Test 4: Chapters 30, 31, 33, & 35
Test 4: Chapters 30, 31, 33, & 35 NBSN3010C
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This 15 page Study Guide was uploaded by Trisha Riley on Sunday October 4, 2015. The Study Guide belongs to NBSN3010C at University of Cincinnati taught by Butts in Fall 2015. Since its upload, it has received 14 views. For similar materials see Continuum of Care for Children and Families in Nursing and Health Sciences at University of Cincinnati.
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Date Created: 10/04/15
Chapter 33 Alterations in Neurologic Function Friday September 11 2 15 234 AM Head injury early signs of Increased lntracranial Pressure ICP 0 Headache 0 Visual disturbance diplopia 0 Nausea and vomiting Dizziness or vertigo 0 Slight change in VS 0 Pupils not as reactive or equal 0 Sun setting eyes sclera visible above the iris cranial nerve VI palsy CAN ALSO BE LATE SIGN 0 Slight change in LOC restlessness Additional signs in infants 0 Bulging fontanel 0 Wide sutures increased head circumference 0 Dilated scalp veins 0 Irritability 0 Highpitched catlike cry Late signs of ICP 0 Significant decrease in LOC 0 Increased systolic blood pressure and widened pulse pressure 0 Bradycardia O Irregular respirations 0 Fixed and dilated pupils papilledema Hydrocephalus pg 1174 0 Congenital structural defect in infancy ie DandyWalker syndrome ArnoldChiari malformation aqueductal stenosis 0 Acquired injury in infancy intraventricular hemorrhage 0 Early Signs 0 Rapidly increasing head circumference tense full or bulging anterior fontanel split sutures Bossing protrusion of frontal area face disproportionate to skill size Difficulty holding up head Macewen or quotcrackedpotquot sign with percussion Prominent distended scalp veins translucent scalp skin Increased tone or hyperreflexia Babinski sign Irritability or lethargy poor feeding o Decline in LOC 0 Late Signs 0 Apnea episodes Shrill highpitched cry Difficulty swallowing or feeding vomiting Regression in developmental milestones Sunsetting eyes sclera visible above iris sixth central nerve palsy causing paralysis of upward gaze O Cardiopulmonary depression severe cases 000000 0000 CFS fluid is higher in the brain Possible causes Pediatric Exam 4 Page 1 0 Space occupying lesion 0 Infection meningitis 0 Accident Signs and symptoms 0 Gait imbalance 0 Speech 0 Weakness 0 If continues for too long head size can get larger Treatment 0 Shunt from one of the ventricles to the peritoneal space where it drains don39t want too much to drain just right Meningitis pg 1165 Most common H Flu B Spinal Tap to diagnose Bacterial family gets rifampin urine turns orange Reye39s Syndrome pg 1171 0 Acute encephalopathy a cerebral dysfunction caused by toxic inflammatory or anoxic insult or injury that may result in permanent tissue damage and hepatic dysfunction Causes influenza or chicken pox Associated with use of aspirin GuillainBarre Syndrome Postinfectious Polyneuritis pg 1171 IVIG do not get flu vaccine Cerebral Palsy pg 1187 0 Happens just before during orjust after birth 0 Cannot be cured 0 Some type of brain injury due to anoxia 0 Should remain same deficit throughout life Seizure Disorders pg 1156 Febrile Seizures TonicClonic Grand mal can become cyanosis Absence Seizures Partial Seizures Aura feeling or smell before seizures precursor Status epilepticus prolonged continuous seizure of 20 minutes or two or more seizures without full return to baseline between episodes Treatment Some children are on several medications to control seizures Meds to know Dilantin overgrowth of the gums dental infections IV is harmful to the skin if it comes out of vein Keppra Neural Tube Defects pg 1178 3 types Spina bifida occulta Meningocele Pediatric Exam 4 Page 2 Meningomyelocele Craniosynostosis pg 1184 Bones form too soon Surgery required to allow brain to expand Large forehead HC is important Posterior fontanel closes by 23 months Anterior fontanel closes by 1218 months Craniosynostosis closes at about 6 months Skull Fractures pg 1203 0 Linear Fracture most common type of fracture can potentially be caused by abuse may have overlying hematoma or soft tissue swelling usually no symptoms Pediatric Exam 4 Page 3 Chapter 30 Alterations in Gastrointestinal Function Wednesday September 23 2 15 92 AM Structural Defects Cleft lip 0 Unilateral opening on one side did not form 0 Bilateral opening on both sides did not form Cleft palate 0 Opening in the soft palate Feeding is hard breast feeding nearly impossible they cannot form suction have to use a long nipple or a bottle in which parentcaregiver has to squeeze Speech is difficult some countries do not perform surgeries Operation Smiles Cleft lippalate surgery 0 Important for infant to not touch suture line or lay on their bellies position them on their side for at least the first 5 days while suture is healing 0 Risk of infection 0 May not be able to eat maintain IV fluids 0 Elbow restraints so they cannot bend their arms stiff with tongue blades Esophageal atresia and Tracheoesophageal fistula 0 Esophageal atresia Esophagus ends no connection to the stomach 0 Tracheoesophageal fistula has an opening to the lungs from esophagus 0 Symptoms choking cyanosis excessive drooling crying O Atresia throw it up 0 Fistulacyanosischoking 0 Nursing NPO raise HOB suction after feeding call MD Pyloric stenosis 0 Stomach goes down into the small intestine narrowed 0 Shows up at about 5 weeks old narrowing is at its worst 0 Cardinal signal projectile vomiting 0 More common in males 0 Babies are irritable and hungry nutrition is large because they lose most feeding 0 Abdominal xray quotalmondolivequot shape where stomach empties Surgery open pylorus up 0 After surgery babies start feeding slowing slow increase 1 spit is okay but vomiting after feeding call MD lntussusception 0 Piece of the small bowel telescopes into large bowel and GETS STUCK 0 Classic signs colicky intermittent pain 8 out of 10 drawn up knees 1015 minutes subsides then comes back 0 Manipulate bowel with enema forcing connection apart if unsuccessful surgery is required because bowel can die 0 Schoolage common 0 Red currant jelly blood and mucous because there is no stool Abdominal Wall Defects Pediatric Exam 4 Page 4 Gastroschisis 0 Polish sausage 0 Intestines on the outside of abdominal wall or covering 0 Need to keep area moist if it dries out bowel can die 0 Moist saline until surgery can be performed Omphalocele 0 at the belly button 0 Intestine coming out 0 Put a silo covering over intestine and little by little push intestine back in not all at once 0 Lose temperature usually under radiant warmer If bowel is not functioning with these defects they will probably be on TPN Anorectal Malformations Anal stenosis 0 Obturators have to be inserted into rectum to make it bigger has to be done a couple times a day to prevent stool from not being able to come out 0 If very severe surgery may be needed 0 Often on bowel regimens high fiber to make stool looser Anal atresia 0 Anus is not open 0 03 1 rectum temperature 0 When the first stool is passed needs documented 0 If thermometer can39t be inserted or no stool do they have an opening 0 Intestines can burst at risk for peritonitis 0 Ostomy in different places 0 Observe stoma pink beefy red skin around it good wound care bags come off regularly use a dressing on the skin to prevent breakdown and attach bag to dressing not skin Hernia bowel pouches out inguinal or stomach 0 Severe surgery is considered Congenital Diaphragmatic Hernia stomach contents go up through the diaphragm due to an opening emergency 0 Lifethreatening 0 Prepare for intubation 0 Possible longterm complications pulmonary HTN Umbilical hernia 0 Results from imperfect closure or weakness of umbilical ring 0 Common condition in childhood and occurs more frequently in Black children and lowbirth weight infants 0 Most defects appear prior to 6 months of age and will resolve spontaneously by 1 year of age 0 Surgery is needed if strangulation occurs or if it is not resolved by 4 to 5 years McBurney39s Point Pediatric Exam 4 Page 5 umbilicus appendix locatib oquot O I upper part of pelvic bone Peptic Ulcers 0 Erosion of the mucosal tissue in the lower end of the esophagus 0 Can be classified as primary or secondary depending on their etiology 0 Primary occur in healthy children 0 Secondary occur in children with preexisting illness or injury such as a burn and in children receiving medications ie salicylates corticosteroids NSAIDs Appendicitis NEC necrotizing enterocolitis which population is most susceptible Pg 1018 0 Potentially lifethreatening inflammatory disease of the intestinal tract Meckel39s Diverticulum 0 Results when omphalomesenteric duct connects the midgut to the yolk sac during embryonic development fails to atrophy 0 Clinical manifestations normally appear by age 2 0 Commonly presents with bloody stool irritability fatigue abdominal pain and distention nausea and vomiting 0 Most commonly presents GI bleeding or obstruction Inflammatory Bowel Diseases 0 Crohn39s disease 0 Chronic inflammatory process can occur randomly throughout the GI tract ileum colon and rectum are common sites 0 Distinct feature development of enteric fistulas between loops of bowel or nearby organs 0 Complications include perforation hemorrhage strictures fistulas liver disease and toxic megacolon O Sx subtle abdominal cramping followed by diarrhea fever anorexia growth failureweight loss general malaise joint pain 0 Ulcerative colitis 0 Chronic recurrent disease of the large intestine and rectal mucosa 0 Inflammation is limited to the mucosa 0 Can involve the entire length of the bowel with varying degrees of inflammation ulceration hemorrhage and edema O Prevalent in Jewish heritage O Sx diarrhea lower abdominal pain and cramping present before and during bowel movement and relieved after stool is often mixed with blood and mucus weight lossdelayed growth nutritional deficiencies arthralgias Disorders of Motility Pediatric Exam 4 Page 6 Gastroesophageal reflux and GERD 0 Disease worry about ulcers 0 Longterm risk damage to the esophagus Constipation 0 Chronic constipation for different reasons 0 Some children will hold their stool and the longer it is in there it loses water constipation is severe 0 Increased fiber enemas Encorpresis 0 Soil their pants 0 Wear dark clothing doesn39t show 0 Extra outfit in nurses office 0 Can be chronic Hirschsprung Disease 0 AKA congenital aganglionic megacolon nerves along colon do not work 0 Xray colon gets huge 0 Genetic more males than females 0 Not diagnosed right away constipation is common 0 Straining to go 0 High fiber increased fluids Gastroenteritis 0 Vomiting and diarrhea 0 Something is irritating intestines 0 Most commonly a viral infection 0 Worry about both vomiting and diarrhea leading to dehydration can be very serious loss of fluid and electrolytes can lead to very sick 0 Rotavirus bright green stool leading cause 0 Try to feed small amounts and see if tolerated Intestinal parasitic disorders 0 Gets into GI tract and spreads 0 Salmonella Shagella usually treat with an antibiotic 0 Stool cultures look for bacteria 0 Larva and eggs stool ova and parasite Disorders of Malabsorption Short bowel syndrome 0 Missing part or large part of intestine 0 Biliary atresia do not have bile ducts from the liver unable to digest food 0 Transplanting 45 or 6 organs multiorgan transplant 0 TPN provided initially 0 Oral and enteral feedings are instituted gradually to allow the bowel time to compensate 0 Maintain skin integrity Celiac disease 0 Glutensensitive enteropathy 0 Manifestations Pediatric Exam 4 Page 7 steatorrhea Chronic diarrhea Growth impairment Abdominal distention Poor appetite Lack of energy 0 Muscle wasting with hypotonia 0 Skinny arms and legs huge belly 0 Avoid wheat barley rye oats OOOOOO Lactose intolerance Feeding disorders 0 Colic paroxysmal abdominal pain and severe crying I Pica indigestion of nonfood items or food items consumes in abnormal quantities or forms ie starch peeling paint paper 0 Rumination rare and serious form of chronic regurgitation of recently ingested food into the mouth followed by rechewing and reswallowing or expulsion of the material Hepatic Disorders Hyperbilirubinemia pg 1033 0 Too much bilirubin in their blood jaundice too high for too long can affect their brain 0 Bili lightsbili blankets draw bilirubin out Biliary atresia pg 1034 0 Results when extrahepatic bile ducts fail to develop or are closed 0 Disorder leads to cholestasis cirrhosis endstage liver disease and death by 2 years old IF LEFT UNTREATED 0 Most common cause of pathologic jaundice in infants and leading indication for pediatric LIVER TRANSPLANT 0 Longterm TPN Viral hepatitis pg 1036 0 Inflammation of the liver caused by a viral infection acute or chronic 0 Acute rapid onset and if untreated can lead to chronic 0 Most common causative organisms hep A hep B and hep C 0 Acute hepatitis 0 Anicteric absence ofjaundice I Usually lasts 57 days I Nausea vomiting anorexia malaise fatigue RUQ pain hepatosplenomegaly fever I Child become irritable looks ill requires rest 0 cteric jaundice I Darkening of urine claycolored stools yellowing of skin and sclera I Phase lasts about 4 weeks 0 Complete recovery may take 1 to 3 months Elements to eliminate Hepatitis B virus infections pg 1037 0 Education about needle sticksunprotected sex 0 Vaccination Hepatosplenomegaly Pediatric Exam 4 Page 8 Cirrhosis pg 1039 Injuries to GI system Seatbelt injury Ingestion of foreign substance or foreign objects Call poison control describe what was ingested vomit or milk HSP can cause severe stomach discomfort purpura over their abdomen Malrotation Emergency Peritonitis or death Pediatric Exam 4 Page 9 Chapter 31 Alterations in Genitourinary Function Friday September 252 2 15 92 AM Bladder Exstrophy 0 Congenital defect 0 Abdominal wall does not fuse during fetal development which leads to 0 Exposure of the bladder wall 0 Separation of the rectus muscles 0 Widening of the symphysis pubis 0 Upper urinary tract is usually normal 0 Clinical manifestations o Bladder mucosa appears as a bright red mass 0 Urine leaks from the ureters onto the skin continuously 0 Females have a bifid split clitoris O Males have a short penis and the glans is flattened with dorsal chordee shortage of skin on the ventral side of the penis that cause the penis to curve 0 Undescended testicles and inguinal hernias are common Hypospadias amp Epispadias 0 Congenital anomalies involving an abnormal location of the urethral meatus 0 Defects result from failure of the urethral folds to fuse completely over the urethral groove 0 Surgical correction generally occurs during the first year of life to minimize psychological effects Nephrosis water on the kidneys and kidney infections can occur with significant damage to the kidneys and is a common cause of renal failure in children Neurogenic bladder an interrupted nerve supply from myelomeningocele or spinal cord trauma impairs bladder voiding function and leads to incomplete bladder emptying VU R Vesicoureteral Reflux 0 Backflow of urine from the bladder into the ureters during voiding another cause of UTI 0 May result from structural anomaly in which the ureters insert in an abnormal position into the bladder 0 Degree of reflux determines if daily antibiotics are needed to prevent infection or if surgery is needed 0 If antibiotic given most commonly Bactrim 0 Surgery involves cutting and repositioning the ureter 0 Mitrofanoff small tunnel from the bladder to the outside of the body used to empty bladder with catheter PruneBelly Syndrome 0 AKA EagleBarrett syndrome 0 Congenital defect characterized by failure of the abdominal musculature to develop 0 Skin covering the abdominal wall is thin and resembles a wrinkled prune 0 Other characteristics 0 Urinary tract anomalies 0 Poor urethral peristalsis o Enlarged bladder 0 High risk for recurrent urinary tract infection Pediatric Exam 4 Page 10 O O Vesicoureteral reflux Bilateral cryptorchidism 0 Occurs predominantly in males 95 0 Incidence of 1 in 3000050000 live births 0 Associated anomalies of PruneBelly Syndrome o GU I Cryptorchidism I Renal dysplasia I Vesicoureteral reflux 0 Respiratory I Pulmonary hypoplasia 0 Cardiovascular I Atrial septal defect I Patent ductus arteriosus I Tetralogy of Fallot I Ventricular septal defect 0 GI I Gastroschisis I mperforate anus I Malrotation with volvulus O Musculoskeletal I Clubfoot I Congenital hip dysplasia I Pectus excavatum I Carinatum Nephrotic Syndrome 0 Common characteristics 0 Edema O Snug fit of clothing and shoes 0 Pallor 0 Hypertension O Irritability O Anorexia O Hematuria o Decreased urine output 0 Nonspecific malaise O Urine may be frothy or foamy 0 Respiratory distress from pleural effusion may occur in some cases 0 Lab findings 0 O 0 3 to 4 protein Hypoalbuminemia serum albumin levels of less than 25gdL BUN and Creatinine 0 Treatment O 0000 O Albumin pulls protein out of abdomen into blood Lasix first Daily weight Fluid balance ampO39s Decreased Na intake Monitor BP and skin integrity 0 Medications used 0 Corticosteroids therapy Pediatric Exam 4 Page 11 Alkylatingcytotoxic agents Immunosuppressants Diuretics Angiotensinconverting enzyme ACE inhibitor 0 Longterm implications for child 0 Relapses occur in many children 0 Relapse after drug therapy is discontinued receive repeat therapy 0000 Acute Renal Failure ARF 0 Sudden loss of adequate renal function in which the kidneys are unable to clear metabolic wastes and to regulate extracellular fluid volume sodium balance and acidbase homeostasis 0 Can result as a complication of nephrotic syndrome 0 1 or 2 episodes are typically reversible more than 2 episodes generally not reversible Chronic Renal Failure CRF 0 Progressive irreversible reduction in kidney function 0 Ultimately leads to endstage renal disease ESRD 0 May need transplant Acute Postinfectious Glomerulonephritis APG 0 ASO or ASLO blood test done to test for recent strep infection 0 Blood in urine 0 Children typically have a complete recovery of kidney function 0 Can be found in family members known as Bright39s disease 0 May not be associated with strep blood in urine more than once may be a sign 0 Treat underlying infection treat symptoms and assess kidney function Hemolytic Uremic Syndrome HUS 0 Most common cause of acute renal failure in young children occurring primarily in those under 4 years of age 0 Classical triad of symptoms 0 Hemolytic anemia pale O Thrombocytopenia 0 Acute renal failure 0 Often associated with ingestion of Ecoli strain 0157H7 found in undercooked meat and unpasteurized milk and juices 0 Eco strain produces toxin that attaches glomeruli collecting ducts and distal tubules toxin damages the lining of the glomerular arterioles causing endothelial cells to swell and become occluded with platelets and fibrin clots partial occlusion damages RBC39s platelets cluster in areas of vascular endothelial damage glomerular filtration is decreased 0 Little to no urine Polycystic Kidney Disease 0 Genetic disorder that has an autosomal recessive and dominant forms 0 Liver abnormalities are associated with both forms of the disease 0 Autosomal dominant results from mutations on the PKDl locus on chromosome 16 and PKD2 on chromosome 4 0 Autosomal recessive gene PKHDl is located on chromosome 6 0 Can lead to chronic renal failure Structural Defects 0 Phimosis foreskin over the glans penis cannot be retracted normal finding in uncircumcised infants and young males avoid pulling foreskin down fast Pediatric Exam 4 Page 12 0 Cryptorchidism undescended testes occurs when both or one testes fail to descend through the inguinal canal into the scrotum testes normally descend during the 7th to 9th month of gestation 0 Testicular torsion an emergency condition in which the testis suddenly rotates on its spermatic cord cutting off blood supply leading to vascular engorgement and ischemia PAIN Sexually Transmitted Infection 0 Need to be treated 0 Young women can be treated without parents knowledge Pelvic Inflammatory Disease 0 An infection of the upper genital tract caused by the ascending spread of organisms in the cervix and vagina 0 Majority are caused by Chlamydia trachomatis or Neisseria gonorrhoeae Pediatric Exam 4 Page 13 Chapter 35 Alterations in Musculoskeletal amp Neuromuscular Functions Friday September 25 2 15 255 AM Congenital Hip Dysplasia Can one or both sides Shortly after birth physician will move leg to listen for clickpop to check Gluteal folds should be even One hip can be lower than the other Pavlik harness used at birth contraption over diaper with straps over shoulders that will pull hip back into place needs to fit properly stay in it at all time keeps hip in place if it does not work surgery can be done Casts after surgery keeps joint immobilized usually made of plaster heavy do not put anything under to itch allow enough room between skin and cast can cause compartment syndrome if it is too tight circulation major tissue damage check cast and circulation Q15 minutes first few hours Hip spica cast hip involved full length and partially on other leg hole is cut out to change diapers Surgery done by 1 or 15 years before walking if pavlik harness did not work If they have the cast usually don t fit into car seat Hip spica cast on for 68 weeks Club foot amp scoliosis Club foot serial casting may require surgery or multiple surgeries Various types 1258 Foot is usually turned Try cast the foot with serial casting moving the foot a little at a time and cast it Scoliosis treatment depends on severitydegree of curve and how quickly it developschanges Usually screened in schoolage or preadolescent around 5th 7th grade sometimes detected earlier Treatment can include a brace that is worn most of the day surgery brace is not taken off daily Degree of scoliosis is severe lungs and heart may be impacted Usually repaired at a certain degree Usually start donating their blood before surgery potential for huge blood loss during surgery Log roll Sometimes a rod is placed to keep it in place Chest wall deformities Broken Bones Types of fractures Spiral fracture suspicious usually Surgery may include pins halo screws potential for infection Skeletal traction for a fractured femur needs to stay in 90 degree for 3 weeks on back Ages schoolage to early adolescence With wrist or arm wait about 48 hours to allow swelling to decrease and increase risk of compartment syndrome usually in a sling first Compartment syndrome swelling circulation possible fasciotomy Pediatric Exam 4 Page 14 Skin traction keep leg straight Keep traction weights aligned and not touching the floor Slipped head of femur SCFE More common in adolescent males Head of femur slips out of place common in obese Tx LegCalves Perthes Schoolage 710 Tx OI osteogenesis imperfecta quotbrittle bonesquot Subject to breaks Often misdiagnosed in ER Silverman series find old breaks Eyes blue sclera CI Family is sometimes suspected of child abuse Neuromuscular nerves and muscles working together Muscular dystrophy Several types Duchenne muscular dystrophy DMD Gender specific to males Genetic mother passes to son As they get older walking becomes difficult clumsy decreased stamina End up in wheelchair by age 1520 Nutrition GuillainBarre Syndrome Paralysis starts Transverse Myelitis Goes across the body Juvenile Arthritis Affects the bones too Osteomyelitis Infection goes all the way down to the bone Usually 36 weeks of antibiotics Pediatric Exam 4 Page 15
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