NYU peds exam II neuro/musculoskeletal set copy12

Increased ICP early sx

H/A, visual changes, vom, dizziness, increased head circ, separated sutures, bulging fontanelles, frontal bossing

Increased ICP late sx

decreased HR + RR, increased systolic BP, widened pulse pressure, shrill high pitched cry, seizures, dilated pupils

Increased ICP interventions

elevate HOB, head straight, decrease stimuli, medicate as ordered

Brain tumor sx

H/A, vomiting, ataxia, seizures, visual disturbances, increased ICP, hydrocephalus, cranial nerve tract signs

Hydrocephalus

enlargement of ventricles due to increase in CSF (too much production or too little absorption)

Hydrocephalus Tx

fix cause, monitor head circumference & seizures, carefully change positions, keep baby calm. VTP shunt

ventriculoperitoneal shunt

to drain CSF, monitor for infection and malfunction, may need revisions

Brain surgery TX

HOB elevated, neruo checks 1-2h, VS frequent, NPO until awake and airway protected, do not remove bandage - reinforce with dry sterile gauze until surgeon removes.

Thermoregulation in brain surgery

may be high or low because of surgery and anesthias

Report : brain surgery

Drainage and odor - could be CSF or infection

Bacterial Meningitis infant SX

fever, cold hands + feet, refuses feeds, vomiting, high pitched moan/cry/whimper, dislikes being held, neck retraction, arching of back, blank stare + expression, lethargic, difficult to wake, pale + blotchy, floppy, stiff, or jerking movements

Bacterial Meningitis Children/Adult SX

stiff neck, headache, fever, vomiting, light sensitivity, drowsy/confused, joint pain, fitting

Bacterial Meningitis Interventions

Minimize stimuli, droplet precautions

Bacterial Meningitis Test

WBC, blood culture, throat culture, urine culture

Bacterial Meningitis RX

antibiotics, antipyretics + analgescis PRN, vaccination for risk groups

Head injury SX

hx, vomit >2x, bruises, H/A, dizzy, abnormal pupils, lacerations, confusion, clear liquid from nose/ear

Head injury Interventions

concussion scale, prep for CT + MRI, ER management, monitor for increased ICP

Pediatric coma scale

eye opening, motor response, auditory response (different with infants) higher number the better

liner skull fracture

minor

Depressed skull fraccture

forceful impact from blunt object, surgery often required to elevate bony pieces + inspect for brain injury

Diastatic skull fracture

most common in Lamboid sutures (back top), observation and usually no treatment

Compound skull fracture

liner or depressed, blunt force, RX + surgery possible

Basilar skull fraccture

severe blunt trauma w/ significant force, due to proximity to brain stem it is very serious.

Basilar skull fracture SX

CSF rhinorrhea + otorrhea, bleeding from ear, Battle's sign, increased risk of infection

Subdural Hematoma SX

vom, LOC, seizures, irritability, retinal hemorrhhage

Subdural hematoma patho

dura still attached to skull, vein rupture, venous blood

Epidural hematoma Sx

voom, headache, lethargy

Epidural hematoma patho

middle meningeal artery rupture, arterial blood, dura depressed from skull

Epidural hematoma complications

compression occurs rapidly and can cause impairment of brain stem, resp, or cardio function

Epidural hematoma TX

prompt surgical evacuation and cauterization of artery, earlier the better

Spina Bifida

neural tube fails to close as a fetus

Spina bifida SX

neural tube abnormalities, dimpling near butt, abnormal patches of hair, hydrocephalus
flaccid paralysis, absence of reflexes, lack of response to pain/touch, club feet, urine dribble, relaxed anus

Spina bifida complications

mobility, GU function, hydrocephalus, latex allergy, occulta, meningocele, myelomeninocele

Spina bifida DX

prenatal, ultra sound, MRI
assess: movement of extremities + anal reflex

Spina bifida interventions

infection control - sterile gauze, catheter cleaned in vinegar + water
surgical prep + fam comfort
folic acid (leafy greans, fruits, potatoes, grains)

Club foot

mal-aligned feet that resist being moved into normal position

Club foot causes

fetal positioning, intrauterine restriction, boys>girls, myelomeningocele

Club foot assessment

anteroposterior Xray w/ Steeple sign
ultrasound

Club foot TX

serial casting, constant every 2 weeks is primary treatment
surgery + PT

Developmental dysplasia of hip

subluxation of complete dislocation of hip
girls > boys, fetal positioning

Developmental dysplasia of hip appearance

asymetric fold of thighs, femur, and trendelenburg gait (unequal hip height)

Barlow

knees in

Ortolani

knees out

Developmental dysplasia of the hip DX

screening - clunk, xray, ultrasound

Developmental dysplasia of the hip TX

Pavlik harness, surgery if harness fails

Pavlick Harness

continuous < 6mo of age, keeps legs abducted
monitor skin - no lotion or powders
clinic visits q1-2wks

Duchenne muscular dystrophy

progressive loss of function due to muscle loss
hereditary, X-linked, fatal by 25

Duchenne muscular dystrophy SX

normal initial development
3yo - loss of function previously attained fine motor -> gross

Gower's sign

Difficulty rising to standing position

has to walk up legs using hands

occurs in Muscular dystrophy

Duchenne muscular dystrophy teen years

wheelchair

Duchenne muscular dystrophy appearance

shoulder's + arms held back awkwardly when walking, sway back, belly sticks out, thin weak muscles, fat stored in lower legs, falls, clumsy, walks on toes - "foot drop"

Duchenne muscular dystrophy DX

screening tools, DNA tests

Duchenne muscular dystrophy TX

upright position to maintain cardio
deep breathing, chest PT/coughing
persevere ambulation + ADLs
overnight bed rails
monitor for depression

Cerebral Palsy

non-progressive permanent disability
movement, speech, voluntary + involuntary
DX from hypoxia

monoplegia cerebral palsy

one limb, usually arm

Hemiplegia Cerebral Palsy

one side, arm, leg, trunk

Diplegia Cerebral Palsy

both arms or both legs

Quadriplegie cerebral palsy

all limbs

Cerebral palsy TX

IM botulin toxin (promote mobility)

Cerebral palsy common complications

deaf, visually impaired, swallowing, sensory, behavior issues, seizures, mental disability (60%)

Slipped Capital Femoral Epiphysis

head of femur separated from the rest of the femur at growth plate

Slipped Capital Femoral Epiphysis risk factors

overweight, growth spurt, african american

Slipped Capital Femoral Epiphysis SX

painful limp w/ referred pain to thigh or knee
tenderness, painful ROM, decreased hip flexion, pain increased when toes point inward, comfort w/ external rotation, inability to bear weight, trendelenburg gait

Slipped Capital Femoral Epiphysis AX

hx of obesity, XRay is definitive, DO NOT AX ROM

Slipped Capital Femoral Epiphysis tx

immediate surgery, immobilization of joint

Scoliosis

lateral curvature and rotation of the spine

Scoliosis SX

uneven posture, shoulder higher than other, hip/rib asymmetry
severe: cardiac + resp compromised, back pain

Scoliosis AX

screening (touch toes), physical, XRay

Scoliosis TX

brace - prevents worsening, does not cure
surgery if >45 degress, rod replacement and bone grafting

Fracture SX

tenderness, bruising, pallor, limited ROM, non-weight bearing, displaced/non displaced

Fracture AX

xray, ultrasound, 5Ps - pulse, pallor, pain, paralysis, parathesia

Non-displaced Fracture TX

casting - non painful
cast gets warm when forming
may take time to dry

Fracture TX

comfort - sedation
traction - pulling

external fixation devices

bone skrewed into external, osteomyelitis complication

Cast teaching

do not stick anything in cast
check cap refill

Osteomyelitis

bacterial infection in bone + tissue around bone

Osteomyelitis SX

fever, crying, redness, warmth, swelling, pain, limping

Osteomyelitis TX

draw labs, prep for surgery
xray, MRI, CT
antibiotics