Title NLOA 1 Semi ✅

SEMI FINALS (Nursing Practice 2: Care of Healthy / At Risk Mother and Child) 0 I. E.1,: Neurologic Disorders, E.6: Cognitive or Mental Health Disorders 1 A. Normals 1 B. Increased Intracranial Pressure (ICP) 1 C. Seizures 1 D. Neural Tube Defects (NTDs) 3 a) Anencephaly 3 b) Encephalocele 3 c) Spina bifida 3 E. Hydrocephalus 3 F. Sturge-Weber syndrome 4 G. Reye’s Syndrome 4 H. Head Injury - in Injuries Portion 4 I. Mental Retardation 4 J. Down Syndrome 5 K. Cerebral Palsy - in Musculoskeletal 6 L. Guillain-Barré Syndrome 6 M. Meningitis 6 N. Tourette Syndrome 7 O. Ataxia-telangiectasia 7 P. Attention Deficit Hyperactivity Disorder (ADHD); formerly Attention Deficit Disorder 7 Q. Autism 8 R. Separation Anxiety Disorder 8 S. School Phobia 8 T. Food Eating Disorders 8 1. Rumination Disorder 8 2. Anorexia Nervosa 8 3. Bulimia 8 4. Binge Eating 8 U. Encopresis 8 V. Manic / Mania 9 W. Schizophrenia 9 X. Bipolar Disorder 9 Y. Oppositional Defiant Disorders 9 Z. Depression and Suicide 9 II. E.2: Vision and Hearing Disorders 11 A. Normals 11 B. Low Visual Acuity (Blindness) 11 C. Color Blindness (Color Deficit) 12 D. Nearsightedness 12 E. Farsightedness 12 F. Glaucoma 12 G. Cataracs 12 H. Hemianopia 12 I. Strabismus (Cross-Eyes or Squint) 12 J. Amblyopia (Lazy Eye) 13 K. Conjunctivitis (Pink Eye) 13 L. Pterygium 13 M. Eye Trauma 13 N. Deafness or Hearing Loss 14 O. Ear Trauma 14 P. Otitis Media 14 Q. Otitis Externa (Swimmer’s Ear) 16 III. E.3: Musculo-skeletal Disorders 17 B. Osteogenesis Imperfecta (OI; Brittle Bone Disease) 17 C. Osteomyelitis 18 D. Juvenile Arthritis (JIA) 18 E. Developmental Dysplasia of the Hip (DDH) 18 F. Fractures 19 G. Scoliosis 20 H. Other Abnormal Vertebral Curves 21 I. Cerebral Palsy (CP) 21 J. Congenital Myotonic Dystrophy 23 K. Facioscapulohumeral Muscular Dystrophy 23 L. Duchenne Muscular Dystrophy (MD) 24 M. Congenital Foot Deformities 25 N. Legg-Calvé-Perthes disease 25 O. Slipped Femoral Epiphysis 25 P. General Intervention and Management 25 IV. E.4: Unintentional Injury 26 A. Poisoning 26 1. Lead Poisoning (Plumbism) 26 2. Acetaminophen Poisoning 27 B. Drowning 27 C. Snake Bites 27 D. Ingestion of Foreign Objects 27 E. Burns 27 F. Deformities from Injuries (?) 28 G. Sprains and Strains 28 H. Head Injury 29 I. Spinal Cord Injury 29 J. Submersion Injury 29 K. Abdominal Injury / Trauma 30 L. Knee Injuries and Kneecap Dislocation 30 V. E.5: Oncologic Disorders 30 D. Leukemia 30 g) Acute Lymphocytic Leukemia (ALL) 31 h) Acute Myelogenous Leukemia (AML) 31 i) Chronic Lymphocytic Leukemia (CLL) 31 j) Chronic Myelogenous Leukemia (CML) 32 k) Chronic Myelomonocytic Leukemia (CMML) 32 l) Myeloproliferative Neoplasms (MPNs) 32 E. Brain Tumors 32 F. Lymphomas 33 a) Hodgkin lymphoma 33 b) Non-Hodgkin lymphoma (NHL) 33 G. Wilms’ Tumor (Nephroblastoma) 34 H. Osteosarcoma (Osteogenic Sarcoma) 35 I. Retinoblastoma 35 J. Rhabdomyosarcoma 35 K. Ewing’s Sarcoma 35 L. Neuroblastoma 35 M. Albright’s disease (Neurofibromatosis) 36 VI. E.7: Family in Crisis: Abuse and Violence 36 A. Child Abuse / Maltreatment 36 a) Physical Abuse 37 b) Munchausen Syndrome by Proxy (MSP) 37 c) Emotional (Psychological) Abuse 37 d) Neglect 37 e) Sexual Abuse 37 B. (Nonorganic) Failure to thrive (NFTT) 38 C. Adolescent Pregnancy 38 D. Death and Dying 38 VII. E.8: Child has a Terminal Illness 38 A. 2020 National Health Goals to reduce long-term illness and early death in children 38 B. Understanding of Death 39 C. Stages of Dying 39 D. Stages of Grief 39 E. Hospice Care 39 F. General Interventions and Health Teachings 39 VIII. Extra 39
NLOA 1 (LT 3, Semi, LT4, Finals) by TMJ (Temporomandibular Joint) CURSOR PARKING LOT Parking fee 25 grams catfood per hour +--------------------------------+ | | | | | | +-------------------------------- I.E.1,: Neurologic Disorders, E.6: Cognitive or Mental Health Disorders A. Normals 1. In children younger than age 3, the ear canal is directed upward. In older children, the ear canal is directed downward and forward. 2. Sound discrimination is present at birth. 3. 5-6 months, the infant can localize sounds presented on a horizontal plane and begin to imitate selected sounds. 4. 7-12 months, the infant can localize sounds in any plane. 5. 18 months, the child can hear and follow a simple command without visual cues. Children who have difficulty with language development by age 18 months should have their hearing evaluated. 6. At birth, visual function is limited to alertness to visual stimuli 8" to 12" (20.5 to 30.5 cm) from the eyes. Normal newborns already have a blink reflex. 7. Tear glands begin to secrete within the first 2 weeks of life. 8. Transient strabismus (deviation of the eye) is a normal finding in the first few months. 9. An infant can fixate on an object and follow a bright light or toy by ages 5 to 6 weeks. 10. An infant can reach for objects at varying distances at ages 3 to 4 months. 11. Vision reaches 20/20 when the child is about 4 years 12. Risk Factors for developing a mental health disorder a) Trauma (History of multiple injuries obtained from a motor vehicle crash) b) Poverty c) Neglect (Father unemployed and mother not always home; Expected to care for younger siblings while mother sleeps) d) Difficult temperament or attachment problems e) Medical illness f) Major losses to the family such as divorce Norepinephrine/ Epinephrine Vasoconstrictor, increases BP and cardiac output ❖ Increased: ❖ Decreased: ❖ SE: Palpitations, TISSUE NECROSIS with extravasation Dopamine ❖ Increased: ➢ vasoconstrictor ❖ Decreased: ➢ dilates renal & coronary arteries ❖ SE: GABA Inhibitory and modulate other neurotransmitter systems rather than to provide a direct stimulus. B. Increased Intracranial Pressure (ICP) 1. Etiology a) Causes (1) Shaken baby Syndrome (2) Craniosynostosis (3) Hydrocephalus 2. Pathophysiology 3. Clinical Manifestations (Signs and Symptoms) a) VOMITING: early sign (can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center) b) Increased Body Temperature c) Bradypnea d) Cushing’s Triad (1) Hypertension:Increased SBP with widened pulse pressure (2) Bradycardia: in response to elevated BP (3) Irregular Respirations: due to brainstem pressure e) Decreased LOC f) Papilledema - edema and inflammation of the optic nerve caused by increased ICP; assessed by ophthalmoscope 4. Labs and Diagnostics (Test Results) 5. Management, Treatment, Interventions a) Cerebral Perfusion Pressure = MAP - ICP C. Seizures 1. sudden, episodic, involuntary alteration in consciousness, motor activity, behavior, sensation, or autonomic function 2. Etiology a) Excessive neuronal discharges (epilepsy) b) Hyperexcitable nerve cells that surpass the seizure threshold c) Neurons overfiring without regard to stimuli or need 3. Pathophysiology 1
NLOA 1 (LT 3, Semi, LT4, Finals) by TMJ (Temporomandibular Joint) 4. Clinical Manifestations (Signs and Symptoms) a) General (1) May experience aura just before seizure’s onset (unusual tastes, feelings, or odors) (2) Eyes deviating to a particular side or blinking (3) Irregular breathing with spasms (4) Usually unresponsive during tonic-clonic muscular contractions; may experience incontinence (5) May be disoriented to time and place, drowsy, and uncoordinated immediately after seizure b) Generalized Seizures: both hemispheres (1) Tonic-Clonic (Grand Mal; major motor) (a) Violent total body seizure (b) Aura; tonic first (20 to 40 seconds); clonic next; postictal symptoms (2) Tonic (a) stiffening (b) Muscles are maintained in a continuous contracted state (rigid posture) (c) Variable loss of consciousness; pupils dilate; eyes roll up; glottis closes; possible incontinence; may experience excessive salivation (3) Clonic (a) Opposing muscles contract and relax alternately in a rhythmic pattern; may occur in one limb more than others (b) Mucus production (4) Atonic (a) Drop and fall attack; needs to wear protective helmet (b) Loss of posture tone; sudden loss of muscle tone followed by postictal confusion (5) Myoclonic (a) generalized short muscle contractions; exhibit movements that are characteristic for her (b) Movement disorder (not a seizure); seen as child awakens or falls asleep; may be precipitated by touch or visual stimuli; focal or generalized; symmetrical or asymmetrical (c) No loss of consciousness; sudden, brief, shocklike involuntary contraction of one muscle group (6) Absence (Petit Mal) (a) brief periods of unconsciousness or unawareness (b) Sudden onset; lasts 5 to 10 seconds; can have 100 daily; precipitated by stress, hyperventilation, hypoglycemia, fatigue; differentiated from daydreaming (c) Loss of responsiveness but continued ability to maintain posture control and not fall; twitching eyelids; lip smacking; no postictal symptoms (7) Akinetic (a) Sudden brief loss of muscle tone or posture (b) Temporary loss of consciousness c) Partial (Focal) Seizures: limited area of cerebral cortex (1) Simple (a) Symptoms confined to one hemisphere (b) May have motor (change in posture), sensory (hallucinations), or autonomic (flushing, tachycardia) symptoms; (c) no loss of consciousness (2) Complex (Psychomotor or Temporal Lobe) (a) Begins in one focal area but spreads to both hemispheres (more common in adults (b) Loss of consciousness; (c) aura of visual disturbances; postictal symptoms d) Status Epilepticus: recurrent or continuos generalized seizure (1) Prolonged or frequent repetition of seizures without return to baseline; may result in anoxia and cardiac and respiratory arrest (2) Consciousness not regained between seizures; lasts more than 30 minutes e) Infantile Spasm: (1) rare; seen in the first few months of life; characterized by signs such as brief flexion of the neck, trunk or legs f) Febrile: (1) Seizure threshold lowered by elevated temperature; only one seizure per fever; occurs in 4% of population younger than age 5; occurs when temperature is rapidly rising (2) Lasts less than 5 minutes; generalized, transient, and nonprogressive; doesn’t generally result in brain damage; EEG is normal after 2 weeks g) Idiopathic (1) Cause unknown; most common type of pediatric seizures; genetic factors may influence neuronal discharge 5. Labs and Diagnostics (Test Results) a) EEG results help differentiate epileptic from nonepileptic seizures. Each seizure has a characteristic EEG tracing 6. Management, Treatment, Interventions a) Antiepileptics (1) PHENYTOIN (Dylantin) 20% taking this has gingival hyperplasia → PROPER ORAL CARE (2) I.V. diazepam (Valium) or lorazepam (Ativan), phenobarbital (Luminal) or fosphenytoin (Cerebyx), phenytoin (Dilantin), valproic acid (Depakote), carbamazepine (Tegretol) (3) Rectal diazepam (Diastat) for home management of intractable or prolonged seizures b) Supportive until the seizure ends (maintaining airway, protecting from injury c) children with seizures should attend regular school and participate in physical education classes and active sports D. Neural Tube Defects (NTDs) 1. group of DEFECTS of the CNS involving cranial or spinal cord 2. may be cystic or non cystic 3. Etiology 2
NLOA 1 (LT 3, Semi, LT4, Finals) by TMJ (Temporomandibular Joint) a) largest group of congenital anomalies consistent with multifactorial inheritance b) 50% related to nutritional deficiency (folic acid) 4. Pathophysiology 5. Clinical Manifestations (Signs and Symptoms) a) Anencephaly (1) absence of the entire brain or cerebral hemispheres (2) Total anencephaly: incompatible with life (3) many are aborted or stillborn (4) living infants survive only a few hours b) Encephalocele (1) meningeal tissue protrudes in a sac through a defect in the skull (2) OCCIPUT - common site (3) little to no residual neurologic impairment in mild cases c) Spina bifida (1) exposure of the spinal cord resulting from a defect of back bone and spinal cord (2) Spina Bifida Occulta (a) the vertebral arch fails to close and the spinal cord and meninges stay within the vertebral canal (b) failure of the vertebrae to close without hernial protrusion (c) Because the central nervous system structures remain in the spinal canal, there are often no adverse physical sequelae, and the condition might remain undiagnosed, or hidden (occult) (3) Meningocele (a) meninges protrude, but the spinal cord is not involved (4) Spina Bifida Cystica (Myelomeningocele) (a) many have hydrocephalus (b) protrusion of spinal cord through incompletely arched vertebrae because of lack of union between the laminae of the vertebrae → motor and sensory function are absent beyond this point (A daily thorough skin check is the best way to evaluate circulatory and skin alterations) (c) 6. Labs and Diagnostics (Test Results) 7. Management, Treatment, Interventions a) Anencephaly b) Encephalocele c) Spina bifida (1) Spina Bifida Occulta (2) Meningocele (3) Spina Bifida Cystica (Myelomeningocele) E. Hydrocephalus 1. Etiology a) Congenital or Acquired b) Causes: (1) Arnold-Chiari malformation (downward displacement of cerebellar components through foramen magnum into cervical spinal canal); common in hydrocephalus with spina bifida (2) Overproduction of CSF by choroid plexus (3) Scarring, congenital anomalies, or hemorrhage; causes CSF to be absorbed abnormally after it reaches the subarachnoid space (communicating) (4) Tumors, hemorrhage, or structural abnormalities; block CSF flow, causing fluid to accumulate in ventricles (noncommunicating) 2. Pathophysiology a) increase in the amount of CSF occurs in the ventricles and subarachnoid spaces of the brain. b) become dilated because of an imbalance in the rate of production and rate of absorption of CSF c) Communicating: free flow of CSF between the ventricles and the spinal theca. Increased pressure on spinal cord is caused by defective absorption of CSF d) Non-communicating: obstruction occurs in free circulation of CSF, causing increased pressure on brain or spinal cord. In most cases, congenital hydrocephalus is noncommunicating 3. Clinical Manifestations (Signs and Symptoms) a) Neonate (1st 4 weeks) (1) Increase head Circumference b) Infant (1 month - 1 year) c) Toddler (1 - 3) d) Preschool (3 - 5) e) School Age (6 - 12) (1) Headache, personality change, and vomiting can each result from a space-occupying lesion that is applying pressure on brain structures. (2) Sutures should be closed, there should be no increase in head circumference occurring with hydrocephalus f) Adolescent (13 - 18) g) im tired to specify what age: (1) Cracked pot” sound when skull is percussed (2) Distended scalp veins (3) High-pitched cry (4) Inability to support the head when upright (5) Irritability or lethargy (6) Decreased attention span (7) Rapid increase in head circumference and full, tense, bulging fontanels (before cranial sutures close); bulging forehead (8) Sunset sign (sclera visible above the iris) (9) Widening suture lines (10) Vomiting (not related to food intake) 4. Labs and Diagnostics (Test Results) a) Angiography, CT scan, MRI differentiate hydrocephalus from intracranial lesions and may demonstrate Arnold-Chiari malformation. b) Light reflects off opposite side of skull with skull transillumination. c) Skull X-rays show thinning of skull with separation of sutures and widening of the fontanels 5. Management, Treatment, Interventions a) Ventriculoperitoneal (VP) shunt - allow CSF to drain from lateral ventricle to the peritoneal cavity (1) Pre-op (2) Intra-op 3