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Pediatric Nursing
Neuro
| Term | Definition |
|---|---|
| Bacterial Meninigitis | infection caused by bacterial agents; Neisseria Meningitidis, Streptococcus pnuemoniae, Haemophilus type B , E. Coli crowded living conditions injuries that provide access to CSF |
| Lab Test for Meningitis | CSF analysis: LUMBAR PUNCTURE |
| LUMBAR PUNCTURE RESULTS-BACTERIAL MENINGITIS | CLOUDY HIGH WBC HIGH PROTEIN CONTENT LOW GLUCOSE CONTENT POSITIVE GRAM STAIN |
| LUMBAR PUNCTURE RESULTS- VIRAL MENINGITS | CLEAR SLIGHTLY ELEVATED WBC NORMAL OR SLIGHTLY ELEVATED PROTEIN CONTENT NORMAL GLUCOSE CONTENT NEGATIVE GRAM STAIN |
| Definite dx test for meningitis | provider measures spinal fluid pressure and collects CSF for analysis Client placed in side lying position, head flexed, knees at chest Walk specimen to lab |
| Petechiae/purple rash | requires immediate medical attention |
| Precautions for Meningitis | Isolate droplet precautions/maintain min 24 hrs after start of antibiotic private rm providers/visitors wear masks Monitor VS, urine output, fluid stat, pain level, neuro stat Maintain safety/seizures precautions-suction* |
| Medication for Meningitis | Dexamethasone; increased ICP reduces neuro complications Not for viral meningitis |
| Pt education for meningitis | Maintain immunizations |
| Complications for Meningitis | ICP Newborns; bulging fontanels, high pitched cry, bradycardia (BAD/CPR), increased head circumference, respiratory changes Children; headaches, nausea, vomiting, seizures, bradycardia(late sign), Provide interventions to reduce ICP-positioning |
| Seizures | abnormal, involuntary, excessive electrical discharges of neurons within the brain |
| Tonic Clonic Seizure | "Grand Mal" onset w/o warning Most common loss of swallowing reflex and increased salivation Risk for falls |
| Absence Seizures | "Petit Mal" onset b/t 4-12 yo, stop by teenage yrs loss of consciousness lasting 5-10 seconds Motionless, blank stare Can immediately resume activities |
| Atonic or Akinetic Seizure | "DROP ATTACKS" onset 2-5 yrs Confusion after child should wear helmet if frequent occurence |
| Nursing Care : Postseizure | Maintain lying on side - prevent aspiration check breathing, VS, pos head/tongue, injuries Perform neuro checks Stay w/ Child *DO NOT OFFER FD/LIQUID UNTIL COMPLETELY AWAKE AND SWALLOW REFLEX RETURNED* Find out if child noticed aura 5min/H2O = 911 |
| Pt Education: Seizures | Call 911: last more than 5 min status epilepticus occurs in h2o unequal pupils unresponsive to pain/hard to arouse 1st seizure apnea vomiting constant 30min after |
| Complications: | Status Epilepticus; 30min+ requires tx ASAP to prevent loss of brain function Maintain airway, admin o2, est. IV, ECG, monitor pulse ox/ABG results Admin load dose of diazepam /lorazepam-buccal, rectal, nasal then-fosphenytoin following phenobarbital |
| Anisometropia | excessive eye rubbing poor school performance headache/vertigo different refractive strength in each eye |
| Cataracts | gray opacity of the lens that prevent light from entering in the eye cant see clearly can lose peripheral vision nystagmus-rapid eye movement strabismus-misalignment no red reflex infant unable to reach and grab things |
| When are babies screened for hearing impairments? | After delivery |
| Sensorineural losses | exposure to constant noise(NICU), interference of neural pathways |
| Expected Findings for older children with hearing impairment | speaking monotone need for repeated convo talk loud act shy/withdrawn dont talk by 24 months yelling to express emotion irritable due to inability to gain attention inattentive to surroundings |
| Down Syndrome | chromosomal abnormality Med Conditions that accompany: congenital heart malformation, hypotonicity, thyroid dysfunction, leukemia, dysfunction of immune system |
| Expected Findings: Down Syndrome | small nose with depressed nasal bridge (saddle nose) high arched narrow palate protruding tongue possible congenital heart defect*EKG* Mother over 35yo |
| PTt Education: Down Syndrome | Aspirate nasal secretions Feeding strategies Regular health care visits Report manifestations of spinal cord compression, neck pain, loss of motor function, bladder incontinence, impaired sensations Prepare for surgery for cardiac probs or strabismus |
| Down Syndrome Complications | about 40%-45% have congenital heart disease |
| Pt Care: Clubfoot | Weekly casting to stretch muscles with subsequent placement for a long leg cast Monitor skin integrity and neurovascular status Preform cast care |
| Expected Findings; Developmental Dysplasia of the hip (DDH) | asymmetry, unequal #skinfolds one leg shorter than the other |
| Pt Care; DDH | 0-6mon: Abduction splint(Pavlik harness) prevent hip flexion and adduction |
| Pt Education: DDH 0-6month | DO NOT ADJUST STRAPS Reinforce how to apply Reinforce skin care-undershirt, knee socks, check skin, massage skin, avoid lotion and powders, place diaper under straps Check skin under straps |
| Complications: DDH 6-12month | Surgical closed reduction w/hip SPICA CAST |
| SPICA CAST Nursing Actions | Perform Skin care esp. in diaper area sponge bath neuro checks Manage PostOp pain |
| SPICA CAST; Pt Education | Sponge bath dont get cast wet use waterfproof barrier around the genital opening of spica cast to prevent soiling w/urine and feces |
| Osteogenesis Imperfecta: Data Collection | Manual blood pressure |
| Osteogenesis Imperfecta: Pt Care | Med: Biphosphonate(pamidronate) IV Nurse Action: Monitor for low Na, K, Ca, Phosp, kidney failure, dysrhythmias, neutropenia, general malaise |
| Scoliosis; Risk Factor | More common in females |
| Scoliosis; Pt Care | Promote adolescents/child positive self image |
| Scoliosis; Surgical Interventions | Assist with freq neuro checks log roll to turn to prevent damage Monitor pressure areas |
| Scoliosis: Complications | Breathing Probs PostOp: superior mesenteric artery syndrome(compression of the duodenum by the aorta and superior mesenteric artery that leads to an obstruction Nursing Actions; Monitor/report nausea, severe vomiting, epigastric pain, belching |
| Cerebral Palsy | non progressive impairment of motor function, of muscle control, coordination, and posture can cause seizures |
| Cerebral Palsy; Pt Care | Communicate w/child direct but include parents ask fam routine care-encourage them to provide encourage fam to help verify the child's needs if communication impaired |
| Cerebral Palsy: Meds | Baclofen; Rx intrathecal/pump central acting skeletal muscle relaxant that decreases muscle spasm and severe spasticity |
| Impetigo | erupts easy causing skin to be moist, secretions dry to honey crusted crusts |
| Furuncle(boil) | larger swollen, red lesion of a single hair follicle Tx:incision, draining, irrigating severe lesions |
| Tinea Corporis(Ringworm of body) | Tx: Topical antifungal-toinaftate or clotrimazole* |
| Ticks:Lyme Disease | Stage 1:3-30 days following bite "bulls eye" red macular/papular lesion at site that expands into bulls eye |
| Black Widow Spiders | Tx: Admin antivenin Admin muscle relaxant Admin analgesic |
| Scabies mite | intense itching, especially at night rash b/t fingers |
| E.Coli | watery diarrhea for 1-2 days followed by abdominal cramping and bloody diarrhea Can lead to HEMOLYTIC UREMIC SYNDROME |
| Samonella | Diarrhea last 2-3 wks headache, confusion, drowsy, seizures*, can lead to meningitis* Usually from undercooked meats and poultry |
| C.Diff | mild, watery diarrhea for a few days possible leukocytosis, hypoalbuminemia, and high fever possible pseudomembranous colitis infection after antibiotics |
| Pt Care: Infectious GI Disorders | Oral Rehydration 50-100ml/kg over 4hr |
| MEDS; Infectious GI Disorder | Metronidazole-FLAGYL and tinidazole for C.Diff and G. Lamblia |
| Pt Education; Infectious GI Disorders | Keep toys away from other kids Clean toys and child play area to prevent further spread Perform hand hygiene after using bathroom Do not share dishes and utensils, wash hot,soapy water clip nails, discourage nail biting, thumb sucking |
| Complications: Infectious GI Disorder | Dehydration-*seizures* Mild Behavior, mucous membranes, anterior fontanel, pulse, BP within expected findings Cap Refill longer than 2 secs Slight thirst Moderate Dry mucous membranes, low tears, low skin turgor |
| Complications: Infectious GI Disorder (Dehydration) | Severe Cap Refill longer 4 sec Tachycardia, orthostatic BP can lead to shock Extreme thirst Very dry mucous membranes No tears, sunken eyes Hyperpnea Sunken anterior fontanel oliguria or anuria |
| Nursing Actions; Infectious GI Disorder (Dehydration) | daily weight Mild-50mL/kg rehydration over 4hr Moderate-100mL/kg rehydration over 4hr Admin Parenteral Fluid Therapy |
| PostOp ; Cleft lip and palate | get VS, o2 sat give pain mgmt to low crying and stress on repair avoid infant sucking on anything avoid spoons, forks, or other objects brought to mouth that could damage incision assess for crusting, bleeding, infection |
| PostOp; Cleft lip | monitor integrity of post op device apply elbow restraints, periodically assess skin use sterile water to clean incision site apply antibiotic ointment |
| PostOp; Cleft palate | place baby on side to drain secretions/prevent aspiration avoid straw, tongue depressor, hard pacifier, rigid utensils, hard tipped sippy cups/suction caths in mouth elbow restraints IV fluids watch for airway obstruction hemorrhage laryngeal spasm |
| PostOp; Cleft lip/palate | speech and language impairment |
| Gastroesophageal reflux -GER; Pt Care | start interventions by admin proton pump inhibitor-omeprazole, esomeprazole, pantoprazole, rabeprazole- or H2 receptor antagonist-cimetidine or famotidine |
| Hypertrophic pyloric stenosis; Expected Findings | Vomiting (projectile) several hrs after eating constant hunger olive shaped mass in RUQ fail to gain wt dehydrate |
| Hypertrophic pyloric stenosis; Pt Care | start clear fluids 4-6hr after surgery start breast milk or formula 24hr afterwards doc tolerance to feedings |
| Intussusception; Expected Findings | sudden abdominal pain screaming w/drawing knees up to chest abdominal mass-sausage shaped stools w/blood and mucus-red,currant jelly* |
| Removal of ruptured appendix | when sudden relief of pain occur=ruptured appendix removed laparoscopically or open surgery |
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