Pediatrics (NURS 355- Liberty University) Test 3

A young child recently diagnosed with a terminal cancer just told the nurse "I have a secret to tell you, but don't tell mommy and daddy. I'm going to die". The parents don't want to tell the child that he is near death. What do you need to start talking to the parents about?

Discuss a good death- home or hospital, drugs for treatment or for pain relief?

What IQ constitutes cognitive impairment?

<70-75

When are cognitive impairment diagnoses made?

Before 18 years old

What is the most common chromosomal abnormality?

Down syndrome

What one maternal cause can increase the risk for having a Downs baby?

Having her baby >40 years old

What is the most common inherited cause of cognitive impairment?

Fragile X Syndrome

The triage nurse said that she is sending back a Fragile X patient. What do you expected to see? Hear? Find?

See- strabismus, long narrow face with large jaw, big ears, big head, very large testes

Hear- Possible mitral valve prolapse, speech problems

Find- Attention deficit, autistic like, cognitive impairment, possible violence

What hospital cause greatly increases the likelyhood of an infant developing hearing loss?

Them being in the NICU (lots of noise)

What are some causes for hearing impairment?

Chronic ear infection

Perinatal infection

NICU stay

Aanatomic malformation

Asphyxia or prolonged oxygen supplementation

Maternal substance abuse

How to treat conductive hearing loss?

Antibiotics

Tympanoplasty

Hearing aids

How to treat sensorineural hearing loss?

Cochlear implants

When is it best to get a Cochlear implant? Why?

Before 1 year old so the child can learn sounds better and learn as he grows instead of having to relearn and getting frustrated

What kind of visual impairment is normal until age 7?

Hyperopia (farsightedness)

How do you treat amblyopia (lazy eye)? Strabismus?

Eye patch on the good eye

Possible surgical repair

How many kinds of autism are there? What are they?

Two

social communication/interaction

Unusually repetitive behavior/interest in certain activities

Do genetics play a role in autism?

Highly probable

What is one of the biggest life changing things for kids with cognitive impairment?

Early diagnosis and intervention

What condition used to be blamed on delivery doctors?

Cerebral Palsy

What is the cause of most cerebral palsy?

Unknown prenatal causes

What is one major complication of cerebral palsy that happens in 10-15% of the children with this condition?

Epilepsy

What is an intrathecal pump? Who is it used for?

A pump inserted into the intrathecal space for cerebral palsy kids

What medication is in an intrathecal pump? What does it do?

Baclofen, it reduces spasticity in cerebral palsy children

What is the most common defect of the CNS?

Spina bifida

How do you prevent neural tube defects?

Folic acid

What is myelomeningocele?

A form of spina bifida where the spine doesn't fully form correctly and the spinal cord protrudes from the back when the baby is born

What is the treatment for myelomeningocele?

Surgery before or very shortly after birth

If after: Keep the baby NPO until surgery, keep the baby prone, Give pacifier for sucking needs and IV fluids for hydration

What is a common surgery, especially for girls, with spina bifida?

Urinary diversion

What are the four types of spinal muscular atrophy?

1- non-sitters

2- sitters

3- walkers

4- adult onset

Are there treatments/cures for muscular atrophy/dystrophy?

Nope, just supportive care

What is pseudohypertrophy? What kind of patient has this?

When fatty infiltration replaces muscles making them look big, but they are useless

Duchenne Muscular Dystrophy patients

What is one big culprit of infant botulism?

Honey

What are some symptoms of botulism?

Constipation, then flaccid paralysis, then ventilator dependency

What is a partial dislocation of the radial head called in children?

Nursemaids elbow

How do you fix nursemaid's elbow?

Put one hand above the childs elbow and have the childs palm up and hinge it up towards their shoulder

What kids get distraction?

Ones who broke their growth plate at a young age and the bone didn't grow

Midgets (Sorry, can't think of the real name)

What is developmental hip dysplasia? How do you recognize it? How do you treat it?

When a baby is born their hip often pops out of socket. You hear/feel orlantis sign when moving their hips. You treat with a Pavlik's harness

A new mother has a baby with developmental hip dysplasia and asks, " Can I take the harness off the baby at bedtime? I don't think he'll be able to sleep with it on". How do you respond?

The baby will sleep fine in the harness and if you did take the harness off it lets his hip pop back out again

How do you treat clubfoot?

Surgery or serial casting

What is osteogenesis imperfecta?

brittle bone disease

What does an osteogenesis imperfecta patient look like?

Large head, small body, barrel chest, sheperd crook legs, blue sclerae, hearing loss, hypoplastic discolored teeth

Why don't OI kids just get a metal skeleton?

It's like trying to nail together ritz crackers

How do you see scoliosis?

Uneven shoulders and hips

How do you treat scoliosis?

Spinal fusion or bracing

How do you treat juvenile arthritis?

ROM exercises/PT/OT

NSAIDs

RA drugs

Night time splinting

What can you expect to see in an infant with increased ICP?

Bulging fontanels

Separated cranial sutures

Distended scalp veins

Sun-setting eyes

Macewen's sign (melon tap)

What are late signs of increased ICP?

Bradycardia- only condition in children that causes bradying

Decreased LOC, motor response, and sensory response

Fixed and dilated pupils

Papilledema

Flexion or extension posturing

Cheyenne-stokes respirations

What do you do when a child is posturing?

Put them in post cardiac hypothermia

What are some nursing care pieces for a child with increased ICP?

Keep head midline

HOB raised >30 degrees

Avoid coughing, sneezing, blowing nose, etc

Minimize environmental noise

Minimize suctioning

What medications could you give for increased ICP?

Mannitol

Antiseizure meds

Sedatives

Paralyzing agents

Abx

Corticosteroids

What is the main diagnostic point for concussions?

The concussed child asks the same question multiple times

A child comes into the ER with bleeding from a head wound. What do you assess first?

Airway (always check airway first)

What is the biggest preventative for head trauma?

Helmets

When should you take a child to the ER for a head injury?

If they sustained the injury from a high speed injury, a fall greater than the childs height, great force was used, if it is suspicious, or if their LOC changes

or

If they have amnesia, more crying than usual, a worsening headache, fluid draining from the ears and/or nose, black eyes, vomiting more than 3 times after the injury, confusion or behavior changes, swelling by the ears, difficulty arousing, neck stiffness, pupil changes, bulging fontanels, or seizure

When taking care of a head trauma child what is your course of action?

Assess ABC's, stabilize neck, clean abrasions with soap and water, keep NPO, assess pain but no administering analgesics, check pupils q4, awaken twice during the nigt to assess

What is an oddly named major cause of death in children over 1 year old?

Near-drowning

When is a child's death considered to be caused by near-drowning?

If they survived for at least 24 hours after submersion

What kind of cancer accounts for 20% of childhood cancers?

Brain tumors/neuroblastomas

How quickly after contracting bacterial meningitis do kids usually die?

Within 24 hours

What is the most common domestic animal to get rabies from?

Cats (12% of all rabies)

What does Reye's syndrome look like?

Fever

Profuse vomiting

Increased ICP

Poor hepatic function

What causes hydrocephalus?

An imbalance between creation of and absorption of CSF

How do you monitor hydrocephalus?

Head circumference

Fontanel tension

Serial ultrasounds to examine ventricle size

What is the treatment for hydrocephalus?

Ventriculoperitoneal shunt placement

What is a preventative for infection built into the ventriculoperitoneal shunt?

A filter that prevents backflow from the peritoneum into the ventricles

What are post-ventriculoperitoneal shunt placement nursing care items?

Place the child on the non-shunt side

Keep the child laying flat

If ICP increases sit the child up

Gradually raise he head of the bed so the head can get used to draining

When does a child Babinski sign usually go away?

By 2 years old

Define epilepsy?

Two or more unprovoked seizures

Can you have a seizure and not have epilepsy?

Can you have epilepsy and not have a seizure?

Yes- one seizure is not epilepsy

No- epilepsy must have seizures

List some seizure precautions

Pad crib/bed

Keep non-soft objects out of resting area

Always have suction and oxygen

Avoid triggers

Protect from self injury

Maintain airway

Turn on side while seizing

Note time and type

At home give buccal midazolam or rectal diazepam

At hospital give IV diazepam or lorazepam

What are absence seizures?

Lapses in conciousness that are often mistaken for daydreaming or "zoning out"

Always appear in childhood with no warning and inability to recall the episode

What are atonic seizures?

Also known as 'drop attacks' the child will suddenly lose muscle tone and may or may not have a loss of consciousness but will not be able to recall the event

What are myoclonic seizures?

Brief shock-like jerks of a muscle or group of muscles with no post-ictal state

What are febrile seizures?

Benign, transient disorder affecting children largely between the ages of 6 months to 3 years; rare after age 5

Associated with a concurrent illness and temperature elevation

Most likely will NOT progress to epilepsy or neuro damage

What are infantile seizures?

Also known as West syndrome these patients often do not lose conciousness but can have a single or up to 150 episodes a day and has a very poor prognosis

What is the indicator for infantile spasms?

A very unique reading on an EEG

What does an infantile spasm look like?

Jackknifing- legs up, arms up, face skewed

What diet is a child with seizures put on?

Keto

What is the keto diet?

High protein, high fat, low carbs

How many drugs is a pediatric seizure patient normally on for seizures?

One drug

Define status epilepticus

Ongoing seizure for 30 minutes or multiple seizures in succession without sensorium returning to normal between them

What is the treatment for status epilepticus?

Maintain airway

Establish IV

IV diazepam or lorazepam

IV fosphenytoin or phenobarbitol

What do you teach parents when sending them back home with a seizure child?

CPR

Rectal diazepam use

Possible activity restriction

Child may wear helmet

Child MUST swim with other people

Teachers and caregivers must be made aware of the situation

What is another name for the anterior pituitary gland?

Adenohypophysis

What is another name for the posterior pituitary gland?

Neurohypophysis

What is the name of the condition where only the posterior pituitary functions?

Panhypopituitarism

What two things can you use to diagnose growth disorders?

The growth curve and a hand x-ray

When is a child diagnosed with precocious puberty?

White girls- under 7

Black girls- under 6

Boys- under 9

In a girl with precocious puberty what do you normally give her?

Lupron Depot shots every 4 weeks and possible growth hormone

What causes DI?

A lack of anti-diuretic hormone

How do you treat DI?

Hormone replacement with aqueous vasopressin given IM/SQ or nasal spray, or brown suspension

What is SIADH?

Over secretion of antidiuretic hormone that cause retention of fluids

What usually causes SIADH?

An infection, tumor, or CNS disease of trauma

What is the most common cause of hyponatremia in the pediatric population?

SIADH

Why does SIADH cause hypotonicity?

Decrease calcium levels

What is one of the biggest nursing interventions for an SIADH patient?

Fluid restriction and daily weights

Why would you possibly hear S4 in a child?

SIADH

What are the three hyperthyroid therapy options?

Methimazole (anti-thyroid drug)

Sub-total thyroidectomy

Total surgery or radioiodine treatment

What is the most common endocrine disorder in children?

Hypothyroidism

Hypoparathyroidism has what effects in children?

Poor growth

Muscle contractions

Neurologic seizures or headaches

GI problems

Why is it important to manage hypoparathyroidism?

Laryngospasms can occur

Low calcium can cause major GI upset and tetany