pediatric final exam

what are five nursing interventions for immune disorders?

prevent infection, prevent/manage allergic reactions, promote skin integrity, promote comfort and health, and immunizations

what is the definition of juvenile idiopathic arthritis?

inflammation primarily affecting joints of children, antibodies primarily target the synovial joints, resulting in decreased mobility, swelling, and pain

what is the diagnostic criteria for juvenile idiopathic arthritis?

inflammation in one or more joints, lasting more than six weeks, and diagnosed prior to 16 years old

at what age does diagnosis of juvenile idiopathic arthritis peak?

between one and three years, just about the time they’re learning to walk/balance

what are systemic symptoms of juvenile idiopathic arthritis?

fever, rash, lymphadenopathy, splenomegaly, hepatomegaly

what are joint symptoms of juvenile idiopathic arthritis?

joint inflammation, pain, redness, warmth, stiffness, swelling, abnormal gait, morning pain

what are growth effects of juvenile idiopathic arthritis?

slow growth rate, uneven growth of extremities, early closure of epiphyseal plates

what are long term effects of juvenile idiopathic arthritis?

small joint contractures, synovitis

what is the definition of oligarthritis?

juvenile idiopathic arthritis affecting one to four joints

what is the most common type of juvenile idiopathic arthritis?

oligarthritis

what type of juvenile idiopathic arthritis is the most severe and complex?

systemic arthritis

what is the definition of polyarthritis?

juvenile idiopathic arthritis affecting five or more joints

what is the definition of uveitis?

inflammation of the middle layer of the eye that can occur with juvenile idiopathic arthritis

what is the definition of systemic arthritis?

high fever, swollen painful joints, rash, affects internal organs and joints

what is pain management for juvenile idiopathic arthritis?

NSAIDs (take with food to avoid GI upset) with corticosteroids as a last resort because of growth inhibition and immunosuppression risks

how can we preserve function in patients with juvenile idiopathic arthritis?

physical therapy, range of motion activities, warm compresses/baths, provide extra time to perform ADLs especially in the morning`

what is additional parent teaching for juvenile idiopathic arthritis?

regular eye exams due to risk of uveitis

what are respiratory symptoms of allergic disorders?

itchy watery eyes, itchy runny nose, sneezing, cough, wheezing, chest tightness, shortness of breath

what are skin reactions of allergic disorders?

rash, hives, swelling, redness, pain

what are gastrointestinal symptoms of allergic disorders?

stomach cramps. bloating, vomiting, diarrhea

what are severe symptoms of allergic disorders?

tongue swelling, throat closing, feeling faint, feeling light headed, a sense of impending doom

what is the definition of anaphylaxis?

an acute immediate and severe IgE-mediated response to an allergen; medical emergency

what are some symptoms of anaphylaxis?

itching, hives on hands/feet, cough, dyspnea, sweating, tachycardia, chest pain, asthma attach, stridor, wheezing

what is treatment of anaphylaxis?

ABCs! depends on symptoms and may include antihistamines, bronchodilators, corticosteroids, preventative inhaled medications, and epinepherine

what are examples of environmental allergens?

pollen, dust mites, mold, animal dander, plants, dyes, chemicals

what are examples of medication allergens?

antibiotics, sulfa drugs

what are examples of food allergens?

cow’s milk, eggs, wheat, soy, peanuts, tree nuts, fish, shellfish

who typically has an allergy to latex?

children with spina bifida

what are examples of testing for allergies?

allergy skin prick tests, RASTS, blood IgE tests, food challenge tests1

what are the four key parts of the endocrine system?

pituitary gland, thyroid gland, pancreas, adrenal glands

what is the function of the pituitary gland?

the “master gland” that controls growth and development in children, producing hormones that signal other glands

what is the function of the thyroid gland?

regulates metabolism and energy production, critical for normal growth and brain development

what is the function of the pancreas?

produces insulin and glucagon to regulate blood sugar levels, a key concern in pediatric diabetes

what is the function of the adrenal glands?

produce hormones that help control metabolism, immune system, blood pressure, and stress response

what is the definition of growth hormone deficiency?

decreased activity of the pituitary gland resulting in too little growth hormone production, affecting both physical growth and development of secondary sex characteristics

what is the clinical presentation of growth hormone deficiency?

normal height/weight at birth, growth falls below third percentile, small mandible and nose, delayed puberty onset

what is the treatment for growth hormone deficiency and how is it administered?

recombinant human growth hormone (rhGH) administered IM at bedtime, stimulates normal hormone peaks, promotes bone growth, and prevents premature epiphyseal growth

what is hyperpituitarism?

increased activity of the pituitary gland with too much growth hormone secreted, causing inappropriately increased growth

what is the presentation of hyperpituitarism?

unfused growth plates, can grow to be seven to eight feet tall

if a patient has hyperpituitarism, what is it called if the growth plates are fused?

acromegaly

what is the definition of central precocious puberty?

the hypothalamus is activated prematurely to secrete gonadotropin-releasing hormone, causing early pubertal changes

at what age is puberty considered to be central precocious puberty?

before 8 in girls and 9 in boys

what is the definition of peripheral precocious puberty?

premature development of secondary sex characteristics due to genetic syndromes or tumors

what is the treatment for hyperpituitarism?

depends on the cause, with surgical removal for pituitary adenoma being the most common

what is the treatment for central/peripheral precocious puberty?

gonadotropin releasing hormone agonists like leuprolide (Lupron)

what is the definition of congenital hypothyroidism?

a condition of deficient thyroid hormone production from birth

what is the clinical presentation of congenital hypothyroidism?

no signs and symptoms at birth, persistent open posterior fontanelle, thickened protuberant tongue, hypotonia, hypoactivity, and an abdominal mass upon palpation

what is treatment for congenital hypothyroidism?

synthetic thyroid hormone (levothyroxine)

what is the pathophysiology of type one diabetes mellitus?

autoimmune condition causing pancreatic beta-cell damage that impairs secretion of insulin

what is the classic triad of clinical manifestations of type one diabetes mellitus?

polyuria, polydipsia, polyphagia

what are symptoms of diabetic ketoacidosis?

nausea, vomiting, abdominal pain, dehydration, fruity breath, deep rapid breathing (Kussmal respirations)

what is treatment for type one diabetes?

continuous glucose monitoring, insulin therapy, nutrition therapy

what is the pathophysiology of type two diabetes?

insulin resistance, increased growth hormone secretion

what are symptoms of type two diabetes?

polydipsia, polyuria, blurred vision, fatigue

what is the treatment of type two diabetes?

normalize blood glucose levels with weight loss, exercise, and diet modification

what are symptoms of hypoglycemia?

tremors, shakiness, pallor, diaphoresis, confusion, irritability

what is the neuromuscular system made up of?

the peripheral nervous system and the muscular system

what makes up the peripheral nervous system?

12 cranial nerves and 31 spinal nerves

t/f: the neuromuscular system is fully formed at birth but immature

true

what types of factors can interrupt or damage development of the nervous/neuromuscular system?

intrinsic factors and extrinsic factors

what is an example of an intrinsic factor?

genetic defects like muscular dystrophy

what is an example of an extrinsic factor?

toxins in the environment like lead

what are key questions when assessing the pediatric neuromuscular system?

prenatal history, perinatal history, gestational age, birth complications, and newborn assessment

what is the definition of hydrocephalus?

a buildup of cerebrospinal fluid in a patient’s brain

what are causes of hydrocephalus?

body is producing increased amounts of cerebrospinal fluid (CSF), body has decreased ability to absorb CSF, or obstruction of flow of CSF

what is the cause of communicating hydrocephalus?

increased CSF production or decreased CSF absorption

what is the cause of noncommunicating hydrocephalus?

obstruction preventing proper flow causing CSF to build up in the brain

symptoms of hydrocephalus are consistent with what?

increased intracranial pressure

what are signs and symptoms of hydrocephalus

enlarging occipitofrontal head circumference, dilated scalp veins, separation of cranial sutures, frontal bossing (enlarged forehead), sunsetting eyes, irritability due to increased pain, emesis, poor feeding

how is hydrocephalus treated?

placement of a shunt to pass CSF to the peritoneal cavity or pleural space

what is the key assessment for hydrocephalus patients?

head circumference

what are key nursing interventions for hydrocephalus?

use pillows to wedge child to assist with laying on their side, continued monitoring of head circumference and neurological assessment to monitor for continued shunt function is essential

what are signs and symptoms of increased intracranial pressure?

irritability, increased sleepiness, shrill/high pitched cry, nausea/vomiting, complaints of stiff neck or headache, seizures, difficulty walking, crossed eyes, blurred vision, unequal size pupils, increased head circumference, bulging fontanelle, altered level of consciousness

what is the definition of meningitis?

an inflammation of the meninges of the brain

what type of meningitis is more dangerous?

bacterial

how is meningitis spread?

close contact with respiratory secretions or hematological/nasopharyngeal inoculation (vaccines)

what age group is at the greatest risk for bacterial meningitis?

newborns and infants

bacterial meningitis may occur secondary to what infections?

otitis media, sinusitis, pharyngitis, pneumonia

what is the body’s inflammatory response to infectious organisms?

brain becomes inflamed and edematous, leading to cerebral edema and increased intracranial pressure

what are clinical manifestations of meningitis in infants?

bulging fontanelle, high pitched cry, fever, hypothermia, poor feeding, restless, irritable, vomiting, diarrhea, dark purple rash

what are clinical manifestations of meningitis in older children?

nuchal rigidity (stiff neck), fever, altered consciousness, vomiting, rash, headache, photophobia

how is brudzinski’s sign performed?

have the child laying supine and try to raise the child’s head toward their chest and place their chin on their chest

what is considered a positive brudzinski’s sign and what does it indicate?

if resistance or pain is met, may flex hip and knees in reaction, indicates meningeal irritation

how is kernig’s sign performed?

lay child supine, flex the leg and hip to 90 degrees and try to straighten it out

what is considered a positive kernig’s sign and what does it indicate?

spinal pain or resistance, indicates meningeal irritation

what is opisthotonic positioning and with what condition is it associated?

child will hyperextend neck and head to relieve discomfort, associated with bacterial meningitis

how is a meningitis diagnosis confirmed?

lumbar puncture and CBC

t/f: all children suspected of meningitis are initially treated with antibiotics, and if it is found to be viral, antibiotics are stopped

true

what are nursing interventions for a patient with meningitis?

watch fluid status with intake and output (too much fluid can cause/exacerbate cerebral edema), having a room near the nurse’s station, decreasing temperature in the room to aid with uncomfortable fevers, analgesia for headaches, nonstimulating dark environment, seizure precautions, monitor for shock and embolic complications

what is reye syndrome and what causes it?

acute non-inflammatory encephalitis and fatty degenerative liver failure that occurs when a child takes aspirin during a viral illness (typically influenza A/B or varicella)

why is reye syndrome difficult to diagnose?

it mimics other metabolic diseases

how is reye syndrome diagnosed?

biopsy

what is the clinical presentation for reye syndrome?

altered LOC, hepatic dysfunction associated with fatty liver, vomiting, CSF with WBCs

whay are the medicines used to treat reye syndrome?

corticosteroids, diuretics, and insulin

what are nursing interventions for reye syndrome?

bleeding precautions and seizure precautions

what is the definition of epilepsy?

seizure actvity that is recurrent and unprovoked

what are possible causes for a seizure?

structural (tumor, cyst), genetic, infectious, metabolic, immune, head trauma, unknown

what is the definition of a seizure?

an electrical disturbance within the brain

seizures are classified according to what?

where the seizure begins, altered LOC associated with seizure, and type of activity exhibited during the seizure

what is the definition of a simple seizure?

consciousness is not impaired, can involve senses or motor function