ENDOCRINE/GI&NUTRITION/INFECTIOUS DX/URINARY-Pediatrics

Children should participate in their diabetes management.

Choosing and cleaning a finger for blood glucose testing before a parent or caregiver performs the puncture . Selecting the site for insulin injection, with a parent or caregiver verifying appropriate site rotation. Pushing the syringe plunger to administer insulin after a parent or caregiver inserts the needle. Identifying signs and symptoms of hypoglycemia and hyperglycemia

scarlet fever. The client has a history of type 1 diabetes mellitus.

Clients with type 1 diabetes should not discontinue insulin usage during an illness. Encouraging fluids and monitoring glucose and ketone levels are priorities for this client. An acute illness (eg, scarlet fever) in clients with type 1 diabetes may trigger the release of stress hormones, which leads to higher blood glucose and ketone levels (sometimes leading to ketoacidosis). Clients with type 1 diabetes do not produce any insulin (unlike those with type 2 diabetes), so clients should not skip administration of external insulin even if not eating. Insulin therapy should be continued as prescribed during an acute illness . Additional sick-day management includes: Increasing frequency of blood glucose level checks (every 1-4 hours) Increasing or decreasing the dose of insulin as needed based on blood glucose levels

congenital hypothyroidism

Clinical manifestations in affected infants may include dry skin, hoarse cry, constipation, bradycardia, or difficulty awakening beginning a few months after birth. If untreated, intellectual disability may occur. Congenital hypothyroidism occurs when abnormal development of the thyroid gland causes complete or decreased secretion of thyroid hormone (TH). Untreated hypothyroidism can cause severe intellectual disability in infants if undetected. Screening occurs after birth for all infants in the United States and Canada to prevent disability and encourage early treatment (ie, levothyroxine). TH plays an important role in growth, development, and regulation of many bodily functions (eg, heat production, muscle tone, skin function, cardiac function, metabolism). Clinical manifestations in affected infants reflect the pathophysiology of decreased TH

cystic fibrosis

Cystic fibrosis causes damage to the GI tract and pancreas, leading to impaired absorption of nutrients and resulting growth deficits. Clients must consume a diet high in calories, fat, and protein.

10-year-old client with abdominal discomfort

DESCRIBE THE PAIN DO THE ASSESSMENT AS ADULT-10 YR.OLD Clients as young as 3 can tell and/or show the examiner where they hurt or how they feel in their own terms 10-year-olds are capable of understanding and assisting in their physical examination. In fact, school-age clients are usually quite interested in equipment and how it works. 10-year-olds are becoming modest and do not want a parent, especially of the opposite sex, in the room with them during a physical examination

pertussis

DROPLET AIRWAY PERTUSSIS Pertussis can occur despite vaccination. Characteristic features include a cough lasting ≥2 weeks with ≥1 of the following: paroxysms of cough, inspiratory whooping sound, and posttussive vomiting. Clients need oral antibiotics, droplet precautions, and supportive measures (humidified oxygen and oral fluids).

pinworm

During the night, the female pinworm lays thousands of microscopic eggs in the skinfolds around the anus, resulting in anal itching and troubled sleep. When the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces. Pinworm infection is treated with anti-parasitic medications.

type 1 diabetes mellitus PRIORITY!

FIRST! If a client with diabetes has symptoms of hypoglycemia (eg, sweating, irritability, tremor, tachycardia, hunger), the nurse should immediately assess the client, check capillary blood glucose, and provide a simple carbohydrate snack that can be digested rapidly (eg, juice, soft drink, candy) (blood glucose <70 mg/dL [3.9 mmol/L]) presents an immediate danger to the client as life-threatening neurologic impairment (eg, lethargy, seizures, coma) can occur when the brain becomes glucose depleted.

lead poisoning

FOLLOW-UP BLOOD WORK COLD WATER WET MOP Clients with elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) require follow-up blood work to ensure that levels decrease. Chelation therapy may be required if levels remain elevated. The priority intervention for clients with elevated BLLs is preventing continued exposure. The home environment should be assessed for lead sources (Option 1). Pediatric and pregnant clients should not live in homes being renovated until the work is complete. Handwashing, especially before eating, is important to remove lead residue. Hard surfaces should be wet-dusted or mopped at least weekly. cold water should be used for consumption if lead plumbing is present. Taps should be flushed for several minutes to clear out contaminated water before use.

strict vegan diet

FORTIFIED BREADS & CEREALS VIT. C WITH IRON CALCIUM & VIT. D SUPPLEMENT risk for dietary deficiencies (eg, iron, protein, calories, vitamin B12, calcium, vitamin D) Iron: Plant sources of iron, which are in smaller quantities and difficult to absorb, should be supplemented with fortified cereals and breads to decrease risk of iron-deficient anemia Vitamin C: Iron absorption is improved when dietary sources of iron and vitamin C are taken together Calcium: Without animal sources of calcium (eg, dairy, eggs, fish), vegan diets require supplementation of calcium and vitamin D for bone health. The nurse should educate the parents on the need for multivitamins or fortified grains as quality vitamin B12 sources.

Bacterial conjunctivitis (pink eye)

Frequent and proper hand washing is necessary to prevent the spread of bacterial conjunctivitis to the other eye or to other individuals. Tissues used to wipe eye medication should be discarded, towels and washcloths should be kept separate, and the child should be discouraged from rubbing the affected eye.

Sweating, trembling, and pale. The client has type 1 diabetes managed with insulin glargine and NPH. What is the most appropriate

GIVE SOFTDRINK Hypoglycemia treatment in a conscious client is administration of 15 g of a quick-acting carbohydrate (Option 4). After treatment, the nurse should recheck BG every 15 minutes, repeating treatment if it remains low. Quick-acting carbohydrate options include: 4 oz (120 mL) of a regular soft drink or fruit juice 8 oz (240 mL) of low-fat milk 1 tablespoon (15 mL) of honey or syrup 6 hard candies Commercial dextrose products Clients experiencing hypoglycemia may develop shakiness, palpitations, sweating, pallor, and altered mental status (eg, difficulty speaking, confusion). If manifestations of hypoglycemia are present, the nurse should check the client's blood glucose (BG) level immediately. A BG of <70 mg/dL (3.9 mmol/L) requires treatment; however, if glucose testing is not readily available, the client should be treated based on symptoms.

pyloric stenosis

HEMATOCRIT & BUN ARE HIGH projectile vomiting, which leads to dehydration and hypokalemic metabolic alkalosis. Dehydration is manifested by hemoconcentration (elevated hematocrit) and elevated blood urea nitrogen. An olive-shaped mass may be palpated in the epigastric area just to the right of the umbilicus. Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. Infants will be hungry constantly despite regular feedings. A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration

parent stated, "Our lives will never be the same." Which statement made by the parent indicates that nursing interventions and education have been effective

In providing diabetes education, the nurse should emphasize that with planning and preparation, diabetes can be managed and controlled and the child can resume regular day-to-day activities and have an independent life. Parents' emotional response, adaptation, and coping strategies impact the child's perception of self and ability to manage the disease.

most at risk for anemia

Infants born at preterm gestation have lower iron stores at birth and are at an increased risk for iron-deficiency anemia. Iron supplementation (eg, oral iron drops, iron-fortified formula) is usually needed by preterm infants at an earlier age (2-3 months).

intussusception

Initially, some infants may have only general symptoms (eg, irritability, diarrhea, lethargy). Subsequently, episodes of sudden abdominal pain (cramping), drawing the knees up to the chest, and inconsolable crying are seen. After an episode, the infant may vomit and then appear otherwise normal. Assessment may show a sausage-shaped abdominal mass. is an intestinal obstruction that occurs when a segment of the bowel folds (ie, telescopes) into another segment. Pressure gradually increases within the bowel, causing ischemia and leakage of blood and mucus into the lumen, which produces the characteristic stool mixed with blood and mucus (ie, red, "currant jelly")

infant's diet. Which statement by the parents is most concerning?

Iron-fortified infant cereals (eg, oatmeal) mixed with formula or breastmilk are appropriate for infants >6 months; however, honey (especially raw or wild) is not recommended for infants age <12 months due to the risk of botulism. Clostridium botulinum spores in honey or soil can colonize an infant's immature gastrointestinal system and release a toxin that causes botulism, a rare but serious illness. The toxin attacks the neuromuscular system, causing progressive muscle paralysis that can potentially lead to respiratory failure and death. Initial manifestations may include constipation, generalized weakness, difficulty feeding, and decreased gag reflex.

measles

MEASLES SHOT FOR FAMILY MEMBER NEGATIVE AIR PRESSURE N-95 Administration of vitamin A supplements to prevent severe, measles-induced vitamin A deficiency, which can cause blindness, particularly in clients in low-resource areas rubeola) is a highly contagious viral illness that affects people of all ages. Measles spreads when infected individuals cough or sneeze, sending the virus through the air, where it remains suspended for up to 2 hours. Widespread vaccination with the measles, mumps, and rubella (MMR) vaccine, such as in the United States, has reduced measles incidence by 99%. However, an increase in international travel and unvaccinated children have caused a resurgence of the disease.

fever, somnolence, and a skin rash from suspected meningococcal meningitis.

NO - AIR PRESSURE NEEDED(NOT NEEDED) Nursing care for a client with suspected meningococcal meningitis includes elevating the head of the bed at 30 degrees, implementing seizure precautions, and minimizing environmental stimuli. The nurse should implement droplet precautions that require the nurse (not the client) to wear a mask when caring for the client. The client wears the mask only if transported outside the room

(UTI) how to avoid repeat infections

NO BUBBLE BATHS DON'T HOLD URINE WIPE FROM FRONT TO BACK Urinary stasis, constipation, and infrequent voiding are contributing factors to UTIs. The child should be encouraged to drink fluids and avoid holding in urine. Tight clothing and synthetic fabrics (eg, spandex, nylon, Lycra) should be avoided; cotton underwear is recommended. Scented soaps, bubble baths, and antibacterial soaps should not be used for bathing a child (the tub should be filled with water only), and the hair should be washed last.

nephrotic syndrome

Nephrotic syndrome is characterized by massive proteinuria, edema, and hypoalbuminemia. Home management includes a low-sodium diet with attractive foods; infection prevention; fluid restriction for severe edema; and monitoring of weight gain and proteinuria to detect relapse. The loss of immunoglobulins causes increased susceptibility to infection. Caregivers should minimize the risk of infection during relapses (eg, limiting visitors)

fifth disease

Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition. are communicable only prior to onset of symptoms (eg, rash, joint pains). The causative agent, human parvovirus, spreads via respiratory secretions. Fifth disease is self-limiting and short-lived; treatment is given to alleviate symptoms. Isolation is not usually required for a non-hospitalized child.

Escherichia coli.

PETECHIAE- concerning most Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury. Hemolysis results in anemia, and low platelets manifest as petechiae or purpura. Therefore, the presence of petechiae in this client could indicate underlying HUS and needs further assessment.

Hypospadias

Postoperatively, the client will have a catheter or stent to maintain patency while the new meatus heals. Urinary output is an important indication of urethral patency. Fluids are encouraged, and the hourly output is documented. Absence of urinary output for over an hour indicates that a kink or obstruction may have occurred and requires immediate follow-up. is a congenital defect in which the urethral opening is on the underside of the penis. Except in very mild cases, the condition is typically corrected around age 6-12 months by surgically redirecting the urethra to the penis tip. Circumcision is delayed so the foreskin can be used to reconstruct the urethra. If not corrected, clients may have toilet-training difficulties, more frequent urinary tract infections, and inability to achieve erections later in life.

group A streptococcal pharyngitis

REPLACE TOOTHBRUSH CLEAR LIQUIDS AND SOFT DIET Pharyngitis caused by group A β-hemolytic Streptococcus is a bacterial throat infection that can cause renal or cardiac complications if not treated. It is important to discard the child's toothbrush 24 hours after starting antibiotics, test siblings age <3 years, and complete the full course of prescribed antibiotics. caused by group A β-hemolytic Streptococcus is a contagious bacterial throat infection that can lead to renal (glomerulonephritis) or cardiac complications (rheumatic fever) if not treated.

temporary colostomy for Hirschsprung's disease.

REPORT GRAY TINGED!! In Hirschsprung's disease, a portion of the colon has no innervation and must be removed. Some children require a temporary colostomy. The stoma created from the surgery should remain beefy red in the immediate postoperative period. Any paleness or graying of the stoma indicates decreased blood supply to that area.

child has been crying and vomiting with a distended belly for the past 4 hours. The infant is now lying quietly in the parent's arms with a pulse of 200/min and respirations of 60/min. Which of the following components of SBAR (situation, background, assessment, recommendation/read-back) communication is most important

REPORT VS-B/P, LOC-LETHARGY In this situation, the client's presentation indicates worsening symptoms that require immediate intervention. The client's lethargy represents a declining level of consciousness. The client also has significantly abnormal vital signs (normal infant pulse rate is 110-160/min, respirations generally around 40/min). These are ominous signs that should be reported immediately. Use of SBAR ensures that the HCP receives the necessary information to make a clinical judgment regarding treatment or need for immediate assessment.

HIV-positive children

Routine immunization is particularly beneficial to children who are HIV-positive as they are more susceptible to preventable diseases due to a compromised immune system. The standard vaccine schedule for a 12-month-old includes Hib, PCV (PVC13), MMR, varicella, and Hep A. HIV-positive children who are asymptomatic and not extremely immunocompromised can receive the appropriate age-specific immunizations as recommended. However, live vaccine preparations (eg, MMR, varicella) are contraindicated in the presence of marked immunosuppression, as determined by CD4 lymphocyte percentages and/or counts (Options 3 and 5). An individual with a CD4 lymphocyte percentage <15% is considered to be severely immunocompromised. Low CD4 lymphocyte counts vary slightly by age due to the normal occurrence of elevated CD4 counts during infancy and early childhood. Low CD4 counts are defined as <750/mm3 for infants 12 months or younger, <500/mm3 for children between age 1-5 years, and <200/mm3 for children age >5 years and adults.

Hirschsprung disease

STAT! DIARRHEA;FOUL SMELLING& FEVER Enterocolitis, a potentially fatal complication of Hirschsprung disease, is characterized by explosive, foul-smelling diarrhea; fever; and worsening abdominal distension. They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. A potentially fatal complication is Hirschsprung enterocolitis, an inflammation of the colon, which can lead to sepsis and death. Enterocolitis will present with fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension.

cyanotic newborn with excessive frothy mucus in the mouth. What should be the nurse's first action?

SUCTION FIRSTTT!!! The initial nursing action for a client experiencing cyanosis and excess oral secretions is suctioning the mouth (ie, oropharynx) to clear the airway (Option 4). Excessive frothy mucus and cyanosis in a newborn could be due to esophageal atresia (EA) and tracheoesophageal fistula (TEF). If EA/TEF is suspected, the infant should be kept supine with the head elevated at least 30 degrees to prevent aspiration. A nasogastric tube should be inserted and connected to continuous or intermittent suction until surgical repair.

rotavirus infection

Symptoms include foul-smelling, watery diarrhea that lasts 5-7 days and is often accompanied by fever and vomiting. Vaccination is available and must be given before the child is 8 months old. However, vaccinated children can still acquire Rotavirus as many strains are not covered by the vaccine. Antibiotics are not effective against this viral agent. Because the virus can easily lead to dehydration, parents should be taught the symptoms (eg, lack of tears when crying, extremely fussy or sleepy, decreased urination, dry mucous membranes). Oral rehydration solutions should be used to combat dehydration is a contagious virus and the leading cause of diarrhea in children less than 5 years old; it is also the cause of many nosocomial infections each year. Rotavirus is spread via the fecal-oral route. Because the virus lives easily outside a human host, transmission can occur through contact with food, toys, diapers, and hands. Meticulous handwashing and proper diaper disposal prevent the spread of the virus

infant formula preparation

THROW AWAY AFTER 2 DAYS WASH THE TOP CANS BEFORE OPENING Infant formula should never be overdiluted, overconcentrated, or microwaved. Unused, prepared formula should be stored in the refrigerator and, if unused, discarded after 48 hours. Formula left over in a bottle after feeding should be discarded.

glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?

The most accurate indicator of fluid loss or gain in an acutely ill client is daily weight A 2.2-lb (1-kg) weight gain is equal to 1,000 mL of retained fluid.

feeding and eating practices with the mother of a 1-year-old

The practice of using a bottle with milk to calm a child at bedtime should be discouraged. A child who falls asleep drinking a fluid high in carbohydrates will likely develop extensive dental caries, a condition known as baby bottle tooth decay.

type 1 diabetes mellitus. What is the priority outcome

The priority for caregivers should be to focus on the child's safety. Managing the child's blood sugars should be the initial goal. Management of type 1 diabetes mellitus requires understanding of blood sugar regulation. If the child becomes hypoglycemic or hyperglycemic, complications could develop. Initial teaching of the parents of a child with newly diagnosed type 1 diabetes should focus on basic safety and survival skills, including proper insulin administration and adequate monitoring of blood sugars. Information should be introduced slowly, repeated often, and given based on the child's developmental age.

sore throat and has a bright red, pruritic rash on the chest that feels like fine bumps and looks like a sunburn

The rash begins on the neck and chest and spreads to the extremities, resembles a bad sunburn, blanches with pressure, and has fine bumps like sandpaper. Additional manifestations of streptococcal pharyngitis (eg, exudative pharyngitis, fever, swollen anterior cervical lymph nodes) are typically present. Because the clinical presentation (ie, rash plus sore throat) is characteristic, but not diagnostic, of scarlet fever, the health care provider will prescribe a rapid streptococcal antigen test to confirm symptom etiology (Option 3). Swabbing the posterior pharynx and tonsils provides test results within minutes. Throat culture may be necessary to verify results. Scarlet fever (ie, scarlatina), a complication of group A streptococcal infection (eg, streptococcal pharyngitis), is common in early childhood and is characterized by a distinctive red rash.

iron deficiency anemia

There are many risk factors for iron deficiency, including insufficient dietary intake, premature birth, delayed introduction of solid food, and consumption of cow's milk before age 1 year. One common cause in toddlers is excessive milk intake, over 24 oz/day. In addition to becoming overweight, toddlers who consume too much milk develop iron deficiency due to the likely exclusion of iron-rich foods in favor of milk, a poor source of available iron. Treatment of iron deficiency anemia includes oral iron supplementation and increased consumption of iron-rich foods (eg, leafy green vegetables, red meats, poultry, dried fruit, fortified cereal). It is also important to limit milk intake (16-24 oz/day) in toddlers to ensure a balanced diet.

sore throat is diagnosed with infectious mononucleosis

Treatment for mononucleosis is largely symptomatic. It includes rest, hydration, pain control for sore throat, and fever reduction. Clients should avoid contact sports such as soccer to prevent injury to the spleen or liver. Breathing difficulty or abdominal pain should be reported to the HCP. Ibuprofen or acetaminophen is appropriate treatment to control pain and manage fever in the child with mononucleosis. Aspirin should be avoided in children due to the risk of Reye syndrome. Contact sports such as soccer should be avoided to prevent injury to the spleen or liver.

Need immediate action- tonsillitis

Trismus (inability to open the mouth due to a tonic contraction of the muscles used for chewing) may indicate a more serious complication of tonsillitis, a peritonsillar or retropharyngeal abscess (collection of pus). Other features include a "hot potato" or muffled voice, pooling of saliva, and deviation of the uvula to one side. This abscess can occlude the airway, making it a medical emergency. Surgical intervention (tonsillectomy or incision and drainage) is often required. In the meantime, maintaining an adequate airway is essential.

BEST SNACK nutrition and feeding practices for young children

When choosing foods for a toddler (age 1-3 years), parents should consider the following factors: Safety: Small, hard, sticky, or slippery foods (eg, hot dogs, whole grapes, nuts, raw carrot sticks, popcorn, peanut butter, hard candy, fruit snacks) pose a choking risk and should not be offered. Nutrient density: Foods should contain valuable nutrients (eg, protein, vitamins) rather than just "empty calories" (eg, sugars). Potential for foodborne illness: Children are at a higher risk for developing food-related infections, especially if given raw, unpasteurized foods (eg, partially cooked eggs, raw fish, raw bean sprouts). Healthy snacks for a toddler include pieces of cheese, whole-wheat crackers, banana slices, yogurt, cooked vegetables, and cottage cheese with thinly sliced fruit

Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority

Wilms tumor is usually diagnosed after caregivers observe an unusual contour in the child's abdomen. Once the diagnosis is suspected or confirmed, the abdomen should not be palpated, as this can disrupt the encapsulated tumor. It is important to post the sign "DO NOT PALPATE ABDOMEN" at the bedside. It is also essential that the child be handled carefully during bathing. (nephroblastoma) is a kidney tumor that usually occurs in children age <5. Most often it involves only one kidney, and the prognosis is good if the tumor has not metastasized.

Intussusception

a palpable sausage-shaped abdominal mass; "currant jelly" stools; inconsolable crying with the knees drawn up to the chest; and bilious, nonprojectile vomiting. An olive-shaped mass is characteristic of pyloric stenosis. Projectile vomiting is frequently associated with pyloric stenosis or increased intracranial pressure.

Pyloric stenosis

hypertrophy of the pyloric sphincter that eventually causes complete obstruction. Classic signs include projectile nonbilious vomiting, an olive-shaped right upper quadrant mass, weight loss, dehydration, and/or electrolyte imbalance (metabolic alkalosis). The amount of milk consumed (particularly with bottle feedings) along with the mother's technique (mainly adequate burping) should be assessed to ensure there is no excessive air swallowing or overfeeding as an etiology. Pyloric stenosis presents with postprandial projectile vomiting (ejected up to 3 feet) followed by hunger (eg, "hungry vomiter"). This is clearly distinguished from the "wet burps" infants have due to a weak lower esophageal sphincter. The emesis is nonbilious as the obstruction is proximal to the bile duct. Infants have poor weight gain and are often dehydrated (eg, sunken fontanelle, decreased skin turgor, delayed capillary refill).

irritability, facial edema, a 1-day history of diarrhea with adequate oral intake, and seizure activity.

hyponatremia secondary to water intoxication, which can present with neurological symptoms (eg, lethargy, irritability, seizures). Breast milk and/or formula provide sufficient hydration for the first 6 months of life. Formula should not be diluted to save money. Hyponatremia may also result from ingestion of plain water (eg, caregiver attempting to rehydrate an infant who has been ill).

ringworm

is a fungal infection that spreads via contact with infected skin, shared surfaces, and personal items (eg, hair brushes). It is treated with antifungal shampoos, creams, and oral medications. Infection spread can be limited by practicing frequent hand hygiene, cleaning shared surfaces, and refraining from sharing personal items. /or oral medications (eg, terbinafine [Lamisil], miconazole).

parent expresses concern about the small amount of food the child consumes. What is the nurse's priority

is a normal period of decreased appetite that occurs in toddlers around age 18 months as a result of decreased metabolic needs. Parents should be taught to provide multiple food options, set a schedule for meals/snacks, and avoid watching TV or playing games during meal time; toddlers should not be forced to eat. Set and enforce a schedule for all meals and snacks Offer the child 2 or 3 choices of food items Do not force the child to eat Keep food portions small Expose the child repeatedly to new foods on several separate occasions Avoid TV and games during meals or snacks

Infant botulism

is food poisoning causing life-threatening paralysis, which occurs after consuming Clostridium botulinum. Infants (age <1 year) with signs of botulism (eg, constipation, difficulty feeding, decreased head control, diminished deep-tendon reflexes) require prompt intervention because respiratory failure may develop rapidly. ften includes administering intravenous botulism immune globulin (BIG-IV), which reduces severity and duration of symptoms by improving immune response. In addition, close monitoring and supportive care (eg, mechanical ventilation, enteral tube feedings) are provided.

saline enema for treatment of intussusception

monitor for passage of normal brown stool, indicating reduction of intussusception. If this occurs, the HCP should be notified immediately to modify the plan of care and stop all plans for surgery.

cleft palate repair

nurse should position the client supine with elevated head of bed, implement pain reduction measures, and remove elbow restraints per facility policy for skin and neurovascular assessment. To prevent damage to the surgical site, hard objects should not be placed into the mouth.

Reye syndrome

often have had a recent viral infection, especially varicella (chicken pox) or influenza. Clinical manifestations include fever, lethargy, acute encephalopathy, and altered hepatic function. Elevated serum ammonia levels are an expected laboratory finding. Acute encephalopathy manifests with vomiting and a severely altered level of consciousness; it can rapidly progress to seizures and/or coma. The risk of developing Reye syndrome increases if aspirin therapy is used to treat the fever associated with varicella or influenza. As a result of this awareness, there has been a significant increase in the use of acetaminophen or ibuprofen for fever management in children.

6-year-old child with cystic fibrosis (CF)

should be swallowed whole or sprinkled on an acidic food; and should not be crushed or chewed. They should not be taken with milk. Excessive intake could result in fibrosing colonopathy. pancreatic enzyme supplements with or just before every meal or snack (Option 2). These enzymes are enteric-coated beads designed to dissolve only in an alkaline environment similar to that of the small intestine. They must not be mixed with a substance that would cause them to dissolve prior to reaching the jejunum. Capsule contents may be sprinkled on applesauce, yogurt, or acidic, soft, room-temperature foods with pH <4.5.

acute diarrhea

the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods). oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea.

suspected esophageal atresia (EA) and tracheoesophageal fistula (TEF)

to prevent aspiration in infants with EA/TEF include maintaining NPO status, positioning the child supine with the head elevated at least 30 degrees, and keeping suction equipment available by the bed. In the most common form of EA/TEF, the upper esophagus ends in a blind pouch and the lower esophagus connects to the primary bronchus or the trachea through a small fistula. EA/TEF can usually be corrected surgically. Clinical manifestations include frothy saliva, choking, coughing, and drooling. Clients may also develop apnea and cyanosis when feeding

acute myelogenous leukemia who was admitted with varicella-zoster virus. The client has multiple lesions that have not crusted. Which of the following instructions should the nurse include?

treatment is supportive in nature and includes: Cool oatmeal baths and topical antihistamines (eg, diphenhydramine) applied to lesions for itching. Acetaminophen as needed for fever or pain Immunocompromised clients (eg, clients with acute myelogenous leukemia [AML]) are at risk for severe varicella (eg, disseminated, pneumonia) and require aggressive therapy, including an antiviral agent (eg, acyclovir). Antiviral therapy should be continued until all the lesions have crusted over (Option 2). VZV is spread via airborne and contact transmission. Clients are most infectious in the days leading up to the rash and continue to be infectious until the entire rash reaches the crusting stage. Varicella-zoster virus (VZV) infection (chickenpox) is characterized by lesions that begin as a maculopapular rash, progress to weeping vesicular lesions, and typically crust over within approximately 1 week. The lesions are often pruritic and/or painful, and clients frequently have an accompanying fever.

pediculosis capitis(KUTO & LIS-A)

(head lice) may be accomplished by using hot water to launder clothing, sheets, and towels in the washing machine; these items should then be placed in a hot dryer for 20 minutes. Treatment of head lice consists of the use of pediculicides and the removal of nits (eggs).

seize during assessment for a high-grade fever. What is the most appropriate

02 SAT, STAY This client likely has febrile seizures. It is important to never leave seizing clients alone as the goal is to prevent them from causing self-injury. The nurse should call out for help if needed. The main objective is to ensure that seizing clients maintain their airway; therefore, it is important to monitor their oxygen saturation levels. If these levels begin to drop or cyanosis occurs, prompt intervention is needed, which may be as simple as a head tilt or jaw thrust.

infant with phenylketonuria

A low-phenylalanine diet is essential in the treatment of PKU (Option 1). Phenylalanine cannot be entirely eliminated from the diet as it is an essential amino acid and necessary for normal development. The diet must meet nutritional needs while maintaining phenylalanine levels within a safe range (2-6 mg/dL [120-360 µmol/L] for clients age <12). There is no known age at which the diet can be discontinued safely, and lifetime dietary restrictions are recommended for optimal health Management of the client with PKU includes: Monitoring serum levels of phenylalanine Including synthetic proteins and special formulas (eg, Lofenalac, Phenyl-Free) in the diet Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet. Encouraging the consumption of natural foods low in phenylalanine (most fruits and vegetables)

intussusception. Which assessment findings require priority

ABD. RIGIDITY WITH GUARDING. Peritonitis is characterized by fever, abdominal rigidity, guarding, and rebound tenderness. This condition can be fatal if it is not treated quickly.

The client's stool has a red, currant jelly appearance. abruptly started crying and grabbing intermittently at the abdomen.

AIR PNEUMATIC ENEMA GIVEN A contrast enema is used for diagnostic purposes and often reduces the intussusceptions. An air enema is considered safer than a barium enema. Intussusception is a process in which one part of the intestine prolapses and then telescopes into another part. It is one of the most frequent causes of intestinal obstruction during infancy. Initially, the telescoping is intermittent, resulting in periodic pain in association with the legs drawn up toward the abdomen. Pain is severe, progressive, and associated with inconsolable crying. Ongoing obstruction can compromise circulation, causing mucosal ischemia, occult bleeding, and, if untreated, grossly bloody "currant jelly" stools (mixture of blood and mucus).

scabies

ALL CLOSE CONTACTS NEED TREATMENT Treatment for scabies typically involves 1 or 2 applications of a scabicide cream (eg, 5% permethrin). For infants and children, permethrin should be massaged into all skin surfaces from the head to the feet, avoiding contact with the eyes. Even after effective treatment, itching often continues for several weeks. All persons in close contact with the client during the lengthy 30- to 60-day incubation period (time from infestation to symptom onset) should also seek treatment To prevent reinfection, clothing and linens should be washed and dried on the hottest settings Scabies is a highly contagious skin infestation of the Sarcoptes scabiei mite. Scabies spreads easily via direct person-to-person contact (eg, skilled nursing facility, day care, prison). The pregnant female mite burrows into the outer skin layer to lay eggs and feces, leaving a superficial burrow track. Intense itching, especially at night, occurs due to the body's inflammatory response to the mite's eggs and feces.

esophageal atresia with tracheoesophageal fistula

APNEA & CYANOSIS Clinical manifestations of EA/TEF include frothy saliva, coughing, choking, drooling, and a distended abdomen. Clients may also develop apnea and cyanosis while feeding. These findings must be reported to the health care provider for further evaluation.

results to most clearly reflect which physiologic process related to nephrotic syndrome

Additional symptoms include decreased urine output, fatigue, pallor, and weight gain. Massive proteinuria - caused by increased glomerular permeability Hypoalbuminemia - resulting from excess protein loss in the urine Edema - specifically periorbital and peripheral edema and ascites; caused by low serum protein and albumin as fluid is pulled into interstitial spaces and body cavities Hyperlipidemia - related to increased compensatory protein and lipid production by the liver

6-month-old about introducing solid foods into the infant's diet

After starting with iron-fortified cereal (mixed with formula, breast milk, or water), parents can begin offering soft fruits and vegetables and simple finger foods. Infants can begin eating solid foods at age 4-6 months. Parents should introduce each new food separately and wait several (eg, 4-7) days between each one to identify any food allergies.

celiac disease

All gluten-containing products should be eliminated from the diet. These include wheat, barley, rye, and oats. Rice, corn, and potatoes are gluten free and are allowed on the diet. Deficient vitamins (mainly fat-soluble vitamins), iron, and folic acid should be replaced. Processed foods (eg, chocolate candy, hot dogs) may contain "hidden" sources of gluten such as modified food starch, malt, and soy sauce. Food labels should indicate that the product is gluten free. Clients will need to be on a gluten-free diet for the rest of their lives. Eliminating gluten from the diet reduces the risk of nutritional deficiencies and intestinal cancer (lymphoma). Eating even small amounts of gluten will damage the intestinal villi although the client may have no clinical symptoms. All sources of gluten must be eliminated from the diet

11 MONTHS measles 2 days ago during a family trip to a theme park. What is the best response

BRING BABY FOR MMR VACCINE recommends that the first dose of MMR vaccine be given to children between age 12-15 months to ensure optimal vaccine response. However, the vaccine is safe for children age <12 months; it could provide some protection or modify the clinical course of the disease if administered within 72 hours of the child's initial measles exposure. Immunoglobulin, if administered within 6 days of exposure, is also utilized as post-exposure prophylaxis. A child who receives the MMR vaccine prior to the first birthday will need to be revaccinated at age 12-15 months and again between age 4-6 years.

A reward system is one of the behavioral strategies used in the treatment of functional incontinence (due to constipation).

Behavioral interventions include the following: Regularly schedule toilet sitting times 5-10 minutes after meals for 10-15 minutes (Option 4) Provide a quiet activity for the child during toilet sitting, which will help pass the time and make the experience more "enjoyable" Initiate a reward system to boost the child's participation in the treatment program; the reward would be given for effort, not for success of evacuation in the toilet (children with retentive encopresis have dysfunctional anal sphincters and little control over bowel movements; giving a reward for something the child has no control over would not be effective) (Option 2) Keep a diary or log of toilet sitting times, stooling, medications, and episodes of soiling to evaluate the success of the treatment

cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources

CALCIUM AND VIT.D -GET FROM OTHER RESOURCES To obtain the recommended 500 mg of daily calcium (for ages 1-3 years), the parents should serve foods such as beans, dark green vegetables, and calcium-fortified cereals and juices. Vitamin D, which enhances the absorption of calcium, is synthesized in the skin by exposure to direct sunlight. Alternate dietary sources include fish oils, egg yolks, and vitamin D-fortified foods (eg, orange juice).

Acute glomerulonephritis (AGN)

CHECK B/P- HYPERTENSION severe hypertension is an anticipated complication that must be identified early. Monitoring and control of blood pressure are most important as they prevent further progression of kidney injury and development of hypertensive encephalopathy or pulmonary edema. immune complex disease most commonly induced by prior group A beta-hemolytic streptococcal infection of the skin or throat. A latent period of 2-3 weeks occurs between the streptococcal infection (eg, pharyngitis) and the symptoms of AGN. Clinical manifestations include periorbital and facial/generalized edema, hypertension, and oliguria, which are primarily due to fluid retention (decreased kidney filtration). The urine is tea-colored and cloudy due to the presence of protein and blood.

prevention of dental caries

CHEW SUGAR FREE GUM NO SUGARY/CARB BEVERAGES MIN. SWEET/STICKY FOODS Brushing after meals Flossing at least twice a day Rinsing the mouth with water after meals or snacks (Option 5) Drinking tap water rather than bottled water (most tap water sources add fluoride to promote dental health, whereas most bottled water does not contain fluoride) Finishing meals with a high-protein food Cariogenic foods increase the risk for cavities and should be avoided. These include refined, simple sugars; sweet, sticky foods such as dried fruit (eg, raisins) and candy; and sugary beverages (eg, colas and other carbonated beverages, fruit drinks/juices)

rash and mild fever after receiving a routine measles, mumps, rubella, and varicella (MMRV) vaccine in the pediatric clinic 5 days ago.

CHILD'S TEMP? Although rare, fever after MMRV vaccination can lead to febrile seizures. Therefore, it is important for the nurse to determine the child's temperature to evaluate the risk for a febrile convulsion. It would also be important for the nurse to instruct the parent to monitor the child's temperature and administer acetaminophen for a fever above 102 F (38.9 C). Children with a history of seizures should be vaccinated with separate MMR and varicella vaccines instead of the combination MMRV vaccine.

Celiac disease (celiac sprue)

Celiac disease is an autoimmune disorder in which an individual cannot tolerate gluten, a protein found in barley, rye, oats, and wheat (BROW). Rice, corn, and potatoes are allowed in the diet and can be used as grain substitutes. Affected individuals must adhere to a gluten-free diet for life.