NR 322 Nursing of Children: Exam Three Study Guide
1. Review Hirschsprung Disease. What is it? Complications? Treatments?
Absence of parasympathetic
... [Show More] ganglionic cells (help sphincters relax) in a segment of the colon, usually at the distal end of the large intestine. The lack of nerve innervation causes an absence of, or alteration in, peristalsis in the affected part of the colon (have trouble relaxing to have BM). MAJOR hallmark sign is absence of that first stool as newborn, called meconium.
Congenital disorder
Disease progression causes most complications. Complications include severe diarrhea, bowel perforation, sepsis, incontinence, stricture formation, enterocolitis, and hypovolemic shock.
Treatment includes surgery to remove the part of the colon without the functioning nerves.
2. Review Crohn’s disease vs. ulcerative colitis. Similarities vs. differences?
Both inflammatory bowel diseases.
3. Management of trauma in children – goals of care, signs of renal trauma, cerebral trauma,etc.
ABCs!!!!
4. What is pyloric stenosis? How do we care for these kids, what complications are we trying to prevent?
Pyloric stenosis is hyperplasia (increased mass) and hypertrophy (increased size) of the circular muscle at the pylorus, the lower opening o the stomach leading into the duodenum. The increased mass and size of the muscle narrows the canal, preventing the stomach from emptying normally. In some cases pyloric obstruction can occur because of the stenosis which leads to vomiting and gastritis from prolonged filling of the stomach. It is most commonly seen in boys between ages 1 and 6 months. Other complications are malnutrition (from lots of vomiting), dehydration (can’t keep anything down), infection, and metabolic alkalosis.
5. Review Intussusception – what is it, symptoms, treatment?
Intussusception is a telescoping of the bowel segments into itself.
S/S: colicky pain characterized by screaming, drawing knees to chest, sweating, and grunting. Vomit containing bile or fecal matter can occur, which can lead to S/S of dehydration, fluid and electrolyte imbalances, and metabolic alkalosis. Red, currant jelly like stool containing mucus and blood is also seen. Inspection and palpation of abd may reveal a distended and tender section. Other signs are fever, increased pulse, shallow resp, and decreased BP.
Treatment includes NG tube to decompress the intestine and minimize vomiting. Therapy may include spontaneous reduction of the bowel, hydrostatic reduction, or surgery.
6. Review the different types of Hepatitis? How are they spread?
BOWELS ARE THE VOWELS.
B AND D GO TOGETHER!!!!
Hepatitis A: This type is caused by consuming infected food or by drinking infected water. Hepatitis A does not result in any chronic disease.
Hepatitis B: This type is basically a sexually transmitted disease (STD). Hepatitis B virus causes this type that can spread by contact with infected semen, blood and some other fluids.
Hepatitis C: This type is spread from a direct contact with an infected person. Hepatitis C Virus causes this type. It has been seen that about 20% of hepatitis C people also suffer from cirrhosis -
Hepatitis D: People who are already suffering from hepatitis B can also get infected with hepatitis D. Hepatitis D virus causes this type. Any contact with perforation of the skin, infected blood and unprotected sex leads to infection. The swelling of the liver is caused by hepatitis D.
Hepatitis E: Anyone can get infected by drinking water containing hepatitis E virus
7. What is hydrocephalus? How do we treat it? Goals of care? How do we minimize complications?
Hydrocephalus is an excess accumulation of CSF within the ventricles of the brain, resulting from interference with normal circulation or absorption of fluid.
Treatment involves removal of the obstruction or creation of a new CSF pathway to divert excess CSF. The bypass is accomplished with a VP shunt or tube, which leads from the ventricles, out of the scull, and passes under the skin into the peritoneal cavity.
The goal of treatment is to bypass the obstruction and drain the fluid from the ventricles to an area where is can be reabsorbed.
Complications of hydrocephalus include mental retardation, impaired motor function, and vision loss. The most serious complication associated with shunt placement is infection. Shunt malfunction is the other major complication and is caused by such mechanical problems as kinking, plugging, migrating, and tube separation.
Severity of complications depends on underlying medical or developmental problems, severity of initial symptoms, and timeliness of diagnosis and treatment
8. What is acute glomerulonephritis? Signs/symptoms? Treatment?
Acute glomerulonephritis is when the glomeruli (filters of the kidney) get inflamed and don’t filter as affectively as they should.
Can be primary (happens on its own) or can be secondary (caused by something else such as trauma or strep infection).
S/S include dark brown-colored urine (PROTEINURIA, OLGURIA, HEMATURIA), Sore throat, fatigue and lethargy, Increased breathing effort, headache, High blood pressure, seizures (may occur as a result of high blood pressure), rash, weight loss, anorexia, fever, joint pain and stiffness, pallor, edema, mild anemia.
Treatment includes antibiotics and possibly; diuretics, antihypertensives, and corticosteroids.
9. What is nephrotic syndrome? Goals of care? Signs/symptoms?
Nephrotic syndrome is when the kidneys are excreting too much protein (proteinuria), which leads too low levels of protein in the body.
S/S include; edema, periorbital edema, scrotal edema, hypoalbuinemia, and hyperlipidemia. Lots of protein in urine.
Goals of care include making sure the nephrotic syndrome doesn’t progress to end stage renal disease, prevent hypovolemic shock, prevent venous thrombosis, skin care, risk for infection (loss of protein makes body not able to fight infection well), risk for resp difficulties, and watching for adverse reactions to steroid therapy. Include a high protein diet in plan of care.
CHILDREN MORE AT RISK FOR FLUID VOLUME DEFIT AND OVERLOAD SO ASSESS ASSESS ASSESS!!!
10. Signs/symptoms of appendicitis? Complications of appendicitis? Nursing interventions?
11. Review Diabetes Insipidus.
12. Review SIADH. What is it? How do we treat it?
Pathophysiology SIADH occurs when ADH is released despite normal or low plasma osmolarity.
Results from abnormal production or sustained secretion of ADH.
Fluid retention. serum hypoosmolality. Diluted hyponatremia.l hypochloremia. Concentrated urine in the presence of normal or increased intravascular volume and normal renal function.
Clinical Manifestations
Extracellular fluid volume expands
Plasma osmolality declines
GFR increases
Na decreases muscle cramping, pain, weakness
Initially pts have thirst, dyspnea on exertion, and fatigue
Low urinary output and increased body weight
Severe symptoms: V/ abd cramps muscle twitching, seizures
Low urine output with a high specific gravity, a sudden weight gain without edema, or a decreased serum sodium level. Monitor intake and output, vital signs, and heart and lung sounds. Observe for signs of hyponatremia, including seizures, nausea and vomiting, muscle cramping, and decreased neurologic function.
Complications As plasma osmolality and Na decrease cerebral edema may occur, leading to lethargy, anorexia, confusion, HA, seizures, and coma
Treatments
treatment is directed at the underlying cause.
Medications that stimulate the release of ADH should be avoided or discontinued
If symptoms are mild and serum sodium is greater than 125 mEq/L (125 mmol/L), the only treatment may be a fluid restriction of 800 to 1000 mL/day.
- This restriction should result in gradual reductions in weight, a progressive rise in serum sodium concentration and osmolality, and symptomatic improvement.
In cases of severe hyponatremia (less than 120 mEq/L), especially in the presence of neurologic manifestations such as seizures, IV hypertonic saline solution (3% to 5%) may be slowly administered. A loop diuretic such as furosemide (Lasix) may be used to promote diuresis, but only if the serum sodium is at least 125 mEq/L (125 mmol/L) because it may promote a further loss of sodium. Because furosemide increases potassium, calcium, and magnesium losses, supplements may be needed. A fluid restriction of 500 mL/day may be indicated for those with severe hyponatremia.
-Vasopressin receptor antagonists, tolvaptan (Samsca) and conivaptan (Vaprisol), are used to treat euvolemia-hyponatremia in hospitalized patients. These medications should be initiated in a closely monitored setting to prevent rapid correction of serum sodium.
Nursing interventions In the acute care setting restrict the patient's total fluid intake to no more than 1000 mL/day (including that taken with medications) and obtain daily weights. Position the head of the bed flat or elevated no more than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Frequent turning, positioning, and range-of-motion exercise (if patient is bedridden) are important to maintain skin integrity and joint mobility. Protect the patient from injury (e.g., assist with ambulation, bed alarm) because of the potential for alterations in mental status. Implement seizure precautions. Provide the patient with frequent oral care and distractions to decrease discomfort related to thirst from the fluid restrictions.
The use of ice chips or sugarless chewing gum helps to decrease thirst. Have the patient weigh daily to monitor changes in fluid balance. Teach the patient to supplement the diet with sodium and potassium, especially if loop diuretics are also prescribed. Solutions of these electrolytes must be well diluted to prevent gastrointestinal (GI) irritation or damage. They are best taken at mealtime to allow mixing with and dilution by food. Teach the patient the symptoms of fluid and electrolyte imbalances, especially those involving sodium and potassium
13. What is juvenile hypothyroidism? Signs/symptoms? Treatments?
14. Review diabetes mellitus.
15. What is DKA? Treatments?
Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.
16. Review the levels of consciousness.
17. Review a normal vs. abnormal neurological assessment.
18. Review what to do during a pediatric trauma – what are our priorities?
ABCs, assess extent of injury, hold neck still.
19. Review post-concussion syndrome.
Post-concussion syndrome is a complex disorder in which various symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion.
Concussion is a mild traumatic brain injury, usually occurring after a blow to the head. Loss of consciousness isn't required for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn't appear to be associated with the severity of the initial injury.
In most people, post-concussion syndrome symptoms occur within the first seven to 10 days and go away within three months, though they can persist for a year or more.
Post-concussion syndrome treatments are aimed at easing specific symptoms.
20. Review bacterial meningitis. What is it? Treatments?
Bacterial meningitis is inflammation of the meninges caused by a bacterial infection. It is diagnosed by a lumbar puncture. It is a life-threatening disease. If meningitis is suspected they will be treated with antibiotics until the lumbar puncture comes back declaring if its viral or bacterial. If bacterial then treatment with antibiotics is imperative. The patient should be isolated because they are very contagious. It is important to keep the noise to a minimum and the lights dim because they are hypersensitive to light and sound. Use a calm reassuring voice. It is important to maintain isolation with these kids for at least 24 hours after the antibiotics are started.
21. Review seizures – types, treatments.
Febrile: seizure because high temperature
Seizure treatment includes MAKING SURE CHILD IS KEPT SAFE WHILE SEIZURE IS OCCURING, anticonvulsants, or having surgery to remove a tumor, lesion, or portion of the brain that is causing the seizures.
22. Review GCS.
THE HIGHER THE SCORE THE MORE ALERT.
OPTIMAL = 15
WORST =3
23. How to care for the immobilized child. Concerns related to immobilization?
Immobilization means you cannot move.
Immobilization can lead to increased risk for fractures, osteoporosis, falls, impaired skin integrity.
It is important to have them on falls precautions and check skin integrity regularly.
The immobilized child is at increased risk for depression, isolation, and anxiety. They have an increased risk of DVT, atrophy, weakness, pneumonia, and skin problems.
There metabolism decreases and because of immobilization have the physiological affect that causes venous stasis and DVTs.
Just because a child is immobilized doesn’t mean you cannot take then out of bed. Take them in a ride in a wagon.
24. Sports injuries and adolescents.
25. What is JIA (JRA)? Treatments?
Chronic inflammatory disease that affects the joints. Causes swelling, painful tender joints, less mobility. Nursing considerations = heat, NSAIDS, education, when inflamed don’t do ROM
Firs line of treatment is with NSAIDS, then move to corticosteroids if the inflammation and pain doesn’t get better.
26. What is systemic lupus erythematosus? Treatments?
SLE is an autoimmune disease that affects connective tissue and blood vessels. For unknown reasons, the body attacks itself by attacking healthy cells and tissues leading to inflammation and damage. It occurs more in girls ages 15-44 years old. They get a butterfly rash on the face. They need to stay out of the sun because of their medications and skin sensitivity. SLE cannot be cured by treatments are; corticosteroids, immunosuppressants, anti-inflammatory medications such as NSAIDS and COX 2 inhibitors, hydroxychloroquine, and holistic treatments.
27. What is CP? Treatments? Types?
Cerebral Palsy is a non-progressive, neuromuscular disorder. It results from damage or developmental defects in part of the brain that controls motor function. Kids with CP cannot control movements in certain parts of their body. They may have completely normal intelligence and may feel as if they are trapped in a body they cannot control. CP cannot be cured but proper treatment can help affected children reach their full potential within the limitations set by this disorder. Treatments can include; baclofen (Lioresal) pump inserted to treat spasticity, oral muscle relaxants, neurosurgery, braces and splints, ROM exercises, artificial urinary sphincters may be indicated for incontinent child.
Caused by brain damage. Non-progressive. Occurs when brain is still under development. (1st 28 days of life). Lack of oxygen (umbilical cord, malpractice, negligence, infections that mom has, injury, shaken baby syndrome, abuse) oxygen supply to brain impaired.
Posture and balance, muscle tone, fine and gross motor skills
Hard to assess what extent of damage is because they are not walking talking yet but can predict what their outlook might be but there is no way to tell for sure.
Child will have better chance if connected with speech, pt, ot to develop as optimally as possible.
There are three types of CP: 1. Spastic 2. Athetoid 3. Ataxic
28. What is Guillain-Barre syndrome? Treatments?
Guillain-Barre is an acute rapidly progressing potentially fatal form of polyneuritis. It leads to deteriorating motor function and paralysis that progresses in an ASCENDING pattern. It affects the peripheral nervous system redulting in edema and inflammation of the affected nerves and loss of myelin. It usually occurs 1-3 weeks after an upper respiratory infection or GI infection. It is caused by an immune response to an infectious organism.
SYMMETRICAL PARAYLISIS (occurs symmetrically starting at feet) STARTS AT FEET AND MOVES UP) Emergence because can hit diaphragm and make them not to breathe and need artificial airway.
The treatment is primarily supportive with special attention to the respiratory, neurologic, and cardiovascular systems and with early recognition of deteriorating status. It is also treated with plasmapheresis, high dose immunoglobins, monitoring nutrition, serum albumin levels, calorie counts, and weights, may require mechanical ventilation and continuous ECG monitoring.
29. What is muscular dystrophy? What is Duchenne muscular dystrophy?
Skeletal muscles help move and they weaken over time. Reason they become weak is genetic. [Show Less]