front 322

Why is there a low incidence of epidural hemorrhage in childhood?

Back 322

-location of middle meningeal artery (is located deeper)
-resilient skull
-widened sutures and fontanels
- lower systolic BP in children

Front 323

What are the layers from the skin to the brain in order?

Back 323

skin
skull
dura mater
arachnoid
pia mater
brain

Front 324

This type of head injury has bleeding between the dura and the cerebrum. It occurs most often in infancy- peaks at 6m. It can be a result of birth trauma, falls, shaking. It develops more slowly: the bleed spreads thinly until it reaches the dura barriers.

Back 324

Subdural hemorrhage

Front 325

What should the nurse suspect if a baby presents with a subdural hemorrhage and retinal hemorrhage?

Back 325

shaken baby sydrome

Front 326

Following a head injury, what should the nurse teach the parents to do at home?

Back 326

-check child every 2 h
-awaken twice during night
- do this for 48h

Front 327

What should the nurse in the hospital setting do following a head injury for a child?

Back 327

-close neuro assessments
- keep child NPO or on clear liquids
- closely watch IVF
- seizure precautions

Front 328

This kind of brain tumor is the most common in children. It occurs on the posterior third of the brain, primarily on the cerebellum or brainstem.

Back 328

Infrantentorial

Front 329

This kind of brain tumor occurs within the anterior two thirds of the brain, mainly in the cerebrum.

Back 329

Supratentorial

Front 330

A child presents with a dull, throbbing headache, vomiting that is getting progressively more projectile, behavior changes (irritability), is fatigued, lethargic, and has cranial enlargment. HR and RR are decreased and BP is increased. The child has neuromuscular changes (clumsy, weak, poor fine motor control) and has a positive babinski sign. He is having visual disturbances. What should the nurse suspect?

Back 330

brain tumor

*seizures are also a clinical manifestation

Front 331

How are brain tumors diagnosed?

Back 331

-based on clinical s/s and neuro assessment
-MRI
-CT
-EEG
-Angiogram

Front 332

How are brain tumors managed?

Back 332

-surgery
-radiation
-chemo
-prognosis depends on type, size, extent of tumor, age of child

*support for hair loss

Front 333

How should a nurse prevetn post-op complications after surgery for a brain tumor?

Back 333

-close neuro checks
- frequent Vs
- frequent dressing checks
- positioning!:
*infrantentorial- flat and on either side
*supratentorial- head elevated above the heart
*NO TRENDELENBERG with either! increases ICP!

Front 334

This is the most common malingnant extracranial tumor of childhood. Affects immature or developing cells. Usually affects autonomic and sympathetic nervous systems... adrenal gland is most common site

Back 334

Neuroblastoma

"neuro"=nerves
"blastoma"=affects immature or developing cells

Front 335

What are some clinical manifestations of neuroblastoma?

Back 335

-depend on location of original tumor and extent of spread to nearby parts of body
-is a "silent" tumor
-exopthalmos, lymphadenopathy, bone pain, varying degrees of paralysis (if spinal cord involved), weakness, weight loss, irritability
-adrenal s/s: flushing, HTN, tachycardia, diaphoresis

Front 336

How is neuroblastoma usually diagnosed?

Back 336

-blood and urine tests- for catecholamines
-CT scan
-Bone scan
-MRI
-PET scan
-bone marrow aspiration/ biopsy

Front 337

How is neuroblastoma managed?

Back 337

-surgery (complete or partial)
-chemo
-radiation (to shrink to a size optimal for surgical removal)
-prognosis: 75% survival if <age 1; 50% for >age 1 (the younger the age at diagnosis, the better chance of survival)

Front 338

This is an acute inflammation of the meninges by H.flu, strep, neisseria meningitidis, group B strep. Infection usually follows recent injury, illness, or procedure. Is an abrupt onset!

Back 338

Bacterial meningitis

*H.flu and strep pneumonia cases have dropped due to vaccines

Front 339

A child presents with a high fever, headache, confusion, seizures, irritability, nuchal rigidity, (+) kernig and brudzinski signs, and a petechial rash. What do you suspect?

Back 339

bacterial meningitis

Front 340

An infant presents with poor feeding, vomiting, bulging fontanel, poor tone, weak cry, irritability, seizures, cyanosis, and respiratory irregularities. What should you suspect?

Back 340

bacterial meningitis

Front 341

How is bacterial meningitis diagnosed?

Back 341

lumbar puncture (increased protein, decreased glucose, culture, cell count, direct antigen testing to look for type)

CSF pressures- done with LP

Enteroviral PCR (take spinal fluid and see whether it is bacterial or viral... takes a week to get back)

Front 342

How is bacterial meningitis managed?

Back 342

isolation!
antibiotics
maintain hydration but monitor fluid overload
maintain ventilation
control seizures
control fever
reduce ICP

Front 343

How is aseptic/viral meningitis different from bacterial?

Back 343

- onset can be abrupt or gradual (while bacterial is always abrupt)
- not as sick as in bacterial meningitis: more generalized s/s
- tx is only symptomatic (antibiotics prescribed until cultures come back negative though)
-not contagious

Front 344

A child presents with a headache, fever, abd pain, vomiting, sore throat, generalized aches, and a maculopapular rash. His CSF has increased lymphocytes. What does this child probably have?

Back 344

aseptic/viral meningitis

Front 345

This is an inflammation of the brain that occurs as a result of direct invasion by a virus or post infectious involvement following a viral illness (herpes simplex, varicella, measles, mumps, toxoplasmosis, all can cause).

Back 345

Encephalitis

Front 346

A child presents with malaise, fever, headache, neck stiffness, ataxia, speech difficulties, stupor, seizures, confusion, coma, and paralysis. What does this child most likely have?

Back 346

encephalitis

Front 347

How is encephalitis diagnosed?

Back 347

lumbar puncture
brain biopsy
viral serology
CT
EEG

Front 348

How is encephalitis managed?

Back 348

acyclovir (if cause is herpes simplex or varicella)
supportive care
frequent neuro checks
control ICP
nutrition/hydration
*long-term effects on infants include learning developmental delays

Front 349

This is a toxic encephalopathy that follows a viral illness (URI, influenza, varicella, AGE). Associated with aspirin use during illness. It is not contagious. Abnormal accumulations of fat develop in the liver and other organs along with severe increased pressure in the brain.

Back 349

Reye syndrome

Front 350

What are Reye Syndrome stages?

*easy to miss b/c so rare

Back 350

Stage I: vomiting, sleepiness, and lethargy

Stage II: restless, irritability, confusion, delirium, (+) babinski, hyperreflexia, sluggish, dilated pupils

Stage III: comatose, decorticate rigidity, hyperventillation

Stage IV: deep coma, fixed&dilated pupils, decerebrate rigidity

Stage V: seizures, no pupillary response, respiratory arrest, flaccid paralysis

Front 351

How is Reye syndrome diagnosed?

Back 351

-LFT (increased SGPT, SGOT, bilirubin)
-elevated PT/PTT
-elevated lipase, amylase
-CT head (cerebral edema)
-EEG
-Lumbar puncture

Front 352

How is Reye syndrome managed?

Back 352

-early dx is key
-maintain hydration
-correct hyperammonemia
-correct/avoid ICP
-tx seizures
-correct coagulopathy
-maintain airway

Front 353

In this disease, seizures result from abnormal electrical discharges from brain cells, often in the cerebral cortex. Can be idiopathic or acquired.

Back 353

Epilepsy

Front 354

How is epilepsy diagnosed?

Back 354

CT scan
MRI
EEG

Front 355

How is epilepsy managed?

Back 355

-anticonvulsants (dilantin, cerebys, tegretol, depakote)
-surgery
-must monitor therapeutic levels every few months
-remember, as a child grows, their dosages will need to be increased!
-avoidance of video games

Front 356

This type of seizure disorder usually accompany a respiratory infection or GI infection. It results from a sudden rise in body temperature, not how high the fever is. There are usually no long-term complication.

Back 356

Febrile seizures

*only start on anticonvulsants if they have >1 seizure

Front 357

This is an imbalance in the production and absorption of CSF in the ventricular system. It is a symptom of an underlying brain disorder resulting in impaired absorption of CSF and obstruction of the CSF flow within the ventricles

Back 357

Hydrocephalus

Front 358

A child presents with abnormal, rapid head growth. He has bulging fontanels, dilated scalp veins, spearated cranial sutures, depressed eyes, irritability, lethargy, headache, confusion, and ataxia. The child cries when he is picked up or rocked, and quiet when held still. What does this child have?

Back 358

Hydrocephalus

Front 359

How is hydrocephalus diagnosed?

Back 359

-prenatal ultrasound
-abnormal enlargment of the head circumference on growth chart
- cranial ultrasound if suture is open
- CT head
-MRI

Front 360

How is hydrocephalus managed?

Back 360

-goal is to re-establish a balance between CSF production and absorption
-Ventriculoperitoneal(VP) shunt
-Diamox reduces CSF production
-Ventriculostomy (drains excess fluid. Must hang bag at the correct level. Temporary tx.)

Front 361

What is an indication of infection in a VP shunt? What is an indication of malfunction of a VP shunt?

Back 361

1. fever

2. increased ICP

Front 362

this is the most common physical disability of childhood. Anoxia plays a key role- lack of oxygen at birth. There is a delayed gross motor development, abnormal motor performance, alterations in muscle tone, abnormal postures, reflex abnormalities, and associated disabilities.

Back 362

Cerebral Palsy

*there are 4 kinds: spastic, dyskinetic, ataxic, and mixed

Front 363

What is the key to diagnosing CP?

Back 363

good neuro and developmental exams- know the milestones of normal development!

*persistent primitive reflexes like tonic neck and moro reflex are red flags

Front 364

What are some warning signs of CP?

Back 364

poor head control after 3 monts
stiff or rigid extremities
arching back
floppiness
unable to sit by 8 months
uses only one side of the body
no social smile by 3 months
feeding difficulties
scissoring
persistant primitive reflexes
not reaching other milestones

Front 365

This type of cerebral palsy is characterized by hypertonicity with poor posture control, balance and coordinated motion. There is an impairment in fine and gross motor skills. The child's active attempts at motion increases abnormal posture.

Back 365

spastic CP

Front 366

This type of CP is characterized by abnormal involuntary movements. The child may drool and have imperfect speech articulation. The child will have slow, wormlike movements that usually involve the extremities, trunk, facial muscles, and tongue.

Back 366

dyskinetic CP

Front 367

This type of CP is characterized by poorly performed, rapid, repetitive movements. The child will have a wide-based gait and will have disentegration of movements of the upper extremities when the child reaches for objects.

Back 367

Ataxic CP

Front 368

This type of CP is characterized by a combination of spasticity and dyskinetic symptoms.

Back 368

mixed CP

Front 369

How is CP managed?

Back 369

-early recognition and promotion helps child gain optimal development.
-coordination of services= PT, OT, ST to establish communication, social, and motor skills
-Ankle-foot braces to reduce deformity
-Mobilization devices
-Meds to reduce spasticity
-Anti-seizure meds (due to brain damage at time of anoxia)

Front 370

This disease is characterized by defects involving failure of the bony spine to close.

Back 370

Spina bifida

Front 371

This form of spina bifida is where the defect is not visible externally (and therefore may go undiagnosed)

Back 371

spina bifida occulta

Front 372

This form of spina bifida is where there is a visible defect, and can involve either the meninges and spinal fluid (____a____) or involve the mininges, spinal fluid, as well as nerves (___b___).

Back 372

Spina bifida cystica.

a) meningocele
b) meningomyelocele

Front 373

How can spina bifida be diagnosed?

Back 373

-AFP testing
-CVS
-cystica is easily detected at birth
-MRI
-CT
-myelography

(occulta must be diagnosed by MRI, CT, or myelogram. is not detected by other methods)

Front 374

A child has spina bifida. He has paralysis of his lower extremities, incontinence, hip dislocation, contractures, scoliosis, and hydrocephalus. What kind of spina bifida does this child have?

Back 374

Spina bifida cystica

*the degree of symptoms varies depending on the level of vertebral involvement.
*the higher up on the spinal column it occurs, the less function the child will have.

Front 375

A child has spina bifida. He was symptom-free but his nurse noted a sacral dimple with tufts of hair. He has soft, subcutaneous lipomas. As he has gotten older, he has bowel and bladder disturbances and progressive gait problems. What type of spina bifida does this child have?

Back 375

Spina bifida occulta

*can have symptoms or be symptom-free
*may not have any symptoms until older, and then may have certain degrees of incontinence or constipation

Front 376

How is spina bifida managed?

Back 376

-in newborn, prevent infection with cystica (cover with dressing, keep moist)
- surgery within first 12-48h to manage cystica
- shunting for hydrocephalus
- provide mobility devices for children when possible
- teach children who are incontinent to self-cath q4h (b/c they cannot empty bladder fully and are at risk for UTIs)
-bowel managment/ training program

Front 377

This is a hereditary disease with gradual degeneration of muscle fibers due to an absence of dystrophin (a protein that keeps muscle cells intact). Onset is between 3-5 years. The child will have progressive muscular weakness, wasting, and contractures.

Back 377

Duchenne Muscular Dystrophy

Front 378

What are some clinical manifestations of duchenne muscular dystrophy?

Back 378

-often the first signs noticed are problems with running, climbing, riding a bike
- may have delayed motor skills
- waddling gait
- lordosis
- frequent falls
- gower sign (sitting--> standing position will walk hands up legs)
- enlarged muscles
- mental deficiency
- contractures
- obesity

*progresses until death occurs from respiratory or cardiac failure
*every muscle in body is affected

Front 379

How is Duchenne Musular Dystrophy managed?

Back 379

- try to maintain function in unaffected muscles for as long as possible w/ ROM, surgery to release contractures, bracing, performing ADLs
- genetic counseling (1st and 2nd degree relatives)
- no cure

Front 380

This is a very rare immune-mediated disease often associated with viral or bacterial infections or vaccines. It is characterized by inflammation and edema of the spinal and cranial nerves, and demyelinization and compression of the nerve roots. There will be impaired nerve conduction resulting in complete or partial paralysis of the affected muscles.

Back 380

Guillan-Barre Syndrome

Front 381

How is Guillan-Barre Syndrome diagnosed?

Back 381

- based on clinical manifestations
- lumbar puncture shows increased protein in CSF
- EMG (electromyelogram)
- nerve conduction velocity test

Front 382

What are some initial clinical manifestations of Guillan-Barre syndrome?

Back 382

muscle tenderness
paresthsia and cramps
muscle weakness

Front 383

What are some clinical manifestations of paralysis from Guillan-Barre syndrome?

Back 383

- paralysis ascends from lower extremities
- involves muscles of the trunk, arms, and those supplied by cranial nerves
- intercostal and phenic nerves cause SOB and shallow respirations

Front 384

What are some other clinical manifestations of Guillan-Barre syndrome?

Back 384

- depressed or absent DTRs
- urinary incontinence or retention
- constipation
- sensory impairment of varying degrees

Front 385

How is Guillan-Barre syndrome managed?

Back 385

- symptomatic treatment
- corticosteriods in early stages
- intubation or tracheostomy (deaths occur mainly from resp. failure)
- plasmapheresis
- IV immunoglobulin

*muscle function begins to return after 2d to 2w after onset of symptoms.
*Rate of recovery depends on severity of disease

Front 386

What are some major causes of spinal cord injury?

*spinal cord injury is not a common cause of disability in childhood

Back 386

MVA
falls from heights
breech delivery
GSW/ violence
sport injury

Front 387

What are some spinal precautions you should take when an accident has occurred?

Back 387

-never remove infants/small children from carseats
- cervical collar
- backboards
- maintain neutral position of head/neck at all times
- remain in spinal precautions until X-rays confirm that there is no injury

Front 388

What are some s/s of spinal cord injuries?

Back 388

-muscle weakness
- loss of voluntary muscle movement
- breathing problems
- loss of feeling in chest, arms, legs, etc
- loss of bowel or bladder function

Front 389

How are spinal cord injuries treated?

Back 389

-IV corticosteroids
- mechanical ventilator
- foley catheter
- feeding tube
- PT/OT/ST
- rehabilitation