Final (34-66)

The plan of care for a child with osteomyelitis should include strategies for:

(Lecture) -IV antibiotics until CRP normal, then PO -Bedrest, immobilization -Surgical incision and drainage -Long term: May need home IV antibiotics

You explain to his parents that the occurence of osteomyelitis in children is usually related to:

(Lecture) Etiology -Most often metaphysis of long bones -Staph Aureus in children -Group B strep in neonates -Bacteria that is circulating in the blood get lodged in the capillary bed and starts the bone infection

Which of the following is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle?

(Quizlet) o Increases the pain threshold. o Increases metabolism in the tissues. o Produces a deep tissue vasodilation. o *Reduces edema formation.* This should have no effect on the pain threshold. This should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated. Elevating the extremity uses gravity to facilitate venous return to reduce edema.

Which of the following is an important consideration in preventing injuries during middle childhood?

(Quizlet) Most injuries occur in or near school or home.

Because Paul has a low platelet count, which of these measures should be included in his care?

*Bleeding precautions*, soft tooth brush, vitals, clutter free zone,

If helping Dena's new parents to adapt to their new family situation, the best advice professionals could offer would be to:

*Consistency and boundaries*

Discipline based on love of the child should be carried out with conviction and confidence. Probably the most important aspect of a healthy parent child relationship is:

*Consistency in discipline* is considered the most important aspect of a healthy parent-child relationship (Lecture)

The laboratory report indicated that Paul has a very low platelet count, a low RBC, and a large number of immature white blood cells. Because of the large number of immature WBC, the nurse must include which of these measures in planning his care?

*Neutropenic precautions*

If a nurse encounters a child abuse situation, she could be sued for damages and lose if:

*She does not report it!* -A misdemeanor with 6 to 12 months incarceration -A fine of 1,000 to 5,000 dollars -Both incarceration and a fine -May be liable for damages if further harm occurs -May loose nursing license or risk disciplinary actions from the California State Board of Nursing

All of the following are important prognostic factors of *ALL* except:

- WBC at diagnosis: *<50K is better* - Age at diagnosis: *2-10 years* is best - *Early response to therapy*: Rapid response is best - Cytogenetic features - Immunologic Subtype: *early B cell* have better outcomes - Gender (*Female* > Male) (Lecture)

Which statement is true regarding Hodgkin's disease?

-Hodgkin disease affects about 29 in 1 million children, mostly adolescents. -The malignancy *originates in the lymphoid system and primarily involves the lymph nodes* -It predictably *metastasizes to nonnodal or extra lymphatic sites, especially the spleen, liver, bone marrow, lungs, and mediastinum* although no tissue is exempt from involvement (Fig. 31-4). -It is classified according to four histologic types: (1) lymphocytic predominance, (2) nodular sclerosis, (3) mixed cellularity, and (4) lymphocytic depletion. -With present treatment protocols the histologic stage of the disease has less prognostic significance.

Immediate postoperative care of the child who has undergone surgical resection of a brain tumor includes:

-Observe/evaluate *fine & gross motor movements* -*Evaluate LOC/check pupillary* response -Listen to family members assessment -*↑head of bed* -*Quiet* environment -Limited/gentle movements -Assess pain needs

Situation for 47-50, Paul Jackson, 4 years old, is admitted to the pediatric unit with symptoms of acute leukemia. Early symptoms of acute leukemia in children generally include:

-The onset of leukemia varies from acute to insidious. In most instances the child displays *remarkably few symptoms*. For example, leukemia may be diagnosed when a minor infection, such as a cold, fails to completely disappear. -The child continues to be *pale, listless, irritable, febrile, and anorexic*. Parents often suspect some underlying problem when they observe the *weight loss, petechiae, bruising without cause, and continued complaints of bone and joint pain.*

Debbie, age 7, has fractured her elbow and a long arm cast is applied. The nurse performs a neurovascular assessment of Debbie's affected hand. Which sign indicates a potential problem.

5 Ps (pain, *pallor*, paralysis, *pulses*, parasthesias)

To be most effective discipline do all except:

??? you DO want to listen, be honest, give positive attention, set limits, disapprove behavior not child

Parents who would punish Dena rather than explain or give positive examples would be using which style parenting?

Authoritarian

Dena needs set standards and established limits appropriate to her actual abilities. The most effective style of parenting in parents who would adopt her would be:

Authoritative

The most important nursing measure in caring for a child in a cast is:

Book: When a child or adolescent first faces the prospect of a prolonged period in a brace, jacket, or other device, the therapy program and the nature of the device must be explained thoroughly to both the child and the parents so that they will understand the anticipated results, how the appliance corrects the defect, the freedoms and constraints imposed by the device, and what they can do to help achieve the desired goal -*peripheral pulses*? (Lecture)

ALL is confirmed by which of the following procedures:

CBC - but does not dx type of Leukemia ↓ *Bone marrow aspiration and biopsy*: - Morphology - Cytochemistry - Immunophenotyping - Cytogenetics (Lecture)

Fourteen-year-old Kathy has a difficult time buying clothes. They never fit well and one hip seems to be higher than the other. it was discovered that she has scoliosis. The most important aspect of this deformity is that:

Complex spinal deformity in three planes: (1) Lateral curvature (2) Spinal rotation causing rib asymmetry (3) Thoracic hypokyphosis

Tommy is a 3 year old who presents refusing to move his right hip, extreme irritability, and a fever of 103 degrees rectally. His diagnosis is R/O osteomyelitis. As you are admitting him you prepare the parents and Tommy for all but one of the following:

FEVER - Only present in osteomyelitis. DON'T GIVE STEROIDS! (Quizlet) [POSSIBLY] a. Examination of joint fluid -Organism identification and antibiotic susceptibility testing are essential for effective therapy. -Obtain cultures of aspirated subperiosteal pus along with cultures of blood, joint fluid, and infected skin samples. -Bone biopsy may be indicated if blood culture results and radiographic findings are not consistent with osteomyelitis. -Supporting evidence for osteomyelitis includes leukocytosis, elevated erythrocyte sedimentation rate, and elevated C-reactive protein.

Research has demonstrated that school-age children who skip breakfast:

Lower levels of *folate, calcium, iron and iodine* if skipped breakfast (Lecture Childhood Nutrition)

The parenting process is often very difficult during the first year because:

Parenting is often very difficult during the first year because of the *infants rapid growth and development* (Lecture)

For 39-42, Dena is the 8 year old daughter of a single mother who has been killed in a car accident. Dena has no other known family. Dena had been left on her own for years because of her mother's working and social life. The social worker assigned to Dena's case finds her to be in a need of responsible, caring adult attention. The style of parenting of Dena's mother would be considered:

Permissive

When caring for a child who has a preoperative diagnosis of Wilm's tumor, the nurse should:

Place a sign over the bed that says *"Do Not Palpate the Abdomen"*

A youngster has just returned from surgery in a hip spica cast. The priority nursing intervention would be which of the following?

Really good peri-care (Check lecture) (Quizlet) o elevate the head of the bed. o *check circulation.* o turn the child to the right side. o offer sips of water Elevating the head of the bed might help with comfort. The nurse must be observant to the risk of increased swelling in the extremities. The chief concern is that the extremity may continue to swell. This must be assessed to ensure that the cast does not become a tourniquet. The child's position should be changed every 2 hours. This is acceptable, but only after the assessment of the extremities is completed

A child is receiving chemotherapy to induce remission in ALL. The nurse anticipates some degree of neutropenia. Which nursing diagnosis would the nurse put in the management plan?

Risk for *infection* (Discuss)

The three major complications from leukemia and it's treatment are:

The three main consequences are: (1) *anemia* from decreased erythrocytes (2) *infection* from neutropenia (3) *bleeding* from decreased platelet production

The early signs and symptoms of brain tumor in the infant:

a. are similar to those of a young child's b. may be undetectable while the sutures are open c. will be demonstrated as *vomiting after feedings* d. will be demonstrated as *HA and vomiting* For instance, in infants whose sutures are still open, a bulging fontanel indicates hydrocephalus (book)

All of the following statements about combination chemotherapy (use of more than one type of drug) are true except:

with combination therapy: more side effects, hard to know which drug caused which side effect

A distinguishing feature of many abusing parents is:

younger parents, single parents, single parent families with an unrelated partner, socially isolated with few relationships, less than high school education, low income, low self esteem, substance abusers, *victims of abuse themselves*

The nurse is preparing an adolescent girl for an anterior spinal fusion instrumentation to treat scoliosis. Which of the following should the nurse include?

• Team approach to treatment • Bracing • Exercise • Surgical intervention for severe curvature (various systems of instrumentation and fusion) Book: -Preoperative teaching is critical for the adolescent to be able to cooperate and participate in his or her treatment and recovery. -Since the surgery is extensive, the patient is taught how to manage his or her own PCA pump; how to log-roll; and the use and function of other equipment, such as a chest tube (for anterior spinal fusion) and Foley urinary catheter. -It is recommended that the child or adolescent bring a favorite toy (age dependent) or personal items such as a favorite stuffed animal, laptop computer, cell phone (for web surfing, texting, and e-mailing), movie player, MP3 player, or portable compact disc player for postoperative use. -Meeting with a peer and his or her family members who have undergone a similar surgery may also be of value.