Neuro
1. Unable to sit supported by 8 months.
2. No smile at 3 months
EARLY signs/symptoms of increased ICP?
Irritability, high pitched cry, poor feeding, bulging fontanels, separated cranial sutures, nausea, projectile vomiting, headache, blurred vision, lethargy, losing ability to follow simple commands, seizures, drowsiness, increased head circumference.
Hydration is important in management of a sickle cell patient in crisis, but is also an important teaching for general management of the disease.
Why?
It prevents a decrease in blood volume (hypovolemia), which decreases perfusion.
This is the major cause in vaso-occlusion, and throws them into a vaso-occlussive crisis, which results in immense pain and increases chances of clotting.
What are the major diagnostic tests for neuroblastoma?
CT Scan
24 hour urine: positive for catecholamines?
Adrenal neuroblastoma that presents with malignant hypertension and high norepinephrine and dopamine levels (found in a catecholamine/24 hour urine test).
Describe the positioning a child should be in when undergoing a spinal tap procedure.
Side-lying in a "cannonball" position, head to chest
What condition is an imbalance in production and absorption of CSF, and can also be a blockage in the ventricles due to malformation or tumor?
Hydrocephalus
What are the qualifications for an epilepsy diagnosis?
2 or more unprovoked seizures more than 24 hours apart.
What is hemophilia? What are the two types and what is the treatment?
Inherited blood disorder that is caused by deficiencies in specific coagulations/clotting.
Hemophilia A: Deficiency of clotting factor 8
Hemophilia B: Deficiency of clotting factor 9
Factor replacement (specific to the type of hemophilia), vasopressin, and steroids.
Where is Ewing's sarcoma usually found and what signs and symptoms would be presented?
In the shafts of long bones and trunk bones.
Weakness, pain, swelling, limping, impaired ROM.
LATE signs/symptoms of increased ICP?
Abnormal pupils, BRADYCARDIA, decreased sensory/motor responses, abnormal posturing.
What are some signs of Abusive Head Trauma/Shaken Baby Syndrome?
Respiratory distress
Bulging fontanels
Increase in head circumference
Vomiting
Seizures
Apnea
Irritability
Lethargy
What are some risk factors for iron-deficiency anemia?
What labs are done to determine a deficiency?
Diet too high in cow's milk (usually seen in patients between 12-36 months of age)
Malabsorption disorders
*H+H and CBC (will have a decreased RBC count)
Leukemia is a cancer that causes an increase in the production of immature white blood cells in the body.
What are the early signs/symptoms?
Late?
Early: Fever, infections, bruising, pallor, GI upset, unsteady gait, anemia, lethargy, malaise, anorexia.
Late: Pain, hematuria, GI ulcers, increased ICP, petechiae, enlarged organs, weight loss.
What does the CSF analysis look like for a positive viral meningitis diagnosis?
Clear, with normal protein and glucose levels
Signs and symptoms of meningitis?
1. Photophobia
2. Headache, Nausea and Vomiting
3. Irritability, high pitched cry
4. Poor feeding/FTT
5. Nuchal rigidity (neck stiffness)
6. Fever/seizures
7. Bulging fontanels (Late sign)
8. Petechiae
How is bacterial meningitis diagnosed, and what does a positive diagnosis look like?
Spinal tap/lumbar puncture, the CSF is cloudy, has an elevated WBC count has elevated protein, and decreased glucose levels.
What are some signs and symptoms that someone is in sickle cell crisis?
Pain
Shortness of breath
Fever
Shortness of breath
Fatigue
Pallor
Jaundice
Osteosarcoma is usually mistaken for what?
Growing pains because it is located at the ends of the bones, where the growth plates are located.
What are some nursing interventions for patients with increased ICP? Meds?
1. Elevate HOB to 30 degrees
2. Position head in neutral, midline position
3. Educate to avoid coughing/straining/blowing nose
4. Administer stool softeners
5.Insert catheter
6. Minimal/No suctioning
7. Seizure precautions
8. DECREASE STIMULI
Mannitol, osmotic diuretics, antiepileptics, antibiotics if CSF leak or injury.
What is the criteria for qualification for an ADHD diagnosis and what are some interventions that we would take or teach these patients and family?
Inattention, hyperactivity, and impulsivity shown in TWO OR MORE settings (ie. school, church, after school activities)
Frequent breaks, safety measures for impulsivity, decrease distractions.
Calm and firm approaches, with clear limits, and structured environment.
Positive feedback and patience.
Physical activities to help with hyperactivity, break tasks down to make more manageable.
Autism is the neurodevelopmental disorder that affects an individual's ability to communicate and interact with other people, with a wide scale/range of difficulty in functions.
What are some major indicators of autism?
NO SMILE BY 3 MONTHS
NO EYE CONTACT
LACK OF BABBLING BY 12 MONTHS
NO WORDS BY 18 MONTHS
Repetitive actions
Strict need for routines
Unusual attachment to certain objects
Speech Delay
Withdrawn behavior
What are some manifestations of anemia?
Pallor
Bruising
Fatigue/weakness
Shortness of breath
Jaundice (because of decreased RBC)
Clubbing
Sometimes tachycardia
Where is Wilm's tumor located, and how would you describe the tumor?
Cancerous tumor located in the KIDNEYS (NEPHROblastoma).
The tumor is unilateral (if bilateral, it has metastasized), and is a firm/non-tender palpable abdominal mass. "Olive-shaped" and is found in the flank, usually on the back and is sometimes found when giving kids a bath.
Posturing occurs when control of motor function is lost, what is decorticate posturing? Decerebrate? While both ominous, which is indicative of more extensive brain damage?
Decorticate: Arms are tight TO the body, legs are extended and flexed inward (De"CORE"ticate, extremities are pulled toward the core)
Decerebrate: Arms are extended and flexed outward/prone (E's=extended/extension)
Decerebrate is indicative of more extensive brain damage