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pediatric patient

Trust vs. mistrust attachment to mother, which lays foundations for later trust in others
autonomy vs shame and doubt gaining some basic control of self and environment
initiative vs. guilt becoming purposeful and directive
industry vs. inferiority developing social, physical, and school skills
identify vs. role confusion making transition from childhood to adulthood , developing sense of identity
intimacy vs. isolation establishing intimate bonds of love and friendship
generativity vs. self-absorption fulfilling life goals that involve family, career, and society; developing concerns that embrace future generations
integrity vs. despair looking back over one's life and accepting its meaning
infancy 0-1yr
early childhood 1-3yr
late childhood 4-6yr
school age 7-11yr
adolescence 12-19yr
early adulthood 20-44yr
middle adulthood 45-65yr
later years 65r to death
infancy trust vs. mistrust
early childhood autonomy vs. shame and doubt
late childhood initiative vs. gulit
school age industry vs. inderiority
adolescence identify vs. role confusion
early adulthood intimacy vs. isolation
middle adulthood generativity vs. self-abosorption
later years integrity vs. despair
Scenario: A 5 year old with autism lives with her mother, two brothers, and grandmother. the child was recently hospitalized with a respiratory infection and has special needs because of her autsim..1) which of the following describes this family's compos 1)extended family. an extended family includes one or more parents, one or more children, and other family members, such as a grandmother. a nuclear family includes two parents and their children. a blended family includes at least one step parent, step s
Match the parenting style to the statement that most reflects the style. 1) democratic. 2) dictatorial. 3) permissive. 1)" Tonight is a school night, so you need to come home by 10 p.m. 2) " your curfew is 10 p.m. you know that" 3) " as long as you have your homework done, I don't care when you come home."
Which of the following should be included in a family assessment? Genogram, structure, developmental task, family function/roles, family stressors. These should all be included in a family assessment. the child's physical growth is part of that child's individual assessment.
True or False: when providing care to a child, the nurse should not be concerned about what the child thinks about the care. False: the child's opinion should be considered when providing care.
List three guidelines for promoting healthy behaviors in children. set realistic limits and expectation based on developmental tasks. validate the child's feelings. provide reinforcement for appropriate behavior. focus on the child's behavior when discipling the child. explain expectations to a child in a manner the chil
True or False: when a child is admitted to the pediatric unit, the nurse should keep in mind that the family of the child also needs nursing care. True: although the child is priority, the family also needs nursing care.
difference in language, habits, customs, attitudes, and beliefs can lead to feelings of___________ and ____________in children. isolation and loneliness
True of False: the need for an interpreter may inhibit the support that families need during the illness of a child. True: language and cultural barriers may impede the support structure that families need during the illness or death of a child.
Which of the following is appropriate when using and interpreter? ask the family one question at a time. use lay terms if possible. do not interrupt the interpreter and family as they talk. Asking the family one question at a time, using lay terms, and not interrupting will promote communication between the family and t
when working with a child from a culture different from the nurse's, what nonverbal actions should the nurse take to promote culturally sensitive interactions? observer for clues regarding appropriate use of eye contact; determine whom to address information or questions; allow the family to determine the distance between parties in the room; take time and do not appear rushed; actively listen; and determine the
True of False: children are not affected by cultural barriers. False: children may not be able to work through their worries or grief if cultural barriers are present.
List five basic assessments that should be included in the physical assessment of a child over 3 years of age. height, weight, temperature, RR, HR, BP.
By the what age should the anterior fontanel be closed? 18months. the posterior fontanel usually closes by 2 months, and the anterior fontanel usually closes by 18 months.
Rank the following assessments in the order they should be performed on a 9 month old. 1: RR, 2: HR, 3: Weight, 4: Axillary temp. perform a physical examination on a child starting with the least invasive, progressing towards the most invasive. assessing the respiratory rate is the least invasive, followed by the HR, which requires touching
What is rooting reflex? turns head to side when cheek or mouth is touched.
what is palmar grasp? will grasp object when palm is touched.
what is plantar grasp? toes will curl downward when sole of foot is touched.
what is moro reflex? legs flex, arms and hand extend when startled by a loud noise.
what is asymmetric tonic neck reflex? Extension of the arm and leg on the side when the head is turned to that side with flexion of the arm and leg of the opposite side.
what is the expected outcome of the olfactory nerve in a 14 year old adolescent? individually identifies smells through each nostril.
what is the expected outcome of the optic nerve in a 14 year old adolescent? intact visual acuity
what is the expected outcome of the oculomotor nerve in a 14 year old adolescent? no nystagmus
what is the expected outcome of the trochlear nerve in a 14 year old adolescent? able to look down with eyes
what is the expected outcome of the trigeminal nerve in a 14 year old adolescent? able to clench teeth together.
what is the expected outcome of the abducens nerve in a 14 year old adolescent? able to look laterally with eyes
what is the expected outcome of the facial nerve in a 14 year old adolescent? symmetrical facial movements
what is the expected outcome of the acoustic nerve in a 14 year old adolescent? no vertigo
what is the expected outcome of the glossopharyngeal nerve in a 14 year old adolescent? intact gag reflex
what is the expected outcome of the vagus nerve in a 14 year old adolescent? speech is clear
what is the expected outcome of the spinal accessory nerve in a 14 year old adolescent? equal strength of shoulder
what is the expected outcome of the hypoglossal nerve in a 14 year old adolescent? tongue in midline.
A 9 mont old infant weight 3.86 kg (8.5lbs) at birth. currently, at his well-child check-up, he weighs 8.1kg (18lbs). is this infant weight normal for his age? yes. an infant should gain 0.7kg (1.5lbs) per month for the first 6 months, and 0.3kg (0.75lbs) per month the last 6 months of the first year. the child gained 4.3 (9.5lbs), which is within the normal range.
The mother is an infant asks a nurse when she can expect her infant to begin walking. what gross motor skills should the infant develop before he begins walking? getting up to sitting position and sitting alone, pulling up to a standing position, standing holding on/ or standing alone, development is cephalocaudal; therefore, before the infant can walk, he must develop the skills of sitting and standing.
A mother of an infant tells the nurse that her infant makes many sounds. what should the nurse tell the mother about the language development of an infant? the infant will first respond to noises and turn her head toward the sound. as she grows she will vocalize "oos" and "aahs", laugh and squeal, pronounce single-syllable words, and then begin to speak two and then three word phrases.
An 8 month old infant is brought into the health facility by his parent. the nurse notes several bruises on the infant's abdomen, legs, and arms. the infant also has a cut on his scalp, hi clothes are dirty, and he has areas of redness and skin breakdown Bruising, welts, and lacerations, poor hygiene, and fear of strangers may be indications of abuse. a child who is abused does not usually demonstrate normal growth and development and positive interaction with caregivers.
Which of the following immunizations should be given to a 4 month old infant? haemophilus influenzae type B (HIB), polio (IPV), Diptheria and tetanus toxoids and pertussis(DTaP), Pneumonococcal vaccine (PCV), Rotavirus vaccine (Rota).
Which of the following foods should be introduced into an infant's diet first? iron-fortified cereals. cereal is the first food introduced to an infant. maternal iron stores in the infant begin to diminish around4 months; therefor, iron-fortified cereal should be used. pureed yellow vegetable followed by pureed fruits are then intro
List the immunizations that should be given to each of the age groups... 12-15months: Hib, PCV, IPV, MMR, and Varicella. 12-18months: Hep A, given in two doses, at least 6 months apart. 12-23months: DTaP. 12-36months-yearly TIV.
A parent of a 20 month old toddler is concerned about how often the child seems to be getting hurt. why are toddlers prone to accidents? Toddlers are still developing their fine and gross motor skills, while at the same time trying to exert their independence through movement. developmental tasks include developing autonomy, independence, the desire to try things along, wanting to explores
A parent of a 17 month old toddler is frustrated with the toddler's behavior. the parent tells the nurse that the child is "bad" but doesn't know how to make the toddler behave better. which of the following responses should the nurse make to this patient "consistently enforce well-defined limits, such as no climbing on the counters." toddlers need to have consistent boundaries enforced for discipline to be effective. behavior should not be enforced with only rewards or only punishments. trial and error la
A 13 month old toddler is being discharged from the hospital. what are potential health risk that should be addressed to the parents? poisoning, burns, falls. a cholesterol screening may start as early as adolescence. peer pressure usually begins during the school age years, becoming more of a risk during adolescence.
The parent of a 2 year old toddler tells the nurse that she is frustrated with her child's behaviors. the child throw temper tantrums and says "No" every time she tries to help her. although the parent knows toddlers do this, she cannot understand why. th increase their independence. the drive for independence is express by the toddler opposing the desire of those in authority and attempting to do everything for herself.
The parents of a 14 month old toddler want to know why their daughter has not been responsive to toilet training. the toddler is standing by herself but still crawls for locomotion. her vocabulary is developing, but she does not seem to understand what it voluntary control of anal and urethral sphincters; gross motor skills of sitting, walking and squatting; fine motor skills for removing clothing; communication skills to indicate toileting need; cognitive skills to follow directions; and the ability to re
A nurse is providing nutritional teaching to a group of parents whose children attend a local day care. which of the following is the most effective way to encourage good nutritional habits for preschool children? server nutritious foods that all family member will eat. preschoolers learn by example. seeing family member eat healthy food will encourage them to do the same. offering snacks as alternative and allowing the child to eat only what she asks for will not
A parent asks the nurse at a well child visit why his 4 year old sone is always talking about "George". the parent tells the nurse that the family does not even know anyone named "George". the child tells his parents about George's escapades, such as clim George is most likely an imaginary friend or playmate. imaginary playmates help children in many ways. when the child is lonely, and imaginary playmate can be companion. an imaginary friend also experiments with things that the child is afraid of trying.
The parents of a preschooler are worried because their child has so much trouble going to sleep at night. what strategies can be used to help a preschool child go to sleep? place a night light in the child's room, keep a regular bedtime schedule, read a bedtime story to the child, allow the child to play quietly in her room.
True or False: magical thinking can be the cause of a preschooler's feelings of guilt? True: words and thoughts are powerful to preschoolers. they believe that others can see the thought they have. therefore, if something bad happens and the child thought bad thoughts, then the child believes he is responsible for the event.
What immunizations should a preschool child receive if all immunizations have been kept up to date? DTaP, Inactivated poliovirus (IPV), measles, mump, and rubella (MMR), and varicella. in addition, yearly trivalent inactivated influenza vaccine (TIV) for preschoolers 36-59month.
Vision screening is done on a preschool child to detect and possibly treat_______ and ________. Myopia and amblyopia
Which of the following statements made by the parent of a preschooler indicates that the parent understands the need her child has for injury prevention? "I programmed the number to the poison control center into my cell phone." preschoolers are great imitators and may mimic other by taking medications or drinking colored liquids. therefore, having the number to the poison control center available is vital
When teaching a class about pubertal changes in girls, a question is asked about when development appears. number the following changes in the order they occur. menarch, breast buds, appearance of pubic hair. 1. breast buds, 2. appearance of pubic hair, 3. Menarche.
The mother of a 9 year old child reports that her son develops stomach cramping every sunday night before school how can the nurse assist this parent and child? the nurse can explore with the child's mother possible reasons for this behavior. the child may be experiencing difficulties with academics, peers, and or teachers. the nurse can give the mother guidance as to how to talk with her child. follow-up may be
True of False: school age children should be screened for scoliosis. True: Scoliosis can be detected during the school age years and will allow for early intervention.
What immunizations should a school age child receive between the ages of 11-12? Tetanus and diphtheria toxoids and pertussis vaccine (Tdap), measles, mumps, & rubella vaccine (MMR), human papillomavirus vaccine (HPV) in 3 doses, and meningococcal vaccine (MCV4)
Which of the following activities demonstrates that a school-age child is working toward a healthy achievement of Erikson's developmental task of industry? the child brings home completed school work to show parents. school age children are working on developing a sense of industry, which becomes inferiority when the child does not achieve the tasks. school age children are proud of their academic achievemen
What should be included in a course on safety during the school age years? wearing helmets when riding bicycles or skateboarding. firearm safety. wearing seat belts. school age children are active and need to take precautions, such as wearing helmets and pads when skateboarding or bicycling, as well as wearing seat belts when in
Identify three strategies parents can use to decrease the risk of obesity in school age children. Avoid or reduce fast-food meals, encourage physical activities, do not use food as rewards, provide nutritious meals.
Identify the order of sexual maturation in males.... 1.size of testes increase. 2. pubic hair appears. 3. rapid growth of genitalia occurs. 4. axillary hair grow. 5. downy hair appears on upper lip. 6. voice changes.
Sleep habits change with puberty due to ________ and _________. Increased metabolism and rapid growth.
Adolescents are likely to take risks because... they see themselves as invincible to bad outcomes.
an adolescent visits the school nurse because of pain in his shoulder. the nurse discovers that the adolescent has been lifting weights daily as he prepares for baseball. what should the nurse include in her discussion with the adolescent to help reduce t Instruct the adolescent to consult with his coach to make sure the proper technique is being used for weight lifting. adolescents need to know how to properly use the sporting equipment to prevent injuries. weight lifting can be continued if the equipment
Identify five behavioral changes that may indicate an adolescent is socially isolated or depressed? poor school performance, lack of interest in things that had been interest to the adolescent in the past, not interacting with other, disturbances in sleep or appetite, expression of scuicidal thoughts.
A mother of a 2 month old infant asks a nurse when she should introduce solid foods into her infants' diet. which of the following responses by the nurse is most appropriate regarding the mother's question? " you may fee your baby rice cereal at 6 months." although breast milk is recommended for up to 1 year , infants may be given iron-fortified cereal, such as rice cereal, between 4-6 months. iron-fortified cereal is the first solid food to be introduced, f
Which of the following foods are introduced into an infants diet after 1 year. whole milk, eggs, peanuts. food that may be introduced during infancy include iron-fortified cereals, most green and yellow vegetable, most fruits, and meat. whole milk is not given due to the infant's need for iron, which is not part of a whole milk. egg
True or False: Toddlers should not be allowed to eat sandwiches. False: toddlers enjoy eating finger foods. these food provide them with a sense of autonomy.
True or False: fruit juices should be limited to 4-6oz per day for toddlers? true: fruit juices are high in sugar content and should be limited for toddlers.
A nurse is teaching a class about nutrition to a high school health class. which of the following foods selected by adolescents indicates and understanding of good nutritional practices? green salad with low fat dressing, peanut butter and apple slices, pasta and tomato sauce.
Which of the following strategies will help appropriate weight gain in children and adolescents? regular physical activity. eating low-fat dairy products. encouraging the child/adolescent to participate in shopping and meal preparation.
Match the following play activities with the appropriate age group. Watching black and white mobiles=birth to 3 months. playing peek-a-boo= 6-9 months. holding a soft rattle=3-6months. playing with cloth books=1-3 years. banging large blocks=9-12months.
Before cleaning an abrasion on a 3 year old, what diversional activity could a nurse use to help decrease the child's anxiety? have the child clean the owie on her doll. having the child perform a task on a comfort toy, such as a doll, helps reduce anxiety.
True or False: when working with a child who is developmentally delayed, the nurse should use diversional activities appropriate for the child's age. False: the nurse should determine the developmental level of the child, and then select activities appropriate to that child's level of development.
Which of the following play activities is expected for a preschooler? Finger painting. finger painting is a creative activity for the preschooler. playing on a sports team, reading, and or playing a musical instrument are activities for older children.
what age group is most likely to engage in collecting trading cards? school age child. school age children enjoy collecting various things. early school-age children may not have organization to their collection, while older school age children are organized and specific with their collections.
What activities would adolescents most likely engage in? playing video games with peers, participating in school sports, reading or listening to music.
A 5 year old child is hospitalized an is in skeletal traction for a fractured femur. which of the following is the most appropriate diversional activity for this child? playing with puppets.
True or false: if an infant is sleeping, a nurse may ask the parents at the bedside to verify his name. False: a client identity should always be verified by the hospital id band.
When administering oral medications to a child with a feeding tube, the nurse knows to.... check tube placement, administer medication by gravity flow, flush adequately , and clamp tubing.
which of the following sites is the most appropriate for administering an immunization to an infant? Vastus lateralis is the most developed muscle in the infant; therefore, it is the site of choice for administering IM injections in infants.
list 3 interventions with rational that a nurse can use to decrease the risk of medication errors when administering medication to children. have a second nurse verify dosage calculation/ adult medication forms may be used requiring calculation of very small doses. obtain accurate weight of child/ dosage are usually based on weight or body surface area. mix medications with small amounts of li
When instilling an otic solution into a child's ear, the nurse should pull the auricle________. Down and back. pulling the auricle down and back, instead of up and back as in an adult will help open the ear canal and facilitate administration of the medication. this method straightens the child's ear canal, making it easier to instill the otic solut
When can the vastus lateralis injection site be used? may be used for toddlers and older children. recommended site for infants < 2 years. may use the sitting position.
when can the ventrogluteal site be used for injection? may be used for toddlers and older children. may use the prone position
when can the deltoid be used for injections? may be used for toddlers and older children. less local side effects than with vastus lateralis. may use the sitting position.
A 10 year old child has just had an appendectomy following a ruptures appendix. a nurse is monitoring the child's response to antibiotics, posoperative healing, and pain control. which of the following tools is most appropriate for assessing the child's p Visual analogue scale (VAS). this is the most appropriate for this child. the FLACC scale is used for infants and children up to 7 years. the FACES and CHEOPS scales are appropriate for early childhood.
A nurse suspects that a 15 year old adolescent is experiencing pain. the nurse ask if the adolescent would like her pain medication. the adolescent tells the nurse that she will wait until the pain worsens. which of the following statements by the nurse i " If you let the pain get too bad, the medication will not work as well." giving medication when pain is perceived keeps the pain under control. it is easier to prevent pain than to treat it. the adolescent should be able to understand this concept.
how can prior experiences with pain influence current sensitivity to pain? prior experience can decrease sensitivity if prior pain relief measure were effective. prior experience can increase sensitivity if prior pain relief measure were ineffective.
When should the effectiveness of nonpharmacologic pain interventions be evaluated? the effectiveness of nonpharmacologic pain interventions should be evaluated around 30-60 min following interventions. it usually takes about 30-60 mins for the body to adjust to the interventions for pain reduction.
For which of the following children should a nurse use the child's behavior s as an indication of pain verses self-report? 2 year old is not able to verbalize pain. however, this child may exhibit signs of distress such as crying, irritability, and restlessness.
A 5 year old child is scheduled for a dressing change that will produce moderate pain. what preprocedural interventions should the nurse perform? administer pain medication prior to the procedure.
Thirty to 60 min following administration of an oral pain medication to a child, it is important that a nurse.... evaluate the effectiveness of the pain medication.
which of the following is an appropriate nonpharmacologic pain management technique for a 5 year old child with fracture femur? distraction, being held or rocked, positioning.
and adolescent fractures his left leg. the leg is surgically repaired, and a long-leg cast is applied. during the first night in the hospital, the adolescent calls the nurse to the room and states. "my leg hurst really bad." the next action the nurse shou obtain more information regarding the adolescent report. a complete assessment of the pain should be performed before taking any action.
an 18 month old child is admitted to the hospital for pneumonia. the child is in a mist tent with 24% O2 and has an IV of D5W 0.2 NS at 45 mL/hr infusing in his right arm . what are stressors this child and his family might experience? Strange environment, lack of control, separation anxiety. toddlers are developing a sense of autonomy so lack of control and strange environment are threatening. fear of bodily harm occurs with preschoolers, and concern about body image is associated with
which of the following nursing interventions is most appropriate for the needs of a 7 year old child being hospitalized for an extended time? provide play activities that foster a sense of normal routin.
crying is what stage of separation anxiety? protest.
withdrawal and quietness is what stage of separation anxiety? despair
lack of protest when parents leave is what stage of separation anxiety? denial
identify measures that would help a 4 year old with the stressors of hospitalization? allowing the child to handle equipment if it is safe. therapeutic play. validating the child's fears. explaining all procedures carefully in clear simple language.
how can a nurse assist the family of a hospitalized toddler with separation anxiety? first, have at least one parent stay with the child as much as possible. place the child in a room close to the nurse's desk. finally, explain the concept of separation anxiety to the parents to help them cope with the child's behavior.
list several issues that an adolescent who is hospitalized might experience. feeling of isolation, especially from peers. worries regarding the outcome of the illness and how it may affect activities and school. noncompliance with treatment regimen if it interferes with activities or makes the adolescent appear different. concerns
Spina Bifida A congenital neural tube defect
4 types of Spina Bifida Occulta, Cystica, Meningocele, Myelomeningocele (last two-won't know which one until they go in and see)
Hydrocephalus is a very common side effect of these types of Spina Bifida Meningocele or Myelomeningocele
Spina Bifida where there is no nerves is called Meningocele
Spina Bifida where there IS nerves is called Myelomeningocele
Anacephaly "no brain" baby dies at birth usually-failure of the brain to form
myelomeningocele most severe form of spina bifida where the spinal cord and meninges protrude through the spine
complication of Spina Bifida Hydrocephalus
tx of spina bifida surgical closure
possible cause for Spina Bifida anti-seizure meds taken by mom
Hydrocephalus water on the brain-either a problem with overproduction or inability to absorb
Hydrocephalus in older children usually caused by tumors-no head enlargement (fontanels are closed), manifested by N/V, change in LOC or personality, motor and/or visual problems
Hydrocephalus diagnosed by what CT scan or MRI
Treatment of Hydrocephalus remove the cause (tumor etc.)Dr, or place a shunt
Drains CSF from Ventricle to Peritoneal Cavinty Ventoriculoperitoneal Shunt
major complication of Ventriculoperitoneal shunts infection and/or malfunction
Ventriculoperitoneal shunt a one way flow valve goes from valve on back of head into peritoneum
papilledema a side effect of ICP-is is optic disc swelling. The swelling is usually bilateral but can be unilateral
decerebrate/decorticate posturing posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage
Cheyne stokes respirations consistent shallow, rapid breathing followed by periods of apnea (side effect of ICP)
Obtundation mild/moderate reduction in awakeness with limited response to environment; will fall asleep unless stimulated
Stupor dazed state
Coma no motor or verbal response to noxious stimuli
Persistent vegetative state permanently lost function of cerebral cortex
Pediatric Glascow Coma Scale Three part assessment: Eyes, verbal response, motor response
score for peds GCS 15 means unaltered LOC, 3 is the worst score-means extremely decreased LOC
How frequent do you assess a peds pt with LOC problems? every 15 minutes to 2 hours-depends on injury/condition
Can pain cause ICP? yes
hypoxia lasting more than 4 hours may cause irreversible brain damage (may just be 89%, just a little below...but for a long time will cause lots of damage)
CO2 causes vasodilation, increased cerebral blood flow, and increased ICP
GCS score of <7 indicates reason for ICP monitoring, <8 w/resp distress
Coup means bruising at the point of impact
contrecoup means bruising at a site far removed from the point of impact
primary head injuries are those that occur at a time of trauma: skull fx, contusions, intracranial hematoms, diffuse injury
What is the leading cause of hypoxia? near drowning
What is the second leading cause of death in children? Drowning
"near-drowning" means survived at least 24 hours after submersion
bigges type of meningitis dealt with bacterial
acute inflammation of the CNS, decreased incidence w/HIB, may be caused by bacterias: Strep. pneumoniae, group B strep, E. coli Bacterial Meningitis
How is Bacterial Meningitis transmitted? Droplet infection from nasopharyngeal secretion, organisms then spread thru CNS
Comes on quickly, need a lumbar puncture to confirm, presents w/headache, stiff neck, need abx immediately Bacterial Meningitis
purpura of the lower extremities may be seen with this Bacterial Meningitis-caused from bleeding
Nonbacterial Meningitis (Aseptic Meningitis) causative agents are prnicipally viruses
frequently associated with other diseases such as measles, mumps, herpres, leukemia Nonbacterial Meningitis (Aseptic Meningitis)
Onset is abrupt OR gradual...either Nonbacterial Meningitis (Aseptic Meningitis)
Headache, fever (higher than Bacterial Meningitis), malaise Nonbacterial Meningitis (Aseptic Meningitis)
Tuberculosis Meningitis more likely to occur in very young children or in immunosuppressed children
Ischemic infarction may occur, fever, altered LOC, seizures, common complication is Hydrocephalus Tb Meningitis
Inflammatory process f CNS with altered function of brain and spinal cord Encephalitis
Cause of Encephalitis variety of causative organisms-viral most frequent-vector reservoir in U.S.: mosquitoes and ticks
Encephalitis Sudden or gradual onset, malaise , fever, h/a, dizziness, stiff neck, N/V, Ataxia, speech difficulties, seizures
Rabies an acute infectio of the CNS
caused by virus transmitted by saliva of infected animal Rabies
Rabies virus multiplies in muscles, and fatal if untreated-highest incidence in human is <15 years old
12% of cases come from domestic animals, especially cats-wild:raccoons, skunks, foxes, and bats Rabies
A disorder defined as toxic encephalopathy assoc. w/other characterisitic organ involvement Reye Syndrome (RS)
Fever, profoundly impaired consciousness, and disordered hepatic function Reye Syndrome (RS)
Most cases follow a common viral illness and may be assoc. w/aspirin therapy for fever Reye Syndrome (RS)
Seizures caused by malfunctions of the brains' electrical system, determined by site of origin
The most common neurologic dysfunction in kids Seizures
focal seizure okay, then stop and stare for 30 or more seconds, then unaware of seizure
Types of seizures Epileptic or Nonepileptic (most are idiopathic, but may have genetic factors)
more seizure in this age group than any other younger than 2
defined as greater or more than 2 "unprovoked" seizures Epilepsy
Cause of Epilepsy Idiopathic (cause unknown)
Major causes of seizures in children are birth injuries (anoxia) or congenital defects of CNS, acute inf., in kids >3-usually idiopathic
Absence Seizures formerly called petit mal or "lapses"
brief loss of consciousness, niminla or no change in muscle tone, almost always appear in ages 4-12 Absence Seizures
Sudden onset of 20+ events/day, no warning/aura, last 5 to 10 sec., lip smacking, eyes and face twitching, no incontinence Absence Seizure
Absence Seizures often misdiagnosed as inattention/daydreaming, ADD/ADHD
Atonic Seizures sudden momentary loss of muscle tone, onset age 2-5, MAY lose consc., sudden fall to ground often on face, if less severe-head droops forward several times
Myoclonic Seizures Sudden brief contractions of muscle group either single or repetetive, no loss of consc., often occur when falling asleep, may be mistaken for startle reflex
Infantile Spasms Onset in first 6 to 8 months of life
Infantile Spasms Usually associated with some degree of mental retardation-may be from already having a brain injury-often assoc. with cerebral anomailies like anoxic brain injury or PKU
Status Epilepticus seizure lasting more than 30 minutes or series of seizures without regaining premorbid LOC
Status Epilepticus treated by: maintain airway, establish IV access, Meds, turn on side to let drewel out
Don't come back to the way they were pre-seizure Status Epilepticus
Damages white and grey matter and results in stroke like effect Status Epilepticus
Febrile seizures cause unknown, usually in fevers above 101.8 and occurs while rising, not after
Phenobarbital used for febrile seizures, neonatal seizures, if pt doesn't respond to diazepam, high doses may require respiratory support
Phenytoin (Dilantin) PO or slow IV push, onset is 5 to 30 minutes, duration 12 to 24 hours
Valproic Acid Depakote, Depaken-give IV or PO
Side effect of Valproic Acid (Depakote, Depakene) Hepatotoxicity
Diazepem Valium IV, Diastat (rectal gel)
med of choice for status elipticus is Diazepam (Valium, Diastat) Onset 3-10 min and short duration
Ativan Alternative to diazepam
Ativan may be preferable to diazepam-longer duration, less resp. distress in kids older than 2
Monotherapy one treatment (tx of choice for peds, gradual increase in dose until seizure control or signs of toxicity)
Polypharmacy more than one drug-used in peds if uncontrolled with one drug
When do you discontinue seizure meds? When seizure free for 2 year-s, nml EEG-avoid D/C during puberty or when subject to freq. inf., recurrence poss within first year
inflammation of the meninges (the membranes that protect the brain and spinal cord) meningitis
viral meningitis most common form and commonly resolves without tx
After LP have pt lie on back for 4-8 hours to prevent leakage and causing h/a
LP for meningitis shows cloudy CSF=bacterial, or clear=viral
Brudzinski's sign the flexion of the hips and knees when the child's head is purposefully flexed
Kernig's sign is the pain associated with extending the knee when the hip is flexed
Nuchal rigidity resistance of the neck to passive range of motion
Cushing's reflex a late neurological sign of increased intracranial pressure in which there is increased BP w/widened pulse pressure and bradycardia
Reye syndrome primarily affects the liver and brain
The most common disability in children Cerebral Palsy
Spina Bifida occulta there is a defect in the bony spine INVISIBLE to the eye with no manifestation or problems
meningocele the spinaldefect and the sac-like protrusion are present, but only spinal fuid and meninges are present in the sac-after repair, no further sx usually, since nerves aren't damaged
high AFP levels in pregnant women means neural tube defect of the fetus
strabismus abnormal alignment of one or both eyes-nml in ages 6 months and younger
status elipticus state of continuous seizure activity (may last 30 minutes) brain's hyperactivity is a risk and the brain can't supply enough glucose...neurons become exhausted and can be life-threatening.
Tonic Clonic Seizure the body alternates between musculas rigidity and jerking (a grand mal seizure)
absence seizure A type of generalized seizure characterized by a sudden, momentary break in consciousness; also called petit mal seizure
atonic seizure Head drop; loss of posture; sudden loss of muscle tone. If the lower limbs are involved, this could cause the client to collapse
myoclonic seizure rare, nonconvulsive, sudden, brief lightning-jerks of 1+ extremities; no alteration of consciousness; may -> tonic-clonic; treat w/ valproic acid
Define the classifications of cognitive impairment. mild IQ of 50-55 to 70-75,Moderate IQ 35-40 to 50-55 ,Severe IQ 20-25 to 35-40,Profound IQ below 20-25
Outline nursing interventions for the child with cognitive impairment that promote optimum development, including during hospitalization. 1) provide toys and activities,2) social interaction with other children in about the same developmental age.,3)Explain procedures,4) simple explanations,5) Explain by practice or visual aids rather than verbally,6) Evaluate childs understanding of materi
Identify the major biologic and cognitive characteristics of the child with down syndrome. its a chromosomal abnormality, characterized from mild to moderate range of CI, physical characteristics, slowed language development, congenital anomalies, sensory problems, diminished growth, and sexual development.
Outline nursing interventions for the child with down syndrome. 1) support family at time with diagnoses,2) assist family in preventing physical problems,3,) assist in prenatal diagnosis and genetic counseling.
Identify the major characteristics associated with fragile X syndrome. Physical features: Increased head circumference. Long,wide and or protruding ears, long, narrow face with prominent jaw, strabismus, mitral valve prolapse, aortic root dilation, hypotonia, enlarged testicles(especially postpuberty),Behavioral Features:mil
List the general classifications of hearing impairment and the effect on speech. Deaf: refers to a person whose hearing disability precludes successful precessing of linguistic information through audition, with or without a hearing aid. Hard of hearing: refers to a person who, generally with the use of a hearing aide, has residual he
Outline nursing interventions for the child with hearing impairment, including during hospitalization. 1) tactile and visual aids 2) answer question through drawing, writing, or gestures. 3) cards for toilet, food, water, parent 4) child advocate 5) socialization with other children.
List the common types of visual disorders in children. Myopia (nearsightedness)Hyperopia (farsightedness)
Astigmatism Anisometropia: different refractive strength in each eye Amblyopia: reduces visual acuity in one eye Strabismus: squint or cross eye- malalignment of eyes Cataracts: opacity of crystalline lens Glaucoma: increased intraocular pressure
Outline nursing interventions for the child with visual impairment, including during hospitalization. 1) Talk to child what is occuring and about surroundings. 2) Identify ourself to the child each time. 3) Explain undentified sounds' 4) Bring items from home to make hospital stay comfortable. 5) orient child to surroundings 6) explain to cleaning staff t
Outline nursing interventions for the child with retinoblastoma. Nurses important goal is to have a high index of suspicion for this rare malignancy. if parents report noticing a strange light in the eye or expression, concerns must be taken seriously. Family support throught ordeal and procedures,education of eye care
Outline nursing interventions for the child with autism spectrum disorders. Family support: telling the parents it is not their fault.
Created by: SGT.MOSS