Nursing Care of Children ATI
A nurse is caring for a 2-year-old child who has cystic fibrosis. The nurse is planning to take the child to the playroom. Which of the following activities would be appropriate for the child? Cutting figures from colored paper Drawing stick figures using crayons Riding a tricycle. Building towers of blocks
Building towers of blocks Building towers of blocks is an appropriate activity for a 2-year-old child. It promotes ne-motor development, and knocking blocks down provides a means of dealing with the stress of hospitalization.
CRIES
The nurse should use the CRIES pain assessment scale when assessing the need for pain management in infants who are less than 40 weeks of age.
FACES
The nurse should use the FACES pain rating scale for pediatric clients who are 3 years old and older. This scale allows the toddler to point to the face that depicts their current level of pain. The nurse can then determine the need for pain management.
Numeric
The nurse should use the numeric pain rating scale when assessing the need for pain management in pediatric clients who are 8 years old and older. The nurse should identify that a 3-year-old toddler does not yet possess a concept of numbers and numerical value to eectively use this pain rating scale.
A nurse is teaching a school-age child and their parent about postoperative care following cardiac catheterization. Which of the following instructions should the nurse include?
Wait 3 days before taking a tub bath." The child should keep the site clean and dry for at least 3 days to reduce the risk of infection. Tub baths should be avoided for 3 days to avoid immersion of the incision in water.
Hemophilia A Guardian reports that the toddler fell at home while playing with toys. Since the fall, the toddler has been very irritable, crying uncontrollably, and grabbing at their left knee. The toddler can walk but insists on being picked up 1115: Toddler is alert during the exam. Extremities are warm and dry to touch. Decreased movement of the left leg observed. Tenderness noted with palpation of the left knee joint. Pain level assessed as 6 on a scale of 0 to 10 using the FLACC scale. 1145: Toddler is fussy and crying. Pain assessed as 8 on scale of 0 to 10 using the FLACC scale. Left knee observed to be ecchymotic and edematous. 1115: Temperature 36.9° C (98.4° F) Heart rate 110/min Respiratory rate 28/min Oxygen saturation 98% on room air Potential Prescriptions Administer factor VIII. Apply ice packs to the affected joints. Administer morphine PRN pain. Perform passive range-of-motion (ROM) exercises during the first 12 hr following injury. Elevate the affected joints.
Administer factor VIII is anticipated. The child is experiencing an acute episode of hemophilia due to a recent fall. During this acute episode, there is potential for internal bleeding into the joint spaces. Therefore, administering factor VIII is anticipated to control bleeding. Apply ice packs to the affected joints is anticipated. The child is experiencing an acute episode of hemarthrosis due RN Nursing Care of Children Online Practice 2019 B with NGN CLOSE Exhibit 1 Exhibit 2 Exhibit 3 Exhibit 4 Medical History Hemophilia A to a recent fall, as evidenced by the bruising and swelling of the knee joint. Therefore, applying ice packs to the aected joints is anticipated to manage discomfort and decrease bleeding into the joint. Administer morphine PRN pain is anticipated. The child is experiencing severe pain. Opioids can be administered in the inpatient setting to relieve pain. Otherwise, acetaminophen can be given at home for pain. Aspirin and NSAIDs should be avoided because they inhibit platelet function and might increase bleeding. Perform passive range-of-motion (ROM) exercises during the first 12 hr following injury is contraindicated. The child is experiencing an acute episode of hemarthrosis Passive ROM exercises canincrease bleeding into the joint for the rst 48 hr following injury. The toddler should be encouraged to exercise the joint as tolerated. Elevate the aected joints is anticipated. The child is experiencing an acute episode of hemarthrosis due to a recent fall, as evidenced by the bruising and swelling of the knee joint. Elevation of the joint, along with the application of ice, is anticipated to help decrease bleeding and swelling in the join
A nurse is caring for a preschooler who was recently admitted to a pediatric unit. Nurses' Notes The preschooler's guardians report that their child had a gastrointestinal illness with some vomiting and diarrhea about 1 week ago. Their child started to feel better. However, within the last 2 days, they noticed several small bruises that appeared on their child's arms and legs. Additionally, the guardians report the child is lethargic. Vital Signs 0900: Temperature 37.2° C (99.0° F) Heart rate 110/min Respiratory rate 22/min Blood pressure 108/70 mm Hg Oxygen saturation 98% on room air Pain rating per FLACC scale 0 1000: Temperature 38.2° C (100.8° F) Heart rate 108/min Respiratory rate 22/min Blood pressure 114/74 mm Hg Oxygen saturation 98% on room air Pain rating per FLACC scale 0 Diagnostic Results Hemoglobin 8.8 g/dL (9.5 to 14 g/dL) Hematocrit 28% (30% to 40%) WBC count 8,000/mm3 (5,000 to 10,000/mm3) Platelets 100,000/mm3 (150,000 to 400,000/mm3) BUN 20 mg/dL (5 to 18 mg/dL) Creatinine 0.8 mg/dL (0.2 to 0.5 mg/dL) Total protein 6.4 g/dL (6.2 to 8 g/dL) Total cholesterol 202 mg/dL (120 to 200 mg/dL) Is each finding is consistent with nephrotic syndrome, acute poststreptococcal glomerulonephritis, or hemolytic uremic syndrome Temperature BUN level Platelet count Blood pressure Cholesterol level
Temperature is consistent with acute poststreptococcal glomerulonephritis and hemolytic uremic syndrome. According to the EMR, the child's temperature is outside the expected reference range and is increasing. The child who has acute poststreptococcal glomerulonephritis may present with a low-grade fever. The child who has hemolytic uremic syndromemay experience fever that is high enough to cause hallucinations and lethargy. BUN level is consistent with acute poststreptococcal glomerulonephritis and hemolytic uremic syndrome. According to the EMR, the child's BUN level is elevated, which indicates an impairment of kidney function. With acute poststreptococcal glomerulonephritis, a streptococcal infection invades the inner membranes of the kidney, which aects filtration and blood flow. With hemolytic uremic syndrome, intravascular coagulation occurs in the endothelium of the glomeruli of the kidneys, which impairs ltration and blood ow. Platelet count is consistent with hemolytic uremic syndrome. According to the EMR, the child's platelet count is low, which indicates thrombocytopenia. With hemolytic uremic syndrome, intravascular coagulation occurs in the endothelium of the glomeruli of the kidneys, which impairs ltration and blood ow due to the aggregation of platelets. Blood pressure is consistent with nephrotic syndrome, acute poststreptococcal glomerulonephritis, and hemolytic uremic syndrome. According to the EMR, the child's blood pressure is elevated, which indicates narrowing of the blood vessels, possibly due to kidney impairment from these conditions. Cholesterol level is consistent with nephrotic syndrome. According to the EMR, the child's cholesterol level is slightly elevated. This could be related to diet or increased liver production of lipoproteins to compensate for proteins lost in the urine
A nurse is providing teaching to the parents of a preschooler who has heart failure and a new prescription for digoxin twice daily. Which of the following instructions should the nurse include in the teaching?
"Brush the child's teeth after giving the medication." The nurse should instruct the parents to brush the child's teeth after administering digoxin to prevent tooth decay caused by the medication, which comes as a sweetened liquid to enhance the taste.
A nurse at a pediatric clinic is assessing a 5-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? Head lags when pulled from a lying to a sitting position Absence of startle and crawl reflexes Inability to pick up a rattle after dropping it Rolls from back to side
CORRECT: Head lags when pulled from a lying to a sitting position At the age of 5 months, the infant should have no head lag when pulled to a sitting position; therefore, the nurse should report this finding to the provider. Absence of startle and crawl reexes The startle reflex disappears by the age of 4 months, and the crawl reex disappears around the age of 6 weeks. • Inability to pick up a rattle after dropping it At the age of 5 months, the infant can visually follow a dropped object, but the infant is unable to pick the object up until around the age of 6 months. Rolls from back to side The infant should be able to roll from her back to her side at the age of 4 months.
A nurse is assessing a 6-month-old infant following a cardiac catheterization. Which of the following findings should the nurse report to the provider? Temperature of 37.5° C (99.5° F) Apical pulse rate 140/min BP 86/40 mm Hg Respiratory rate of 32/min
BP 86/40 mm Hg A BP of 86/40 mm Hg is indicative of hypotension and bleeding in a 6-month-old infant and should be immediately reported to the provider.
A nurse is providing teaching to the parents of a 4-year-old child about fine motor development. Which of the following tasks should the nurse include in the teaching as an expected finding for this age group Copies a circle Cuts foods using a table knife Begins writing in cursive Prints first and last name clearly
CORRECT: Copies a circle The nurse should explain that copying a circle is a skill achieved by the age of 4 years Cuts foods using a table knife The nurse should explain that cutting food using a table knife is a ne-motor skill expected of 7- year-old children. Begins writing in cursive Initial use of cursive writing is an expected skill for an 8- to 9-year-old child. Prints first and last name clearly The nurse should explain that children will print their rst name around the age of 5 years.
A nurse is assessing a 9-month-old infant during a well-child visit. Which of the following findings indicates that the infant has a developmental delay Creeps on hands and knees Inability to vocalize vowel sounds Uses crude pincer grasp Stands by holding onto support
Creeps on hands and knees The infant should creep on her hands and knees at the age of 9 months, and begin to stand while holding onto furniture at the age of 10 months. CORRECT: Inability to vocalize vowel sounds The infant should begin vocalizing vowel sounds at the age of 7 months, and by the age of 10 months, be able to say at least one word. Uses crude pincer grasp Most infants demonstrate a crude pincer grasp at 9 months of age and the use of a dominant hand is also evident. Stands by holding onto support The ability to stand holding onto support is typically present at 10 months of age.