Upgrade to remove ads
Only $35.99/year

Quiz 7

Terms in this set (137)

What is the most common chromosomal abnormality in children?
What is it evidenced by?
How does it occur?
1) Down syndrome
2) evidenced by various physical characteristics and by cognitive impairment
3) occurs when cell division is abnormal; as a result, there is extra genetic material from chromosome 21 and, in less than 5% of cases, a translocation of chromosome 21
What are common associated problems with Down syndrome?
1) cardiac defects
2) respiratory infections
3) feeding difficulties
4) delayed developmental skills
5) mental retardation (low IQ range of 20-70)
6) skeletal defects
7) altered immune function
8) endocrine dysfunctions; hypothyroidism; diabetic muscular infarction (DMI)
What are common physical characteristics of a child with Down syndrome (from head to toe)?
1) small head
2) flat, wide nasal bridge
3) inner epicentral eye fold
4) upward, outward slant of eyes
5) brush field spots on the iris (white spots)
6) small, irregularly shaped ears; low-set
7) small mouth and protruding tongue
8) short neck
9) short, stubby hands with a single crease in palm (Simian crease)
10) short arms and legs in comparison to their body
11) short in stature
12) hypotonic flexibility
13) atlantoaxial instability
14) short, stubby toes with an enlarged space between the big toe and other toes
15) hyper extensible and lax joint (hypotonia)
What are the nursing plans and interventions for a child with Down syndrome?
1) assist and support parents during the diagnostic process and management of child's associated problems
2) assess and monitor growth and development
3) teach use of bulb syringe for suctioning nares
4) teach signs of respiratory infection
5) assist family with feeding problems
6) feed to back and side of mouth
7) monitor for signs of cardiac difficulty or respiratory infection
8) refer family to early intervention program
9) refer to other specialists as indicated: nutritionist, speech therapist, physical therapist, and occupational therapist
What is the nursing goal in caring for a child with Down syndrome?
help the child reach their optimal level of functioning
What is cerebral palsy?
Non progressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (involuntary movements). This injury can occur to a healthy infant during uterine development, the birthing process, or exposure to an infection such as meningitis during the early years of development; it is irreversible. The extent of the damage is dependent on the location of trauma to the brain; the symptoms either worsen or improve overtime
What are some associated problems that may occur in a child with cerebral palsy?
cognitive impairment or seizures
What are some causes of cerebral palsy?
1) anoxic injury before, during , or after
2) maternal infections
3) kernicterus
4) low birth weight (major risk factor)
What are the nursing assessments done for a child with cerebral palsy?
1) persistent neonatal reflexes (Moro, tonic neck) after six months
2) delayed developmental milestones
3) apparent early preference for one hand
4) poor suck, tongue thrust
5) spasticity (may be described as "difficulty with diapering" by mother or caregiver)
6) scissoring of legs (legs are extended and crossed over each other, feet are plantar flexed; A common characteristic of spastic CP)
7) involuntary movements
8) seizures
What are the nursing plans and interventions for a child with cerebral palsy?
1) identify CP through follow-up of high-risk infants such as premature infants, breech births, cardiac and/or respiratory distress during birth, low Apgar scores, a product of multiple pregnancies, and/or severe jaundiced
2) refer to community-based agencies
3) coordinate with physical therapist, occupational therapist, speech therapist, nutritionist, orthopedic surgeon, and neurologist
4) support family through grief process at diagnosis and throughout the child's life, caring for severely affected children is very challenging
5) administer anticonvulsant medications such as phenytoin (Dilantin) if prescribed
6) administer diazepam (Valium) for muscle spasms if prescribed
How is an infant or child with cerebral palsy to be fed?
use nursing interventions to prevent aspiration through positioning the child upright and supporting the lower jaw
What is the minimum amount of symptoms a child up to 16 years old need to exhibit to be identified as having Attention Deficit Disorder?
six of the inattention symptoms
What are ADD orders classified as?
both neurodevelopment and genetic
What is spina bifida?
Malformation of the vertebrae and spinal cord resulting in varying degrees of disability and deformity depending on the location of the malformation. It is often referred to as a neural tube defect
What are the different types of spina bifida?
1). spina bifida occulta
2) meningocele
3) myelomeningocele
What is spina bifida occulta?
defect of the vertebrae only; no sac is present and it is usually a benign condition, although bladder and bowel issues may occur
What is the difference between meningocele and myelomeningocele?
What is the same?
1) meningocele contains only meninges and spinal fluid and has less neurologic involvement than a myelomeningocele
2) myelomeningocele is more severe than meningocele because the sac contains spinal fluid, meninges, and nerves
3) both have a sac present at some point along the spine
How does one prevent their child from developing spina bifida?
Women in childbearing years before and during pregnancy should consume a minimum of 400 micrograms of folic acid daily , whether from a supplement or folic-enriched foods such as egg yolks, dark green vegetables, citrus fruits, juices or beans
What should every child with spina bifida be screened for?
latex allergy
What are the nursing assessments for a child with spina bifida?
1) spina bifada occulta: dimple with or without hair tuft at base of spine
2) presence of sac in myelomeningocele is usually lumbar or lumbrosacral
3) flaccid paralysis and limited or no feeling below the defect
4) head circumference at variance with norms on growth grids
5) associated problems
What are the associated problems with spina bifida?
1) hydrocephalus (90% with myelomeningocele)
2) neurogenic bladder, poor sphincter and tone
3) congenital dislocated hips
4) club feet
5) skin problems associated with anesthesia below the defect
6) scoliosis
What are the nursing plans and interventions in pre-operative period for a child with spina bifida?
1) keep sac free of stool and urine
2) cover sac with moist sterile dressing
3) elevate foot of bed and position child on his or her abdomen, with legs abducted
4) measure head circumference at least every 8 hours or every shift; check fontanel
5) assess neurologic function
6) monitor for signs of infection
7) empty bladder using Credé method, or catheterize if needed
8) promote parent-infant bonding
What are the nursing plans and interventions in the postoperative period for a child with spina bifida?
1) place infant in prone position
2) make same assessments as preoperatively
3) assess incision for drainage and infection
4) assess neurologic function
What is the long-term care for a child with spina bifida that needs to be taught to the family?
1) teach family catheterization program when child is young
2) help older children to learn self-catheterization
3) administer propantheline (Pro-Banthine) or bethanechol (Urecholine) as prescribed to continue to improve continence
4) develop bowel program (high-fiber diet, increased and regular fluids, suppositories as needed)
5) assess skin condition frequently
6) assist with range-of-motion (ROM) exercises, ambulation, and bracing, if client is able
7) coordinate with team members: neurologist, orthodontist, urologist, physical therapist, and nutritionist
What are the indications of phenobarbital (PO, IM, IV)?
1) tonic-clonic and partial seizures
2) longest acting of common barbiturates
3) usually combined with other drugs
What are adverse reactions of phenobarbital (PO, IM, IV)?
1) drowsiness
2) nystagmus
3) ataxia
4) paradoxic excitement
What are the nursing implications for phenobarbital (PO, IM, IV)?
1) therapeutic levels: 15.40 mcg/mL
2) avoid rapid IV infusion
3) monitoring blood pressure during IV infusion
What are the indications for phenytoin (PO,IV)?
tonic-clonic and partial seizures
What are some adverse reactions of phenytoin (PO, IV)?
1) gingival hyperplasia
2) dermatitis
3) ataxia
4) nausea, anorexia
5) bone marrow depression
6) nystagmus
What are the nursing implications of phenytoin (PO, IV)?
1) therapeutic levels: 10-20 mcg/mL
2) monitor any drug interactions
3) do not administer with milk
4) ensure meticulous oral care
5) monitor CBC
6) report to physician if any rash develops
7) for IV administration, flush IV line before and after with normal saline only
What are the indications for fosphenytoin sodium (IM, IV)?
1) generalized convulsive status epilepticus
2) prevention and treatment of seizures during neurosurgery
3) short-term parenteral replacement for phenytoin oral (Dilantin)
What are the adverse reactions for fosphenytoin sodium (IM, IV)?
1) rapid IV infusion can cause hypotension
2) severe: ataxia, CNS toxicity, confusion, gingival hyperplasia, irritability, lupus erythematosus, nervousness, nystagmus, paradoxic excitement, Stevens-Johnson syndrome, toxic epidural necrosis
What are the nursing implications for fosphenytoin sodium (IM, IV)?
1) use for short-term parenteral use (IV infusion or IM injection) only
2) should always be prescribed and dispensed in phenytoin sodium equivalents (PEs)
3) before IV infusion, dilute D5W or NS to administer
4) infuse at IV rate of no more than 150 mg PE/min
What are the indications for valproic acid (PO)?
1) absence seizures
2) myoclonic seizures
What are the adverse reactions for valproic acid (PO)?
1) hepatotoxicity, especially in children less than 2 y/o
2) prolonged bleeding times
3) GI disturbances
What are the nursing implications for valproic acid (PO)?
1) monitor liver function
2) potentiates phenobarbital and Dilantin, altering blood levels
3) therapeutic levels: 6-12 mcg/mL
What are the indications for carbamazepine (PO)?
1) tonic-clonic, mixed seizures
2) drowsiness
3) ataxia
What are adverse reactions of carbamazepine (PO)?
1) hepatitis
2) agranulocytosis
What are the nursing implications of carbamazepine (PO)?
1) monitor liver function while on therapy
2) therapeutic levels: 6-12 mcg/mL
What are the indications for lamotrigine (PO)?
1) partial seizures
2) tonic-clonic seizures
3) absence seizures
What are the adverse reactions of lamotrigine (PO)?
1) dizziness
2) headache
3) nausea
4) rash
What are the nursing implications for lamotrigine (PO)?
1) withhold drug is rash develops
2) do not discontinue abruptly
What are the indications for clonazepam (PO)?
1) absence seizures
2) myoclonic seizures
What are the adverse reactions of clonazepam (PO)?
1) drowsiness
2) hyperactivity
3) agitation
4) increased salvation
What are the nursing implications for clonazepam (PO)?
1) therapeutic levels: 20-80 mcg/mL
2) do not abruptly discontinue this drug
3) monitor liver function, CBC, and renal function periodically
What is hydrocephalus?
condition characterized by an abnormal accumulation of cerebrospinal fluid within the ventricles of the brain that does not drain properly from the cranium
What is hydrocephalus usually caused by?
What does it result in?
What is it most often associated with?
1) usually caused by an obstruction in the flow of CSF between the ventricles
2) results in enlargement of the ventricles, which causes pressure on the brain tissue
3) most often associated with spina bifida; it can be a complication of meningitis
Why do infants with hydrocephalus have enlarged head circumferences?
a result of widening fontanels that compensate for accumulating CSF and that help relieve pressure of the developing brain
What are the nursing assessments done for hydrocephalus?
1) signs of intracranial pressure in toddlers and older children
2) signs of increased intracranial pressure in infants
What are the signs of intracranial pressure in toddlers and older children?
1) change in LOC
2) irritability
3) vomiting
4) headache on awakening
5) motor dysfunction
6) unequal pupil response
7) seizures
8) decline in academics
9) change in personality
What are the signs of increased intracranial pressure in infants?
1) irritability, lethargy
2) increasing head circumference
3) bulging fontanels
4) widening suture lines
5) "sunset" eyes
6) high-pitched cry
7) feeding difficulties
8) decreased muscle tone and strength
What are the nursing plans and interventions for a child with hydrocephalus?
1) prepare infant and family for diagnostic procedures
2) monitor for signs of increased ICP
3) maintain seizure precautions
4) elevate head of bed
5) prepare parents for surgical procedure (e.g., ventricular shunt placement)
6) purpose of the shunt is to drain the excess fluid
7) postoperative care
8) teach home care program
What is postoperative care done for a child with hydrocephalus?
1) assess for signs of shunt malfunction
2) assess for signs of infection (meningitis)
3) monitor I&O closely
4) assess surgical sites (head & abdomen)
What are signs of shunt malfunction in the infant with hydrocephalus?
1) change in size, signs of bulging, tenseness in fontanels, and separation of suture lines
2) irritability, lethargy, or seizure activity
3) altered vital signs and feeding behavior
What are signs of shunt malfunction in the older child (increase in ICP) with hydrocephalus?
1) change in LOC
2) complaint of headache
3) changes in customary behavior (sleep patterns, developmental capabilities)
What are signs of infection (meningitis) in a child with hydrocephalus?
1) increase fever greater than 38.6 C (100.5 F0
2) shunt tract appears reddened, tender, and swollen; drainage may be present
3) decrease feeding/increase vomiting
4) stiff neck and headache
What is the home care program that should be taught to families of a child with hydrocephalus?
1) teach to watch for signs of increased ICP or infection
2) note that child will eventually outgrow shunt and show symptoms of difficulty
3) note that child will need shunt revision
4) provide anticipatory guidance for potential problems with growth and development
What are seizures?
Who are the more common in?
What can they be associated with?
1) uncontrolled electrical discharges of neurons in the brain
2) more common in children under the age of 2 years
3) can be associated with immaturity of the CNS, fever, infection, neoplasms, cerebral anoxia, and metabolic disorders
What are the different categories of seizures?
generalized and partial
What are the different types of generalized seizures?
1) tonic-clonic (grand mal): consciousness is lost
2) absence (petit mal): momentary LOC, posture is maintained; has minor face, eye, hand movements
3) myoclonic: sudden, brief contractors of a muscle or group of muscles, no postictal state, may or may not by symmetrical or include LOC
What are the different phases of tonic-clonic (grand mal) seizures?
1) tonic phase: generalized stiffness of entire body
2) clonic phase: spasm followed by relaxation
What are the nursing assessments for a tonic-clonic (grand mal) seizures?
1) aura (a warning sign of impending seizure)
2) LOC
3) tonic phase: generalized stiffness of entire body
4) apnea, cyanosis
5) clonic phase: spasms followed by relaxation
6) pupils dilated and nonreactive to light
7) incontinence
8) post-seizure: disoriented, sleepy
What are the nursing assessments for absence seizures (petit mal)?
1) onset between 4 and 12 years of age
2) lasts 5-10 seconds
3) child appears to be inattentive, daydreaming
4) poor performance in school
What is the most common cause of increased seizure activity?
medication noncompliance
What are the nursing plans and interventions for the child with seizures?
1) maintain airway during seizure, turn client on side to aid ventilation
2) do not restrain client
3) protect client from injury during seizure and support head (avoid neck flexion)
4) document seizure, noting all data in assessment
5) maintain seizure precautions
6) support during diagnostic tests (EEG and CT)
7) support during workup for infections such as meningitis
8) administer anticonvulsant medications as prescribed
9) monitor therapeutic drug levels
10) teach family about drug administration (dosage, action, and side effects)
What are seizure precautions?
1) reduce environmental stimuli as much as possible
2) pad side rails or crib rails
3) have suction equipment and oxygen quickly accessible; set up at the bedside/crib side; tape oral airway to the head of the bed
What should not be used during a seizure? Why?
tongue blade, padded or not, because it can cause traumatic damage to the oral cavity
What anticonvulsant medications are used for tonic-clonic seizures?
phenytoin, carbamazepine, phenobarbital, and fosphenytoin
What anticonvulsant medications are used for absent seizures?
ethosuximide and valproic acid
What is bacterial meningitis?
What is it usually caused by?
Where is the usual source for bacterial invasion?
What are some other sources of bacteria from wounds?
What occurs because of it?
1) bacterial inflammatory disorder of the meninges that cover the brain and spinal cord
2) usually caused by H. influenzae type B (less prevalent), Streptococcus pneumoniae, or Neisseria meningitidis
3) usual source of bacterial invasion is the middle ear or the nasopharynx
4) other sources of bacteria from wounds include fractures of the skull, lumbar punctures, and shunts
5) exudate covers brain and cerebral edema occurs
What does a lumbar puncture show for the child with bacterial meningitis?
1) increased white blood cells (WBCs)
2) decreased glucose
3) elevated protein
4) increased ICP
5) positive culture for meningitis
What are the nursing assessments for older children with bacterial meningitis?
1) classic signs of increased ICP
2) fever, chills
3) neck stiffness, opisthotonos
4) photophobia
5) positive Kernig sign (inability to extend leg when thigh is flexed anteriorly at hip)
6) positive Brudzinski sign (neck flexion causing adduction and flexion movements of lower extremities)
What are the nursing assessments for infants and young children (3 months to 2 years old) with bacterial meningitis?
1) absence of classic signs
2) ill, with generalized symptoms
3) poor feeding
4) vomiting, irritability
5) bulging fontanel (an important sign)
6) seizures
What are the nursing assessments for the neonate (birth to 2 months) with bacterial meningitis?
1) very difficult to diagnose
2) temperature nonspecific: may be normal, hypothermia or hyperthermia
3) symptoms can appear a few days after birth
4) infant has difficulty eating and refuses to eat when prompted
5) weak cry
6) vomiting and diarrhea may be present
7) movement decreases, along with tone
8) restless, sleep pattern changes
9) late sign: bulging and tense fontanel
What are the nursing plans and interventions for a child with bacterial meningitis?
1) administer antibiotics (usually ampicillin, ceftriaxone, or chloramphenicol) and antipyretics as prescribed
2) isolate for at least 24 hours
3) monitor vitals and neurologic signs
4) keep environment quiet and darkened to prevent overstimulation
5) implement seizure precautions
6) position for comfort: head of bed slightly elevated, with client on side if prescribed
7) measure head circumference daily in infants
8) monitor I&O closely
9) administer Hib vaccine to protect against H. influenzae infection
What is Reye Syndrome?
What are the causes?
What is the occurrence associated with?
How is it staged?
1) acute, rapidly progressing encephalopathy and hepatic dysfunction
2) causes include antecedent viral infections, such as influenza or chickenpox
3) occurrence is often associated with aspirin use
4) disease is staged according to the clinical manifestations to reflect the severity of the condition
What are the nursing assessments for Reye syndrome?
1) usually occurs in school-age children
2) lethargy, rapidly progressing to deep coma (marked cerebral edema)
3) vomiting
4) elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, serum ammonia, decreased prothrombin time (PT)
5) hypoglycemia
With meningitis, what might cause fluid retention (cerebral edema) and dilution hyponatremia?
inappropriate antidiuretic hormone (ADH) secretions
What are the nursing plans and interventions for a child with Reye syndrome?
1) provide critical care early in syndrome
2) monitor neurologic status: frequent noninvasive assessments and invasive ICP monitoring
3) maintain ventilation
4) monitor cardiac parameters (i.e., invasive cardiac monitoring system)
5) administer mannitol, if prescribed, to increase blood osmolality
6) monitor I&O accurately
7) care for Foley catheter
8) provide family with emotional support
What is the third most common cancer in children after leukemia and lymphomas?
How are they oriented? What does this cause?
Where do they occur?
What are the most common types?
1) brain tumors
2) most pediatric brain tumors are infratentorial, making them difficult to excise surgically
3) tumors usually occur close to vital structures
4) medulloblastomas are the most common childhood brain tumors
What are the nursing assessments for brain tumors?
1) headache
2) vomiting (usually in the morning), often without nausea
3) loss of concentration
4) change in behavior or personality
5) vision problems, tilting of the head
6) in infants there are widening sutures, increasing frontal occipital circumference, tense fontanel
What is a common presenting symptom of brain tumor in children?
headache upon awakening
What are the nursing plans and interventions for a child with a brain tumor?
1) identify baseline neurologic functioning
2) support child and family during diagnostic workup and treatment
3) if surgery is treatment of choice, provide preoperative teaching
4) assess family's response to the diagnosis and treat family appropriately
5) after surgery, position client as prescribed by HCP
6) monitor IV fluids and output carefully, over hydration can cause cerebral edema and increased ICP
7) administer steroids and osmotic diuretics as prescribed
8) support child and family to promote optimum functioning postoperatively
What is the preoperative teaching if surgery is the treatment of choice for a child with a brain tumor?
1) explain that head will be shaved
2) describe ICU, dressings, IV lines, etc.
3) identify child's developmental level and plan teaching accordingly
4) radiation to the tumor site is sometimes performed before surgical excision of the tumor, in an attempt to shrink the size of the tumor and to save as much brain tissue as possible
What position are most postoperative clients from removal of a brain tumor placed in?
What positioning may large tumors require?
1) prescribed to lie flat or turn to either side
2) a large tumor may require that the child not be turned to the operative side
What is muscular dystrophy?
inherited disease of the muscles, causing muscle atrophy and weakness
What is the most serious and most common of the dystrophies?
When does it appear?
By the age of 9-11 years old, how does it progress?
What is the life expectancy?
1) Duchenne muscular dystrophy, an X-linked recessive disease affecting primarily males
2) appears in early childhood (ages 3-5) (children appear normal at birth until signs and symptoms of the disease manifest)
3) by the age of 9-11, the child loses the ability to walk independently
4) life expectancy generally in the third decade
What are the nursing assessments for the child with muscular dystrophy?
1) waddling gait, lordosis
2) increasing clumsiness, muscle weakness
3) Gowers sign: difficulty rising from a squatting position, has to use arms and hands to "walk" up legs to stand erect
4) pseudo hypertrophy of muscles (especially noted in calves) due to fat deposits
5) muscle degeneration, especially the thighs, and fatty infiltrates (detected by muscle biopsy); cardiac muscle also involved
6) delayed cognitive development, severity of the cognitive impairment varies
7) later in disease: scoliosis, respiratory difficulty, and cardiac difficulties
8) eventual wheelchair dependency, confinement to bed
What are the nursing plans and interventions for a child with muscular dystrophy?
1) provide supportive care
2) provide exercises (active and passive)
3) prevent exposure to respiratory infection
4) encourage a balanced diet to avoid obesity
5) support family's grieving process
6) support participation in the Muscular Dystrophy Association
7) coordinate with health care team: physical therapist, occupational therapist, nutritionist, neurologist, orthopedist, and geneticist
What are fractures?
What may younger children with fractures be at risk for?
What is important to check for?
1) traumatic injury to the bone
2) younger children diagnosed with fractures may be at risk for child abuse
3) important that the story of the incident matches the injury and sounds plausible
How are the different types of fracture classifications?
1) complete fractures: bone fragments are completely separate
2) incomplete fractures: bone fragments remain attached (e.g., greenstick, bends, buckles)
3) comminuted fractures: bone fragments from the fractured shaft break free and lie in the surrounding tissue (rare in kids)
4) spiral fractures: fracture line results from twisting force; forms a spiral encircling the bone
Fractures that occur in the epiphyseal plate (growth plate) may affect what?
growth of the limb
Why are fractures in older children common?
they fall during play and are involved in motor vehicle accidents
What fractures in infants may be related to child abuse?
spiral fractures (caused by twisting)
What are the nursing assessments for fractures?
1) general condition
2) possibility of being able to use fractured extremity due to intact periosteum
3) the five Ps (may indicate of ischemia)
What are the general conditions observed during the nursing assessment of fractures?
1) visible bone fragments
2) misalignment of the limb
3) pain
4) swelling
5) contusions
6) child guarding or protecting the extremity
7) limited range of motion
What are the five Ps that may indicate the presence of ischemia during the nursing assessment of a fracture?
1) pain
2) pallor
3) pulselessness
4) paresthesia
5) paralysis
What are the nursing plans and interventions for a child with a fracture?
1) obtain baseline data and frequently perform neuromuscular assessments
2) report abnormal neuromuscular assessments promptly!!
3) maintain traction if prescribed; note bed position, type of traction, weights, pulleys, pins, pin sits, adhesive strips, Ace wraps, splints and casts
4) maintain child in proper body alignment; restrain if necessary
5) monitor for problems of immobility
6) provide age-appropriate play and toys
7) prepare child for cast application; use age appropriate terms when explaining procedures
8) provide routine cast care after application; petal cast edges
9) teach home cast care to family
What is the baseline data and neuromuscular assessments obtained during the care of a child with a fracture?
1) pulses: check pulses distal to the injury to assess circulation
2) color: check injured extremity for pink, brisk, capillary refill
3) movement and sensation: check injured extremity for nerve impairment, compare for symmetry with uninjured extremity (child may guard injury)
4) temperature: check extremity for warmth
5) swelling: check for an increase in swelling, elevate the extremity for prevention
6) pain: monitor for severe pain that is not relieved by analgesics
7) newly fractured sites are generally splinted and braced until swelling goes down; once the swelling has subsided, a cast is applied to the affected extremity
What is compartment syndrome?
What is the result of compartment syndrome?
If compartment syndrome occurs and is not treated immediately with fasciotomy, what can happen?
1) a progressive decrease of tissue perfusion occurring as a result of increased pressure from edema or swelling that presses on the tissues and vessels
2) as a result, there is compromised circulation with abnormal neuromuscular checks
3) it not treated, it can result in permanent nerve damage, possibly leading to amputation of the limb
What is skin traction?
force is applied to the skin
What are the different types of skin traction?
1) buck extension traction: lower extremity, legs extended, no hip flexion
2) Dunlop traction: two lines of pull on the arm
3) Russell traction: two lines of pull on the lower extremities
4) Bryant traction: both lower extremities flexed 90 degrees at hips (rarely used because extreme elevation of lower extremities causes decreased peripheral circulation)
What is skeletal traction?
pin or wire applies pull directly to the distal bone fragment
What are the different types of skeletal tractions?
1) Ninety-degree traction: 90 degree flexion of hip and knee, lower extremity is in a boot cast (this traction can also be used on the upper extremities)
2) Dunlop traction: may be used as skeletal traction
What can be a source of infection for a child with traction to treat fractures?
pins so monitor for signs of infection and clean and dress pin sites as prescribed
What is a consideration when moving the client in bed who is being treated with traction for a fracture? Why?
it is necessary to hold and move the weights of the traction (skin or skeletal) as the client changes positions to avoid additional tension on the traction and fracture sites
What is home cast care to teach to family for a child with a fracture?
1) neuromuscular assessment of casted extremity
2) not to get cast wet
3) in the presence of a hip spica, family may use a Bradford frame under a small child to help with toiling, they must not use an abduction bar to turn child
What are medications (with their routes) prescribed for skeletal disorders?
1) infliximab (IV)
2) methocarbamol (PO, IM, IV)
3) cyclobenzaprine (PO)
What are the indications for medications used in skeletal disorders?
narcotics to treat pain, stiffness, and discomfort
What are adverse reactions of medications used in skeletal disorders?
1) nausea
2) vomiting
3) fever
4) chills
5) dizziness
6) drowsiness
7) chest pain
8) allergic response: rash, difficult breathing, etc.
What are the nursing implications when using medications used in skeletal disorders?
1) review history: heart disease (all), thyroid disorders, and use of MAOIs
2) Remicade use can worsen TB
What is developmental dysplasia of the hip (DDH)?
abnormal development of the femoral head in the acetabulum, usually diagnosed at birth
What are contributing factors to developmental dysplasia of the hip?
1) breech position in utero
2) familial history of developmental dysplasia of the hip
3) oligohydraminos
What is the treatment for developmental dysplasia of the hip?
1) initial treatment at birth, continuous wearing of abduction devices for 6-12 weeks
2) if treatment is not effective, then place in abduction brace for 3-6 months
3) if correction is still needed or not discovered until 6 months of age, then surgical correction with placement of a spica cast for 12 weeks postoperatively
What are the nursing assessments for an infant with developmental dysplasia of the hip?
1) positive Ortolani sign ("clicking" with abduction; is the sound heard when the health care provider maneuvers the femoral head and it slips back into the acetabulum)
2) positive Barlow maneuver ("feel" the dislocation as the femur leaves the acetabulum when the health care provider adducts and extends the hips while stabilizing the pelvis
What are the nursing assessments for an older child with developmental dysplasia of the hip?
1) limp no affected side
2) Trendelenburg sign
What are the nursing plans and interventions for a child with developmental dysplasia of the hip?
1) perform newborn assessment at birth
2) apply abduction device or splint (Pavlik harness; Frejka or von Rosen splint) as prescribed; therapy involved positioning legs in flexed abducted position
3) teach parents home care
4) teach how to provide care for an infant in Bryant traction (used if splinting is ineffective)
5) provide nursing care for a child requiring surgical correction including preoperative teaching (including cast application) and postoperative care
What does the nurse need to teach the parents about home care for the child with developmental dysplasia of the hip?
1) teach application and removal of device (iron 24 hours a day)
2) teach skin care and bathing (physician may allow parents to remove device for bathing)
3) teach diapering
4) teach that follow-up care involves frequent adjustments because of growth
What should the nurse teach about how to provide care for an infant in Bryant traction (used if splinting is effective) to treat developmental dysplasia of the hip?
1) instruct to maintain hips in 90 degree flexion
2) instruct to elevate buttocks off bed
3) instruct to monitor circulation to feet
4) instruct to meet developmental needs of an immobilized infant
5) incorporate family in care
6) prepare family for spica cast application
What is the postoperative care for a child requiring surgical correction due to developmental dysplasia of the hip?
1) assess vitals
2) check cast for drainage and bleeding
3) perform neuromuscular assessments of extremities
4) promote respiratory hygiene
5) administer narcotic analgesics or morphine either IV (preferred) or IM
6) teach family cast care when child gets home, including checking the cast for "hot spots" (possibly indicative of infection)
What is scoliosis?
What factors into the development of scoliosis?
What does treatment depend on?
1) Lateral curvature of the spine that generally occurs during rapid growths spurts in adolescents
2) hereditary conditions, neuromuscular diseases congenital spine defects in trauma or infections to the spine may factor in the development of scoliosis
3) treatment depends on the curvature of the spine
What are the nursing assessments for scoliosis?
1) most commonly in adolescent females (10-15 y/o)
2) elevated shoulder or hip
3) head and hips not aligned
3) while child is bending forward, a rib hump is apparent (ask child to bend forward from the hips with arms hanging free, and examine child for a curve of the spine, rib hump, and hip asymmetry)
What are the nursing plans and interventions for a child with scoliosis?
1) screen all adolescent children, especially females, during growth spurt
2) prepare child and family for conservative treatment, such as the use of a brace
3) prepare child and family for surgical correction if required
4) provide postoperative care
What is the conservative treatment that the nurse needs to prepare the family and child with scoliosis for?
1) teach application of brace (Boston, Wilmington, and Milwaukee are the most common used), to include wearing 23 hours a day, wearing a shirt underneath brace to decrease skin irritation, and checking skin areas of irritation or breakdown
2) suggest clothing modification to camouflage brace
3) reinforce prescribed exercise regimen for back and abdominal muscles
4) plan ways of improving self-concept with adolescent
5) teach family that severe, untreated scoliosis can cause respiratory difficulty
6) a brace does not correct the spine's curve in a child with scoliosis, it only stops or slows the progression
What should the nurse prepare the family and child with scoliosis for if surgical correction is required?
1) teach child in family log-rolling technique
2) teach how to practice respiratory hygiene
3) orient child to ICU
4) discuss postoperative tubes: indwelling urinary catheter, nasogastric tube, and chest tube (if anterior fusion is performed)
5) describe postoperative pain management, PCA may be used
6) obtain a baseline neurologic assessment
What is postoperative care for the child who received surgical correction for scoliosis?
1) perform frequent neurologic assessments
2) log-roll for 5 days
3) administer IV fluids and analgesics if prescribed
4) perform oral hygiene (client NPO)
5) monitor nasogastric tube and bowel sounds
6) assist with ambulation, provide body jacket, progressively ambulate
7) teach child and family that body jacket will be worn for several months until the bone fusion is stable
8) determine the need for a teacher in the home
9) encourage child's participation in care to promote self-esteem
What is juvenile arthritis (JA) or juvenile idiopathic arthritis (JIA)?
chronic inflammatory disorder of the joint synodic is considered one of the most common rheumatoid conditions occurring in children under the age of 17
How is juvenile idiopathic arthritis diagnosed?
when the client presents with the following symptoms for a minimum fo 6 weeks:
1) continuous arthritic pain in single or multiple joints
2) repetitive fevers up to 39.44 C (103 F)
3) systematic indications appearing as pinkish/reddish rash on the legs, arms, and trunk
What is the cause of juvenile idiopathic arthritis?
exact cause is unknown, the child's immune system attacks the synovial lining of the joints
Wha are the nursing assessments for juvenile idiopathic arthritis?
1) joint swelling and stiffness (usually large joints)
2) painful joints
3) generalized symptoms: fever, malaise, and rash
4) periods of exacerbations and remissions
5) varying severity: mild and self-limited or severe and disabling
6) lab data: latex fixation test (usually negative) and elevated ESR
7) poorest prognosis includes positive rheumatoid factor and polyarticular systemic onset
What are the nursing plans and interventions for the child with juvenile idiopathic arthritis?
1) plan home program of prescribed exercise, splinting, and activity
2) assist in identifying adaptations in routine (e.g., Velcro fasteners, frequent rest periods)
3) support the maintaining of school schedule and activities appropriate for age
4) teach about medication regimen (combination drugs are used)
5) teach child and family about side effects and toxic effects of prescribed drugs
6) inform child and family that the optimum anti-inflammatory effects of drugs may take a month to achieve
7) encourage periodic eye exams for early detection of iridocyclitits so as to prevent vision loss
8) encourage family to allow child's independence
What is the medication regimen for a child with juvenile idiopathic arthritis?
1) NSAIDS (aspirin, tolmetin sodium, ibuprofen, naproxen)
2) Anti-rheumatic drugs
3) Corticosteroids (prednisone)
4) Cytotoxic drugs (cyclophosphamide, methotrexate)
What are corticosteroids used for in treatment for a child with juvenile idiopathic arthritis?
Why is long-term use avoided?
1) used in short term in low doses during exacerbations
2) long-term use is avoided because of the side effects and their adverse effects on growth
What should the nurse teach about how to provide care for an infant in Bryant traction (used if splinting is effective) to treat developmental dysplasia of the hip?
1) instruct to maintain hips in 90 degree flexion
2) instruct to elevate buttocks off bed
3) instruct to monitor circulation to feet
4) instruct to meet developmental needs of an immobilized infant
5) incorporate family in care
6) prepare family for spica cast application
What is the postoperative care for a child requiring surgical correction due to developmental dysplasia of the hip?
1) assess vitals 2) check cast for drainage and bleeding 3) perform neuromuscular assessment of extremities 4) promote respiratory hygiene 5) administer narcotic analgesics or morphine either IV (preferred) or IM 6) teach family cast care when child gets home, including checking the cast for "hot spots" (possible indication of infection)
What should the nurse teach about how to provide care for an infant in Bryant traction (used if splinting is effective) to treat developmental dysplasia of the hip?
1) instruct to maintain hips in 90 degree flexion
2) instruct to elevate buttocks off bed
3) instruct to monitor circulation to feet
4) instruct to meet developmental needs of an immobilized infant
5) incorporate family in care
6) prepare family for spica cast application
What should the nurse teach about how to provide care for an infant in Bryant traction (used if splinting is effective) to treat developmental dysplasia of the hip?
...
Students also viewed