Exam 2 study g

What not to do for RSV?

No Chest Physiotherapy

nursing dignosis for dehydrations

fluid volume deficit is with excessive GI losses in stool and emission altered nutrion: less body requirements with diarrhea and vomiting knowledge deficits for fate

OM interventions

fluids, upright feeds, avoid chewing, cleans ears, analgesic, antibiotics, monitor hearing loss <3 pull pinna down and back (canal curves down) >3 pull pinna up and back

Group A Streptococcus syptopms and management

headaches, fever, sandpaper rash, white patches Medicacal management syontomatic treatment. If bacterial give antibiotics surgical: Tonsillectomy

Clinical for Hirschsprings

history of mechanism ileum, episodes of constipation with diarrhea. Abdomen is distended. Vomiting

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?

Urging the child to continue to take oral fluids Administering an oral analgesic Teaching the child to take long, slow breaths Assisting with racemic epinephrine nebulizer therapy ——

Cleft Palate Feedings

Use cup to feed no straws, nipple, pacifies that might hurt the palate

1 kg = 1L fluid

(Pre-illness wt - illness wt) ————————————————. X100 Pre-illness

how to calculate Systotic hypotension

1 month to 10 years : 70 + (2 X years in age)

CF managements

1. Bronchodilators 2. Hypertonic saline. Looses up secreations 3. Doran's Alfa. (Sciccors, cuts it up) 4. Nebulizer anti tips (kills) infection control, chest percussions with vest IV antibiotics, exercise, O2 therapy, NSAIDS

Asthma what happens during exacerbation

1. Bronchonstriction: tightening of smooth muscles of bronchi and bronchioles (tight wheezing sounds) 2. Airway hyperresponsiveness: increases bronchial hypersensitivity to multiple stimuli (twitching) 3. Airway edema / inflammation: lining of airways become inflamed and hyper secretes mucous (inflammed)

Asthma mediatins

1. Long term control: preventive, inhaled corticosteroids 2. Rescue meds: quick acting, beta-agonists always use appropriate size for MDI admin

The nurse is assessing several children. Which child is most at risk for dysphagia?

7-month-old with erythematous rash 8-year-old with fever and fatigue 5-year-old with epiglottitis —— 2-month-old with toxic appearance

Which statement is most accurately related to the diagnosis of colic?

A partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. There are recurrent paroxysmal bouts of abdominal pain. ——- In this disorder the sphincter that leads into the stomach is relaxed.

intussusception assessment

Acute onset Sever abdominal pain, vomiting, jelly stools (blood and mucous) need Ultrasound to confirm RLQ pain,

acetainophen

Analgesic efforts to inhibit pathways in the CNS, for fever and pain assess for temp and pain 15mg/kg Asses Weights

What does Croup effect

Bronchi Epiglottis laryryo trachea

Strep select all apply for symptopms

Headaches fever sandpaper rash white patches

A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse?

Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses." —— "You have a very good physician who I trust completely. I'm sure everything possible is being done for your child." "Oftentimes it is more beneficial to treat the symptoms of bronchiolitis rather than try to kill the bacteria with an antibiotic." "Your physician probably doesn't want to take a chance of your child building up an immunity to the antibiotic in case the condition worsens and more antibiotics are needed."

appendicitis post op

Clear liquids to regulars diet early ambulating assess bowel functions vital signs, pain, I&O,

Which syptopms does meconium ileus belongs to?

Cystic fibrosis and Hirshspring's

The nurse is caring for a child admitted with gastroesophageal reflux (GER). Which clinical manifestation would likely be seen in this child?

Effortless vomiting just after the child has eaten. — Forceful vomiting followed by the child being eager to eat again Severe constipation with occasional ribbon-like stools Bouts of diarrhea with failure to gain weight

HPS expected outcomes

Electrolytes and fluid balance report demonstrate ability to feed, recognize complications want to burp them and give time between feeds no infections

Epiglottis

Emergency!!! Inflammation and swelling of epiglottis, partial upper airway obstruction. Rapid onset

Clef lip/palate interventions

Encourage breastfeeding prevent aspirations / meet nutrion Al needs feeding may be challenged use special feeding devices (break feeder/ plastic bottle) feed upright frequent burping and sitting up straight

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Explosive diarrhea Projectile vomiting —- Severe abdominal pain Frequent urination

Teaching points of OM

Exposure to tobacco, daycare, and congenital anomalies protective: breastfeeding, vaccine, URI syptopms and completing antibiotics

RSV

Factors: preterm babies, underlying compromise initial onset: nasal congestion, runny nose, wet cough, fever advanceL distress, tachypnea, tachycardia, fever, wheeze, decrease O2, lethargic

cleft lip

Failure of fusion of oral cavity

cleft palate

Failure of fusion of palate structures Inside the mouth

Select all applying syptopms of grastrintenal

Freq bulky greasy stools (floats and smells), failure to fain weight, thin arms and legs, pot belly, abdominal distention, meconium ileus, deficiency in fat, anemia

CF Gastrointestinal

Freq bulky greasy stools (floats and smells), failure to fain weight, thin arms and legs, pot belly, abdominal distention, meconium ileus, deficiency in fat, anemia nutrion high calorie, high protein, high fats, multi vitamins, vitamins A,D,E,K, laxatives, histamines, insulin formula supplements

Hirschsprung disease (congenital aganglionic megacolon)

Ganglio cells absent results lack of persistalis causing enlargement of the end of colon. Builds up with fecal material on exam rectum is empty of feces and sphincter is tight diagonons by rectal biopsies

The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease. —- Short bowel syndrome (SBS)

neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?

Gastroenteritis Ulcerative colitis (UC) Hirschsprung disease. —- Short bowel syndrome (SBS)

What is a late sign of dehydration

Hypotension is a late sign in children with dehydration renal failure

Severe dehydration treatments

IF fluids, 20 ml / kg child is showing sings of shock, failure of PO

severe dehydration

IV fluids Signs of nshock Ped bolus, normal saline or lactated ringers 20ml / kg

Ruptured treastment

IV fluids, antibiotics, NPO, labs,

perforation of appendix

Increase fever, sudden relieve from pain S&SL distention, rigid, boat abdominal pain, inability to pass feces, Tacycardia, rapid shallow breathing, restlessness lead to SEPSIS & SHOCK when appendix burns, poop gets all over and leads to infections of other organs

what makes young children more vulnerable to respiratory illness?

Infections stream from one structure to another infectios an affect both upper and lower

Asthma key messages

Inflammation as underlying cause controllers vs quick relieves triggers self management when to reach provider vaccines!

gastroenteritis

Inflammation of GI system Syptopms Vomiting: leads to metabolic alkalosis diarrhea : loss of fluid and imbalance results in dehydration

Croup respiratory sounds

Inspiration strider and restrictions barking or "seal like" cough, audible, inflammation and tightening of upper airways Will audible hear strider but aulticates wheezing

intussusception

Intestines slides (telescoping) into adjacent part of intestines. Majorly at the ilium joints into colon blocks food of fluids rom passing through also cuts off blood supply which leads to necrosis

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?

Iodized salt Saturated fat Pancreatic enzymes —— Calories from protein

Important concepts with HPS

Need to know Weight

Necrotizing Enterocolitis (NEC)

LEATHEL in newborns inflammation if ingestion from bacteria causes necrosis to colon and intestine S&S: feeding intolerance and vomiting Late signs: blood diarrhea Treatment: stop feedings, use tubes to give nutrion, antiobiotics

Why does mist therapy help with RSV

Looses secretions, make cough more effective,

peak flow

Measures lung function, does force exploratory volume. Not feasible with young children

Asthma Assessment

Monitor vital signs and O2 assess respitory effor, breath sounds, subjective data, changes in apperence SOB, increase accessory muscles, hear wheezes, tripod position, cough, chest tightness, restlessness

GERD interventions

Monitor weight feeding from simple, thick, burping, and position medications: histamine H2 antagonists, PPIs (proton pump inhibitors) surgical

What type of breather is infants?

Nose breathers

appendicitis

Obstruction of appendices lumen. Leaders to impaire perfume to area can quickly progress

mild dehydration

Oral rehydration Avoid high sugar content PO stable with out signs of shock

Mild dehydration treatments

PO water/ fluids stable without signs of shock avoid high sugar

The nurse is assessing a 10-day-old infant for dehydration. Which finding indicates severe dehydration?

Pale and slightly dry mucosa Blood pressure of 80/42 mm Hg Tenting of skin. ——— Soft and flat fontanels (fontanelles)

Which electrolyte does the client with cystic fibrosis need in abundance?

Potassium Sodium —— Chlorine Magnesium

Intussusception planning / intervention

Pre-op: monitor signs of peroration, peritonitis, dehydration, sepsis, shock, NPO, labs Hydrostatic reduction to relieve obstruction using enema Post op: routine, iv fluids, monitor for stools

Hirschsprings interventions

Pre: enemas, nutrion Al corrections, abdominal assessments education: surgical corrections, removal of the bowels in the ganglion Post: pain control, IV, nothing per rectum, NPO, repogle to prevent abdominal distention, monitor losses, teach osteomy care

appendicitis interventions

Prepare for surgery IV fluids (electrolytes, antiobiotics ) NPO - using replogle for stomach decompression. Takes some fo the stomach parts out pain relieve teaching

Things to look for at HPS

Projectile vomiting, poor weight gain, metabolic alkalosis. Movable mass and see waves from abdominal pain

Diagnosis of asthma

Pulmonary function tests allergy test peak flow meter

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?

Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test. ——

Hypertrophic Pyloric Stenosis (HPS)

Pylori's (muscle) at the lower end of stomach becomes enlarged and thickened causing contradiction o the canal between stomach and duodenum inflammation and edema can lead it to complete obstruction

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described?

Refusal to eat Vomiting about 2 hours after feeding Chronic diarrhea Vomiting immediately after feeding ——

Albuterol

Relaxes bronchial smooth muscles, treats asthma side effects: tachycardia, cardiac arrhythmias, and anxiety assess lung sounds and O2

Hirschsprings main syptopm

Ribbion love foul smelling stools

Cystic fibrosis manifestations

S&S: early meconium lieu's in newborn thick mucus obstruction, mucus purple t, extensive bronchial it is, long term increase work of breathing, excercise intolerance, SOB, tachypnea s

s/s of intussusception

Severe colicky abdominal pain with vomiting Currant jelly stools (blood & Mucous)

Upper airway differnces

Shorter, narrower, small oral cavities, larger tongues, long floppy epiglottis, larynx,

GE reflex

Spitting up with no other signs

GERD (gastroesophageal reflux disease)

Spitting up with poor weight gain, excessive crying, irritability, arching, respitory syptopms.

foreign body aspiration

Sudden coughing with wheezing interventionsL back blows / chest thrusts for infants abdominal trusts for children discharge: prevention, safety checks, foods, items, toys and CPR

Dehydration syptom

Sunken fontanelle , reduce LOC, dry mucous membranes, reduce skin turgor, sunken eyes, lack of tears, reduce capillary, tachypnea, tachycardia, hypotension, oliguria, weight loss,

pyloromyotomy

Surgery to allow pylorus to streach out

an infant is brought to the ED with complain of vomiting and nausea. Which nursing assessment finding should indicate to a nurse that the infant's dehydration is severe?

The infant is lethargic with urinary output of less than 1ml/kg/hr the infant has weak pulses, poor skin turgor, and cool moltled skin ——- the infant has warm skin, increases pulses and cap refills of 2 seconds infant is irritable with dry mucous membrans and increases respirations

What occurs in the gastrointestinal system of the child with Hirschsprung disease?

There is a partial or complete mechanical obstruction in the intestine. —— There is a severe narrowing of the lumen of the pylorus. There is an invagination or telescoping of one portion of the bowel into a distal portion. There is a relaxed sphincter in the lower portion of the esophagus.

Appendicitis dischaarge

Toleration regular diet, pain controlled with PO meds

Epiglottis Assessment

Tripod position, strider, distress, drooling cause can't swallow due to everything is swollen, hypoxia / dyspnea, cyanosis, decreases LOC treatmentL continue O2, antiobotics, equipment prevention: HIB vaccine Dont swab the throat, use trach

what is a late sign of dehydration?

hypotension lethargic, sunken eyes, absent crying

What is the most accurate indication of dehydration?

Weight

Nursing diagnoses for cleft lip/palate

imbalance nutrion / fluid volume deficit ineffective breathing patters / impaired gas exchange impaire parenting: encourage early participations in care, allow time for questions, infections: assess frequently, cleans with sterile water

Strep signs of bleeding

increases swallowing and bowel movements

Untreated GAS lead to

acute fever, acute glomerulenphritis, permanent damage to hear & kidneys, and PANDAS

OM Acute-chronic

acute: <3 weeks, pulling of ear, crying, lethargic, fever Inflammation of middle ear with fluid collecting. Feeling of fullness, orange discoloration, balance issues (vertigo) Hearing and speech effects if not treated ChronicL need tube placements.

Cleft lip/palate post operative care

airway Position : upright to prevent aspiration Protect suture line: Logan bow lip protection, arm/elbow restrains, avoid hard objects, nothing in mouth, sot food only, clean it Pain admin pain on regular schedule, comfort measures (swaddling, sucrose, distractions)

cystic fibrosis (CF)

alters transport of sodium and chloride. Defective CFTR Poitier, increases thick secretions and recessive genes

The client states, "I had my heart set on breastfeeding but my infant was born with a cleft lip. My dreams of breastfeeding are destroyed." Which response by the nurse is appropriate?

am so sorry your infant has a cleft lip. Bottle feeding will be easiest for you and your infant." "You may still breastfeed your infant. I will show you appropriate techniques to use." —— "You can use a supplemental nursing system to get a similar experience." "You should speak with a lactation consultant before making a decision on which feeding method to use."

A child is hospitalized with dehydration as a result of rotavirus. When reviewing the plan of treatment, what can the nurse anticipate will be included? Select all that apply.

antidiarrheal agents antibiotic therapy IV fluid administration —— monitor of intake and output——- daily weight assessment—-

A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula?

assess patency of the nares. ——- test the oxygen saturation add humidification to the delivery device assess the lung sounds

Nasophyargitis (common cold)

assess: runny nose, cough, ear infections (fluids), nasal congestion, fever care: bulb suctions mouth than nose to withdraw mucus before feedings and sleep, meds for fever, rest, cool mists,

Cleft lip/palate discharge

avoid hard objects in mouth feeding techniques infeciton prevention restrain use pain management telling parents that its not their fault

cystic fibrosis (CF) overall

increases the thickness stocky mucous all over the body. Defective CFTR protein

Cystic fibrosis progression

bronchial epithelium is destroyed infection spread to peri bronchial tissues weeks bronchial walls. O2/CO2 decreases peri bronchial fibrosis ensures

Therapeutic management for asthma

reduce readmission for exacerbation treaments with medication, control of triggers, education

A mother is told that her child will receive total parenteral nutrition. She asks the nurse what this means. The nurse bases her response on knowledge that total parenteral nutrition is:

daily IM injections of vitamins. nutrition through a nasogastric tube. administration of Ringer's lactate through a peripheral IV line. administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV. ——

Prednisolone sodium phosphate:

decrease inflammation by suppressing leukocytes adverse effects: bradycardia, shock, edema, heart failure, mood changes may cause osteoporosis assess lung sounds, O2

The nurse is preparing to receive a 6-year-old child with epiglottitis to the emergency department. For which immediate intervention should the nurse plan?

endotracheal intubation —- antibiotics corticosteroids fluids for hydration

Asthma non-environment

exercise, stress, illness, Gastroesiphagel reflux, and medications

Otitis media

exposure to smoke, daycares, and congenital anomalies need to finish all meds inflammation and blockage

Lower airways differences

fewer immature alveoli, narrower bronchioles, smaller lungs, immature intercostal muscles

CF primary goals and teaching

ineffective airway learned with increase pneumonia sections impaired gas exchange high calorie, high fat, high protein, vitamins, pancreatic enzyme replacements. Teaching: appointments, when to call, infection prevention, immunizations, meds, nutrion needs, airways clearance and drainage

What to avoid

milk produces as it increases mucus and phlegm citrus juice: it burns Straws: dont want to poke the mouth Red liquids: missen as bleeding coughing / throat clearing

The nurse is reviewing the medical record of a child with a cleft lip and palate. When reviewing the child's history, what would the nurse identify as a risk factor for this condition?

mother age 42 with pregnancy ——- maternal use of acetaminophen in third trimester preterm birth history of hypoxia at birth

Exercise induces asthma

needs pre-treatment with short acting beta agonist 15-30 mins before

Cystic fibrosis diagnostic

newborn screening, sweat chloride test, exorcise pancreatic dysfunction, frothy stools, floats, high levels of fecal fat

CF nutrion

nutrion high calorie, high protein, high fats, multi vitamins, vitamins A,D,E,K, laxatives, histamines, insulin formula supplements

Which statement is most accurately related to the diagnosis of pyloric stenosis?

partial or complete intestinal obstruction occurs. A thickened, elongated muscle causes an obstruction at the end of the stomach. —— There are recurrent paroxysmal bouts of abdominal pain. In this disorder the sphincter that leads into the stomach is relaxed.

Interventions for tonsillectomy

position for facilitate drainage suction equipment Ice - color to reduce inflammation acetaminophen Discourage coughing / throat cleaning monitor signs of bleeding (swallowing)

STREP PRE / Post

pre: NPO, Post: position to facilitate drainage, suction equaipment. Coughing, ice color to reduce inflations, acetaminophen, provide clear cool liquids

Asthma goals

prevent exacerbation, provide care, release bronchiaspasm, relieve inflammation, monitor function, self management inflammation as underlying causes, use MDI, triggers, monitor, vaccine, use bronchodilator's, wait before puffs, 2nd puff is better due the airways is open.

The nurse is caring for a 5-year-old child with ineffective airway clearance. What intervention(s) will the nurse prioritize in the child's plan of care? Select all that apply.

repositioning —- opening the airway with the jaw-thrust technique — administering medications such as bronchodilators and steroids — attaching a cardiorespiratory monitor— auscultating breath sounds—- applying oxygen to maintain O2 saturation levels >92%

The nurse is performing a routine assessment on a 3-year-old child. Which finding(s) prompts the nurse to perform an in-depth assessment of the child's respiratory status? Select all that apply.

restlessnes —— tachycardia —— tachypnea —— diaphoresis —— polyuria diarrhea

Nursing diagnoses for GE

risk for aspirations impared swallowing deficient fluid volume imbalanace nutrion respirorty distress anxiety impaired parenting

The nurse is conducting a physical examination of an infant with suspected pyloric stenosis. Which finding indicates pyloric stenosis?

sausage-shaped mass in the upper mid abdomen perianal fissures and skin tags abdominal pain and irritability hard, moveable "olive-like mass" in the upper right quadrant ——-

Acute Tonsillitis and Pharyngitis

sore throat with swallowing, fever, inflammed tonsils

RSV treatments and interventions

starts common cold than next day distress Direct contact transmission!! Intervenion: bulb suction, elevated HOB, humidifies O2, equipments, monitor status, hydrating, relax!! Treatment: mist therapy, Nebulizer s, nasal suctions, oxygen in test, nasal cannula

A nurse is teaching the parents of a child with cystic fibrosis how to perform chest physiotherapy. Which of the following techniques would the nurse include in the teaching plan? Select all that apply.

suctioning postural drainage. —- percussion. —- deep breathing. —- coughing ——

The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which intervention?

suctioning a tracheostomy tube —— administering drugs with a nebulizer providing tracheostomy care suctioning with a bulb syringe

Dehydration symptopms

sunken fontanellse, reduce LOC, dry mucous membranes, reduce tissue turgor, sunken eyes, lack of tears, reduce cap refills, tachypnea, tachycardia, hypotension, oliguria, sudden weight loss,

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client?

tachycardia —- hypoactivity bronchial muscle relaxation increased appetite

croup syptopms

viral infections of throat, larynx, and trachea low fever, noisy, agitates, restless, fridgetening, increases distress and hypoxia management: protract airways, continue O2, maintain hydration, supplement O2 with humidications Do not use decongestation for babies

Croup management

• Airway management • Maintain hydration, orally or intravenously • High humidity with cool mist • Nebulizer treatments - Epinephrine- Racemic Epi - Steroids