What interventions are most important for a patient with a cast?
Good skin care and orthoneuro checks
How do you detect Scoliosis?
Adam�s Test
Which cast/harness is most effective for older kids with hip dysplasia?
Spica cast
What is a diagnostic assessment for cerebral palsy?
Startle reflex after 6 months of age
What is an important intervention for children with CP?
Get in school early to help them learn to function individually
What is the treatment for febrile seizures?
Acetaminophen
What isolation precautions do you use for a patient that has meningitis?
Gloves, mask, gown
What is amblyopia?
Lazy eye
What is the treatment for amblyopia?
Patching the good eye for one hour each day
How do you transfer a patient that has scoliosis?
Log roll
Is MD inherited or is it an acquired disease?
Inherited
Do we as nurses manipulate fractures?
No
What are some causes of hearing loss?
Heredity, rubella, jaundice and LGA
What are early signs of ICP in older children?
Headache, vomiting, cognitive, personality and behavioral changes, diplopia, blurred vision, anorexia, nausea, weight loss and seizures
What is diplopia?
Double vision
What are some late signs of ICP?
Decreased LOC, decreased motor response to command (loss of B&B), abnormal sensation to painful stimuli, decreased pupil size and reactivity, decerebrate/decorticate posturing, abnormal breathing pattern due to pressure on brain stem.
VS changes due to ICP?
Increased temp and BP, decreased HR and RR
What is a sign of a concussion?
Early sign Projectile vomiting, late stage posturing
If there is a change in VS with ICP this indicative that the ______ is involved.
Hypothalamus
______ is very important intervention for patient with ICP.
Reverse trendelenburg Positioning
Intervention for ICP includes ___________ to help reduce cerebral edema.
Corticosteroid such as dexamethasone (Decadron) and manitol
Interventions for ICP include _____, given IV to remove fluid from interstitial tissue and reduce pressure.
Decerebrate and Decorticate posturing are signs of?
Late signs of Increased ICP= brain stem involvement
This type of posturing occurs when the midbrain is not functional; characterized by rigid extension and adduction of arms and pronation of wrists with the fingers flexed; legs extended and feet plantar flexed.
Decerebrate
This type of posturing occurs when the arms are adducted and flexed on the chest with the wrists flexed, hands fisted; lower extremities extended and internally rotated; feet plantar flexed; and denotes brainstem involvement
Decorticate
This type of posturing is seen with a major increase in ICP, a brainstem problem and/or brain damage. Seizures can also cause this temporary posturing.
Opisthotonous
An extreme hyperextension spasticity pattern where the patient assumes a total �bridging� or �arching� position. The individual may primarily bear weight on their heels and top or back of their head or posture with their heals contracting the buttocks and back of head resting on the spine. This is an extrapyramidal effect.
Opisthotonous
This is a problem with brain development and happens during fetal development.
Neural tube defects
Neural tube defects can be caused by.
Tetratogen exposure and decreased folic acid
Neural tube defects may be discovered by.
A sonogram or mom�s alpha-feta-protein (AFP) test
______ is the absence of the cerebral hemispheres.
Anencephaly
______ occurs when the upper end of the neural tube fails to close in early intrauterine life.
Anencephaly
_____ is revealed by an elevated level of AFP in the maternal serum or on amniocentesis and confirmed by a sonogram.
Anencephaly
With ______ the infant will have a brain stem, and the body continues to grow, the infant can live long enough to be born yet survival is not possible.
Anencephaly
______ brain growth is so slow and disproportionate that it falls more than three standard deviations below normal on growth charts.
microcephaly
What are causes of Microcephaly?
TORCH viruses and ETOH
With children who have ______ the prognosis depends on the extent of restriction of brain growth and on the cause, they will usually have some type of MR.
Microcephaly
General term for all spinal disorders �divided spine�?
Spina bifida
_____ occurs when the posterior laminae of the vertebrae fails to fuse?
Spina bifida occulta
This type of spina bifida is so common that is may be missed?
Spina bifida occulta
_____ may be noticeable as a dimpling at the point of poor fusion, sacral spine.
Spina bifida occulta
_____ meninges covering the spinal cord herniated through unformed vertebrae.
Meningocele
With ____ there is still skin covering, but spinal cord protrudes through the vertebrae.
Meningocele
_____anomaly appears as a protruding mass, usually approximately the size of an orange, at the center of the back, looks like edema.
Meningocele
What is the treatment for meningocele?
Surgery
______the spinal cord and the meninges protrude through the vertebrae?
Myelomenegecele
With _____ the spinal cord ends at the point, and motor and sensory function is absent beyond this point.
Myelomenegecele
with _______ there is no skin covering.
Myelomenegecele
What are some signs and symptoms of myelomenegecele?
Urinary dribblers, flaccidity, lack of sensation of the lower extremities, club foot, and hydrocephalus due to trauma to the spinal cord
With ______ encourage parents to touch their infants even though they are not able to hold them. Why can�t they hold their baby?
Myelomenegecele, b/c of the open exposure and risk for infection
What is a major symptom of myelomenegecele?
Decreased response to painful stimuli in lower extremities
What is a pre op intervention of an infant with myelomenegecele?
Place infant in prone position with moist sterile saline gauze dressing over the site
How do you assess for hydrocephalus?
Measure head circumference daily and watch for bulging fontanel
______ is a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction. Affected children also may have speech, or ocular difficulties, seizures, cognitive challenges (MR) or hyperactivity.
Cerebral palsy
What causes CP?
Lack of oxygen to the brain
Causes of ______ are associated with low birth weight, premature birth, or birth injury.
Cerebral palsy
Severe jaundice can cause hypoxia therefore causing _______?
Cerebral palsy
What is a primary intervention in teaching parents about their children diagnosed with CP?
The importance of passive and active muscle exercises to prevent contractures
Children with ________ need periods of adequate rest.
CP
Is CP a (nonprogressive/progressive) disease?
Nonprogressive
What is amblyopia?
Lazy eye
_____ is curable if treated before age 6, and then changes decrease significantly?
Amblyopia
____ can be treated if discovered before 6 years of age; early recognition is therefore important.
Amblyopia
_____ (cross-eyes) caused by unbalanced muscle control.
Strabismus
This eye infection is caused by bacteria, fungus or virus.
Conjunctivitis
This eye infection is characterized by watery eyes and pustular drainage.
Conjunctivitis
Interventions for conjunctivitis include.
Good hand washing, wipe drainage from inner to outer canthus to avoid more contamination
Conjunctivitis is highly contagious what type of precautions do you use?
Contact
What is Hyperopia?
farsightedness
What is myopia?
An error in refraction in which light rays are focused in front of the retina, enabling the person to see distinctly for only a short distance
What is astigmatism?
A form of ametropia in which the refraction of a ray of light is spread over a diffuse area rather than sharply focused on the retina, due to differences in curvature
What is Nystagmus?
Involuntary back-and-forth or cyclical movements of the eyes
What are greenstick fractures? Who do they commonly affect?
Not broke all the way through, kids
What causes spiral fractures?
Abuse
What is as comminuted fracture?
A single bone broken in more than 1 place
How is a comminuted fracture repaired?
Open reduction
What is the concern with comminuted fractures?
High risk for infection
What is a transverse fracture?
A straight across break
What is a compound fracture?
A bone that is broken and penetrating through the skin
What is the concern assoc. with a compound fracture?
Infection
What is a compression fracture?
Fracture of the vertebra caused by pressure
A compound fracture is also called a _____?
Open fracture
A fracture of a diseased or weakened bone produced by a force that would not have fractured a healthy bone?
Pathological fracture
Fracture without rupture of ligaments or skin, usually transverse?
Simple fracture
Is a surgical technique that is used to align and repair bone?
Open reduction
With this type of fracture repair rods or screws are used and is rarely used with children except in cases of scoliosis.
Internal fixation
With this type of fracture repair no incision is made, bone manipulation is done through the skin.
Closed reduction
With this type of fracture repair there is a high risk for infection?
Open reduction
What are ortho neuro checks? And how often are they done?
Cast care including checking the skin color, temp, capillary refill, distal pulses usually every 2 hours
What is an important intervention to teach parents of a child with a cast?
Keep it clean and dry, cover for bathing
What is the intervention to keep swelling down with a cast? What can swelling cause?
Ice and swelling. Compartment syndrome
____ skin traction for treatment of hip synovitis or muscle spasms of the lower extremities or lower back.
Bucks Traction
This type of traction is applied with adhesive strips aligned with the long axis of the leg. Weights sufficient enough to produce the required extension are fastened to the inferior end of the strips by a rope that is run over a pulley to permit free motion.
Bucks traction
_____ is the use of opposing forces to straighten and reduce spinal curves that are severe when first diagnosed or that progress despite bracing.
Halo Traction
____ traction is achieved using a ring of metal held in place with four stainless steel pins inserted into the skull bones.
Halo traction
What interventions are needed with Halo traction?
Good skin care and good antibiotic are
MD affects more ____ than ____.
Boys than girls
MD is a ____ disease?
Progressive
What is the Gower�s sign?
The inability to rise from the floor except using the hands to �walk up� the body
What is the Gower�s sign a diagnostic for?
MD
What is subluxation?
Maintains contact with the acetabulum but no fully located in hip joint
What is dislocated hip dysplasia?
Its where there is no contact between the femoral head and acetabulum
What is dysplasia?
Acetabulum is shallow or sloped instead of cup shaped
What is a positive Barlow�s sign indicative of?
Dislocation
What is a positive Ortolani�s test indicative of?
Reduction
What is a Galeazzi�s sign indicative of?
Shortening of affected femur
This type of brace for hip dysplasia is worn continually except for bathing.
Pavlik Harness
_____ occurs as a compensatory mechanism in children who have unequal leg lengths and sometimes in children with ocular refractive errors that cause them constantly to tilt their head sideways.
Scoliosis
Scoliosis is more common in _____ than _____.
Girls than boys
What is the name of the brace worn for scoliosis?
Milwaukee brace
How often is a Milwaukee brace worn and what is the problem with this?
16-23 hours, compliance
This brace is worn for scoliosis and extends over the spine and is worn 24 hours.
Charleston Bending
Spinal instrumentation means ____ are placed beside the spine
Rods
The edema that accompanies spinal instrumentation surgery can impair____.
Circulation to the lower extremities
____ seizures are characterized by rigidity, extension of extremities, fixed jaw, respiratory cessation and dilated pupils.
Tonic
_____ seizures are characterized by rhythmic jerking of extremities, autonomic symptoms and possibly incontinence.
Clonic
Treatment of seizures includes what drugs?
Depaken, Tegretol, Dilantin and Phenobarbital
What diet changes might be prescribed for patients with seizures?
Ketogenic diet
What is a ketogenic diet?
High in fat and low in protein and carbohydrate
Can Phenobarbital be stopped abruptly?
No
What causes seizures?
Cerebral edema, lack of oxygen
What is a drop seizure, and what is its characteristic?
Atonic, sudden loss of muscle tone followed by confusion
Anything that causes pressure or swelling on the brain can cause______?
Seizures
_____ seizures consist of starring spells-last for a few seconds and can be accompanied by rhythmic blinking and twitching of the mouth or extremity.
Absence
What is the treatment for absence seizures?
There is no first aid measure necessary
Simple partial seizures may be characterized by?
Focal motor components, aura before seizure, visual changes
This type of seizure begins as simple and progresses to unconsciousness.
Complex seizure
This type of seizure is characterized by a sudden change in posture, such as an arm dropping, motor, sensory or behavioral changes.
Complex seizures
What is the treatment for complex seizures?
Tegretol, Depaken, Dilantin and Phenobarbital
____ seizures are associated with high fever.
Febrile
Febrile seizures last for how long?
15 to 20 seconds
Once a child has a febrile they are more prone to having another? (True/False)
True
Children usually outgrow _____ seizures.
febrile
_____ is a seizure that last continuously for longer than 30 minutes.
Status epilepticus
What is the treatment for status epilepticus?
IV Ativan or valium
Status epileptus has a very poor prognosis why?
Because of irreversible brain damage
What causes status epileptus?
Severe cerebral edema
_____ seizures are characterized by rapid movements of the trunk or the infant suddenly slumps forward from a sitting position or falls from a standing position.
Myoclonic (infantile)
This type of seizure tends to burn itself out by 2 yrs.
Myoclonic
What is the treatment for myoclonic seizures?
Parenteral adrenocorticotropic hormone (ACTH) and Vitamin B6, and Topamax
____ sign is when the hips are abducted the hips with the hips and knees flexed, a palpable click is felt.
Ortolani�s sign
____ sign is when the hip dislocates under the examiners fingers while adducting then extending the legs.
