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peds quiz # 3


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What is Retinoblastoma?
-most common congenital malignant intraocular tumor of childhood primarily in children younger than 5 years
What causes Retinoblastoma?
-caused by a mutation in a gene and may occur sporadically or be inherited
-develops when the mutated gene is unable to produce the natural signals to stop the growth of retinal cells
Diagnostic evaluation:
-few obvious signs, typically the parent who observe a whitish "glow" in the pupil, known as the cat's eye reflex or Leukoria(most common)
-strabismus (second most common)
-decreased vision
-persistant painful erythematous eyes
-blindness (late sign)
Therapeutic Management:
aim of therapy is to preserve useful vision and eradicate the tumor at the time of diagnosis
-with advanced tumor growth or no hope for useful vision enucleation (removal)of the affected eye is the treatment of choice.
Nursing Considerations:
-have a high suspicion for this rare malignancy
-families with history of retinoblastoma require follow-up
-parent education reguarding pre and post enucleation procedure, before-after pics, helping with adjustment
-care of socket: irrigate with ordered solution, apply antibiotic ointment, the dressing consists of an eye patch taped over the surgical site and is changed daily
-support family; may feel guilt
What is Conjucntivitis?
-Inflammation of the conjuctiva from virus or bacteria
What are the clinical manifestations?
-earaches: S/Sx: crying, pulling on ear
-loss of appetite
Therapeutic Management/ Nursing Care:
-bacterial is treated with antibiotic
-virus' run natural coarse
-irrigate eyes
What is Otitis Media?
-Inflammation/infection of the middle ear
Who is at risk for Otitis Media?
-smokers in the house
-bottle fed babies
-winter months (cold/flus)
-many cases of OM are preceded by viral respiratory infection; mainly RSV and influenza
-most episodes of acute otitis media occur in the first 24 months of life
-occurs infrequently in children older than 7
-preschool age boys>girls
Otitis Media and infant feeding methods:
Breastfed infants have a lower incidence than formula-fed infants. Breastfeeding may protect infants against respiratory viruses and allergy because breast milk contains secretory immunoglobulin Ig A, which limits the exposure of the eustachian tube and middle ear mucosa to microbial pathogens and foreign proteins. Reflux of milk up the eustachian tubes is also less likely to occur in breastfed infants because of the semivertical positioning during breastfeeding
-most believe that the primary defect in NTDs is a failure of neural tube closure during early development (the first 3 to 5 weeks) of the embryo.
Therapeutic Management/
Nursing Care:
-back blows and chest thrust if under 1 year
-abdominal thrust if over 1 year
-heimlich maneuver for older child
-removed instrumentally
-post removal care: high-humidity atmosphere
prophylaxis antibiotic
-Teaching prevention
Never do finger sweep
What is a myringotomy?
-A surgical incision of the eardrum,may be necessary to alleviate the severe pain of Acute Otitis Media
-is also preformed to provide drainage of infected middle ear fluid in the presence of complications (mastoiditis, labrinthitis, or facial paralysis) or to allow purulent middle ear fluid to drain into the ear canal for culture
What is tympanostomy tube placement?
-Tympanostomy tubes are pressure equalizer tubes or grommets that facilitate continued drainage of fluid and allow ventilation of the middle ear.
-Myringotomy with or without insertion of PE tubes should not be performed for initial management of OME, but may be recommonded for children who have recurrent episodes of OME with a long cummulative duration.
Foreign Body Aspiration:
-Most common in children under age 3
Most common food offenders:
-hot dogs, candy, nuts, and grapes
-avoid hard candies, marshmallows, large amounts of peanut butter, and fruits with seeds
-snack foods such as peanuts and popcorn are kept away from young children, hot dogs must be cut into small, irregular pieces rather than served sliced into sections, because their size (diameter)
-most dangerous is dry beans
Head Injury:
A pathologic process involving the scalp, skull, meninges, or brain as a result of mechanical force.
-leading cause of death in children older than 1 year of age
The 3 major causes of brain damage in children are
1. Falls
2. Motor Vehicle injuries
3. Bicycle injuries
-Neurologic injury accounts for the highest mortality, with boys affected twice as often as girls.
-in motor vehicle accidents children younger than 2 years of age are almost exclusively injured as pedestrians or cyclists
The larger head size and insufficient musculoskeletal support render the very young children
vulnerable to accelaration-deccelration injuries.
Primary head injuries:
Are those that occur at a time of trauma and include skull fractures, contusions, intracranial hematoma, and diffuse injury.
-the widespread use of folic acid of childbearing age is expected to signifigantly decrease the incidence of SB.
-it has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of all cases
-For women who have had a previous pregnancy affected by NTDs, folic acid is inceased to 4 mg under supervision of practioner begining 1 month before a planned pregnancy and continuing during the first trimester.
Goal of Nursing Management:
*Maintain cerebral perfusion
-prevent secondary ischemia
Types of Head Injury:
-most common, transient and reversible neuronal dysfunction, with instantaneous loss of awarness
-sudden head injury with disruption of neural activity & change in LOC
-confusion and amnesia following head injury are the hallmarks of concussion
Types of Head Injury:
-visible bruising and tearing of cerebral tissue
-represent petechial hemorrhages along the superficial aspects of the brain at the site of impact (coup injury) and or lesion remote from the site of direct trauma (countercoup injury)
-can occur at site of fracture
-can involve areas of hemorrhage, infarction, necrosis and edema
Types of head injury:
-tearing of brain tissue may occur with depression and compound fractures
Subdural Hematoma-
bleeding between dura mater and arachoid layer of meningeal cover brain
Acute subdural hematoma
-2 to 14 days past injury
Chronic subdural hematoma:
-weeks or months after injury
Epidural Hematoma
-bleeding between dura and inner surface of skull
Warning signs after a head injury: (first 24 hrs)
-changes in LOC
-increase drowsiness, confusion, difficult to arouse
-bleeding or watery drainage from nose or ears
-pupils slow to react or unequal
-blurred vision
-loss of sensation to any extremity
-slurred speech
Diagnostic Measures:
-C/T scan
-Cervical Spine x-rays
Assessment for CSF
-Otorrhea: drainage from the ear
-Rhinorrhea: drainage from the nose clear and thin
Nursing Management:
Depends on head injury-
-Assess airway
-Assess head injury/spinal injury
-Monitor oxygenation status
-Monitor neuro status: Glasgow coma scale
-IV access if needed
-monitor vital signs
-keep warm
-assess for otorrhea & rhinorrhea
Patient Teaching:
-If patient was unconscious for less than 5 minutes usually discharged to home
-notify PCP-warning signs after head injury**
-have someone stay with person
-abstain from alcohol or drugs that may increase drowsiness
-avoid driving or operating heavy machinery
-if symptoms of increased ICP occur-ER
Increased Intracranial Pressure:
-changes in LOC
-impaired eye movement
-decrease sensory/motor function
-pupillary changes
-change in vital signs
increase B/P, decrease pulse, changes in respiratory pattern
Increased Intracranial Pressure in Infants:
-bulging fontanels
-cranial suture separation
-increase head circumfrence
-high pitched cry
What is Meningitis?
-Inflammation of the arachnoid and pia mater of the brain and spinal cord.
-Fall, Winter, and associated with upper resp. infection (URI)
What causes Meningitis:
Signs & Symptoms:
Children & Adolescents-
-usually abrupt onset
May develop:
-aggressive behavior
-nuchal rigidity
Infants & Young Children:
-bulging fotanel
-nuchal rididity may not be present
-poor feeding
-marked irritability
Therapeutic Management of Acute Bacterial Meningitis:
-Acute bacterial meningitis is a medical emergency hat requires early recognition and immediate initial therapy including:
-isolation precautions
-initiation of antibicrobial therapy
-maintance of optimal hydration
-maintance of ventilation
-reduction of increased ICP
-management of bacterial shock
-control of seizures
-control of extreme temperature
-correction of anemia
-treatment of complications
Diagnostic Studies:
spinal tap for CSF testing
Nursing Interventions:
-Assess neuro status
-Assess function of C II, IV, VII, VIII
-Isolation precautions
What is a major priority of nursing care of a child with suspected meningitis?
-To administer the antibiotic as soon as it is ordered. The child is also placed on respiratory isolaton for at least 24 hours after implementation of antimicrobial therapy.
What else can the nurse do for the child with meningitis?
-The room should be kept as quiet as possible, and environmental stimmuli kept at a minimum, because most affected children are sensitive to noise, bright lights, and other external stimuli.
-Most children are comfortable without a pillow and with the head of bed slightly elevated, a side lying position is more often assumed because of nuchal rigidity
-the nurse should avoid actions, such as lifting the child's head, that cause pain or increase discomfort
-measures are taken to ensure safety because children with meningitis are often restless and subject to seizures
-head circumfrence is measured on the infant because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis
What is Encephalitis?
Encephalitis is an inflammatory process of the CNS that produces altered function of various portions of the brain and spinal cord.
What causes Encephalitis?
-Can be caused by a variety of organisms, including bacteria, spirochetes, fungi, protozoa, helminths, and viruses
can result either by direct invasion of the CNS by a virus or postinfectious involvement of the CNS after a viral disease
Diagnosic Evaluation:
Clinical Manifestations of Encephalitis:
onset: sudden or gradual
-neck stiffness
-nausea & vomitting
-speech difficulties:mutism
-altered mental status
Severe cases:
-high fever
-coma (may proceed to death)
-ocular palsies
Nursing Management:
-Monitor vital signs: assess for hyperthermia
-Assess neurological status
-Monitor for ICP:administer meds as prescribed; Mannitol, Corticosteroids
-Monitor for seizure activity
What is Spina Bifida?
Myelomeningocele is a complex malformation of the spinal cord, nerve roots, meninges, vertebral bodies, and skin.
What is a neural tube defect?
NTDs constitute the largest group of congenital anomomalies that is consistent with multifactorial inheritance.
Normally the spinal cord and cauda equina are encased in a protective sheath of bone and meninges. Failure of the neural tube closure produces defects of varying degrees
What is spina bifida oculta?
-refers to a defect that is not visible externally. It occurs most commonly in the lumbosacral area (L5 and S1) SB occulta may not be apparent unless there are associated cutaneous manifestations or neuromuscular disturbances.
What is spina bifida cystica?
Refers to a visible defect with an external saclike protrusion.
-The two major forms of SB cystica are meninocele, which encases meninges and spinal fluid but no neural elements, and myelmeningocele, which contains meninges, spinal fluid, and nerves.
Is it possible to detect SB prenatally?
yes, fetal ultrasound and elevated concentrations of alpha-fetoprotein (AFP), a fetal specific gamma-globulin, in amniotic fluid may indicate presence of ancephaly or myelomeningocele.
-the optimum time for peforming these tests is between 16 and 18 weeks of gestation
Nursing Care:
-sterile, moist covering with normal saline
-prevent infections (bowel and bladder)
-neuro assessments
-pre and post op care
How do you take folic acid?
To ensure daily intake of the recomended amount of folic acid,women must take a folic acid supplement, eat a fortified breakfast cereal containing 100% of the recommended dietary allowance of folic acid, or increase their consumption of foritfied foods (cereal, bread, rice, grits, pasta) and foods naturally rich in folate (green leafy vegetable and citrus fruits).
-contraindicated in epileptic women taking antiepileptic medications during pregnancy
Latex Allergies & Spina Bifida:
-Latex allergy was idenified as being a serious health hazard when a report linked intraoperative anaphylaxis with latex in children with SB.
-Ask all patients about allergies to latex, stress the importance of the allergy history to all personal

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