module 4 PEDS

Which response by the nurse has the highest priority?

"Have you thought about how you would kill yourself"

According to Erickson, which statement by the client indicates that he is achieving the tasks of his stage of growth and development?

"I really hate it when my mom kisses me in front of my friends"

How should the nurse respond to David if he wants to tell nurse something but only if she promises not to tell anyone

"If I believe it affects your care, I will have to tell someone"

risk factors for impaired glucose regulation

Age Racial and ethnic groups Family history Lifestyle Medical risk factors Selected medications

DMD when symptoms first appear s/s

3-7 when child can walk walddling, wide based gait, uses gowers maneuver to rise from floor

The nurse is assessing an 11-year-old patient receiving conscious sedation to set a fractured leg. Which assessment finding indicates that the patient might need respiratory support? A. Absent gag reflex B. Regular respiratory rate C. Coughing D. Sleeping

A

The nurse, surveying the assisted living facility regarding safety features for patients with sensory deficits, notes that accommodations that are most appropriate are A. Fire and smoke alarms with both sound and flashing lights B. Colorful throw rugs to designate the purpose of various rooms C. Alarms on all exit doors D. Steps painted with dark colors

A

What intervention will the nurse employ to prevent injury to the patient with bone cancer? A. Using a lift sheet when repositioning the patient. B. Positioning the patient so the heels do not touch the mattress. C. Providing small, frequent meals rich in calcium and phosphorus. D. Applying pressure for a full 5 minutes after intramuscular injections.

A

What intervention will the nurse employ to prevent injury to the patient with bone cancer? A. Using a lift sheet when repositioning the patient. B. Positioning the patient so the heels do not touch the mattress. C. Providing small, frequent meals rich in calcium and phosphorus. D. Applying pressure for a full 5 minutes after intramuscular injections.1. A 3-year old child is brought to the emergency department with injuries the father stated occurred when the child fell off of his tricycle. Upon assessment, numerous bruised areas, old and fresh, are noted on the child's back, buttocks, and shoulders. Radiologic examination reveals fractured ribs and a healed fractured humerus. Based on these findings, what should be the nurse's next course of action? a. Report the child as a victim of child abuse immediately. b. Ask the father to provide further details of the incident, obtain a medical history of the child, and then interview the child separately. c. Ask the father if he has been physically abusive to the child. d. Ask the father if he believes the child's mother has been physically abusive to the child.

A

Unless contraindicated, all surgical patients should routinely be given acetaminophen and an NSAID in scheduled doses throughout the postoperative course. Opioid analgesics are added to the treatment plan to manage moderate-to-severe postoperative pain. A local anesthetic is sometimes administered epidurally or by continuous peripheral nerve block.

A Body alignment and thermal management are examples of nonpharmacologic measures to manage pain. They can be used individually or in combination with other nondrug therapies. Proper body alignment achieved through proper positioning can help prevent or relieve pain. Thermal measures such as the application of localized, superficial heat and cooling may relieve pain and provide comfort. PCA, neurostimulation, and peripheral nerve blocks are not totally self-managed or alternative therapies, because they are used under the direction of medical professionals.

Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. At a minimum, pain should be reassessed A. With each new report of pain. B. After administration of a stronger analgesic. C. Every 10 minutes. D. Every 60 minutes.

A Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. At a minimum, pain should be reassessed A. With each new report of pain. B. After administration of a stronger analgesic. C. Every 10 minutes. D. Every 60 minutes.

The ability to receive and interpret stimuli has nursing implications that are a priority in what human need? A. Safety. B. Socialization. C. Nutrition. D. Mobility.

A Safety is the highest priority of the needs listed. Socialization is affected by deficits. Nutrition concerns can be experienced but not at the same level as basic safety concerns. Mobility may lead to safety concerns when one is having decreased sensory input.

Which of the following statements is essential when teaching a patient who has received an injection of iodine-131? A. "Do not share a toilet with anyone else for 3 days." B. "You need to save all your urine for the next 7 days." C. "No special precautions are needed, because this is a weak type of radiation." D. "You need to avoid contact with everyone except family members until the radiation device is removed."

A The radiation source is an unsealed isotope that is eliminated from the body mainly through urine and feces. This material is radioactive for about 48 hours after instillation. The patient should not share a toilet with others for 3 days to ensure the isotope has been completely eliminated and is no longer radioactive

Palliative care can be used to promote which of the following items? (Select all that apply): A. Physical functioning. B. Reduction in disease exacerbations. C. Improved quality of life. D. Discussion on advance directives.Palliative care can be used to promote which of the following items? (Select all that apply): A. Physical functioning. B. Reduction in disease exacerbations. C. Improved quality of life. D. Discussion on advance directives.

A B C D If optimally delivered, palliative care can provide patients with aggressive symptom management while helping to restore and promote physical functioning. Management of symptoms helps to reduce the exacerbations that are common to chronic disease. Palliative care provides an opportunity to engage patients and families with earlier and supportive discussions about advance care planning. Palliative care supports an improved quality of life

What are the most important reasons for considering the use of palliative care in patient care management? (Select all that apply): A. Patients live with multiple chronic diseases several years before dying. B. Patients live with debilitating symptoms that interfere with the quality of life. C. Palliative care is reserved for those patients who are considered terminally ill. D. Palliative care is used to reduce the symptoms associated with chronic disease.

A B D Because of the aging population in the United States, the older patient often lives with multiple diseases for several years before dying. These diseases produce symptoms that interfere with the activities of daily living and quality of life. Palliative care is symptom management and should be integrated into the management of chronic disease and not reserved only for terminal illness.

The nurse is planning care for a patient with hypercalcemia secondary to bone metastasis. Which of the following interventions will be included in the plan of care? (Select all that apply): A. Increasing oral fluids. B. Placement of an oral airway at the bedside. C. Monitoring for Chvostek's sign. D. Implementing seizure precautions. E. Hyperactive reflex assessment. F. Observation for muscle weakness.

A F Serious complications of hypercalcemia include severe muscle weakness, dehydration, loss of deep tendon reflexes, paralytic ileus, and electrocardiographic changes. Early manifestations of hypercalcemia include fatigue, loss of appetite, nausea, vomiting, constipation, and polyuria (increased urine output

rash vs cellulitis

A bacterial infection that often shows up as a rash, cellulitis can spread rapidly. Cellulitis is a skin infection caused by staphylococcus or streptococcus bacteria. It is not contagious. Cellulitis appears as a red, swollen skin rash (usually on the lower legs or arms) that feels tender and hot.

The nurse practitioner orders a wet-to-dry normal saline solution (NSS) dressing for a patient who has a stage III pressure ulcer on the sacral area. The patient's daughter will be dressing the wound at home. Which of the following steps should the nurse include in the teaching plan? (Select all that apply): A. Cleansing the wound. B. Managing pain. C. Applying a dry sterile dressing. D. Using cold water in the bath.

AB Administering pain medications will ensure that the patient is comfortable prior to a dressing change. The nurse should cleanse the wound and then apply the sterile dressing. The order calls for a wet-to-dry normal saline dressing. A cold water bath would be contraindicated for pressure ulcer treatment.

The nurse would explain to a patient that effective treatments for atopic pruritus include (Select all that apply): A. Oral steroids. B. Topical steroids. C. Oral antihistamines. D. Topical antihistamines. E. Topical petroleum ointment.

AB Oral and topical steroids may be given for acute cases of atopic pruritus. Oral and topical antihistamines are not usually given, because they are ineffective and may cause further irritation. Petroleum is also ineffective.

The nurse in the skilled nursing facility is very busy and unable to answer the call bell lights. Which tasks related to skin care can the nurse delegate to the nursing assistant? (Select all that apply): A. Applying over-the-counter lotions to skin that is not broken. B. Assisting the client with frequent turning to prevent pressure ulcers. C. Covering the client who complains of being cold with more blankets. D. Placing a sterile gauze pad over broken skin to contain drainage. E. Assessing a patient complaining of an itching rash.

ABCD

Which of the following processes have the strongest links to intracranial regulation? (Select all that apply): A. Cognition. B. Mobility. C. Oxygenation. D. Perfusion. E. Safety.

ABCD Cognition, mobility, oxygenation, and perfusion have the strongest links to intracranial regulation and include processes that are essential for the nurse to consider when caring for a patient with intracranial concerns. Cognitive function is dependent on an optimally functioning brain. Mobility is frequently affected by intracranial regulation problems, with the most common example being a cerebrovascular accident. Perfusion and oxygenation are intimately involved with intracranial regulation, and without adequate perfusion and oxygenation, the brain cannot function. Other processes that may be closely related include clotting and pain, and interpersonal violence may also be a consideration. Safety refers to the prevention of injuries or freedom from accidents, both of which could be related to intracranial regulation but would not be the strongest links for the nurse to consider.

To help decrease the threat of melanoma in a blonde-haired, fair-skinned patient at risk, the nurse would advise the patient to (Select all that apply): A. Wear sunglasses. B. Drink plenty of water. C. Eat plenty of foods high in vitamin K. D. Apply sunscreen 30 minutes prior to exposure.

AD Wearing sunglasses and using sunscreen are recommended by the National Cancer Institute. Drinking water will help with heat exhaustion but will not prevent melanoma. Green tea, fish oil, soy products, and vitamin E are thought to be helpful in minimizing the risk of developing melanoma; however, vitamin K can cause the blood to clot and has not been indicated.

tool used to assess pain should be based on

AGE of child

Which intervention should the nurse implement during David's hydrotherapy?

Active range of motion exercises of his extremities

Which intervention will the nurse implement? For burns

Administer the Lactated Ringer's solutions prescribed via an infusion pump

Which action is included when a Level I disaster is declared?

All local hospitals prepare to receive casualties

Upon entering the room, the nurse finds the patient, who has just had a mastectomy, crying. When the nurse asks about her crying, the patient states, "I know I shouldn't cry because this surgery may well save my life." What is the nurse's best response? A. "It is okay to cry; mourning the loss of your breast is important for getting past this." B. "I know this is hard, but chances of survival are greatly improved now." C. "Would you like to talk to someone who also has had a mastectomy?" D. "How have you coped with difficult situations in the past?"neuroblastoma most develop where other sites diagnostic therapeutic management -whats used to evaluate renal involement prognosis

Amost common malignant extracranial solid tumor of childhood most develop in adrenal gland or retroperitoneal sympathetic chain other sites: head, neck, chest, pelvis diagnostic: locate primary site and sites of metastasis, S/S depends on location and stage of disease, skeletal survey, radiologic studies, bone marroe eval, IV pyelography to evaluate renal involvement prognosis: the younger pt is dx, better the prognosis

Which action should the nurse take before completing the assessment?

Ask the parents to leave the room before obtaining information from David

Which intervention will the nurse implement to assess for Curling's ulcer?

Assess the gastric aspirate for pH and blood the color of coffee grounds

12. The core dynamic of the abuser in Intimate Partner Abuse (IPA) is? a. Sexual Arousal b. Power & Control c. Frustration d. Self-esteem

B

13. Which community agency provides services to those who are victims of domestic violence? a. Aloha House b. Women Helping Women c. Child and Family Services d. Maui Support Services

B

15. A nurse educator is orienting new nursing staff to the behavioral health unit when one nurse asks, "How will I know which clients are potentially violent?" Which response by the nurse educator is best? a. "Just be alert and aware of your client's behavioral clues.' b. "As you plan care, review the client charts to determine who has a history of violence." c. "Your orientation will include an in-service on violent clients and how to identify them?" d. "A client will usually tell you they are angry about something."

B

8. A mother brings in an eight-month-old infant who is having difficulty breathing. The nurse assesses bleeding in the baby's retinas. The mother states that the child was being cared for by the father while the mother was out of the house. What is the most appropriate initial response of the nurse? a. Question the mother about the events prior to the respiratory distress. b. Identify this situation as a medical emergency. c. Inform the mother that the period of greatest danger has passed. d. Report the situation to the children's protective services agency.

B

A cancer patient's susceptibility to the syndrome of inappropriate antidiuretic hormone (SIADH) can be suspected with which of the following laboratory results? A. Serum potassium of 5.2 mmol/L. B. Serum sodium of 120 mmol/L. C. Hematocrit of 40%. D. Blood urea nitrogen (BUN) of 10 mg/dL.

B

The mother of a 7-year-old girl brings her daughter to the pediatrician's office for an annual examination. On assessment, the pediatric nurse notes signs or symptoms that may suggest a diagnosis of precocious puberty. Which assessment finding is inconsistent with the nurse's knowledge of this condition? A. Breast development B. Brittle hair C. Menstration D . Some pubic hair

B

The nurse manager of a neuromedical surgical unit reviewing potential manifestations of seizures with an orientee would become concerned if the new nurse included which of the following dysfunctions as a manifestation? A. Autonomic. B. Family. C. Motor. D. Sensory.

B Although family dysfunctions can result from long-term stress, this would not be a manifestation of a seizure. Autonomic dysfunctions can be evident in a number of body systems, including the respiratory system (affecting breathing) and the cardiac system (affecting heart rate). Motor dysfunctions are the common manifestations seen with seizure disorders such as the tonic-clonic type. Sensory dysfunctions are manifestations such as the aura preceding a seizure that is often described by patients.

A patient with prostate cancer is taking estrogen daily to control tumor growth. He reports that his left calf is swollen and painful. Which of the following would be the nurse's best action? A. Instruct the client to keep the leg elevated. B. Measure the calf circumference and compare the measurement with the right calf circumference measurement. C. Apply ice to the calf after a 10-minute massage of the area. D. Document assessment findings as an expected response with estrogen therapy.

B An adverse reaction to hormonal manipulation therapy is the development of thrombus formation. Massaging a calf that is swollen and painful is never correct, because this action might break a clot, causing formation of an embolus, which could then travel to the lungs.

End-of-life care is most synonymous with which of the following types of care? A. Palliative care. B. Hospice care. C. Supportive care. D. Quality of life.

B End-of-life care is most synonymous with hospice care. Hospice care uses palliative care for the imminently dying by introducing a team of interdisciplinary health care professionals at the end of a patient's life. The Medicare Hospice Benefit requires that a patient have a prognosis of 6 months or less to be enrolled in this type of care. Palliative care is incorrect since it can be used to manage symptoms in patients who are living with symptomatic chronic disease several years before death. Supportive care is the type of care predominately used for patients with cancer and undergoing active cancer therapies. Quality of life can be enhanced through the implementation of all of these deliveries of care.

Intracranial regulation would be a priority concern for the nurse caring for a patient with an admitting diagnosis of A. Failure to thrive. B. Tramatic brain injury. C. Upper respiratory infection. D. Urinary tract infection.

B Intracranial regulation would be a concern for a patient who suffered a traumatic brain injury. The primary concern for a patient with failure to thrive would be nutrition. The primary concern for a patient with an upper respiratory infection would be oxygenation. Concerns for the patient with a urinary tract infection would be thermoregulation and pain.

A 65-year-old woman has fallen while sweeping her driveway, sustaining a tissue injury. She describes her condition as an aching, throbbing back. This is characteristic of A. Neuropathic pain. B. Nociceptive pain. C. Chronic pain. D. Mixed pain syndrome.

B Nociceptive pain refers to the normal functioning of physiologic systems that leads to the perception of noxious stimuli (tissue injury) as being painful. Patients describe this type of pain as dull or aching, and it is poorly localized. Neuropathic pain is described as shooting, tingling, burning, or numbness that is constant in the extremities, as in diabetic neuropathy. Chronic pain lasts longer than 30 days and is characterized by a disease affecting brain structure and function, such as chronic headaches or open wounds. Mixed pain syndromes are caused by different pathophysiologic mechanisms such as a combination of neuropathic and nociceptive pain; this occurs in syndromes such as sciatica, spinal cord injuries, and cervical or lumbar spinal stenosis.

Nursing diagnoses for patients with sensory perceptual variances might include (Select all that apply): A. Knowledge deficit for nutrition. B. Risk for injury. C. Impaired mobility. D. Altered nutrition that is less than the body requirements. E. Decreased cardiac output.

BCD Nursing diagnoses for patients with sensory perceptual variances might include (Select all that apply): A. Knowledge deficit for nutrition. B. Risk for injury. C. Impaired mobility. D. Altered nutrition that is less than the body requirements. E. Decreased cardiac output.

hypothyroidism what are they usually admitted for?

BRADYcardia 30-40, lack of thyroid hormone to stimulate heart to beat

when to know CSF is bacterial or virus

Bacteria: decrease glucose, increase protein viral: normal glucose, increase protein

palliative VS Hospice

Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the patient is not going to survive the illness. Palliative treatment is designed to relieve symptoms, and improve your quality of life. It can be used at any stage of an illness if there are troubling symptoms, such as pain or sickness. Palliative treatment can also mean using medicines to reduce or control the side effects of cancer treatments.

14. All of the following behaviors except for one are considered uncivil in the nursing profession. Identify the one exception. a. Make rude remarks or put-downs towards others. b. Intentionally exclude or leave others out of activities c. Mentor new staff or recent nursing graduates d. Go above someone's head or fail to follow procedures to resolve conflicts

C

16. Which type of abuse is often not recognized by nurses and other health care professionals? a. Scalding b. Slapping c. Traumatic Brain Abuse / Shaken Baby Syndrome d. Suffocation

C

6. A client comes to the emergency department with a broken wrist and severe bruises inflicted by a beating by the intimate partner. The client states an intention to remain in the relationship at this time. What is the most appropriate response by the nurse? a. "You will need to leave the relationship." b. "I will call a lawyer for you if you wish." c. "Let's develop a safety plan for repeated violence." d. "Here is a list of services that can help you."

C

7. A nurse is teaching a class on domestic violence to high school students. Which statement by a student would indicate to the nurse that further teaching is needed? a. "Violence often begins in a dating relationship." b. "The abuser will often apologize and promise to stop." c. "If you are educated and have money, abuse does not happen." d. "Abusers are often excessively jealous and possessive."

C

A patient with breast cancer asks the nurse why 6 weeks of daily radiation treatments is necessary. What is the nurse's best response? A. "Your cancer is widespread and requires more than the usual amount of radiation treatment." B. "The cost of larger doses of radiation for a shorter period of time is justified by the results." C. "Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time." D. "It is less likely your hair will fall out or you will become anemic if radiation is given in smaller doses over a longer period of time."

C Because of the varying responses of all the cancer cells within a given tumor, smaller doses of radiation given on a daily basis for a set period of time provides multiple opportunities for the destruction of cancer cells while minimizing damage to normal tissues.

A patient voices an understanding of instructions about furosemide (Lasix) when he states A. "I will report any blurred vision." B. "I expect that this will cause me to have increased sensitivity to saltiness." C. "If I notice ringing in my ears, I will call the doctor." D. "I know that I need to monitor my feet for possible skin changes."

C One of the side effects of furosemide is ringing in the ears (tinnitus). Furosemide does not cause changes in vision, in taste regarding saltiness, or in sensation of the skin.

Intracranial function can be disrupted by degenerative disease of the brain, including A. Encephalitis. B. Meningitis. C. Parkinson's disease. D. Brain tumors.

C Parkinson's disease is an exemplar of the degenerative diseases that can affect intracranial regulation. Encephalitis is an exemplar of the inflammatory disorders that can affect intracranial regulation, as is meningitis. Brain tumors are exemplars of a third type of pathologic process that can affect intracranial regulation.

An infant born with hydrocephalus is to be discharged after insertion of a ventriculoperitoneal shunt. Which common complication of this type of surgery should the nurse explain to the home caregivers to prepare them for the patient's discharge? A. Excessive fluid accumulation in the abdomen. B. Eyes with sclera visible above the irises. C. Fever accompanied by decreased responsiveness. D. Violent involuntary muscle contractions.

C The most common complication of surgery would be infection as evidenced by fever and decreased responsiveness. This is true for a patient of any age. The fluid in the peritoneum would be reabsorbed; excessive accumulation is not common. The setting sun sign, or eyes with the sclera visible above the irises, is a late sign of increased intracranial pressure. The early signs are taught prior to discharge. Seizures are not a common complication of ventriculoperitoneal shunt surgery.

Optimal symptom management is primarily based upon A. Physician-directed care. B. Nurse-directed care. C. Evidence-based practice. D. Hospice-directed care.

C The use of the best evidence can support high-quality interventions that are used in optimal symptom management and improved quality of life. Physician-directed care and Nurse-directed care are incorrect since palliative care is an interdisciplinary team approach to care. Hospice-directed care is incorrect as it is for the terminally ill and dying patient.

hematologic and immunologic dysfunction

CBC, H&P comments by parent regard childs lack of energy food diary of poor iron sources frequent infections bleeding

A nurse is instructing a nursing assistant in how to prevent pressure ulcers in a frail elderly client. The nursing assistant indicates that she understands the instruction when she agrees to (Select all that apply): A. Bathe and dry the skin vigorously to stimulate circulation. B. Keep the head of the bed elevated 30 degrees. C. Offer nutritional supplements and frequent snacks. D. Turn the patient at least every 2 hours.

CD The patient should be turned at least every 2 hours because permanent damage can occur in 2 hours or less. If skin assessment reveals a stage I ulcer while the patient is on a 2-hour turning schedule, the patient must be turned more frequently. Protein-calorie malnutrition is another major risk factor for developing pressure ulcers. Additional supplements boost nutritional status, which is essential to healthy skin. Use of donut pads, elevation of the head of the bed, and overstimulation of the skin may all stimulate, if not actually encourage, dermal decline.

nurse review lab finding in child suspected of having addisons disease. which finding would be consistent with this condition? albumen 4.0 coritsol 2 mg K 4.4 Na 139

Cortisol

11. Which intervention is most appropriate for the nurse to implement with an aggressive client exhibiting an early level of anger escalation? a. Administer ordered sedative medication. b. Place the client in seclusion. c. Use a physical restraint. d. Talk with the client to discover the source of distress and relieve the distress.

D

3. The nurse overhears a group of student nurses in the break room discussing the role of the health care professional in suspected child abuse. The nurse concludes that the student who most accurately understands the role is one who makes which statement? a. "Nurses should only report child abuse if they are certain." b. "Nurses should tell the child's doctor if child abuse is suspected." c. "Only the physician can report child abuse." d. "Nurses are required to report any case of suspected child abuse to child protective services."

D

The nurse is talking to the parents of a child with pediculosis capitis. When explaining how to manage pediculosis capitis, the nurse should state: A. "You will need to cut the hair shorter if infestation and nits are severe." B. "You can distinguish viable from nonviable nits and remove all viable ones." C. "You can wash all nits out of hair with a regular shampoo." D. "You will need to remove nits with an extra-fine tooth comb or tweezers."

D

Which of the following pain assessment tools is most appropriate for a 14-year-old client? A. A FLACC behavioral pain assessment scale B. Poker chip tool C. Faces pain-rating scale D. Numeric scale

D

Comfort care is an intervention carried out by which of the following professional disciplines? A. Medicine. B. Clergy. C. Volunteers. D. Nursing.

D Comfort care is a term that is often used by physicians and nurses in the context of dying, terminally ill, or seriously ill patients. Yet, comfort care is predominantly used by nurses, who attend to the dying patient and family by providing physical comfort measures, such as repositioning, mouth care, and skin care, while valuing the ongoing medical management of the patient's symptoms. Therefore, the other answers are incorrect - it is primarily the nurse who provides comfort care.

The signs and symptoms of increased intracranial pressure would include A. Dehydration. B. Hunger. C. Nausea. D. Vomiting.

D Symptoms of increased intracranial pressure include headache, decreased consciousness, and vomiting without nausea. Signs may include cranial nerve VI palsies, papilledema, periorbital bruising, and the late sign of Cushing's triad. Cerebral or brain parenchymal edema rather than dedydration occurs for many reasons. There may be chewing or swallowing problems, but hunger is not associated with increased intracranial pressure. One of the key signs of increasing intracranial pressure is vomiting occuring without nausea.

The nurse is teaching a family about sensory alterations. The nurse needs to provide additional teaching if a family member states A. "I am going to wear earplugs when I mow the lawn." B. "If I stop smoking, I might enjoy eating more!" C. "So grandpa's stroke is why he thinks his left arm and leg aren't there any more." D. "My cousin has autism, and I am going to hug him more so he understands how much I care."

D The nurse is teaching a family about sensory alterations. The nurse needs to provide additional teaching if a family member states A. "I am going to wear earplugs when I mow the lawn." B. "If I stop smoking, I might enjoy eating more!" C. "So grandpa's stroke is why he thinks his left arm and leg aren't there any more." D. "My cousin has autism, and I am going to hug him more so he understands how much I care."

Which action should be implemented to help these family members?

Designate specific family areas that are staffed with counselors

nonpharmacologic methods for pain

Distraction-toys, digital devices, TV cutaneous stimulation, sucrose sol, TENS, guided imagery, relaxation, hypnosis, heat/cold (ice decreases swelling), acupuncture

patient with meningitis , what type of room ? when can you DC this type of room for pt

Droplet precautions DC 24 Hours after Abx are started

most common pathogen of meningitis what vaccine to prevent

E.coli, group B strep Hib vaccine

minor topical analgesics EMLA L-M-X4 absorption times

EMLA 60 min L-MX4 30 min

educable mentally retarded constitutes of what % of population with CI trainable mentally retarded about what % of CI

Educable mentally retarded constitutes 85% of the population with CI Trainable mentally retarded about 10% of those with CI

What is the priority nursing intervention upon admission f/u with burn

Establish and maintain an open airway

Which nursing diagnosis has the highest priority in the emergent phase?

Fluid volume deficit related to increased capillary permeability

when CPS goes to visit child at the home how should she approach the kid

Get down on the knees to calmly talk to the kid face to face

at 2 months, what vaccinations?

Hib, IPV, rotavirus, Dtap, HepB, pneumococcal

Which statement by Mary's grandmother supports a common cultural communication expectation in the African-American heritage?

I really don't want to talk about my son's situation.

child returned to ped ICU following brain tumor resection. which nursing assessment takes priority ICP skin integrity pain and discomfort mobility

ICP

Which action should the nurse take when officer wants to see kids record in hospital

Inform the officer that he must first speak to David's parents

koplik spots

Koplik's spots: Little spots inside the mouth that are highly characteristic of the early phase of measles (rubeola) white spots in cheeks shows days before getting measles

therapeutic management of head trauma

LOC for several minutes, prolonged or continued seizures NPO at first surgical therapy

neuro assessment why imp to know last assessment what terms to use lethargy obtundation stupor coma persistent vegetative state

LOC, imp to know last assessment to compare findings use: A&O x lethargy: sluggish speech obtundation: arouses with stimulation, less than alert, dull stupor: responds only to vigorous and repeated stimulation coma: no motor persistent vegetative state: permanently lost function of cerebral cortex

How should the nurse respond about how you get sickle disease

Mary has the disease because she inherited the gene from both of her parents, who were carriers.

microcephaly

Microcephaly is a condition where a baby's head is much smaller than expected. During pregnancy, a baby's head grows because the baby's brain grows. Microcephaly can occur because a baby's brain has not developed properly during pregnancy or has stopped growing after birth, which results in a smaller head size. Microcephaly can be an isolated condition, meaning that it can occur with no other major birth defects, or it can occur in combination with other major birth defects.

epitaxis common in recurrent or severe episodes may indicate underlying diseases such as care management: bleeding usually stops when and by how\what to do with child

NOSEBLEED common in childhood reccurent may indicate: vascular abnormalities, leukemia, thrombocytopenia, clotting factor deficiency diseases care management: remain calm keep kid calm, bleeding usually stops within 10 min after nasal pressure have child sit up and lean forward and apply pressure to soft lower part of nose

physiologic manifestations of pain

NOT ALWAYS RELIABLE INDICATOR OF PAIN tachycardia, tachypnea, inadequate cough and lung expansion, HTN, pupil dilation, pallor, increased perspiration (might think its a fever), secretion of catecholamines, adrenocorticoid hormones

pain meds are not given via what route considerations of drug administration

NOT given IM allow time for drug to take effect, administer drugs by nonpainful route when possible, avoid delays in performing procedures, doc results of pain management

Which action should the nurse implement?

Notify the healthcare provider immediately

Which action should the nurse implement with drain from site

Outline the drainage on the dressing and write the date and time

intervention for pain school age and adolescents

PCA and epidural use, hypnotherapy, breathing, guided imagery, distraction

Which action is implemented first by the triage personnel?

Place a disaster tag securely on each victim

Which intervention should the nurse implement?

Premedicate with an opioid analgesic 20 minutes prior to applying this medication

Clinical management of glucose regulation primary screening collaborative interventions

Primary: diet, exercise, weight control screening: hgb A1c, cholesterol, microalbuminuria screening detects complications for BP, dental foot and eye exams collaborative interventions: educate, nutrition therapy, monitor meal related blood glucose values, pharmacologic agents: oral hypoglycemic agents and insulin

Into which triage category should David be placed?

Priority 1, Color Red

Which action should the nurse implement?

Provide visitors with isolation gowns and instruction in hand hygiene

What is the best response by the nurse to Earlene's statement about sickle cell disease???

Red blood cells become 'C' shaped, stiff, and sticky, which blocks the blood vessels.

nurse caring for toddler hospitalized after MVA. based on eriksons dev model which behavior would you anticipate can occur as result of hospitalization -regression to a previous behavior -belief that they are being punished -fear of bodily mutilation -loss of independence

Regression to a previous behavior

educational topics on 5 week old kid to parents s/s what to do if s/s safety others

SS of infection and dehydration- poor feeding, increased sleeping, irritability acetominophen, increase fluids, call physiciain safety : don't leave baby alone, car seat,

ST consequence of HYPERglycemia LT consequence

ST: not enough glucose reaching cells and dehydration LT: end organ disease due to microvascular damage (retinopathy, nephropathy, peripheral neuropathy) and macrovascular angiopathy (HTN, cardiovascular and peripjheral vascular disease)

5 week old Eriksons stage

Trust vs mistrust parents should be at hospital with them

neurologic examination

VS, skin, eyes, motor function, posturing, reflexes Kernings: positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance) = meningitis Babinski

IM injection for baby Rocephin?

Vastus lateralis

prognosis of leukemia (factors for determining) care management

WBC count, age at time of dx, type of cell involved, gender, karyotype analysis care management: prepare for procedures, relieve pain, prevent complication of myelosuppression (infection, hemorrhage, anemia) use precautions with chemo agents manage probs of drug toxicity - Nausea/vomiting - Anorexia - Mucosal ulceration - Neuropathy - Hemorrhagic cystitis - Alopecia - Mood changes - Moon facies

immune thrombocytopenia "idiopathic thrombocytopenic purpura" type of disorder characterized by what does it often follow in acute chronic management

acquired hemorrhagic disorder characterized by: excessive destruction of platelets (thrombocytopenia), purpura: discoloration caused by petechiae beneath skin normal bone marrow with increased immature platelets or eosinophils often follows URI or other infection in acute and self limiting chronic >12 months duration management: support, IV immune globulin, anti D antibody

abuse

act of misuse, exploitation, action to injurt hurt damage others

what is violence

actions individuals take to intentionally hurt others

seizure disorder acute vs chronic nursing role medications DON'T DO S/S postical should not go swimming bc should not stop taking med

acute (nonrecurrent) chronic (recurrent) role: prevention, immediate care, planning for seizure precautions and med management med: DON'T: tie them down, put anything in mouth DO: explain what's going on, block hazards/remove objects close to pt, speak calmly, track time and observe which extremities are moving S/S: blank stare, chew, fumbling, wandering, shaking, confused speech postical: period after seizure where they're breathing, mumbling, but not alert should not go swimming bc they can have seizure at any time do not suddenly stop taking meds just bc they don't show symptoms

bacterial meningitis how to prevent can be caused by common cause diagnostic procedure transmission - type of precaution appears as manifestations PAGE 1440 nuchal rigidity how is lumbar puncture done

acute inflammation of meninges and CSF -prevent by Hib vaccine -can be caused by various bacterial agents -common cause: strep pneumoniae, group B strep, e.coli -diagnostic procedure: lumbar puncture -droplet infection from nasopharyngeal secretions appears as extension of other bacterial infection through vascular dissemination and organisms then spread through CSF nuchal rigidity: push neck foward and if it rejects Meningism is the triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area

how school age and adolescents understand pain at what age can child describe pain in more detail and location?

age 8,

major procedure sedation two goals

analgesia: relieve pain anxiolysis: reduce anxiety

RBC disorders anemia causes morphology diagnostic evaluation

anemia: most common, decrease in number of RBC or hgb concentration below normal, decreased oxygen carrying capacity of blood causes: depletion of RBCs or hgb morphology: changes in RBC size, shape, color, or combination Diagnostic eval: hgb <10/11

sickle cell crisis precipitating factors

anything that increases bodys need for oxygen or alters transport of oxygen -trauma -infection, fever -physical and emotional stress -increased blood viscosity caused by dehydation -hypoxia

3 YO with Hx of hydrocephalus has recently undergone a vp shunt insertion. which post op interventions most appropriate -assessing signs of infection and for neurological function -maintain HOB at 90 degree -encourage patient to lie on operative site -encourage pt to lie supine for first 24 H

assessing signs of infection and for neurological function

ped nurse providing care to ped patient with primary adrenal insufficiency. which item in pt hx most likely cause of this condition? autoimmune destruction genetic abnormality infectious process steroid therapy

autoimmune destruction

a ped nurse is offering health prevention lecture in community. which topic appropriate to discuss in this lecture -use of DEET containing products contraindicated in school age children -avoid areas infested with mosquitoes can be helpful in preventing encephalitis -incidence of reyes syndrome increased bc of use of tylenol -varicella vaccine not to be given to children with arthritis or kawasaki disease

avoiding areas infested with mosquitoes can be helpful in preventing encephalitis

nurse explains to parents of a child undergoing an oncological work up that the exact cause of most cancers is unknown, but some factors knwon to be involved. which is inconsistent with this understanding virus genetics environmental exposures bacterial infections

bacterial infections

infection of skin examples of skin infection

bacterial infections abscess formation severity varies with skin integrity, immune and cellular defenses examples: impetigo contagiosa, pyoderma, cellulitis

atopic dermatitis (eczema) begins during? usually occurs when? associated with what?

begins during infancy, occurs usually when cold, hereditary tendency associated w/ food allergies, allergic rhinitis, asthma

four types of measures to assess child's pain

behavioral physiologic self report multidimensional

child dx with chronic immune thrombocytopenia. which dx platelet count supports this? below 5,000 below 10,000 below 50,000 below 150,000

below 150,000

ped nurse aware that which disease process most commonly inherited genetic disease worldwide sickle cell anemia beta thalassemia cooleys anemia hemosiderosis

beta thalassemia

Hemophilia results from inheritable pattern is what? identification of a specific factor deficiency allows for? types of hemophilia A B Von willebrand disease deficiency of what

bleeding disorder that results from deficiences of specific clotting factors -inheritable pattern is X linked recessive -identification of specific factor deficiency allows for definitive tx Types: hemophilia A: "classic", deficiency of factor VIII b "christmas disease" caused by deficiency of factor IX von willebrand disease: deficiency of von willebrand factor and factor VIII

sickle cell crisis what diagnostic test by ED physician should be made what prescription to be given IV

blood cultures IV: dextrose in NS at 75 ml/hr pump

therapeutic management of thalassemia potential complications treat with

blood transfusion to maintain normal hgb levels potential complication: hemosiderosis treat with: iron chelating drugs )deferoxamine desferal) drugs bind excess iron for excretion by kidney

ER nursing process of sexual abuse how to interview abuser?

careful detailed HX, document! -get hx separate from victim -parents questioned about family hx of sexual victimization

immobilization devices cast traction distraction

cast: made of fiberglass or plaster of paris traction: 90/90 to reduce dislocations and immobilize fx in child distraction: to lengthen a bone

DKA diabetic ketoacidosis what are ketones how they present what type of respiration do they have? results from? how can they die? therapy should be instituted in what setting?

cells are not able to metabolize sugar so the body breaks down alternate sources of energy. ketones are released and excess of this are eliminated in urine (ketouria) or lungs (acetone breath) ketones in the blood are strong acids that lower pH and produce ketoacidosis -present: confused, lethargic, BS high 800-1000, acidotic -kussumaul's respiration: deep rapid resp with mouth open, hyperventilation of metabolic acidosis resulting from respiratory systems attempt to eliminate excess CO2 by increased depth and rate results from: progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma, and may cause death -can die by coma, confused hyperventilating therapy instituted in: ICU setting

types of precocious puberty central peripheral

central: early maturation and development of gonads and secondary sex characteristics peripheral: premature development of breasts, sexual hair, menses

type 1 DM characterized by (pathophysiology) most DM of childhood is more prominent in?

characterized by destruction of beta cells leading to insulin deficiency (beta cells destroyed and can't produce insulin) -with deficiency of insulin, glucose is not able to enter the cell and remains in the blood causing hyperglycemia -onset in childhood and adolescence but may occur at any age -most DM in childhood is type1 -more prominent in caucasians

juvenile hypothyroidism congenital untreated leads to? rarely occurs from what in US?

child born with it untreated leads to MR mental retardation rarely occurs from dietary iodine insufficiency in US

cerebral trauma more common in

children and elderly

seborrheic dermatitis what is it commonly occurs where also seen where tx

chronic, recurrent inflammatory reaction of skin with unknown cause -commonly occurs on scalp (cradle cap) -also seen on eyelids, nasolabial folds, ears TX: remove crusts, antiseborrheic shampoo

complication of VP shunt what does VP shunt do

clot, infection VP shunt prevents child from having long term brain damage A ventriculoperitoneal (VP) shunt is a device used to relieve pressure from the brain caused by fluid accumulation. VP shunting is a surgical procedure that is primarily used to treat a condition called hydrocephalus, which occurs when excess cerebrospinal fluid (CSF) collects in the brain's ventricles.

hospital procedures for rape

collect evidence, provide support and education, provide community resources

thermal injury burns what is most common type of burns in HI? toddlers? older children? others?

common in HI: kids fall into hot fires in bbq pits -toddlers: hot water scalds -older children: flame related burns =child abuse or child matches or lighter for 1/10 house fires

pet and wild animal bites most common in? -majority of dog victims are? between what age? tx? what are you concerned about rabies?

common in pediatrics -most dog bite victims are boys between 5-9 YO -tx: wound care and prophylactic abx -rabies concern: prophylactic

Peds Glasgow coma scale consists of score for unaltered LOC score for extremely decreased LOC (worst possible score)

consists of: eyes, verbal, motor response *score does not include pupil size or reaction score of 15: unaltered score of 3: extremely decreased

what is the thyroid function? what does it control? what two hormones do they secrete what is TH made up of?

controls BMR basal metabolic rate, impact systems of body TH is made up of : thyroxin T4, triiodothyronine T3 and calcitonin

devleopmental milestone at 2 months old

coos, gurgles, develops social smile

long term effects of victims of abuse

depression, suicidal thoughts/attempts, low self esteem, anxiety disorders, PTSD, substance abuse, impaired relationship outside of family

-therapeutic of HYPOPITUITARISM dosage increased when? when to end therapy?

directed towards CORRECTION of underlying disease process dosage increased when time of epiphyseal closure nears EOT when radiologic evidence that closure occured

life cycle of abuse

during pregnancy, as a child, involve in relationships, and become fraila dn dependent as an elderly

defects in hemostasis

dysfunction in clotting mechanisms, vascular influence, role of platelets, clotting factors

promoting normal development in early childhood school age adolescence

early childhood: basic trust, separation from parents, beginning independence school age: industry/activity adolescence: developing independence/autonomy

nursing care management of acromegaly

early identification of children with excessive growth rates, growth charts, early tx, emotional support, body image concerns

pituitary hyperfunction child may reach?

excess GH before closure of epiphyseal shafts resulting in overgrowth of long bones*** may reach 8ft or more vertical growth plus increased muscle weight generally in proportion to height

cerebral malformation - hydrocephalus characterized by affects how many children brain compressed bc clinical manifestations in early/late infancy and childhood Treatment

excessive accumulation of fluid in the brain congenital or acquired affects 1/500 children brain compressed bc of extra fluid if CSF accumulates clinical manifestations*** • P1134 -abnormal behaviors • Early Infancy-abnormal head growth, Buldging fontanels • Later infancy-Fontanel enlargement, depressed eyes • Childhood- headache, vomiting, confusion treatment: Shunt placement goes in intracranial to drain fluid

prognosis of thalassemia expect to live into common causes of death what is the potential cure care management

expect to live well into adulthood with proper management common causes of death: heart disease, postsplenectomy sepsis, multiple organ failure, bone marrow transplantation is potential cure care management: promote compliance with transfusion and chelation therapy, assist with anxiety provoking tx, foster childs and familys adjustment to chronic stress, observe for complications

head injury etiologies

falls, MVA, bike and sports injuries

what is dwarfism what to do

familial or caused by tumor identify whats happening, replace hormone before epiphyseal plates stops growing bc if they wait too long child wont get growth hormone in time to grow

-diagnostics of HYPOPITUITARISM

family hx growth patterns and health hx, change in bone growth physical examination psychosocial eval radiographic survey endocrine studies

signs of hashimotos disease

fatigue, sluggishness, weight gain, diff swallowing, pale dry skin, puffy face, constipation, depression, dry thinning brittle hair, slowed pulse rate, feeling cold, joint and muscle pain, diff getting pregnant, irregular or heavy menstruation, irritability, memory loss, enlarged heart, hoarseness

third degree burn how can you get it? how does it look like? feeling?

fire, contact with hot objects -tough, leathery, marbled, pale white brown tan black or red, does no blanch on pressure, dull, edema -variable pain and often severe

patho of head injury especially vulnerable to what type of injuries how often to wake them up to make sure they're ok -why child's response diff -mechanical trauma are direct result of?

force of intracranial contents can't be absorbed by skull and musculoligamentous support of head, involving scalp, skull, meninges, brain resulting of mechanical force -vulnerable to acceleration-deceleration injuries -wake them up Q2H to make sure they're ok -childs response diff bc larger head size and insufficient musculoskeletal support -3/4 of mechanical trauma are direct result of brain injury

intellectual disability IQ onset before what age

functional strength and weaknesses of 2/10 impairment of adaptive skills onset before age 18

3 YO admitted with low neutrophil count 10 days after chemo for ALL. which roommate selection most appropriate 3YO with bronchiolitis 5YO with fx femur 4YO with strep infection 3YO with hx of diarrhea

fx femur

Fragile X syndrome type of disease abnormal gene of what chromosome most me are what? what % of females mentally deficient

genetic cognitive impairment after DS -abnormal gene on lower end of long arm of X chromosome -most males mentally deficient -30% females males have only the nonfunctioning x females have one normally functioning X and one nonfunctioning x

Down syndrome type of disorder biggest risk increasing bc? types of anomalies/deficits life expectancy common signs of DS

genetic disorder, most common in US, Trisomy 21 biggest risk is maternal age >40 -cardiac abnormalities, hearing and vision deficits, alzheimers disease, other conditions life expectancy: increasing from 25 years in 1983-60 years Signs: decreased or poor muscle tone, short neck, excess skin at back of neck, flattened face and nose, small head and ears

nursing process in ER with victim what can nurse tell victim what to give victim

get in touch with their feeling, have patience, understanding, caring privacy, confidentiality, open ended questions is empathetic and respectful way, take pics of injuries with consent, validate their feelings and fears, assess coping patterns nurse tells victim "noone deserves to be abused" and explain abuse is common -give written materials on violence with 24H hotline number 0tell victim they don't need to talk and will be there -help to develop safety plan/guide

hormone to RAISE glucose

glucagon, cortisol

common diagnostic tests for glucose regulation

glucose screening assess antibodies to confirm type1 DM lipid analysis microalbuminuria Creactive protein

glycosuria glucogenesis

glycosuria: when serum glucose exceeds renal threshold, glucose spills into urine glucogenesis: cells break down protein for conversion to glucose by the liver

a nurse visiting a day care notices a boy trying to get up off the floor by kneeling, rising to his feeet while keeping his hands on the floor, then walking his hands up his legs until he is standing. which assessment finding does this nurse document? positional instability gowers maneuver kernigs sign grey turners sign

gowers maneuver

what role does grandmother usually play in AA culture

grandmother usually plays critical role in child care and economic support

Hypopituitarism (GH growth hormone) deficiency -tend to be? -affects? -inhibits -consequences depend upon?

growth hormone deficiency, tend to be small -affects thyroid -inhibits somatic growth -consequences depend on degree of dysfunction (gonadotropin deficiency, GH, TSH, corticotropin)

reasons for not reporting rape

guilt feeling they caused the rape embarassed fear of police response fear of retribution from rapist

nurse reviewing chart on child who has sickle cell disease and notes dx "dactylitis" . what does nurse understand abotu this condition? prolonged painful erection atypical pneumonia avascular necrosis of hip hand foot syndrome

hand foot syndrome

ped nurse uses head to toe approach when conducting a physical assessment on an infant. which sequence represents correct technique? -HR, urine output, RR, presence of bowel sounds -head circumference, lung sounds, presence of bowel sounds, urine output -presence of eye drainage, abdominal pain, lung sounds, urine output --urine output, skin color, skin turgor, HR, bowel sounds

head circumference, lung sounds, presence of bowel sounds, urine output

nursing care management of DMD death usually occurs by what age and from what?

help child and family cope, design program to foster independence and activity as long as possible, teach child self-help skills appropriate health care assistance (respite care, SNF, home health) death usually by 25 typically from lung disorders

effects of anemia on circulatory system

hemodilution decreased peripheral resistance increased cardiac circulation and turbulence (may produce murmur, cardiac failure may ensue) cyanosis growth retardation

childs lab value show RBC small, dense, round with hgb 8.5. based on this, which disease process does nurse suspect hemosiderosis cooleys anemia hereditary spherocytosis hemophilia

hereditary spherocytosis

acromegaly what is it S/S

high blood of growth hormone (tumor in adrenal gland) visual field defects, sweat, galactorrhea (prolactin), cardiomegaly HTN, sexual dysfunction, peripheral neuropathy, prominent supraorbital ridge, large nose and jaw, teeth separated or lacking, abnormal glucose (glucosuria/polyuria), spade shaped hands and feet, arthrosis

nurse reads in childs chart that lab studies positive for reed sternberg cells. which disease nurse associate this finding with? ALL rhabdomyosarcoma glial cell brain tumor hodgkins disease

hodgkins disaese

ED nurse knows which type of bite has highest risk of infection cat dog human squirrel

human

human bites from? Risk of? tx

human bites from rough play, fights, victims of child abuse -risk of infection -wound care

diagnostic eval of hemophilia what type of inheritance lab findings low level of what? normal level of what?

hx of bleeding episodes, over prolonged bleeding, hemarthrosis, ecchymosis x-linked inheritance lab findings: low levels of factor VIII or IX, prolonged thromboplastin time normal: platelet count, parathormone level, and fibrinogen level

TX for atopic dermatitis

hydrate skin, relieve pruritis, reduce inflammation, prevent/control secondary infection

Goiter

hypertrophy of thyroid gland

DIC disseminated intravascular coagulation disorder of coagulation that occurs as complication of what pathologic processes pathophysiology therapeutic management type IV?

hypoxia, acidosis, shock, endothelial damage first stage of coagulation process is abnormally stimulated, excessive amounts of thrombin are generated, fibrinogen is converted rapidly to fibrin with aggregation and destruction of platelets therapeutic management: early recognition, control of underlying or initiating cause, platelet or fresh frozen plasma transfusion exchange transfusion in newborn IV heparin

-Nursing care of HYPOPITUITARISM

identify and assist with dx, support, emotional adjustment of child, prepare for test and med administration

parents of 5YO with ALL are told their child is in remission and want to stop chemo. which response by nurse is appropriate yes we usually stop chemo as soon as remission is achieved no specific evidence that favors continuing or stopping tx if tx is dc most children have a relapse w/in short time of course, decision about tx is entirely up to you as parents

if tx is DC most children have a relapse w/in short time

complications of burn injuries

immediate threat of airway compromise, shock, infection (local and systemic sepsis), inhalation injuries, aspiration, pulmonary edema, pulmonary embolus

acne most commonly in pathophysiology TX

in adolescents -hair follicle and sebaceous glands, or comedogenesis (clogged pores) TX: overall health and meds

therapeutic management of leukemia 4 phases -induction -CNS prophylactic therapy -intensification -maintenance

induction 4-6 weeks CNS prophylactic therapy: intrathecal chemo intensification (consolidation) therapy: to eradicate residual leukemic cells and prevent resistant leukemic clones maintenance therapy: to reserve remission

types of atopic dermatitis ages? infantile eczema childhood preadolescent and adolescent

infant: 2-6months childhood: 2-3YO pre/adolescent: 12YO to early adult

what is pustules

infection

childs medical record states he has an altered LOC. what is priority prob for nurse to assess for this child trauma abusive head trauma infection of brain or meninges brainstem abnormality

infection of brain or meninges

vapocoolant sprays for minor procedures, when does it take affect?

instantaneous

hormone to LOWER glucose

insulin

therapeutic management for DM1 glucose monitoring levels? lab measurement at what %? teaching

insulin therapy glucose monitoring: <126 hgb A1C <7% keep below bc can affect systems to get damaged and have long term multiple health prob teaching: nutrition, exercise, snacks, how to manage hypoglycemic episodes

ped nurse is awar ethat which is precipitating cause of legg calve perthes disease? -genetic abnormality -interruption in blood flow -birth trauma -dietary deficiency

interruption in blood floq

integumentary problems should be in what type of isolation

isolation bc rash is open/drain, erythema, may not be contagious from rash but may be viral/bacerial

kyphosis VS lordosis

kyphosis: nonpainful spinal curvature of spine "hunchback" lordosis : excessive backward cavity of the spine "swayback"

NTD neural tube defects occurs more in?

largest group of congenital anomalies in US spinal cord and cauda are encased in sheath of bone and meninges that may involve entire length of neural tube or small portion -occurs more in girls and in Caucasians

muscular dystrophies S/S

largest group of muscular diseases in children -genetic origin with gradual degeneration of muscle fibers, progressive weakness and wasting of skeletal muscles -increasing disability and deformity with loss of strength S/S: difficulty arising from sitting or supine position Boys: waddling gait and lordosis, fall frequently, develop characteristic manner of rising from a squatting or sitting position on floor (Gower sign), enlarged calves

neoplastic disorders are almost half of childhood cancers involve what

leading cause of death from disease in children past infancy almost half of all childhood cancers involve blood/blood forming organs leukemia and lymphomas

submersion injury (near drowning) major cause of what survival for at least how many hours after submersion pathophy therapeutic managenent

major cause of accidental death in children that can occur in even small amt of water survival for at least 24 H after submersion patho: hypoxia (PE, atelectasis, airway spasm), Aspiration, hypothermia, increased risk bc of largeness of surface are in comparison with body mass therapeutic management: • Emergency resuscitative efforts at the scene • Management: based on degree of cerebral insult • Aspiration pneumonia: frequent complication • Hospitalization for observation • Prognosis: best predictor is the length of submersion

where to treat major moderate minor burn injury

major: specialized burn center moderate: hospital with expertise in burn tx minor: outpatient setting

koplik spots are seen with what disease?

measles

a child with special needs has moved into community. which health care resource should school nurse direct the childs family toward? ==medical home -ped clinic -home health care -community center

medical home

difference between meningocele and myelomeningocele

meningocele: changes in spinal column with fluid myelomeningocele: nerves and muscles in sac, more severe and causes paralysis of leg

clinical manifestations of juvenile hypothyroidism

mental decline constipation sleepiness myxedematous skin changes (dry skin, sparse hair, puffiness around eye), bradycardia

long term complication of DM

microvascular complications (nephropathy and retinopathy) macrovascular disease, neuropathy poor vascular changes as early as 2.5-3 years after Dx with excellent control, can be delayed 20 years

arthropod bites and stings may cause what type of discomfort manage with?

mild to moderate discomfort manage with symptomatic measures and prevention of secondary infection bees: stinger penetrates skin

prognosis of hemophilia how to improve quality of life treatment options

mild to moderate hemophilia: patients live near normal lives control symptoms and limit joint damage to improve quality of life tx: gene therapy, working copy of factor VIII gene introduced

which of IQ classifications can live a normal life with support

mild/moderate

AIRWAY, COUGH AND GAG REFLEX, LOC characteristics of minimal moderate deep sedation

minimal: maintains airway independently and continuously, cough and gag reflex intact, responds to verbal stimuli moderate sedation: maintains airway independently and continuously, reflexes intact, easily aroused with verbal or gentile physical stimulation deep sedation: unable to maintain airway, partial or complete loss of reflexes, not easily aroused responds to repeated or painful stimuli

medical procedures for pain minor procedures major

minor: topical anesthetics major: sedation

lymphocytic thyroiditis (Hashimotos disease) or juvenile autoimmune thyroiditis occurs more after what age and peaks when?

most common cause of thyroid disease in children and teens occurs more after 6YO and peaks at adolescene

leukemia most frequent in peak onset disease of? morphology of leukemia pathophysiology which organs most affected overproduction of? how does cellular destruction take place consequences diagnostic evaluation lumbar puncture to?

most common childhood cancer more frequent in boys >1YO peak onset 2-5YO broad group of malignant diseases of bone marrow and lymphatic system -complex disease with varying heterogeneity, classifications are increasingly complex morphology: ALL acute lymphoid leukemia, ANLL or AML acute nonlymphoid myelogenous leukemia, stem or blast cell leukemia patho: unrestricted proliferation of immature WBC in blood forming tissues of body most affected organs: liver and spleen overproduction of WBC, often acute form causes low leukocyte count cellular destruction takes place by infiltration and subsequent completion for metabolic elements consequences: anemia from decreased RBCs, infection from neutropenia, bleeding tendencies from decreased platelet production, marked infiltration, enlargement and fibrosis of spleen liver and lymph glands diagnostic eval: peripheral blood smear (immature leukocytes, frequently low blood cell counts) lumbar puncture to evaluate CNS involvement bone marrow aspiration or biopsy

Hyperthyroidism graves disease caused by? peak incidence how do they act? graves disease management

most common in childhood caused by autoimmune response to TSH receptors enlarged thyroid gland and exopthalmos peak incidence 12-14YO but may be present at birth, familial association very impulsive management: antithyroid meds, radioactive iodine therapy, subtotal thyroidectomy, Betablockers to decrease HR*******

brain tumors most common what arise from ? infratentorial tumors involve? supratentorial tumors occur mainly in? diagnostic eval therapeutic management care management

most common solid tumors in children can arise from any cell in brain or spinal cord infratentorial tumor: cerebellum and brainstem supratentorial tumors: occur mainly in cerebrum diagnostic eval: S/S, r/t anatomic location, size and childs age, lumbar puncture, MRI CT EEG therapeutic: depends on type of tumor, surgery, radiotherapy, chemotherapy, combo of modalities, care management: prepare for dx and op procedures, consider how it affects childs body image, prevent postop complications, support

Duchenne Muscular Dystrophy (MDM) "psydohypertrophic MD" patho diagnostic/confirmation what lab will be high prenatal dx incidence in? characteristics cognitive impairment complications what is gowers sign

most severe and most common X-linked inheritance pattern, 1/3 are fresh mutations, ****Positive family hx and display of usual characteristics of disease -blood polymerase chain reaction for dystrophic chain mutation confirmation: electromyelogram (EMG), muscle biopsy, serum enzyme measurement high in what lab value: creatine kinase in first 2 years of life before onset of clinical weakness prenatal dx: early as 12 weeks gestation -incidence in 1/3500 male births characteristics: onset 3-7 YO progressive muscle weakness, wasting, contractures, enlarged calf muscles (thighs and upper arms-firm or woody on palpation), o Later stages: profound muscular atrophy progressive generalized weakness in adolescence, death from respiratory or cardiac failure, loss of independent ambulation by 9-11 YO • Waddling gait, frequent falls, Gower sign o child turning onto side or abdomen, flexing knees to assume a kneeling position, then with knees extended gradually pushing torso to an upright position by "walking" the hands up the legs) • Lordosis cognitive impairment: mild, about 20 points below normal, present in 25-30% of patients complications: contracture deformities of hips knees ankles, disuse atrophy, obseity, profound muscular atrophy in later stages, mental deficiency common gowers sign: Gowers' sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength.

Linear depressed communited basilar open diastatic growing

o Linear fractures are those in which the lines of the fracture are predetermined by the site and velocity of the impact, as well as by the strength of the bone. These are uncommon before 2 to 3 years of age but constitute the majority of childhood skull fractures. Most linear skull fractures are associated with an overlying hematoma or soft-tissue swelling (Schutzman & Greenes, 2001). o Depressed fractures are those in which the bone is locally broken, usually into several irregular fragments that are pushed inward, causing pressure on the brain. The inner portion of the bone is more extensively fragmented than the outer portion, which almost invariably produces tears in the dura. These are uncommon before 2 to 3 years of age. In infants and very young children, the soft, malleable bone may become dented in a peculiar rounded or "Ping-Pong ball" depression, without laceration of either skin or dura. o Comminuted fractures consist of multiple associated linear fractures. They usually result from intense impact. These types of fractures often result from repeated blows against an object and may suggest child abuse. o Basilar fractures involve the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bones. Because of the proximity of the fracture line to structures surrounding the brainstem, this is a serious head injury. Approximately 80% of the cases may include clinical features such as subcutaneous bleeding in the posterior neck area and over the mastoid process (battle sign). Bleeding around the eyes (raccoon eyes) or bleeding behind the tympanic membrane (hemotympanum) may occur. o Open fractures cause communication between the skull and the scalp or the surfaces of the upper respiratory tract. Open fractures increase the risk of CNS infection. They may have an overlying laceration called a compound fracture. Open fractures can also create an opening in the paranasal sinuses or middle ear that can lead to CSF rhinorrhea or otorrhea. Facial paralysis, vertigo, tinnitus, or hearing loss may develop. o Diastatic fractures are traumatic separations of the cranial sutures. These most frequently affect the lambdoid suture and are rarely seen beyond the first 3 years of life. They require no specific treatment but should be observed for "growing fractures." o Growing fractures are skull fractures associated with an underlying dural tear that may be caused by a leptomeningeal cyst, dilated ventricles, or a herniated brain. Neurologic symptoms include headache, seizures, and asymmetric cranial growth (Schutzman & Greenes, 2001). Infants and young children who have isolated skull fractures should be evaluated for growing skull fractures from 1 to 2 months after the injury

primary head injuries

o Skull fracture o Contusions o Intracranial hematoma o Diffuse injury o ****3 major causes of brain damage in childhood are falls, motor vehicle injuries, bicycle or sports-related injuries o Concussion most common

SN teaching mother of infant ways to prevent iron deficiency anemia. which instruction causes the RN to intervene and correct teaching? "give your chile whole milk instead of low fat milk be sure to feed iron fortified cereals offer solid foods first, then bottle WIC can provide with iron fortified infant formula

offer solid food first then bottle

diagnosis of thalassemia onset values to look for RBC changes often seen when presentation

onset may be insidious, later half of infancy -low hgb and hct -hematologic studies -RBC changes often seen by 6 weeks of age presentation: severe anemia, growth failure

Therapeutic management for juvenile hypothyroidism adolescents show? what to know about digitalis?

oral TH replacement -prompt tx for brain growth in infant -compliance with med regiment is crucial!!! adolescent show lethargy and lack of response digitalis: go slowly bc can impact cardiac status

child presents in ped clinic where parent reports that his facial features appear coarser than before and new onset of hyperhidrosis. which dx test does nurse prepare the parent and pt for? 24 hr UA anti insulin antibdy oral glucose tolerance test serum hormone assay

oral glucose tolerance test

which area to assess cyanosis in dark skin?

oral mucosa

intervention for pain in infants, toddlers, preschoolers

oral/IV meds OTC, hold swaddle rock, sucrose solution for infant, bloubbles for toddler, preschoolers use distraction technique

anaplasia means lack of cell growth out of control growth slow deformed growth benign growth

out of control growth

meningitis intervention pain hydration infection ICP

pain Q4H with FLACC scale hydration: strict I&O, perfusion, daily weights, NPO upgrade as tol, monitor for SIADH infection: Abx, infection, lab ICP: irritability, LOC, frontal occipital circumference every shift, seizure precautions

5 Ps in compartment syndrome

pain, pallor, pulselessness, paresthesia, paralysis

sickle cell anemia (hemoglobinopathies) includes? causes? who to likely carry this? if both parents have it, what % chance of getting the disease pathophysiology prognosis (cure/tx?) why would they have freq bacterial infections and what does bacterial infection cause usual life span

partial or complete replacement of normal Hgb A with abnormal Hgb S includes: anemia, C disease, hgb E, ischemia disease causes: autosomal recessive disorder who is more likely to carry this disease: AA if both parents have it, 25% chance kid will hav eit pathophysiology: obstruction caused by sickled RBC vascular inflammation increased RBC destruction abnormal adhesion, entanglement, meshing of rigid-sickle shaped cells, local hypoxia, cellular death prognosis: No cure, bone marrow transplantation supportive care/prevention of sickling episodes frequent bacterial infections bc of immunocompromise and is the leading cause of death in young children usual life span into the fifrth decade

mother sees burrows on childs hand. what med does nurse teach mother about lindane malathion permethrin 5% spinosad

permethrin

care management of hemophilia

prevent bleeding with safe environment and dental hygiene recognize and control bleeding RICE prevent crippling effects of bleeding genetic counseling

Primary Secondary Tertiary PREVENTION

primary: identify those at risk and reduce stressors, factors, INCREASE social supports, coping measures, self esteem secondary: intervention to decrease stress, depression, social dysfunction, and care giver burden tertiary: healing and rehab to reduc traumatic aftereffects

primary hypothyroidism secondary hyperthyroidism

primary: thyroid can't produce amt of hormones pituitary calls for secondary: thyroid isn't being stimulated by pituitary to produce hormones

Diabetes insipidus (DI) principal disorder of? results from? produces? primary causes? secondary causes? priority concern? what to do daily result of? monitor? S/S: tx:

principal disorder of posterior pituitary results from hyposecretion of ADH*** produces uncontrolled diuresis primary cause: familial or idiopathic -secondary: trauma, tumors, CNS infection, aneurysm from head injury priority concern: fluid balance bc urinate alot weigh daily result of: injury, concussion, spina bifida, hydrocephalus, incision post op monitor: sodium, I&O, if someone came in for injury S/S: major I&O imbalance, increase in output treat: F&E replacement, drug-

nurse consults child life specialist to help plan care for a child who is immobilized and is increasingly anxious. what is priority intervention for this child? allowing school to provide a tutor providing diversional activities consulting a social worker admnistering pain med

providing diversional activities

relief of skin prevent scratching by:

pruritis: most common complaint with skin lesions cooling baths or compresses • Prevent scratching o Mittens/covering for younger children o Short nails o Antipruritic medications

parent calls clinic to ask about s /s of impetigo which info does nurse provide? erythema and swelling of fingers groups of small flesh colored or pink papules painful, watery blsters often near nose pustules that have honey colored exudate

pustules that have honey colored exudate

nodule

raised, caused by something underneath the skin, potentially a tumor - more serious

child safety rules with seats in car rear face at booster seat

rear face until height and weight 1 YO <20 lb booster seat: 4-7 YO

Apheresis

removal of blood from individual, separation of blood into its components

therapeutic management of hemophilia IV admin or nasal spray of? what prevents clot destruction

replace missing clotting factor by replacement therapy with factor concentrate and home infusion IV or nasal spray of Desmopressin DDAVP which causes 2-4x increase in factor VIII activity, and used for mild hemophilia prevents clot destruction: aminocaproic acid

what is major concern if upper body/face is involved? upper airway obstruction may require?

respiratory trauma following inhalation of heated gases and toxic chemicals produced during combustion -heat damage below vocal cords is rare -***upper airway obstruction may require endotracheal intubation

sickle cell therapeutic management possible prophylactic abx for how long monitor what count? blood transfusion may what?

rest to minimize energy loss hydration through oral or IV electrolyte replacement analgesia for pain blood replacement for anemia Abx for infection possible prophylactic abx for 2months to 5 years monitor for reticulocyte count regularly to evaluate bone marrow function blood transfusion may reduce ischemia if given early in crisis

second degree burn how can you get it? how does it look like? feeling?

scalds, flash flame -blistered, moist, serous drainage, edema, mottled pink or red, reddened, blanches on pressure and refills -very painful, sensitive to touch

a child has lice. parent wants to know what to do with childs stuffed animals. which response most appropriate seal in plastic bag in garage for two weeks spray with anti lice fumigating product throw away, they can't be cleaned wash in hottest water possible and line dry

seal in plastic bag in garage for 2 weeks

Rape what is intent of rapist date rape

sexual act forced on another without consent intent of rapist to control, dominate, humiliate victim NOT for sexual pleasure Date rape: most times rape drugs used to overpower and incapacitate individual

what is SARS model what are nurses role

sexual assault resource service combines crisis intervention model and rape trauma syndrome into a model that provides acute care after rape and during LT healing process of rape trauma syndrome -nurses trained in Obs and mental health, oncall 24H, care for all raped individuals, provide emotional support nurses role: maintain nonjudgmental attitude, help regain control, find support, ensure personal safety be accepting and supporting encourage the reporting of rape be patient and tolerant don't let victim blame self assess level of anxiety, coping skills, support system

behavioral clinical manifestations of pain

short attention span, irritability, facial grimacing, biting, pursing lips, protecting painful area, drawing up knees, lethargic, withdrawn, sleep disturbances

child admitted for an allogeneic bone marrow transplant. nurse aware that donor marrow is coming from what source? cadaver child sibling lab created

sibling

nurse is preparing 7YO child to have cast removed from his leg which statement most appropriate to prepare child for procedure as soon as cast comes off you can get up and move around -sound of the cast saw is very loud and may be a little scary -you must sit very still so we dont accidentally hurt your leg =dont worry you will be asleep during the cast removal

sound of cast saw is very loud and may be a little scary

nurse assessing growth and dev in 4 YO child. which sentence indicates child is prob speaking appropriately for her age "i hungry no. no nap play ball with me i want to go to the park

splay ball with me

Burns Therapeutic management what to do ?? first priority whats critical in first 24 hours nutrition medication

stop burning process assess victim condition cover burn to prevent contamination transport to appropriate level of care provide reassurance • First priority: airway maintenance • Fluid replacement therapy: critical in first 24 hours • Nutrition: enhanced metabolic demands • Medication: antibiotics, analgesics, anesthetics for- procedural pain (debridement)

wound acute vs chronic fissure

structural or physiologic disruption of skin, activates tissue repair responses acute: heal unevenfully in 2-3 weeks chronic: does not heal in 3 weeks, associated with complications, systemic prob fissure: open wound

classification of cognitive impairment IQ mild moderate severe subaverage

subaverage: 70-75 or below mild: 50-70 moderate: 35-50 severe: 20-35

ped nurse is admitting a child with hx of seizure activity. what will nurse ensure is at bedside to implement seizure precautions ventilator suction equipment intubation equipment soft restraints

suction equipment

precautions to prevent sunburn in children

sun protection, stay in shade, cover

dermatophytosis (fungal infection) ringworm caused by how transferred example

superficial infections that live on the skin • Ringworm is caused by a group of filamentous fungi • Transmission from person to person or infected animal to human • Examples: tinea capitis, tinea corporis, tinea pedis, candidiasis

child dx with pituitary tumor. what medical management does nurse prepare child and family for? chemo radiation tx steroid infusions surgical removal

surgical removal

therapeutic management of acromegaly

surgical tx to remove tumor -radiation/radioactive implants -HRT after surgery in some cases (thyroid extract, cortisones, sex hormones)

what the RN tells family about sickle cell anemia and infections, and vaccinations

susceptible to infections and vaccinations may help prevent a crisis

pathophysiology of thermal injuries causes

systemic response involves capillary permeability causes: edema, hypovolemia, anemia

hyperthyroidism more in? nursing care? what type of environment? dietary requirements medications tend to become what?

tachycardia more in women -put in quiet room, dont encourage to have lots of friends and visitors and keep them in a calm and peaceful environment -meet childs increased metabolic rate, -meds for cardiac impact -tend to become tachypnea so want them to eat and have additional nutrtition

nurse working with children knows which burn is most common type in ped population? contact flame scald thermal

thermal

when kid cries about parent who passed away and say she went to sleep what do you say?

to honest and tell the kid that the mom did not die and to remind her that she died in a car accident

characteristics of burns depth of injury first, second, third, fourth degree severity of injury burn in face worry about?

total body surface area: use age related charts first: superficial second: partial thickness third: full fourth: full plus underlying tissue -burn in face worry about respiratory complications

Diabetes mellitis what type of disorder peak incidence comes with?

total or partial deficiency of hormone insulin -most common endocrine disorder -peak incidence 10-15YO -comes with DKA

therapeutic management of anemia care management of anemia

transfusion after hemorrhage if needed nutritional intervention for deficiency anemias supportive care: IV fluids to replace intravascular volume, oxygen therapy, bed rest care management: assessment of age racial or ethnic bg, careful hx, stool for occult blood, prepare for lab tests, decrease tissue oxygen needs, prevent complications

concussion results from loss of awareness and response how long it lasts? followed by? LOC is not a ?

transient and reversible**** resutsl from trauma to head instant loss of awareness and responsiveness lasting for minutes to hours followed by amnesia and confusion LOC is NOT a hallmart sign

therapeutic management of precocious puberty

tx discontinued at age for normal pubertal changes to resume psychological support

ped ICU nurse providing care with DIC. which tx option most appropriate for this pt tx underlying condition administer massive blood transfusions therapeutic hypothermia routine vit k admin

tx underlying condition

opioid analgesics **Morphine to treat route dosing based on safety--what to administer if child RR decreasing side effects

used to treat severe pain, preferred route: oral, IV dosing based on weight administer NARCAN if RR decreasing side effects: sedation, N/V, constipation, itching less common SE: resp depression, cardiovascular collapse, addiction some may have itching response

diaper dermatitis patho usually from? -nursing considerations cadidiasis of diaper area has? dermatitis candidiasis

usually from irritation of urine and feces, -detergents not rinsed from clothing or chemical irritation (diaper wipes) -candidiasis of diaper area has pustules and irritation dermatitis: red, raised candidiasis: swelling

wound care basics how to wash what to avoid open wounds clean after swimming why?

wash with mild soap and water and rinse -avoid povidone-iodine, alcohol, hydrogen peroxide cover open wounds by leaving wide margin of intact skin around dressing, remove if leakage occurs, clean after swimming bc it can become chronic (bacteria can cause infection)

when assessing for primary skin lesions on children, what does nurse look for? crusts keloids scales wheals

wheals

drug reactions AR most often seen in treatment

• Adverse drug reactions are most often seen in skin (rashes most common reaction) • May be immediate or delayed following administration of drug • Treatment: discontinue drug, antihistamines, corticosteroid therapy if very severe • Red, spotchy if drug reaction

what to monitor for during sedation

• Airway is patent • Respiratory effort, color, vital signs • Pulse oximetry • Level of consciousness • Emergency equipment and reversal medications are available

types of HSCT

• Allogenic: stem cells from a histocompatible donor • Transplantation of stems cells from umbilical cord blood • Autologous: stem cells from patient's own marrow • Peripheral stem cell transplantation

meds for increased ICP

• Antibiotics for infectious processes • Corticosteroids for inflammation and edema • Sedatives or antiepileptics • Sedation or amnesic anxiolytics • Barbiturates (controversial) • Paralytic agents

rehab after major burn

• Begins once wound coverage has been achieved • Prevention/management of contractures • Physical/occupational therapy • Multidisciplinary team • Facilitate adaptation of child and family

drugs used for sedation

• Benzodiazepines Diazepam (Valium) Midazolam (Versed) Lorazepam (Ativan) • Hypnotics/barbiturates Thiopental Pentobarbital • Methohexital • Ketamine • Propofol (Diprivan) or etomidate • Analgesics: Fentanyl

late signs of increasing ICP

• Bradycardia • Decreased motor response to command • Decreased sensory response to painful stimuli • Alterations in pupil size and reactivity • Extension or flexion posturing • Decreased consciousness • Coma

nervous system tumors brain tumors and neuroblastoma derived from? CNS tumor account for % of? tx?

• Brain tumors and neuroblastoma are derived from neural tissue • CNS tumors account for approximately 20% of childhood cancers • CNS tumors are difficult to treat, and survival rates are poor

etiology of Cognitive impairment

• Chromosome anomalies: anomalies—Down's syndrome; fragile X syndrome • Prematurity, low birth weight, postmaturity, Zika • Environmental influences: deprived environment e.g hx of MR among parents & sibs • Unknown prenatal influences: microcephaly, hydrocephalus, meningomyelocele • Psychiatric disorders with onset in childhood: autism • Intrauterine infection and intoxication • Trauma (prenatal, perinatal, postnatal) • Metabolic or endocrine disorders • Inadequate nutrition • Postnatal brain disease

functional impairments (adaptive skills)

• Communication • Home living • Community use • Leisure • Health and safety • Self-care • Social skills • Functional academics • Work • Self-direction

cranioschisis exencephaly anencephaly encephalocele rachischisis/spina bifida meningocele myelomeningocele

• Cranioschisis—A skull defect through which various tissues protrude • Exencephaly—Brain totally exposed or extruded through an associated skull defect; fetus usually aborted • Anencephaly—If fetus with exencephaly survives, degeneration of the brain to a spongiform mass with no bony covering; incompatible with life usually beyond a few days • Encephalocele—Herniation of brain and meninges through a defect in the skull producing a fluid-filled sac • Rachischisis or spina bifida—Fissure in the spinal column that leaves the meninges and spinal cord exposed • ****Meningocele—Hernial protrusion of a saclike cyst of meninges filled with spinal fluid (see Fig. 55-5, C) •*****Myelomeningocele (meningomyelocele) —Hernial protrusion of a saclike cyst containing meninges, spinal fluid, and a portion of the spinal cord with its nerves (see Fig. 55-5, D)

decorticate decerebrate

• Decorticate: arms to center, core • Decerebrete: arms stick out to side

lesions

• Erythema • Ecchymoses • Petechiae • Primary lesions • Macules, papules, vesicles • Secondary lesions • Distribution pattern • Configuration and arrangement

clincal manifestations of increased ICP in children

• Headache • Forceful vomiting • Seizures • Drowsiness, lethargy • Diminished physical activity • Inability to follow simple commands

subsequent complications of head injuries def of herniation nurses job

• Hypoxic brain injury • Cerebral edema • Increased ICP • Infection: especially for open head • Epidural hemorrhage • Subdural hemorrhage • Herniation: pressure from swelling pushes down and affects breathing/circulation • Nurse job: identify early changes with GCS*** any change should be REPORTED

age related skin manifestation infants early childhood school age adolescents

• Impetigo, warts, herpes, Contact, Acne • Infants: "birthmarks" • Early childhood: atopic dermatitis • School-age children: ringworm • Adolescents: acne

contact dermatitis type of reaction example

• Inflammatory reaction of skin to chemical • Initial reaction in the exposed region • Characteristic sharp delineation between inflamed and normal skin • Primary irritant • Sensitizing agent • Examples: diaper dermatitis, reaction to wool, reaction to specific chemical

clinical manifestations of increased ICP in infants

• Irritability, poor feeding • High-pitched cry, difficult to soothe • Fontanels: tense, bulging • Cranial sutures: separated • Eyes: setting-sun sign • Scalp veins: distended

neurologic diagnostic procedures

• LP, subdural tap, ventricular puncture • EEG (seizure disorder) • Radiography, CT, brain scan

classic behavioral features of Fragile X

• Mild-to-severe cognitive impairment/normal IQ with learning disabilities • Delayed speech and language • Hyperactivity • Autistic-like behaviors • Aggressive behaviors • Normal IQ with learning difficulties

observation of seizures: how long it lasts

• Onset • Behavior • Movement • Face • Eyes • Respirations • Incontinence

somatic reaction of rape physical trauma skeletal muscle tension GI irritability GU disturbance

• Physical Trauma (general soreness and bruising from the attack) • Skeletal Muscle Tension (tension headaches, fatigue, and sleep pattern disturbances) • Gastrointestinal Irritability (stomach pains, change in appetite, and nausea) • Genitourinary Disturbance (vaginal discharge, itching, a burning sensation on urination, and generalized pain. Rectal bleeding and pain with anal sex)

how to care for major burns how is skin graft done>

• Primary excision • Debridement • Topical antimicrobial agents • Biologic skin coverings o Allograft (human cadaver skin) o Xenograft (porcine skin) o Synthetic skin substitutes o Split-thickness skin grafts (sheet or mesh graft) skin graft done by taking skin frmo somewhere else of victim body

poison ivy, oak, sumac produces caused by penetrates through

• Produces localized lesions • Caused by urushiol from plant's leaves and stems • Sensitivity may develop after one or two exposures and may change over time • Penetrates through the epidermis and bonds with the dermal layer • Hawaii- mangos,

infections transmitted by arthropods what is transmitted by infected fleas, ticks, mites/. most common tick-borne disorder? focus on?

• Rickettsiae: Rocky Mountain spotted fever transmitted by infected fleas, ticks, and mites • Lyme disease: most common tick-borne disorder in United States • Vaccine against Lyme disease • Focus on prevention

therapeutic management for Fragile X

• Tegretol/Prozac—behavioral control • Stimulants for hyperactivity (similar to attention-deficit hyperactivity disorder management) • Referral to early intervention program-best outcomes • Expected to live a normal life span • Genetic counseling bc it is a genetic disease

Wiskott aldrich syndrome

• Thrombocytopenia • Eczema • Immunodeficiency of selective functions of B lymphocytes and T lymphocytes • X-linked recessive inheritance

• When both parents have sickle cell trait, what is the chance that each of their children will have sickle cell anemia? A. 25% B. 50% C. 75% D. 100%

A

chicken pox

A highly contagious viral infection causing an itchy, blister-like rash on the skin. red spots all over

Which snack is best for the nurse to provide David?

A peanut butter sandwhich

meds to treat ADHD autism

ADHD: stimulants autism: antidepressants,

potentially fatal complication that may occur when patient has sickle cell crisis

CVA, HF

Postoperative surgical patients should be given acetaminophen and _______________ in scheduled doses throughout the postoperative course, unless contraindicated. A. Antihistamine. B. Local anesthetic. C. Opioids. D. Nonsteroidal anti-inflammatory drug (NSAID).

D Unless contraindicated, all surgical patients should routinely be given acetaminophen and an NSAID in scheduled doses throughout the postoperative course. Opioid analgesics are added to the treatment plan to manage moderate-to-severe postoperative pain. A local anesthetic is sometimes administered epidurally or by continuous peripheral nerve block.

Which intervention has the highest priority?

Ensure meticulous hand washing before and after David's care

if there is a problem in endocrine what do you see

GROWTH problems

Which behavior indicates to the nurse that Earlene understands about acute exacerbations of sickle cell anemia?

She demonstrates how to accurately read an oral thermometer.

How should the nurse respond?

The healthcare provider will make an incision in David's leg to relieve the pressure

cognitive impairment definition & diagnosis

any type of mental difficulty or deficiency used with intellectual disability (cognitive impairment) diagnosis: made after a period of suspicion by family or health pro, some made at birth

when teaching parents of child dx with VW disease, which info most appropriate for nurse to provide boys affected twice as often as girls only female children affected boys and girls affected equally often not inherited and occurs randomly

boys and girls affected equally often

exencephaly anencephaly what happens to brain and skull?

brain exposed or extruded through skull defect and fetus is usually aborted if fetus survives degeneration of brain to a spongiform mass occurs brainstem function may be intact incompatible with life beyond a few days

nurs provides teaching to parents of 6YO being dx after chemo. which instruction by nurse most appropriate do not allow child to play with other children for few days be sure to encourage child to brush teeth vigorously every day if child feels warm take temp rectally bring child to ED for fevere of 101.2

bring child to ED for fever of 101.2

why can't you give tylenol to kids

can cause Reyes syndrome

how toddlers report pain

can usually understand concept of "more or less" 3 choices on pain scale: none, some, alot

scabies caused by when does inflammation occur treatment?

caused by mite as female burrows into epidermis to deposit eggs and feces -inflammation occurs 30-60 days later -topical tx scabicides (permethrin or lindane) and oral tx : ivermectin if body weight >15 kg

management of hypoglycemia symptoms of hypoglycemia

check sugar if having tantrums/cries give OJ if <70 or glucose tabs/gels, gumdrop, honey, raisins, soda cake icing, recheck in 15 minute if <70 then give another OJ symptoms: acting out, arguing in adolescents, fussy

pediculosis capitis (head lice) common in what children? where do they lay eggs nits hatch in how many days? tx? prevention?

common in school age -female lay eggs at base of hair shaft -nits hatch 7-10 days -tx: pediculicides and removal of nits -prevention of spread and recurrence

nursing care for child with impaired cognitive function

communication, discipline, socialization, sexuality, helping families adjust to future care, verbal skills may be delayed so may need hearing and interpretation (recessive and expressive skills) and sign learn sign language need discipline like normal children- limit setting socialization is needed teach adolescents about sexuality inquire about childs skills when hospitalized

how to prevent CI prenatal

counseling, education regarding nutrition and tobacco dangers of chemicals including exposure to alcohol rubella immunization genetic counseling folic acid supp

increased ICP consists of caused by manifestations in infants and children Late signs

cranium brain 80%, CSF 10%, blood 10% -caused by: trauma, bleeding, edema, tumors bc it puts pressure in the brain manifestations: o Infants- bulging fontanels (bc its soft), irritability, high-pitched cry, drowsiness o Children- headache, N/V, diplopia, seizures, lethargy, inability to follow simple commands • Late Signs: Bradycardia, altered pupil response, decreased response to commands and pain, cheynes stokes resp., posturing, coma

pituitary disorders may be due to? clinical manifestation depend on may result in?

d/t ORGANIC (can identify cause) or idiopathic clinical manifestation depend on hormone involved may result in overproduction or deficiency of hormone

child with DI being monitored for fluid balanch. which assessment most accurate way to determine fluid balance? daily weight hemodynamic monitoring I&O urine osmolality

daily weight

care management of sickle cell crisis

educate family and child, early intervention for giver, penicillin recognize S/S of splenic sequestration provide supportive therapies during crisis meet psychosocial needs of family

clinical manifestation of lymphocytic thyroiditis tracheal?

enlarged thyroid gland, usually symmetric, firm, nontender, freely moveable tracheal compression, sense of fullness, hoarseness, dysphagia (hard to swallow)

common in sexual abuse done by?

father/step dad/moms bf

gigantism in? acromegaly in?

gigantism in children acromegaly in adults

DDH developmental dysplasia of the hip

if theres creases on hip when on their stomach. can hear click , dislocation of the hip , hip joint

Type 2 DM onset who is at risk may require what

insulin resistance, onset at 40 YO risk: native american, hispanic, AA may require insulin injections

child has hearing loss following several ear infections. which assessment is priority for this child language prob balance prob head size out of norm metabolic disorders

language prob

clinical manifestations of Fragile X

long face with prominent jaw (prognathism) large protruding ears, large testes (macro-orchidism), less obvious in prepuberty, characteristics vary in female

child admitted with neutropenia. which nursing action takes place? place in contact isolation maintain strict handwashing disinfect belongings brought from home do not allow visitors in childs room

maintain strict handwashing

pain tools for neonate infants children with communication and cognitive impairment

neonate: CRIES, PIPP, NIPS infants: FLACC, NIPS children with comm and cog impairment (noncommunicating childrens pain checklist)

NTD patho how to prevent prenatal detection

neural tube doesn't form right and brain or spine is damage that happens w/in first few weeks of pregnancy often before woman knows she is pregnant patho: failure of NT to close during embryos early development (3-5weeks), multifactorial etiology, genetic mutation in folate pathways maternal obesity, DM, low B12 status take Folic acid (B9) to prevent 0.4 mg/day begin at preconception and will prevent 50-70% of all cases prenatal detection: • Elevated alpha-fetoprotein in amniotic fluid; 16 to 18 weeks of gestation • Uterine ultrasound-extent of lesion • Possible termination before 20-24 weeks • Chorionic villus sampling • Elective prelabor cesarean birth may lead to decreased motor dysfunction- protect sac from rupture • Amniocentesis of AFP • U/S—extent of lesion • Possible termination before 20-24 weeks • Schedule C/S to manage sac without labor/stress

palliative vs hospice care

palliative: pain and symptom management hospice care:

aplastic anemia pancytopenia? hypoplastic anemia? causes: therapeutic management nursing care

pancytopenia: simultaneous depression of all formed elements of the blood -profound anemia, leukopenia, thrombocytopnia hypoplastic anemia: profound depression of RBCs but normal WBC and platelets causes: primary (congenital) and secondary (acquired) therapeutic management: immunosuppresive therapy, bone marrow transplantation nursing care: similar to that of leukemia

which endocrine gland responsible for calcium metabolism adrenal hypothalamus parathyroid thyroid

parathyroid

what does folic acid for prenatal care

prevents spina bifida

Clinical manifestations for Mobility primary prevention screening collaborative interventions pharmacologic agents

primary: physical activity, protect against injury, nutrition, fall prevention measures screening: fall assessment screening collaborative interventions: turn reposition, align; skin assessment and care; ROM, deep breathing, weight bearing, measures to optimize elimination, nutrition, exercise (ambulation, joint mobility, stretching, balance) pharmacologic agents: antiinflammatory agents, analgesics, nutrition supplementation

reduced immune response increases...

risk for infection. keep them comfortable and any unresolved pain should be reported to MD

precocious puberty occurs more in? potential causes? ethnic differences african american girls show signs of puberty at what age

sexual development before 9YO in boys/<8YO in girls -occurs more in GIRLS -potential causes: disorder of gonads, adrenal glands, hypothalamic pituitary gonadal axis ethic diff: girls might enter full blown puberty anytime between 9-15YO, boys 11-17 AA at 8.8 YO

what to delegate to UAP regarding a patient receiving unit of blood?

take hourly VS

sick day rules

take insulin even if they're sick check BS Q4H ketone testing with each void give calorie containing liquids in place of solid foods follow usual meal plan encourage rest and sleep notify MD with concerns

what is nurses responsibility in educating families about hwo to care for child at home after minor surgery -test rectal temp -assess childs LOC -teaching S/S of infection -teaching signs of poor air exchange

teach s/s of infection

thyrotoxicosis may occur from may be precipitated by Treatment

thyroid crisis or storm HR 180-190 may occur from sudden release of hormone may be precipitated by infection, surgery, discontinuation of antithyroid therapy tx: antithyroid drugs, propanolol, cardiac implications is most serious

nursing care management of goiter

thyroid enlargement at birth may compromise airway, become noticeable during periods of rapid growth

Latex allergies whos at risk

urogenital anomalies, multiple surgeries, VATER association, preterm infants, venticuloperitoneal shunt, cerbral palsy, quadriplegia

impetigo

usually in face, bacteria infection and contagious

management of hematologic disorders blood transfusion therapy what to do use blood within? infuse over? monitor for? what are some transfusion rxn?

verify identity of recipient and donors blood monitor VS, use appropriate filter use blood within 30 min of arrival infuse over 4 hrs max monitor for transfusion rxn transfusion rxn" hemolytic, febrile (fever, chills), allergic rxn: urticaria, pruritis, laryngeal edema, air emboli may occur when blood transfused under pressure hypothermia

nonbacterial meningitis (aseptic) caused by freq associated with onset manifestations tx

virus associated w/ measles, mumps, herpes, leukemia -abrupt or gradual onset -manifestations: HA, fever, malaise Tx: symptomatic

when is chicken pox not contagious

when the lesions are completely dried up

violence is high in what type of people?

with psychiatric illness: psychotic features, borderline/antisocial personality, substance abuse disorders

severe combined immunodeficiency disease

• A defect characterized by the absence of both humoral and cell-mediated immunity - Swiss-type lymphopenic agammaglobulinemia - X-linked agammaglobulinemia - History of recurrent severe infections from infancy

characteristics of abusers

• A history of abuse, neglect, or emotional deprivation as a child • Family authoritarianism: raise children as they were raised by their own parents • Low self-esteem, feelings of worthlessness, depression • Poor coping skills • Social isolation (may be suspicious of others): few or no friends, little or no involvement in social or community activities • Involvement in a crisis situation: unemployment, divorce, financial difficulties • Rigid, unrealistic expectations of child's behavior • Frequent use of harsh punishment • History of severe mental illness, such as schizophrenia (they're hearing voices, not • Violent temper outbursts • Looking to child for satisfaction of needs for love, support, and reassurance (often unmet because of parenting deficits in family of origin) • Projection of blame onto the child for parents' "troubles" (e.g., stepparent may project hostility toward new mate onto a child) • Lack of effective parenting skills • Inability to seek help from others • Perception of the child as bad or evil • History of drug or alcohol abuse • Feeling of little or no control over life • Low tolerance for frustration • Poor impulse control

hematopoietic stem cell transplantation HSCT for leukemia donors antigen peripheral stem cells

• Donors: may be relatives or nonrelatives • Antigen matched or mismatched • Peripheral stem cells: may be used • Umbilical cord blood • Graft-versus-host disease • Severe organ damage

systemic mycotic (fungal) infections

• Invade viscera and skin • Wide spectrum of disease • May appear as granulomatous ulcers, plaques, nodules, and abscesses

consequences of HYPOglycemia

Irritability Fatigue Mental confusion Seizures Unconsciousness Potentially leads to cellular death

common symptoms associated with altered mobility

Pain Reduced joint movement Reduced sensation or loss of sensation Falls Fatigue Altered gait or imbalance Reduced functional ability Examination Techniques

How should the nurse explain to David the rationale for wearing these pressure garments?

"The pressure stocking will help prevent scarring that could occur while the burn is healing"

How should the nurse respond about skin graft

"The skin will probably be taken from you son's back"

respiratory management in unconscious child primary concern cerebral hypoxia lasts what does pCO2 cause? have minimal? risk of?

****airway management primary concern ***-cerebral hypoxia lasts >4 min may cause irreversible brain damage -pCO2 causes vasodilation which increases cerebral blood flow and increased ICP (keep O2 and CO2 in normal level

therapeutic management for DMD primary goal

****no effective tx, keep child as active as possible, genetic counseling for family primary goal: maintain function in unaffected muscles as long as possible range of motion, bracing, performance of ADL, surgical release of contractures prn

Which intervention(s) will meet David's needs during his hospital stay?

-Provide David with compact discs and video games -Obtain a laptop computer with internet access for David

thalassemia what type of disorder deficiency in what affects who more pathophysiology anemia results from overabundance or erythrocytes is found in where

-genetic disorder -deficiency in rate of production of globin chains in the hgb -affects descendents of ppl living near mediterranean sea pathophys: normal postnatal hgb includes 2 a and 2 b thalasessemia chains -anemia results from defective synthesis of hgb, structural impairments of RBCs, shortened life of RBC -overabundance of erythrocytes is found in bone marrow

iron deficiency anemia caused by generally preventable by pathophysiology therapeutic management nursing care management

-inadequate supply of dietary iron -generally preventable by: iron fortified cereals and formulas for infants, special needs for premature infants, adolescents at risk bc of rapid growth and poor eating habits -pathophysiology: many number of factors, "milk babies" -therapeutic management: increase in amount of iron the child receives -nursing care management: diet, iron supplementation

first degree burn how can you get it? how does it look like? feeling?

-sunburn, low intensity flash, brief scald -dry surface, red, blanches on pressure and refills, minimal or no edema -painful, sensative to touch

which children at high risk for abuse

1. Children who have physical, mental, or emotional problems (premature birth, hyperactivity, congenital defects, product of a multiple birth, or chronic illness). 2. Family is experiencing high levels of stress 3. One or both parents have a history of child abuse, depression, anxiety, social isolation, or substance abuse 4. One or both parents currently use or abuse substances 5. Society approves the use of force to punishment or discipline children 6. Unplanned pregnancies 7. Lack of economic resources and social supports 8. Inadequate living conditions

characteristics of adult survivors of incest

1. Lack trust (unsatisfactory mother / child relationship) 2. Low self-esteem 3. Poor sense of identity 4. Feel trapped (encouraged not to tell others / possible threats) 5. Tell mom and often she does not believe them and this is confusing to the child (child left with self doubt and inability to trust own feelings)

reporting elderly abuse may be problematic bc?

1. Seldom reported, because both the abuser and victim frequently deny / ignore its occurrence. It is difficult to prove and frequently the victim's level of competence is questioned. 2. Elderly fear being placed in an institution, would put up with anything to stay in their home. 3. Elderly have fears about abandonment, reprisals, shame, and embarrassment. 4. Some accept the abuse from one generation to the next. 5. Problems with legal, medical, and social barriers: a. Client competency -who is legally responsible for this person. b. Social Service can't walk into a person's home without the owner's permission. c. Clients will frequently not prosecute their family members. d. Difficult to prove injuries in this population, because of their high risk for falls.

Elder abuse % and what age types of abuse -characteristics of abused

10% of older adults age 65+ -physical assault, rough handling, withholding food, personal/medical care, abandonment, psychosocial, financial, emotional/sexual abuse

hodgkin lymphoma more prevalent in what age classification diagnostic eval biopsy for dx and staging with presence of? what to do with advanced disease therapeutic management care management

15-19 YO classification: Ann Arbor staging system classfication A: asymptomatic B: temp of 38degreee C or higher for 3 consecutive days, night sweats, unexplained weightloss of 10% or more over 6 mon enlarged cervical or supraclavicular lymphadenopathy, cough, abdominal discomfort, anorexia, presence of Reed Sternberg cells advanced disease: bone marrow aspiration therapeutic management: radiation, chemo, care management: prep for procedures, SE, family support

B thalassemia has how many types

4 types minor: asymptomatic silent carrier trait: mild microcytic anemia intermediate: moderate to severe anemia plus splenomegaly major: needs transfusions to survive

nonhodgkin lymphoma more prevalent in what age originates where primarily involves what often metastasizes to where clinical appearance cell type dissemination mediastinal involvement and invasion of what

<14 YO neoplastic disease originating in lymph system primarily involves lymph nodes often metastasizes to spleen, liver, bone marrow, lungs other tissues clinical appearance: usually diffuse not nodular,

range S/S of hypoglycemia

<70 reduced cognition tremors diaphoresis weakness hunger headache irritability seizure

range S/S of hyperglycemia

>100 in fasting or 140 when not fasting polyuria polydipsia dehydration fatigue fruity odor to breath kussmaul breathing weight loss hunger poor wound healing

1. The family scenario that presents the greatest risk for family violence is: a. A husband who is unemployed and has low self-esteem associated with lack of employability, a wife who loses her job, and a developmentally delayed 3-year-old son. b. A husband who finds employment 2 weeks after a layoff from his previous job, a wife who has stable employment, and a child doing well in school. c. A single mother with an executive position, a 10-year-old precocious daughter, and a widowed grandmother living in the household to provide childcare for the 10-year-old child. d. A single gay male parent, an adolescent son who has just begun dating girls, and the father's unmarried sister who has come to visit for 2 weeks.

A

10. The nurse is counseling an extremely distressed female victim immediately after a sexual assault. What is the nurse's most important initial intervention? a. Reassure the victim that the sexual assault was not her fault. b. Ask the client to provide a sample of pubic hair for the evidence kit. c. Collect a serum specimen for pregnancy testing. d. Teach the client about the risk for sexually transmitted infections.

A

2. An 18 month-old client is scheduled for a minor surgical procedure. The client has numerous large bruises of different stages over back and buttocks. The mother states that the child must have fallen down while playing alone outside but cannot provide specific information about these incidents. How should the nurse evaluate this situation? a. Possible abuse b. Immature parenting c. Normal findings in an 18 month-old d. Indications of tissue fragility

A

4. A pregnant female comes to the emergency department with bruises on her arms and abdomen after a fight with her boyfriend. What is most important for the nurse to address when teaching this client? a. Risks of pregnancy complications caused by abuse b. Assertiveness training to deal with the boyfriend c. Childbirth classes to prepare for the birth d. Instructions on the use of resources available to her

A

9. An older adult has been admitted to the hospital for dehydration. The client is poorly dressed, has body odor, appears unkempt, and has numerous unexplained bruises. In addition, he states that he has not been receiving his medications from his caregiver. What is the nurse's priority initial action? a. Determine if the client is experiencing abuse or neglect. b. Contact the appropriate elderly protective services agency. c. Explore methods of rehydration attempted at home. d. Inquire about medications the client is taking.

A

A patient is not certain whether she and her family should participate in a genetic screening plan. She asks the nurse why the X-linked recessive disorder that has been noted in some of her family members is expressed in males more frequently than in females. What is the nurse's best response? A. "The disease tends to show up in males because they do not have a second X chromosome to balance the expression of the gene." B. "One X chromosome of a pair is always inactive in females. This inactivity effectively negates the effects of the gene." C. "Females are known to have more effective DNA repair mechanisms than males, thus negating the damage caused by the recessive gene." D. "Expression of genes from the male's Y chromosome does not occur in females, so they are essentially immune to the effects of the gene."

A

Children are most often enticed to join a gang because it offers them? a. A sense of belonging b. Mechanism to gain wealth c. An opportunity for acting out d. Activities that are purposeful

A

During the nurse's initial assessment of a school-age child, the child reports a pain level of 6 out of 10. The child is lying quietly in bed watching television. The nurse should? A. Administer the prescribed analgesic B. Ask the child's parents if they think the child is hurting C. Reassess the child in 15 minutes to see if pain rating has changed D. Do nothing, since the child appears to be resting

A

Of the reported rapes, most arte committed by? a. Acquaintances b. Father / Stepfather c. Husband / ex-husband d. Strangers

A