Term
| What are the two kinds of meningitis? |
|
Definition
| Viral (asceptic) and bacterial (septic) |
|
|
Term
| What care is needed for Viral vs. Bacterial meningitis> |
|
Definition
| Viral only requires support care. Bacterial is contagious, treatment based on stage. |
|
|
Term
| What are some of the viral causes for Meningitis? |
|
Definition
Cytomagalo, adeno, mumps, herpes, and arbo virus.
CAMHA |
|
|
Term
| What are the bacterial agents that cause Meningitis? |
|
Definition
Meningococcal, Pneumococcal, Influenza type B, E. Coli.
IMPE |
|
|
Term
| What is a late sign of meningitis in infants and toddlers? |
|
Definition
|
|
Term
| What is considered an initial sign of Meningitis from toddler to adulthood? |
|
Definition
|
|
Term
| What are the reliable factors for diagnosis in children age 2 and up? |
|
Definition
| Brudzinski's sign and kernig's sign, along with petechia or purpura. |
|
|
Term
| What is Brudzinski's sign? |
|
Definition
| If you flex the childs neck, their lower extremities flex. |
|
|
Term
|
Definition
| You can't fully extend the knee 90 degrees in a child who is supine |
|
|
Term
| What lab tests identify meningitis? |
|
Definition
Viral: CSF that is cloudy with elevated WBC and protein, positive gram, lower glucose.
Bacterial: Cloudy CSF, slightly elevated WBC, negative gram stain. |
|
|
Term
| What are nursing considerations for assisting a lumbar puncture to test CSF? |
|
Definition
Have he child urinate
Apply EMLA 45 minutes to 1 hour before
Place child in side-lying position, head flexed, knees up to chest.
Label the vials
Monitor for bleeting or infection |
|
|
Term
| How long after a lumbar puncture will a child need to remain still to prevent leakage? |
|
Definition
|
|
Term
| What does a nurse need to do if a child with meningitis present with petechia or a purpuric rash? |
|
Definition
| Place the client on isolation with droplet precautions. |
|
|
Term
| Which steroid do you use for Hib induced meningitis and what do you use it for? |
|
Definition
| Decadron. It can manage increased cranial pressure and reduce neurologic complications. |
|
|
Term
| Which analgesic is used to manage pain in meningitis? |
|
Definition
| Tylenol/Acetaminophen with codeine. |
|
|
Term
| What nursing consideration should be kept in mind before administering acetaminophen or ibuprofen? |
|
Definition
|
|
Term
| What systems does Reye syndrome usually affect? |
|
Definition
Liver and brain
Liver Dysfunction, Cerebral edema |
|
|
Term
| What medication and agent is Reye syndrome linked to? |
|
Definition
| Aspirin and Influenza season. |
|
|
Term
| What lab tests will identify Reye syndrome? |
|
Definition
Liver enzymes (ALT, AST, Ammonia all elevated)
Electrolytes: Altered do to edema and liver changes. |
|
|
Term
| What diagnostic procedures will identify Reye syndrome? |
|
Definition
Liver biopsy (clottingtime may be extended)
Lumbar puncture (rule out meningitis.) |
|
|
Term
| What should be monitored in a patient with Reye syndrome? |
|
Definition
| Bleeding times and possibilities for hemorrhage. |
|
|
Term
| What medications are offered to a patient with Reye? |
|
Definition
Mannitol (osmotic diuretic) to decrease cerebral swelling.
Vitamin K to improve clotting. (SubQ) |
|
|
Term
| What can you expect of a patient's recovery by discharge when they've recovered from Reye syndrome? |
|
Definition
| Liver function fully regained, may have some neurological deficits. |
|
|
Term
| What are 2 complications to a client with Reye syndrome? |
|
Definition
1) Neurologic Sequelae (Nero complications including speech, heargin and developmental delays)
2) Death |
|
|
Term
| What are the suspected viruses that are linked to Reye Syndrome? |
|
Definition
| Influenza, Gastroenteritis or varicella. |
|
|
Term
| What is a Tonic Clonic seizure? |
|
Definition
| No warning, loss of consciousness ~10-20 seconds ,loss of swallowing leading to violent jerking. After, confused for several hours, impaired in fine motor and possibly speech. |
|
|
Term
| What are absence seizures? |
|
Definition
| Occur between 4-12yo. Loss of consciousness 5-10 seconds, mimics daydreaming. |
|
|
Term
| What are the 3 phases of a tonic clonic stages refered to as? |
|
Definition
1) Tonic (initial)
2) Clonic (Shaking stage)
3) Postictal (recovery) |
|
|
Term
| What is a myoclonic seizure? |
|
Definition
| Variety of seizures either symmetric or not. No postictal state, may keep consciousness. |
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|
Term
| What is an atonic seizure? |
|
Definition
| Muscle tone lost with some confusion. Some falling. |
|
|
Term
| What are the two simple partial seizures? |
|
Definition
Aversive (eyes away from a focus, may keep consciousness)
Rolandig (tonic-clonic during sleep) |
|
|
Term
| What is a simple partial with sensory signs seizure? |
|
Definition
| Tingling or numbness that spreads to other parts. |
|
|
Term
| What are complex partial seizures? |
|
Definition
| Altered behaviour, inability to respond, impaired consciousness, confusion, auras. |
|
|
Term
| What diagnostic procedures are used to help identify what causes the seizures? |
|
Definition
MRI (malformations or tumors)
EEG (May identify the origin of activity)
Lumbar (infection)
CT (Hemorrhage, infarct) |
|
|
Term
| What 5 medications are frequently used for seizure control? |
|
Definition
Diazepam (Valium), Phenytoin (Dilantin), Carbamazepine (Tegretol), Valproic acid (Depakene), Fosphenytoin sodium (Cerebyx)
DPCVF or VDTDC |
|
|
Term
| What are the 4 surgical interventions for seizures? |
|
Definition
1) Tumor removal
2) Focal resectiong
3) Hemispherectomy (remove one hemisphere)
4) Corpus callosotomy (separate the 2 hemispheres) |
|
|
Term
| How does a vagal nerve stimulator help control seizures? |
|
Definition
| It can abort a surgery or lessen it. |
|
|
Term
| What is a status epilepticus seizure? |
|
Definition
| Lasts over 30 minutes with no postictal phase. |
|
|
Term
| What medications are used to try to stop a status epilepticus seizure? |
|
Definition
1) Valium or Ativan
2) Cerebyx if the first didn't work.
3) Phenobarbital if the other two treatments fail. |
|
|
Term
| What kind of drug therapies are used in nebulized aerosol therapy? |
|
Definition
| Bronchodilators, corticosteroids, mucolytics. |
|
|
Term
| How long does nebulized aerosol therapy last? |
|
Definition
|
|
Term
| How does the child inhale nebulized aerosol therapy? |
|
Definition
| Breathing throug the mouth, after medication is added to a container and attached to O2. |
|
|
Term
| What medications are used in Metered Dose Inhaler MDI or Dry Powder Inhaler DPI therapy? |
|
Definition
| Bronchodilators or Corticosteroids. |
|
|
Term
| How does a child use MDI treatments? |
|
Definition
| Shake 5-6 times, Inhaler with a spacer, held 2-4cm away from the mouth. |
|
|
Term
| How does a child use a Dry Powder Inhaler (DPI)? |
|
Definition
| Do not shake, exhale, place mouthpiece between lips and take a breath in with the medication. Rinse mouth and expectorate after use. |
|
|
Term
| What is a possible complication of chest physiotherapy? |
|
Definition
| Decreased O2 sat while drainage is taking place. |
|
|
Term
| At how many liters per minute should you humidify O2 being given? |
|
Definition
|
|
Term
| What is an early sign of hypoxemia? |
|
Definition
|
|
Term
| What is a clinical manifestation of oxygen toxicity? |
|
Definition
| Unconsciousness, increased PaCO2. |
|
|
Term
| Which tonsils are removed during a tonsillectomy? |
|
Definition
| Palatine on the sides of the oropharynx. |
|
|
Term
| What is the main thing you want to have parents look for when a child has a tonsillectomy? |
|
Definition
| Bleeding signs. Tachycardia, hemoptysis (coughing up blood). Possible hypotension |
|
|
Term
| What child age is most at risk for developing a respiratory illness? |
|
Definition
| Infants at 3-6 months of age with the loss of maternal antibodies. |
|
|
Term
| Why are children more at risk for respiratory illnesses? |
|
Definition
| Shorter airway, narrower than adults, more easily obstructus, shorter eustachain tubes so easier access in. |
|
|
Term
| What are the 4 Croup syndromes? |
|
Definition
| 4 different medical disorders. Bacterial epiglottits, acute laryngotracheobronchitis, Acute spasmodic laryngitis, Influenza A and B. |
|
|
Term
| Which Croup syndrome is a medical emergency? |
|
Definition
|
|
Term
| What causes Bacterial Epiglottitis? |
|
Definition
|
|
Term
| What are the signs and symptoms of bacterial epiglottitis? |
|
Definition
| Stridor, sore throat, high fever, dysphagia, dysphonia, chin pointed out, mouth open, tongue out. |
|
|
Term
| For respiratory disorders, what does a chest x-ray help identify? |
|
Definition
| Potential infiltration in pneumonia. |
|
|
Term
| What is the treatment if someone has bacterial epiglottitis? |
|
Definition
| Intubation, humidified oxygen, racemic epinephrine, steroids and IV fluids. |
|
|
Term
| What antibiotics are used to treat bacterial epiglottitis? |
|
Definition
| Cephalosporin or ceftriaxone sodium. |
|
|
Term
| What are complications from respiratory illnesses? |
|
Definition
Pneumothorax (air in the pleural space)
Pleural effusion (fluid in the pleural space) |
|
|
Term
| What are the medications used to treat asthma? |
|
Definition
Bronchodilators (-buterol and terbutaline)
Cholinergic antagonists (Atrovent) |
|
|
Term
| What do you need to observe for when giving a child an albuterol treatment? |
|
Definition
|
|
Term
| What do you need to observe for when giving a child an ipratropium treatment? |
|
Definition
|
|
Term
| Which anti-inflammatory agents are used to treat asthma? |
|
Definition
| Corticosteroids: Methylprednisolone and prednisone. |
|
|
Term
| What are the combination medications used to treat asthma? |
|
Definition
Fluticasone/salmeterol (Advair)
Inhaled corticosteroids |
|
|
Term
| When taking a corticosteroid, what should you encourage the child to do? |
|
Definition
1) Rinse mouth if using an inhaler
2) Eat food with an oral. |
|
|
Term
| What test can be used to confirm a diagnosis of cystic fibrosis? |
|
Definition
| Sweat Chloride. Greater than 60 for infants, greater than 40 for all others indicates cystic fibrosis. |
|
|
Term
|
Definition
| Too much CO2 in the blood. |
|
|
Term
| Which virus and transmission of the virus is the most common cause of diarrhea in children under age 5? |
|
Definition
| Rotovirus. Fecal/oral route |
|
|
Term
| What labs do you generally see for determining diarrhea? |
|
Definition
CBC with differentials (for anemia or infection)
Hct, HGB, BUN, Creatinine and specific gravity levels elevated.
Stool for occult blood
Urinalysis |
|
|
Term
| Which bacterial causes of diarrhea do you avoi using antibiotics and why? |
|
Definition
Botulinum, E coli, salmonella.
Destroying the bacteria can cause more of the toxic effects (Toxins released from Botulinum, e.coli more likely to cause hemolytic uremic syndrome, salmonella isn't shortened by using antibiotics.) |
|
|
Term
| What bacteria are not treated with antimotility agents? |
|
Definition
E. coli, Salmonella, Shigella.
May prolong the illness or cause more toxic effects. |
|
|
Term
| What medications do you use for C. Diff and G. Lamblia? |
|
Definition
|
|
Term
| What are the values for mild, moderate and severe dehydration? |
|
Definition
Mild: 3-5% loss of weight in infants. 3-4 in children.
Moderate: 6-9% weight loss in infants, 6-8 in children.
Severe: Greater than 10% weight loss in infants and children. |
|
|
Term
| What is Hirschsprung disease? |
|
Definition
| Aganglionic Megacolon (No ganglions = no nerves, giant colon, collapsed rectum) |
|
|
Term
| When identifying stools for suspected intussusception, what is an major identifying feature? |
|
Definition
| Red jelly like stool (mixed with blood and mucus) |
|
|
Term
|
Definition
When the small intestine enters the large intenstine, trapping blood vessels and lymph nodes.
Also: The most common childhood abdominal urgency in the ER. |
|
|
Term
| What is Meckel's Diverticulum frequently confused with? |
|
Definition
| Appendicitis. Both can present with stomach pain in approximately the same location. |
|
|
Term
| For Hirschsprung disease, what kind of diet and treatment is recommended? |
|
Definition
High protein, low fiber, high calorie diet
Treatment is surgery to try to give some exit for fecal material. |
|
|
Term
| Is Cerebral Palsy a progressive or nonprogressive neuromusculoskeletal disorder? |
|
Definition
| Nonprogressive impairment of motor function (muscle control, coordination and posture.) |
|
|
Term
| What primitive reflexe remains with a Cerebral Palsy child? |
|
Definition
|
|
Term
| What is spastic cerebral palsy? |
|
Definition
Hypertonic (spastic or tight muscles, ^ deep tendon reflexes), fine and gross motor skills impaired.
Affected limbs shorter/thinner.
Can affect one to all extremeties.
Gait with legs intoeing and on balls of feet. |
|
|
Term
| What is dyskinetic Cerebral Palsy? |
|
Definition
Nonspastic.
Athetoid (Jerking movements with trunk, neck, face and tongue. Slow/wormlike)
Dystonic (Slow twisting of trunk and extremeties) Abnormal posture. |
|
|
Term
| What is Ataxic Cerebral Palsy? |
|
Definition
| Wide gait with difficult coordination, issues with repetitive items, quick or precise movements. Shakiness. |
|
|
Term
| How do you diagnose Cerebral Palsy? |
|
Definition
| MRI (Look for strcures or abnormal areas near the bone) Sedation used as needed. |
|
|
Term
| What are considered possible causes of Cerebral Palsy? |
|
Definition
| Seizures, speech and communication problems as well as developmental delays due to possible poor nutrition or oxygenation in the womb. |
|
|
Term
| What medications are used to treat Cerebral Palsy? (LVBA) |
|
Definition
Lioresal - Muscle relaxent to decrease spasms. Orally or intrathecally.
Valium - Skeletal muscle relaxent (Not for infants and younger children)
Botox - REduces spasticity in specific muscle groups. Used in lower extremities.
Antiepileptics - Seizure control |
|
|
Term
|
Definition
| Failure of he osseous spine to close. Nerual tube defect present at birth. |
|
|
Term
| What are the two kinds of spinal bifida |
|
Definition
Spina Bifida Occulta - Lumboscral area, not visible.
Spina Bifida cysstica - Visual sac protrusion. Either meninocele (spinal fluid and meninges) or myleomeningocele (meninges, spinal fluid and nerves.) |
|
|
Term
| What are risk factors for spina bifida? |
|
Definition
| Low folic acid, malnutrition, obesity or diabetes. |
|
|
Term
| How can you visually identify spina bifida? |
|
Definition
Lumbosacral: Dimpling in the lumbosacral area
SpinaeL Protruding sac midline. |
|
|
Term
| How do you prepare an infant for surgery to close the mylelomeningocele sac? |
|
Definition
Put them in a warmer, no clothes
Keep the sac covered with a .9%NS sterile nonadhering dressing, changed Q2h.
Keep infant prone
Antibiotics |
|
|
Term
| What is a possible complication of spina bifida? |
|
Definition
Increased intracranial pressure, may need shunt surgery. Teach parents shunt malfunction & hydrocephalus signs.
Bladder & orthopedic issues. |
|
|
Term
| What is a comon complication in a child with Down Syndrome? |
|
Definition
| Respiratory infections due to poor muscle tone and poor drainage. |
|
|
Term
| Is Muscular Dystrophy a progressive musculoskeletal disorder? |
|
Definition
| It is, progressive degeneration of symmetric skeletal muscle groups. |
|
|
Term
| What can you expect with Duchenne muscular dystrophy? |
|
Definition
Most common, onset between 3 and 7 years old. Fatigue, lordosis, delayed motor skills. Mild cognitive issues related to learning difficulties.
Respiratory ad cardiac issues by age 20. |
|
|
Term
| What medications are used to help treat Duchenne muscular dystrophy? |
|
Definition
Corticosteroids to increase muscle strength.
Bronchodilators:Enhance expansion of lungs. |
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