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Nsg213
Nsg213 Exam
| Question | Answer |
|---|---|
| bending of light rays through the lens of the eye | refraction |
| rays focus on the front of the retina, nearsighted | myopia |
| rays focus behind the retina, farsighted | hyperopia |
| rays focused over a diffuse area on the retina rather than being clearly focused | astigmatism |
| refractive powers of the eyes are unequal | anisometropia |
| binocularity should occur by what age | 6 months |
| What is strabismus? | unequally aligned eyes, known as crossed or lazy eye |
| Is there a family history in patients with strabismus? | 50% of children will have family history |
| What is extropia? | In strabismus, when eye deviates out- divergent |
| What is estropia? | In strabismus, eye deviates in- convergent |
| How do the eyes look if a patient has vertical strabismus? | one pupil is higher than the other |
| Difference between monocular and alternating strabismus | *monocular- same eye deviates constantly *alternating- one eye deviates and then the other |
| possible causes of strabismus | *prematurity *traumatic brain injury *retinoblastoma *congenital rubella *genetic defects *cerebral palsy |
| Manifestations of strabismus | *squinting *closes one eye to see *tilts head to side *inaccurate eye hand coordination *double vision *symptoms of refractory errors |
| What is ambient light in the infant? | check to see if light relects on same part of eye on both eyes |
| Up to what age is occasional occurrence of strabismus normal? | 6 weeks |
| What is the hirshberg's test? | shining light at pupils to determine centering |
| What is the cover test? | cover one eye for 5 seconds, remove cover, eye drifts back to normal position = latent strabismus |
| Management of strabismus | *Correct Early!!! *muscle exercises *surgical correction of muscles |
| What is diminished receptive vision, can be unilateral or bilateral? Results when there are 2 different images (strabismus), brain supresses one image- blindness results | ambylopia |
| How can ambylopia be avoided? | Early intervention and correction- brain center reception complete by 6-7 years of age |
| Manifestations of cataracts | *opacity of lens *infant fails to reach for objects *infant does not respond to visual stimuli *pupil opening white not black *older children report blurred vision |
| Post op care after cataract surgery | *maintain light sedation *may have eye patches *slow intro to fluids/food to avoid n/v *avoid crying *fit with contact lens after healing |
| Manifestations of congenital glaucoma (recessive gene inheritance) | *cornea appears enlarged *cornea edematous *cornea hazy *blue tinge to sclera Symptoms usually noticed shortly after birth |
| What is done for congenital glaucoma? | *immediate surgery- goniotomy, new opening for canal of schlem- multiple surgeries *diamox- supresses production of aqueous humor *miotic- increases aqueaous humor drainage *laser therapy *avoid drugs that dilate pupils |
| What visual acuity is considered partially sighted? | 20/70 to 20/200 |
| Who is considered legally blind? | acuity of 20/200 or worse in corrected eye |
| What are some etiologies of visual impairments in children? | *perinatal or postnatal infections(gonorrhea, chlamydia, rubella, syphilis, toxoplasmosis) *retinopathy or prematurity *perinatal or postnatal trauma *fetal alcohol syndrome |
| How is conjuctivitis treated? | *opthalmic antibiotics *systemic antibiotics if needed |
| What do you always want to use with caution regarding medication in the eyes? | Use of steriods- could exacerbate viral infections |
| What is the risk of cellulitis in the face? | may spread to eye and damage optic nerve if not treated with IV antibiotics |
| What are some ways to prevent visual impairment? | *prenatal care/ prevention of prematurity *rubella immunizations for all children *safety counseling for preventing eye injuries |
| Screening and assessments for visual impairment | *newborns-preschoolers- screen annually *older children- screen every 2-3 years *observe for squinting, rubbing of eyes, water/red eyes *distance of holding reading material *learning difficulties |
| What to do if a foreign body is in eye? | evert upper lid, moistened cotton swap to remove debris |
| Chemical in eye- first action? | flush with water |
| Treatment for corneal abrasions? | antibiotic wash, patch eye |
| Treatment for hematoma of eye (black eye) | ice pack 20 min on 20 min off |
| What to do for a penetrating eye trauma? | MEDICAL EMERGENCY- *patch both eyes to prevent movement |
| Occurs when the ciliary body is injured- opposite eye is at risk for becoming inflamed and blindness can occur in the non affected eye. Very serious condition. | Sympathetic iritis |
| Possible causes if hearing impairment | *anatomic malformation *low birth weight *ototoxic drugs *chronic otitis media *perinatal asphyxia *perinatal infection *cerebral palsy |
| To ensure proper speech, by what age must a hearing impairment be diagnosed and treated with a hearing aid? | diagnosed by 3 mos and hearing aid by 6 mos |
| Conductive hearing loss- which part of ear is affected? | middle |
| Type of hearing loss caused by nerve deafness | sensorineural |
| What can cause a mixed conductive and sensorineural loss? | recurrent OM with complications |
| What is organic hearing impairment? | dysfunction of reception of stimuli and meaningful communication |
| What causes functional hearing impairment? | non organic- psychological disorders |
| Red flags to alert you of possible hearing impairment in infancy | *lack of startle reflex *absence of babbling by 7 mos *general indifference to sound *lack of response to spoken word |
| Therapeutic management of hearing dysfunctions | *hearing aid *cochlear implants- 1 year and older- child must learn to re-hear, older children who learned sign language may have difficult time |
| High risk age group for otitis media | 6mos-2years then 5-6 years |
| Risk factors for otitis media? | *infants fed supine or use pacifier *recent infection (flu) *daycare *changes in climate *smoke *genetic predisposition |
| What is the purpose of the eustachian tube? | flat, closed structure that allows drainage from iddle ear- when clogged, air cannot escape causing negative pressure- bacteria from nasopharynx can back up causing infection |
| Manifestations of what? red, bulging eardrum, poor eardrum mobility, rupture of eardrum, external drainage, crying, fussy, poor sleeping, pulls at ear, poor feeding, tinnitus, fullness | otitis media |
| Management for otitis media | *decrease pressure *reduce inflammation *antibiotics *prevent rupture of eardrum *preserve hearing *relieve pain *surgery *change risk factors |
| Surgical intervention for otitis media that involves incision in bottom of eardrum and drainage | myringotomy |
| Insertion of tubes into ears | tympanostomy- allows drainage and allows ability to dry up |
| Why would a child have their adenoids and tonsils removed? | compound reoccurence of otitis media and tonsilitis or sleep apnea |
| If a child had a tympanostomy, what is important to teach? | no swimming, keep ears dry |
| possible complications of otitis media? | *mastoiditis *hearing loss *otitis externa |
| Which auditory condition? known as swimmers ear, very painful over pinna and tragus, may have drainage, swollen lymph nodes, lining of external ear canal is inflamed | otitis externa |
| what to do for otitis externa? | *bacterial or antifungal drops Prevent by using 2%acetic acid eardrops to keep ear dry |
| etiology of childhood seizures | *brain center development *ionic microenvironment *immaturity of electrical circuits *reduced threshold for seizure signals |
| Major causes of seizures in children | *birth injuries/head trauma *anoxia/hemorrhage/electrolyte/BS/drug withdrawal *congenital defects of CNS *genetic *tumor *acute infections |
| What are some common seizure triggers for children? | *changes in dark light patterns *sudden loud noises *extreme temp changes *dehydration *fatigue |
| Diagnostics used to determine cause of seizure | *EEG *MRI *glucose, electrolytes, BUN, Ca++ *Lumbar Punture |
| Are single seizures usually treated with long term meds and considered epilepsy? | No, only recurrent seizures |
| Which type of seizure? prodromal period, aura, loss of consiousness, automatic behavior, postictal tiredness/sleeping. Occurs in temporal lobe. | complex partial seizure |
| Which type of seizure? *prodromal period and aura *flexion, extension, tremors *apnea, cyanosis, noisy resperiations, incontinence, sudden brief cx of muscle *impaired consiousness *both hemispheres involved *may be mistaken as exaggerated startle re | generalized tonic clonic |
| Which type of seizure? brief LOC 5-30 sec max,sudden onset, up to 20x/day, returns to prior activity, motor-lip smacking, twitching of eyes and face, no incontinence, misdiagnosed as daydreaming | absence seizures, petit mal |
| At what age is a febrile seizure most common? | between 6 mos and 3 years-- rare after age 5 |
| When does a febrile seizure occur? | WHEN temp is rising, NOT after,temp of greater than 101.8 usually, may last 15 minutes |
| What to do for a febrile seizure? | *high doses of antipyretics *protect from injury *call 911 is lasts longer than 5 mins *diazepam (rectal) |
| What is status epilepticus and what to do for it? | seizure lasting longer than 30 min- can cause intracranial insult. Maintain airway, IV access, meds |
| Dilantin- how many mg/min, what kind of fluids, side effects? | *PO or IV push- less than 50 mg/min *no glucose, mix with normal saline only *SE: gingival hyperplasia, ataxia, rashes, acne, hirsutism, osteoporosis |
| Drugs of choice for status epilepticus | *Valium- IV or intraosseous *Ativan-preferred in US,IV or intraosseous *no parenteral access, IM Versed |
| When would you give IV dilantin or cerybex, then go to phenobarbital or versed? | for continuous seizures |
| Ceryebyx- given with what? What rate? What route? | *glucose or saline *up to 150 mg/min *IV or IM |
| Valium- what routes? what is it used for? | rectal (diastat) or IV- tx status epilepticus |
| Which drug of choice for seizures older than 2 years of age? | Ativan causes less resp distress |
| Versed- What route? What is it used for? | intranasal, used for acute epileptic seizures |
| Acute inflammation of the CNS, can be caused by many bacterial agents | Bacterial Meningitis |
| Symptoms infants with bacterial meningitis may have | *mild fever *blank stare, inactive *irritable *vomiting/anorexia *high pitched cry *bulging fontanel *can progress to seizures |
| Symptoms children older than 2 may have with bacterial meningitis | *fever *n/v *fatigue/sleepiness *headache *discomfort looking at bright lights *confusion *nuchal ridgity *convulsions |
| A disease of the adrenal glands commonly caused by neisseria meningitidis- infectious process leads to meningococcemia with massive hemorrhage, low bp, shock, DIC, and purpura- leads to adrenocortical insufficiency | Waterhouse-Friderichsen Syndrome |
| How is bacterial meningitis diagnosed? | *signs and symptoms *opisthotonos- arching of back *CSF evaluation- turbid(wbcs) or xanthochromia(yellow, orange or pink- lysis of RBCs, breakdown of hemoglobin into oxyhemoglobin, methemoglobin, and bilirubin) |
| When does discoloration of the spinal fluid occur? | after RBCs have been in fluid for about 2 hours and lasts 2-4 weeks |
| What will likely be seen in the spinal fluid within 12 hours of a subarachnoid hemorrhage? | xanthochromia |
| CSF protein levels should be at least __________? | 150 mg/dL |
| What does it mean if there is decreased glucose in the CSF? | bacterial infection- bacteria uses up glucose |
| Management of bacterial meningitis | *isolation *antibiotics *dexamethasone *hydration balance *electrolyte monitoring *assess for subdural effusion *DIC management |
| Causes of aseptic meningitis? | *viruses *measles, mumps, herpes, leukemia |
| How is aseptic meningitis diagnosed? | Lumbar punture |
| manifestations for aseptic meningitis? | headache, fever, malaise |
| Inflammatory process of CNS with altered function of brain and spinal cord, usually secondary to othe infection, usually viral in cause- can be caused by mosquitos and ticks | encephalitis |
| Diagnostics for encephalitis | CSF, virus identification, R/O guillian barre syndrome, reye syndrome |
| Manifestations of encephalitis | *malaise *fever *headache/ dizziness *stiff neck *n/v *ataxia *speech difficulties If severe- *high fever *disorientation *seizures *ocular palsies *paralysis |
| etiology of reyes syndrome | unknown- but associated with ASA use and viral infections |
| Which illness? acute, non inlammatory encephalopathy | reye syndrome |
| What organs does reyes syndrome affect? | fatty degenerative changes in the brain, liver, and kidneys |
| Diagnostics for reyes syndrome | *ELEVATED AMMONIA *liver biopsy *hypoglycemia *lactic acidosis *cerebral edema and IICP |
| What are the primary threats for a child with reyes syndrome? What is the prognosis? | ammonia and IICP are the primary threats to recovery, may have subtle neuro deficits |
| Nursing considerations for reyes syndrome | *intensive care *foley *ng tube *i and o *bleeding issues *ventilatory management *mannitol *vitamin k *may be in barbituate coma |
| How do you know a child with reyes syndrome is worsening? | decorticate or decerebrate posturing |
| What condition? Neural tube defect- failure to close- could be in lumbar or lumbosacral, could be occulta(hidden), meningocele(meninges), or myelomeningocele(nerves and meninges) | spinal bifida |
| Diagnostics for spina bifida | *elevated alpha fetoprotein(amniocentesis, fetal ultrasound) *clinical presentation *MRI/CT *diagnostics to determine bowel and bladder status |
| Newborn care of a myelomeningocele or meningocele sac | *moist NS dressings *assess for sac leaks *prone positon *hips slightly flexed *NO DIAPERING *keep perianal area clean at all times |
| Surgical closure of a meningocele sac must be done w/in how many hours to prevent risks of infection, hydrocephaly, b & b dysfunction, motor dysfunction, skin breakdown | 24-72 hours |
| Post op care after surgical closure of a meningocele | *prone position for several days *avoid holding in surgical area *assess b and b function *motor function *assess ICP *hydrocephalus/head circumference *skin for breakdown |
| What is ditropan given for in a child with spinal bifida? | neurogenic bladder- souce of UTI, may have to self cath, may have urinary diversion |
| Why would a child with spinal bifida need fiber, laxatives, suppositories, and enemas? Also MACE- flush out colon. | for neurogenic colon |
| What can cause hydrocephalus? | *could be congenital *disturbances in CSF flow *tumor *myelomeningcele *spinal bifida |
| Which type of hydrocephalus? impaired absorption of CSF within the subarachnoid space | communicating |
| Which type of hydrocephalus? obstruction to flow of CSF through ventricular system | noncommunicating |
| management of hydrocephalus | *head circumference *fontanel tension *sunset eyes *developmental delay *ICP monitoring *CO2 monitoring May have VP shunt |
| signs of IICP | *irritability/restlessness *drowsiness, change in normal behavior *fatigue, somnolence *unable to follow commands, memory loss *weight loss *headache *seizures *diplopia *blurred vision *vomiting |
| How does oxygen and CO2 play a part in ICP? | If low O2 and high CO2, vessels dilate, ICP increases If high O2 and low CO2, vessels constrict, ICP decreases |
| Sleep is restorative, it does the following: | *repairs and renews epithelial cells *repairs and renews brain cells *triggers GSH from pituitary *less epinephrine is released so here is less interference with cell division and wound healing |
| Sleep is conservative, it does the following: | *energy conservation du to lowered BM *lowered bp,p,r,temp *decreaesed digestive secretions *decreased urine production *decreased reflexes |
| Infants need how many hours of sleep per night? | 9-11, total 15 hrs/day |
| night sleep patterns are developed by what age? | 3-4 months, if they are breastfed, they will sleep less |
| Toddlers need how many hours of sleep per night? | 10-12, naps |
| How much sleep does a preschooler need? | 12hrs/night, usually no naps |
| How many hours of sleep does a school age child need? | 8-10 hrs/night |
| Adolescents need how many hours of sleep per night? | 8-9 |
| Why do adolescents usually have episodes of tiredness and fatigue? | Their heart and lungs have not grown enough keep up with demand |
| Downsideds of cosleeping? | *SIDS *poor sleep *child becomes dependant of parents bed *suffocation of child *strangulation |
| Repetitive episodes of upper airway obstruction that occurs during sleep, usually associated with reduction in blood oxygen saturation | obstructive sleep apnea |
| Symptoms of sleep apnea | *daytime sleepiness *frequent episodes of obstructed breathing while sleeping *snoring *restless sleep *irregular breathing *excessive perspiring *bedwetting *nightmarees *night terrors *sleeps with mouth open *chest retraction *failure to thr |
| An overnight test that involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level, and audio monitoring for snoring, gasping, etc | Polysomnogram |
| Management of a child with sleep apnea | *tonsils and adenoids out if needed *c-pap *bi-level positive airway pressure *polyp removal *correction of facial deformities *fixing deviated septum |
| Sleep walking | Somnambulism |
| WHen does sleep walking occur? | during 3rd or 4th non-REM sleep stages, early in the night, may be caused by fatigue or aniety |
| Typical age of sleepwalking | 6-12 years old |
| Nightmares are a symptom of the child's what? | insecurities |
| manifestations of night terrors | *child bolts upright *eyes wide open, look of fear and panic *sweating, breathing fast, rapid heart rate *will seem awake but are inconsolable *lasts about 5-30 min, will not remember |
| Diagnosis of night terrors | history of child waking up being inconsolable |
| Prevention of night terrors | stick to bedtime routine, wake child up before they usually have night terrors |
| sleepwalking, sleeptalking, and night terrors are considered to be a disorder of what? | arousal and are a partial arousal from non-REM sleep |
| What is the "phase shift" that adolescents experience during puberty? | melatonin production tapers off later in the evening than it did in prior years- the brain's circadiam timing system switches on later at night as pubertal development progresses |
| What does the acronym "BEARS" refer to? | 5 questions to see if your child has sleeping problems Bedtime, Excessive daytime sleepiness, Awakenings, Regularity and duration of sleep, Snoring? |
| Child abuse is thought to stem from what 3 factors interacting between the parent and child? | 1. parental characteristics 2. characteristics of child 3. environmental characteristics |
| What are the effects of child abuse and neglect? | lack of trust and relationship difficulties, core feelings of being worthless or damaged, trouble regulating emotions |
| Which type of child abuse? pattern of failing to provide for a child's basic needs, food, clothing, hygiene, supervision. | child neglect |
| which type of child abuse? constant belittling, calling names, yelling, threatening, ignorning child for punishment, no hugs, kisses, exposing child to abuse of others | emotional child abuse |
| Difference between physical abuse and discipline. Discipline has these factors: | unpredictability- no clear boundaries or rules, lashing out in anger, using fear to control behavior |
| What usually results from sexual abuse? | feelings of shame and guilt, self-loathing, sexual promiscuity later |
| Warning signs of emotional abuse in children | *excessively withdrawn, fearful or anxious *extremes in behavior *doesn't seem attached to caregivers *acts inappropriately like an adult or infantile |
| Warning signs of neglect in children | *clothes ill fitting, filthy *hygiene consistently bad *untreated illnesses or injuries *frequently unsupervised *frequently late for school or misses school |
| Warning signs of physical abuse in children | *frequent unexplained injuries *always watchful and alert *injuries appear to have a pattern such as marks from hand or belt *shies away from touch, flinches at movement *wears inappropriate clothing, such as long sleeves on hot day |
| Disorder that results from severe abuse early in life- children are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones | Reactive attachment disorder |
| Risk factors for child abuse and neglect | *domestic violence *substance abuse *untreated mental illness *lack of parenting skills *stress and lack of support |
| characteristics of children that contribute to abuse | *illegitimate *unwanted *preemie *health problems *hyperactive |
| Once a suspected abused child is admitted to the hospital, after reported to CPS, how do you treat the family? | *be positive *consistent nsg care *be a role model *praise child for abilities *show attention *avoid asking parents lot of questions *promote parental attatchement *encourage child to talk about feelings |
| Intentional production of physical or psychological signs and symptoms in another person who is under the individual's care | munchausen's syndrome by proxy |
| Children at risk for munchausen's syndrome by proxy | 15 mos to 6 years |
| Warning signs of munchausen's syndrome by proxy | *illness prolonged, unusual *symptoms inapropriate *multiple allergies *symptoms disappear when caretaker leaves *one parent usually absent during visit *hx of SIDS in sibling *parent overly attached *parents show inordinate concern for feelings of |
| diagnosis of munchausen's syndrome by proxy | *urine toxicology screening *chemistry panels *ecg *drug levels *cultures *coagulation tests *head ct scan -parent is removed from care |
| type of behavior that is passed down from one generation to another, has emotional and behavioral characteristics that interfere with the individual's ability to have a healthy relationship. Also known as relatonship addiction | co-dependency |
| Which type of child role in the "family trap"? usually the oldest child, overly responsible, assists co-dependent parent i running the family. As adults will feel superior to others and perfectionaly seek a better life,feels guilty when familyleft behind | Hero |
| Which type of child role in the "family trap"? can be the second child, seeks attention by negative behavior as all positive attention is given to the hero, family troublemaker, often blamed for families troubles | scapegoat |
| Which type of child role in the "family trap"? born into already highly stressed family, quiet, withdrawn, prefers to be alone, values items more than people. As adults, prefer non human contact careers, lonely | lost child |
| Which type of child role in the "family trap"? child is family's pain eater, brings the whole family together by making them laugh. class clown, appear to be immature, as adults they maby be percived as insensitive and unable to be serious- numb inside | mascot- extremeley vulnerable, fearful, and sad |
| Manifestations of IICP in infants | *irritability/poor feeeding *high pitched cry, difficult to soothe *fontanels bulging *cranial sutures seperated/scalp veins distended *eyes/setting-sun sign *dolls eyes |
| Late signs of IICP | *decreased LOC *decreased motor response to command *decreased sensory response *alterations in pupils *papilledema *decerebrate or decorticate posturing *cheyne-stokes resp |
| Nsg care for a child with IICP | *HOB 30-45 degrees *cervical collar if needed *avoid extreme hip flexion *avoid valsalva-hold breathe when turning *well spaced activities *avoid isometric exercises |
| Disorder of impaired gross motor movement, coordination, posture, abnormal muscle tone, intellectual dysfunction, language deficits, and perceptual problems- caused by abnormalities in brain, no muscle or nerve involvement | cerebral palsy |
| Manifestations of cerebral palsy | growth and development milestones not attained- usually appears before a child reaches 3 years of age |
| Is cerebral palsy a progressive disorder? | NO- if changes, it is not cerebral palsy |
| Possible etiologies for cerebral palsy | *prenatal-brain abnormalities, infections *perinatal-asphyxia, CVA *preterm, low birth weight *kernicterus- brain injury due to hyperbilirubinemia *shanken baby syndrome *head trauma, cerebral infections early in life |
| Diagnostics done for a child with cerebral palsy | *MRI- brain and spinal cord *EEG *genetic testing *hearing/vision |
| management for cerebral palsy | *surgical release of tight tendons, neurosurgical rhizotomy, braces, assistive devices *meds *baclofen pump *botox injections *PT *anti seizure meds |
| Subsequent complications from head injuries | *hypoxic brain injury *increasing ICP *infection *hematoma *cerebral edema |
| transient and reversible head injury, instantaneous loss of awareness and responsiveness lasting for minutes-hours, followed by amnesia and confusion | concussion |
| damage to actual brain tissue | laceration |
| coup injury | bruising at the point of impact |
| countercoup injury | bruising at the site opposite from the point of impact |
| What can a fracture on the underside of the skull result in? | tearing of the meningeal artery causing severe hemmorhage with hypovolemic hyptotension |
| type of fracture? fracture line simple or complex | linear fracture |
| type of fracture? associated with lacerations | depressed fracture |
| type of fracture? depressed fracture with many fragments | comminuted |
| type of fracture? follows suture line | diastatic |
| type of fracture? serious, battle sign and raccoon eyes | basilar |
| diagnostic evaluatin for head trauma | *ABCs *vital signs *neuro exam *CT/MRI *behavioral/sensorium assessment |
| management for head trauma | *frequent vitals and neuro checks *npo initially *possible surgical interventions *analgesia and sedation *rehab |
| Levels of consciousnss in descending order | *full consciousness *confusion *disorientation *lethargy *obtundation *stupor *coma *persistent vegetative state |
| Diagnostics for neurological symptoms | *labs-glucose, CBC, elecrolytes, blood culture if fever, liver *CT/MRI, echo, ultrasound, brain scan, PET scan *Lumbar Pucture *EEG *Xray |
| cerebral hypoxia lasting longer than ___ hours may cause irreversible brain damage | 4 |
| medications for neuro patients | *osmotic diuretics *antiseizure meds *sometimes barbituates *paralyzing agents *antipyretics |
| Nsg care for unconscious child | *i and o *foley *moniter urinary output q2-4hrs *fluid restriction *osmotic diuretics *vs, high range normal bp *no closed mouth coughing *pupil assessments *cognition *turgor *do not suction nares *monitor temp *test stols for blood |
| pain management for comatose child | *assess for signs of pain, pain increases ICP *alterations in vs |
| drug therapies for a comatose child in pain | *opiods *fentanyl+versed+vecuronium *tylenol with codeine |
| Central diabetes insipidus can bbe caused by: | head injury, infection, surgery, tumor- damage to hypothalamus or pituitary gland |
| SIADH can result from what? | Increased intracranial pressure |
| Which problem occurs from altered pituitary secretion and involves decreased urine output with hyponatremia and hypo-osmolality | SIADH-fluid restriction, observe for electrolyte imbalances, vasopressin |
| What are some possible causes for cognitive dysfunction? | *genetic predisposition *perinatal injury *environmental eposures *neurologic and medial conditions |
| Interventions for a child with cognitive dysfunction | *sensory deficits need to be diagnosed and corrected *address self esteem and confidence *avoid misdiagnosing by labeling the behavior (ADHD) |
| Defined as substantially subaverage intellectual functioning, considerable limitations in adaptive functioning in 2 or more of the following: communication, home living, interpersonal skills, self care, self direction, academic skills, health, work,etc. | intellectual disability |
| Prevention of intellectual disability | *rubella vaccination *genetic counseling *use of folic acid *educate about fetal alcohol syndrome *educate about lead exposure |
| Known as trisomy 21, most common chromosomal abnormality | down syndrome |
| eitiology for down syndrome | *likely multiple causes *maternal age- most downsyndrome children have mothers less than 35 |
| manifestations for down syndrome | *seperated sag sutures *small nose & chin, flat nasal bridge, round face, high arched palate, protruding tongue *eyes upward outward slant *hyperflexible, hypotonia *neck, thick w/excess skin *short limbs, space between 2nd & big toe *simian crease |
| congenital anomalies that may go along with down syndrome | *40-45% heart defects *renal, hirschsprung, TE fistula *altered immune function *skeletal defects |
| Do children with down syndrome generally have intellectual disabilities? | yes, generally mild to moderate disability, from severe disability to low-average intelligence |
| Second most comon genetic cause of intellectual disability after down syndrome, x linked dominance with reduced penetrance, gender differences, most common in males | fragile x syndrome |
| How does fragile x syndrome affect males? females? | Most males are mentally deficient, while onlye 30% of females are. |
| Physical appearance of a child with fragile x syndrome | *long face, proganthic jaw, large ears, strabismus *mitral valve prolapse *macro-orchidism *palate- high arch *hyperextensible finger joints/ palmar crease *flat feet |
| Behavioral manifestations of a child with fragile x syndrome | *mild to severe intellectual disability/normal IQ with learning disabilities *delayed speech and language *hyperactivity *autistic-like behaviors *aggressive behaviors |
| Therapeutic management for fragile x syndrome | *tegretol/prozac *stimulants for hyperactivity *mimic behavior |
| Which dysfunction? Brain dysfunction accompanied by broad range and severity of intellectual and behavioral deficits | Autism |
| Diagnostic criteria for autistic disorder | *impairment in social interaction and communication *restricted repetitive and stereotype patterns of behavior, interests, and activities *delays or abnormal functioning with onset before 3 years |
| Nursing considerations for autism | *wide variations in individual client response to tx *no cure *highly structured routines and intensive behavior modification programs *pet therapy |
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