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1307 Unit 4 BP
| Question | Answer |
|---|---|
| Legge-Calve-Perthes Disease | asceptic necrosis of head of femur; s/s pain in hip and groin and a limp with muscle spasms and limitation of motion; mimic synovitis (innovation of a joint); difficult to diagnose; diagnosis done by radiographic examiniation that may need to be repeated |
| stages of Legge-Calve-Perthes Disease | each lasts 9 months to 1 year; first stage - x-ray studies show opacity of the epiphysis of femur; 2nd stage - epiphysis becomes mottled and fragmented; 3rd stage - reossification occurs |
| treatment of Legge-Calve-Perthes Disease | in the past immobilization for 2 years or more; currently - containing femoral head within the acetabulum during the revascularization process so the new femoral head will form to make a smoothly functioning joint; use of brace during healing; surgery |
| Bryant's traction | used for treatment of fractured femur in child under 2; legs wrapped with elastic bandages (removed daily to observe skin); check skin temp, color of legs and feet frequently; hips should not rest on the bed; severe pain may be from circulatory difficulty |
| Buck's traction | body provides countertraction to weights; used for short-term immobilization to correct contractures and bone deformities such as Legg-Calve-Perthes disease; don't let child slide down in bed; weights hang freely; ropes aligned with pulleys |
| Russell traction | more effective for older children; same as Buck's but leg is elevated and hoist is placed under knee (see pg. 885) |
| Duchenne's muscular distrophy | most common muscular dystrophy; x-linked; mostly in males, females are carriers; first signs within 3-4 yrs; difficulty standing and walking and later trunk muscle weakness; mild mental retardation; Gower's sign when getting up from floor; lordosis |
| Duchenne's muscular distrophy | highly increased serum creatinine phosphokinase levels; decrease in muscle fibers seen in biopsy (confirms diagnosis); no treatment; kyphosis can develop and cause decrease in respiratory function, increasing infections; breathing exercises necessary |
| treatment for soft tissue injury | RICE (rest, ice, compression, elevation) |
| x-ray definition | used for suspected pathological condition; affected areas compared with unaffected |
| bone scan | pathological conditions not seen on x-rays |
| CT | cross sectional picture of bone and relationship to other structures |
| MRI | detailed pics of soft tissue |
| ultrasound | rule out foreign body in soft tissues, joint effusions, developmental dysplasia of the hip |
| osteomyelitis | bone infection from Staph. aureus; more common in boys; results from a primary infection burns, or furuncle, penetrating wound or fracture; infection carried through blood to metaphysis (growing portion) of bone where abcess forms, ruptures and spreads |
| neurovascular checks and musculoskeletal assessment | CMS - circulation, movement, sensation; assesses for impaired neurovascular function; observe, document, report the five P's (pain, pulse, paresthesia, paralysis, pallor); check for heat, non-fitting cast, temperature (danger signals) |
| scoliosis - functional - define | lateral curvature of spine, two forms (functional or postural) - more common type; causes: poor posture, muscle spasm from trauma, unequal length of legs; when primary problem is corrected, elmination of functional scoliosis begins |
| Milwaukee brace | first type of scoliosis brace, more commonly used for kyphosis; exerts pressure on chine, pelvis, convex side of spine; worn 23 hrs over t-shirt to protect skin |
| tracheoesophageal fistula | upper (proximal) end of the esophagus ends in a blind pouch and the lower (distal) segment from the stomach is connected to the trachea by a fustulous tract |
| s/s tracheoesophageal fistula and nursing care | chokes, coughs, regurgitates when fed as it enters the blind pouch; continuous gentle suction to avoid mucous aspiration; IV fluids; observe for signs |
| dehydration - how do you know? | sunken eyes, dark circles under eyes, poor skin turgor, anuria, lab shows high specific gravity, dark urine, decreased activity, no tears when crying, mouth sticky and dry |
| pyloric stenosis | characterized by hypertrophy of the circular muscle fibers of the pylorus, severe narrowing of its lumen; distal end of stomach becomes dilated |
| s/s pyloric stenosis | eats well, gains weight first weeks of light; later starts vomiting after meals; within a few days the vomiting increases in frequency and force, becoming projectile |
| nursing care for pyloric stenosis | determine when vomiting started and it's characteristics; physical exam may show dehydration; help determine need for fluid and electrolyte replacement |
| treatment for pyloric stenosis | impaired colon removed and anastomosis of intestine performed; temporary colostomy with closure in a few months; no tap water enemas - can lead to WATER INTOXICATION and death; use only normal saline enemas |
| pinworms | child unknowingly swallows pinworm eggs; hatch in intestinal tract and grow in cecum; femal work lays eggs on the perineum; s/s - anal itching; treatment - antihelmintics (Mebendazole (Vermox); repeat meds in 2-3 weeks; teach handwashing; change bedding |
| roundworms | large intestinal worm found only in humans; from contact of feces of people with infestation; found where sanitary facilities are lacking |
| hookworms | live in human intestinal tract, attaches itself to the wall of small intestine; eggs come out in feces of host; prevalent in areas where infected human feces are on the ground and where soil, moisture, temp are favorable for development (SE US, W Africa) |
| constipation | ribbonlike stools; abdominal distention; anorexia; vomiting; failure to thrive; laxatives without success; untreated leads to intestinal obstruction and shock, interocolitis; barium enema and rectal biopsy |
| diarrhea | common in a variety of conditions; may be mild, accompanied by slight dehydration, or extremely severe; simple diarrhea can quickly turn into life-threatening diarrhea; treatment BRAT diet, liquids in small amounts, nonsalty soups or broths |
| gastroenteritis | infectious diarrhea; inflammation of stomach and intestines; identify and erradicate cause; oral rehydration |
| vomiting | can cause alkalosis |
| diarrhea | can cause acidosis |
| Tylenol antidote | acetylcystine (Mucomyst) |
| lead poisoning | caused by ingestion of lead from paint from old houses, toys from other countries, etc; treatment - chelating agents bind to lead |
| Celiac disease | malabsorptive disorders; malabsorption with steatorrhea(fatty stools); common causes cystic fibrosis and gluten-induced enteropathy; malabsorption prob.; 6 mos - 2 yrs; large bulky frothy stools, triggered by URI; restrict wheat, barley, oats, rye |
| oral rehydration therapy | Pedialyte |
| thrush - treatment and prevention | fungal infection in the oral cavity; causes white patches on the tongue; treatment - Nystatin |
| UTI | common in "diaper age" and 2-6 years; fever, n/v, foul-smelling urine, weight loss, increased urination; little or no fever; short urethra in females; abnormal urinary system; urinary stasis; short-term indwelling catheter; antimicrobrial agents |
| more causes of UTI | tight clothing, poor hygiene, local inflammation, oils in bubble bath/shampoos |
| hypospadias | opening of urethra is on ventral (under) surface of glans |
| epispadias | opening of urethra located abnormally on dorsal (upper) surface of glans penis |
| nephrotic syndrome | severe proteinuri leading to edema and hypoalbuminemia; s/s ascites, abdominal pain, periorbital, dependent to generalized (shifts with sleep); oliguria, dark frothy UOP; BP is normal |
| glomerulophritis | accute inflammation of glomeruli; most common form of necrosis; 1-3 weeks after strep infection; s/s coke, tea colored urine, increased BUN, creatinine, ESR; decreased albumin; severe oliguria; mild-mod edema; peri-orbital edema; HTN; abdominal pain |
| assessment of burns | assess airways especially if around face or mouth; severity depends on area, extent, depth, burn is calculated according to body surface area |
| pain with burns | 2nd degree burns will hurt around edges; 3rd degree - nerve damage - won't hurt as bad at first; give pain meds 30 minutes before wound care; clean with mild soap and water; debridement - to remove necrotic skin |
| nephrostomy tube | temporary; to drain urine from kidneys when there is an issue or blockage |
| Willm's tumor | abdominal neoplasm of kidney most common in intra-abdominal tumor; peaks at 3 y.o.; treatment - surgery, chemo with radiation, support, prepare for diagnostic tests/treatments; no abdominal palpitation (may rupture/spread); careful handling and bathing |
| Undescended testes | when one or both testes do not descend, called cryptochordism; usually normal in size, cause for failure to descend not clearly understood; orchiopexy is procedure to bring testes down into scrotum and anchor it there; injections of hcg |
| VCUG | diagnostic test for vesicoureteral reflux; inject with dye and pee on table |
| acidic urine | prevents UTI |
| scabies | female mite burrows in areas between the fingers and toes and in warm folds of body, like axilla and groing; seen as black dot at the end of burrow; severe itching, causing scratching with secondary infection |
| treatment of scabies | Elimite or lindane lotion - scrub with soap and water the apply lotion as directed. Permiethrin is preffered due to decreased risk of neurologic problems; left on skin 8-14 hrs; treat people in close contact; wash clothing, soft toys, bedding |
| pediculosis capitis - treatment | Pronto, RID, Nix (Permethrin), prescription is Malathion (Ovide); use again 7-10 days later |
| pediculosis capitis - prevention | wash bedding and clothing in hot water and dry in hot dryer; vacuum carpets, car seats, mattresses, upholstery, pillows, stuffed animals, dry clean non-washables, seal in plastic bag 2 weeks; wash hair items; report to school or daycare; clean headphones |
| acne prevention | well-balanced nutritious diet; caused by increased hormones, especially androgens; heredity; irritation and irritating substances (vigorous scrubbing; growth of anaerobic bacteria |
| cradle cap | seborrheic dermatitis - thickened, yellow, oily, adherent, crustlike scales and forehead; resembles eczema; doesn't itch; treatment - shampooing on regular basis |
| eczema - cause | characterized by 3 factors: hereditary predisposition, hypersensitivity of deeper layers of skin to protein or proteinlike allergens; allgergens to which child is sensitive that may be inhaled, ingested, or absorbed through direct contact |
| eczema - s/s | usually starts on cheeks and spreads to extensor surfaces of arms and legs; entire trunk may become affected; reddening of skin is quickly followed by papule and vesicle formation; itching is intense, scratching makes skin weep and crust |
| common eczema allergens: | foods (egg white, cow's milk, wheat products, orange juice, tomato juice); inhalants (house dust, pollens, animal dander); materials (wool, nylon, plastic) |
| treatment for eczema | elimination diet; hypoallergenic diet; relieve itching (emollients, special baths, alternate soaps), hydrating skin (bathing, special soaps); relieve inflammation (medications); prevent infection (meds, special baths) |
| spongiosis | breatkdown of dermal cells (in eczema) |
| eczema | asthma is also often seen along with eczema; rarely seen in breastefed babies until solids are introduced; symptom rather than disease; oversensitive to allergens; some children devleop triad of symptoms (atopic dermatitis, asthma, hay fever) |
| topical therapy | best applied right after warm bath; in direction of hair growth; pea-size amount of ointment; use elbow restraints; no topical steroids if viral infection present; avoid cortisone creams |
| prickly heat - cause | miliaria - caused by excessive heat and moisture; retention of sweat and glad becomes blocked and inflammation response begins; tiny, pin-head reddened papules develop; may itch; harmless; seen in hot weather; reversed by removing clothes |
| strawberry nevus | common hemangioma; harmless; disturbing to parents; on head or face; starts flat, may become raised; gradually blanches; removed with laser or excision |
| diaper rash treatment | change frequently without waiting for obvious leaking; wash and cleanse each change; no baby powder; A&D ointment |
| frostbite - areas affected | fingers, toes, ears |
| diabetes mellitus | |
| hypoglycemia treatment | sugar, orange juice, etc |
| hypothyroidism, s/s, treatment | s/s - sluggishness, dry skin, cold hands and feet, dry brittle hair, enlarged tongue; treatment - Levothyroxine |
| diabetes insipidus | thirst never satisfied; watch for water intoxication; commonly seen with head injury; decreased pituitary function and decreased vasopressin (ADH); polydipsia, polyuria, weight loss, dehydration, dry skin |
| precautions for varicella | contact precautions (after sores appear); droplet/airborn precautions (before sores) |
| incubation period for varicella | 14-21 |
| Hep B immunizations | series; 1st is at birth or 2 months after (will be combination vaccine @ 2 months) |
| Hep A | mandatory vaccine; fecal contaminated with food or water; well water can cause (in the past) |
| if allergic to eggs | cannot get flu, varicella, MMR vaccines (pros/cons would be weighed for MMR) |
| Fifth's disease | hand-foot-mouth - rash on palms and trunk; looks like they've been slapped - sores in mouth; droplet/airborn precautions |
| opportunistic infection | immune system is down; takes advantage of low immune system (when taking corticosteroids or chemo) |
| what type of immunity is a vaccination? | active, or artificially acquired |
| neutropenic patient | no fresh flowers or fruits; protecting them from us - put on mask when entering; they mask when leaving their room |
| Mantoux Test | TB test |
| Emula Cream | deadening cream before shots, IVs, etc |
| antibiotic directions | take it all; use birth control |
| whooping cough vaccine | pertussis; live, attenuated vaccine |
| why would the nurse delay immunizing? | fever or viral infection |
| Lyme Disease | cover yourself; light clothing; check for ticks |
| Rubeola - tell-tell sign | Koplik spots - small red spots with blue-white centers |
| MMR schedule | 12 months, 15 or 18 months, 4 years old |
| who will not get live virus? | immunocompromised or family member who is immunocompromised |
| what meds contradict vaccines? | chemo, corticosteroids |
| VCUG | check kidney function; uses dye to check that urine stays in the bladder, doesn't go back up into kidneys |
| Scabies is a | parasitic infection caused by itch mite. Female mite burrows under the skin and lays eggs. Itching is intense. Seen in body folds |
| Tx of Scabies | Elimite - ecveryone is treated. |
| Important to remember with lice and scabies | do not forget to clean the sheets, stuffed animals, couch, and anything child may have come in contact with. |
| Prevention of lice | do not share combs, headgear or bed linens! |
| Treatment of Lice | Nonprescription meds are available to treat cases of head lice. Products such as Pronto, RID, NIX. These are safe and usually effective in killing the lice. |
| Superficial or First degree burns | epidermis is inuured but there is no destruction of tissue or nerve endings - prompt regen. dry, no blisters or edema, painful. |
| Partial-Thickness or Second Degree burns | Moist blebs or blisters, Mottled white to pink cherry red in color. Very painful. May include fat domes of subq layer. |
| Full-thickness or Third Degree Burns | Dry with leathery eschar until debridement; charred blood vessels visible under eschar. Mixed white, dark , charred in color. Little or no pain; hair pulls out easily. Down to and including subq. tissue may include fascia, muscle and bone! |
| Emergency Treatment of burns | Cool water (small areas). Clothing should be romed but wrapped with a sheet to prevent shivering. |
| acne prevention | foods are not a trigger, general hygiene: cleanliness, rest, and avoidance of emotional stress. Do not squeeze. |
| tay-sachs | deficiency of enzyme needed for fat metabolism. Evident at 5-6 months of age when their growth starts to slow. Causes mental and physical deterioration. Blindness. Mental retardation. There is no treatment. Emotional support. |
| Ultimate goal for child with diabetes is | self-management. |
| Staphylococcal infection | compromises bacteria that are found in dust and skin. Under normal conditions it doesn't cause problems. Spreads readily. |
| Treatment and nursing care for a staph infection | ointments. MRSA-strict standard precautions |
| Scalded skin syndrome- staph aureus | looks like a burn. child abuse suspected. Strict isolation, iv antibiotics, prevention of secondary infections, maintainw armth and fluid electrolyte balance. |
| Tinea Pedis | Athletes foot. Between toes, on instep and on soles. OTC topical therapy. Aggravated by heat and moisture. Keep feet DRY. |
| Nutrition for healing with burns | high protein high calories |
| Six C's of burn care | Clothing, cooling, cleaning, chemoprophylaxis (medications), covering, comfort |
| RSV precautions | Contact transmission precautions to prevent the spread of infection. |
| Lyme disease | caused by a deer tick bite. Incubation: 3-30days. Not communicable bw people. Avoid ticks. Inspect skin after being in wooded area. Starts as a red papule that spreads and becomes a large round red ring. Antibiotics to treat. |
Created by:
akgalyean
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