NCLEX OB and PEDs

Shoulder distortia

Definition - Failure of usual obstetric maneuvers to deliver fetal shoulders Risk factors - Fetal macrosomia - Maternal obesity - Excessive pregnancy weight gain - Gestational diabetes mellitus - Postterm pregnancy Warning signs - Protracted labor - Retraction of fetal head into the perineum after delivery (turtle sign) NEEED TO FACILITATE RAPID BIRTH Flex maternal thighs back toward abdomen

The nurse is caring for a 2-week-old client who has tetralogy of Fallot. Which assessment finding is a priority to report to the health care provider? 1. Hematocrit level of 67% (0.67) 2.Murmur on heart auscultation 3.Newborn becomes fatigued during feeding 4.Weight gain of 0.6 lb (0.27 kg) since birth

Hematocrit 67% Infants with tetralogy of Fallot (TOF), a cyanotic cardiac defect, experience chronic hypoxemia due to decreased pulmonary blood flow and circulation of poorly oxygenated blood. To compensate for prolonged tissue hypoxia, erythropoietin production increases to produce additional oxygen-carrying RBCs. The increase of RBCs is known as polycythemia (ie, elevated hemoglobin and/or hematocrit) and results in increased blood viscosity. Clients with polycythemia require close observation because of an increased risk for blood clotting (ie, thrombus formation), which can cause stroke. Therefore, an elevated hematocrit level is a priority to report to the health care provider because additional interventions (eg, IV hydration, potential partial exchange transfusion) may be warranted (Option 1).

Hydrocephalus

Hydrocephalus results in the buildup of CSF in the brain and can cause symptoms of increased ICP (eg, headache, vomiting). Fever and nuchal rigidity are not expected. Treatment includes ventriculoperitoneal shunt placement to drain excess CSF from the brain.

Betamethasone

IM corticosteroid Corticosteroids accelerate fetal lung maturity by stimulating surfactant production, which reduces the risk of respiratory distress syndrome following birth. Interventions to delay preterm birth (eg, tocolytics) are simultaneously indicated so corticosteroids can have greater efficacy

Why penicillin for preterm birth?

IV antibiotics for group B Streptococcus (GBS) prophylaxis (eg, penicillin): During pregnancy, the client is screened for GBS colonization around 36 weeks gestation. If labor occurs before that time, antibiotic prophylaxis is indicated until results of a GBS test are known because the newborn at preterm gestation is at high risk for neonatal sepsis if infected. Antibiotics are most effective if administered at least 4 hours prior to a vaginal birth

Toilet training

Toilet training is a major developmental achievement for the toddler. The degree of readiness progresses relative to development of neuromuscular maturity with voluntary control of the anal and urethral sphincters occurring at age 18-24 months. Bowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years. In addition to physiological factors, developmental milestones rather than the child's chronological age signal a child's readiness for toilet training. These include the ability to: Communicate the need to use the toilet and follow directions Ambulate to and sit on the toilet Remain dry for several hours or through a nap Pull clothes up and down Imitate the toilet habits of adults or older siblings Express an interest in toilet training

fifth disease

slapped face appearance viral illness caused by the human parvovirus and affects mainly school-age children. The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. The child will have a distinctive red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces. The child may have general malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. Affected children typically recover quickly, within 7-10 days. Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition.

Epiglottitiis

supraglottic inflammatory process occurs most commonly with children Haemophilis influenzae type B (HiB) manifestations - restlessness - stridor - drooling EMERGENCY - need endotracheal intubation

Kawasaki disease

systemic vasculitis of childhood > 5days of - fever -nonexudative conjunctivitis -lymphadenopathy -mucositis -hand and foot swelling -maculopapular rash First line tx - IVIG - aspirin to prevent coronary artery aneurysm Hallmark findings - irritability - joint pain - skin pealing

Placental abruption

the placenta seperates from the uterine wall while the fetus is in utero. Manifestations would include abdominal rigidity, firm uterine resting tone between contractions, fetal heart rate abnormalities (eg, late decelerations), and dark-red vaginal bleeding.

extrapyramidal symptoms

- acute dystonia: involuntary muscle contraction - akathisia: motor restlessness and repetitive movements -pseudoparkinsonism: shuffling gait and muscle rigidity - tardive dyskinesia: uncontrollable rhythmic movement

chest tube drainage for infant when to notify provider

3mL/kg/hr for 3 consecutive hours or 5-10mL/kg in 1 hour

Boggy uterus deviated to the right and slightly above the umbilicus and saturated perineal pad in <1hr = excessive

Assist to bed pain uterine atony = boggy then perform a fundal massage Oxytocin is a uterotonic that increases contraction of the myometrium, constricting vessels at the previous placental implantation site. An oxytocin infusion should be initiated if initial attempts to control postpartum bleeding (relief of bladder distention and fundal massage) have failed. The usual postpartum oxytocin IV dosage is 125-200 milliunits/min.

Management of shoulder dystocia (BE CALM)

B Breathe; do not push E Elevate legs & flex hips, thighs against abdomen (McRoberts) C Call for help A Apply suprapubic pressure L EnLarge vaginal opening with episiotomy M Maneuvers: Deliver posterior arm Rotate posterior shoulder (Woods screw): apply pressure to anterior aspect of the posterior shoulder Adduct posterior fetal shoulder (Rubin): apply pressure to the posterior aspect of the posterior shoulder Mother on hands & knees: "all fours" (Gaskin) Replace fetal head into pelvis for cesarean delivery (Zavanelli) SUPRAPUBIC PRESSURE

Hemophilia child hit head reports n and headache

bleeding disorder caused by a deficiency in coagulation proteins. Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention. Clients with hemophilia who are injured should be monitored closely for bleeding (eg, intracranial bleeds, bleeding into joints). Signs of an intracranial bleed include lethargy, headache, irritability, and vomiting. An intracranial bleed is lethal if not managed urgently; therefore, administration of factor VIII is the priority for this client A CT scan should be performed for diagnostic purposes, but the bleeding must be managed urgently. Even if bleeding is evident on the CT scan and the client is taken to surgery, the procedure cannot be performed without simultaneous factor VIII replacement.

osteogenesis imperfecta

brittle bone disease Osteogenesis imperfecta (OI) (brittle bone disease) - is a rare genetic condition resulting in impaired synthesis of collagen by osteoblasts. - Collagen allows bone to be somewhat flexible while still maintaining strength. - Impaired collagen causes bones to be frail and easily fractured. Clinical manifestations - can range from mild defects to lethal disease in utero. OI is usually transmitted by autosomal dominant inheritance. - The nurse's priority for a client with OI is careful handling to minimize additional fractures. Care of the infant with OI includes: - Checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs (Option 3) - Lifting the infant by slipping a hand under the broadest areas of the body (eg, back, buttocks) so the pressure is distributed - Repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull

Varicella-Zoster

chicken POX or staph aureus Vesicular lesions

Atopic Dermatitis (Eczema)

chronic skin disorder characterized by pruritus, erythema, and dry skin. In infants, red, crusted, scaly lesions may also be present. It is commonly first diagnosed before age 1 year. The exact cause is unknown, although it is associated with an impaired skin barrier that allows penetration of allergens, leading to an immune response. The primary goals of management are to alleviate pruritus and keep the skin hydrated to prevent scratching. Scratching leads to the formation of new lesions and predisposes to secondary infections. Important measures to prevent scratching include cutting and filing nails short, placing gloves or cotton stockings over the hands, not wearing rough fabrics or woolen clothing, and applying moisturizer. These measures would have an immediate effect in preventing scratching.

Anticipated findings in a newborn less that 31 weeks?

decreased muscle tone Lanugo difficulty with thermoregulation NO SWALLOW REFLEX UNTI 32 weeks brief episodes of apnea

Preterm labor risks

diagnosed when regular, painful uterine contractions cause progressive cervical dilation and effacement before term gestation. A client may have risk factors for PTL including a prior preterm birth, short cervical length, maternal infection, or uterine overdistension from multifetal gestation (eg, twins). Clients who report signs of labor (eg, painful, frequent contractions; lower back pain) often require one or more vaginal examinations as prescribed by the health care provider to diagnose labor (eg, perform vaginal examination on admission and repeat in 1-2 hr). Cervical dilation of ≥2 cm or advancing dilation and effacement (eg, cervix changed from 2 cm dilated and 25% effaced to 3 cm dilated and 50% effaced) at <37 weeks gestation confirms this client's probable diagnosis of PTL

Increased caput succedaneum

edema of soft tissue of fetal scalp prolonged pressure difficulty moving through the birth canal

Late decelerations

fetal hypoxemia

Scabies

highly contagious skin infestation easily spread skin to skin intense itching tx - scabicide cream (Permethrine) all skin surfaces except around eyes - All person close contact should be treated - wash linens in HOT water

Placenta Previa

implantation of the placenta partial or complete covering of the cervical os PAINLESS vaginal bleeding after 20 weeks gestation nurse - type and screen blood - 2 large bore IV's - Electronic fetal monitoring - pad counts to assess bleeding DO NOT perform vaginal exam can damage placenta

Influenza

incubation period 1-4 days peak transmission 1 day before symptoms appear Lasts 5-7 days transferred by inhaled droplets

Bacterial meningitis

infection that causes inflammation of the membranes covering the brain and spinal cord (ie, meninges). This is a rare, life-threatening complication of neurosurgery. Inflammation and bacterial growth within the meninges lead to increased cerebrospinal fluid (CSF) volume and increased intracranial pressure (ICP). Without intervention, increased ICP may lead to nerve ischemia and permanent functional impairment (eg, hearing loss, visual impairment, paralysis), brain herniation, or death. The initial priority is protecting other clients and staff from exposure because bacterial meningitis is highly contagious. Once the client is isolated, diagnostic testing (eg, lumbar puncture, blood cultures) is performed, and broad-spectrum antibiotics (eg, ceftriaxone, vancomycin) are initiated. Antibiotic administration should not be delayed because bacterial meningitis can rapidly become fatal without treatment.

Kwasaki disease

inflammatory condition of unknown origin that causes systemic vasculitis (ie, blood vessel inflammation) in children. The coronary arteries are especially vulnerable, and life-threatening coronary artery aneurysms and heart failure may occur. Clinical manifestations of KD\ - high fevers unresponsive to antibiotics or antipyretics, -conjunctivitis - strawberry tongue (mucositis) - swollen and cracked lips, and erythema of the hands and feet with skin peeling (ie, desquamation). - fever > 5days - cervical lymph node> 1.5cm treatment - IV immunoglobulin (increases plasma oncotic pressure pulls fluid into the intravascular space can lead to fluid overload) - aspirin (risk of reyes syndrome BUT with KD benefit outweighs risks) MONITOR signs of heart failure (S3 gallup heart sound, tachycardia, decreased urine output)

Braxton Hicks contractions

irregular, often painless contractions that occur throughout pregnancy and do not result in cervical dilation. In contrast with true labor contractions, Braxton Hicks contractions typically dissipate with comfort measures (eg, increased fluids).

Fetal Alcohol syndrome

leading cause of intellectual disability and developmental delay in the United States. Diagnosis includes history of prenatal exposure to any amount of alcohol, growth deficiency, neurological symptoms (eg, microcephaly), or specific facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures). Asking about alcohol use during pregnancy can identify newborns and infants who are at risk for FAS. Family support, early intervention, and prevention for subsequent pregnancies are important for families with an infant with this diagnosis.

nephrotic syndrome

massive proteinuria hypoalbuminemia severe edema daily dipstick urinalysis to determine loss of protein

Epstein pearls

multiple small, white-yellowish, epithelial inclusion cysts found in the midline of the palate in newborn infants small, white cysts found on the hard palate of newborns. These cysts are considered common findings, and they disappear a few weeks after birth.

intussusception

occurs when the intestine telescopes, or slides, into another part of the intestine. Clinical manifestations include - sudden abdominal pain, - bilious vomiting, - a sausage-shaped abdominal mass, and stool that contains mucus and blood (ie, currant jelly stool). Treatment involves -an air enema to "push" the telescoped portion of the intestine back into a normal position.

Candida albicans

oral thrush Manifestations include white patches on the oral mucosa, palate, and tongue The patches are nonremovable and tend to bleed when touched. The affected infant may have difficulty sucking or feeding due to the associated pain. Thrush is generally linked to antibiotic therapy or poor caregiver hand hygiene. The infection is usually self-limited, but treatment with a fungicide (eg, nystatin) may quicken recovery.

Signs of labor

painful contractions that do no decrease with normal comfort measures lower back pain that radiates to the abd regular frequency of contractions 2 or greater in 10 mins or contraction every 5 mins progressive effacement and dilation cervix dilated from 3-5

Valporate (Depakote) used in utero?

SPINA BIFIDA neural tube defects

Cigarette smoking in utero puts child at risk of

perinatal loss, sudden infant death syndrome, low birth weight, and prematurity. Specific facial characteristics or syndromes are not typically caused by tobacco exposure in utero.

Misoprostol (Cytotec)

prostaglandin E1, is a cervical ripening agent. Cervical ripening is a process that normally occurs before the onset of labor in which the cervix softens and becomes more pliable so that dilation and effacement can occur more easily during contractions. Mechanical or pharmacologic cervical ripening methods simulate this process and increase the client's probability of achieving a vaginal birth. In addition to ripening the cervix, prostaglandins (eg, misoprostol, dinoprostone) can stimulate frequent contractions. Therefore, administration of misoprostol is contraindicated if: - the client is receiving another uterotonic simultaneously (eg, oxytocin) - the client has a history of uterine surgery (eg, cesarean birth) due to an increased risk of uterine rupture at the surgical scar site - the client has an abnormal fetal heart rate pattern or uterine tachysystole (ie, >5 contractions in 10 min)

MMRV vaccine complication

reaction 5-12 days after dose low grade fever mild rash swelling and errythema irritability and restlessness febrile seizures = administer acetaminophen if temp > 102

chorioamnionitis

risk when preterm prelabor rupture of membranes purulent amniotic fluid abdominal discomfort bactermia can result causing prolonged dysfx labor tx - IV gentamycin - manage maternal temperature

McRoberts maneuver

sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter of the free anterior shoulder

cup and Oz to ML

1 cup = 8 oz = 240 mL 1 oz = 30mL

The nurse assessing a 2-year-old should expect the child to be able to perform which actions? Select all that apply. 1.Build a tower with blocks 2.Draw a square 3.Hop on one foot 4.Say own name 5.Walk without help

1,4,5 Developmental milestones that a 2-year-old toddler should meet include: Motor skills: Walks alone, builds block towers, draws lines, kicks a ball Language: Knows 300+ words, uses 2- to 3-word phrases, states name Cognitive/social skills: Engages in parallel play, imitates others, exerts independence

Ascending Stairs with Crutches

1. Assume the tripod position (ie, crutch stance) and place body weight on the crutches while preparing to move the unaffected leg. 2. Place the unaffected leg (ie, good leg) onto the step. 3. Transfer body weight from the crutches to the unaffected leg and then use the unaffected leg (ie, good leg) to raise the body up onto the step. 4. Advance the affected leg and the crutches together up the step. 5. Realign the crutches with the unaffected leg on the step before repeating the process.

When does the anterior fontanel close?

12-18 months

FLACC pain scale

2 months to 7 years old It uses facial expressions, leg movement, activity, cry, and consolability to assess the client's level of pain.

When does posterior fontanel close

2-3 months

Normal uterine contraction frequency

2-5 contractions in 10 minutes concerning if >5 in 10 minutes

FACES pain skill for

3 years and older

When can a child copy a square or draw one

3-5 (preschool years)

Normal blood glucose for infant

40-60 hypoglycemia - jitteriness - cyanosis - tremors - pallor - poor feeding - retractions - lethargy - low O2 sat - seizures

when should a child babble speak first words

6 months 12 months

Stop NSAIDS how many days before surgery

7 days

Oligohydraminos

< 500 mL of amniotic fluid associated with - utero-placental insufficiency - fetal renal abnorms Amniotic fluid is produced by the fetal kidney and serves 2 major purposes - to prevent cord compression and promote lung development. This can occur due to fetal kidney anomalies (eg, renal agenesis or urine flow obstruction) or fluid leaking through the vagina (eg, undiagnosed ruptured membranes). Fluid volume also declines gradually after 41 weeks. Small uterine size for gestational age or a fetal outline that is easily palpated through the maternal abdomen should raise suspicion for oligohydramnios. Ultrasound confirms the diagnosis Major complications of oligohydramnios are: Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid. Therefore, additional neonatal personnel should attend the birth in anticipation of possible resuscitation Umbilical cord compression - continuous (not intermittent) fetal monitoring should be applied to monitor for variable decelerations

The nurse is assisting the health care provider with a lumbar puncture for a 6-year-old client with suspected meningitis. Place in order the steps the nurse should take.

A lumbar puncture is a sterile procedure used to gather a specimen of cerebrospinal fluid (CSF) for diagnostic purposes (eg, meningitis). A needle is inserted into the vertebral spaces between L3 and L4, and a sample of CSF is obtained. When assisting with a lumbar puncture, the nurse should: Verify informed consent (Option 2) Gather the lumbar puncture tray and needed supplies Explain the procedure to the client and parents Have the client empty the bladder (Option 3) Place the client in the appropriate position (eg, side-lying with knees drawn up and head flexed or sitting upright and bent forward over a bedside table) (Option 1) Assist the client in maintaining the proper position (hold the client if necessary) Provide a distraction and reassure the client throughout the procedure Label the vials as the specimens are collected (Option 5) Apply a bandage over the needle insertion site after the procedure (Option 6) Monitor the client for development of a headache (Option 4)

Celeoxib (Celebrex)

CLASSIFICATION: therapeutic: anti-rheumatic, nonsteroidal anti-inflammatory. Pharmalogic: COX-2 inhibitor ADMINISTRATION: PO SIDE EFFECTS: GI-Bleeding, abdominal pain, diarrhea, constipation, nausea, heart failure, MI, stroke, thrombosis, edema, and hypertension. NURSING IMPLICATION: assess site of pain, may be due hard on the liver, monitor for increased AST/ALT blood levels. CLIENT TEACHING: watch for GI symptoms ACTIONS: inhibits enzyme COX-2 which is required for prostaglandin synthesis. ADDITIONAL INFORMATION: commonly prescribed for osteoarthritis, and rheumatoid arthritis.

Antidote for magnesium sulfate toxicity?

Calcium gluconate

Tumor Lysis Syndrome

Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. You can try to prevent this with hydration and allopurinol. TLS may result in the following life-threatening conditions: Hyperkalemia (>5.0 mEq/L [5.0 mmol/L]) that can cause lethal dysrhythmias Large amounts of nucleic acids (normally converted to uric acid and excreted by the kidneys) that can overwhelm the kidneys and cause hyperuricemia and acute kidney injury (AKI) from uric acid crystal formation Hyperphosphatemia (>4.4 mg/dL [1.42 mmol/L]) that can cause AKI and dysrhythmias Hypocalcemia (<8.6 mg/dL [2

NSAID drugs

N - Naproxen S - Salicylates A - Advil I - Ibuprofen D - Diclofenac S - Sulinclac

Infant born 30 minutes ago has bilateral lung crackles

NORMAL to auscultate crackles first 1 hr of life

Aspirin in infants

NOT be used in infants EXCEPT in kawasaki disease Reyes syndrome - swelling of liver and brain INSTEAD fever treated with ibuprofen or acetaminophen

A client at 9 weeks gestation arrives at the clinic for an initial obstetric appointment. The nurse reviews the client's medical history and obtains a list of current medications. The nurse recognizes that which of the following medications should be clarified with the health care provider immediately? Select all that apply. 1.Albuterol 2.Doxycycline 3.Insulin aspart 4.Isotretinoin 5.Levothyroxine 6.Lisinopril

Clients with preexisting conditions (eg, asthma, hypertension, diabetes) may require changes to medication therapy if they become pregnant. In particular, teratogenic or unnecessary medications should be discontinued (before conception, when possible). The nurse should refer a client taking contraindicated medications to a health care provider immediately. For example: Doxycycline, a tetracycline antibiotic, is avoided in pregnancy because it can impair bone mineralization and discolor permanent teeth in the fetus (Option 2). Isotretinoin (Accutane) has a black box warning for severe birth defects. Retinoids may not be prescribed to women of childbearing age without a formal agreement to participate in iPLEDGE (a prescription tracking program) and a commitment to use two forms of contraception (Option 4). ACE inhibitors such as lisinopril (Prinivil) have a black box warning for use in pregnancy because they can affect fetal renal function and lung development or cause fetal death (Option 6).

The nurse is caring for a 12-month-old client. Which of the following would be expected age-related findings? Select all that apply. 1.Birth weight has tripled 2.Cruises along furniture 3.Kicks a ball 4.Searches for hidden objects 5.Speaks in two-word phrases

Developmental surveillance is the continuous process of monitoring a client's growth and development, using screening tools and physical assessments, to quickly identify potential delays. Early identification promotes timely referral and intervention, so the client is more likely to reach full growth potential. Developmental milestones are patterns of motor, language, cognitive, and social skills seen in most clients by a specific age and are helpful guides for developmental surveillance. By age 12 months, clients typically reach the following growth and developmental milestones: The client's birth weight has tripled (Option 1). The client has developed the gross motor ability of cruising (ie, holding onto furniture while walking) (Option 2). The client understands object permanence (ie, the knowledge that even though an object or person is not in the direct line of vision, the object or person still exists) as evidence by searching for hidden objects (Option 4). (Options 3 and 5) At age 2 years, clients typically have developed the gross motor ability of kicking a ball and language skills of speaking in two-word phrases.

A nurse in a pediatric clinic is performing a physical examination of a 30-month-old child. Which finding requires further evaluation? 1.Bladder and bowel control are achieved 2.Chest circumference is greater than abdominal circumference 3.Current weight is 6 times greater than birth weight 4.Head circumference increased by 1 in (2.5 cm) in the past year

During the toddler years, physical growth begins to slow. Instead of a linear curve, the toddler's growth should resemble a step-like pattern, accounting for the growth spurts that occur during early childhood. A child's weight gain slows to an average yearly weight gain of 4 to 6 lb (1.8 to 2.7 kg). By age 30 months, a toddler's weight should be approximately 4 times greater than birth weight. A 30-month-old client who weighs 6 times the initial birth weight requires further evaluation by the health care provider. Family nutrition, meal habits, and activity level should be evaluated, and the nurse should provide education on these topics if needed A toddler achieves bowel and bladder sphincter control by age 24 months; as bladder capacity increases, a 14- to 18-month-old child is able to hold urine for up to or greater than 2 hours. Chest circumference exceeds abdominal circumference after age 2, resulting in the child having a taller and more slender appearance. Head circumference increases by 1 in (2.5 cm) during the second year and growth continues to slow until age 5 when the head circumference increases less than 0.5 in (1.25 cm) per year.

Reyes syndrome

Encephalopathy cerebral edema Acute fatty liver - increase AST ALT - increase PT PTT INR - Increase NH3 (ammonia) Aspirin in children can cuase EXCEPTION - kwasaki disease benefit outweighs risk

Hirschsprung's disease

Enlarged mega colon bilious vomiting, abdominal distention failure to pass meconium failure of internal anal sphincter relaxation distended abd unable to pass meconium (24-48hrs) vomit green bile aganglionic section lacking nerve cells section of the distal large intestine missing nerve cells surgical removal required enterocollitis: fatal complication, inflammation of the colon that leads to death or sepsis -fever, lethargy, explosive foul smelling dirrhea, rapidly worsening abd distention

A 2-year-old child is brought to the emergency department for a severe sore throat and fever of 102.9 F (39.4 C). The child is drooling and has distressed respirations and inspiratory stridor. What action should the nurse take first? 1.Assess an accurate temperature with a rectal thermometer 2.Directly examine the throat for the presence of exudates 3.Obtain IV access for anticipated steroid administration 4.Position the child in the tripod position on the parent's lap

Epiglottitis is inflammation of the tissues surrounding the epiglottis, a long, narrow structure that closes off the glottis during swallowing. Edema can develop rapidly and obstruct the airway by occluding the trachea. In children, epiglottitis is typically caused by the bacterium, Haemophilus influenzae type b. Manifestations include sudden-onset high fever, drooling, difficulty swallowing (dysphagia), agitation, lack of spontaneous cough, and acute respiratory distress. If the nurse suspects that the child is experiencing epiglottitis, the priority nursing action is to protect the airway because untreated epiglottitis can lead to respiratory arrest and death. The tripod position opens the airway and helps airflow. The child should be allowed to assume a position of comfort (usually sitting rather than lying down) (Option 4). (Options 1 and 3) Invasive procedures (ie, rectal temperature assessment, obtaining intravenous access) should be avoided to prevent the child from crying. The nurse needs to be cautious until the airway is secure due to the child's increased risk for laryngospasm and respiratory arrest. (Option 2) The nurse should not attempt to examine the child's throat because manipulation of the oral cavity can further aggravate the child's condition, leading to respiratory arrest.

The nurse in the emergency department is receiving change of shift report on four clients. Which client should the nurse assess first? 1.6-month-old with respiratory syncytial virus and SpO2 90% on room air 2 .1-year-old with otitis media and a temperature of 102.6 F (39.2 C) 3.2-year-old with a sore throat who is drooling and sitting in the tripod position 4.3-year-old who has inspiratory stridor and a barking cough

Epiglottitis, a sudden-onset medical emergency often secondary to Haemophilus influenzae infection, causes severe inflammatory obstruction above and around the glottis. Epiglottitis typically progresses from having no symptoms to completely occluding the airway within hours. Sitting in a tripod position (ie, upright and leaning forward with the chin and tongue sticking out) is a classic presentation. The child likely drools and is restless and anxious secondary to airway obstruction and hypoxia. This client is the nurse's priority because epiglottitis is life-threatening and may require intubation

Scarlett Fever (group A strep)

Etiology Streptococcus pyogenes common in early childhood distinctive rash rash begins head and neck spreads to extremities resembles a bad sunburn Clinical features - Fever & pharyngitis - Tonsillar erythema & exudates - Strawberry tongue - Tender anterior cervical nodes - Sandpaper rash Diagnosis - Rapid streptococcal antigen test - Throat culture Treatment - Penicillin (eg, amoxicillin)

A client who is pregnant at 30 weeks gestation comes to the prenatal clinic. Which of the following vaccines may be administered safely at this prenatal visit? Select all that apply. 1.Influenza injection 2.Influenza nasal spray 3.Measles, mumps, and rubella 4.Tetanus, diphtheria, and pertussis 5.Varicella

Health promotion during pregnancy includes the administration or avoidance of certain vaccines to decrease risks to the pregnant client and fetus. Pregnant clients have suppressed immune systems and are at increased risk for illness and subsequent complications. Some viruses (eg, rubella, varicella) can cause severe birth defects if contracted during pregnancy. Inactivated vaccines contain a "killed" version of the virus and pose no risk of causing illness from the vaccine. Some vaccines contain weakened (ie, attenuated) live virus and pose a slight theoretical risk of contracting the illness from the vaccine. For this reason, clients should not receive live virus vaccines during pregnancy or become pregnant within 4 weeks of receiving such a vaccine. During influenza season (October-March), it is safe and recommended for pregnant clients to receive the injectable inactivated influenza vaccine regardless of trimester

The nurse is performing an assessment on a neonate shortly after delivery. The nurse is most concerned about which assessment finding? 1.Bilateral rales found on lung auscultation 2.Dullness over bladder found on percussion 3.Ptosis of right eyelid found on facial inspection 4.Single testicle found on genital palpation

Eyelids should sit above the pupils symmetrically with irises showing. Ptosis (drooping of the eyelid below the level of the pupil) could indicate paralysis of the oculomotor nerve. This finding warrants further investigation. At the time of birth, there should be no cranial nerve abnormalities. (Option 1) Crackles (rales) indicate fluid in the lungs and are expected immediately after birth. Rales will clear as the neonate transitions to extrauterine life. However, wheezes, stridor, or persistence of crackles after the first few hours of birth are abnormal and should be reported. (Option 2) Percussing dullness in the hypogastric area is a normal finding when the bladder is full. The neonate should void spontaneously within a few hours after birth. (Option 4) An undescended testicle (cryptorchidism) at birth is not concerning. Most undescended testes descend spontaneously by age 6 months.

Autism spectrum disorder at risk for

Impaired interpersonal relationships: Clients with ASD may be disinterested in social interaction and have difficulty showing affection and interpreting conversation Learning difficulties: Clients with ASD may have trouble focusing on tasks and have a limited range of learning interests (eg, preferring only math), making it challenging to engage them in other areas of learning Malnutrition: Clients with ASD can have a narrowed interest in foods, resulting in an insufficient intake of necessary nutrients. In addition, clients with ASD often experience gastrointestinal disturbances, including constipation and diarrhea, due to narrowed food intake Self-harm behaviors: Changes in routine and environment can trigger repetitive or harmful behaviors (eg, head-banging, hand-biting). When self-harm behaviors persist into adulthood, they may be preceded by suicide attempts related to cooccurring psychiatric comorbidities (eg, depression, anxiety) Sleep disturbances: Clients with ASD often experience difficulty falling and staying asleep. Hyperresponsiveness to sensory stimulation (eg, lights, noises, sensations) can also contribute to disruptive sleeping patterns

The nurse assesses 4 infants. Which assessment finding would require follow-up by the health care provider? 1.3-week-old whose anterior fontanelle bulges with crying 2.4-week-old whose posterior fontanelle is soft 3.6-month-old with birth weight of 7 lb 3 oz (3.3 kg) who now weighs 12 lb (5.4 kg) 4.12-month-old with birth weight of 6 lb 4 oz (2.8 kg) who now weighs 20 lb (9.1 kg) Submit

Infant growth is fast paced during the first year of life, with birth weight doubling by age 6 months and tripling by age 12 months. During the first year, birth length increases by approximately 50%. At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months. (Options 1 and 2) At birth, the infant has non-ossified membranes called fontanelles; these "soft spots" lie between the bones of the cranium. The 2 most noticeable are the anterior and posterior fontanelles, which are soft and non-fused. Fontanelles should be flat, but slight pulsations noted in the anterior fontanelle are normal as is temporary bulging when the infant cries, coughs, or is lying down. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months. (Option 4) This assessment shows tripling of the birth weight by age 12 months, a normal finding.

The nurse assesses 4 children in the clinic. Which assessment finding requires the nurse's priority action? 1.A 3-month-old with fever, vomiting, high-pitched cry, and irritability 2.A 9-month-old with diarrhea who is refusing fluids and cries without tears 3.An 11-month-old with cold symptoms and an abdominal breathing pattern 4.An 18-month-old who cries when the caregiver leaves

Infants with underlying infection and increased intracranial pressure (ICP) will be very irritable and have fever and a high-pitched cry. Other signs of increased ICP include changes in pupillary reaction, sunset eyes, dilated scalp veins, poor feeding, vomiting, and bulging fontanelles. The 3-month-old needs to be seen first due to the potential for bacterial meningitis. If bacterial meningitis is suspected, droplet precautions should be initiated and the infant should be treated with antibiotics immediately. (Option 2) The absence of tears when crying indicates moderate dehydration. This infant needs evaluation but is not the priority. (Option 3) In children under age 6 years, the diaphragm is the major respiratory muscle. This infant is displaying normal respiratory effort. Furthermore, cold symptoms are common in children. (Option 4) Separation anxiety (distress when the primary caregiver is absent) is common in this age group (age 8 months to 2 years).

A student nurse is preparing to administer the hepatitis B vaccine to a newborn. Which statement by the student nurse requires the preceptor to provide further teaching? 1."A ⅝-inch, 25-gauge needle is appropriate for intramuscular injection in newborns." 2."I will clean the injection site with an antiseptic swab before administration." 3."I will draw the medication into a 1-mL syringe." 4."The medication should be administered into the deltoid muscle."

Intramuscular (IM) injections (eg, hepatitis B vaccine, vitamin K) are commonly administered to newborns shortly after birth or before discharge. The vastus lateralis muscle in the anterolateral middle portion of the thigh is the preferred site for IM injections in newborns (age <1 month) and infants (age 1-12 months). The deltoid muscle is an inappropriate injection site for newborns due to inadequate muscle mass (Option 4).

Infant formula

Keep bottles, nipples, caps, and other parts as clean as possible (ie, boil or wash in the dishwasher). Wash the tops of formula cans (eg, concentrated formula) with hot water and soap prior to opening to prevent contamination Refrigerate any unused, prepared formula or unused, opened formula (eg, ready-to-feed, concentrated), but use within 24 hours or discard to reduce the risk of bacterial growth Warm bottles in a pan of hot water or under warm tap water for several minutes. Test formula temperature on the inner wrist before serving to the infant (should feel lukewarm, not hot).

A nurse is evaluating the fetal monitoring strip of a laboring primigravida at 38 weeks gestation who has an epidural and is receiving an oxytocin infusion. The client has external fetal monitors and an intrauterine pressure catheter in place. Which of the following interventions should the nurse implement? Select all that apply. Click on the exhibit button for additional information. (Late Decels) 1.Decrease the epidural infusion rate 2.Initiate an IV bolus of 0.9% sodium chloride 3.Prepare for amnioinfusion 4.Reposition the client to supine 5.Stop the oxytocin infusion

Late decelerations occur after the onset of a uterine contraction and continue beyond its end. The lowest point (nadir) occurs near the end of the contraction before the fetal heart rate gradually returns to baseline. Late decelerations occur when fetal oxygenation is compromised (eg, uteroplacental insufficiency, uterine tachysystole, hypotension). Immediate steps to correct late decelerations include: Stopping oxytocin if it is being administered (Option 5) Repositioning the client to the left/right side Administering an IV bolus of isotonic fluid (eg, lactated Ringer solution, 0.9% sodium chloride) as needed (Option 2) If late decelerations persist or variability is absent or minimal, the nurse should prepare for emergency delivery. Epidural infusions can cause late decelerations due to maternal hypotension. The nurse should discontinue the epidural infusion if maternal hypotension occurs. Amnioinfusion is administered through an intrauterine pressure catheter to relieve variable decelerations, not late decelerations; variable decelerations are usually caused by cord compression secondary to loss of amniotic fluid (eg, after rupture of membranes, because of oligohydramnios). Supine positioning can obstruct blood flow to the placenta. The client should be placed in a side-lying position to promote placental perfusion. This action relieves compression of the aorta and inferior vena cava, which can affect cardiac output, cause hypotension, and decrease placental perfusion.

Name the live attenuated vaccines

Live attenuated: "LIVE one night only! See SMALL YELLOW CHICKENs get vaccinated with SABIN and MMR! It's INcredible" 1. Small pox 2. Yellow fever 3. Chicken pox (VZV) 4. Sabin polio virus 5. MMR (Measles, Mumps, Rubella) 6. Influenza (IntraNasal)

Shoulder dystocia

McRobert's maneuver (legs flexed onto abdomen) Suprapubic pressure greater than 5 mins risks fetal asphyxia

The nurse is performing the initial assessment of a newborn. Which of the following findings should the nurse report to the health care provider? Select all that apply. 1.Cyanosis of the hands and feet 2.Decreased muscle tone 3.Heart rate of 150/min 4.Sacral dimple with a 0.4 in (1 cm) skin tag 5.Single artery in the umbilical cord

Nurses caring for newborns must be able to distinguish between normal physiologic variations and unexpected findings that require further intervention. Unexpected findings in newborns include: Decreased muscle tone (ie, hypotonia), which may indicate a congenital neurological abnormality (eg, Down syndrome) or spinal injury (Option 2). Newborns normally have increased muscle tone and should resist movement of the extremities. Sacral dimples, with or without tufts of hair or skin tags, are associated with spina bifida occulta, which is an incomplete closure of vertebrae that cannot be seen externally (Option 4). Presence of a single umbilical artery, which is sometimes associated with congenital defects, particularly of the kidneys and heart (Option 5). Normal umbilical cords contain 2 arteries and 1 vein.

The nurse is preparing to teach the perinatal unit staff about caring for newborns with either omphalocele or gastroschisis. Which of the following statements are appropriate for the nurse to include? Select all that apply. 1."An omphalocele with an intact peritoneal sac should be covered with a sterile, nonadherent dressing immediately after birth." 2."If immediate surgical repair of the defect is planned, the newborn should be fed via a nasogastric tube instead of breastfed." 3."Newborns with omphalocele or gastroschisis require IV access for fluid and electrolyte replacement." 4."Newborns with omphalocele or gastroschisis should be monitored closely for temperature instability and infection." 5."Petroleum jelly should be applied to the exposed bowel of newborns with gastroschisis before it is covered with plastic."

Omphalocele and gastroschisis are congenital defects of the abdominal wall. An omphalocele occurs when bowel, usually covered with a peritoneal sac, herniates through the abdominal wall via the umbilical opening. Gastroschisis occurs when bowel herniates through the abdominal wall without a protective peritoneal sac. Immediately after birth, the nurse should cover the herniated bowel to prevent injury; a nonadherent dressing (eg, plastic bowel bag; sterile, saline-soaked gauze covered by loose plastic) is necessary to prevent fluid loss and protect the bowel from drying (Option 1). The nurse should monitor for temperature instability, infection, and fluid loss and initiate IV access to facilitate antibiotic administration and fluid and electrolyte replacement 1 2 4

oxytocin

Oxytocin is administered during labor to increase the strength and frequency of contractions (ie, labor augmentation). However, labor augmentation is not appropriate for a client who is in PTL, unless birth is medically indicated (eg, preeclampsia, infection).

Pyloric stenosis

Pathogenesis Thickening of pylorus → gastric outlet obstruction Risk factors: first-born male, positive family history, macrolide antibiotic exposure History Age 3-6 weeks Projectile nonbilious emesis Immediately postprandial Usually followed by interest in refeeding ("hungry vomiter") Clinical findings Palpable, olive-shaped epigastric mass Visible peristalsis Signs of dehydration (eg, sunken fontanelle) Treatment IV fluids Surgical intervention (pyloromyotomy) thickened pylorus muscle blacks passage of gastric contents postprandial projectile vomiting signs of dehydration - sunken fontanel - dry mucous membranes palpable olive shaped mass

why magnesium sulfate for preterm birth?

Preterm birth is a significant cause of morbidity and mortality among newborns. Underdevelopment of organ systems and low birth weight can lead to severe complications (eg, cerebral palsy, respiratory distress syndrome). magnesium sulfate to the maternal client who is in preterm labor (PTL) at <32 weeks gestation is recommended for fetal neuroprotection. Although the mechanism of action is not fully understood, magnesium sulfate administration to clients who are <32 weeks gestation decreases the newborn's risk of cerebral palsy or reduces the severity of cerebral palsy. Due to administration of magnesium sulfate, the nurse should assess the client frequently for magnesium toxicity. Anticipated interventions include monitoring deep tendon reflexes hourly for a decreased or absent response because magnesium causes neuromuscular and respiratory depression when blood levels are too high. The nurse should also monitor strict intake and output because magnesium is excreted via the kidneys; a decreased urine output (eg, <30 mL/hr) may indicate inadequate excretion of the medication.

The nurse is caring for a client with scleroderma. Which assessment finding indicates the most serious complication of the disease and requires priority intervention? 1.Abrupt-onset hypertension and headache 2.Blue and cold fingertips 3.Dry cough and exertional dyspnea 4.Heartburn and difficulty swallowing

Scleroderma is an overproduction of collagen that causes tightening and hardening of the skin and connective tissue. This is a progressive disease without a cure, and treatment is aimed at managing complications. Renal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. Early recognition and treatment of renal crisis is needed to prevent acute organ failure. Even with treatment, this can be fatal. (Option 2) Raynaud phenomenon can develop secondary to scleroderma. It is characterized by vasospasm-induced color changes in the fingers, toes, ears, and nose. This requires urgent treatment (eg, immersing hands in warm water) but is not life-threatening. (Option 3) Pulmonary fibrosis is a progressive complication of scleroderma that is defined as scarring of lung tissue, which then causes reduced function, dry cough, and dyspnea. Some clients may be placed on oxygen. This is not immediately life-threatening. (Option 4) Heartburn and dysphagia (difficulty swallowing) are common symptoms associated with scleroderma. This is due to the disease process of internal scarring, and it is not life-threatening.

Syphilis in pregnancy

Screening -done at first prenatal visit -third trimester and delivery tx - IM pencillin pregnancy effects - intrauterine fetal demise - preterm labor Fetal affects - hepatic - hematologic - musculoskeletal - failure to thrive STD that is teratogenic need pencillin desensitization if allergic DOXYCYLCINE not used in pregnancy

APGAR scoring

Sign 0 points 1 point 2 points Appearance/color: Completelyblue/pale Body pink,extremities blue Completelypink Pulse: Absent <100/min >100/min Grimace/reaction: Absent Grimace/whimper Cough/sneeze/cry Activity/muscle tone: Limp Some flexion Active/spontaneous Respiratory effort: Absent Slow, weak cry Regular,good cry total out of 10 done immediately after birth and 5 minutes after

A client is admitted to the intensive care unit with diabetic ketoacidosis. The client is most likely to exhibit which of the following arterial blood gas results? 1.pH 7.26, PaCO2 56 mm Hg (7.5 kPa), HCO3 23 mEq/L (23 mmol/L) 2.pH 7.30, PaCO2 30 mm Hg (4.0 kPa), HCO3 15 mEq/L (15 mmol/L) 3.pH 7.40, PaCO2 40 mm Hg (5.3 kPa), HCO3 24 mEq/L (24 mmol/L) 4.pH 7.58, PaCO2 48 mm Hg (6.4 kPa), HCO3 44 mEq/L (44 mmol/L)

The arterial blood gas (ABG) result most consistent with the diagnosis of diabetic ketoacidosis (DKA) is metabolic acidosis or partially compensated metabolic acidosis (pH 7.30, PaCO2 30 mm Hg [4.0 kPa], HCO3 15 mEq/L [15 mmol/L]). DKA is a life-threatening complication of type 1 diabetes characterized by hyperglycemia (>250 mg/dL [13.9 mmol/L]) resulting in ketosis, a metabolic acidosis. Glucose cannot be taken out of the bloodstream and used for energy without insulin, which individuals with type 1 diabetes cannot produce. Similar to a state of starvation, the body begins to break down fat stores into ketones, causing a metabolic acidosis (low pH and low HCO3). As a compensatory mechanism, this client has deep and rapid respirations with fruity/acetone smell (Kussmaul respirations) in an attempt to reduce carbon dioxide levels by inducing a respiratory alkalosis to partially compensate for the ketoacidosis, which has nearly normalized the pH.

Diagnostic criteria for failure to thrive

Weight trajectory that decreases over ≥2 major percentile lines on a growth chart Daily weight gain less than expected for age Weight <80% of ideal weight for age & sex Decreased weight for length (weight for length <10th percentile or weight for age < length for age) Weight <2nd percentile for age (corrected for preterm infants) & sex

Tinea Capitis (Scalp Ringworm)

Tinea capitis (ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding, towels, hats). Treatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungal medication (eg, griseofulvin oral suspension) that the client must take for several weeks to months. Keratin-producing cells absorb griseofulvin, causing resistance to the fungus; because the fungus requires keratin (protein in hair and skin cells) to live and grow, it is not able to reproduce. To ensure that infected keratin is shed completely, treatment with griseofulvin should not be discontinued early, even if symptoms (eg, itching, scaling) decrease (Option 1). (Option 2) The client will best absorb griseofulvin (ie, suspension, microsized tablets) when taken after/with high-fat foods (eg, ice cream). (Option 3) Photosensitivity is a common side effect of griseofulvin treatment, and the client should avoid prolonged exposure to the sun and use sunscreen. (Option 4) The client should apply medicated shampoo (eg, 1% selenium sulfide) to the scalp a few times each week.

An emergency department nurse is assigned to triage. Which client should the nurse assess first? 1.Five-year-old with a superficial leg laceration 2.Lethargic 3-month-old with diarrhea for the past 12 hours 3.Seven-year-old with a elevated temperature of 101 F (38.3 C) and hematuria 4.Seventeen-year-old with severe, acute abdominal pain

Triaging clients involves decision-making about whose needs/problems are most urgent and create the greatest risk to survival. Two popular frameworks can assist the nurse in making these decisions and setting priorities. In the "First, Second, and Third" priority level framework, the priority needs progress from the first (most immediate) to the third (least) level of risk. They include: ABCs plus V - airway, breathing, circulation, and vital signs Mental status changes, acute pain, unresolved medical issues, acute elimination problems, abnormal laboratory values, and risk Longer-term issues such as health education, rest, and coping Infants have a high percentage of body water (70%-80% of body weight) and become dehydrated rapidly. This client is at increased risk for fluid and electrolyte disturbances. In addition, the infant is lethargic (listless), indicating a change in level of consciousness. This client would be assessed first

A client comes to the labor and delivery unit stating, "My water just broke at home." On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina. Which nursing intervention would be appropriate? 1.Apply suprapubic pressure 2.Assist the client to the knee-chest position 3.Perform Leopold maneuvers 4.Perform the McRoberts maneuver

Umbilical cord prolapse occurs when the umbilical cord slips below the presenting fetal part and causes cord compression and impaired fetal oxygenation. A loop of cord may be palpated during vaginal examination or visualized protruding from the vagina. An emergency cesarean birth is usually required unless vaginal birth is imminent and considered safe by the health care provider. Positioning the client on the hands and knees with the buttocks elevated above the head (knee-chest position) or in the Trendelenburg position relieves pressure on the compressed cord (Option 2). The nurse may also use a sterile, gloved hand to lift the presenting part off the cord. Other actions include administration of oxygen and IV fluids.

Fetal station slow decent

Unchanged station for several hours large malpositioned fetus

Varicella Zoster Virus

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

Benztropine (Cogentin)

anticholinergic/antiparkinson treats extrapyramidal symptoms - acute dystonia: involuntary muscle contraction - akathisia: motor restlessness and repetitive movements -pseudoparkinsonism: shuffling gait and muscle rigidity - tardive dykinesia: uncontrollable rhythmic movement

Aripiprazole (Abilify)

treats ASD antipsychotic medication Important antipsychotic adverse effects Extrapyramidal adverse effects - Acute dystonic reaction: sudden-onset, sustained muscle contractions - Akathisia: subjective restlessness with inability to sit still - Drug-induced parkinsonism: tremor, rigidity, bradykinesia, masked facies Tardive dyskinesia - Involuntary movements after chronic use (eg, lip-smacking, choreoathetoid movements)\ Aripiprazole, an atypical antipsychotic medication, is used in the treatment of irritability associated with autism spectrum disorder (ASD), schizophrenia, bipolar disorder, and other mental health disorders. Aripiprazole works as a partial agonist at the serotonin and dopamine receptor sites. As a result, the medication has a more favorable safety profile (eg, less metabolic effects, lower potential for prolactin release) than other antipsychotics; however, it may be less effective in symptom relief. Clients taking aripiprazole should be instructed to not abruptly stop taking the medication because it can cause withdrawal symptoms (anxiety, dizziness, tachycardia, diaphoresis, insomnia, vomiting) and risk exacerbating previous symptoms. These medications should be weaned over time and substituted with an alternate medication under the supervision of a health care provider

Advanced maternal age is associated with?

trisomy 21 or down syndrome

School-aged children

typically in the concrete operational stage. During this stage, children begin to have concrete thoughts, use logic when thinking about events (eg, principles of conservation), and develop a concept of time (eg, ability to read a clock), which continues into adolescence.

adolescent

typically in the formal operational stage. During this stage, adolescents develop moral reasoning, abstract cognitive thinking, and begin to think about the future (eg, "Even though I didn't pass this test, I can work hard and do better next time.")

Preschool-aged children

typically in the preoperational stage. During this stage, children transition out of egocentrism and begin to have more social awareness. The preschooler will strive for autonomy by attempting to control situations through intense emotional displays known as temper tantrums (eg, "I want to drink my juice now!"). Magical thinking is also present in this stage and commonly includes make-believe play (eg, dolls, imaginary friends).

Brain herniation

when a rapid increase in ICP leads to protrusion of portions of the brain through openings into adjacent structures. Clinical manifestations include Cushing triad (eg, bradycardia, irregular respirations, and hypertension with widening pulse pressure). Treatment includes osmotic agents (eg, mannitol) to reduce ICP and surgical intervention.