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PEDS FINAL

QuestionAnswer
why are kids susceptible to head injury? large head size in comparison to body, gravity, incomplete myelination/greater plasticity, smaller subarachnoid space, softer/gelatinous brain, flexible skull
layers protecting brain scalp, galea, subgaleal space, periosteum, skull, dura, arachnoid, pia, brain
epidural hematoma collection of ARTERIAL blood between skull and dura. Arterial bleed causes brain compression, loss of O2 and increased ICP
epidural hematoma- manifestations periods of lucidity intermixed with unconsciousness
how do kids get epidural hemorrhage? (what type of injury causes it?) skull fractures- laceration of middle meningeal artery
subdural hemorrhage bleeding between the dura and arachnoid membranes, VENOUS, slower onset, steady decline in LOC
signs and symptoms of subdural hematoma irritability, vomiting, increased head circumference, bulging anterior fontanel, lethargy, coma, seizure, headache
intracerebral hemorrhage bleeding of arteries that feed brain
diffuse axonal injury damage to white matter tracts due to shearing of axons
cerebral edema inflammatory response to an infection, trauma, ischemia, tumors. Fluid collects between and within neurons, and causes displacement of blood vessels and brain tissue (causes increased ICP)
increased intracranial pressure increased pressure in cranium that is direct result of cerebral edema or space occupying lesion. Can lead to brain herniation syndrome
clinical manifestations of increased ICP in infants irritability, poor feeding, high pitched cry, difficult to soothe, bulging/tense fontanels, separated cranial sutures, setting sun sign of eyes, distended scalp veins
early signs of increased ICP headache, N/V, altered LOC, restlessness, lethargy, confusion
late signs of increased ICP Cushing's triad (indicates herniation), characteristic posturing, unresponsive to painful stimuli, dilated/nonreactive pupils
Cushing's Triad 1) Decreased RR (respiratory depression) 2) Decreased HR (bradycardia) 3) Widening pulse pressure (HTN)
Decorticate Posturing position of flexion- arms tight to body, flexed elbows/wrists/fingers, legs extended and internally rotated --> indicates dysfunction of cerebral cortex or lesions of corticospinal tracts above brainstem
Decerebrate Posturing extension, pronation, flexed wrists/fingers, clenched jaw, extended neck, arched back --> dysfunction of midbrain or brainstem, poorer prognosis
nursing implications for increased ICP vital signs to look for cushings triad, arterial line to measure CVP, foley, ICP monitoring, IV access, HOB 15-30 degrees, mannitol
mannitol osmotic diuretic to decrease fluid volume, pulls water from CNS into intravascular space
side effects for mannitol hypotension and dehydration
meningitis acute inflammation of meninges
signs/symptoms of meningitis abrupt onset of fever, chills, nuchal rigidity, opisthotnos (bak arched, neck forward), photophobia, HA, drowsiness, stupor, petechiae, purpuric rash
meningococcemia (waterhouse friderichsen syndrome) major complication of meningococcal meningitis--> causes septic shock, DIC, purpura, mortality 90%
nursing implications of meningitis isolation precautions (droplet), LP prep, IV insertion, antibiotic, comfort measures
Reye Syndrome linked to post viral illness in conjunction with aspirin treatment, most commonly flu or varicella. Causes cerebral edema, fatty liver, fever, vomiting, altered LOC, increased ICP
myelodysplasia malformation of the spinal canal and cord
spina bifida midline defect involving failure of the osseous (bony) spine to close
spina bifida occulta defect that is not visible externally (sometimes hair tuft, dimple, lipoma, nevi)
spina bifida cystica visible defect with external saclike protrusion
meningocele sac encases meninges and spinal fluid, but no neural elements
myelomeningocele sac contaisn meninges, spinal fluid, spinal cord, and nerves. Most commonly occurs in lumbar or lumbosacral area
when/why does myelomeningocele develop? develops during first 28 days of pregnancy due to neural tube defect (folic acid deficiency)
manifestations of myelomenigocele sensory impairment, flaccid/partial paralysis (varies), foot weakness and deformity, bowel and bladder sphincter disturbance, hydrocephalus
nursing implications of myelomenigocle care of sac preop (sterile moist dressing), prone position, hydrocephalus management, bowel and bladder management, latex allergy, parent support and education
hydrocephalus imbalance between CSF production and resoprtion, results in enlarged head, distended scalp veins, full fontanel, sunsetting sign, thin scalp
treatment for hydrocephalus VP shunt (ventriculoperitoneal shunt)
complications of VP shunt malfunction (obstruction) and infection
signs/symptoms of VP shunt complication fever, vomiting, acting funny--> get a CT
seizure paraoxysmal electrical discharge from neurons in brain
aura warning signal prior to seizure
postictal period after seizure characterized by deep sleepiness, muscle aches, dreamy state, amnesia, nausea, or confusion
automatisms lip smacking, picking at clothes, swallowing, sucking
febrile seizures occur at 6 months- 5 years, self limiting, control fevers
partial seizures one hemisphere is activated, may eventually generalize to both hemispheres
simple partial seizure simple symptoms with no loss of consciousness
complex partial seizure complex symptoms with loss of consciousness
simple-complex generalized seizure evolve into tonic clonic due to spread to both hemispheres
generalized seizures without focal specificity, bilateral hemisphere involvement
tonic clonic (grand mal) preceded by aura, loss of consciousness and fall to ground, tonic followed by clonic muscle contractions, may have incontinence, 2-5 minutes long
absence seizures (petit mal) sudden loss of consciousness with staring eye fluttering, occurs frequently throughout the day, no aura, incontinence or fall, automatisms may be present
status epilepticus seizure lasting >30 minutes, no recovery of consciousness, emergency (cant breath) = cerebral hypoxia. Need oxygen, IV access, suction, ativan and fosphenytoin, cardiac monitor, vital signs
strain stretch or tear of muscle/tendon
sprain stretch or tear of ligament
grade 1 sprain stretching nd tearing, no joint instability
grade 2 sprain partial tear, some joint instability, limited ROM
grade 3 sprain complete ligamentous tear, joint unstable, cannot bear weight
reasons to xray sprain/strain pain near malleoli AND bone tenderness posterior edge of distal 6 cm or tip of malleolus OR unable to bear weight for 4 steps
treatment for strains and sprains Protection, rest, ice, compression, elevation
complete fracture all the way through
incomplete fracture fragments remain attached
transverse fracture crosswise, at right angle to the long axis of bone
oblique fracture slanting but straight, between a horizontal and perpendicular direction
spiral fracture slanting and circular, twisting around bone shaft
simple (closed) fracture does not produce a break in the skin
compound (open) fracture open wound through which bone protrudes (cover areas of exposed bone, control bleeding, consider contaminated, abx prophylactically)
greenstick fracture bone is angulated beyond limits of bending, compressed side bends and tension side fails, which causes incomplete fracture
buckle fracture compression of porous bone producing a buckle or torus fracture (occurs at metaphysis)
diaphyseal central shaft of long bone
metaphyseal widened end of long bone
epiphyseal growth plate
salter harris fractures involve growth plate at different levels, 5 types--> same, above, lower, through, ruined
acute fracture care pain management (muscle spasms), immbolization, splinting, assess circulatory status
conscious sedation drugs ketamine and atropine
cast care dont get wet or put anything in it, elevation, circulatory status, pain management, follow up care
purposes of traction decrease spasms, realignment, prevent contractures and deformities, immobilization, rest
3 fractures that need traction supracondylar humeral, femoral shaft, subtrochanteric
buck's traction applied with legs in extended position, short term mobilization for legg calve perthes and hip dislocation. Relieves back and leg spasms,
Russell's traction skin traction on lower leg and a padded sling under knee, 2 lines of pull (one longitudinal,one perpendicular to leg), pulls contracted muscles, allows realignment of lower extremities, immbolizes hip and knee in flexed position, no turning/hip flexion
halo traction head fixed in hyperextended position, nurse must prevent infection/skin breakdown --> pin care
complications of traction skin breakdown, nerve compression, vascular compromise, damage from pins
compartment syndrome high pressure within muscle compartment of extremity due to tight cast, dressings, trauma, surgery, burns. Can cause permanent damage within 4-6 hours, becomes necrotic in 24-48 hours. Causes burning, tinging, numbness, and pain. Treatment is fasciotomy
osteomyelitis bacterial colonization on bone, usually staph aureus. Causes bone destruction, abscess sequestrations, joint involvement.
manifestations of osteomyelitis pain, fever, irritability, possible inflammation
legg calve perthes (idopathic osteonecrosis) avascular necrosis of femoral head epiphyses, sudden onset of painful limp, limited ROM
developmental dysplasia of the hip- signs positive ortolani, barlow, galeazzi (asymmetric leg length), uneven gluteal folds, limping (late sign)
treatments for DDH newborn-6 months= Pavlik harness infants 6 mo-18 mo= short leg hip spica cast children: unsuccessful
Club Foot forefoot adduction, foot plantar flexion, curve of forefoot, inflexible
treatment of clubfoot early- manipulation and casting ; 6-9 months surgical intervention
Metatarsus adductus in-toeing- forefoot adducted only, full ROM; treated with forefoot stretching exercises
metatarsus varus in-toeing- forefoot adducted and inverted, limited ROM; treated with serial casting/bracing until 3 yrs
cerebral palsy group of disabilities caused by brain insult in utero or early infancy, not always accompanied by mental impairment
physical s/s cerebral palsy poor head control after 3 months, stiff or rigid extremtiies, flaccidity, arching back, cant sit unsupported by 8 months, unilateral movements
QOL interventions for cerebral palsy physical therapy, occupational therapy, speech/language therapy, special ed, surgery, meds
scoliosis spinal deformity typically involving lateral curvature of the spine, spinal rotation, thoracic hypokyphosis
clinical manifestations of scoliosis spinal curve, asymmetric scapula and extremities, inequality between arms and waist
treatment for scoliosis curves 25-40 degrees 4-6 year program, wear Milwaukee brace for 23 hours of day,
anatomy of pediatric airway that increases risk for obstruction, infection, and aspiration nose breathers, smaller airways/inc resistance/in RR, right bronchus shorter and wider than left, trachea shorter and narrower, large tongue and head, weak neck muscles, short eustachian tubes, thin chest wall, elastic ribs, lungs developed by age 5-6
wheezes air passes through narrow airway, continuous, inspiratory or expiratory --> asthma, foreign body
rhonchi air passes through secretions, clears with cough, continuous, inspiratory or expiratory --> bronchitis
rales/crackles air passes through fluid filled airways, persists with cough, intermittent, inspiratory --> pneumonia, heart failure
acute streptococcal pharyngitis group A B-hemolytic streptococci infection, causes fever, headache, abdominal pain, cervical lymphadenopathy, exudate, strawberry tongue, rash
serious complications of acute strep pharyngitis acute rheumatic fever, acute glomerulonephritis
treatment of acute strep pharyngitis penicillin (oral, 10 days) or IM (better compliance), fluids, antipyretics, gargles, neck compresses
infectious mononucleosis infection spread by oral transmission of epstein barr virus; causes malaise, fatigue, fever, sore throat, headache, lymphadenopathy, splenomegaly, skin rash
nursing care fo mono antipyretics, analgesics, rest/fluids, gargle warm salt water, no sports 1 month (splenic rupture risk)
influenza spread by direct contact with nasopharyngeal secretions, causes dry cough, hoarseness, sudden onset of fever/chills, body aches, joint pain, loss of appetite, nausea, vomiting, photophobia
croup syndromes occur in late fall/early winter, ages 6 mo-3 yr, characteristic hoarse barking cough, inspiratory stridor, respiratory distress
acte epiglottis inflammation of the epiglottis and supraglottic region with H influenza, occurs at age 2-6 yo
symptoms of acute epiglottis abrupt onset, severe sore throat, pain with swallowing, drooling, muffled voice, high fever, inspiratory stridor, mild hypoxia, respiratory distress, barking cough; sit upright with chin out and mouth open
management of acute epiglottis emergency!- monitor airway, prep for possible trach or intubation, DO NOT use tongue depressor, IV fluids, abx, racemic epinephrine, corticosteroids
prevention of acute epiglottis Hib vaccine
pertussis whooping cough, highly contagious; cough with or without whoop, apnea in infants
treatment of pertussis antibiotics, support therapy (tylenol, motrin, albuterol, oxygen), prevent with dtap/tdap
pneumonia infection of the lung parenchyma
s/s of pneumonia tachypnea, fever, malaise, cough, rhonchi, crackles, retractions, nasal flaring, irritability, restlessness, lethargy, vomiting, diarrhea, referred abdominal pain
possible complications of pneumonia pneumothorax, pleural effusion, respiratory distress syndrome
treatment of pneumonia rest, increased PO fluids, antipyretics, antibiotics, bronchodilators, oxygen, CPT/postural drainage
asthma chronic inflammatory condition of the airways (inflammation, bronchospasm, bronchoconstriction)
symptoms of asthma dyspnea, wheezing, coughing (non-productive), worse at night
management of asthma oral meds, nebulizers (MDI with spacer, bronchodilators ICS)
prevention of asthma attacks avoiding triggers/allergens, medication compliance, regular visits to PCP
Peak expiratory flow meter measured in am/pm, used as reference to personal best, can help guide treatments/interventions
Asthma action plan green zone (80-100)= in control yellow zone (50-79)= add quick relief red zone (<50%)= seek help
cystic fibrosis mechanical obstruction form increased viscosity of exocrine (mucous producing) gland secretions--> autosomal recessive disease
general symptoms of cystic fibrosis increased viscosity of mucous gland secretion, elevation of sweat electrolytes, increased metabolic enzymes, abnormalities of autonomic nervous system
lung/respiratory s/s of CF thick, sticky mucus buildup, bacterial infections frequently. Frequent sinusitis
skin s/s of CF sweat gland production of salty sweat
liver/pancreas s/s of CF blocked ducts
GI symptoms of CF intestines cannot fully absorb nutrients, growth failure from malabsorption and anorexia, large bulky amounts of foul smelling stool
treatment of pulmonary symptoms of CF prevent and minimize pulmonary complications, bronchodilators, mucolytics, daily CPT, vest, supplemental oxygen, antibiotics for infections
treatment of GI symptoms of CF replacement of pancreatic/digestive enzymes (30 min before meals), adequate nutrition for growth (increased protein, calories, carbs), may need Ng or G tube for feeds, fat soluble vitamins and salt supplementation, prevent GERD/constipation
congenital heart disease a defect that occurs during the development of the heart or blood vessels near the heart before birth
cardiac catheterization catheter inserted through artery or vein in leg or neck, can be diagnostic of interventional
post catheterization care monitor pulses and extremity perfusion, monitor insertion site and dressing, vitals q 15, flat in bed, affected leg straight for 4-6 hours
possible complications of cardiac catheterization bleeding/hematoma, loss of puls ein affected extremity, arrythmias
acyanotic congenital heart diseases (left to right shunt) patent ductus arteriosus (increased pulmonary blood flow), coarctation of the aorta (obstruction of flow)
congenital heart disease than causes increased pulmonary blood flow patent ductus arteriosis
patent ductus arteriosis communication between the pulmonary artery and aorta, normally closes 1-3 days after birth, but remains patent
PDA patho blood shunts from high pressured aorta to lower pressured pulmonary artery (L->R shunt). Blood recirculated to lungs, returned to left atrium. Increases workload on left heart, pulmonary congestion/resistance, potentially increased RV pressure/hypertrophy
clinical manifestations of PDA may be asymptomatic or show symptoms of heart failure, tachypnea, poor feeding, murmur
indomethacin prostaglandin inhibitor can close PDA in newborns and infants, otherwise needs surgical ligation or coil
CHD that causes obstruction of blood flow coarctation of the aorta
coarctation of the aorta narrowing of aorta near insertion of ductus arteriosus
coarctation of the aorta patho increased pressure proximal to the defect (upper extremities) and decreased pressure distal to it (lower extremities). The left heart must work harder.
clinical manifestations of coarctation of the aorta high blood pressure and bounding pulses in upper extremities, weak/absent femoral pulses and cool lower extremities with lower blood pressure
surgical treatment of coarctation of aorta resection of coarcted part with end to end anastamosis OR balloon dilitation/stent placement/grafts
cyanotic congenital heart defects (right to left shunt) tetralogy of fallot (decreased pulmonary blood flow), hypoplastic left heart syndrome (mixed blood)
CHD that causes decreased pulmonary blood flow tetralogy of fallot
tetralogy of fallot 4 defects: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septum defect
pathophysiology of tetralogy of fallot pulmonary stenosis causes RV hypertrophy and blood flow to overriding aorta (deoxygenated blood goes to organs), the worse pulmonary stenosis is, the more right to left shunting and the less blood that gets oxygenated
manifestations of tetralogy of fallot cyanosis, tachypnea, murmur, tet spells (sudden decrease in oxygen saturation)
knee-chest position cuts off lower extremity circulation to increase pressure in left ventricle (increases afterload) --> causes blood to shunt left to right and go to lungs and causes oxygenated blood to go to aorta
treatment for tetralogy of fallot surgery- complete repair (close VSd, fix pulmonic valve)
CHD that causes mixed blood flow hypoplastic left heart syndrome
hypoplastic left heart syndrome underdevelopment of the left side of the heart, resulting in a hypoplastic left ventricle and aortic atresia
patho of HLHS oxygenated blood from left atrium flows across patent foramen ovale to right atrium, to the right ventricle and out pulmonary artery. Descending aorta receives blood from patent ductus arteriosis supplying systemic blood flow
symptoms of HLHS cyanosis, heart failure, when PDA closes -> CV collapse and death if not treated
treatment of HLHS norwood, glenn and fontan
norwood procedure at birth- anastamosis of main pulmonary artery to aorta to create new aorta and a shunt to provide pulmonary blood flow
glenn shunt 4-8 months; superor vena cava attached to right pulmonary artery
fontan procedure 3-4 yrs old; inferior vena cava to right pulmonary artery (vena cava will bypass the right atrium and go straight to the lungs through the pulmonary artery. Blood will come back to left atrium, shunt through large atrial septum and out aorta)
heart failure inability of the heart to pump enough blood to meet metabolic demands of the body/organs
right sided heart failure inability of right heart to pump venous blood into the pulmonary circulation; results in back up of fluid in body = edema
s/s right heart failure weight gain, ascites, edema, hepatomegaly
left sided heart failure inability of left heart to pump into the systemic circulation, results in back up of fluid to lungs = pulmonary congestion
s/s left heart failure tachypnea, retractions, cough, dyspnea
medical management of heart failure digoxin, ACE inhibitors, diuretics, reduce stress/activity, supplemental oxygen
digoxin decreases heart rate, improves contractility, can cause toxicity
digoxin toxicity (level >2.0) bradycardia, prolonged PR interval, N/V, blurred vision
potassium levels and digoxin low k+ enhances effects of digoxin and causes toxicity (keep K+ 3.5-5.0)
ACE inhibitor decreases blood pressure, decreased afterload
diuretics decrease pulmonary congestion, decreases preload
1st degree burn superficial; pain, redness
2nd degree burn partial thickness (epidermis and varying layers of dermis); painful, moist, red, blistered
3rd degree burn full thickness (epidermis and dermis, subQ tissues); nerve endings, sweat glands, hair follicles destroyed
4th degree burn full thickness and underlying tissues (muscle, fascia, bone)
emergency care priorities of burns stop burning process, assess victims condition, cover burn to prevent contamination, transport child to appropriate level of care
first priority interventions when burn patient arrives AIRWAY!!, fluid replacement, antibiotics, analgesics, anesthetics
care of major burns primary excision, debridement, topical antibiotic agents, biologic skin coverings/grafts
care of minor burns wound dressing, debridement, dressing
rehab after major burns begins once wound coverage has been achieved, must prevent contractures to facilitate ROM, PT/OT
atopic dermatitis in infant (eczema) inflammatory skin condition, red pruritic patches on face, postive family history of asthma and allergies, increased incidence in asians (occurs up to 3 yo)
atopic dermatitis in child 4-10 years old; dry, pruritic wrists, ankles, antecubital, popliteal areas, keratosis pilaris. Hx asthma and allergic rhinitis
treatment/rx for atopic dermatitis avoid/reduce irritants, topical steroids (rotopic/elidel)
contact dermatitis inflammatory reaction of skin to chemical, characteristic sharp delineation between inflamed and normal skin
diaper demratitis friction, exposure to urine/feces, contact allergen, caregiver neglect
candida diaper dermatitis bright, beefy red, confluent satellite lesions, thrush; treated with nystatin cream TID
stevens johnson syndrome hypersensitivity reaction, usually to a drug (NSAIDs, sulfa, anticonvulsants).sudden onset pleomorphic rash, petechiae, vesicles, bullae (MM), increased temp, HA, malaise, arthralgias, conjunctivitis, cough, pericarditis, <10% epidermal sloughing
impetigo honey colored crusted patches or bullae, staph aureus with or without group A strep, 2-7 yo.
tx impetigo mupirocin for localized diseae, cephalexin, augmentin, dicloxacillin for widespread lesions
scabies lesions for 4-6 weeks after contact with the mite sarcoptes scabie, mite burrows under skin and lays eggs--> severe pruritus
tx for scabies 5% permethrn cream (elmite) x 12 hrs +/- 2nd rx in 1-2 weeks, invermectin for deworming
scabies lesions in infants palms, soles, head, moves head to toes
scabies lesions in older chldren finger webs, wrists, axillae, waist, nipples, genitals
tinea corporis ringworm; scaly, annular border, transmission from infected person or pets; tx with antifungal creme
Created by: alexadianna