Term
| What factors affect Total Body Water (Fluid & Elctrolytes) in children? |
|
Definition
| The younger the child = decrease in whole body content in body. It's very east for a little baby to dehydrate quick. (Premature babies=90% water, Infants 70-80% water, 2 yo-adults=50-60% water. MEN have more water in body bc lean muscle tissue has more water. women have more fat, so less water. ECF is higher in newborns & it's lost first. Infants have a greater surface area to body mass in infants. Have a higher basal metabolic rate (2-3x adults). Immature kidney function. Greater vulnerability to severe electrolyte losses. |
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Term
| When ___________ occurs, the body fluid lost is more than the fluid gained. |
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Definition
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Term
| Dehydration is often associated with __________ imbalance. |
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Definition
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Term
| Dehydration secondary to _____________ is especially scary. There are 3 million office visits yearly. 200,000 hospitalizations & 500 deaths from it. |
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Definition
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Term
| 50-90 ml/kg TBW loss and a 5-9% loss . . . is categorized as what level of dehydration? mild, mod or severe? |
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Definition
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Term
| If a person loses < 50 mL/kg TBW in less then a 48 hr period. Up to a 5% loss of body weight. is categorized as what level of dehydration? mild, mod or severe? |
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Definition
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Term
| If a person loses greater than or equal to 100 mL/kg TBW. Has a 10% or higher loss, this is categorized as ___________ dehydration. |
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Definition
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Term
| Two-year-old male arrives to ER with a history of vomiting and diarrhea. The child weighed 40 lbs (18.18 kg) 2 weeks ago. The present weight is 17kg. What is the classification of this child’s dehydration? |
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Definition
| started out 18.18 kg-17kg = 1.18 kg of weight loss. Take that divided by original weight. 1.18/18.18 = 0.0649 or 6.4% loss = moderate dehydration. |
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Term
| Calculate dehydration & classify... 22 kg, now 19 kg. |
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Definition
| 22-19=3 kg 3 kg/22kg=0.136. 13.6% Severe dehydration. |
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Term
| What clinical manifestations would you expect from MILD dehydration? |
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Definition
few loose stools
pale
tacky mucous membranes
VS unchanged
Fairly normal behavior |
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Term
| What clinical manifestations would you expect from MODERATE dehydration? |
|
Definition
Several loose watery stool
Irritability
Grayish color
Dry mucous membranes
Sl. depressed anterior fontanel
Inc. pulse, BP normal or lower
Capillary refill 2-3 sec. |
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Term
| What clinical manifestations would you expect from SEVERE dehydration? |
|
Definition
Lethargy
Mottled skin
Parched mucous membranes
Sunken anterior fontanel (if baby)
Rapid pulse, BP is lower. O2 sat was normal, but looks very moddled and grey. Gave NS bolus & looked normal. Can really change min to min.
Capillary refill greater than or equal to 3 sec. |
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Term
| Classify as isotonic, hypertonic or hypotonic. An equal loss of sodium & water. Has normal Na+ = 130-150 |
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Definition
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Term
| Classify as isotonic, hypertonic or hypotonic. If the water loss is greater than the sodium loss, the serum sodium is GREATER than 150. |
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Definition
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Term
| Classify as isotonic, hypertonic or hypotonic. If the water loss is less than the sodium loss, sodium is less than 130. This type is seen often with renal failure, excessive water intake or gastric irrigation |
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Definition
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Term
| Other clinical manifestations of ______ dehydration in an infant are sunken fontanelle, sunken eyes & cheeks, few or no tears, dry mouth or tongue and sunken abd. |
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Definition
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Term
| What kind of water should you use for bottle feedings (esp in children with teeth) and why? |
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Definition
| tap water b/c it has fluoride (or make sure the bottled water has it) |
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Term
| As discussed, sodium can become imbalanced and cause dehydration. POTASSIUM can also become imbalanced. Acid-base imbalances that occur are metabolic acidosis & metabolic alkalosis. If a child has tube & secretions are draining out & not being replaced, what imbalance are they at risk for? Or if the baby is on diuretics |
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Definition
| metabolic alkalosis (higher pH) |
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Term
| What is the oral rehydration followed for MILD dehydration? |
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Definition
| oral rehydration solution (ORS)- 50ml/kg over 4 hrs (reassess after 2hrs). Give Pedialyte. Mainly remember, NO GATORADE b/c it's high in sugar & increases loss in the intestines. If they're going to use gatorade make sure it's 1/2 water. |
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Term
| What oral rehydration protocol is done for MODERATE dehydration? |
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Definition
| ORS 100ml/kg over 4hrs (give 100 mLs per 1 kg over 4 hrs) |
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Term
| Following Mild & Moderate Dehydration is Maintenance Therapy. What is done here? |
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Definition
| normal fluid maintenance for weight (plus stool loss)- continue breast feeding and or regular diet for age after rehydration achieved. |
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Term
| How much ORS would a 5kg infant with mild dehydration initially require per hour? |
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Definition
| 50/kg over 4 hours. 50 mL x 5 kg = 250 mL over 4 hours. 250/4=62.5 mL/hr |
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Term
| What is the normal fluid maintenance requirement for a child less than 10 kg? (For these next few, she said "What you need to print off & bring to clinicals to calculate with" - not sure if need to memorize) |
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Definition
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Term
| What is the normal fluid maintenance requirement for a child who weights 10-20 kg? |
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Definition
| 1000 mL + 20 mL/kg for each kg above 20 kg |
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|
Term
| What is the normal fluid maintenance requirement for a child weighing over 20 kg? |
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Definition
| 1500 mL + 20 mL/kg for each kg above 20 kg |
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Term
| What is the normal URINE OUTPUT requirement? |
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Definition
| 1 mL/kg/hr. Often they're not urinating every hour, so be looking at it over a 4 hr period. If urine output is just a little low, what are you going to do? When calculating this, this is minimal urine output. Really you’re just going to encourage increased fluids. |
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Term
| What is the daily fluid requirement for a 25 kg child? |
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Definition
| Protocol: Over 20 kg=1,500 mL + 20 mL/kg for each kg above 20 kg. Problem: 1,500 + 20 (5) = 1,600. 1,600/24 hrs = 66.67 mL/hr (usually with children we round to hundreds, unless otherwise told) You will have calculations on the exam. |
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Term
| What is the therapeutic management for SEVERE dehydration? |
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Definition
| IV fluids (Ringer's Lactate) @ 40 mL/kg/hr until pulse and behavior return to normal (given as bolus) then 50-100 mL/kg ORS (Oral replacement). |
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Term
| If they're unable to take PO & ongoing replacement is needed then... |
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Definition
| 1/2 replacement is given 1st 8 hours, then remaining volume in the next 16 hours. |
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Term
| WHen is K+ added to the childs IV? |
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Definition
| AFTER THE FIRST VOID, you NEVER add K+ until they've voided b/c you must ensure good renal function before. |
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Term
| For a history of vomiting, give.. |
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Definition
| 1 tsp q 2-3 min until vomiting stops |
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|
Term
| What are the nursing interventions for assessment of dehydration? |
|
Definition
| Take their apical pulse (located at 5th ICS or apex of heart) & listen on the child. Checking BP, it can be hard to get on a small child. On young kids we take it on their leg. If they cry, wait 10 minutes before doing BP b/c it will be elevated. |
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Term
| What is the nursing interventions for Measurement of accurate I & O? |
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Definition
| Weighing the diapers. Have charts w/ dry weight and brands. Take urine and stool, but be sure to take bottom wipes out. |
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Term
| What are the Dehydration nursing interventions for measurement of specific gravity? |
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Definition
| Normal Specific Gravity & goal is 1.005-1.020. The specific gravity of urine in a dehydrated patient is abnormally high b/c more particles in urine & more concentration w/o water. So, if dehydrated urine specific gravity is above 1.020. |
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Term
| What other nursing interventions may be required for dehydration? |
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Definition
| Parenteral IV fluid therapy, providing oral intake, skin care (Diarrhea breaks skin down fast, need emollient like super duper diaper goop. Works well.), education to parents |
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|
Term
| What is the most common cause of VIRAL diarrhea? |
|
Definition
|
|
Term
| What is the most common cause of BACTERIAL diarrhea? |
|
Definition
| E. Coli (invasion parasites are a cause of diarrhea!) |
|
|
Term
| Can anything else cause diarrhea, besides a virus or bacteria? |
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Definition
| Yes, a Systemic infection outside GI tract would cause it. |
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Term
| Diarrhea's #1 cause overall is __________. What can be done to prevent this? |
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Definition
| ROTAVIRUS. There is an immunzation to protect: Rotarix & Rotateq vaccine |
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Term
| Who does Rotavirus affect? |
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Definition
| Children 6 mo's - 2 years. Adults have acquired immunity. They will usually have fever, vomiting and diarrhea & it causes majority of hospitalizations & many deaths. It is seasonal and happens the most during FALL. |
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Term
| Diarrhea affects young children often b/c of what factors? |
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Definition
| Young infants LACK NORMAL ENTERIC FLORA, they're always putting their fingers in their mouth, they ingest contaminated foods, antibiotics (disrupt normal flora) and epidemics. |
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Term
| How is diarrhea managed therapeutically in children? |
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Definition
| assess for a F & E imbalance, rehydrate, maintain fluid therapy, reintroduce an adequate diet (if they stop vomiting, they can eat whatever they want, but no caffeine & be careful with fruit juices b/c lots of carbs) |
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|
Term
| Is anti-diarrhea drug therapy used with children? |
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Definition
| NO! It's very toxic to children. |
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Term
| More nursing interventions for diarrhea are to obtain a thorough history. WHat else? |
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Definition
| Assess their stool (look at amt, color & consistency). Monitor for signs of dehydration. Look at lab studies. (imbalances in Na+ or K+) Carefully assess their skin & ensure ointment is on. Maintain adequate f & e requirements. Provide teaching to parents. Most parents do not understand S & S of diarrhea & how to treat it. |
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Term
| When are children started on TPN to provide enough calories? |
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Definition
| After about 3 days, they will start on TPN. A whole L of D5 has calories, but not enough in a day. |
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Term
| Childrens digestive systems are not the same as adults. What is different? |
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Definition
| Children have DECREASED EMPTYING TIME (stomachs empty quicker), they have a SMALL STOMACH CAPACITY, they have an IMMATURE RELAXED LOWER ESOPHAGEAL SPHINCTER (LES) (easy to spit up, developed by 18 mo's-2 yrs), and a LOWER ACID level in stomach. |
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|
Term
| SHORT BOWEL SYNDROME is a _____________ disorder. |
|
Definition
| malabsorptive. (the decreased surface area causes decreased absorption of electrolytes and vitamins). They can't absorb nutrients adequately. |
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Term
| What is the most common reason for Malabsorptive disorder/Short Bowel Syndrome? What else causes it? |
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Definition
| NEC (necrotizing enterocolitis) - common in premature babies. As they get older, an intestinal obstruction or Crohn's disease cause short bowel syndrome. |
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Term
| What commonly happens with short bowel disorder is their bodies are not ready for anything, but they have to be fed. It causes inflammation/infections/perforation of intestines. Then need surgery to remove part of intestine. Then they develop short bowel syndrome. How much intestines can a baby lose without problems? How much causes problems? |
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Definition
| Can lose 50% and be alright. You can survive with 15 cm of your jejunum. Losing 70% would cause severe malabsorption. If less than 15 cm, would require intestinal transplant. |
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Term
| THerapeutic Management of Short Bowel syndrome is focused on preserving the bowel. What is done to rest the bowel & what is the babies nutrition during this? |
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Definition
| There is a temporary colostomy to rest the bowel. The baby is on TPN with lipids. Problem is they can't be on TPN long-term, it will destroy the liver. The liver can't process & causes cholestasis. Longterm, will start a central line. |
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Term
| Nurses are trying to stimulate intestinal adaptation and minimizing complications (like what?) with short bowel syndrome. |
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Definition
| central line infection, clot development & education to parents-going to need a lot of community support. (they'll feel isolated b/c you can't take these babies out like most) |
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|
Term
| Do babies with short bowel syndrome ever go home? |
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Definition
| Yes, it's important for nurses to prepare the family for home therapy with babies who have short bowel syndrome. Will include... financial, educational and often have problems with child care |
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Term
| What developmental and emotional stimulation is really important for a baby who has short bowel syndrome? (hint, they're NPO and on TPN) |
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Definition
| NEED TO STIMULATE THE SUCKING RESPONSE IN THE BABY. A child who is NPO for more than 6 mo's will lose sucking ability and not take anything by mouth until they eat regular food. These babies need PACIFIERS pacifier if not eating anything by mouth. Imp to be sucking, even if feeding is through gatrostomy or feeding tube. |
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|
Term
| What is an imperforated anus? |
|
Definition
| It is an anorectal malformation that is no obvious anal opening in baby. |
|
|
Term
| imperforated anus is classified as high, intermediate or low. |
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Definition
| low=tissue covering easy to correct. medium=1/2 way increase rectum is blocked. high=complete block. |
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|
Term
| Imperforated anus has a slightly higher incidence in ______. |
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Definition
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|
Term
| Imperforated Anus may be associated with other congenital abnormalities. If there is a GI defect, you need to check out _________________ as well. MUST RULE OUT.... |
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Definition
| urinary system. Must rule out: VATER's SYNDROME... is malformed (Verterbral, Anorectal, Tracheal/Trachealesophageal fistula), Renal/Radius Bone (sometimes cardiac). |
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|
Term
| TO summarize, if baby has imperforated anus (no anal opening), where else may they have problems? |
|
Definition
| Vertebra, trachea, esophagus, renal, radius bone in arm and need cardiac evaluation. |
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|
Term
| What kind of diagnostic studies are done for imperforated anus? |
|
Definition
| Invertogram (dye is injected into rectum), Ultrasound (of abd & renal to see kidney function), cardiac evaluation & spinal films |
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|
Term
| Babies should have their first BM within... |
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Definition
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|
Term
| IF a baby has imperforated anus, an IV is done right away. IS an NG tube done right away? |
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Definition
| No they will not do an NG right away unless it's going to be more than 24 hrs until surgery (doesn't happen much). They can wait 24 hrs without doing an NG on these babies. |
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Term
| Can babies with imperforated anus breast feed before surgery? |
|
Definition
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Term
| What is the name of the surgery for imperforated anus? What nursing intervention is required post-op? |
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Definition
| Anoplasty. Anal Dilations are necessary post-op. When baby comes back to the unit, use metal rod to dilate rectum 4x/day b/c adhesions can form over rectum. Teach parents to do at home for 4-6 weeks. |
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Term
| When is a divided sigmoid colostomy (temporary colostomy) done on imperforated anus patients? |
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Definition
| They may have this until they're 6-9 mo's of age. Reason for this is they’re older, they have more tissue to work with for the repair. |
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|
Term
| The standard approach to manage high imprforate anus is colostomy in the newborn period followed by ... |
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Definition
| posterior saggital anorectoplasty at 6-9 mo's. |
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|
Term
| What is done for a baby coming back a post-op imperforated anus if it's a LOW lesion? what kind of cleansing? ointment? position? feedings? are best... |
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Definition
| side-lying sort of prone position w/ bottom kind of up and diapers underneath so stool will stay away from surgical site. Requires frequent, gentle perineal cleansing -will squirt cleansing solution on there & dab it. Apply protective ointment. Regular feedings once peristalsis starts (after anesthesia) have good bowel sounds… they can eat fairly quickly usually after arriving on unit. |
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|
Term
| What is done for a baby coming back a post-op imperforated anus if it's a HIGH/INTERMEDIATE lesion? |
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Definition
| IV fluids are given, have NG (measure & replace what they use) & NPO until peristalsis returns and colostomy care. Babies sometimes don’t have to wear bags, can put diaper up higher. Just ensure protective ointment on abdomen to prevent skin breakdown. No routine interval to replace colostomy care on children, just do when leaking. -(Temporary colostomy is done usually right away, usually surgery w/in 24 hrs. If more, put NG down)- |
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|
Term
| Often babies who have an inital surgery for imperforated anus will need another. When is the second surg done? |
|
Definition
| On average, 6-12 mo’s or so. Have a good prognosis. May have long-term problems w/ constipation. Baby may be harder to train for continence of stool. Overall, they have a flatter bottom. |
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|
Term
|
Definition
| a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or fibrosed (excess tissue). Causes accumulation of fats & bile in ducts & gallbladder. Progresses to intrahepatic ducts and causes cirrhosis. Leads to liver failure. Babies are Jaundiced b/c of excess rbc's breaking down into bilirubin |
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|
Term
| Biliary Atresia is a congenital defect & it happens soon after birth. About 15% will have associated defects (usually narrowing of bowel or cardiac defects). What is a normal picture of a baby born with this.... |
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Definition
| Sometimes something has occurred in 1st trimester w. mother (radiation, drugs, ischemia, viruses). Usual situation is baby is about 10 days old, babies suddenly not eating as well and looks yellow. They’re normal at birth, jaundice develops after 1st week of life (often the first sign) or jaundice at birth that just does not go away. Effects on liver increase, they’ll have a green/brownish effects to skin. Gradually stools becomes clay colored & dark urine. If no surgery, at 2-3 months the liver will fail. |
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|
Term
| What are the clinical manifestations of Biliary Atresia? |
|
Definition
| Normal at birth, Jaudice beyond 1st week (jaundice happens before change in stool), Greenish bronze appearance of skin, Gradually stools become clay colored & urine is dark, Portal Hypertension, End-Stage Renal Disease. If nothing is done, Liver can be destroyed within 2 months. |
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|
Term
| There are many diagnostic evaluations done for a child when biliary atresia is suspected, but is there definitive test? |
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Definition
| No, blood work can show liver is being affected, but no real diagnosis. |
|
|
Term
| What is done if the baby has biliary atresia? |
|
Definition
| SURGICAL PROCEDURE (KASAI procedure): a disection & resection of the extrahepatic bile duct. If done in first 10 weeks, have 80-90% chance of success. If it is not successful, a HEPATIC TRANSPLANT is done. 28-69% 4 year survival. |
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Term
| Before surgery for biliary atresia, nurses have a very active role in diagnosis and treatment. Nurses need to monitor VS carefully, why? |
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Definition
| These babies are at risk for BLEEDING TENDENCIES and BP needs to be monitored carefully. Watch for bleeding problems in liver babies! |
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|
Term
| Babies with possible biliary atresia will be having multiple blood draws. What special nursing jobs are done for babies with lots of blood draws? |
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Definition
| EFFICIENT COLLECTION OF MULTIPLE BLOOD SAMPLES! If you draw blood from baby, takes about 3 wks to be replaced. You can easily remove too much. Charts according to childs weight tell how much blood can be removed per day. The nurse will be adding up minimal amount of blood needed for tests w/o needing transfusion. |
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|
Term
| What are the caloric requirements needed by a baby with biliary atresia? They need to be closely monitored by the nurse. |
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Definition
| These babies need 1.5 times the amount of calories normally needed! The disease process uses up a lot of calories, but may not want to be eating r/t ascites or other SE of atresia. ***(might have test Q, baby w/ biliary atresia receiving this many calories a day. Is this efficient? Look at nutrition module & review. Don’t expect to memorize table. Question will have info for calculation.) |
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|
Term
| Babies w/ biliary atresia may have ____________ <--what with their skin?? |
|
Definition
| PRURITIS. have skin breakdown with itching. A lot of times on meds. (Need to be careful w/ sedating meds on children though long-term b/c may lower development.) Need to keep fingernails trimmed short. (Can tell parents to bring in nail clippers b/c no clippers at the hospital.) |
|
|
Term
| What are the most common craniofacial malformations? |
|
Definition
|
|
Term
| Why does cleft lip & cleft palate occur? |
|
Definition
| Unknown, but some factors that increase risk are... 1. may be a genetic (could be distant cousin, really not a definite genetic pattern) 2. increase incidence in relatives 3. environmental (ex/ of chemicals spill) 4. maternal SMOKING IN 1ST TRIMESTER increases incidence |
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|
Term
| Is cleft lip & cleft palate unilateral or bilateral? Is midline common? Are all defects similar? |
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Definition
| It can be either. Midline is rare. Defects vary from slight indentation to complete cleft. |
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|
Term
| Can cleft palate occur as an isolated incident or can it happen with cleft palate? |
|
Definition
| Both happen. Cleft palate occurs alone & with cleft lip. |
|
|
Term
| When is a cleft lip usually fixed? |
|
Definition
| 6 weeks to 4 mo's (early closure will help bonding & psyche of parents) |
|
|
Term
| When is cleft palate usually fixed? |
|
Definition
| 12-18 months. <-- before child develops faulty speech habits. Want to fix CP before they start to talk so when 1-1 1/2. |
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|
Term
| B.J. was born with a cleft lip and cleft palate. His father had a cleft lip and cleft palate at birth. Upon seeing the baby said, “ I don’t want anything to do with this baby. He can be adopted. I can’t bear to see the baby go through with what I did growing up.” How would you respond? |
|
Definition
| Call social worker to help, stay w/ mom, try to find the father, let him vent… In this situation, want plastic surgeon to come and talk fairly fast. Reinforce techniques have improved. |
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|
Term
| A big nursing intervention for Cleft Lip & Cleft Palate is to provide Psychosocial Support. The other, is to teach Feeding Techniques. What is the ESSR method? |
|
Definition
| E (ENLARGED NIPPLE so formula gets out easier) S (STIMULATE SUCK REFLEX: The baby will move lips like they are sucking, but there is no suction mechanism. Feeding becomes a complication, special bottles used. Can press on bottle and squeeze milk out. Put tube in side of babies mouth, have baby suck on chest & mom pushes on bottle. To suck on breast, they would need palate to be repaired. Encourage mom to pump breast milk.) S (SWALLOW FLUID APPROPRIATELY) R (REST WITH FACIAL EXPRESSIONS) |
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|
Term
| For a baby just coming back from CL surgery, what is the most important, like always? They have a lot of secretions, what do you do? |
|
Definition
| AIRWAY, Don’t want to use a suction catheter. Use bulb syringe to try to get mucous out, something soft. Want to keep calm as possible, hold a lot. Crying puts tension on the lip. Overall care is to PROTECT SURGICAL SITE (No suction catheter, reduce crying, no nipple or straw!) |
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|
Term
| How is a baby fed post-op cleft lip surgery? |
|
Definition
| Feed using sm. paper cup, a syringe with soft rubber tubing, or a lg. scoop spoon. Just kind of drip it into the mouth. |
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|
Term
| Your nurse friend is preparing to feed a baby post-op CL surgery with a nipple or straw, what do you say? |
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Definition
| Do NOT use a nipple or straw post-op cleft lip. You're not going to be touching or hitting their surgical site, it needs to be protected. Use a small paper cup that can drip into the babies mouth instead. |
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|
Term
| What is the only position post-op for a cleft lip baby? |
|
Definition
|
|
Term
| Post-op cleft lip surgery, the baby is wearing elbow restraints so do not hit their face. What will nurses do for these babies, how often are they released? |
|
Definition
| Nurses will take the elbow restraints off every couple, 2-3 hours to exercise the arm. They will be wearing these for 4-6 weeks. It needs to be done often and it will be for awhile.. |
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|
Term
| An older child who has cleft lip surgery may require a _______ _______. |
|
Definition
|
|
Term
| What wound care is the nurse doing surrounding the cleft lip? How is it cleansed? ointment, etc... |
|
Definition
| Cleanse drainage with COTTON-TIPPED APPLICATOR dipped in saline and DAB. Do NOT use a washcloth & do not rub. 2-3 times/day CLEANSE SUTURE line with 1/2 STRENGTH HYDROGEN PEROXIDE and RINSE with SALINE. A thin layer of ANTIBIOTIC OINTMENT may be prescribed and need to be applied. |
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|
Term
| Cleft Palate babies are at higher risk for affect to the _________. They are usually in the ICU. Nurses are looking for signs of _________ distress. |
|
Definition
|
|
Term
| Are babies with CP suctioned post-op? |
|
Definition
| NO, they are NOT suctioned |
|
|
Term
| How are CP babies fed post-op? |
|
Definition
| Nothing goes into the mouth! Packing removed after 2-3 days/ If spoon used, just drop in mouth. Will be cup fed again. Soft diet- avoid hard objects in mouth No straw, spoon, anything… |
|
|
Term
| What position are post-op Cleft Palate babies in? |
|
Definition
| PRONE. (cleft palate=prone on tummy, unlike cleft lip it is supine on back). Want on tummy, so secretions can drain out. They’ll be sedated b/c a lot of pain, head is usually positioned to the side… they will be a little older, like 9 mo’s. Just w/ CP surgery. Usually CP and CL are not done at the same time. CL is repaired early, then do CP later. Often revisions too… Elbow restraints for 4-6 weeks are also applied here. |
|
|
Term
| What is a Tracheoesophageal fistula? |
|
Definition
| an abnormal connection between the trachea & esophagus. surgery is required immediately. |
|
|
Term
| If babies have a tracheoesophageal fistual, the babies will eat normally, but when they _____ the secretions go into the trach. |
|
Definition
|
|
Term
| If the trachea & esophagus are not connected at all, what does the baby look like? |
|
Definition
|
|
Term
| Why do TE fistulas happen? |
|
Definition
| Most are an accident in embryology, 30-70% have associated malformations and they may have hx of maternal polydraminos (too much fluid in the amniotic sac) |
|
|
Term
| Most common TE fistula malformation is... |
|
Definition
| the stomach being attached to the trach. stomach goes into a blind pouch. |
|
|
Term
| What kind of clinical manifestations are often seen on babies with TE fistulas? |
|
Definition
| DROOLING, LARGE AMTS of FROTHY SPUTUM, CYANOSIS, When fed formula returns through nose & mouth. Secretions can back into trachea when baby cries (airway danger! aspiration, pneumonia...) |
|
|
Term
| How is a TE fistula diagnosed? |
|
Definition
| cathether through the esophagus will diagnose |
|
|
Term
| How are T-E fistulas managed? |
|
Definition
| GASTRIC OR BLIND POUCH DECOMPRESSION (get food out of blind pouch in trachea. Usually put tube down into pouch in esophagus, hook up to low suction to drain secretions, until surgery happens. Aspiration pneumonia develops, needs to be treated before surgery. Gastric or Blind Pouch is decompressed & so is stomach until surgery if pneumonia develops. PEG tubes are not put in children). Intermittent or continuos suctioning. NPO (Not allowed ANYTHING by mouth), IV fluids. Transfer to the NICU asap, they have chest tubes, . Do surgical repair (THORACOTOMY). |
|
|
Term
| What are the nursing interventions for TE fistula? |
|
Definition
| Assist with diagnosis, MAINTAIN AIRWAY, monitor IV fluids, Manage Decompression Tube, Provide supportive care, family support. |
|
|
Term
| Nurses need to be checking for increased secretions out of babies chest tubes following TE fistula surgery? |
|
Definition
| They'll start to feed orally after 10 days usually. Used to use blue dye to see if anything came out chest tube, now they just use clear water, just want to make sure there are not leaks. LOOK FOR INCREASED SECRETIONS from chest tube! As long as eating ok, they’ll take gatrostomy tube out at about 6 weeks. |
|
|
Term
| Failure to Thrive. Is it a symptom or a diagnosis? |
|
Definition
| a symptom, NOT a diagnosis |
|
|
Term
| _____ is a state of inadequate growth from inability to obtain & or use calories for growt |
|
Definition
|
|
Term
| A patient with FTT is below __-__% on the growth charts |
|
Definition
|
|
Term
| There are 3 categories of FTT. Idiopathic, Organic & Non-Organic. What are the causes for Idiopathic? |
|
Definition
|
|
Term
| There are 3 categories of FTT. Idiopathic, Organic & Non-Organic. What are the causes for Organic? |
|
Definition
| Any congenital problem, malabsorption, biliary atresia |
|
|
Term
| There are 3 categories of FTT. Idiopathic, Organic & Non-Organic. What are the causes for Non-Organic? |
|
Definition
| Neglect, Poor Education, Malnutrition, Psychology |
|
|
Term
| A risk factor for FTT is a PHYSICAL DISEASE or DEFECT. Is this organic or non-organic FTT? |
|
Definition
|
|
Term
| A risk factor for FTT is POVERTY, INADEQUATE NUTRITION, FAMILY STRESS, FEEDING RESISTANCE, INSUFFIENCENT BREAST MILK, DEFICIENT MATERNAL CARE or MATERNAL-CHILD ATTACHMENT. Is this organic or non-organic FTT? |
|
Definition
|
|
Term
| Assessment is HUGE w/ failure to thrive. Often won’t know the cause of the problem initially so assessment is large. If baby gains weight on admission then it’s probably ________________. |
|
Definition
| non-organic. If the baby continues to not gain weight when in hospital, the problem is likely organic. |
|
|
Term
| What are the 4 areas that really need to be assessed with FTT? |
|
Definition
1. Physical: (look at their technique when feeding. Observe how parents feed & you want to feed the baby your self too. Is this baby fussy all the time? Is that baby getting adequate rest and sleep?)
2. Psychological
3. Social
4. Spiritual: Need to assess spiritual beliefs b/c babies have been on real strange diets related to religion. Ex/ lettuce water. |
|
|
Term
| Treatment for FTT is directed at |
|
Definition
| reversing malnutrition. usually need a multi-disciplinary team involvement. |
|
|
Term
| If the baby is not gaining weight in the hospital (organic FTT) then the 2 main diseases to rule out are: |
|
Definition
| Cystic Fibrosis & Celiac Disease |
|
|
Term
| What do you do if parents still adamantly refuse to feed their baby formula? |
|
Definition
| 24 hour hold on babies in hospital, illegal for parents to remove. |
|
|
Term
| The nutritional mgmt for FTT babies is going to be Daily wt., I & O, careful calorie count. What are these babies diets like? |
|
Definition
| High in calories & high in protein, unlimited feedings |
|
|
Term
| Why is adequate protein so important? |
|
Definition
| VERY imp initially b/c affects cognitively, can cause brain damage. |
|
|
Term
| Nursing interventions for FTT are: Promote positive feeding interaction. What does this mean? |
|
Definition
| During feeding the nurse needs to teach... no TV, no telephone, hold baby close. Parents really don’t know how to feed the baby! The baby resists and is burning up more calories crying. If it gets to that point, may need tube feeding. |
|
|
Term
| Nurses are also going to be promoting proper __________ with FTT |
|
Definition
|
|
Term
| Guidelines for promoting a positive feeding interaction are: |
|
Definition
• Consistent non-stimulating environment
• Firm but calm schedule
• Stay with child
• Consistent care givers
• Don’t force |
|
|
Term
| What are the strategies to promote proper parenting in FTT? |
|
Definition
• Encourage but don’t pressure
• Teach through example
• Develop parent feeding plan
• Offer opportunity for discussion
• Promote parent self-esteem & confidence
• Refer available resources
• Teach appropriate stimulation & play |
|
|
Term
| What is Hypertrophic Pyloric Sphincter? |
|
Definition
| Grossly enlarged circular muscle of pylorus (The ganglion cells are immature at pyloric sphincter at bottom of stomach so muscle develops around there. Over time, this totally obstructs the lower part of the stomach.) Severe narrowing pyloric canal. Over time, inflammation develops and then obstruction develops. |
|
|
Term
| Hypertrophic Pyloric Sphincter develops when? |
|
Definition
| Develops 1st few weeks of life. |
|
|
Term
| Hypertrophic Pyloric Sphincter typical scenarios: M.L. is a 6-week-old male with a history of projectile vomiting of formula immediately after eating for the past week. Initially he was frequently irritable but the past 2 days has acted “sleepy.” Sphincter is closed, almost closed.. what else happens? |
|
Definition
| they take milk in and they’re vomiting back fresh milk (not bile colored or anything) b/c it’s only been in there a second. When they vomit it’s PROJECTILE VOMITING. Eventually can become dehydrated & have electrolyte problems… that’s when they become lethargic. They’re fussy initially b/c they’re hungry, when they throw it up, they cry again b/c they’re hungry. Parents are often frustrated and haven’t had a lot of sleep. So frustrated, often bring child to ER. |
|
|
Term
| What are the key elements to look for in assessment of Hypertrophic Pyloric Sphincter (HPS)? |
|
Definition
| Palpable olive-shaped tumor (just right of umbilicus) & Gastric peristalsis (because formula isn’t able to move through stomach you will see the waves moving across Left to Right just trying to get through) |
|
|
Term
| Babies with HPS are often: CONSTIPATED & DEHYDRATED too. What F & E imbalance can happen if it goes on long enough? |
|
Definition
|
|
Term
| 99% of HPS can be diagnosed from the assessment, but they may also do an ultrasound & barium studies. What are the babies electrolytes like? |
|
Definition
| Na+ & K+ are going to be decreased d/t vomiting. Cl-, pH, BiCarb, BUN is going to be increased. If dehydrated, sometimes it will increase Liver func enzymes. |
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|
Term
| Preoperatively, babies will need __ ________ before surgery for HPS. |
|
Definition
| IV fluids. (NG if going to be more than 24 hrs) |
|
|
Term
| What is the surgery for Hypertrophic Pyloric Sphincter called? |
|
Definition
| Ploromyotomy. Tiny incision, cut muscle and it pops away from that sphincter. It’s only a 15 min surgery, not a lot of anesthesia. When back on floor, will prob hear bowel sounds. Usually fed within 6 hours. They’ll have a distinct feeding schedule. Usually a small amt of formula every few hrs. Start w/ glucose formula, then ½ stream formula to full formula. If baby is spitting up, they’ll start all over. It’s a gradual process. There will be a little emesis at first. |
|
|
Term
| Nursing Interventions for HPS include: |
|
Definition
• Monitor IV fluids
• Accurate I & O
• Observation vital signs
• Management NG tube
• Pain assessment They do need narcotics for pain meds.
• Supervision feedings
• Family support: Once have surgery, shouldn’t have further problems. |
|
|
Term
| Celiac Disease is a ____________ disorder. There is an intolerance to protein gluten. What foods can they not eat? |
|
Definition
| Malabsorption. Can not eat Gluten (found in wheat, barley, rye and oats). It destroys the villi in the intestines. |
|
|
Term
| How do people get Celiac Disease? |
|
Definition
| May have an INHERITED PREDISPOSITION. Adults can acquire this after major trauma as an immune response though. It is rare in Asians or African-Americans. |
|
|
Term
| What are clinical manifestations of "early" celiac disease? |
|
Definition
| Stools- frothy, foul odor, growth failure, muscle wasting, distended abd, anemia |
|
|
Term
| What will "late" clinical manifestations of Celiac Disease present? |
|
Definition
| Failure to Thrive (FTT), diarrhea, constipation, abd pain, vomiting, behavioral changes, dental enamel defects |
|
|
Term
| If pt. comes in with organic FTT, the first things they're going to rule out are... |
|
Definition
| Celiac Disease & Cystic Fibrosis. This is if they’re less than 3% on growth charts, not super severe… always look at parents. |
|
|
Term
| The first symptoms of celiac disease occur w/in ______________. |
|
Definition
|
|
Term
| How is celiac disease diagnosed? |
|
Definition
| Jejunal Biopsy (middle pt of small intestine) |
|
|
Term
| How is Celiac Disease treated? |
|
Definition
| Withdrawal from Gluten, Treatment is primarily diet management. These patients may go undiagnosed for years. |
|
|
Term
| Celiac Disease parents & pt's are going to need diet management. what is Ok & what is not? |
|
Definition
| Not OK=wheat, barley, rye or oats. (teach to look for hidden sources of wheat & to read labels extensively). OK= Can eat corn, rice, potatoes. Can eat potato bread. Refer the fam to a registered nutritionist. Give family support & send to celiac web sites for recipes. Nurses need to stress long-term complications. They are not going to have a huge problem from one cupcake, maybe a tummy ache, but long-term it adds up. |
|
|
Term
| A 6-year-old with Celiac Disease is starting 1st grade. Is it possible for her to eat school lunch? Plan a lunch for her. |
|
Definition
| 100% corn taco shells would work. Need to be aware of diet options at school & parties too so parent could send their child a special treat. |
|
|
Term
| A young adult with Celiac Disease likes fast food after work. How would you respond? |
|
Definition
| You might suggest maybe once a week. If you tell them absolutely NO fast food, they’re going to prey fast food. So work something out with them. Most fast food places are fairly truthful in fast food facts so workout something they could eat. |
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|
Term
| __________________ is Invagination or telescoping of one portion of the intestine into another. Intestines basically telescope w/in themselves. |
|
Definition
|
|
Term
| Intussception is the most common cause of intestinal obstruction in children (3 mo-5 yrs). true or false? |
|
Definition
|
|
Term
| Intussception has an increased incidence in children of what sex and what disorder? |
|
Definition
| Males and children with Cystic Fibrosis |
|
|
Term
| 5-10% of cases of intussception occur due to mass or Meckel’s Diverticulum. |
|
Definition
| May be secondary to a bowel infection, but they really don’t know. |
|
|
Term
| C.K. is a 10-month-old male with a 1-day history of vomiting. His mother said that he cries very loud and pull his legs up tight at frequent intervals. He passed a normal brown stool today. On physical exam, you palpate a soft, nontender abdomen except for a SAUSAGE SHAPED MASS in the UPPER RIGHT QUADRANT. What do you suspect? |
|
Definition
| Intussception (will probably have assessment related Q on this) |
|
|
Term
| With intussception, they initially have acute (sudden), colicky abdominal pain, sausage-shaped mass in upper rt.quadrant, normal stool. As stool tries to go through, they’ll have acute pain and they draw their legs up. As stool goes through, they relax. Later if left untreated, they will develop a classic ________ _______-like stool, abdomen is tender and distended b/c not all stool is able to get through. |
|
Definition
| Currant jelly (usually intussception is an acute problem, but can be chronic where it goes back & forth) |
|
|
Term
| If the bowel perforates due to Intussception, what are the manifestations happening? |
|
Definition
| Initially pain is decreased, then increased. fever, abd is more distended, tachcardic, restless |
|
|
Term
| If intussception is not treated, may develop fever and signs of peritonitis. Chronic picture may occur with .... |
|
Definition
| diarrhea, anorexia, weight loss, occasional vomiting, and periodic pain |
|
|
Term
| What are the diagnostic studies done to test for Intussception? |
|
Definition
• Subjective findings alone
• Rectal exam
• Abdominal radiograph and or ultrasound
• Barium enema
(They’re looking for signs of perforation. Usually can be corrected w/ an enema.
They’ll inject air w/ or w/o contrast into anus, that air will go up and stretch out the intestine. If caught early, will correct self with enema. After a couple days though, they will have to do surgery.) |
|
|
Term
| How do stools look in intussception? |
|
Definition
| Like "Currant Jelly." Also becomes of narrowing, they may look "Ribbon Like" |
|
|
Term
| WHat are some therapeutic methods to help Intussception? |
|
Definition
1. Spontaneous reduction- 10%
2. HYDROSTATIC REDUCTION- air with or without water-soluble contrast or barium- has 75% success
3. Surgical intervention if reduction unsuccessful or for perforation. |
|
|
Term
| What is Hirschsprung’s Disease? |
|
Definition
| Congenital anomaly- absence of parasympathetic ganglion cells affected areas (mostly in the distal colon). (more common on MALES & may have a congenital anomaly) |
|
|
Term
| A 6-month-old male brought to his HCP office with a history of a bowel movement every 7-10 days. So, he has history of constipation. He passes thin stool that looks like “ribbon.” He doesn’t want to eat & is gaining weight slowly. His abdomen appears distended. Kids get ABD Distention. |
|
Definition
| Hirschsprung’s
Disease Pt |
|
|
Term
| A Newborn with clinical manifestations of ______________ disease would have delayed passage of Meconium. |
|
Definition
| Hirschprung's ... meaning in baby doesn't have BM w/in 24 hrs. Hirschsprung's disease is something that is considered when this happens. |
|
|
Term
| An infant with Hirschsprung's Disease will have what clinical manfestations? |
|
Definition
| abdominal distention, bilious vomiting, constipation |
|
|
Term
| How does an older child manifest with Hirschsprung's Disease? |
|
Definition
| progressive constipation, ribbonlike stools, presence of palpable fecal mass |
|
|
Term
| How is Hirschprung's Disease diagnosed? |
|
Definition
| rectal biopsy (cells in colon) &/or anorectal manometry (put instrument in colon, stimulating different areas, looking for response). |
|
|
Term
| How is Hirschsprung's Disease managed? |
|
Definition
• Stabilize (May have impaction, will do stool softeners)
• Temporary colostomy (want bowel to return to normal size before they do surgery)
• Eventual anastomosis of proximal & distal ends of intestines (so in surgery can remove a smaller area. Usually it’s 6 mo’s that they let bowel rest before final repair) |
|
|
Term
| What nursing interventions are done for Hirschsprung's Disease? |
|
Definition
• Diagnosis (will be getting hx, do they have hx of constipation?)
• Assessment
• Preoperative Care
• Postoperative Care (going to have NG until peristalsis returns. Going to be collecting NG drainage & then have order to replace IV fluid)
• Home Care (Parents need to be taught how to care for the colostomy) |
|
|
Term
| How common is GER in infants? |
|
Definition
| Pretty common, 25-30% infants have GER. It is pretty common to spit up a lot, gradually as sphincter matures the GER decreases. 90% clear up by 19 months. |
|
|
Term
| What is the difference between GER and GERD? |
|
Definition
| GER is not chronic like GERD or w/ actual damage to mucosas usually. GER gets better with age & GERD does not. GER usually resolves by first birthday. |
|
|
Term
| Why does GER happen in babies? |
|
Definition
| Inappropriate relaxation of lower esophageal spincter (LES). Tone is low at birth & increases with age. |
|
|
Term
| Signs of GERD in an Infant are: |
|
Definition
| emesis, FTT, anemia, iritability, gagging during feeding, apnea, recurrent pneumonia |
|
|
Term
| Signs of GERD in an Older Child? |
|
Definition
| emesis, blood emesis & stool, heartburn, dysphagia, abd & chest pain, chronic nocturnal asthma |
|
|
Term
| When is GERD considered severe? |
|
Definition
| When baby doesn’t gain weight appropriately and has FTT they are diagnosed as severe. ALTE = apparent life threatening event |
|
|
Term
| What diagnostic tests are done for GERD? |
|
Definition
• Barium swallow (initially to ensure no obstruction or hernia)
• Esophageal manometry
• Esophagoscopy
• pH monitoring |
|
|
Term
| How does the pH monitoring for GERD work? |
|
Definition
| They're diagnosed w/ pH monitoring. Similar to an NG it is inserted in nose down to sphincter w/ probe on end that continuously monitors pH to that area. They monitor for 18-24 hrs. There is a strict pattern to follow for diet. Record pH every 20 minutes and what child was doing at the time. If they’re drinking milk & pH is going up, what’s happening? They’re aspirating. Milk is a base. Sometimes will have feed apple juice. So expecting pH to go down. Not eating and pH goes down? Reflux, stomach is normally acidic and it will cause it to go down. Normal pH is 6 in stomach. (Questions on this content) |
|
|
Term
| How is GERD managed pharmacologically? |
|
Definition
| In an infant: antacids are NOT given. In a child CONSERVATIVE MEASURES are used. It is alright to give antacids (Maalox or Mylanta then progress to H2 antagonist (Zantac) > replace with proton pump inhibitor (Prilosec) or prokinetic drug (Reglan) |
|
|
Term
| Who can be given Prilosec? |
|
Definition
| Prilosec is used in children greater than 1 year with severe GERD only due to side effects |
|
|
Term
| What diet treatments are done to help kids with GER/GERD? |
|
Definition
| aboid overfeeding, keep upright 20 min's after feeding (avoid putting in car seat!), place on a slant with HOB elevated 6 inches, thicken feedings? (it's controversial, causes sphincter to open up even more.) |
|
|
Term
| What position should a GER/GERD baby be in according to new guidelines from American Academy of Pediatrics? |
|
Definition
place on back only!
EVEN w/ GERD they need to be on their back b/c of the risk of SIDS. They DO need to be on their back. |
|
|
Term
| When is surgery used to manage GERD? Surgery is not the first form of management and baby must have one of these to be a candidate... |
|
Definition
| 1. FTT with persistent vomiting after 1-2 mo's intensive medication & nutrition management. 2. recurrent pneumonia 3. ALTE more than once 4. Severe esophagitis |
|
|
Term
| What is done in a GERD surgery? |
|
Definition
| They take a piece of the stomach muscle and wrap it around the esophagus |
|
|
Term
| Post-op GERD surgery, the babies NG tube comes out, what do you do? |
|
Definition
| Any NG going through a surgical site should ONLY be put back in by a surgeon! at any age. |
|
|
Term
|
Definition
| a functional disorder involving repeated passage of feces into places not appropriate for that purpose. Occurs at least 1x a month for 6 months *** Not having BM, when supposed to be having a BM. Often feel mass in the colon b/c of history of constipation. They’ll have smears in their underwear. Large rectum b/c they’re used to retaining stool. They are trying to control this area of their life. (maybe a new sibling) They are holding stools and it becomes painful. Because holding them, they develop more constipation, can develop an impaction. |
|
|
Term
| Encopresis is seen a lot in first grade, when they can't hold their stools & they go in their pants. If developed at age 5 maybe, they are also going to rule out... |
|
Definition
| SEXUAL and PHYSICAL abuse. |
|
|
Term
| Can encopresis happen in infants? |
|
Definition
| No, it requires a chronological and mental age at least 4 years |
|
|
Term
| Does encopresis happen to boys or girls more? |
|
Definition
|
|
Term
| What are the risk factors for encopresis? |
|
Definition
| CONSTIPATION. These kids CONTRACT instead of relaxing, their external rectal sphincter. They have ABNORMAL MOTILITY in their stomach & small intestines. Their intestines STRETCH and the cycle starts again. |
|
|
Term
| A pt with encopresis has: |
|
Definition
| constipation->pain->withholding->acquired megacolon->LARGE STOOLS->constipation. (a change in a childs life brings about strange behavior) |
|
|
Term
| Encopresis risk factors are: |
|
Definition
| toilet training techniques, stool patterns, stress, trauma, disturbed parent-child relationship, sexual and physical abuse, termperament |
|
|
Term
| Encopresis manifestations are: |
|
Definition
| they have MINIMAL DISTENTION (Not a lot), movable fecal masses are palpable, bowel sounds are normal or decrease in frequency, evidence of fecal soiling around anus, large rectum |
|
|
Term
| Encopresis & ___ go together |
|
Definition
|
|
Term
| Clinical manifestations of encopresis are: |
|
Definition
| general malaise, headache, abd cramping, decrease appetite, sense fullness, nausea, vomiting, enuresis, increase incidence UTI (in girls) (Kids may be smelly & other kids make fun of them) |
|
|
Term
| What is the therapeutic management of Encopresis? |
|
Definition
| Try to treat the cause, do an abd x-ray, ESTABLISH REGULAR BOWEL HABITS (these kids can not feel their bowels like others, goal is 1-2/day), they'll have dietary changes & BEHAVIOR THERAPY. |
|
|
Term
| Encopresis calls for _____________ modification. |
|
Definition
|
|
Term
| Tell about a good BOWEL MANAGEMENT PROGRAM for Encopresis... |
|
Definition
| 1. Fleet Enema to remove impaction 2. Mineral oil 3 tsp TID or QID. 3. "Toilet" at regular intervals 4. Colace 5-10 mg/kg/24 hrs 5. Increase dose of water-soluble vitamins 6. High roughage diet 7. Do NOT PRESSURE the child |
|
|
Term
| Why does obesity occur in children? what are some risk factors? |
|
Definition
| Genetic, metabolic & endocrine, caloric equilibrium, sociocultural, Psychologic problems: low self-esteem, w/drawal from social interaction, depression, anxiety and feelings of rejection. Decreased Physical Activity, Television Viewing |
|
|
Term
| If parents are obese, __% of kids are obese. (There is a genetic & behavior component) If parents are overwt, 14% of kids are overwt. |
|
Definition
|
|
Term
| Only __% of kids have a central cause for obesity (like hyperthyroidism) |
|
Definition
|
|
Term
| How should diet be managed to help reduce obesity? |
|
Definition
| Parents ARE in control of what is presented as food before their child. The child should not be in control of “only eating happy meals.” They do have preferences, but try to balance their nutrition. If don’t get one day, try to get the next day. |
|
|
Term
| What other measures should be done to reduce obesity? |
|
Definition
| Physical Activity ensured each day, Behavior Modification (child should not be on diet alone), should be whole family. . It should not be drastic. As they get taller, they get slimmer. Get enough food to get normal development. Reduce calories so gaining appropriately, then as they get taller, they will slim down. Sociocultural (Low income) is a factor. Drugs. Surgical Techniques last resort. Can cause problems to liver though long-term d/t electrolyte imbalances. |
|
|
Term
| How many obese people actually have an underlying disease causing it? |
|
Definition
|
|
Term
| What are some psychological problems associated with obesity? |
|
Definition
| low self esteem, withdrawal from social interaction, depression, anxiety & feelings of rejection |
|
|
Term
| Obesity - Body Mass Index is calculated form a child's weight & height. The calculation will be included on the test. Know that a BMI of ___ - ___ is at risk for becoming overweight. While a BMI of ____ is overweight. |
|
Definition
| 85-95=at risk for being overweight. 95+ is overweight. |
|
|
Term
| What are appropriate nursing interventions for an overweight child? |
|
Definition
* Assessment & screening
* Education behavior modification plan
* Nutrition and physical activity counseling
* Care of the overweight child in the acute care setting Will teach family planning, know programs around. CMH has the Body Shop, kids and parents come each week to learn about exercise and nutrition. Overwt kids can be afraid to interact w/ peers, but when group is together it’s amazing how much exercise happens. (Weight can be the focus of the parent, but often need to focus on this later if they’re post-op and need to deal with pain mgmt. Wt issues can come later.) |
|
|
Term
| Does a BMI change according to age & sex? |
|
Definition
| Yes, it varies. It's based on the child's weight & height. |
|
|
Term
| The Pediatric Glasgow Coma Scale is similar to an adults. Looks at eyes, verbal response & motor response. It is same for kids 2 +, but what if they are less than 2? |
|
Definition
| look at how they smile, agitated, restless and what their responses are. |
|
|
Term
| WHat is the lowest & highest scores possible on the pediatric glasgow coma scale? |
|
Definition
| 3 is the lowest & worst possible. It indicates extremely decreased LOC. A score of 15 indicates an unaltered LOC, best score possible. |
|
|
Term
| What areas are assessed in a neuro exam on a child? |
|
Definition
| VS, skin, eyes, motor function, posturing, reflexes (are they moving all extremities?) |
|
|
Term
| Nurses should always look at variations in _____ size - it indicates altered level of consciousness. |
|
Definition
|
|
Term
| Child's posturing is "decorticate." What does this indicate? |
|
Definition
| involves rigidity, flexion of the arms, clenched fists, and extended legs. The arms are bent inward toward the body with the wrists and fingers bent and held on the chest. damage to corticospinal tract - pathway between brain & spinal cord. |
|
|
Term
| Child's posturing is "decerebrate." What does this mean? |
|
Definition
| involves rigid extension of the arms and legs, downward pointing of the toes, and backward arching of the head, extended neck, clenched jaw. Indicates damage to the brainstem. |
|
|
Term
| Brain size in babies. How big is a babies brain as an infant, 1 year old, 3 year old, 6 year old? |
|
Definition
| infant=25%, 1 year old=50%, 3 year old=75%, 6 year old=90% (so by the time they're 6 years-old, the head is about the size of an adults). |
|
|
Term
| Head circumference in babies. What is normal for an infant? What about in relation to their chest? (imp b/c brain is growing so fast at this time) |
|
Definition
| 34-35 cm. There head is 1 inch larger than their chest at this time. |
|
|
Term
| How many cm is a normal circumference at 6 months & 1 year? WHen are head & chest circumference equal? |
|
Definition
| 6 mo=44 cm, 1 year=47 cm. Head & chest circumference is equal by about One year-old. |
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|
Term
| _________ in an infants head can compensate for increases in ICP. |
|
Definition
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Term
| Why would there by continued separation of sutures & fontanels in a child? |
|
Definition
| related to IICP, may occur until 10-12 years old |
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Term
| ________________ is rare in infancy, but it is due to open sutures & fontanels (occur b/c of IICP) |
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Definition
|
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Term
| The real problem with fontanels is not if they are separated & spread, this is normal. The real problem is when they are overriding. why? |
|
Definition
| potential neurologic damage. need these fontanels open to assure brain growth. |
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Term
| The nurse should palpate the fontanels during assessment. When do the anterior & posterior fontanels normally close? |
|
Definition
| posterior = 2 months. anterior = 18 months (1.5 years) |
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Term
| Explain when myelinization of CNS happens in a child. When does it begin & end usually? |
|
Definition
| Begins in utero (about wk 16 or 4 months in the womb) and completes usually by puberty. |
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|
Term
| What does myelinization of the CNS promote? |
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Definition
| Promotes progressive coordination & fine motor development. So as myelinization occurs the newborn reflexes disappear. |
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|
Term
| Hydrocephalus. What is it? (Can break the word apart to understand...) |
|
Definition
| Water. Brain. = water on the brain. |
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|
Term
| Why does hydrocephalus occur? |
|
Definition
| DISTURBED CSF DYNAMICS: may be an imbalance between production & absorption of CSF, CSF accumulate in the ventricles, or the ventricles are dilated & the brain compressed. |
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|
Term
| Why does hydrocephalus occur if it's 'congenital?' |
|
Definition
| Congenital Anomaly (abnormal occurence) or Intrauterine Infection |
|
|
Term
| Why does hydrocephalus occur if it's 'acquired?' |
|
Definition
| Infection, Neoplasm (proliferation of cells) or Hemorrhage |
|
|
Term
| Hydrocephalus can occur for congenital or acquired reasons. It can even happen with an unknown etiology. true or false? |
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Definition
|
|
Term
| THere are 2 types of Hydrocephalus. What are they? |
|
Definition
| communicating & noncommunicating. |
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Term
| Communicating Hydrocephalus occurs b/c of a blockage __________ the ventricular system. Noncommunicating Hydrocephalus occurs b/c of a blockage _________ the ventricular system. |
|
Definition
| communicating=outside. noncommunicating=within, inside |
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Term
| Communicating hydrocephalus is outside the ventricular system. The CSF is inadequately circulated or reabsorbed in the __________________ space. |
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Definition
|
|
Term
| Does communicating hydrocephalus have obstruction in the ventricles? |
|
Definition
| No, there is no obstruction in the ventricles for Communicating |
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Term
| Postinfection (like Meningitis) or maybe a subarachnoid hemorrhage would be examples of _______________ hydrocephalus. |
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Definition
|
|
Term
| With communicating hydrocephalus, there is not an obstruction through the ventricles, but it does not get into the __________________ space. |
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Definition
|
|
Term
| ________________ hydrocephalus actually prevents the CSF flow from reaching the subarachnoid space for the reabsorption. There is an obstruction. |
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Definition
|
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Term
| Stenosis of Aqueduct of Sylius. Dandy-Walker Syndrome (obstruction of foramina of Magendie and Luschka) are causes of ________________ hydrocephalus |
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Definition
|
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Term
| CHROID PLEXUS Tumor is a rare cause of hydrocephalus. It causes an ____________ in CSF secretion. |
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Definition
|
|
Term
| What factors are going to influence the process when hydrocephalus occurs? |
|
Definition
| 1. acuity of onset 2. timing of onset 3. associated structural malformations |
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Term
| The early S/S of IICP may be subtle in an infant. As pressure increases, the S/S become more pronounced and the __________ deteriorates. |
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Definition
|
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Term
| What are some other S/S of IICP in an infant? See these for hydrocephalus. |
|
Definition
| head is enlarged, bulging anterior fontanel, but NONPULSATILE, dilated veins on scalp, sutures are separated, Macewan Sign ("cracked pot" hollow sound when tap on head), Setting-sun eyes, "bossing" of the frontal bone is an unusually prominent forehead, changes in LOC, baby is irritable and/or lethargic, poor feeding is a sign of IICP, Opisthotonos (rigid & severe arching of back), shrill, high pitched cry, developmental delays, seizures |
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|
Term
| Opisthotonos is a sign of IICP in an infant. What is this? |
|
Definition
| rigid arching of the back & overextension of the head |
|
|
Term
| Signs of IICP in an older child are... |
|
Definition
| headache, N/V, ataxia (they can walk but there is a hitch in the get along, an abnormal gait), strabismus (eye deviations), diplopia (dbl vision), the pupils response to light is sluggish or unequal, papilledema, changes in LOC, potential intellectual impairment, seizures |
|
|
Term
| Cushing's Triad is a LATE sign of IICP. What happens? |
|
Definition
| HTN (high BP), bradycardia (low HR), apnea (no movement of muscles of lungs... decreasing oxygen in the body) |
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|
Term
| Hypertension, Bradycardia & APnea are signs of what? |
|
Definition
| Cushings Triad - late signs of IICP |
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Term
| The diagnosis of hydrocephalus includes many parts. May do a fetal ultrasonography, HEAD CIRCUMFERENCE measurement, neuro studies with CT & MRI, want to evaluate the size & position of ventricles and subarachnoid spaces. Is sedation necessary? |
|
Definition
|
|
Term
| How would you assess Kernig's Sign? |
|
Definition
| Flex hips & knees... if pain then sign of meningitis. |
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|
Term
| How would you assess Brudzinski's sign? |
|
Definition
| when you move the neck, see pain and the knees come up. Nuchal rigidity is a sign of meningitis. |
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|
Term
| How should the child be positioned for a lumbar puncture? |
|
Definition
|
|
Term
| SIgns of bacterial meningitis include |
|
Definition
| CSF is cloudy, really high WBCs (ex had 25,000 when norm is 0-5), presence of polymorphonuclear cells, increased protein and decreased glucose |
|
|
Term
| Compare findings for viral meningitis... |
|
Definition
| CSF is clear, WBC is increased, but not as high & no polymorphonuclear cells, protein & glucose would be more normal. |
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|
Term
| What is the usual antimicrobial management of a child with meningitis? |
|
Definition
| Start on some broad spectrum antibiotics like Vancomycin & cephalosporin. get culture. Move to Penicillin G when found out it was bacterial meningitis. Give Rifampin prophylactically to all members of household. |
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|
Term
| How does surgery help hydrocephalus? |
|
Definition
| May try to correct the obstruction or do Shunt placement. |
|
|
Term
|
Definition
| shunts ventricles to the peritoneal cavity |
|
|
Term
| There are 2 types of shunts. The Ventriculoperitoneal (VP) shunt or the Ventriculoatrial (VA) Shunt. Which one is much more common for children? |
|
Definition
| VP - ventriculoperitoneal shunt. Best for children, esp neonates and young infants. |
|
|
Term
| What are the risk of a VP shunt for hydrocephalus? (Remember it's shunting the CSF from the ventricles in head to the abdomens peritoneal cavity)... what might happen? |
|
Definition
| bowel perforation, ascites, paralytic ileus, peritonitis (listen to bowels, assess for pain, constipation, etc..) |
|
|
Term
| The Ventriculoatrial (VA) shunt is a lot more rare and shunts CSF from ventricles right into the .... is this common? |
|
Definition
| atrium. No, it is a lot less common. Used rarely, in older children, perhaps who have had abd problems previously. |
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|
Term
| Risks involved with doing a VA shunt are... |
|
Definition
| CHF, septicemia, bacterial endocarditis and pulmonary edema. (all problems staying within the heart). Unlike VP shunt, all risks are in abd or bowels. |
|
|
Term
| There can be complications with the shunts used for hydrocephalus. What are some of them? |
|
Definition
| 1. Malfunction or Obstruction (watch for signs of IICP) 2. Shunt Infection (watch for signs of IICP, a fever, a stiff neck, a wound or shunt tract inflammation, abdominal pain). 3. Subdural Hematoma (related to rapid DECREASE in CSF pressure) - there is a depressed fontanel. |
|
|
Term
| If a shunt is done for hydrocephalus, will the person ever need revisions? |
|
Definition
| Yes, most require 5-7 revisions during their lifetime at a minimum. The time varies between, but the most common reason is the child's growth. Common times for shunt revision are as a toddler & before growth acceleration of puberty. Additional revisions are usually related to shunt complications. |
|
|
Term
| Pre-op nursing care for a VP shunt requires nurse to observe VS, IICP/Neuro: look for changes in LOC, irritability, pupil reactivity and symmetry, fontanels and suture lines. Really need to measure what? how often? |
|
Definition
| head circumference, 1-2 times/day. Done with VS usually. Report acute increases. |
|
|
Term
| What position should VP shunt repair pt's be in pre-op? |
|
Definition
| HOB at 30 degrees+, keep head/neck in straight alignment, turn & reposition every 1-2 hrs. |
|
|
Term
| What kind of mattress and diet should VP shunt repair pt's be in pre-op? |
|
Definition
| pressure reducing mattress, small, frequent feedings & accurate I & O. Support the family too. |
|
|
Term
| What position should a pt be in post-op VP shunt or repair? |
|
Definition
| position on UNOPERATED SIDE - want NO pressure on the shunt valve. Going to keep the head flat initially & graudally increase the HOB. If the HOB is moved up too rapidly, get DECREASE in CSF pressure and may cause a subdural hematoma. |
|
|
Term
| What does the nurse need to do with the patients abdomen & bowel sounds post-op VP shunt? |
|
Definition
| MEASURE ABD GIRTH & ASSESS FOR BOWEL SOUNDS |
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|
Term
| Nurse is going to be monitoring & reporting the operative side post-op VP shunt... |
|
Definition
| Operative side: redness, swelling, bleeding, leakage (CHECK GLUCOSE IF LEAKAGE). |
|
|
Term
| What are signs of shunt complication, post-op VP shunt? |
|
Definition
| signs of IICP, if the fontanel is bulging or depressed, head circumference is increased, they have a fever, stiff neck, shunt tract inflammation. |
|
|
Term
| Nurses really need to be involved with _______ management post-op VP shunt. |
|
Definition
|
|
Term
| When does a nurse pump the shunt post-op VP shunt? |
|
Definition
| ONLY WHEN ORDERED BY A PHYSICIAN |
|
|
Term
| Before discharging pt after VP shunt surgery. What signs of shunt malfunction/infection need to be taught to the family??? Really need to know what to be looking for. |
|
Definition
| Red flags are ABDOMINAL DISTENTION or DISCOMFORT are signs of infection. |
|
|
Term
| What other discharge plans are done after VP shunt? |
|
Definition
| Promote normal development, enroll in child development program as needed, have home care referrals as needed, Give resources to family. |
|
|
Term
| The prognosis of hydrocephalus is __________. |
|
Definition
|
|
Term
| The prognostic factors affecting hydrocephalus are... |
|
Definition
| the rate hydrocephalus develops, amount of brain damage done before the shunt is irreversible, the frequency of complications, the cause of hydrocephalus affects prognosis (eg malignant tumor), and the related defects (eg myelomeningocele) |
|
|
Term
| Myelomeningocele & Hydrocephalus are related. What is the myelomeningocele?? |
|
Definition
| Spina Bifida - birth defect in which the backbone and spinal canal do not close before birth. So, being born with spina bifida increases risk for hydrocephalus d/t CSF. It's related! |
|
|
Term
| _______ _______ are the bundle of nerves in a human embryo. That develop into the brain & spinal cord. |
|
Definition
|
|
Term
| Spina Bifida, Anencaphaly and Encephalocele are examples of _______ _______ defects. |
|
Definition
|
|
Term
| absence of both cerebral hemispheres and the overlying skull is ______________. |
|
Definition
|
|
Term
| Herniation of the brain through skull defect is: ______________. |
|
Definition
|
|
Term
| ________ __________ is a neural tube defect malformation involving failure of the osseous (bony) spine to close. (a spinal cord not fully protected). |
|
Definition
|
|
Term
| What kind of comfort measures would be done for a child with meningitis? |
|
Definition
| decrease stimulation in the room, quiet, low lights |
|
|
Term
| How long is a child with meningitis placed in isolation? |
|
Definition
| They're put in isolation immediately, usually for at least 24 hours until they know what's going on. |
|
|
Term
| Describe the purpose of doing the BAER test with meningitis. |
|
Definition
| The BAER test is a hearing test that must be done before a pt with meningitis goes home. Hearing loss is a big side effect with meningitis. |
|
|
Term
| What are potential long-term problems of meningitis? |
|
Definition
| deafness, blindness, paralysis, if left completely untreated it will cause death. |
|
|
Term
| What is the definitive diagnosis for meningitis? |
|
Definition
|
|
Term
| If there is leakage at the VP operative site, you want to check _________. |
|
Definition
|
|
Term
| Spina Bifida OCCULTA manifests how? |
|
Definition
| there are no observable manifestations |
|
|
Term
| Spinal Bifida OCCULTA has an incomplete fusion of the posterior _______________ , but normal spinal cord & nerves. |
|
Definition
|
|
Term
| Does Spina Bifida OCCULTA usually result in serious neuro dysfunction? |
|
Definition
|
|
Term
| Spina Bifida CYSTICA (MENINGOCELE) is a defect in the posterior ____________ ______. What is present? |
|
Definition
| vertebral arch. There is usually a cystlike sac present wit meninges & CSF. There are no neural elements. |
|
|
Term
| Spina Bifida CYSTICA (MYELOMENINGOCELE) is a defect in the vertebral arch. The Cystlike sac contains: meninges, CSF, portion of spinal cord and nerves. There is ________________ involvement. |
|
Definition
|
|
Term
| There are still some unknown causes of Myelomeningocele (worst spina bifida), but what are some? |
|
Definition
| mom's deficient in FOLIC ACID during pregnancy (now advised a month before conception) b/c the sensitive period of neural tube closure is in the first 4 weeks of gestation, other factors are: genetic predisposition, maternal hyperthermia (hot tubs, saunas when pregnant), antiepileptic drugs (eg valproic acid, carbamazepine), maternal age at pregnancy (teenage moms & women over 35) |
|
|
Term
| Myelomeningocele (spina bifida) is more common in which sex? What race? has there been an increase or decline? If you have one child with this, can you have another? |
|
Definition
| females, whites, there has been a decline (d/t prenatal screening and folic acid), the risk of 2nd child in family is about 5% |
|
|
Term
| The sensitive period of neural tube closure is when? |
|
Definition
| first 4 weeks of gestation |
|
|
Term
| Myelomeningocele happens d/t failure of neural tube closure &/or splitting of already closed neural tube. Where is the usual location on spine? The neuro dysfunction that occurs in the child is related to... |
|
Definition
| usual location = lumbar or lumbosacral spine. The neuro dysfunction that results is r/t defect's location & the nerve involvement. |
|
|
Term
| WHen the spinal cord is developing, what happens in spina bifida that's different? |
|
Definition
| fluid cyst and open skin overlying open neural tube in a spina bifida case. |
|
|
Term
| Prenatal diagnosis of spina bifida (Myelomeningocele) involves an ultrasound scan. They will look for elevated levels of ___________________ at 16-18 weeks of gestation in the amniotic fluid & maternal serum. This is offered to all pregnant women & is recommended if mom has borne a child with NTDs. |
|
Definition
|
|
Term
| Spina Bifida - Myelomeningocele after birth is based on clinical manifestations. What are some clinical manifestations that may occur b/c it IS variable.?? |
|
Definition
| Paralysis, tethered spinal cord, "dimpling" of the spinal cord, foot and joint problems, bladder & bowel problems (d/t pressure on nerves), Chiari II malformation (obstruction of flow that causes hydrocephalus), hydrocephalus, skin problems, latex allergy (develops from all the surgeries these babies have). |
|
|
Term
| What is a Chiari II malformation? |
|
Definition
| It's a block of the 4th ventricle. the lower brainstem and cerebellum are displaced downward into the cervical canal & it causes hydrocephalus after spina bifida) Really needs early intervention. |
|
|
Term
| When is the Spina Bifida - Myelomeningocele surgery? |
|
Definition
|
|
Term
| babies need atiobiotics, orthopedic help, bladder/bowel mgmt, VP shunting if needed. What are their medications? |
|
Definition
| stool softeners and anticonvulsants |
|
|
Term
| 1/2 of pregnancies in US are unplanned. What is the recommended folic acid intake? |
|
Definition
| Daily intake of folic acid for all women of childbearing age. Dose=0.4 mg daily (supplied in many multivitamins). Begin at least 1 month prior to planned pregnancy. |
|
|
Term
| Recommended dose of folic acid is 0.4 mg. What about for a woman who has already given birth to a child with NTD? |
|
Definition
|
|
Term
| What position are spina bifida patients supposed to be in pre-op? |
|
Definition
| Prone - flat on their abdomen, hips are slightly flexed, use a pressure reducing mattress and maintain their position/alignment (with diaper rolls, pads or small sandbags.) |
|
|
Term
| What skin care is done for spina bifida pt's before they go to surgery? |
|
Definition
| prevent infection & drying of sac. Want to prevent irritation & no clothes or covers are allowed. Will cover with a STERILE nonadherent dressing. Moisten it with NS, use sterile technique and change often, every 2-4 hrs. Give prophylactic antibiotics. Going to steri-drape below the defect. NO diaper - pads under child are changed frequently. |
|
|
Term
| Before surgery in a spina bifida (myelomeningocele) baby the nurse will closely watching signs of infection. Watching what? |
|
Definition
| Inspect sac for redness, clear or purulent drainage, abrasions. Watch other signs of elevated temperature, irritabillity/lethargy, nuchal rigidity (stiff neck!), elevated WBC's. **Really watch out for signs of nuchal rigidity, meningitis** |
|
|
Term
| Spina Bifida (Myelomeningocele) babies are closely monitored for hydrocephalus. How is this done? |
|
Definition
| Head circumference (measure 1-2x/day, mark head w/ marking pen, report acute increases) & look for signs of IICP. |
|
|
Term
| Following spina bifida (myelomeningocele) surgery... watching for .... |
|
Definition
| A lot of the same: infection, head circumference, IICP/neuro status, movement of extremities, bowel & bladder elimination, growth & development, family support |
|
|
Term
| Discharge instructions following spina bifida (myelomeningocele) are teaching... |
|
Definition
| skin care, bowel/bladder mgmt, diet, activity/mobility, latex allergy, to enhance development & promote psychological adjustment (one big goal is to get them upright) |
|
|
Term
| What are spina bifida (myelomeningocele) children eating? |
|
Definition
| Get OT assistance if having trouble eating. A Gastrostomy may be needed. Other children eat too much considering decreased mobility (monitor their weight & a low-calorie diet may be necessary). need to maintain good fluid intake. give a high fiber diet. |
|
|
Term
| What should nurses teach parents to observe & report after spina bifida baby goes home? |
|
Definition
| Check operative site for redness discharge, take fever, check skin breakdown, neuro status/IICP changes, **URINARY TRACT INFECTIONS (cloudy or foul smelling urine!!!)** Changes in functional ability in lower extremities & bladder & bowel habits. |
|
|
Term
| The prognosis for spina bifida (myelomeningocele) babies is variable. What are some of the factors that affect their prognosis? |
|
Definition
| Neuro deficit, Motor ability, Bladder innervation, cerebral anomalies. There is an INCREASED SURVIVAL RATE with aggressive management. |
|
|
Term
| ______________ is an inflammation of the meninges (infection of membranes & fluid) of the brain AND SPINAL CORD. |
|
Definition
|
|
Term
| How is bacterial meningitis transmitted? |
|
Definition
| Droplet infection from nasopharyngeal secretions. It appears as an extension of other bacterial infection through vascular dissemination. Organisms then spread through the CSF. |
|
|
Term
| What is the definitive test for bacterial meningitis? |
|
Definition
|
|
Term
| Nonbacterial meningitis (Aseptic Meningitis) is usually caused by... |
|
Definition
| Viruses. Like measles, mumps, herpes, leukemia. |
|
|
Term
| The onset of of nonbacterial (viral) meningitis can be abrupt or gradual. What are the manifestations? |
|
Definition
|
|
Term
| What routine immunizations would help prevent meningitis? |
|
Definition
| Pneumococcal & H. Flu vaccines. Pneumonia & flu vaccines. Maybe, MMR vaccine. |
|
|
Term
| What is the proper position for a lumbar puncture (definitive diagnosis)? |
|
Definition
| restrained and on their side |
|
|
Term
| __________ involves inflammation of the cerebral cortex |
|
Definition
|
|
Term
| Encephalitis is an INFLAMMATORY process of the CNS with altered function of brain and spinal cord. There are many causative agents, they are VIRAL most frequently. What are the 2 big reasons for encephalitis in the US? |
|
Definition
|
|
Term
| ________________ represents inflammation of both the meninges AND the cerebral cortex of the brain. |
|
Definition
|
|
Term
| What usually occurs before meningitis? |
|
Definition
| Some sort of infection. *Meningitis is secondary to infection* Usually nasopharyngeal and middle ear infections and the INFECTION TRAVELS INTO THE BLOODSTREAM. |
|
|
Term
| What are the risk factors for meningitis? |
|
Definition
| Age (college, young adult), infection can be bacterial or viral, males, african americans have higher rates of meningitis. seasonal (Fall & Spring increases rates). any neuro procedures like shunts have been done or previous head trauma. Chronic conditions like sickle cell, diabetes and renal insufficiency increases meningitis. |
|
|
Term
| What are some sings of meningitis causing IICP? |
|
Definition
| irritability, restlessness, poor feeding, anorexia, nausea, vomiting, behavior changes, decreased LOC, seizures. |
|
|
Term
| What are some clinical symptoms of meningitis? Related to the inflammation & irritation... |
|
Definition
| Fever, photophobia (light hurts eyes), nuchal rigidity, spinal rigidity, opithotonos (rigidity & severe arching of back & neck), Kernig's sign is + (hurts to flex legs & hips), Bruzinski's sign is + (hurts to move neck), skin changes & see petechiae, purpura, poor perfusion, etc.. |
|
|
Term
| If child has bacterial meningitis. what are the CSF abnormalities? |
|
Definition
| Color is cloudy & purulent, cell count is elevated & polymorphnuclear leukocytes predominate, protein is elevated, glucose is decreased (less than 1/2 of the blood glucose). |
|
|
Term
| To assess ____________ Sign: put the child supine, flex hips and knees of one leg, extension in leg causes pain (spasm of the hamstring muscle) and resistance to the extension. |
|
Definition
|
|
Term
| To assess ____________ sign: child is supine, examiner raises the child's head & flexes the neck forward. The child's knees and hips flex involuntarily. |
|
Definition
|
|
Term
| Empiric Antibiotic Therapy is began _____ obtaining cultures (before the results). The beginning treatment for meningitis pt's is Vancomycin and/or third generation cephalosporins. |
|
Definition
| after (start on broad spectrum asap |
|
|
Term
| Based on culture results of meningitis there is continuing antibiotic therapy necessary. Common drugs given are ampicillin, gentamicin, cefotaxime, ceftriaxone, vancomycin. How long are they on these antibiotics? |
|
Definition
| High dose IV for 7 days or longer |
|
|
Term
| Meningitis children will have repeated lumbar punctures until CSF is ______. |
|
Definition
|
|
Term
| Meningitis Chemoprophylaxis is ______________ and it's given prophylactically to high risk contacts & household contacts. The day care during previous 7 days & mouth-to-mouth rescusitation. |
|
Definition
|
|
Term
| Why is Dexamethasone given to a meningitis patient? |
|
Definition
| A steroid, given to lessen the meningeal inflammation & PREVENT DEAFNESS |
|
|
Term
| When is Dexamethasone given to Meningitis patients? Is it recommended? |
|
Definition
| Yes, it is recommended by the AAP for meningitis. It is given BEFORE ANTIBIOTICS are given. |
|
|
Term
| What are the comfort measures for meningitis? |
|
Definition
| Pain assessment, give pain medication, keep the HOB elevated, NO pillow, side-lying is usually more comfortable b/c of nuchal rigidity. |
|
|
Term
| If a child has mild to moderate pain with meningitis, what is given? |
|
Definition
| acetaminophen (Tylenol) with codeine. (do NOT give children aspirin!) |
|
|
Term
| If pt has pretty severe pain d/t meningitis opioids like Morphine might be given. Why is there use controversial? |
|
Definition
| Opioids like Morphine will mask signs of altered consciousness, depress respirations. |
|
|
Term
| _________ can be given to reverse opioid effects. |
|
Definition
|
|
Term
| Meningitis requires to decrease sensory stimulation. What measures are done for these children? |
|
Definition
| Quiet rooms, subdued lighting, restrict visitors, prevent sudden jarring of bed, gentle handling |
|
|
Term
| Meningitis patients need to be kept in Isolation. When & for how long? |
|
Definition
| Isolation is immediate. Respiratory isolation continues at least 24 hours. Until culture results are obtained. While the antibiotic is having an effect. |
|
|
Term
| Initially fluids are given to meningitis pt's to correct deficits. Why are they potential fluid restriction later? Must monitor I & O and Urine specific gravity. |
|
Definition
| to prevent further fluid accumulation related to: cerebral edema, subdural effusion and SIADH. |
|
|
Term
| What is the BAER test? brain stem acoustical evoked response |
|
Definition
| hearing evaluation done at the end of meningitis therapy b/c of high risk to lose hearing. |
|
|
Term
| what problems can happen following meningitis? |
|
Definition
| deafness, blindness, paralysis, seizure disorder, hydrocephalus, mental retardation, learning disabilities |
|
|
Term
| There are Epileptic & Nonepileptic seizures. MOST seizures are ______________. |
|
Definition
|
|
Term
|
Definition
| they're associated with a sudden, transient alteration in brain function. Seizures are caused by an EXCESSIVE DISORDERLY DISCHARGE OF ELECTRICAL IMPULSES by neuronal tissue. |
|
|
Term
| _________ is a disorder of the CNS. It's caused by abnormal electrical discharges and results in RECURRENT seizures. |
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Definition
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|
Term
| _________ ___________ is a seizure that lasts 30 minutes or longer OR it is a series of seizures too brief to allow child to regain consciousness between each seizure. Going to give valium, ativan. |
|
Definition
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|
Term
| What are some common triggers to pediatric seizures? |
|
Definition
| changes in dark-light patterns (camera flashes, headlights, rotating fan blades, reflections off snow or water) sudden loud noises, extreme temperature changes, dehydration, fatigue. |
|
|
Term
| Some s/s of a seizure in a child is... |
|
Definition
| changes in LOC, involuntary movements, posturing, changes in perception, behaviors or sensations. |
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Term
| Risk factors to seizures are: |
|
Definition
| idiopathic, congenital defects, acute encephalopathy, metabolic disorders, ingestion of toxic substances, head injury, environmental stimuli, high fever. (electoencephalogram-EKG can be, but over 4th person may have an abnormal one, so this is not a definitive test) |
|
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Term
| What is an Absonce (Petit-Mal) seizure? |
|
Definition
| there is a staring, but there is no falling down. Think absence. |
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Term
| What is an atonic seizure? |
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Definition
| it is a falling down. Person actually falls w/ a seizure. |
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Term
| The stage before a seizure starts is called the "preictal" or preseizure stage. Try to document.. |
|
Definition
| timing, aura (if present), environmental stimulants |
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Term
| During the "ICTAL" or actual seizure phase, document: |
|
Definition
| time of onset, description of body movements, skin color, respiratory distress, incontinence, frothing secretions, automatisms (involuntary functioning in eye or whatever part), duration of seizure and medications. |
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Term
| What should be documented in the "Postictal" post seizure phase? |
|
Definition
| Level of awareness, motor ability, speech difficulty and the time frame to reorientation and stabilization |
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Term
| The goal of antiepileptic drugs is to |
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Definition
| raise the threshold of seizures above the neuronal excitability. |
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|
Term
| What is monotherapy? Why is it so helpful in seizure patients? |
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Definition
| Being on ONE antiepileptic drug to control seizures. Really helps b/c noncompliance is a big problem. |
|
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Term
| SEIZURE CONTROL is more important than the particular drug level of antiepileptic drugs in the body, yes! What should be monitored while on antiepileptic drugs? |
|
Definition
| serum drug level, blood count & liver function tests |
|
|
Term
| What is the problem with Dilantin? What needs to be advised while on it? |
|
Definition
| Causes gum hyperplasia. Need good oral hygiene, gum stimulation. Dental appointment every 3-6 months for checkup and cleaning of teeth. |
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Term
| When are antiepilepsy drugs even considered to be taken off of? |
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Definition
| Seizure free for 2 years (if not driving), normal EEG, seizure free for 3 years (if driving) & withdrawal MUST be slow over several weeks. |
|
|
Term
| What are the initial drugs given for status epilepticus? Second round? |
|
Definition
| lorazepam (Ativan) & diazepam (Valium). 2nd roung=fosphenytoin sodium (Cerebryx) |
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Term
| What should a nurse do when a tonic-clonic seizure occurs? |
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Definition
| Remain calm, briefly look at watch to time seizure, gently ease child to the floor, side-lying position is best so not to hyperextend neck, loosen tight clothing, do NOT restrain childs movements, do NOT force anything between teeth, observe/document seizure activity, report to physician |
|
|
Term
| How often are VS taken after seizure? Where is temp taken? |
|
Definition
| Every 15 minutes, axillary (armpit) temp |
|
|
Term
| What other nursing interventions are necessary for a child following a seizure? |
|
Definition
| monitor cardio & oxygen, suction & give oxygen when needed, IV line & anticonvulsants when needed, safe environment, urge onlookers to leave the scene, support the child/family/peers |
|
|
Term
| When should a parent call medical assistance for the seizure? |
|
Definition
| seizure lasting longer then 5 minutes, difficulty awakening, shows signs of injury, pupils are not equal after seizure, vomits continuously 30 minutes after seizure ended (possible acute problem), pregnancy or other medical id, a second seizure happens |
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|
Term
| Febrile seizures are generalized seizures that are associated with fever. They are frequently associated with... |
|
Definition
| an acute viral illness (kids has an upper respiratory tract infection or a GI infection at the time of seizure). |
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|
Term
| a Simple Febrile Seizure lasts less than ___ minutes and does NOT recur within a 24-hour period. |
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Definition
|
|
Term
| Febrile seizures usually occur at what age? |
|
Definition
| 3 months-5 years. Unusual after 5 years old. The peak incidence is at 23 months (almost 2 years old). |
|
|
Term
| How are febrile seizures managed in the ER? |
|
Definition
| reduce fever, (NO TEPID SPONGE BATH - shivering increases metabolic output), Lumbar puncture/sepsis workup, Parental reassurance is important (benign condition, no danger of dying, no brain damage!) Good news. |
|
|
Term
| Going to want to teach parents about seizure mgmt strategies. Are continuous anticonvulsant meds recommended in children? What if there is another seizure? |
|
Definition
| No, continuous antiepileptic drugs are NOT given for simple febrile seizures. Tell them to call 911 if seizure lasts longer then 5 minutes. |
|
|
Term
| ________ ______ is the MOST COMMON permanent physical disability in childhood. |
|
Definition
|
|
Term
| When does Cerebral Palsy occur? What is impaired? |
|
Definition
| CP has an early onset. CP impairs control of movement and posture. |
|
|
Term
| Why does Cerebral Palsy occur? |
|
Definition
| Brain insult or injury in the early periods of brain development. |
|
|
Term
| When does the brain injury that causes Cerebral Palsy occur? |
|
Definition
| from the prenatal period to 2 years of age. It is most common before the onset of labor. Happens usually in the womb. |
|
|
Term
| Cerebral Palsy is the most common reason for neonatal (newborn) _______________ caused by unknown prenatal factors. |
|
Definition
|
|
Term
| What are the 4 types of cerebral palsy? |
|
Definition
| Spastic, Dyskinetic/Athetoid, Ataxic, Mixed |
|
|
Term
| _________ Cerebral Palsy has hypertonicity. There is poor control over posture, balance and coordinated motion. There is persistent primitive reflexes, EXAGGERATED deep tendon reflexes and later contractures. Have body stiffness & are very RIGID. and Babinski present (keep those primitive reflexes) |
|
Definition
|
|
Term
| What is Cerebral Palsy "spastic hemiplegia?" |
|
Definition
|
|
Term
| _____________ Cerebral Palsy is characterized by Athetosis (slow writhing movements in the extremities, trunk, neck, facial muscles, tongue). There are abnormal involuntary movements. CHOREOID: involuntary irregular, jerky random movements. DYSTONIC: disordered muscle tone. |
|
Definition
|
|
Term
| ___________ cerebral palsy pt's have an unstable gait, but are able to walk & often toe walk. have rapid, repetitive movements that are performed poorly. They have uncontrolled arm movements when the child reaches for an object. |
|
Definition
|
|
Term
| early warning signs of CP include: |
|
Definition
| poor head control after 3 months, inability to sit by 8 months, no smiling by age 3 months, stiff or rigid arms or legs, floppy or limp body posture, use of only one side of the body, or only the arms to crawl, persistent primitive reflexes, excessive irritability, feeding difficulties (persistent tongue thrusts, frequent gagging or choking w/ feeding, after 6 mo's of age, tongue pushing soft food out of the mouth. |
|
|
Term
| Some associated problems that occur with CP are: |
|
Definition
| learning disabilities & mental retardation (not in ALL cases tho), visual deficits, heading deficits, communication deficits, seizures, feeding & eating problems (tongue), bowel & bladder problems. |
|
|
Term
| Major goals of therapy for cerebral palsy are: |
|
Definition
| early recognition of the disorder. Promotion of an optimum developmental course. Enable affected children to attain their potential within the limits of their dysfunction. 40-50% have a normal IQ. KEEP THEM UPRIGHT AS MUCH AS POSSIBLE. |
|
|
Term
| how can we enhance the nutritional intake of a child with cerebral palsy? |
|
Definition
| position child semi-upright, provide a HIGH CALORIE diet, supplement diet with vitamins, minerals, protein. Manual jaw control (move their jaw with your hand while feeding). Gastrostomy may be needed. |
|
|
Term
| What happens with cerebral palsy patients dental health? |
|
Definition
| needs METICULOUS ORAL HYGIENE! Must visit the dentist every 6 months. Close monitoring if child is on med like phenytoin (Dilantin) |
|
|
Term
| What are some antispasmodics that cerebral palsy patients might be on? |
|
Definition
| Dantrolene, Baclofen, Diazepam (Valium), Botulinum Toxin Type A (original use for Botox was to help with muscle spasticity in cerebral palsy patients) |
|
|
Term
| Baclofen Infusion Pump may be used? what for? |
|
Definition
| it's an antispasmodic & muscle relaxant, sometimes infused in CP pt's abdomens |
|
|
Term
| Cerebral Palsy pt's need to have their growth & development promoted. What can be done for them that helps? |
|
Definition
| ** Encourage early intervention programs ** Give them consistent discipline like a normal child, encourage their INDEPENDENCE& self-care based on the child's capabilities, encourage socialization as well. |
|
|
Term
| Why are exercises done for CP patients? What kind of incentives to move are done? Want to promote developmental skills. Encourage the used of aids to facilitate locomotion (walking). |
|
Definition
| exercise is to prevent contractures. Incentives to move like toy out of reach. |
|
|
Term
| What measures are done to promote a safe environment for cerebral palsy patients at home? |
|
Definition
| pad sharp edges of furniture, side rails on bed, avoid throw rugs/polished floors, protective helmet, safe toys, safety restraints, seizure precautions. |
|
|
Term
| How should a cerebral palsy pt be spoken to? |
|
Definition
| talk slowly & deliberately, use pictures to reinforce speech, encourage early speech therapy, encourage use of augmentative devices as ordered. |
|
|
Term
| The prognosis for Cerebral Palsy patients depends on type & severity. Death is usually due to a ______________ illness. |
|
Definition
| respiratory (e.g. aspiration pneumonia) |
|
|
Term
| If you are in a patients room when they have a seizure (instead of elevator) what might you have to use, that you didn't? |
|
Definition
| SUCTION to assure airway is clear |
|
|
Term
| What are causes of mental retardation (MR)? |
|
Definition
| can be intrauterine infections & intoxification, trauma (pre, peri or postnatal - any lack of oxygen), metabolic & nutritional disorders, prematurity, LBW, postmaturity, unknown prenatal influences, gestational disorders, chromosomal abnormalities, psychiatric with onset in child's developmental period (most well known is autism) |
|
|
Term
| some ways to prevent mental retardation: |
|
Definition
| rubella immunization, get genetic counseling to prevent something that runs in the family, take folic acid supplements during pregnancy, avoid alcohol during pregnancy, educate about lead exposure, prenatal care and childhood nutrition. |
|
|
Term
| early behavioral signs of mental retardation are: |
|
Definition
| irritable or not being responsive to contact, decreased alertness to voice, poor/slow feeding, poor eye contact during feeding, language delay, gross motor delay, check for presence of syndromes at birth that are known for mental retardation |
|
|
Term
| Routine developmental screenings are helpful for the diagnosis of mental retardation. Standardized tests may be given & are helpful. Some children are not identified way until they demonstrate poor performance in school! Mental retardation is diagnosed when the child has delayed progress in achieving _____________ ____________. |
|
Definition
| developmental milestones. |
|
|
Term
| MILD mental retardation is in 85% of cases. They have an IQ from 50-75. They are educable and able to work and contribute to society. Their mental age is... |
|
Definition
|
|
Term
| Moderation mental retardation is trainable. Their IQ is 35-55. They are able to achieve some degree of independence in self-care & simple academic skills. Their mental age is __-__ years. |
|
Definition
|
|
Term
| Severe mental retardation is classified as having an IQ of __-__. Their mental age is 3-6. Can learn simple skills but needs continuous support for life. |
|
Definition
|
|
Term
| Profound Mental Retardation is an IQ below ___-___. Mental age is below 3 yrs old. Has severe limitations in self-care, communication and mobility. Needs constant supervision. |
|
Definition
|
|
Term
| A diagnosis of mental retardation requires a subaverage intellectual function. The IQ is ___ or below. Onset has to be before 18 years of age. AND have functional impairments in at least 2 areas (communication, home living, community use of resources, work, health & safety, functional academics, leisure, self-direction, self-care, social skills) |
|
Definition
|
|
Term
| Promoting optimum development of person with MR includes developing ares & setting boundaries. explain... |
|
Definition
| Develop communication (verbal & nonverbal skills), socialization is important (teach them socially acceptable behaviors too, maintain a proper appearance, expose to strangers & peers), discipline needs to start early (so they know when doing something bad or wrong). They need practice & reinforcement of skills d/t poor short-term memory, use step-by-step) |
|
|
Term
| How is sexuality dealt with for MR? |
|
Definition
| Adolescence is a difficult time, they have the same hormones & want to get to know the opposite sex. We used to do hysterectomy & vasectomy, this is NOT done anymore. There are contraception issues. |
|
|
Term
| Do children with MR have the same play & exercise needs? |
|
Definition
| Yes, they NEED to play and may need help to play. Have the same needs as other children. Assistance to initiate the play activity. They have a prolonged need for sensorimotor play (stimulate touch, sight - prolonged need & may go on...) |
|
|
Term
| patients with MR need optimum development of self-help skills. What can nurses do to help & who is their primary caretaker? |
|
Definition
| parents are the primary caregivers & need support. They're going to be the teachers to the children. Give parents info on commercially available devices that aid in achievement of independence. |
|
|
Term
| When a child with MR is in the hospital, does anyone stay? What should a nurses communication be like? |
|
Definition
| Yes, the parents are encouraged to stay with the child during hospitalization. Assessment really helps learn the child's functional abilities, needs and routines. Use simple, short, concrete explanations. |
|
|
Term
| Down Syndrome is caused by a __________ abnormality. |
|
Definition
| chromosome (Trisomy 21). Normally there is a pair of chromosomes, 2 for each set. With downs, there is 3 chromosomes on #21. In trisomy 21, the presence of an extra set of genes leads to OVEREXPRESSION of the involved genes, leading to increased production of certain products. |
|
|
Term
| Does down syndrome happen in caucasians or african americans more? |
|
Definition
|
|
Term
| What causes down syndrome? |
|
Definition
| the cause is NOT KNOWN. In 95% of cases the chromosome pairs fail to separate during meiosis resulting in 47 chromosomes or three chromosomes on the 21st pair. There is a relationship to maternal age & paternal age. Maternal age=at 40 yo the incidence of downs is 1 in 110. At 45 yo it is 1 in 30. |
|
|
Term
| Down syndrome can be caused by heredity rather than parents age too. Some caused by "__________" in which part of an extra 21st chromosome is attached to another chromosome. Another cause is "mosaicism" where some cells have 46 chromosomes & some have 47 chromosomes. this is higher functioning downs. (normal is 22 pairs, 44 total) |
|
Definition
|
|
Term
| What are the clinical manifestations of Downs Syndrome? What is the head shape, tongue like, ears, toes and hands? |
|
Definition
| Round head, Tongue is thick, Ear may be folded, Space between the big toe, Hand has big crease |
|
|
Term
| What does the head of a down syndrome child look like? |
|
Definition
| has a separated sagittal suture, flat occipt, small rounded skull, large anterior fontanel, sparse hair |
|
|
Term
| What do the eyes look like in a child with downs syndrome? |
|
Definition
| upward, outward slant, epicanthal folds, Brushfield's spots (skeckles on iris in eye) |
|
|
Term
| What does the mouth & nose look like in Down Syndrome children? |
|
Definition
| short palate, protruding tongue, open mouth, small nose, depressed nasal bridge |
|
|
Term
| what do the ears look like in down syndrome kids? |
|
Definition
| small ears, overlapping upper helixes |
|
|
Term
| What do the necks look like in down syndrome kids? |
|
Definition
|
|
Term
| What is the musculoskeletal system like in down syndrome kids? |
|
Definition
| short stature, hypotonic, muscle weakness, hyperflexibility, shortened rib cage |
|
|
Term
| What are the hands & feet like in down syndrome kids? |
|
Definition
|
|
Term
| broad short hands, transverse palmar crease, wide space between big & second toe, broad short stubby feet |
|
Definition
|
|
Term
| What are the abdomen & genitalia like in down syndrome kids? |
|
Definition
| protrusion of abd, flabby muscles, umbilical hernia, small penis, cryptochidism (undistended testicles) |
|
|
Term
| What is intelligence normally like in down syndrome children? |
|
Definition
| Severe retardation to low average intelligence (average is about 50) |
|
|
Term
| What is the social development of down syndrome children usually like? |
|
Definition
| 2-3 years beyond their mental age during early childhood. They are happy & not irritable. Socially, down syndrome children are very normal in early childhood. |
|
|
Term
| what is the growth & weight like in down syndrome children? |
|
Definition
| growth in height is reduced. They are overweight by 36 months. |
|
|
Term
| A very common congenital anomaly in Down Syndrome children is... |
|
Definition
| 40-50% have congenital heart disease (CHD) especially septal defects. |
|
|
Term
| Other deficits that happen in Down Syndrome children are: |
|
Definition
| Renal agenesis, duodenal atresia, Hirschsprung Disease (difficulty in bowel motility), TE fistula, skeletal defects, atlantoaxial instability (concern is 1st & 2nd vertebra if not noticed by age 2 when active can compress spinal cord. |
|
|
Term
| What are some problems that occur with down syndrome childrens eyes & ears? |
|
Definition
| strabismus, nystagmus, astigmatism, hyperopia, myopia, excessive tearing, cataracts, hearing loss, otitis media, narrow ear canals. |
|
|
Term
| Other problems for Down Syndrome children are altered immune functioning, increased incidence of leukemia, thyroid dysfunction. What about sexual development? |
|
Definition
| development sexually is delayed or incomplete. Most men are sterile, postpubertal females can be fertile & a small number have children. MOST problems with downs are fixable. We've seen an increase in life expectance & many live until they're 55 even. |
|
|
Term
| Management of Down Syndrome is done by... |
|
Definition
| evaluating sight & hearing, test thyroid function regularly, surg to correct what can, special growth charts, assess for atlantoaxial instability, consider GH therapy for short stature |
|
|
Term
| What helps with down syndrome babies? what are they at risk for? |
|
Definition
| swaddle infants to help with their hypo tonicity & hyper extensibility of joints. High risk for respiratory infections and constipation b/c of decreased muscle tone. |
|
|
Term
| B/c of down syndrome childrens big tongue they may have problems eating. Later in life it is important to monitor eating habits, height & weight... why? |
|
Definition
| obesity is common in downs syndrome |
|
|
Term
| What does the skin of down syndrome child become as they get older? |
|
Definition
|
|
Term
| Down Syndrome is the MOST common cause of mental retardation. What is the second most common? |
|
Definition
|
|
Term
| what sex is affected by fragile x syndrome? how? |
|
Definition
| Happens to both sexes but affects them differently. Males are affected more severely than females. Most males are mentally deficient & it only affects 30% of females. Both can be carriers of the condition. |
|
|
Term
| Fragile X syndrome is caused by an abnormal gene, where? What chromosome is it? |
|
Definition
| on the lower end of the long arm of the X chromosome. Gene looks broken or pinched off & that's why it's called the fragile site. The gene is responsible for producing the protein needed for brain and neuro development and function. |
|
|
Term
| What do children who have fragile x syndrome look like? |
|
Definition
| large head circumference, long face with prominent jaw, large prominent ears, high arched palate, large testes, mitral valve prolapse, hypotonia and hyperextensible finger joints, flat feet, palmar creases |
|
|
Term
| Fragile X Syndrome kids have developmental delays. They have speech & language problems. Mild to severe retardation. short attention spans. Hypersensitivity to... what? |
|
Definition
|
|
Term
| Fragile X syndrome kids may ROCK, HAVE SOCIAL ANXIETY, AVERT THEIR GAZE, TALK TO THEMSELVES. How do they react to changes in routine? What can their behavior be like? |
|
Definition
| Inability to tolerate changes in routine. May have Aggressive behavior. |
|
|
Term
| When a child with Fragile X syndrome is young, is the best support for their diagnosis through physical features or behavioral observation? |
|
Definition
| Behavioral observations may best support diagnosis when young. Because the physical features are less obvious before puberty |
|
|
Term
|
Definition
|
|
Term
| What medications may Fragile X syndrome children be on? |
|
Definition
| Prozac or Tegretol to control behavior outbursts. CNS stimulants to improve attention span and decrease hyperactivity. speech & language therapies; special education assistance. address musculoskeletal issues, MITRAL VALVE PROLAPSE, otitis media and seizures are common in Fragile X. |
|
|
Term
| What would a nurse recommend to a family with fragile X? |
|
Definition
| GENETIC COUNSELING b/c it's a hereditary condition. Refer to the National Fragile X Foundation. |
|
|
Term
| Why do hearing impairments happen? |
|
Definition
| anatomic malformation, low birth weight, ototoxic drugs, chronic ear infections, anoxia (low oxygen) pre or post delivery, congenital infections, bacterial meningitis, environmental noise, head trauma, childhood infectious diseases |
|
|
Term
| What is the cause of CONDUCTIVE hearing loss? how common is it? |
|
Definition
| Interference with sound transmission to the middle ear. it is the MOST COMMON reason for hearing loss in childhood. |
|
|
Term
| most common reason for conductive hearing loss to middle ear is... |
|
Definition
| Otitis Media with Effusion (OME). Could just be a foreign body or wax in the ear canal. |
|
|
Term
| SENSORINEURAL hearing loss is caused by... |
|
Definition
| damage to the inner ear structures or the auditory nerve itself. also called perceptive or nerve deafness. not relaying info on. Sound is distorted & have problems with sounds. |
|
|
Term
| Causes of Sensorineural hearing loss are.. |
|
Definition
| congenital deficits, ototoxic drugs, infections, or exposure to excessive noise. |
|
|
Term
| Why does mixed conductive-sensorineural hearing loss occur? |
|
Definition
| interference with transmission of sound in the middle ear and along the neural pathways. Cause is recurrent otitis media and its complications. |
|
|
Term
| Why does "central" hearing loss occur? |
|
Definition
| usually involves actual brain damage which results in the inability to process information. Aphasia (can't speak) and agnosia (can't recognize objects) occurs along with too. |
|
|
Term
| An infant with hearing loss may act like.. |
|
Definition
| no startle or blink reflex to loud noises, sleep through loud noises, absence of babble or voice inflections by 7 months (speech is highly dependent on hearing. can't hear? won't speak), indifference to sound, failure to localize a sound by 6 months, lack of response to spoken word or failure to follow verbal directions. |
|
|
Term
| How do children act that have hearing impairments? |
|
Definition
| use gestures instead of words after 15 months, fail to develop intelligible speech by 24 months, monotone speech quality, head banging & foot stomping b/c hear vibrations not sounds), yelling or screaming to express pleasure, annoyance or need, ask to repeat statements & answer incorrectly, avoid social situations & are shy & withdrawn. |
|
|
Term
| if a chid has a foreign body or wax in ear, do you get it out? |
|
Definition
|
|
Term
| hearing aids work best with ______________ hearing loss. |
|
Definition
| conductive (does not help sensorineural hearing loss) |
|
|
Term
| What does a cochlear implant do? what hearing loss does it work best for? |
|
Definition
| bypasses damage and directly stimulates undamaged nerve fibers to transmit signals to brain. best for SENSORINEURAL HEARING LOSS. |
|
|
Term
| If a child lip reads, how should you help communicate? |
|
Definition
| attract the child's attention, face child directly, stand close and do not walk around, use facial expressions, speak clearly and at an even rate. |
|
|
Term
| A child that uses hand signals to augment lip reading is using ________ speech. (feeling your face while talking to understand) |
|
Definition
|
|
Term
| In what ways can communication be facilitated in a hospitalized hearing impaired child? where should the parents be? |
|
Definition
| use tactile & visual aids constantly reassess child's understanding, be sure child can see you before doing any procedures, be sure hearing aid is working properly. Ideally, parents should be in room with child. |
|
|
Term
| Can impaired hearing kids socialize with hearing kids in the hospital? |
|
Definition
| Yes, nurses should encourage it. |
|
|
Term
| How can hearing loss be prevented? |
|
Definition
| avoid exposure to environmental noise pollution, counseling of pregnant women concerning the need for prenatal care, genetic counseling as needed, avoid ototoxic drugs, treat otitis media and prevent recurrences. |
|
|
Term
| Otitis Media is one of the most common diseases of early childhood. What age has highest incidence of Otitis media? |
|
Definition
|
|
Term
| How is otitis media spread? |
|
Definition
| exposure to other children (daycares, large families), etc... are risk factors. Children exposed to second hand smoke are at risk. |
|
|
Term
| _______ _________ is an inflammation of the middle ear without reference to etiology or pathogenesis. |
|
Definition
|
|
Term
| what is inflammation of the middle ear with rapid onset of fever and pain? |
|
Definition
|
|
Term
| What is fluid in the middle ear without symptoms of acute infection? May occur as an extension of acute otitis media... develops into this. |
|
Definition
| otitis media with effusion (OME). the inflammation develops into fluid. |
|
|
Term
| Is otitis media contagious? |
|
Definition
| No, but the respiratory infection bugs can spread cause infection & may cause the ear infection |
|
|
Term
| what is acute otitis media often caused by? |
|
Definition
| Viruses: streptococcus pneumoniae, H. influenzae, and moraxella catarrhalis. |
|
|
Term
| What is otitis media often caused by? |
|
Definition
| RSV and influenza and by blocked Eustachian tubes from the edema of URI's, allergic rhinitis or large adenoids. |
|
|
Term
| Why is bottle feeding more of a risk factor for otitis media than breast feeding? |
|
Definition
| bottle fed causes more reflux into middle ear when laying flat. Plus the immunoglobulins in breast milk help prevent infection. |
|
|
Term
| Otitis media can cause perforation & scaring of the eardrum. Can cause _____________ hearing loss. Mastoiditis (inflammation of mastoid bone). Meningitis (infection in brain). |
|
Definition
|
|
Term
| Signs of ACUTE otitis media are... |
|
Definition
| pain, irritability, crying, pulling, rubbing, high temp is common, enlarged lymph nodes, signs of respiratory infection, vomiting & diarrhea, loss of appetite, discomfort with sucking and chewing |
|
|
Term
| Diagnosis of ACUTE otitis media sees... |
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Definition
| tympanic membrane is BRIGHT RED or YELLOW & BULGING, Cannot see landmarks and the membrane is immobile. Purulent discolored effusion may be present. |
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Term
| How does a baby with otitis media with effusion act? |
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Definition
| severe pain, FEVER is usually ABSENT, sense of FULLNESS in ear, POPPING SENSATION when swallowing, feelings of motion in ear, decreased hearing, exudate accumulates and pressure increases with a potential for rupture, rupture results in the presence of purulent drainage in the external canal. |
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Term
| How do you know a rupture has likely happened with OME? |
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Definition
| presence of purulent drainage in the external canal. |
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Term
| What does the ear look like in otitis media with effusion? |
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Definition
| immobile and/or orange-discolored membrane, may see a visible fluid level or behind drum if air is present above fluid or air bubbles, drainage |
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Term
| How is acute otitis media managed? |
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Definition
| Older children=wait & watch approach. Children under 2, this is not used. Given AMOXICILLIN (80-90 mg/kg/day) as antibiotic for 10-14 days, treat fever & pain with heat/cold, Tylenol or Ibuprofen (NO aspirin). Benzocaine drops can be used for local pain. |
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Term
| Do steroids, decongestants and antihistamines help acute otitis media? |
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Definition
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Term
| a Myringotomy may be necessary to alleviate severe pain and to prevent rupture of membrane in acute otitis media. What is this? |
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Definition
| tiny incision in eardrum to relieve excessive fluid in acute otitis media |
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Term
| What should be tested 3 months after an episode of acute otitis media? |
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Definition
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Term
| With recurrent episodes of acute otitis media, __ _____ may be inserted. Also, an adenoidectomy may be necessary |
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Definition
| PE Tubes (pressure equalizing) |
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Term
| When are antibiotics indicated with OME? |
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Definition
| antibiotics are not required at first, but may be indicated for effusions lasting longer than 3 months. May be long term. |
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Term
| Placement of __________ tubes may be recommended for recurrent episodes of otitis media with effusion or after 4-6 months of bilateral effusion and hearing deficit. Adenoidectomy may be necessary if enlarged. Hearing must be monitored over time. |
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Definition
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Term
| How is drainage cared for with an ear infection? |
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Definition
| cleanse EXTERNAL canal with STERILE cotton swabs or pedgets. If ear wicks are used, place them loose enough to allow drainage to flow out of ear. |
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Term
| What parent education is necessary regarding antibiotics for AOM? |
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Definition
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Term
| Parents should be taught to feed their infants in what position to prevent ear infections (otitis media)? |
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Definition
| upright position rather than supine/flat on their back. Avoid "propping the bottle." |
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Term
| If a child has trauma d/t a stick , knife, firecracker, gun, sling shot, paint ball gun - it is referred to as _________________ wounds. |
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Definition
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Term
| If a child has an eye trauma due to a baseball, bat, laceration, foreign body, blow from a fist, thermal, and chemical burn it is considered ______________ wound. |
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Definition
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Term
| How should a penetrating eye injury be treated? |
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Definition
| take to ER! remove in surgery by an opthalmologist. be aware of any development of hyphema (blood in eye) |
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Term
| How should a nonpenetrating eye injury be dealt with? What if it's a chemical? |
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Definition
| Most nonpenetrating: apply ice for 24 hours and rest. However if Chemical: irrigate eye immediately and with copious amounts of water for 20 minutes. |
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Term
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Definition
| hemorrhage in anterior of eye. If present see an ophthalmologist. |
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Term
| What is done for a foreign body? |
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Definition
| examine the eye for presence of object. Evert upper lid to examine. If freely moveable use corner of a moistened gauze pad to remove. Do NOT IRRIGATE or rub the eye with a foreign body. |
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Term
| ___________ is the most common eye infection. how is it treated? |
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Definition
| conjunctivitis. has bacterial & viral causes. Treatment is with topical antibiotics (for Bacterial). Severe infections may require systemic antibiotics. Keep the eye clean & remove secretions. |
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Term
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Definition
| Lazy Eye, it is reduced visual acuity in one eye & it is progressive |
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Term
| Why can Amblyopia (Lazy Eye) result in blindness? |
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Definition
| misalignment of eyes so that one focuses better than the other. Diplopia (double vision) occurs. One eye becomes stronger and the brain suppresses the image of the weaker eye. If the condition continues the brain will accomodate by permanently suppressing the weaker eye image. Vision in the weaker eye will be lost. |
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Term
| What causes amblyopia (lazy eye)? |
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Definition
| ptosis (droopy eyelids), refractive errors not resolved, strabismus untreated (Cross eyes), congenital cataracts |
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Term
| How is Amblyopia ("lazy eye") treated? |
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Definition
| correct misalignment or obstruction with surgery, medication or corrective lenses, patching of good eye to force the weaker eye to work. |
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Term
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Definition
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Term
| Estropia is an ___________ deviation of eyes. While Extropia is an ___________ deviation. |
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Definition
| estropia=inward, extropia=outward |
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Term
| Strabismus usually involves an _____________ in the extraocular muscles. May be caused by a congenital defect, paralysis, or poor vision. Brain is receiving 2 images. |
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Definition
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Term
| what are the signs of strabismus clinically? |
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Definition
| cross or wall eyes, squinting, tilting head (b/c of double vision), close one eye to see, difficulty focusing from near to far, headaches, dizziness, decreased acuity in vision. |
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Term
| How is strabismus treated? |
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Definition
| glasses may be worn to correct refractive errors, patching may be used, eye exercises may be used in conjunction w/ surgery, meds may be used to weaken muscles to make accomodation easier, surgery to shorten or lengthen muscles. |
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Term
| What should be done for a child with visual impairments in the hospital? |
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Definition
| arrange room with safety in mind, keep furniture and articles in same place, id self when enter the room, talk to children about everything you are doing, encourage self-care as much as possible, provide appropriate play activities, encourage parents to room-in and stay with child. |
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Term
| A child who has visual problems since birth may have challenges with... |
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Definition
| bonding, motor development, language, play/social skills, education |
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Term
| A deaf & blind child who has the combined sensory deficits will have a profound effect on the child's ________________. |
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Definition
| development. Their milestones will be significantly delayed. |
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Term
| Deaf blind children learn to communicate with special training. they will use hand spelling. Also the Tadoma method: use of hand over the speakers mouth to monitor facial movements (hand on face while talking). Methods used are similar to a blind child, but really need to encourage ___________ experiences. |
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Definition
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Term
| A deaf-Blind child will use consistent tactile and vibratory cues for sensory stimulation. How do they ambulate & get around? |
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Definition
| provide safe & secure experiences while learning and then help them to learn environment on a gradual and planned basis. Use a sighted guide, trailing by touching objects such as a wall, use of a cane, planned mobility program based on child's age & needs, and functional status. |
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Term
| What are the prospects like for deaf-blind children? What does a nurse help the family deal with? |
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Definition
| future is unpredictable, but the best prognosis is if it is acquired deaf blindness and it is not since birth. Also, helps if they have few other disabilities. These children may require lifelong parental or residential care. Nurse needs to help families deal with future goals and plans for the care of these children. |
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Term
| Autism is a brain dysfunction that has both behavioral & ______________ defects. It has a huge range of severity. |
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Definition
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Term
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Definition
| unknown. there are genetic links (one child with autism gives a high chance of having another). |
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Term
| When does autism occur? Does it affect males or females more? |
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Definition
| symptoms show early, in 18-36 months... 1.5-3 years old can tell autism. It is 4 times as common in MALES than females. |
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Term
| To diagnose a child as autistic, what is the criteria? |
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Definition
| must have social interaction impairments, communication impairments, behavior is restricted and repetitive. There are delays or abnormal function with onset before 3 years of age. |
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Term
| How will a child with autism act? |
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Definition
| inability to maintain eye contact, limited functional play: interacts with toys in an unusual manner, majority have some degree of mental retardation, speech and language delays, autism is a severely disabling disease, most will require lifelong supervision, some show improvement with the language & communication skills. start treatment early with autism! If they have the ability to communicate, have a better lifelong prognosis. |
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Term
| __________ children do not like routine changes, do not maintain eye contact, they are dependent and use hand clapping. |
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Definition
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Term
| what are the treatment objectives for an autistic child? |
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Definition
| promote positive reinforcement, increase social awareness of others, teach verbal communication skills, decrease unacceptable behavior. |
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Term
| When hospitalized, the parents should be with their autistic child as much as possible. What other nursing care helps the autistic child? |
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Definition
| avoid extra auditory and visual distractions, bring familiar objects from home, nurses should take extra care when administering meds, treatments & feedings with autistic children. Nurses should very minimally hold and have eye contact with autistic children. |
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Term
| A chronic condition is one that lasts longer than ___ months. can be disfigurement, can be dependency on meds, special treatments necessary, etc... |
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Definition
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Term
| Today, there is much more children with chronic illness & disability then 7 years ago even. true or false? |
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Definition
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Term
| _____ is the most common chronic childhood disease. |
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Definition
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Term
| What does the term "medically fragile" mean? |
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Definition
| being dependent on a medical device for survival or prevention of further disability. |
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Term
| How does chronic illness effect an infant? |
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Definition
| interferes with TRUST and interferes with parental attachment, there are less opportunities for these children to learn through positive sensorimotor opportunities, there are adverse effects on the neuropsychological development (due to exposure to noise, lights, pain, etc..) |
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Term
| How do chronic conditions interfere with toddlers? |
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Definition
| interferes with AUTONOMY. child may be restricted in movement, play, behavior and social interactions. This may involve increased parental control and limit the setting. This may interfere wit meeting normal milestones at this age. |
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Term
| Chronic disease in toddlers biggest problem is for their _____________. what should nurses promote doing for toddlers? |
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Definition
| mobility. Nurses should offer toddlers choices, tell parents not to do everything for the child and give them time, it will encourage their development. |
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Term
| A normal preschooler develops initiative and purpose, can recognize association between body, parts, and ability to function. Preschoolers have "magical thinking." what is that? |
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Definition
| believe their thoughts/behaviors can cause illness and disabilities and these things may occur b/cof punishment for some misdeed or thoughts on their part. They will feel really guilty & you need to encourage that it's not their fault, they're not being punished & it's not b/c of anything they did or thought. |
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Term
| Chronic illness will effect a preschooler by potentially... |
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Definition
| interfering with learning & environment, socializing with peers, decreases ability to develop self confidence, decreases self esteem, may interfere with optimal motor development, body image and sexual identity. (usually id with same sex parent and may not with disease) Help these pre-schoolers PLAY <--very imp |
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Term
| school age children are developing a sense of ____________ & ____________. |
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Definition
| accomplishment & industry. The normal child gains social skills, peer interactions, masters new info, learns to cope with stress and acquires self-sufficient skills in the development of this task. |
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Term
| How does chronic illness interfere with the development of a school age child? |
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Definition
| frequent absences from school, limited opportunities to achieve & compete with peers, can cause feelings of inferiority and low self-concept. |
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Term
| Since school age children have a better understanding of their condition, they are more capable of... |
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Definition
| participating in their own care. (can self monitor some.... for ex diabetes) |
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Term
| School age child with chronic disease is more aware of differences between themselves and their peers. School age children with chronic disease may have further ____________ difficulties and limitations. |
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Definition
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Term
| Adolescence is really a rough time for a chronic illness. How will chronic disease interfere with them? |
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Definition
| they'll be more dependent instead of independent for their age, decrease in future goals or planning aspirations, may w/draw from social activities and relationships, less independent, they often have rebellious and risk taking behaviors. they need EDUCATION to know how to care for themselves, what they can & can't do. |
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Term
| What are the goals of family centered care? |
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Definition
| today families assume the major burden of providing care and coordinating complex care for the member of the family who needs it. the GOAL of family centered care is to minimize the manifestation of illness and to MAXIMIZE THE CHILD's POTENTIAL. The PARENTS become the experts in providing care for their child. |
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Term
| The "normalization" of child with a chronic disease is... |
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Definition
| family view of the child is a "normal" part of their life & is part of the routine. The child's schedule & needs are part of the normal routine. Focus is on the normal aspects of the child and family life. |
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Term
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Definition
| process of integrating children with special needs into regular classrooms and child care centers. |
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Term
| What does the IFSP (individual family services plan) do? |
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Definition
| school & family get together and plan the child's development. |
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Term
| When the family is told about their childs diagnosis, what should be done? |
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Definition
| assure area of privacy & allow time for questions, give them time to absorb, use simple, direct language and do not use medical jargon, assure someone to answer their Q's that arise promptly, end it on a positive note and emphasize the child's strengths and potential for development as well as treatment or rehab. Assure parents of nurse available to answer questions and give assistance. |
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Term
| The initial stage in the grief process is shock, disbelief, denial and anger. It may last days to months. The _________________ phase gradually follows the shock phase. what characterizes this phase? |
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Definition
| adjustment phase - starts when there is an OPEN ADMISSION the condition exists. |
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Term
| During the adjustment period, what are the 4 parental reactions that really affect the child's eventual response to his chronic condition? |
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Definition
| 1. overprotection 2. rejection: they detach themselves emotionally. may give basic care, but won't get attached. 3. denial: act like it doesn't exist. 4. gradual acceptance: will eventually come. they will incorporate them & their disability with realistic goals. |
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Term
| ______________ is the the adjustment process ends when the family develops realistic expectations & reintegrates the illness w/ family life. |
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Definition
| reintegration. "social reintegration" is when family activities & relationships go outside home & include child as a member. |
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Term
| The final stage of the grief process is the __________________ phase. where the family looks at what remains, instead of what's lost. The family is motivated to learn about the child's illness and how they function. |
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Definition
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Term
|
Definition
| Grief process, adjustment period (overprotect, reject, deny, gradually accept), reintegration and acknowledgement |
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Term
| Chronic Sorrow is an emotion that is shown through the span of the parent-child interaction. feelings surface and mourn loss at times throughout the year. This is a coping mechanism. What events may trigger emergence of this? |
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Definition
| birthdays, anniversaries. |
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Term
| Should siblings be informed about their siblings course of illness? Should they visit in the hospital? |
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Definition
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Term
| If the parents are absent from home it may instigate behavior adjustment with younger siblings. what feelings might happen in the sibling? |
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Definition
| jealousy, anger, guilt and resentment are not uncommon. They may fear they caused the illness, fear they may develop the illness, they'll resent their parent giving the ill child indulgences, they'll resent inconsistent discipline given to ill sibling. |
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Term
| How can siblings be helped? |
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Definition
| encourage child to "play" out concerns, prepare child in advance for treatment changes, include sibling in as many decisions as possible, allow family members & peers to be part of treatment regimen, id areas child can be in control to decrease feelings of helplessness, apply same family rules to the chronically ill child (discipline as appropriate), encourage a positive attitude and self image. |
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Term
| What are the 2 long-term coping strategies that help families through chronic illness? |
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Definition
| 1. give illness meaning with existing scientific or spiritual philosophy of life 2. share illnesses burden with people inside & outside the family network. Get help from family & friends. |
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Term
| Establishing support systems is very imp when a child is chronically ill. Definitely refer them to Community resources. Explain Parent-to-Parent and Parent-Professional Partnerships? |
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Definition
| parent to parent=support from other parents in the same situation is very unique. parent-professional partnerships=HC needs to show respect and support for families. PARENTS are the experts on their child. Partnerships are based on trust and built with communication. |
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Term
| What is the goal of caring for a child & family dealing with a chronic illness? |
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Definition
| Goal is optimal family functioning, as defined by the FAMILY, not the health care team. |
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