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PEDS FINAL
| Question | Answer |
|---|---|
| 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
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