MedSurg Exam 4 (peds)

What is the immune system?

Body's defense mechanism against a disease and infection

What is innate immunity?

present at birth (nonspecific)

What is acquired immunity?

gained after birth active or passively

What is active immunity?

Through immunizations or illness

What is passive immunity?

Immunoglobulins or mothers breast milk

What are white blood cells?

cells that attack and destroy the organism causing infection made in the bone marrow

What are B cells?

produce antibodies or immunoglobulins, formed after B lymphocyte encounters and engulfs an antigen, and begins to produce identical copies of antibody

What are T cells?

differentiate on exposure into a subtype of cell that may directly attack antigen or stimulate the activation of other cells

What are phagocytes?

found throughout the body, responsible for recognizing and ingesting foreign antigens as they enter the body

What is inflammation?

The immune systems response to harmful stimuli

What is acute inflammation?

inflammation lasting minutes or weeks that are caused by injuries and infections like splinters, cuts, and sprains

What is chronic inflammation?

inflammation lasting months/years. diet, autoimmune diseases, and general stress are common causes

What are the possible complications of inflammation?

tissue damage and development of chronic inflammation.

What is a hypersensitive reaction?

inappropriate responses of the immune system to a normally harmless substance

What are common triggers for allergic reactions?

dust, animal fur, pollen, molds, foods, insect venom, drugs, latex

What are the clinical manifestations of an allergic reaction?

watery/itchy eyes, runny nose, sneezing, urticaria, angioedema

What is provocative testing?

direct exposure to allergen

What are Serum IgE measurements?

blood draw to determine whether IgE in the blood combines with a specific allergen used for the test

What is a skin prick test?

drops of a dilute solutions of allergens are put on patients skin and pricked with a needle and is evaluated for a reaction

How can food allergies be prevented?

breastfeeding infants until 4-6months, introduce foods to infants by 6 months, avoid foods that that cause a reaction

What is desensitization therapy?

Small amounts of the allergen injected under the skin and gradually increased until maintenance dose is reached

What are antihistamines?

Drugs that block the effects of histamines

What are mast cell stabilizers?

drugs that stop mast cells from releasing histamines and other substances that cause swelling and inflammation

What are corticosteroids?

Prescribed only when symptoms are very severe or widespread and all other treatments are ineffective. must be weened off of steroids.

What is an anaphylactic reaction?

Sudden, widespread, potentially severe and life-threatening allergic reactions. can be caused by any allergen but does not usually occur after first exposure.

What are the manifestations of a anaphylactic reaction?

usually begin within 15 minutes of exposure, symptoms can range from mild to severe but person has the same symptoms each time

What is the therapeutic management of an anaphylactic reaction?

establish an airway, administer epinephrine, give IV fluids, possibly give corticosteroids and bronchodilators, do NOT wait for tests treatment must be given immediately

What is appendicitis?

inflammation of the vermiform appendix

What does the appendix do?

helps maintain normal flora, Stores good bacteria after diarrhea

What are the clinical manifestations of appendicitis?

Abdominal pain (starts at umbilicus & radiates to RLQ), McBurney's point, poor appetite, fetal position, elevated temperature, N/V, decreased or absent bowel sounds, increased WBC, experiencing rebound tenderness

What are the diagnostics for appendicitis?

CBC, Urinalysis (rule out UTI), pregnancy test, CT scan, ultrasound

What are the complications of appendicitis?

rupture, peritonitis, Ileus

What is the pre op nursing care for an appendectomy?

NPO, give IV fluids, pain relief, no heat/enemas/laxatives, monitor for signs of rupture and peritonitis

What are the signs and symptoms of a ruptured appendix?

sudden relief of pain followed by increasing pain

What are the signs and symptoms of peritonitis?

Tachycardia, tachypnea, increased temperature, abdominal bloating and distention

What is the post op nursing care for an appendectomy?

monitor VS, surgical site, encourage ambulation and incentive spirometer, pain control, IV fluids, clear liquid diet until passing gas, antibiotics

What is celiac disease?

an autoimmune gastrointestinal disorder that causes intestinal intolerance that produces mucosal lesions and damages the villi

What are villi?

finger like projections in the wall of the intestine that aid in intestinal absorption by increased surface area

What are the clinical manifestations of celiac disease?

mouth ulcers, anemia, lactose intolerant, N/V, fractures, unexplained slow growth/weight loss, rashes, irregular periods, irritable, greasy/odorous stools, hair loss, diarrhea, enamel changes

How is celiac disease diagnosed?

blood tests checking for the antibodies +Tg, IgA, EMA, biopsy of villi (villi will appear flat)

What are the complications of celiac disease?

malnourished, cancer, refractory disease

What is the treatment for celiac disease?

gluten free diet for life

What is inflammatory bowel disease (IBD)?

chronic intestinal inflammation (ulcerative colitis, Crohn's)

What is ulcerative colitis?

autoimmune disease that causes inflammation and ulcers in the lining of the colon and the rectum. This disease is a continuous pattern

What are the signs and symptoms of ulcerative colitis?

urgent/frequent bowel movements, low RBCs, weight loss, cramping, elevated temperature, electrolyte imbalance, rectal bleeding, severe diarrhea

What are the complications of ulcerative colitis?

flare ups/remission, rupture, toxic megacolon, colon cancer

What is Crohn's disease?

autoimmune disease that causes inflammation in all layer and anywhere in the GI tract, there is no cure, there can be scattered patches of diseased intestine

What are the clincial manifestations of Crohn's disease?

pain, ulcers, diarrhea, fissures, weight loss

What are the complications of Crohn's disease?

abscesses, fistulas, malnourishment, fissures (tears), strictures (narrowing caused by inflammation and scar tissue)

What are the diagnostics for Crohn's disease?

H&P, CBC, ESR, CRP, stool samples, CT/ultrasound, colonoscopy, endoscopy with biopsy, barium enema with X-ray

What is the therapeutic management of IBD?

control inflammation, obtain long term remission, promote normal growth and development, allow for as normal lifestyle as possible, medications, nutritional support, surgical team, NO NSAIDS

What medications are given for IBD?

Sulfasalazine, Mesalamine, Olsalazine, Balsalazide, prednisone given during flare ups.

What immunosupressors are given for IBD?

Azathropine, Immuran: need to monitor liver and pancreatic enzymes, no live vaccines

What is the surgical treatment for ulcerative colitis?

Colectomy & Proctolectomy (removal of colon and rectum), Ileoanal Anastomosis (Stool can pass from small intestines to anus with no permanent ostomy)

What is the surgical treatment for Crohn's disease?

Colectomy & Proctectomy, Strictureplasty (Widen the narrowed area without removal of intestine), bowel resection (Affected part of bowel is removed)

What is the nursing care for IBD?

VS, GI assessments, monitor for complications, regular cancer screenings, NPO but can advance diet as symptoms decrease

What is intracranial regulation?

The ability of the cranial contents (brain, blood, cerebral spinal fluid) to maintain normal intracranial pressure

What are the cranial differences in children ?

open fontanels, cranial sutures ossified by age 5, larger heads with weaker neck muscles, thinner cranial bones, less myelinated nerves (easily injured)

What are the symptoms of increased intracranial pressure (ICP)?

headache, blurred vision, changes in behavior, confusion, high blood pressure, shallow breathing, seizures, vomiting, Weakness or problems with moving or talking, lack of energy

What are the symptoms of ICP in INFANTS?

irritability, difficulty to console, high pitched cry, poor feeding, tense/bulging fontanels, separated cranial sutures, distended scalp veins, setting sun eyes

What is Cushing's triad?

This is the body's last attempt to oxygenate the brain, indicates a SEVERE lack of O2 to brain tissue

What are the 3 signs of Cushing's triad?

widening pulse pressure, bradycardia, apnea/irregular respirations

What is herniation?

abnormal protrusion of brain tissue through openings in rigid intracranial barriers

What can decrease ICP?

sedation, hyperventilation, hydration, mannitol, BP control, corticosteroids, removal of CSF, position (HOB elevated 30 degrees keep head midline), Minimize stressful procedures, Decrease environmental stimuli

How is ICP decreased in extreme measures?

Therapeutic hypothermia: cooling blanket is placed on patient, it is important to gradually bring temp down and monitor for shivering.

Pentobarbital coma: medically induced coma

Decompressive craniotomy: bone flap to make room for brain swelling

How is ICP monitored?

intraventricular catheter: most accurate way of monitoring, catheter is placed into ventricle and can be used to drain CSF

Subdural screw (bolt): used in emergencies, hollow screw is inserted through a hole drilled in the skull into the dura mater

Epidural sensor: sensor is inserted between the skull and dural tissue

What is meningitis?

Inflammation of the protective membranes (meninges) covering the brain and spinal cord

What is viral meningitis?

Viral infection of the meninges, almost never life threatening, usually recovers in 7 days

What are the clinical manifestations of meningitis?

headache and photophobia, hard stiff neck (nuchal rigidity), high fever

What are the diagnostics for viral meningitis?

CSF analysis

What is bacterial meningitis?

acute inflammation of CNS, serious

What precautions are people with meningitis on?

droplet

What is Kernig's sign?

Inability to straighten the leg when the hip is flexed to 90 degrees

What is Brudzinski's sign?

Hips and knees flex when the neck is flexed

What is the diagnosis for ICP?

lumbar puncture

What is the nursing care for a lumbar puncture?

empty bladder, position: rounded back lying on side or bent over, monitor dressing for drainage

What are some long term complications of bacterial meningitis?

epilepsy, motor defects, deafness, visual defects, speech/cognitive defects

What is hydrocephalus?

accumulation of CSF within the ventricles in the brain

What are some causes of hydrocephalus?

imbalance in production/absorption of CSF, developmental defect, trauma, infection, neoplasms, Myelomeningocele

What are the clinical manifestations of hydrocephalus?

headache, blurred vision, changes in behavior, confusion, high blood pressure, shallow breathing, seizures, vomiting, Weakness or problems with moving or talking, lack of energy, large/heavy head

What is the treatment for hydrocephalus?

Ventriculoperitoneal Shunt (Can become infected or obstructed)

What does aldosterone do in the body?

helps regulate blood pressure by Signaling organs (kidneys and colon) to increase the amount of sodium sent into the bloodstream or the amount of potassium released in the urine. too much aldosterone = high BP

What does cortisol do in the body?

regulates the body's stress response, help control metabolism, suppresses inflammation, regulates BP, regulates BS, and controls the sleep-wake cycle

What is Addison's disease?

too little corticosteroids

What are the clinical manifestations of Addison's disease?

low: BP, weight, temp, mood, energy, sodium, glucose, hair

high: pigmentation, potassium

What is Cushing's syndrome?

too much corticosteroids

What are the clinical manifestations of Cushing's syndrome?

high: BP, glucose, sodium

Big: belly, red face, fat pad, hair, risk for fractures

What are the causes of Addison's disease?

autoimmune: body attacks adrenal or pituitary glands

Diseases: cancer or infections

Damage/trauma to adrenal glands

What are the causes of Cushing's syndrome?

long term use of steroids, pituitary or adrenal tumors, small cell lung cancer

What are the treatments for Addison's disease?

steroids (lifelong/long term), Prednisone or Hydrocortisone in times of high stress, IV fluids for low BP, Diet- high protein, carbs, and sodium

What is the treatment for Cushing's disease?

remove tumor, taper steroids

What is an Addisonian crisis?

Significant drop in blood pressure that may lead to hypotensive shock and death

What is a fracture?

Break or crack in a bone when more stress is placed on the bone than that bone can withstand that can be caused by trauma, twisting, or disease

Why are fractures more common in childhood and not infancy?

Bones are less dense and more porous in young children, Children are more active than adults and they have limited gross motor coordination

What is a simple or closed fracture?

Does not produce a break in the skin

What is an open or compound fracture?

Fractured bone protrudes through the skin

What is a complicated fracture?

Bone fragments have damaged other organs or tissues

What is a comminuted fracture?

Small fragments of bone are broken from fractured shaft and lie in surrounding tissue

What is a transverse fracture line?

Crosswise at right angles to the long axis of the bone

What is an oblique fracture line?

Slanting but straight between a horizontal and a perpendicular direction