N308 Peds exam 6

A nurse is providing teaching about epistaxis to a child and his family. Which of the following should the nurse include as an appropriate action to take when managing an episode of epistaxis? (select all that apply). A. Press the nares together for at least 10 min. B. Breathe through the nose until bleeding stops. C. Pack cotton or tissue into the naris that is bleeding. D. Apply a warm cloth across the bridge of the nose. E. Insert petroleum into the naris after bleeding stops.

A. Press the nares together for at least 10min. C. Pack cotton or tissue into the naris that is bleeding.

A nurse is providing teaching about the management of epistaxis to a child and his family. Which of the following positions should the nurse instruct the child to take when experiencing a nosebleed? A. Sit up and lean forward B. Sit up and tilt the head up C. Lie in a supine position D. Lie in a prone position

A. Sit up and lean forward

What is the progression of the development of Immunity/Immune response (also covered to some degree in Chapter 37 as well as in the Immunization computer program)

Administration of a vaccine stimulates the immune system to produce antibodies against a specific disease. Vaccines have the same antigen as the disease, but it is either killed or weakened and therefore not strong enough to cause the disease. Antibodies disappear after they destroy the infection/antigen, but memory cells are formed to protect from future exposures to that same infection. This is called immunity.

A nurse is caring for an infant whose screening test reveals that he might have sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease? A. Sickle solubility test B. Hemoglobin electrophoresis C. Complete blood count D. Transcranial Doppler

B. Hemoglobin electrophoresis

A nurse is preparing to administer iron dextran IM to a school-age child who has iron deficiency anemia. Which of the following actions by the nurse is appropriate? A. Administer the dose in the deltoid muscle. B. use the Z-track method when administering the dose. C. Avoid injecting more than 2mL with each dose. D. Message the injection site for 1 min after administering the dose.

B. Use the Z-track method when administering the dose.

Common medications used for allergies

Benadryl and Corticosteriods

implications/nursing interventions for Lead poisoning

Blood tests, source of lead exposure, nutrition tips to decrease absorption, test other family children that may have been exposed, educate on developmental/behavioral problems and resources to help resolve/improve

Effects of exercise on DM

Children active with sports will require a snack 30 minutes prior to activity Prolonged activities will require food intake every 45 to 60 minutes. Adjustment in diet and insulin can be required with changes in activities.

labs test results you would expect to find with leukemia

CBC - anemia (low blood count), thrombocytopenia (low platelets), neutropenia, leukemic blasts (immature WBCs

signs and symptoms and treatments for Precocious puberty

Child develops sexual characteristics before the usual age of pubertal onset because Gonads produce increased amounts of sex hormones

A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding of the teaching? A. "I should take my child to the emergency department if his stools become dark" B. "My child should avoid eating citrus fruits while taking the supplements." C. "I should give the iron with milk to help to help prevent an upset stomach." D. "My child should take the supplement through a straw."

D. "My child should take the supplement through a straw."

signs and symptoms and treatments for Delayed puberty

Delayed secondary sexual development o In females- no breast development by age 13 or no menarche by age 16 o In males- no testicular enlargement or scrotal changes or pubic hair by age 15

Nursing interventions for Wilms tumor

Do not palpate abd., caution around tumor site (prevent trauma), assess coping/support, assess developmental delays and growth, monitor for infection, antibiotics, skin clean dry and lubricated, oral hygiene, diversional activities - Treatment - surgical removal, preoperative chemo/radiation, post op chemo/radiation.

priority nursing interventions for the child with leukemia?

Emotional support, peer contact, assess pain, pharmacological/nonpharm pain management, Chemotherapy

Clinical manifestations of sickle cell

Family history of sickle cell anemia or sickle cell trait * Reports of pain * Shortness of breath, fatigue * Pallor, pale mucous membranes * Jaundice * Hands and feet cool to touch * Dizziness * Headache * CBC-anemia * Sickle turbidity-presence of HbS, * Hgb electrophoresis- gives definitive diagnosis * Hgb- decreased * WBC - elevated * bili/reticulo- elevated * peripheral blood smear - reveals sickle cells

Laboratory tests and expected results used for diagnosis and treatment of DM.

Fasting glucose of 126mg/dL or more Random glucose of 200mg/dL or more Oral GTT of 200mg/dL or more in a 2hr sample. HbA1C- Target for peds with DM is 6.5-8%.

procedures that are used to diagnose HGHD?

GH stimulation X-Ray CT MRI

How allergic response occurs

In response to any vaccine, and is a contraindication for receiving further doses of that vaccine or other vaccines containing that substance.

signs and symptoms of vaso-occlusive crisis- Chronic

Increased risk of respiratory infections and osteomyelitis o Retinal detachment and blindness o Systolic murmurs o Renal failure and enuresis o Liver cirrhosis; hepatomegaly o Seizures o Skeletal deformities; shoulder or hip avascular necrosis

treatments for IDA, including dietary treatments

Iron supplements * Iron-fortified cereals and formula * For older children it is dried beans and lentils; peanut butter; green, leafy vegetables; iron-fortified breads and flour; poultry; and red meat.

side effects of treatments for IDA/including medication

Iron supplements o 1 hour before or 2 hours after milk or antacid - prevent decreased absorption o GI upset - common at start, decrease over time o If tolerated give on empty stomach - increases absorption o Give with Vitamin C to increase absorption o Use straw with liquid prep to prevent staining of teeth o Z-track into deep muscle, don't massage muscle

Lead poisoning causes

Lead-based paint and lead-contaminated dust in older buildings are the most common sources of lead poisoning in children. Other sources include contaminated air, water and soil.

Long term effect of medications used for allergies.

Look for drowsiness, sometimes Benadryl makes a child hyperalert.

What is the recommended treatment for epistaxis?

Maintain a calm demeanor with the child and family * Have the child sit up with the tilted slightly forward to prevent aspiration of blood. * Apply pressure to the lower nose with the thumb and forefinger for at least 10 min. * If needed, pack cotton or tissue into the side of the nose that is bleeding. * Apply ice across the bridge of the nose if bleeding continues. * Breath through mouth

Safety for diabetes

Mnitor vital signs and any sign of hyper or hypoglycemia

Systemic Lupus Erythematosus- signs & symptoms

Nursing implications- Butterfly rash, fatigue, fever, joint pain, skin lesions (worse with sun), Raynaud's phenomenon, SOB, CP, Dry eyes, HA

Iron deficiency anemia causes

Poor diet, rapid growth, menses, strenuous activities, and obesity * Premature birth resulting in decreased iron stores * Excessive intake of cows' milk in toddlers o Milk is not a good source of iron o Milk takes the place of iron-rich solid foods * Malabsorption disorder * Poor dietary intake of iron * Increased iron requirements (blood loss).

Define the effects of Primary Immunodeficiency versus secondary (acquired)immune deficiency-

Primary - genetic, hereditary, Secondary - due to extrinsic factors that affect pts. immune system

nursing diagnoses and interventions appropriate for the child with HGHD and for their family?

Promote growth Enhance self-esteem Provide education

Education on how to give insulin

Teach appropriate techniques for self-monitored blood glucose, including obtaining blood samples, recording and responding to results, and correctly handling supplies and equipment.

treatments for sickle cell anemia.

Promote rest to decrease oxygen consumption * Administer oxygen as prescribed if hypoxia is present * Maintain fluid and electrolyte balance o Monitor I&O o Give oral fluids o Administer IV fluids with electrolyte replacement Administer blood products, usually packed RBC's and exchange transfusions per facility protocol. Observe manifestations of hypovolemia and transfusion reaction. * Treat and prevent infection o Administer antibiotics o Perform frequent hand hygiene o Give oral prophylactic penicillin o Administer pneumococcal conjugate vaccine, meningococcal vaccine, and Haemophilus influenza type B vaccine. * Monitor and report laboratory results * Pain management

nursing interventions for a severely ill/dying child based on developmental age/level-

Provide comfort measures and assess coping and support system, monitor for infection (antibiotics), pain management, monitor lab values and VS, educate family on process.

Diet instructions for DM

Read labels for nutritional value Meal planning is based on the requirements of growth and development of the child. Plan meals Eat at regular intervals Count carbohydrates Avoid high fat diets

Definitely know the differences in anatomy & physiology of pediatric clients

Red blood cell production- * Lymphoid production- * Erythropoietin (EPO)- * Hemoglobin-Three types * Hbg A-After 6 months of age this is predominant * Hbg F-fetal-fetal-higher in neonatal period--has much shorter life spanà increased risk of anemiaàdecreased oxygen caring capacity * Hbg A2 * Iron- * Receives from mother via placenta * Period of Physiologic anemia-(2 to 6 months) * Adolescence-Another time of rapid growth * The normal WBC range for a 6-month-old infant is 5.0 to 19.0. 9.0 to 30.0 is a normal range for infants from birth to 2 weeks old; 4.8 to 10.8 is a normal range for a 6-year-old to an 18-year-old; and 5.0 to 10.0 is a normal range for adolescents and adults older than 18 years old.

risks associated with sickle cell anemia

SCD is an autosomal recessive genetic disorder. * SCA primarily affects African-Americans. Other forms of SCD can affect individuals of Mediterranean, Indian, or Middle Eastern descent. * Children who have the sickle cell trait do not manifest the disease but can pass the trait to their offspring.

Effects of Lead poisoning on the child

Severe mental and physical impairment, behavioral, low IQ, poor grades, hearing problems, short/long term learning disabilities, growth delays

signs and symptoms of vaso-occlusive crisis- acute

Severe pain, usually in bones, joints, and abdomen. o Swollen joints, hands, and feet o Abdominal pain o Hematuria o Obstructive jaundice o Visual disturbances

DKA or hyperglycemia-

Signs and symptoms Anorexia, nausea, and vomiting Lethargy, stupor, altered level of consciousness, confusion Decreased skin turgor Abdominal pain Kussmaul respirations and air hunger Fruity (sweet-smelling) or acetone breath odor Presence of ketones in urine and blood Tachycardia and, if left untreated, coma and death

hypoglycemia (Insulin reaction)

Signs and symptoms Hunger, lightheadedness HA Anxiety and irritability Pale, cool Skin Diaphoresis Irritability Normal or shallow respirations Tachycardia and palpations Strange or unusual feelings Decreasing level of consciousness Difficulty in thinking and inability to concentrate Change in emotional behavior Slurred speech Headache and blurred vision Seizures leading to coma

What are the treatments for HGHD?

Somatropin- used for Growth Hormone replacement Other hormone replacement therapy

role of the Endocrine system?-

The immune system is the bodys defense against infectious organisms and other invaders. Through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease.

Inflammatory response of systemic erythematosus nursing interventions

assess skin integrity, pain, photosensitivity, adequate fluids/nutrition, pain management

Common allergies

eggs. peanuts. soy. wheat. tree nuts (such as walnuts and cashews) fish. shellfish (such as shrimp)

signs and symptoms of Leukemia

low grade fever, pallor, increased bruising/petechiae, listlessness, enlarged liver, lymph nodes and joints, abd., leg and joint pain, constipation, HA, vomiting/anorexia, unsteady gait, hematuria, ulcerations in the mouth, enlarged kidneys and testicles, increased ICP

effects of the treatments for leukemia-

mucosal ulceration, skin breakdown, neutropathy (constipation, foot drop, jaw pain), loss of appetite, hemorrhage cystitis, alopecia

Signs & Symptoms of Wilms tumor

painless, firm, nontender abdominal swelling/mass, fatigue, malaise, weight loss, fever, hematuria, HTN a. Metastasis - SOB, cough, dyspnea, CP