Peds Exam 3

The nurse is assessing for pain in a 2-month-old infant. Which behavior indicates that this baby is experiencing pain?

Continued crying after diaper change and being fed

A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this patient's care at this time?

Impaired oral mucous membrane related to effects of chemotherapy

An 18-month-old child is admitted with signs of increased intracranial pressure. What should the nurse observe when assessing this patient?

Increased temperature and decreased respiratory rate

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the:

Induction stage

The community nurse is planning a program that focuses on the 2020 National Health Goals to alleviate pain. Which information should the nurse include that focuses on pain control in children? (Select all that apply.)

Instruct on avoiding unintentional injuries by using safety belts and helmets. Explain that pain can be managed with medicine or nonmedication measures.

The nurse is preparing the medication leucovorin to provide to a child who is currently receiving methotrexate for a brain tumor. What should the nurse explain to the child and parents regarding the purpose of this medication?

It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells

The nurse wants to assess the amount of pain a preadolescent with scoliosis experiences throughout the day. Which tool should the nurse use to make this assessment?

Logs and diaries

Intracranial Pressure S/s

Look for Cushing's Triad: Bradypnea Bradycardia Hypertension.

seizure teaching to parents should include

Maintain a normal lifestyle for child Give medication at the same time every day and NEVER stop the medications abruptly

Retinoblastoma

Malignant tumor of the retina of the eye. Inherited autosomal dominant pattern. 5 year survival rate for children with retinoblastoma is good. If it is spontaneous it may or may not happen in both eyes. If it is inherited it tends to develop bilaterally.

ABO Incompatability

Maternal blood type is O and the fetal blood type is either A or B type blood. Do not cross the placenta - infant born ABO is not born anemic. Preterm are not effected because the receptor sites for anti A or anti B do not appear on red blood cells until late in fetal life.

CRIES

Measures post op pain in the infant. Looks at Crying, Requiring oxygen, Increased vital signs, Expression and Sleep

treatment for acute lymphocytic (lymphoblastic) leukemia

Methotrexate

Hyperbili assessment

Most infants do not appear jaundice at birth because of maternal circulation has evacuated rising indirect bili level. Progresive jaundice usually occurs within 24 hours of life. Dangerous if bili level is above 20mg/dl in term infant and as low as 12 mg/dl in preterm because brain damage from bili induced neuro dysfunction can occur Second concern is infant is forced to use glucose stores to maintain metabolism in presence of anemia

The nurse is concerned that a child receiving vincristine is developing an adverse reaction to the medication. What did the nurse most likely assess in the patient?

Numb fingertips

The nurse is caring for an infant who will have surgery. What type of pain assessment would the nurse use?

Observation of facial and body actions

s/s of autonomic dysreflexia

Heavy sweating Anxiety Slow heart rate Blurry vision Dilated pupils Goosebumps on the lower body Trouble breathing Stuffy nose

Retinoblastoma Assessment

Occurs early in life 6 weeks to preschool age. Equally in boys and girls. Upon examination, child's pupils look white or described as typical "cat's eyes" child develops strabismus and the eye becomes more nonfunctional. Tumor metastasizes readily along the course of the optic nerve. Children with a family history should have an eye exam 3 times a year until 5.

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder?

The child should maintain an active lifestyle.

The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately?

"Do not palpate abdomen."

The nurse is preparing to conduct a health history with the parents of a preschool-age child admitted for an appendectomy. Which questions should the nurse plan to use to learn more about the child's ability to manage pain? (Select all that apply.)

"How does your child usually react to pain?" "How do you know when your child is in pain?" "What do you do for your child when your child is hurting?"

The nurse teaches a mother pain management techniques to use for a toddler with otitis media. Which statement indicates that the mother needs additional teaching?

"I should give my toddler one baby aspirin."

When providing education to a parent regarding pain management for a toddler with otitis media, which statement by the parent indicates further teaching needs?

"I should give my toddler one baby aspirin."

The parents of a child with a thoracic-level spinal injury are anxious to learn the long-term prognosis for their child and ask if the child will walk again. How should the nurse respond to the parents?

"It will be several weeks before an answer to your question is possible."

The nurse instructs the parents of a child with Guillain-Barré syndrome on care that will be needed once the child is discharged home. Which statement made by the parents indicates that teaching has been effective?

"Our child might experience weakness even after recovering from the illness."

A female patient asks the nurse why she is always asked if she is pregnant before having an X-ray. What should the nurse explain to the patient?

"Radiation to a fetus can cause a malignancy."

A postpartum patient is upset that the baby was born with a congenital port-wine birthmark on the skin of the upper part of the right side of the face. What should the nurse explain to the mother about this birthmark?

"The baby may have some numbness on the left side of the body because of the birthmark."

An important nursing intervention to institute with an infant prior to surgery for a Wilms' tumor is to place a sign over his crib that reads:

"do not palpate abdomen."

Meningitis

#1 sign is severe, stiff neck (nuchal rigidity). ; usually get a vaccine before going to college because of living in close quarters with others

Myelomeningocele

(Spina Bifida) :focus on no bladder control or lack of. Interventions- keep patients dry. -Place on prone position- NOT supine. -After surgery monitor for signs of hydrocephalus. -Frequent diaper changes

During a home visit, the mother of a child with chronic pain is distraught because the child always seems to be uncomfortable despite receiving pain medication as prescribed. What should the nurse instruct the mother to do to help this child's pain? (Select all that apply.)

Offer a back rub or other comfort measures. Stay with the child and offer love and support. Provide pain medication with a positive expectation that it will take the pain away. Ask the child what might help relieve the pain, such as extra pillows or a warm drink

The nurse is completing the health history of a 6-month-old baby with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?

One pupil appears white.

how is pain seen in children

Pain is seen through vital signs just like in the adult population. Typically you will see an increase in heart rate and increase in blood pressure.

The nurse is planning care for a school-age patient experiencing undiagnosed limb pain. Which nursing diagnoses regarding pain should the nurse consider when designing this patient's plan of care? (Select all that apply.)

Pain related to an invasive procedure Disturbed sleep pattern related to chronic pain Fear related to anticipation of painful procedure

iron deficiency anemia assessment

Pale mucous membranes Fatigue Tachycardia Spoon shaped nails (long term finding) Enlarged heart (possible) Enlarged spleen (possible) Poor muscle tone Decreased activity Hemoglobin/Hematocrit lab tests You may also find that the child has PICA syndrome, or the eating of nonfood substances (clay, dirt, ice, etc)

iron deficiency anemia

Patients with anemia have decreased oxygen binding capacity and delivery to organs, muscles and other tissues. This leads to fatigue. To compensate for the lower oxygen binding capacity, the heart will beat faster to distribute oxygen bound red blood cells throughout the body.

Ferrous sulfate nursing education

Place medication in orange juice to help with the taste and absorption. Avoid placing the iron with milk or tea. Drink the medication through a straw. Educate child to brush his/her teeth after taking this medication Educate to consume fresh fruit and lots of water Instruct the parents to watch for black stools, as this is a common side effect Encourage high fiber foods

Vincristine classification

Plant alkaloid/vesicant

While assessing a school-age child with a brain tumor after morning report, the child has an episode of projectile vomiting. What should the nurse do to help the child?

Provide a snack until the breakfast tray arrives.

A preadolescent child with ataxia-telangiectasia is demonstrating an exacerbation of choreoathetosis. What should the nurse do to help this patient?

Provide comfort measures.

Radiation side effects

Radiation sickness (fatigue, anorexia, nausea, vomiting) - if GI is eradicated Often prescribed an antiemetic Skin reactions - erythema and tenderness and typical local effects. Maintain good skin hygiene and use mild soaps or moisturizers to help preserve skin integrity

The nurse is planning care for a preschool-age child diagnosed with meningitis. What should the nurse identify as a priority goal for this patient's care?

Reduce the pain related to nuchal rigidity.

An adolescent is being evaluated for appendicitis. When assessed for pain, the patient points to the lower left abdominal region. What type of pain should the nurse document that this patient is experiencing?

Referred pain

Conscious sedation

Refers to a stage of depressed consciousness usually obtained through IV analgesia therapy The technique allows the child to be both pain free and sedated for a procedure Protective reflexes are left intact and a child can respond to instructions during the procedure Used for painful procedures such as dental extractions, wound care, bone marrow aspiration, MRI, and endoscopy Drugs used: chloral hydrate, sedative-hypnotic analgesic combination (relieves both anxiety and pain and depresses the child's memory of the event)

The nurse is planning care for a preschool-age child with spastic cerebral palsy. Which nursing diagnosis should the nurse identify to guide care for this patient's musculoskeletal status?

Risk for disuse syndrome related to spasticity of muscle groups

You teach a child to use a FACES pain rating scale prior to surgery. At that time, she points to the smiling face. Following surgery when you suspect she has pain, she points again to the smiling face. You would interpret this as

She is using the scale to predict what she would like, not what she has.

The nurse is caring for a preschool-age child recovering from a lumbar puncture. What should the nurse do to ensure the patient does not develop a spinal headache?

Take the pillow away and have the patient lie flat in bed.

The nurses caring for children on an oncology unit are planning an open-house presentation on cancer prevention actions to support the 2020 National Health Goals. Which topics should the nurses include in their presentation? (Select all that apply.)

Teaching testicular self-examination Explaining the reasons to avoid excessive sun exposure The importance of frequent health assessments to identify the symptoms of leukemia

The nurse is caring for a 4-year-old child with acute lymphocytic leukemia (ALL). Why should the nurse assess this child's temperature using the axillary route instead of a rectal temperature?

The child has a low platelet count.

The nurse is caring for an 8-month-old baby diagnosed with spastic cerebral palsy. Which assessment finding supports this medical diagnosis?

The child has a strong Moro reflex when startled.

The nursing is planning care for a child recovering from neck surgery for rhabdomyosarcoma. Which outcome suggests the best long-term prognosis for this patient?

The child tolerates chemotherapy provided after complete removal of the neck tumor.

When discharging a child home with parents and medication, nurses should reinforce the following education:

The correct dosing The correct frequency of administration The expected level of relief The number to call in case they have any questions

The nurse is planning outcomes for an adolescent male diagnosed with Hodgkin disease. Which outcome should the nurse use to address feelings of powerlessness with the disease?

The patient attends recommended appointments.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction the nurse would give her parents regarding this is:

Their child will have to practice good tooth brushing.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. The nurse would want to teach her parents that:

Their daughter should maintain an active lifestyle.

Partial (focal) seizures

These seizures originate from a specific brain area, seizure movement will be localized to a certain part of the body. - Motor signs begins in the fingers and spreads to the wrist, arm, and face in clonic contraction - If movement remains localized, no loss of consciousness - If spread is extensive seizure can cross the midline and become generalized - Important to observe children carefully to distinguish the difference

Pain Experience survey

This survey will be asked to both child and parent. This is one of the only scales that utilizes both patient and parent input.

long term effects of radiation on hormones

Thyroid Hypothalamic Pituitary gland Growth hormone deficiency Adrenal insufficiency

A 6-year-old girl suffers head trauma following a motor-vehicle accident. An intravenous infusion of 10% dextrose/water is begun. For which of the following findings would it be most important to monitor her during this time?

Urinary output and specific gravity of urine

The nurse is planning a program for a community that focuses on the 2020 National Health Goals for neurologic health. Which topics should the nurse include in this presentation? (Select all that apply.)

Use of helmets for bicycle and motorcycle safety Practicing good hand washing technique and infection control Importance of proper emergency care to protect the head and neck

The nurse is caring for a child with a closed head injury. The child's blood pressure is 120/58 mmHg, and intracranial pressure is 16 mmHg. What is this child's cerebral perfusion pressure? (Enter numeric value only. Calculate to the nearing hundredth decimal point.)

84.67

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

A 15-year-old girl who has heavy menstrual periods

Types of Seizures

Absence Tonic/Clonic Febrile Partial (focal)

Acute Lymphocytic (Lymphoblastic) Leukemia

Accounts for 75% of leukemias and involves the lymphoblasts. Decreased production of red blood cells and platelets.

The nurse is planning to assess the amount of pain that a 15-year-old child is experiencing after a motor vehicle crash. Which pain scale should the nurse use to measure this patient's pain?

Adolescent Pediatric Pain Tool

Tonic/Clonic Seizure

All muscles will contract/relax Consists of three stages: - Prodromal - hours or days of a warning to immediately before the seizure is about to occur - May consist of drowsiness, dizziness, malaise, lack of coordination, or tension - Tonic-clonic stage - Tonic: All muscles of the body contract, extremities stiffen, the face distorts, air is pushed through the glottis from contraction of the chest muscles to produce a guttural cry, and the child falls to the ground - Clonic: muscles of the body rapidly contract and relax, producing quick, jerky motions - Postictal stage Sleeping soundly for 1-4 hours rousing only to painful stimuli Medication: Daily administration of antiseizure medication - meds usually continued until the child has been seizure free for 2-3 years Valproate (Depakote) Carbamazepine (Tegretol) - Do not abruptly stop

A school-age child with a fractured leg is crying. The child will not move the extremity, lies very still, and denies the presence of pain. What should the nurse recognize as the possible reason for this child's behavior?

An injection was given for pain in the emergency room.

iron deficiency anemia therapeutic management

focuses on treatment of the underlying cause, which is the lack of iron iron compound such as Ferrous Sulfate for 4-6 weeks is the drug of choice to improve RBC formation and replace the iron stores. The diet of the child must be changed to one rich in iron and Vitamin C Some children will also be prescribed iron dextran by injection. This medication is given IM using the Z-Track method because it stains the skin.

A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child:

has a low platelet count.

Dexamethasone MOA

its a steroid; used for head trauma (ICP or injury)

what can you do to test for leukemic cells in CSF

lumbar puncture

infant pain scale

observe facial and body actions. If infant is inconsolable after feeding, swaddling and diaper changes, then child is likely expressing pain.

Vincristine Special considerations

paresthesia of fingers and toes, foot drop may occur, may need stool softener, tissue necrosis occurs if infiltrated.

The nurse is caring for a 4-year-old with sickle cell anemia. A physical finding you might expect to see in him is:

slightly yellow sclerae.

Some children with iron-deficiency anemia may be prescribed iron dextran by injection. This should be injected:

via Z-track technique

When discharging a child home with parents and meds, nurses should reinforce the following

Correct dosing, correct freq. Of admin, expected level of relief and # to call if they have any questions

long term effects of radiation on nervous system

Demyelination and necrosis of white matter of the brain which results in lethargy, sleepiness, possible seizures Grey matter - learning disabilities

The nurse working in pediatrics is aware of the special needs of children related to pain assessment. What is the highest priority for the nurse to consider when completing a pain assessment?

Developmental age of child

The nurse is using blowing bubbles during a procedure with a child as an alternative pain-management technique. What type of alternative pain management is this considered?

Distraction

While the phlebotomist draws blood from a toddler's right arm, the nurse is having the child blow bubbles with the left hand. Which pain management technique is the nurse using with the child?

Distraction

The nurse is preparing discharge teaching for the parents of a school-age child who was recently receiving patient-controlled analgesia. What should the nurse include when teaching the parents about pain management for this patient? (Select all that apply.)

Dosing of pain medication Frequency of pain medication Expected level of pain relief Contact number to call with questions

febrile seizures

Due to rapid rise in body temp, then follows the tonic/clonic pattern Associated with high fever (102-104) - sudden spike of fever Most common type in preschool age children, although can occur as late at 7 years of age Can occur after immunization with live vaccines Seizure is usually generalized tonic-clonic pattern (lasting 15-20 seconds) EEG tracing afterwards Meds: - Oral medication should not be given - Suppositories may be given at the appropriate dose - Antipyretics to reduce fever below seizure levels - Antibiotic therapy if infection is documented

A 16-year-old has suffered a thoracic-level spinal injury from a diving accident. To initiate CPR at the poolside, which measure would be most important?

Elevate the mandible to assess airway with the head in a neutral position.

hyperbilirubinemia

Excessive destruction of red blood cells, which leads to elevated bili levels.

Hospice

Family, friends, and younger children, pets are allowed unlimited visiting. Children are invited to bring possessions with them that are important. They are given the choices regarding the degree of pain relief they want. Strong analgesia often used to make child pain free. Death is an extension part of life, not separate entity.

A high-school football player has been diagnosed as having osteosarcoma of the femur. His mother is angry because she told him not to play football. Which health teaching points would you include in the teaching plan for the boy and his mother?

Football injuries do not contribute to the development of a tumor.

The mother of a high school football player diagnosed with osteosarcoma of the femur is angry because she did not want him to play football. Which health teaching point should the nurse include in the teaching plan for the patient and mother?

Football injuries do not contribute to the development of a tumor.

A boy with hemophilia A is scheduled for surgery. Which precautions would you institute with him?

Handle him gently when transferring him to a stretcher.

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed?

He has noticed one pupil appears white.

The nurse is using a postoperative pain management scale to determine if a newborn recovering from emergency surgery is experiencing pain. Which observations indicate that the child is experiencing level 3 pain this time? (Select all that apply.)

High-pitched cry Baby has not fallen asleep Heart rate elevated to greater than 20% over the baseline

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily?

His stools will appear black.

The nurse is assessing pupil size and reaction to light in a child with a cervical neck injury. Which cranial nerve is the nurse assessing in this patient?

III (oculomotor)

Retinoblastoma Management

If they are allowed to grow they will cause blindness. Important goal is to preserve as much vision as possible. If the tumor is small it will be treated with cryosurgery (freezing the tumor to destroy local cells) Photocoagulation - laser surgery to destroy blood vessels supplying tumor Radioactive applicators If the tumor is metastasized, the child may also receive radiation treatment and chemotherapy (vincristine, cyclophosphamide, etc.) If the tumor is large, enucleation of the eye may be necessary. After enucleation the child has a large pressure dressing applied to the empty socket. - Observe for bleeding on the dressing and obtain vitals frequently. - Child may need to be restrained so they don't tug at the dressing for 48 hours. - After 48 the dressing is removed and a small eye patch is applied. - Irrigation of the empty socket with normal saline solution or application of an antibiotic ointment may be prescribed with dressing changes. - Eye prosthesis is fitted 3 weeks after surgery. Prostheses in children do not need removed and cleaned daily. In children this young, leaving it in place prevents removing and playing with it.

Prior to conducting a blood-drawing procedure, the nurse teaches a child to imagine swimming in a cool, shady park with friends and family. Which technique did the nurse use with this patient?

Imagery

The nurse is preparing to provide a preschool-age child with an injection. Which technique should the nurse use when applying EMLA cream to the injection site?

Apply it at least 1 hour before the procedure.

An adolescent recovering from a spinal cord injury calls out for help. The patient's face is bright red, and the patient is experiencing a severe headache. What is the first thing that the nurse should do for this patient?

Assess if the urinary retention catheter is blocked.

long term effects of radiation on bone

Asymmetric growth of bones Easy fracturing Scoliosis Kyphosis Hypoplasia

A child being treated for leukemia is diagnosed with neutropenia. What should the nurse instruct the parents and child to prevent infections? (Select all that apply.)

Avoid large crowds. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections.

Neutropenic Precautions

Avoiding large crowds Inspecting the skin daily for scratches and scrapes Remove house plants, flowers from home Stay away from people with obvious illness (colds, rashes, infections)

Hyperbili Management

Bili levels can be measured by either a blood draw of holding TcB to skin. Initiation of early feeding (8 to 10 times a day), use of phototherapy, and exchange transfusion all may be measures necessary to reduce the TsB levels.

Ferrous sulfate side effects

Black stools, GI upset, anorexia, nausea, vomiting, constipation, stained teeth

Retinoblastoma Evaluation

Check to see if metastasis has occurred How they are adjusting to the loss of vision Notice it most at school age when participating in sports and activities

absence seizure

Child will break off into staring spells Form of generalized seizures Occur more often in girls than boys usually between ages 4 and 12 No first aid measures are necessary - downplaying the importance of these episodes to help the child maintain a positive self-image Can be controlled by ethosuximide (Zarontin), valproate or lamotrigine - If seizures are controlled by medication children can participate in normal school activities

FACES pain scale

Children will point to a face on a pain scale placed in front of them. Be careful with this, because sometimes, children will point to what they want to be instead of what they are feeling.

long term effects of radiation on organs of chest and abdomen

Chronic pneumonitis and pulmonary fibrosis resulting in obstructive or restrictive chronic lung disease Left ventricular dysfunction, valve abnormalities, early coronary artery disease or conduction abnormalities GI - chronic malabsorption Head - alopecia, impaired growth of teeth, reduced salivary gland function

A preadolescent weighing 99 lb is prescribed carbamazepine (Tegretol) 10 mg/kg per 24 hours in two divided doses. How much medication will the nurse provide the patient for one dose? (Enter numeric response only.)

225 mg

A child with leukemia is prescribed to receive ondansetron hydrochloride (Zofran) 0.15 mg/kg intravenously prior to receiving the first dose of chemotherapy. The child weighs 55 lb. How many milligrams of the medication should the nurse provide to the child? (Numeric value only. Calculate to the nearest tenth decimal point.)

3.8 mg

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

Antiemetic

first sign of autonomic dysreflexia

a red flushed feeling on your face or a pounding headache.

autonomic dysreflexia

a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).

head injury

always check pupil response (cranial nerve 3 oculomotor)

Acute Lymphocytic (Lymphoblastic) Leukemia chemotherapy agents

cause oral ulcerations that interfere with the patients nutrition because of pain, and leave a portal for infection, so they are at risk for impaired skin integrity.

Acute Lymphocytic (Lymphoblastic) Leukemia radiation therapy

causes nausea because it destroys rapid growing cells. Cells of the stomach lining can be destroyed, hence the nausea. Typically patients undergoing radiation will be given an Antiemetic.

Vincristine side effects

constipation, alopecia, joining and muscle pain, muscle weakness

Alternative Pain techniques

distraction techniques; EMLA cream- topical cream an hour before you do the procedure.

Spinal Cord Injuries/Autonomic Dysreflexia

excessively high blood pressure. More common in people with spinal cord injuries that involve the T6 and above. -S/S are: Heavy sweating, anxiety, slow heart rate, blurry vision, dilated pupils, goosebumps on lower body, trouble breathing, stuffy nose. -can be caused by an irritant below the level of injury: Such as Bladder: irritation of bladder wall, UTI, blocked catheter or overfilled bag. Bowel: distended or irritated bowel and/or constipation.