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Disease symptoms: hoarseness, barky cough, stridor, resp. distress; symptoms often occur at night croup
cause of croup? virus; majority of cases-parainfluenza
treatment: corticosteroids, bronchodilators (racemic epinephrine nebulizer), cool air humidification, take to ER if begins to drool and can't swallow croup
fast/abrupt onset; sore throat, fever, 4 Ds (drooling, dysphagia, dysphonia, distressed inspiratory airway), irritable/restless/anxious (may cause tachycardia and tachypnea), muffled voice epiglottitis
cause of epiglottitis? most often Hib; strep or staph bacteria
treatment: ATBs (if bacterial), IV fluids, emotional support to frightened patient and family, instruct on Hib vaccination epiglottitis
first rhinorrhea and sneezing, then increased cough and wheezing, tachypnea, retractions, nasal flaring, apnea, cyanosis bronchiolitis
How is bronchiolitis contracted? direct contact of resp. secretions
diagnosed by: low pulse ox, CXR, blood gases (carbon dioxide retention and hypoxemia), ELISA or IFA nasally bronchiolitis
treatment: less severe--antipyretics, hydration, observation; more severe-- cardio/resp monitoring, pulse ox, O2 with humidity; pulmonary hygiene (ie suctioning); rest bronchiolitis
autosomal recessive disorder cystic fibrosis
Cystic Fibrosis affects _______ glands, resulting in: exocrine; excessive mucous production, excessive chloride production by sweat glands
failure to thrive, meconium ileus, poor growth, bulky/greasy stools, frequent colds or bouts of pneumonia, clubbing Cystic Fibrosis
diagnosed by: positive sweat test (chloride), absence of pancreatic enzymes, newborn screening, DNA identification of mutant genes Cystic Fibrosis
nonpharm. treatments: promote removal of lung secretions, prevent and treat lung infections, manage pulmonary complications, postural drainage, cupping, chest physiotherapy Cystic Fibrosis
pharm. treatments: bronchodilators, inhaled recombinant human DNase (Pulmozyme), ATBs, pancreatic enzymes and Vitamins A, D, E, K (to promote adequate digestion and absorption of nutrients) Cystic Fibrosis
cardiac disorders that increase pulmonary blood flow ASD, VSD, PDA
heart murmur, few symptoms in children, SOB, poor growth ASD
surgical closure, closure with cardiac cath, patch repair, follow up with cardiologist ASD
a holosystolic harsh murmur is heard along left sternal border VSD
repair with a patch pulmonary artery banding VSD
harsh continuous machine-like murmur under left clavicle Patent Ductus Arteriosus (PDA)
treatments are: indomethacin, insertion of Coils to occlude during heart cath, thoracoscopic Patent Ductus Arteriosus (PDA)
4 defects of Tetralogy of Fallot "PROV" Pulmonary stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect
tet spells, squatting, clubbing, increased irritability, poor growth, systolic murmur Tetralogy of Fallot
Tetralogy of Fallot must have surgical repair by how old? Within first year of life
narrowing of aorta obstructs flow Coarctation of Aorta
increased B/P in upper extremities, decreased B/P in lower extremities, few symptoms, headache Coarctation of Aorta
cardiac cath, balloon dilation, stent placement Coarctation of Aorta
underdeveloped left side of heart, aorta, aortic valve, left ventricle, and mitral valve Hypoplastic Left Heart Syndrome
symptoms: ashen in color, difficulty breathing, symptoms appear when PDA closes Hypoplastic Left Heart Syndrome
prostaglandin E to keep PDA open until surgical repair; surgery in 3 stages shortly after birth Hypoplastic Left Heart Syndrome
Thickening occurs of the pyloric sphincter creating an obstruction pyloric stenosis
Sx: projectile vomiting, olive-shaped mass in upper right abdomen, failure to gain weight pyloric stenosis
Ultrasound reveals an elongated, sausage-shaped mass or elongated pyloric area pyloric stenosis
surgery for pyloric stenosis Pylorotomy by Laparoscope
A part of the intestine telescopes into another part, resulting in lymphatic and venous obstruction along with ischemia or increased mucus in the intestine Intussusception
currant jelly stools, sudden abdominal pain, drawing knees to chest-screaming, stools mixed with blood and mucus, vomiting, diarrhea, fever or dehydration Intussusception
hallmark sign is: palpate a sausage-shaped mass in the upper mid-abdomen Intussusception
Air or barium enema; sometimes this cures it--makes it telescope back out. Surgeon should be avail. at time of enema in case of emergency (unsuccessful enema or perforation) Intussusception
IV fluids, NG tube, assess stools, intake/output and prepare for procedures (Air enema with or without contrast by radiologist) or surgery Intussusception
A structural anomaly of the GI tract caused by a lack of ganglion cells in the segments of the colon resulting in decreased motility and mechanical obstruction Hirschsprung disease
diagnosed by rectal biopsy Hirschsprung disease
Sx in newborns and infants: abd distension, failure to thrive, newborn--failure to pass meconium in a few days after birth, refusal to eat, vomiting (newborn-vomiting bile), constipation or watery diarrhea Hirschsprung disease
Sx in older child: failure to thrive, abdominal distention, palpable fecal mass, constipation, visible peristalsis or foul-smelling ribbon-like stool. Hirschsprung disease
Surgery-removal of the aganglionic section of the bowel and place a temporary colostomy Hirschsprung disease
A complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development Meckel’s Diverticulum
abdominal pain or bloody, mucus stools or asymptomatic; diagnosed by Radionucleotide scan Meckel’s Diverticulum
Nursing care: Pre- and post-op care from surgical removal Meckel’s Diverticulum
An immune disorder in which gluten (found in grains) causes damage to the sm. intestine; villi of the sm. intestine are damaged d/t body’s response to digestion of gluten; malabsorption disorder occurs; actually affects 1% of population Celiac Disease (Celiac Sprue)
Sx: diarrhea, steatorrhea, failure to thrive, anemia nutritional deficiencies, distended abdomen, wasted buttock, thin extremities Celiac Disease (Celiac Sprue)
Diagnose- Biopsy of intestine – damaged villi Celiac Disease (Celiac Sprue)
Treatment for Celiac Disease (Celiac Sprue) gluten-free diet
meatus opening below the glans penis and may be a ventral curvature of the penis; treatment: surgery performed in the first year of life and male circumcision not performed Hypospadia
meatus opening above the glans penis; treatment: surgery performed in the first year of life and male circumcision not performed Epispadia
fluid in the scrotal sac; usually a benign and self-limiting disorder; usually noted early in infancy and often resolves spontaneously by 1 year of age Hydrocele
an enlarged scrotum that may decrease in size when male is lying down; inspect scrotum for a fluid-filled appearance Hydrocele
What is the most common movement disorder of childhood? cerebral palsy
Sx: motor impairments including spasticity, muscle weakness, and ataxia; complications: mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and possibly hydrocephalus cerebral palsy
Hypertonicity and permanent contractures; different types based on which limbs are affected: Hemiplegia: both extremities on one side, Quadriplegia: all four extremities, Diplegia or paraplegia: lower extremities Spastic Cerebral Palsy
most common form of CP; poor control of posture/balance/movement, exaggeration of deep tendon reflexes, hypertonicity of affected extremities, continuation of primitive reflexes, in some children---failure to progress to protective reflexes Spastic Cerebral Palsy
abnormal involuntary movements; infant is limp/flaccid; uncontrolled/slow/worm-like writhing or twisting movements; affects all 4 extremities and poss. face/neck/tongue; movements increase during periods of stress; dysarthria and drooling may be present Athetoid (or dyskinetic) Cerebral Palsy
affects balance and depth perception, rare form of disorder, poor coordination, unsteady gait, wide-based gait Ataxic Cerebral Palsy
combination of the other forms of disorder; most common is spastic and athetoid Mixed Cerebral Palsy
meds for Cerebral Palsy Baclofen (Lioresal) – can be given via implanted pump intrathecally; Diazepam (Valium) – used in older children; Botox-onset 1-3 days, peak 2 weeks, duration 3-6 months
most common neuromuscular disorder of childhood; is universally fatal (usually by age 20 to 25) Duchenne muscular dystrophy
Early childhood (usually 3–6 years); affects primarily males; generalized weakness, muscle wasting---limb and trunk first Duchenne muscular dystrophy
A hallmark finding of this disorder is the presence of the Gowers sign (child cannot rise from the floor in standard fashion because of increasing weakness) Duchenne muscular dystrophy
Promoting mobility (give corticosteroids and calcium; perform passive stretching and strengthening exercises); Maintain CP function (teach deep breathing exercises, perform chest physical therapy); Prevent complications and maximizing quality of life Duchenne muscular dystrophy
this form of muscular dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s) Duchenne muscular dystrophy
T or F? The nurse working in the ER knows that trauma or unintentional injury is a leading cause of childhood morbidity and mortality in the United States. True
abnormalities of the developing hip that include dislocation, subluxation, and dysplasia of the hip joint; femoral head has an abnormal relationship to the acetabulum developmental dysplasia of hip
Sx: leg may appear shorter on the side of the disorder; leg on affected side may turn outward; folds in the skin of the thigh or buttocks may appear uneven; space between the legs may look wider than normal developmental dysplasia of hip
treatments: nonsurgical positioning device or placement of a Pavlik harness; casting; closed reduction surgery developmental dysplasia of hip
lateral curvature of the spine that exceeds 10 degrees; may be congenital, associated with other disorders, or idiopathic scoliosis
symptoms: most are mild with few symptoms; some develop spine deformities that get more severe as they grow; severe form can be painful and disabling; may experience pain in back, leaning to one side, muscle spasms, physical deformity, or uneven waist scoliosis
treatment: depends on severity; often no treatment is necessary; sometimes back brace or surgery (bone grafting, spinal fusion) is needed; physical exercise; therapies--stretching scoliosis
HA, vomiting (possibly projectile), blurred vision/diplopia, dizziness, decreased HR/RR, increased B/P or pulse pressure, pupil reaction time decreased/unequal, sunset eyes, changes in LOC, irritability, seizure activity early signs of increased intracranial pressure
infant: bulging/tense fontanel, wide sutures and increased head circumference, dilated scalp veins, high-pitched cry early signs of increased intracranial pressure
lowered LOC, decreased motor and sensory responses, bradycardia, irregular respirations, Cheyne–Stokes respirations, decerebrate or decorticate posturing, fixed and dilated pupils late signs of increased intracranial pressure
positions for lumbar punctures newborn: positioned upright with head flexed forward; child or older infant: positioned on the side with head flexed forward and knees flexed to abdomen
The nurse is assisting with testing on a child suspected of having a neural tube defect. Which of the following diagnostic tests would be used to confirm this condition? a. ultrasound b. electroencephalogram c. fluoroscopy d. computed tomography d. computed tomography
shunt placement To treat hydrocephalus, a ventriculoperitoneal (VP) shunt catheter is placed in an enlarged ventricle. Shunt diverts flow of CSF within the CNS to the peritoneum, where CSF is now absorbed across the peritoneal membrane into the body's circulation.
S/Sx of shunt infection Elevated vital signs Poor feeding Vomiting Decreased responsiveness Seizure activity Signs of local inflammation along the shunt tract
occurs with damage of the cerebral cortex or spinal tract; extremely rigid muscle tone Decorticate posturing (flexor)
occurs with damage at the level of the midbrain/brain stem; extremely rigid muscle tone Decerebrate posturing (extensor)
An inflammation of the CSF and connective tissues that cover the brain and the spinal cord. Can be viral or bacterial Meningitis
Requires supportive care for recovery. Caused by viruses like: cytomegalovirus, adenovirus, mumps, herpes simplex virus, and arbovirus. viral (or aseptic) meningitis
Very contagious. Treatment needs initiated quickly. Caused by: Neisseria menigitidis, Streptococcus pneumonia, Haemophilus influenza type B (Hib), Escherichia coli bacterial (or septic) meningitis
Since the introduction of these two vaccines, bacterial meningitis has decreased with the exception of infants under age 2 months Hib and pneumonia vaccines
meds for meningitis bacterial-IV ATBs and corticosteroids (dexamethasone/Decadron); both-analgesics (acetaminophen/Tylenol)
poor muscle tone, weak cry, poor suck, refuses feeding, and vomiting or diarrhea; possible fever or hypothermia; neck is supple without nuchal rigidity (stiff neck); bulging fontanels are a late sign. signs of meningitis in newborns
seizures with a high-pitched cry, fever and irritability, bulging fontanels, possible nuchal rigidity (stiff neck), poor feeding, vomiting, Brudzinski’s and Kernig’s signs not reliable for diagnosis signs of meningitis in 3 months to 2 years
seizures (often initial sign), drowsy->delirium->stupor->coma, nuchal rigidity (stiff neck), positive Brudzinski’s sign and Kernig’s sign, fever, chills, vomiting, petechia rash, draining ear signs of meningitis in 2 years through adolescence
lab tests for meningitis blood culture, CBC, CSF analysis (bacterial-cloudy, viral-clear), WBC (up), protein (up), glucose (bacterial-decreased, viral-normal), gram stain (bacterial-positive, viral-negative)
diagnostic tests for meningitis lumbar puncture, CT or MRI---checks for increased ICP and/or abscesses
type of isolation for pt with meningitis droplet
Monitor : VS, I&O, pain level, neuro status, and head circ. for infants. NPO if decreased LOC; then clear liquids and then diet as tol. Decrease environ. stimuli; cool room; no pillow, slightly elevate HOB. Side lying for stiff neck. seizure precautions Meningitis
treatment and goals for meningitis Eradicate virus or bacteria- Be free of infection and inflammation. Continue to get appropriate vaccines: Hib and PCV to prevent
flexion of extremities occurring with deliberate flexion of the neck positive Brudzinski’s sign
resistance to extension of the child’s leg from a flexed position positive Kernig’s sign
lumbar puncture...happens between which vertebrae? measures and collects what? Insertion of a spinal needle into the subarachnoid space between L3 and L4 or L4 and L5 vertebral spaces; measures spinal fluid pressure and collects CSF for analysis
steps for lumbar puncture empty bladder; EMLA cream 45-mins to 3-hours prior to procedure; poss. sedation--fentanyl and Versed; provider will clean site and inject local anesthetic; provider will take pressure readings and collect 3-5 tubes of CSF; pressure DRSG to site
client education post-lumbar puncture Instruct the client to remain in bed for 4 to 8 hrs in a flat position to prevent leakage and a resulting spinal headache. This may not be possible for an infant, toddler, or preschooler.
bladder and/or bowel incontinence; partial or complete lack of sensation; partial or complete paralysis of the legs; weakness of the hips, legs, or feet of a newborn; abnormal feet or legs (ie clubfoot); hydrocephalus symptoms of myelomeningocele
surgery within first few days, ATBs (to prevent infections such as meningitis or UTIs), long-term---bladder and bowel programs, PT/OT, braces, wheelchair myelomeningocele
myelomeningocele, meningocele, anencephaly, and encephalocele neural tube defects
a defect in brain development resulting in small or missing brain hemispheres, skull, and scalp Anencephaly
a protrusion of the brain and meninges through a skull defect; results from failure of the anterior portion of the neural tube to close Encephalocele
birth defect---an external sac-like protrusion that encases the meninges, spinal fluid, and in some cases nerves, is present on the spine; most severe form of neural tube defect; is a type of spina bifida myelomeningocele
a neuro disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, assoc. with abnormal electrical activity in the brain; risk factors: can be from family history, brain injury; cause is often unknown epilepsy
treatment for seizure disorders anticonvulsants (ie-phenytoin, phenobarbital, valproic acid), surgery (to interrupt the impulses), ketogenic diet, vagal nerve stimulator
The nurse observes a child for neurologic disorders. What is the earliest indicator of improvement or deterioration of neurologic status? a. vital signs b. level of consciousness c. motor function d. reflexes b. level of consciousness
Created by: nurse savage
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