Term
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Definition
| Tissue oxygenation influences kidney erythropoietin production. Erythropoeitin stimulates bone marrow production of RBCs. Reticulocyte counts are an indirect representation of erythropoiesis (Normal values 0.5-1.5%). |
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Term
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Definition
MCV: average size (volume) of a RBC
MCH: Average weight of hemoglobin per RBC
MCHC: Average concentration of hemoglobin in a RBC (normalizes at 6 months of age; average is 33 g/dL) |
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Term
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Definition
AKA Polymorphonuclear leukocytes ("PMNs")
Segs: Mature
Bands: Immature
Represent ability to fight bacterial infections |
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Term
| Origin and lifespan of WBC's |
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Definition
Granuloctyes (Basophils, Eosinophils, Neutrophils) come from bone marrow (myelogenous)
Agranulocytes (monocytes and lymphocytes) come from lymphoid tissue
WBC lifespan is difficult to assess because it covers 3 phases: Hematopoeitic, intravascular, and extravascular phases.
Monocytes can live the longest in tissues (60-90 day half life).
Granulocytes can't live in inflamed tissues as long as agranuloctyes |
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Term
| Which cells are good phagocytes? |
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Definition
Monocytes and neutrophils.
Neutrophils work on acute inflammation; monocytes are involved in chronic inflammation. This is because neutrophils like it neutral; once tissue necrosis from inflammation creates a certain level of acidity, neutrophils can't function like they used to and monocytes take over for the long-term/chronic. |
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Term
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Definition
Involved in:
Parasitic infections
Anaphylactic hypersensitivity
Activating fibrinolysin to dissolve clots |
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Term
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Definition
Called "mast cells" once they're in the tissues.
Functions: Release histamine, participate in healing phase of inflammation; participate in prolonged inflammation |
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Term
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Definition
Fragments of megakaryocytic; production is stimulated by thrombopoieitin
Old PLTs removed by liver and spleen
Swell, grow feet, and release vasoconstriction serotonin when they contact a damaged blood vessel (this is how everyday wear-and-tear gets healed) |
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Term
| What are general assessment findings of an anemic child? |
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Definition
Pale
Muscle weakness
PIca (Clay, dirt, ice, paste)
Decreased energy/easily fatigued
History of frequent infections
Food diary of poor iron foods |
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Term
| Anemia causes what CNS effects? |
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Definition
Headache
Irritability
Dizziness/light-headedness
Slowed thought processes
Decreased attention span
Apathy, depression
Growth retardation if chronic |
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Term
| As the heart tries to compensate for anemia by increasing cardiac output, what complications can develop? |
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Definition
Murmur
Heart failure with exercise, infection, or emotional stress |
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Term
| What is the difference between anemia of acute blood loss vs. anemia of chronic blood loss |
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Definition
Acute hemorrhage creates temporary anemia while RBCs are returning to normal.
Chronic blood loss depletes iron stores, leading to microcytic and hypochromic anemia. |
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Term
| When someone presents with fatigue, dizziness, headache, apathy, growth retardation, pallor, and any other signs suggesting anemia, what should you ask as the nurse? |
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Definition
Ask about typical diet--are they lactose intolerant? Adquate iron intake?
Do you notice chronic or recurrent infections?
Any cravings for nonnutritive substances?
Any obvious blood or black and tarry blood in stools?
Does anyone in your family have sickle cell disease or thalassemia? |
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Term
| Which reflex should be gone no later than 8 weeks old? |
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Definition
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Term
| Which reflexes should be gone no later than 4 months? |
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Definition
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Term
| Which reflexes should be gone no later than 6 months? |
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Definition
Tonic Neck/Fencing
Palmar grasp |
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Term
| Which reflex should be gone no later than 10 months? |
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Definition
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Term
| Absence of which reflexes can indicate a brainstem problem? |
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Definition
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Term
| What is the significance of an abnormal or absent plantar grasp? |
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Definition
| S1-S2 spinal nerve abnormality |
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Term
| Which reflexes should be gone by 2 years old? |
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Definition
Babinski
Landau (Lifts head and legs when prone)
Neck righting (Rotates trunk same direction as head turn) |
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Term
| What is the possible score range on the Glasgow Coma Scale, and what are the significant scores? |
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Definition
Score can range from 3-15
<7 = coma
<5 = little possibility of recovery |
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Term
| What is the significance of dilated and fixed, and pinpoint pupils? |
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Definition
Dilated and fixed = brain herniation, anoxia or seizures
Pinpoint = poisoning or brainstem dysfunction |
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Term
| How do arterial oxygen and CO2 affect cerebral blood flow? |
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Definition
Increased cerebral blood flow comes from arteriole dilation, which occurs with hypercapnea (CO2 > 40) and profound hypoxia (O2 < 50).
Decreased cerebral blood flow comes from constricted arterioles, which occur with hypocapnea (CO2 < 25-30) |
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Term
| How can the pediatric skull accommodate increased ICP? |
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Definition
| In children, open fontanels can compensate for the pressure by bulging, and skull sutures can widen or even reopen up until 5 years. However, you should always be able to feel a pulsation of the bulging fontanel; if you no longer feel pulsation, compensation is no longer occurring, and this is a medical emergency. |
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Term
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Definition
| ICP is regulated by the brainstem's control over arteriole diameter in response to [CO2]. Normally it is kept at 5-15 mmHg via a mean arterial pressure of 50-170mmHg. |
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Term
| Cerebral Perfusion Pressure calculation |
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Definition
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Term
| Definition of Increased ICP? |
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Definition
| Sustained pressure above 15 mmHg |
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Term
| What are the consequences of increased ICP on the brain? |
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Definition
Decreased blood flow (Increased CO2, decreased O2)
Decreased cerebral perfusion pressure (MAP-ICP)
Acidosis
Further vasodilation
Brainstem herniation (which could cause death) |
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Term
| What will you see in a child with BRAIN HERNIATION from increased ICP? |
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Definition
Flaccid paralysis
Fixed and dilated pupils
Death?
May develop hydrocephalus Arnold-Chiari malformation with tonsillar herniation? |
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Term
| The first signs of increased ICP that you may notice are behavioral/personality changes. What are they? |
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Definition
Irritable/restless
Lack of interest
Decline in school and physical performance
Fatigued, drowsy, spend more time sleeping
Vomiting without nausea, anorexia, weight loss
Unable to follow simple directions
Great increased pressure causes memory loss
Headache and slurred speech
Pupil and VS changes (Increased temp, decreased/irregular respirations)
Seizures
Abnormal posturing |
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Term
| 6 Areas of the Pediatric Neuro Exam |
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Definition
1. Mental status (A&O?)
2. Cranial nerves
3. Coordination
4. Motor function (muscle tone, movement, strength, size)
5. Sensory function (DTR)
6. Pupils |
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Term
| When would an unconscious child need a hypothermia blanket? |
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Definition
| For a temperature >104 (40 C) |
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Term
| Why would an unconscious child need to be on a ventilator? |
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Definition
| Often their respirations are slow and irregular, which will allow CO2 buildup. You need a ventilator to decrease CO2 so that arterioles will constrict and decrease cerebral blood flow/ICP. |
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Term
| What is Cushing's Response? |
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Definition
A late sign of increased ICP, which means the brainstem is at risk. The signs are:
Decreased HR (Bradycardia)
Decreased/Irregular RR
Increased SBP with unchanged DBP (Widened pulse pressure = greater MAP = greater CBF) |
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Term
| Which drugs can decrease cerebral edema? |
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Definition
Mannitol (Osmotic diuretic)
Antiepileptics: Phenobarbital, diazepam, phenytoin
Sedation |
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Term
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Definition
| A condition at birth where baby is born with too much cerebrospinal fluid, either from increased production, decreased reabsorption, or blockage of drainage from the ventricles. The extra fluid enlarges head circumference and fontanels and raises ICP. The child may need a ventricular-peritoneal shunt |
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