unit 4 PEDS

the parent of an infant asks the nurse what to watch for to determine whether the infant has CP. which is the nurse's best response? 1. whether the infant cannot sit up without support before 8 months 2. whether the infant demonstrates tongue thrust before 4 months 3. whether the infant has poor head control after 2 months 4. whether the infant has clenched fists after 3 months

4

which should the nurse tell the parent of an infant with spina bifida? 1. "bone growth will be more than that of babies who are not sick because your baby will be less active" 2. "physical and occupational therapy will be helpful to stimulate the senses and improve cognitive skills" 3. "nutritional needs for your infant will be calculated on the basis of activity level" 4. "fine motor skills will be delayed because of the disability"

2

which statement by the mother would lead the nurse to suspect sexual abuse? 1. "she has just started masturbating" 2. "she has lots more temper tantrums" 3. "she now has an invisible friend" 4. "she wants to spend time with her sister"

2

which statement is true of abused children? 1. they will tell the truth if asked about their injuries 2. they will repeat the same story that their parents tell 3. they usually are not noted to have any changes in behavior 4. they will have outgoing personalities and be active in school activities

2

which would be the nurse's priority intervention if a 7 year old's mother tells the nurse she has noticed excessive masturbation? 1. tell her it is normal development for children this age 2. ask the mother if anyone is abusing the child 3. talk with the child and find out why she is touching herself 4. investigate thoroughly the circumstances in which she masturbates

2

what is the most likely cause of a child's illness if it is unexplained, prolonged, recurrent, and extremely rare and usually occurs when the caregiver is present? 1. genetic disorder 2. munchausen syndrome by proxy 3. duchenne muscular dystrophy 4. syndrome of inappropriate antidiuretic hormone

2

what should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. weigh diapers for 24 hr UOP 2. measure head circumference 3. offer clear fluids 4. assess for infection

2

which activity should an adolescent just diagnosed with epilepsy avoid? 1. swimming with a friend 2. being in a car at night 3. participating in any strenuous activities 4. returning to school right away

2

which is the best action for the nurse to take during a child's seizure? 1. administer the child's rescue dose of oral diazepam 2. loosen the child's clothing, and call for help 3. place a tongue blade in the child's mouth to prevent aspiration 4. carry the child to the infirmary to call 911 and start an IV line

2

which is the most appropriate nursing intervention when caring for a child newly admitted with a mild head concussion and no cervical spine injury? 1. keep HOB flat, side rails up, and safety measures in place 2. elevate HOB, side rails up, and safety measures in place 3. observe for drainage from any orifice and notify physician immediately 4. continually stimulate the child to keep awake to check neurological status

2

a newborn with a repaired myelomeningocele is assessed for hydrocephalus. which would the nurse expect in an infant with hydrocephalus? 1. low pitch cry and depressed fontanel 2. low pitch cry and bulging fontanel 3. bulging fontanel and downwardly rotated eyes 4. depressed fontanel and upwardly rotated eyes

3

the nurse is caring for an infant with myelomeningocele who is going into surgery later today for closure of the sac. Which would be a priority nursing diagnosis before surgery? 1. alteration in parent-infant bonding 2. altered growth and development 3. risk of infection 4. risk for weight loss

3

the nurse is developing a plan of care for a child recently diagnosed with CP. which should be the nurse's priority goal? 1. ensure the ingestion of sufficient calories for growth 2. dec ICP 3. teach appropriate parenting strategies for a child with special needs 4. ensure that the child reaches full potential

3

the parent of an infant with CP asks the nurse if the infant will be mentally retarded. which is the nurse's best response? 1. children with CP have some amount of mental retardation 2. approximately 20% of children with CP have normal intelligence 3. many children with CP have normal intelligence 4. mental retardation is expected if motor and sensory deficits are severe

3

basal skull fracture

a skull fracture that occurs in the basilar portion of the brain

seizure

abnormal electrical discharges in the brain resulting in abnormal muscle movement

congenital limb defect

abnormal growth of a limb in uterus doctor may remove the abnormal extremity or digits to allow for a more normal lifestyle

Legg-Calve-Perthes Disease

avascular necrosis of the femoral head dec blood supply to the femoral head can happen at random or secondary to other conditions

Slipped Capital Femoral Epiphysis

femoral head detaches from the growth plate can be partial or complete pain radiates down the leg can cause avascular necrosis if not properly treated

osteogenesis imperfecta

genetic mutation that leads to improper bone formation aka "brittle bone disease" major risk for injury s/sx of broken bones will be different from people without this condition

what type of fracture do kids most commonly get?

green stick due to increased cartilage in the body

scoliosis

lateral flexion of the spine

Duchenne muscular dystrophy

most lethal form of muscular dystrophy pertains to diaphragm can cause cardiac or respiratory failure

nuchal rigidity

neck pain that increases with movement (meningitis) babies will arch backwards to relieve pain can be mistaken for posturing or seizure

what does a neuro exam assess for?

cerebral perfusion

spinal cord injury

complete or partial injury to the spinal cord vertebrae can be fractured without injury to the spinal cord caused by direct or indirect force causing a contusion or bruising, compression, hemorrhage, or significant vascular damage resulting in paresthesia or paralysis

spina bifida

congenital malformation of the brain, skull, spinal cord, and/or vertebrae r/f hydrocephalus measure head circumference every day no neurological function below the defect

an increase of blood in cranium = ?

decrease in brain tissue and/or CSF

dysgraphia

difficulties forming letters or writing within a prescribed space.

reactive attachment disorder

difficulty forming healthy attachments due to early profound social neglect, trauma, or loss

ataxic cerebral palsy

difficulty with balance and depth perception; unsteady gait, poor coordination, fine motor control problems

nursing interventions for inc ICP

elevate HOB 15-30 degrees and keep child's head maintained in a midline position to prevent jugular compression and facilitate venous drainage obtain and maintain patent airway- poor oxygenation causes an inc in ICP position pt on the side to dec possible airway obstruction seizure precautions

tonic-clonic seizure

generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups; patient is postictal and confused after seizure is over

early signs and symptoms of inc ICP

headache emesis change in LOC dec in GCS score irritability sunsetting eyes dec eye contact (infant) pupil dysfunction cranial nerve dysfunction seizures

what is the result of impaired circulation and/or malabsorption of CSF?

hydrocephalus

partial simple seizure

lasts 5 minutes; no loss of consciousness or awareness

partial seizure

localized to one area: hands, lips, wrists, arms, or face impaired loss of consciousness at onset

partial complex seizure

loss of consciousness and loss of awareness of surrounding; changes in behavior (lip smacking, picking, inappropriate mannerisms, confusion) following the seizure

what is the diagnostic test for meningitis?

lumbar puncture and CBC CSF will be white/cloudy/pus CBC will show elevated WBC

seizure precautions

maintain airway patency; make sure nothing is in the patient's mouth monitor oxygen saturation administer IV meds raise and pad side rails of the bed

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges

spastic cerebral palsy

most common type; stiff muscles, inc muscle tone, poor control of movement, prone to contractures

myelomeningocele

most severe form of spina bifida in which the spinal cord and meninges protrude through the spine no neurological function below the defect laminectomy and closure of the defect performed as soon after birth as possible

what is the hallmark sign for meningitis?

nunchal rigidity- neck stiffness that intensifies upon movement children will also arch backwards in attempt to alleviate pain

a child with CP has been fitted for braces and is beginning physical therapy to assist with ambulation. the parents ask why he needs the braces when he was crawling without any assistive devices. select the nurse's best response 1. the CP has progressed and he now needs more assistance to ambulate 2. as your child grows, different muscle groups may need more assistance 3. most children with CP need braces to help with ambulation 4. we have found that when children with CP use braces, they are less likely to fall

2

the nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for MD is which of the following? 1. electromyelogram 2. nerve conduction velocity 3. muscle biopsy 4. creatine kinase level

3

which clinical assessment of a neonate with bacterial meningitis would require immediate intervention? 1. irritability 2. rectal temp of 100.6 3. quieter than usual 4. respiratory rate of 24 breaths/min

3

which statement would be most therapeutic to a child whom the nurse suspects has been abused? 1. "who did this to you? this is not right." 2. "this is wrong that your parents did not protect you." 3. "this is not your fault; you are not to blame for this." 4. "I will not tell anyone."

3

which should the nurse prepare the parents of an infant for the following surgical repair and closure of a myelomeningocele shortly after birth? 1. not need any long-term management and should be considered cured 2. not be at risk for UTIs or movement problems 3. have continual drainage of CSF needing frequent dressing changes 4. need lifelong management of urinary, orthopedic, and neurological problems

4

which statement accurately describes child abuse? 1. physical abuse and neglect, usually carried out by a known adult 2. intentional and unintentional physical emotional abuse and neglect 3. sexual abuse of children, usually by an adult 4. intentional physical, emotional, and/or sexual abuse and/or neglect

4

Hip dysplasia

Congenital defect where the femoral head is dislocated from the acetabulum

Club foot

Malformation of the foot due to positioning in the uterus; treated with staged casting

compartment syndrome

Swelling in a confined space (i.e. casts) that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.

Autism Spectrum Disorder (ASD)

a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication; involve limitations in social relatedness, verbal and nonverbal communication, and the range of interests and behaviors

fragile x syndrome

a genetic disorder in which the protein necessary for normal brain development is not manufactured; formally diagnosed through DNA testing

concussion

a transient and reversible brain trauma may lose consciousness multiple concussions may cause cerebral palsy or brain damage

what does a leg length discrepancy indicate?

alteration of the hip bone

lumbar puncture

assesses CSF for abnormalities normal is clear like water

ventricular drain

assesses ICP and drains CSF

mixed cerebral palsy

two or more types of CP combined difficulty with walking, speech, breathing, learning, hearing, etc.

athetoid cerebral palsy

uncontrolled involuntary writing of extremities, often including drooling, speech difficulties, and grimacing

spica hip cast

used after surgery for correction of congenital hip dysplasia

what is the treatment for hydrocephalus?

ventriculoperitoneal shunt

main treatment for hydrocephalus

ventriculoperitoneal shunt catheter is placed in the lateral ventricle where a one-way valve is set at a desired pressure to drain CSF

fracture

when a bone receives more stress than it can absorb

When should the injured area be examined during an assessment?

LAST

kyphosis

excessive outward curvature of the spine, causing hunching of the back.

muscular dystrophy

genetic disorder that causes deterioration of muscle

staged/serial casting

overcorrecting position of the legs to manipulate into a more normal position; position is held in a cast and changed weekly to facilitate further progression into normalcy

MRI

photographs brain structures (1.5-2 hours)

nursing interventions for legg-calve perthes disease

stablize hip/leg until femur has revasularized and reossified traction complete bed rest spica cast HOB stays less than 30 degrees

Osgood-Schlatter disease

tearing of the patellar tendon away from the tibia

what is the hallmark sign for scoliosis?

unequal shoulder lengths

laceration

when an object penetrates into the brain tissue

a child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming. this is most likely a(n): 1. absence seizure 2. akinetic seizure 3. non-epileptic seizure 4. simple spasm seizure

1

A child has a provisional diagnosis of myasthenia gravis. which should the nurse expect in this child? SATA 1. double vision, ptosis 2. tremors and seizures 3. coughing and choking 4. ascending paralysis 5. sensory disturbance

1, 3

which would the nurse expect a child with spastic CP to demonstrate? SATA 1. inc DTR 2. dec muscle tone 3. scoliosis 4. contractures 5. scissoring 6. good control of posture 7. good fine motor skills

1, 3, 4, 5

when assessing neurological status of an 8 month old the nurse should check for which of the following? SATA 1. clarity of speech 2. interaction with staff 3. vision test 4. Romberg test 5. ability to roll over and sit independently

2, 5

The parent of a young child with CP brings the child to the clinic for a checkup. Which of the parent's following statements indicates an understanding of the child's long-term needs? 1. "My child will need all my attention for the next 10 years." 2. "Once in school, my child will catch up and be like the other children." 3. "My child will grow up and need to learn to do things independently." 4. "I'm the one who knows the most about my child and can do the most for my child."

3

the nurse judges teach as successful when a parent of a child with myasthenia gravis states which of the following? SATA 1. my child should play on the school's basketball team 2. my child should medicate every day 3. my child should be allowed to do what other kids do 4. my child should be watched carefully for signs of illness 5. my child should sleep in my room so that I can watch him better

3, 4

the nurse should tell the parents of a child with Duchenne MD that some of the progressive complications include which of the following? SATA 1. dry skin and hair, hirsutism, protruding tongue, and mental retardation 2. anorexia, gingival hyperplasia, dry skin and hair 3. contractures, obesity, and pulmonary infections 4. trembling, frequent loss of consciousness, and slurred speech 5. increasing difficulty swallowing and shallow breating

3, 5

which should a nurse in the ED be prepared for in a child with a possible spinal cord injury? SATA 1. severe pain 2. elevated temperature 3. respiratory depression 4. increased ICP 5. multiple sites of injury

3, 5

what is the inital diagnostic test for head trauma and stroke?

CT- only takes 10 minutes to complete

down's syndrome

During cell development, the fetus receives 47 chromosomes instead of the normal 46. The extra chromosome changes the development of the body and the brain.

signs and symptoms of fragile x syndrome

Physical features: Large head; elongated face; prominent ears, chin, and forehead ■ Developmental delays: Not reaching milestones in line with children in the same age group ■ Learning disabilities: Difficulty learning new skills; poor intellectual development ■ Social/behavioral difficulties: Poor communication, self-abuse, no eye contact, difficulty paying attention (CDC, 2020d)

signs/symptoms of down's syndrome

Poor muscle tone ■ Slanting eyes with folds of skin at the inner corners (epicanthal folds) ■ Hyperflexibility ■ Short, broad hands with a single crease across the palms of one or both hands ■ Broad feet with increased space between the first and second toes ■ Flat bridge of the nose ■ Short, low-set ears ■ Short neck with extra folds of skin ■ Small head ■ Small oral cavity and airway

lordosis

abnormal increase in the forward curvature of the lumbar spine

contusion

bruising of the brain tissue resulting in bleeding and/or inc ICP blood stops; not actively bleeding

What are children's bones mostly comprised of?

cartilage

late signs and symptoms of inc ICP

further dec in LOC bulging fontanelles dec spontaneous movements posturing papilledema pupil dilation with dec or no response to light inc blood pressure irregular respirations cushing's triad

craniotomy

partial removal of skull

what is the primary intervention for hip dysplasia?

pavlik harness must be less than 1 year old dr is the only person that can adjust must wear 24/7 for the first 2-3 weeks

what does a neurovascular exam assess for?

peripheral perfusion

meningocele

protruding sac is located on the spine at the level of the defect, usually covered by a thin layer of muscle and skin meninges protrude through the spine, but neuro functioning is not usually affected

s/sx of basal skull fracture

raccoon eyes blood pooling in sinuses battle sign (blood pooling under ears) CSF and blood drip out of nose

EEG

records electrical activity in the brain diagnostic test for seizures

dyscalculia

significant inability to understand or recognize numbers or functions of numbers, or copy them correctly, or follow sequences.

dyslexia

significantly impaired ability to read; words or letters may be "mixed up" or distorted, making it impossible to recognize what others see.

four types of cerebral palsy

spastic ataxic athetoid mixed

four types of spina bifida

spina bifida occulta closed neural tube defects meningocele myelomeningocele

hematoma

when blood seeps into the dural or subdural space is actively bleeding subdural or epidural

which is the nurse's best response to the parents of a neonate with a meningocele who ask what they can expect? 1. after initial surgery to close the defect, most children experience no neurological dysfunction 2. surgery to close the sac will be postponed until the infant has grown and has enough skin to form a graft 3. after initial surgery to close the defect, the child will likely have motor and sensory deficits 4. after the initial surgery to close the defect, the child will likely have future problems with urinary and bowel continence

1

the nurse is planning care for a child with a T12 spinal cord injury. which lifelong complication should the child and family know about? SATA 1. compromised skin integrity 2. incontinence 3. loss of large and small motor activity 4. loss of voice 5. spasticity

1, 2, 3, 5

the mother of a child with Duchenne MD asks the nurse who in the family should have genetic screening. who should the nurse say must be tested? SATA 1. mother 2. sister 3. brother 4. aunts and all female cousins 5. uncles and all male cousins

1, 2, 4

which will help the school age child with MD stay active longer? SATA 1. normal activities such as swimming 2. using a treadmill every day 3. several periods of rest every day 4. using a wheelchair upon getting tired 5. sleeping as late as needed

1, 3, 4

which statement is true of shaken baby syndrome? SATA 1. there may be absence of external signs of injury 2. multiple reports of the baby crying for long periods of time 3. shaken babies usually do not have retinal hemorrhage 4. shaken babies usually have signs of a subdural hematoma 5. shaken babies have signs of external head injury

1,3,4

After spinal cord surgery, a patient suddenly complains of a severe headache. What should be the nurse's first action? 1. Check the blood pressure. 2. Check for a full bladder. 3. Ask if pain is present somewhere else. 4. Ask if other symptoms are present.

2

what would be the priority intervention when a 10 year old comes to the school nurse's office because of a headache, and the nurse notices various stages of bruising on the inner aspects of the upper arms? SATA 1. call the child's parent and ask if acetaminophen can be given for the headache 2. call the child's parent and ask about the arm bruises 3. ask the child what happened to her arms and have her describe the headache 4. inquire about the child's headache and bruising on her arms; file mandatory reporting forms 5. call the child's parent to pick her up from school and complete required school nurse visit forms

2 & 3

a parent of a newborn diagnosed with myelomeningocele asks what is/are common long-term complications? the nurse's best response is which of the following? SATA 1. learning disabilities 2. UTIs 3. hydrocephalus 4. decubitus ulcers and skin breakdown 5. nutrition issues 6. attention deficit disorders

2, 3

which of the following would be included in the plan of care for a hospitalized newborn following repair of a myelomeningocele? SATA 1. skull x-ray 2. daily head circumference 3. MRI 4. vital signs every 6 hours 5. holding to breastfeed

2, 3

After airway, breathing, and circulation have been assessed and stabilized, which intervention should the nurse implement for a child diagnosed with encephalitis? 1. Assist with a lumbar puncture, and give reassurance. 2. Obtain a throat culture, then begin antibiotics. 3. Perform initial and serial neurological assessments. 4. Administer antibiotics and antipyretics.

3

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply. 1. Sunken anterior fontanel. 2. Complaints of blurred vision. 3. High-pitched cry. 4. Increased appetite. 5. Sleeping more than usual.

3, 5

which food would be the best for a child with Duchenne MD? SATA 1. high carb, high protein foods 2. no special food combinations 3. extra protein to help strengthen muscles 4. low calorie foods to prevent weight gain 5. thickened liquids and smaller portions that are cut up

4, 5

which assessment of an 18 month old with burns on his feet would cause suspicion of child abuse? 1. splash marks on his right lower leg 2. burns noted on the right arm 3. symmetrical burns on both feet 4. burns mainly noted on the right foot

3

an infant is born with a sac protruding through the spine, containing CSF, a portion of the meninges, and nerve roots. this condition is referred to as: 1. meningocele 2. myelomeningocele 3. spina bifida occulta 4. anencephaly

2

cerebral palsy

a disorder caused by brain trauma resulting in abnormal posture and muscle movements muscle weakness, poor motor control, or shaking (spasticity) of the arms and legs

a 10 month old is carried into the ED by her parents after she fell down 15 stairs in her walker. Which would be your highest priority nursing intervention? 1. assess airway while simultaneously maintaining cervical spine precautions 2. assess airway, breathing, and circulation simultaneously 3. prepare for diagnostic radiological testing to check for injuries 4. obtain venous access and draw blood for testing

1

a child diagnosed with meningitis is having a generalized tonic-clonic seizure. which should the nurse do first? 1. administer blow-by oxygen and call for additional help 2. reassure the parents that seizures are common in children with meningitis 3. call a code and ask the parents to leave the room 4. assess the child's temperature and blood pressure

1

which gross motor skills should the nurse assess in a 3 month old with spina bifida? 1. head control 2. pincer grasp 3. sitting alone 4. rolling over

1

the parents of a preschooler with MD are asking questions about the course of their child's disease. which should the nurse tell them? SATA 1. "MD usually results in progressive weakness" 2. "The weakness that your child is having will probably not increase" 3. "your child will be able to function normally and not need any special accommodations" 4. "the extent of weakness depends on going to daily PT" 5. "your child may have pain in his legs with muscle weakness"

1, 5

which priority item should be placed at the bedside of a newborn with unrepaired myelomeningocele? SATA 1. a bottle of normal saline 2. a rectal thermometer 3. extra blankets 4. a blood pressure cuff 5. latex-free gloves

1, 5

which symptoms will a child suffering from complete spinal cord injury experience? SATA 1. loss of motor and sensory function below the level of the injury 2. loss of interest in normal activities 3. extreme pain below the level of injury 4. loss of some function with sparing of function below the level of injury 5. loss of bowel and bladder control

1, 5

the parent of a toddler newly diagnosed with CP asks the nurse what caused it. the nurse should answer with which of the following? 1. most cases are caused by unknown prenatal factors 2. it is commonly caused by perinatal factors 3. the exact cause is not known 4. the exact cause is known in every instance

2

a child with a newly applied left leg cast initially feels fine, but then starts to cry and tells his mother that his leg hurts. Which assessment would be the mother's first priority? 1. cast integrity 2. neurovascular integrity 3. musculoskeletal integrity 4. soft tissue integrity

2

over the past week and infant with a repaired myelomeningocele has had a high-pitched cry and has been irritable. length, weight, and head circumference have been at the 50th percentile. today the length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. the nurse should do which of the following? 1. tell the parent this is normal for an infant with a repaired myelomeningocele 2. tell the parent this might mean the baby has increased ICP 3. suspect the baby's ICP is low because of a leak 4. refer the baby to the neurologist for follow up care

2

the nurse is aware that cloudy CSF most likely indicates: 1. viral meningitis 2. bacterial meningitis 3. no infection, because CSF is usually cloudy 4. sepsis

2

the nurse is caring for an infant with a myelomeningocele. the parents ask the nurse why the nurse keeps measuring the baby's head circumference. select the best response 1. babies' heads are measured to ensure growth is on track 2. babies with a myelomeningocele are at risk for hydrocephalus, which shows up as an increase in head size 3. because your baby has an opening on the spinal cord, your infant is at risk for meningitis, which can show up as an increase in head size 4. many infants with myelomeningocele have microcephaly, which can show up as a dec in head size

2

the nurse knows that teaching was successful when a parent states which of the following are early signs of MD? 1. increased muscle strength 2. difficulty climbing stairs 3. high fevers and tiredness 4. respiratory infections and obesity

2

a child is being admitted with the diagnosis of meningitis. select the procedure the nurse should do first 1. administration of IV antibiotics 2. administration of maintenance fluids 3. placement of a foley catheter 4. send the spinal fluid and blood samples to the laboratory for cultures

4

the nurse evaluates teaching of parents of a child newly diagnosed with CP as successful when the parents state that CP is which of the following? 1. inability to speak and uncontrolled drooling 2. involuntary movements of lower extremities only 3. involuntary movements of upper extremities only 4. an increase in muscle tone and DTRs

4

what causes an increase in intracranial pressure?

increase in tissue, blood, and/or cerebral spinal fluid

osteomyelitis

infection of the bone children have increased blood flow compared to adults, which increases risk for osteomyelitis

encephalitis

infection of the brain tissue, which can result in brain tissue death can be caused by West Nile or meningitis

meningitis

infection of the tissue surrounding the brain and spinal cord