Pediatric Nursing Diseases

A nurse is caring for a patient experiencing a vaso-occlusive crisis secondary to sickle cell anemia. The main goals of therapeutic management of a crisis include all of the following: Correct: - Provide hydration through IV and oral therapy - Avoid all antibiotics during crisis - Manage metabolic acidosis through electrolyte replacement

- not a choice. Promote rest and minimize energy expenditure to improve oxygen utilization. Bed rest may be helpful to reduce oxygen demand in the initial phase of a crisis, but it will not help resolve the pain crisis.

Infant continuation.... ● With suspected failure to thrive (FTT) - Observe the parents' actions when feeding the child. - Maintain a detailed record of food and fluid intake. - Follow the child's cues as to when food and fluids are provided. - Sit directly in front of the child's high chair when feeding the child. - Provide a quiet, stimulation-free environment at meal times to avoid distractions and focus attention on food intake. Do not play music videos during scheduled meal times.

Male urine collection. Wash and dry the infant's genitalia and perineum thoroughly. Apply the adhesive of the collection device. Place the infant's penis and scrotum inside the collection bag in order to ensure a snug fit and prevent leaking.

Infant fine motor skills: - The 2-year-old child will draw vertical lines and make circular strokes. Dehydration in an infant, findings: ● Slight tachypnea. - Flat or sunken fontanel - Increased heart rate. - Decreased urinary output

● When administering medications to an infant, a needleless oral syringe or medicine dropper is placed in the side of the mouth (buccal cavity alongside the tongue) to prevent gagging and aspiration. - Medication should never be mixed into an infant's regular formula to be given through a bottle.

A nurse is caring for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following actions should the nurse take? Correct: - Administer ibuprofen or acetaminophen for mild to moderate pain. If pain is not relieved, the nurse should administer an opioid analgesic. - Encourage the child to increase daily fluid intake to reduce blood viscosity and prevent sickling of red blood cells. - Apply warm compresses to painful joints. - Ensure the child receives all immunizations to prevent infection. Infection is a major cause of death in children who have sickle cell anemia.

live virus immunizations

Congenital hypothyroidism. The child who has congenital hypothyroidism has a thyroid gland that is absent, small, or malfunctioning; however, the child does not require surgical removal of the gland. ● "Your child will need to take thyroid hormone replacement for her entire life." In congenital hypothyroidism, the child does not manufacture an adequate amount of thyroid hormone to maintain the appropriate metabolic rate. The child will require life-long thyroid hormonal replacement for normal growth and development.

●

Otitis media ● "We should not smoke around our child." Preventing exposure to tobacco smoke at home can prevent further episodes of ear infections because tobacco smoke can cause inflammation of the respiratory tract. ● The child should receive and antibiotic such as amoxicillin. ● Massage the anterior area of the ear following administration of antibiotic eardrops. Warm Otic solution before instilling it in the infant's ear. ● Pull the auricle up and back for children older than 3 years of age and downward and straight back for children younger than 3 years of age.

A child who has an ear infection is not contagious; therefore, the child may play with other children who have ear infections. A child who has recurrent ear infections is able to swim; however, wearing earplugs might aid in decreasing the risk of infection. A child who has recurrent ear infections should not forcefully blow his nose during a cold, because this causes organisms to ascend through the eustachian tubes.

A nurse is assessing an adolescent for findings of hemorrhage following a tonsillectomy. Which of the following findings is a manifestation of this postoperative complication? Correct: - Frequent swallowing The nurse should monitor the client for hemorrhage following a tonsillectomy. These findings include frequent swallowing or clearing of the throat, tachycardia, pallor, restlessness, decreasing blood pressure, pale mucous membranes, and vomiting bright red blood. The nurse should report these findings to the provider immediately.

A nurse is caring for a school-age client who is postoperative following a tonsillectomy. Which of the following actions should the nurse plan to take to prevent aspiration? Correct: -Withhold fluids until the client demonstrates a gag reflex. The primary role of the nurse is to prevent aspiration for a school-age child who is postoperative following a tonsillectomy. The nurse should assess the gag reflex prior to allowing the child to have fluids. The nurse should also discourage the child from clearing their throat, blowing their nose, or coughing, which all can aggravate the operative site and cause bleeding.

Cystic Fibrosis ● The inability to clear secretions is the priority-finding because the child has a compromised airway and the nurse must act in a manner that ensures transportation of oxygen to the body's cells. ● Oxygen saturation 85%. Report this finding to the provider immediately. ● Increase the child's protein intake. These children require up to 150% of the recommended daily allowances to meet their nutritional needs. - Increasing fiber intake could increase bulk and malabsorption might occur; therefore, it is not indicated for this child.

Blood streaking of the sputum is a common finding with children who have cystic fibrosis and a pulmonary infection. Children who have cystic fibrosis might have dry mucous membranes due to malabsorption of sodium and chloride which results in dehydration. Constipation is common in children who have cystic fibrosis because of malabsorption of sodium and chloride resulting in dehydration.

Human papillomavirus The vaccine for HPV is safe and effective and protects males and females against the disease. HPV vaccines are given in a series of two or three shots over a six-month period. Two doses of the HPV vaccine are recommended if the series is started before the client's 15th birthday. Three doses of the HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years, and for immunocompromised persons.

Cervical cancer is caused by sexually transmitted HPV infection. Vaccination prevents infection and reduces the risk of cancer.

A nurse is reinforcing teaching with an adolescent client who has mononucleosis. Which of the following statements made by the client indicates an understanding of the teaching? (Select all that apply.) Correct: - "I should drink plenty of liquids." - "I should avoid playing football while I am sick." - "I should rest when I need to."

Clients who have mononucleosis can have fatigue, malaise, and fever. The nurse should encourage fluids to prevent dehydration. The client should increase clear fluids and decrease solid foods which increase throat discomfort. Mononucleosis can cause abdominal soreness, which could indicate spleen involvement or splenomegaly. The nurse should instruct the adolescent to avoid strenuous activities or contact sports while sick. The adolescent's spleen could rupture if an injury occurs while performing strenuous activities or participating in contact sports. The nurse should encourage the adolescent to participate in nonstrenuous activities to maintain conditioning of the muscles. Fatigue and malaise are common in clients who have mononucleosis. The nurse should instruct the adolescent to rest as often as needed to facilitate healing.

A nurse is caring for an adolescent who is 2 hr postoperative following a tonsillectomy. Which of the following fluids should the nurse offer to the adolescent? Correct: - Crushed ice The nurse should offer the adolescent crushed ice, cool water, diluted fruit juice, and flavored ice pops following a tonsillectomy. However, the nurse should avoid giving the adolescent orange juice, cranberry juice, ice cream, milk, or pudding. Also, the client should avoid straws because they can damage the surgical site and cause bleeding. Cold, clear liquids are well-tolerated following a tonsillectomy. Liquids that are brown or red should be avoided in order to tell the difference between liquid and fresh or old blood.

Dairy products can cause nausea and increased oral mucus in some individuals. Citrus juices should be avoided as they can be irritating to the throat and typically are not tolerated well.

Infant continuation... Trust is developed by the consistent care given in the first year of life. Egocentrism refers to the fact that infants are self-centered and cannot see things from a point of view other than their own. An 8-month-old infant is considered egocentric. The final dose of the rotavirus immunization is administered prior to the age of 8 months. An additional booster dose is not recommended. ● Object permanence refers to the cognitive skill of knowing an object still exists even when it is out of sight. In discovering a hidden object while playing peek-a-boo, the infant experiences validation of this concept. Expected physical assessment. A heart rate of 175/min is above the expected reference range for a 12-month-old infant; therefore, the nurse should report this finding to the provider. - Respiratory rate 26/min - Blood pressure 88/40 mm Hg - Temperature 37.6° C (99.7° F).

Expected reflexes: Persistence of neonatal reflexes might indicate neurological deficits. - The stepping reflex, in which the infant takes reflexive steps when placed on his or her feet in an upright position, disappears by the age of 4 weeks. ● The Babinski reflex, which is elicited by stroking the bottom of the foot and causing the toes to fan and the big toe to dorsiflex, should be present until the age of 1 year. - The extrusion reflex, which causes the infant to spit out food placed on the tongue rather than moving it to the back of the mouth, is absent by the age of 4 months. - The Moro reflex should disappear at the age of 3 to 4 months. It is an extension of the arms and flexion of the elbows in response to a sudden jarring, followed by flexion and adduction of the extremities.

Diabetes mellitus (diabetes type 1) - Eat three meals per day - insulin requirements of a child who has type 1 diabetes will decrease with exercise. During Illness: - Monitor blood glucose levels and continue taking insulin. Blood glucose levels rise during times of illness and stress; therefore, the child might need to contact the provider for an increased insulin dosage. - Notify the provider of blood glucose levels greater than 240 mg/dL. - Drink fluids without sugars. - Test the urine for ketones to assist in early detection of ketoacidosis. ● "You can use a vial of insulin for up to 30 days." The child can use an opened vial of insulin for 28 to 30 days stored at room temperature or in the refrigerator.

Manifestation of hypoglycemia: - Irritability - Hunger - Sweating and pallor Manifestation of hypoglycemia: - Increase in urination - Poor skin turgor due to dehydration. - Kussmaul respirations To correct hypoglycemia, drink a glass of milk, 120 0z of orange juice, or approximately 15 g of complex carbohydrates. Regular insulin should be drawn up into the syringe prior to drawing up NPH to avoid altering the regular insulin.

A nurse is reviewing the laboratory results of a lumbar puncture (LP) for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect? Correct: - Elevated protein An LP is a diagnostic test in which cerebrospinal fluid is extracted for examination. Manifestations of bacterial meningitis include increased protein in the cerebrospinal fluid.

Other findings: - Manifestations of bacterial meningitis include decreased glucose in the cerebrospinal fluid. - RBCs present in the cerebrospinal fluid can be an indication of bleeding. - Presence of WBCs in the cerebrospinal fluid indicates bacterial meningitis.

A nurse is caring for a client who has suspected meningitis and a decreased level of consciousness. Which of the following actions should the nurse take? Correct: - Place the client on NPO status. Place the client on NPO status due to the client's decreased level of consciousness to prevent aspiration.

Position the client without a pillow and slightly elevate the head of the bed to prevent increasing intracranial pressure. Clients who are immunocompromised require a protective environment. Place a client who has suspected meningitis should be placed on droplet precautions for at least 24 hr after the initiation of antibiotic therapy.

A nurse is providing discharge instructions to the guardian of an 8-year-old child following a cardiac catheterization. Which of the following instructions should the nurse include? Correct: - Give the child acetaminophen for discomfort. The child might experience minor discomfort at the puncture site. The guardian should offer either acetaminophen or ibuprofen. The child should not be given aspirin because of the associated risk for Reye syndrome.

The child can attend school but should avoid strenuous activity. The child should begin fluid intake with sips of clear liquids but can resume a regular diet as soon as she desires. The child should keep the site clean and dry and, therefore, avoid tub baths for at least 3 days after the procedure.

A nurse is caring for a client undergoing preoperative assessment for tonsillectomy the next day. Which of the following laboratory tests does the nurse expect the surgeon to assess in this client? Correct: - Prothrombin time The tonsillar area is very vascular, which can increase the chances of bleeding. If the prothrombin time is not therapeutic, the client could bleed excessively. All clients undergoing tonsillectomy should undergo a basic coagulation workup to check for abnormal bleeding. To reduce the risk of bleeding, the client should avoid aspirin, aspirin containing compounds, Advil, or Ibuprofen for two weeks prior to surgery. Acetaminophen (Tylenol) can be used instead.

Tonsillitis (Tests/Labs): - Throat culture for group A beta‑hemolytic streptococci (GABHS) - Prothrombin time.

A nurse is caring for a client with type 2 diabetes who takes metformin (Glucophage). The client has a cardiac catheterization scheduled. Which of the following should the nurse advise? Correct: - Discontinue the medication prior to the procedure. Diabetes is associated with increased risk of cardiovascular disease. Cardiac catheterization requires the use of potentially nephrotoxic contrast, and metformin compounds the risk of acute kidney injury, so it is discontinued a day before the procedure and 2 days after. During this time, the client is usually placed on sliding scale insulin in order to avoid hypoglycemia as a result of fasting before the procedure.

When a client scheduled for a procedure must be kept NPO, it may be necessary for the prescriber to adjust hypoglycemic medications, including oral hypoglycemics or basal insulin. Metformin is an oral hypoglycemic used in treatment of type 2 diabetes. In addition to the potential for hypoglycemia in a client who is kept NPO, metformin increases the risk of renal injury in clients who are undergoing a diagnostic procedure requiring nephrotoxic contrast.

A nurse is caring for a client who just returned from cardiac catheterization. Which of the following is an appropriate nursing intervention for this client? Correct: - Limit motion of the affected extremity The primary nursing task in a client returning from cardiac catheterization is protecting and monitoring the puncture site. The site should be assessed for bleeding, hematoma, distal pulses, skin color and temperature; tenderness and embolization or closure of the access site due to thrombosis or dissection. The extremity should be placed straight, and the client should be positioned in the supine position, with the head elevated 30 degrees or less. Movement is discouraged immediately after catheterization since the puncture site may hemorrhage. Movements should be discouraged for at least 6 hours.

congestive heart failure. Complications of coronary catheterization can include dysrhythmia, stroke, bleeding, vascular injury, contrast reaction, air embolism, thromboemboli, pulmonary edema and vagal stimulation with bradycardia. The puncture site should be protected. Warm compresses facilitate hemorrhage. Sandbags or pressure bandages are used to promote clotting at the puncture site.

Anaphylaxis Histamine is a potent vasodilator; therefore, the client who is going into anaphylaxis will exhibit: - Tachycardia - Nausea - Hypotension - Urticaria - Stridor

A school nurse is assessing a child who has been stung by a bee. The child's hand is swelling and the nurse notes that the child has allergies to insect stings. Which of the following findings should the nurse expect if the child develops anaphylaxis? (Select all that apply.) - Nausea - Urticaria - Stridor

Tonsillectomy. ● Schedule the child for a preoperative visit to the facility. A preoperative visit to the facility allows the child to observe perioperative processes. This education helps the child feel at ease prior to the surgical procedure.

After 9 years of age, a child understands concepts of death. The nurse should inform the child that he is taking a "special sleep" not that he is being "put to sleep". Children who have pets might refer to being "put to sleep" as death.

Acute lymphocytic leukemia. A nurse is admitting a child who has acute lymphocytic leukemia. Which of the following laboratory values should the nurse expect? ● A child who has acute lymphocytic leukemia has a low RBC. An RBC of 2.5 million/uL is below the expected reference range. - A child who has acute lymphocytic leukemia has a low platelet count. The child should avoid any activities that could cause injury or bleeding, such as riding bicycles or climbing on playground equipment. - A child who has acute lymphocytic leukemia has a very high WBC. - A child who has acute lymphocytic leukemia has a low Hct level. - A child who has leukemia will have a compromised immune system and should not receive the MMR vaccine.

Chemotherapy: ● "I will inspect my child's mouth every day for sores." A child who has leukemia is at an increased risk for mucositis; therefore, the parent should inspect the child's mouth daily for lesions or ulcerations. ● Report to provider low hemoglobin level such as Hgb 6 g/dL

Mononucleosis The most common cause of mononucleosis is the Epstein-Barr virus, but other viruses also can cause similar symptoms. This virus is spread through saliva, and you may catch it from kissing or from sharing food or drinks. Mononucleosis can cause abdominal soreness, which could indicate spleen involvement or splenomegaly. Fatigue, fever, and malaise are common in clients who have mononucleosis. Mono symptoms usually go away on their own after a few weeks. The best treatment is getting plenty of rest, drinking lots of liquids and eating healthy. You may give acetaminophen (Tylenol®)

Client Education: - Encourage fluids to prevent dehydration. The client should increase clear fluids and decrease solid foods which increase throat discomfort. - Avoid strenuous activities or contact sports while sick. The adolescent's spleen could rupture if an injury occurs while performing strenuous activities or participating in contact sports. - Rest as often as needed to facilitate healing

P Pertussis (Whooping cough) Pertussis is a bacterial infection that causes cold-like symptoms, such a cough and runny nose. The cough worsens at night and sounds whooping and barking. Pertussis can cause pneumonia, convulsions, apnea, encephalopathy, and death in infants and children. It can also cause weight loss, loss of bladder control, syncope, and rib fractures in adolescents and adults.

Communicable diseases are spread through transmission of pathogenic microorganisms through the air, through contact, or spray of droplets. Diseases such as rubeola and pertussis have initial symptoms related to the respiratory tract. If left untreated, pneumonia can develop when bacteria or viruses enter the lungs. When caring for a child with one of these infectious diseases, the nurse should assess the child for signs or symptoms of pneumonia, including productive cough, fever, chills, and fatigue.

Cardiac catheterization is performed by inserting a catheter into the heart. It can be used to obtain information about oxygen saturation and pressures within the chambers of the heart. Use of contrast medium allows examination of the structure and function of the heart.. Informed consent is obtained before the study. The nurse should ask the client about an allergy to iodine or shellfish because a contrast agent is used during a left heart catheterization. The client should be NPO for at least 6-8 hours before the procedure, if possible. The nurse should inform the client that local anesthesia is used to prevent discomfort and a sedative may be prescribed. The client may feel palpitations or a flush of warmth during passage of the catheter and may be asked to cough or bear down during insertion. ECG is used to monitor the client during the procedure.

Care After Cardiac Catheterization - Keep the site clean and dry. - Avoid tub baths for the first 3 days. - Avoid strenuous activity. - Consume a regular diet without restrictions. - Use ibuprofen or acetaminophen for pain The nurse should check the client's vital signs every 15 min for 1 hr, then every 30 min for 2 hr as per facility protocol until the client is stable. The nurse should frequently check the client's pulses, temperature and color on the affected extremity, and the insertion site for bleeding or a hematoma and report any changes. The nurse should also check the client for evidence of bleeding that can occur from the incision and drain beneath the client.

Cerebral palsy. ● "Your child will need a botulinum toxin A injection to help with muscle spasticity." Children who have cerebral palsy have spasticity in their muscles. The child can receive botulinum toxin type A injections into affected muscles, which aid in reducing the spasticity.

Children who have cerebral palsy may eat food by mouth; however, the parents might need to use special feeding techniques. Children who have cerebral palsy are able to participate in recreational activities. Some facilities have specific activities for those children who have disabilities.

A nurse is caring for an 18-month-old infant who has chronic otitis media. The nurse should recognize that chronic otitis media will affect which of the following? Correct: - Speech patterns Chronic otitis media can result in hearing loss, which can affect speech development.

Complications of otitis media include meningitis, labyrinthitis, and various types of abscesses and thromboses. Complications of otitis media do not generally affect hand-eye coordination, visual acuity, olfaction, or fine motor skill development.

A nurse is performing an initial home visit to an infant born 3 days ago. Which of the following findings should prompt the nurse to speak to the primary care provider who is caring for the mother and infant? Correct: - The infant's anterior fontanel is bulging The physician should be notified immediately if the infant's fontanels are bulging (which could indicate a serious condition such as meningitis). Bulging of the fontanelle may indicate increased intracranial pressure. A sunken fontanel is a sign of dehydration.

For newborns and infants, monitor head circumference and fontanels for presence of or changes in bulging.

Meningitis (Bacterial). Meningitis is an inflammation of the meninges, the three layers of membranes that enclose the brain and spinal cord, Meningitis is caused by bacteria, a virus, or fungus in the cerebrospinal fluid (CSF). Cerebrospinal fluid analysis, CSF analysis is used to confirm meningitis with spinal puncture. The classic triad of symptoms associated with bacterial meningitis is fever, headache, and neck stiffness (nuchal rigidity). Also, photophobia, vomiting, irritability, headache, seizures. Other signs of meningitis within 2 years through adolescence include a positive Kernig's sign. This refers to a maneuver elicited when the client is lying with the thigh flexed on the abdomen. If the leg cannot be completely extended, this is a positive Kernig's sign. A positive Brudzinski's sign is elicited when the client's neck is flexed, and the examiner flexes the knees and hips. When the lower extremity of o

Hydrocephalus is a condition where there is excessive accumulation of CSF (cerebrospinal fluid) in the ventricles of the brain. In children the fluid buildup causes enlargement of the head. Causes include genetics, hemorrhage, meningitis, tumor, cysts, and head trauma. Signs and symptoms of hydrocephalus in children include shrill and high-pitched crying, failure of upward gaze, personality changes, headache, loss of bladder control, vomiting, loss of coordination, muscle spasm, and retarded growth. Hydrocephalus is treated by shunting where the CSF is redirected away from the obstruction to other parts of the body to be reabsorbed.

Toddler assessment ● Minimize physical contact with the child initially, and then progress from the least traumatic to the most traumatic procedures. If the child becomes uncooperative, the nurse should perform the procedures more quickly. ● At the age of 15 months, the toddler should be able to scribble spontaneously - Most toddlers have bowel and bladder control during the daytime by 24 to 30 months of age. - Use of the appropriate pronoun when referring to self occurs until 30 months of age. - At the age of 18 months, the toddler should be able to make strokes imitatively. -A toddler develops an intense focus and interest in pictures at 15 months of age.

● Building towers of blocks is an appropriate activity for a 2-year-old child. It promotes fine-motor development, and knocking blocks down provides a means of dealing with the stress of hospitalization. 2-year-old toddler nutrition: ● Should consume 1,000 calories daily. - should have 2 oz of protein daily - should have no more than 24 oz (3 cups) of milk per day. - should consume 8 oz (1 cup) of vegetables per day.

Immunizations ● Children should receive booster doses of the DTaP immunization between the ages of 4 and 6. It is around this age that blood titers drop due to decreasing antibodies. The infant should receive the PCV immunization at 2 months, 4 months, and 6 months, and the fourth dose between 12 to 18 months. The infant should receive the Hib immunization at 2 months, 4 months, and 6 months, and the fourth dose between 12 to 18 months The infant should receive the Hepatitis (Hep B) immunization at birth, 1 to 2 months, and the third dose at 6 to 18 months.

● The pneumococcal and influenza vaccines are recommended for all children exposed to and infected with HIV.

Buck's traction Buck's traction is skin traction, which works without the use of pins. The child who is in Buck's traction is not ill and should be encouraged to continue socialization through various means. The nurse should not move or adjust the weight to ensure proper alignment and correct healing.

Interventions: - Traction might lead to neurovascular compromise. The nurse should assess for edema, pulses, pain, color, and temperature of the extremity every 4 hr.

Sickle cell anemia. A child who has sickle cell anemia must maintain adequate hydration because dehydration might cause sickle cell crisis that can occlude the child's circulation. During a shift report, a child who has sickle cell anemia and a urine specific gravity of 1.030, is a priority and has to be seen first.

Interventions: - Maintain hydration, offer flavored popsicles as a source of fluid.

A charge nurse is alerted that a 10-year-old child is being admitted from the Emergency Department with a diagnosis of meningococcal meningitis. Which of the following is the highest priority nursing intervention? Correct: - Institute droplet precautions This client has a highly infectious form of bacterial meningitis, caused by Neisseria meningitides bacteria. Bacterial meningitis is considered a medical emergency. Droplet precautions are necessary and should be the priority on admission. The presence of petechiae or a purpuric-type rash requires immediate medical attention.

A private room is preferable for clients on droplet precautions, but if it is not available, the client may be placed in a room with another client who has the same active infection, if no other infections are present. A distance of at least 3 feet must be maintained from other clients if a private room is not available. Healthcare workers should wear a mask when working within 3 feet of the client. If transport is necessary, the same as airborne precautions apply; the client should only leave the room for medical reasons and should wear a surgical mask. Close contacts of the client should be treated with prophylactic antibiotics. Meningococcal conjugate vaccine is recommended for adolescents of high-school age and college freshmen in dormitories.

A client is being monitored after a cardiac catheterization 3 hours earlier through a left femoral artery catheterization site. Which of the following observations suggest a potential complication and should be reported immediately to the healthcare provider? (Select all that apply.) Correct: - Increasing swelling at the site of catheterization - Numbness in the left foot The nurse should perform first the assessment of the puncture site. Cardiac catheterization requires puncturing an artery. This client is at risk for bleeding from the puncture site. A thrombus may form and occlude the blood vessel. If an arterial thrombus forms, the affected extremity will appear cool and pale with diminished pulses, decreased sensation, and delayed capillary refill.

Clients generally remain on bed rest for 6 hours after diagnostic catheterization. Clients should be encouraged to drink fluids to maintain a urine output of at least 30 mL/hr in order to flush the intravenous contrast through the kidneys. Post-procedure, the nurse should check peripheral pulses, sensation and color of extremities every 15 minutes for the first hour. The insertion site should be monitored for swelling and bleeding and sandbags should be placed as indicated. The nurse should assess the puncture site for bleeding or oozing. Other abnormalities that can indicate a potential complication include swelling, redness, and pain.

Nephrotic syndrome (nephrosis) ● A child who has nephrotic syndrome is prone to infection, keep the child away from people who have an infection. ● A child who has nephrotic syndrome is not infectious and can be place in the same room with a child with another immunocompromised child such as one who has Leukemia. Expected findings: ● Hyperlipidemia or elevated blood lipid levels (high serum cholesterol, e. g 700 mg/dL). report to PCP. ● Edema to lower extremities (ankles) and genitalia - Proteinuria (protein in urine) present; up to 15 grams of protein in a 24‑hr specimen. Report to PCP Blood protein 5.0 g/dL - Weight gain over a period of days or weeks - Decreased urinary output. - Facial and periorbital edema: decreased throughout the day - Ascites - Anorexia - Muehrcke lines on fingernails (white lines parallel to the lunula)

Corticosteroids are the first-line treatment for children who have nephrotic syndrome. Restrict the child's sodium intake, and, in severe cases, restrict fluids. Medications: prednisone, furosemide, albumin. A serum albumin level is monitored in a child who has nephrotic syndrome. Administering albumin causes serum albumin levels to rise and fluid shifts from the subcutaneous spaces into the bloodstream, which decreases edema. Monitor blood pressure, daily weight, and protein in urine. Lower than the expected serum sodium, and increased platelet count because of hemoconcentration Hemoglobin levels within the expected reference range or elevated.

D DTaP (diphtheria, tetanus, and acellular pertussis. The DTaP is not a live vaccine. No special precautions are needed regarding immunosuppressed family members. A mild fever may be expected with the DTaP.

Delay administering the diphtheria, tetanus, and acellular pertussis (DTaP) in the presence of an acute bilateral ear infection, with or without fever. DTaP vaccine should not be given to a child who has had a life-threatening allergic reaction after a dose of DTaP or who experienced a brain or nervous system disease within 7 days after a dose of DTaP.

A nurse on a pediatric unit is assigned to care for a 6-year-old who is transferred from the emergency department with a suspected diagnosis of meningococcal meningitis. The child has fever, headache, stiff neck, and decreased level of consciousness. Which of the following is the priority action? Correct: - Prepare an isolation room The nurse's first task is to ensure that staff and other clients, particularly clients with compromised immunity, will not be exposed to the illness. Preparation of an isolation room is the most important priority. The client should be placed on droplet precautions in addition to use of standard precautions. Meningococcal meningitis is characterized by fever, headache, and stiff neck. Meningococcemia is a disseminated meningococcal infection characterized by sepsis and rash.

Droplet precautions require a private room or a room with clients who have an infection from the same microorganism, ensuring that each client has his or her own designated equipment. Providers and visitors should wear a mask. Maintain respiratory isolation for a minimum of 24 hr after initiation of antibiotic therapy

Poisoning and Intoxication. ● If the child ingests a hazardous substance instruct the parents to first call the poison control center. ● Check the child's respiratory status with findings that can can result in a compromised airway such as lips that are edematous and inflamed, and he is drooling. These findings indicate that the child might have swelling of the oral cavity and pharynx, ● Injury by a corrosive liquid, such as bleach, is more extensive than by a corrosive solid. Activated charcoal is not administered to whom has ingested a corrosive substance, because it can infiltrate any tissue that is burned. Inducing vomiting is an inappropriate action because it can cause additional harm by causing burns.

For acetaminophen overdose or poisoning.= administer Acetylcysteine. Digoxin immune fab is an antidote for digoxin toxicity. Naloxone is the antidote for opioid overdose. Children who have salicylate, or aspirin, poisoning or overdose should receive vitamin K to decrease bleeding.

​A nurse is caring for a toddler who has a fever, a high-pitched cry, irritability, and vomiting. Which of the following actions should the nurse take? Correct: - Pad the rails of the toddler's bed When caring for a toddler who has manifestations of bacterial meningitis, the nurse should implement seizure precautions, which includes padding the side rails of the bed.

When caring for a toddler who has manifestations of bacterial meningitis, the nurse should keep the head of the bed slightly elevated to decrease intracranial pressure. When caring for a toddler who has a fever, the nurse should avoid giving the toddler a cold bath because it can cause shivering and discomfort. When caring for a toddler who has a fever, the nurse should administer acetaminophen rather than aspirin because aspirin is associated with the development of Reye syndrome.

Infant Assessment ● At the age of 5 months, the infant should have no head lag when pulled to a sitting position ● The infant should be able to roll from her back to her side at the age of 4 months. - The startle reflex disappears by the age of 4 months - The crawl reflex disappears around the age of 6 weeks. ● The infant should begin vocalizing vowel sounds at the age of 7 months - By the age of 10 months, be able to say at least one word. - The infant should creep on her hands and knees at the age of 9 months - Begin to stand while holding onto support, like furniture, at the age of 10 months. - Most infants demonstrate a crude pincer grasp at 9 months of age and the use of a dominant hand is also evident.

Infant Immunizations: ● At birth: ● At 2-month-old: Haemophilus influenzae type B (Hib) and inactivated polio virus (IPV). The Hib immunization is administered at the ages of 2 months, 4 months, and 12 to 15 months. The IPV immunization is administered at the ages of 2 months, 4 months, 6 to 18 months, and 4 to 6 years. - The hepatitis A immunization series is started at the age of 12 months.

Sickle cell anemia is a genetically transmitted disease that results in production of red blood cells that sickle with low oxygen tension in the blood. The sickled cells occlude small blood vessels, causing ischemia and pain. This is known as a vaso-occlusive crisis. Conditions that increase the risk of a vaso-occlusive crisis include dehydration and infection. In addition to hydration, analgesics are prescribed and warm compresses may provide additional relief. Treatments include hydration with IV fluids and replacement of electrolytes if indicated; supplemental oxygen is given for SaO2 <94%. Morphine is the analgesic most commonly used to treat individuals with sickle cell pain crises. Bed rest may be helpful to reduce oxygen demand in the initial phase of a crisis, but it will not help resolve the pain crisis.

Interventions for vaso-occlusive crisis: - Start an intravenous bolus of normal saline - After bolus, maintenance IV fluids 5% dextrose in 0.45% NS at 100 mL/hr - Provide hydration through IV and oral therapy - Manage metabolic acidosis through electrolyte replacement - Supplemental oxygen is given for SaO2 <94%. - Morphine is the analgesic most commonly used to treat individuals with sickle cell pain crises. Transfusion is only required when an aplastic crisis occurs, which refers to the failure of the bone marrow to produce red cells. Aplastic crisis is often due to infection with parvovirus B19.

Chemotherapy ● Use a soft sponge toothbrush when irritation to the mucosal ulcers occurs. ● Encourage quiet play for a child with a low platelet count to reduce the risk for injury, bleeding, and the chance of hemorrhage. ● Leukopenia places the child at risk for infection. Monitor the child for increased temperature or a fever.

Interventions: - Children who have mucosal ulcers should not use hydrogen peroxide as a mouth rinse, because it causes drying effects of the mucosa and might cause further ulceration. - Preschool-age children should not take viscous lidocaine, because it depresses the gag reflex, increasing their risk of aspiration. - Children who have mucosal ulcerations should avoid the use of lemon glycerin swabs because they are very irritating, especially on eroded tissues.

Glomerulonephritis The kidneys of these children are not functioning appropriately. The child who has acute glomerulonephritis should have a restricted potassium intake. ● Glomerulonephritis usually results from a Streptococcus infection. In determining a definitive diagnosis, an antistreptolysin O (ASO) titer indicates that the child has had a recent strep infection. Expected findings: ● Periorbital edema due to decrease in plasma filtration. - Cloudy, tea‑colored urine due to blood and protein in the urine. - Increased creatinine due to impaired glomerular filtration of the kidneys. - Hypertension (elevated blood pressure) due to inadequate function of the kidneys and possibly mild edema. - Exhibit an ill appearance due to the manifestations experienced from the inadequate functioning of the kidneys.

Interventions: ● Check the child's blood pressure every 4 to 6 hr to monitor for hypertension. ● The child who has glomerulonephritis has moderate restriction of sodium and further restriction is given to foods high in potassium with children who have decreased urinary output. For example 3 oz grilled chicken, 1 cup of pear slices, and 120 mL (4 oz) of apple juice, is adequate. - No potato chips. hotdogs, cheese, and bacon which are high in sodium. ● Blood creatinine 1.3 mg/dL is above the expected reference range for school-age child, and should be reported to the provider.

Diabetic Ketoacidosis (DKA). Signs and symptoms: ● high ketone levels in the blood and urine ● Blood glucose level greater than 300 mg/dL. ● Fruity scent of the breath ● Weigh loss ● Mental confusion ● Dehydration ● Electrolyte imbalances: osmotic diuresis ● Potassium levels will initially be elevated. With insulin therapy, potassium will shift into cells and the child will need to be monitored for hypokalemia. Insulin administration: administer four to six injections about 2.5 cm (1 in) apart before switching to another site Administer oxygen to children who are cyanotic and whose arterial oxygen level is less than 80%.

Interventions: ● Provide rapid isotonic fluid (0.9% sodium chloride) replacement. ● When the child's blood glucose level falls between 250 and 300 mg/dL, the nurse should begin IV infusion of 5% or 10% dextrose in 0.9% sodium chloride. The goal is to maintain blood glucose levels between 120 and 240 mg/dL. ● Administer regular insulin continuously through an IV infusion at 0.1 unit/kg/hr. ● Provide potassium replacement therapy in IV fluids. Make sure urinary output is adequate before administering potassium.

A nurse is reviewing laboratory results for a 16-month-old child with an elevated lead level. Which of the following is the most serious concern associated with an elevated blood lead level? Correct: - Neurocognitive impairment The most serious adverse effect associated with elevated blood lead levels (≥5 mcg/dL) is neurocognitive impairment. The renal and neurological system are the primary systems affected by lead poisoning. Chronic lead poisoning can cause growth delay, but the most consequential effect is damage to the neurological system.

Lead poisoning is associated with greater harm in young children, because the brain and nervous system are not yet fully developed. Log-level exposure over a prolonged length of time can lead to developmental delays, including difficulty with reading and impairment of visual-motor skills. Mild to moderate increases in the blood lead level is associated with impulsive behavior and hyperactivity. Extreme elevations are associated with permanent cognitive impairment. They can result in blindness, seizures, and, in severe cases, death.

Lumbar Puncture A lumbar puncture is a procedure used to obtain cerebrospinal fluid from the subarachnoid space of the spinal canal for diagnosis of meningitis, encephalitis, and subarachnoid hemorrhage. The provider inserts a spinal needle into the subarachnoid space between L3 and L4, or L4 and L5 vertebral spaces. Consent must be obtained prior to LP. The procedure is performed using sterile technique. Nursing interventions: - Have the client void prior to the procedure. - A topical anesthetic cream (lidocaine and prilocaine) can be applied over the biopsy area 45 min to 1 hr prior to the procedure. - Place the client in the side-lying position with the head flexed and knees drawn up toward the chest, and assist in maintaining the position. Use distraction methods as necessary. - The client can be sedated with fentanyl and midazolam. - Monitor the site for bleeding, hematoma, or infection and viral signs.

Lumbar Puncture postprocedure: - The client should remain flat for 4-24 hours, depending upon the provider's orders. - Pressure and an elastic bandage are applied to the puncture site after the needle is removed. - The nurse should monitor the puncture site for leakage of CSF or formation of a hematoma and should monitor neurologic status at least every 4 hours for 24 hours after the procedure. - Monitor the client's vital signs and neurological status for evidence of potential side effects of the lumbar puncture. The client should be encouraged to remain well hydrated to reduce the risk of spinal headache. The client should void within 8 hours of the procedure. The nurse will administer analgesics prescribed for pain.

Toddler (1 - 3 years old ) ● Cow's milk is the most common food allergy in children. ● To promote sleep, follow a nightly routine and established bedtime. ● The birth weight should double by 6 months, triple by 12 months of age, and quadrupled by 30 months of age. ● Providing distraction during vaccination, such as helping or allowing a child to blow bubbles while receiving an injection, is a technique that can minimize pain and discomfort for the child. Safety: ● Lock any medications in the medicine cabinet. - Keep the child's crib mattress at the lowest level. - Turn pot handles to the back of the stove while cooking. - Syrup of ipecac is not recommended for the treatment of poisoning in the home. Caustic substances can cause more damage when vomiting is induced.

MMR immunizations are administered subcutaneously; therefore, the nurse would not expect any drainage from the injection site. - The first dose of the MMR immunization is administered at 12 to 15 months of age - Varicella is not administered to children younger than 12 months ● A 3-year-old child has a blood lead level of 3 mcg/dL. A child who has an elevated blood lead level should have an adequate intake of calcium and iron to reduce the absorption and effects of the lead. Dietary recommendations should include milk as a good source of calcium.

A client is scheduled for a lumbar puncture to rule out bacterial meningitis. She tells the nurse that she is fearful of becoming paralyzed from the needle placement in her spinal column. Which of the following responses should the nurse offer? Correct: - "The needle is inserted below the third lumbar vertebrae, which is well below the point at which the spinal cord ends." This therapeutic response provides information that specifically addresses the client's concerns and helps decrease anxiety and fears.

Maintain safety (keep the bed in a low position, implement seizure precautions). Position the client without a pillow, and slightly elevate the head of the bed. The client can also be positioned side-lying to reduce neck discomfort. Provide a quiet environment. Minimize exposure to bright light (natural and electric).

Varicella ● Children who have varicella might commence with a maculopapular rash that progresses to vesicles on erythematous bases that eventually rupture and crust over. Varicella causes a vesicular rash for 6 days. Varicella is not administered to children younger than 12 months

Measles A child who has measles might develop Koplik spots, a transient cephalocaudal rash of maculopapular eruptions of the upper trunk and face, becoming more confluent as it spreads to the lower areas of the body. Fifth disease A child who has fifth disease usually begins with bright red cheeks producing a "slapped-cheek" appearance. Following this, a rash appears on the extremities and trunk. The rash fades centrally, giving a lacy (reticulated) appearance to the rash. Tetanus A child who has tetanus will develop lockjaw and muscle rigidity; however, there is no rash associated with tetanus. Nurses recommend the DTaP immunization to aid in prevention of this disease.

A nurse is creating a plan of care for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following interventions is the priority for the nurse to include? Correct: - Monitor the child's oxygen saturation level Also, secondary: - Encourage fluid intake to prevent dehydration and clumping of red blood cells. - Administer prescribed antibiotics to treat any existing infection. - Apply a warm compress to the joints to reduce pain and inflammation. - Maintain bed rest for this child who is experiencing a vaso-occlusive crisis to minimize energy expenditure and avoid additional oxygen needs.

Meperidine is not recommended because this central nervous system stimulant can produce anxiety, tremors, and generalized seizures.

A nurse is assessing an adolescent for findings of hemorrhage following a tonsillectomy. Which of the following findings is a manifestation of this postoperative complication? Correct: - Frequent swallowing Frequent swallowing is a sign of hemorrhage after a tonsillectomy.

Mouth breathing is common after a tonsillectomy because there can be secretions and old blood in the nasal passages. Emesis of old blood is expected after a tonsillectomy due to fluid restriction. Moderate pain is expected after a tonsillectomy due to the trauma of the surgical procedure.

A nurse in the pediatric intensive care unit (PICU) is assigned to care for a child with acute bacterial meningitis. Which of the following should the nurse prioritize while caring for this client? Correct: - Checking the child's level of consciousness hourly Checking the child's level of consciousness is part of a total neurological check. Decreasing level of consciousness is a sign of increased intracranial pressure, which may occur secondary to cerebral inflammation. The nurse's priority is to assess cerebral function in a client with meningitis. The nurse's first priority is to ensure the client does not have increased intracranial pressure from meningitis.

Nursing care priorities for a child with meningitis include maintenance of adequate cerebral tissue perfusion through reduction of intracranial pressure, maintaining normal body temperature, and protecting the child from injury. Signs and symptoms of increased intracranial pressure (ICP) include headache, drowsiness, decreased alertness, vomiting, and a bulging fontanelle in infants. A widening pulse pressure, with increased systolic pressure and decreased diastolic pressure, is an ominous sign associated with increased ICP. Unrelieved pain can result in increased ICP. The nurse should be aware of clues, including moaning and restlessness, that may indicate inadequate pain relief.

O otitis media (AOM) Acute otitis media (AOM) Pathophysiology: Otitis media (OM) is a common childhood disease caused by the accumulation of fluid in the middle ear, which leads to infection and inflammation. Often preceded by illness due to respiratory syncytial virus or influenza. Appears more commonly in children less than 7 years of age. Signs and Symptoms: Pain and pressure in ear Fever: can be high Enlarged postauricular and cervical lymph nodes Loss of appetite Diagnosis/Labs: Medication/Treatment:

Nursing interventions: - Administer analgesics/antipyretics - Apply heat over the ear and position child with the affected ear downward. - Clean external ear canal with sterile cotton swabs with topical antibiotic ointment if draining. - Reinforce need to complete the prescribed course of antibiotics. Client education: - Breastfeeding helps protect against AOM because breast milk contains secretory immunoglobulin A - Feed infant in upright position. - Never prop the infant's bottle on a pillow - Eliminate the infant's exposure to tobacco smoke. - Avoid forceful nose-blowing during an upper respiratory infection. - Minimizing risks associated with crowded places, such as daycare and siblings who have a history of chronic ear infections.. - Adherence to recommended vaccination schedules also reduces the risk of AOM.

Infant (1 - 12 months) Infants should double their birth weight by 6 months and triple their birth weight by 12 months. The posterior fontanel closes at approximately 2 months of age. The anterior fontanel is closed by 18 months of age. Infants are able to grab feet and pull them to their mouth at the age of 6 months of age. At this age, the infant should also be able to pick up a dropped object and hold her own bottle. ● As the infant transitions into toddlerhood, whole milk intake should average 24 to 30 oz per day. Too much milk can affect intake of solid foods and result in iron deficiency anemia. Skim milk is not recommended until after age 2 since it lacks essential fatty acids which are needed for growth and development. Chilled banana slices are an appropriate food choice and help with teething.

Nutrition: - At 12 months of age, infants are able to eat soft table foods such as mashed potatoes, green beans, bread, and finely chopped meats. Do not give juice to infants less than 4 to 6 months of age. At 12 months of age, offer finger foods to stimulate the pincer grasp. Safety: - Use a stationary infant walker - Soft pillows and cushions should not be used in cribs. - Infants and children should remain in the rear-facing position when in a car seat until the age of 2 years or until they reach the recommended height and weight per the manufacturer's guidelines. - Position car seat at 45 degrees angle. - Secure safety gates at the top and bottom of the stairs. - water heater should not exceed 49° C (120° F). Requires further assessment: ● Legs remain crossed and extended when supine is a finding associated with cerebral palsy.

A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions should the nurse include in the plan of care? Correct: - Implement seizure precautions. The nurse should include implementing seizure precautions in the plan of care because the child has an increased risk for seizure activity. The meningitis and corresponding brain edema and meningeal irritation can result in seizure activity. Meningitis typically causes a very high fever, which increases the risk of febrile seizures.

Placing the client in a semi-Fowler's position, with the head of the bed elevated to between 30° and 45°, will help to reduce edema in the brain. The nurse should keep the room as quiet as possible and the lights dimmed. isolation for the first 24 hr is indicated for a client who has bacterial meningitis due to the highly contagious nature of some types of bacterial meningitis. Additionally, the nurse should implement seizure and isolation precautions, initiate antimicrobial therapy, reduce increased intracranial pressure control temperature, and maintain hydration and ventilation.

Immunizations: Diphtheria, tetanus, and cellular pertussis (DTaP). DTaP is administered at 2 months, 4 months, 6 months, 15-18 months, and at 4-6 years. Hemophilus influenza type b conjugate vaccine (Hib). 2 months, 4 months, 12 months Measles, mumps, rubella (MMR). 12 months Pneumococcal conjugate vaccine (PCV) Hepatitis A The HepA vaccine is recommended for children 12-23 months old. Two hepatitis A immunizations are given during childhood, with the second dose administered 6 to 18 months after the first. Hepatitis B (HepB). 1 month, 2 months, 12 months. Rotavirus: 2 months, 4 months, 6 months Varicella vaccine. 12 months Inactivated polio vaccine (IPV). Inactivated poliovirus should be given in four doses, at 2 months and 4 months of age, at 6-18 months, and again at 4-6 years.

Seven significant childhood diseases can be prevented by vaccines. They include Diphtheria (the 'D' in DTaP vaccine), a disease that can result in respiratory distress, paralysis and heart failure; tetanus (the 'T' in DTaP vaccine; pertussis (the 'P' in DTaP vaccine), which refers to whooping cough and can lead to pneumonia, seizures, brain damage, or death. Most pertussis deaths occur in infants younger than 3 months of age. Haemophilus influenzae type b is prevented by vaccine. The bacteria causes meningitis, pneumonia; ear and sinus infections, bloodstream infections, and infections of the joints, bones, and pericardium; brain damage; severe swelling of the throat; and deafness, primarily in children under the age of 5.. Hepatitis B infection is prevented by vaccine. It is a virus that can lead to severe liver damage, cirrhosis, and liver cancer. Polio is another illness prevented by vaccine. Prior to availability of the vaccine in the 1950s, polio lead to permanent paralysis in more than 15,000 Americans annually. Pneumococcal disease can be prevented by vaccine. It causes meningitis, ear infection, sinus infection, pneumonia, sepsis, brain damage, and hearing loss. Pneumococcal disease has a high fatality rate of 1 death per 15 pediatric cases.

A nurse is caring for a school-age client who is postoperative following a tonsillectomy. Which of the following actions should the nurse plan to take to prevent aspiration? Withhold fluids until the client demonstrates a gag reflex. Correct: - Following a tonsillectomy, the client's gag reflex can be suppressed by local anesthetics or edema. To prevent aspiration, the gag reflex must be present before the client is allowed to have fluids.

Suction the nasopharynx as needed. This action can cause trauma to the denuded tonsil sockets, leading to hemorrhage. Although suction equipment should always be available at the client's bedside in case of hemorrhage or aspiration, it should only be used in an emergency and in the presence of the provider.

Intussusception Intussusception is the invasion of one part of the intestine into the other, creating a pocket. It is a mechanical obstruction that can cause bowel obstruction:, bowel necrosis, and perforation: ● The presence of an intussusception is confirmed by an abdominal x-ray, ultrasound, or CT scan. ● Prepare the child for a barium enema. The pressure created by a barium enema might force the bowel to resume a normal configuration. In the event of surgical intervention, the provider will remove the nonviable portion of the bowel so the bowel is anastomosed, with no need for a colostomy.

Symptoms of intussusception include: Abdominal pain that may come and go Vomiting Bloating Bloody stool Loud crying that comes and goes every 15 to 20 minutes Straining Drawing the knees up Irritability Abdominal pain observed with intussusception is a contraindication for receiving magnesium hydroxide, a laxative. In addition, children such as these are NPO and should not receive anything by mouth.

A mother phones the clinic to report she has an appointment for her six-month-old infant to receive his immunizations that day, but he is running a fever of 103 degrees, has a bad cough, and has not eaten well for the past several days. The nurse's BEST response is to: Correct: Advise the parent to keep the scheduled appointment to have the child seen by the pediatrician but that the immunizations will need to be postponed until the baby is well - The mother should not give the child aspirin because it can increase the risk of developing Reye's syndrome. - Immunizations are not administered to children who are ill. - Withholding oral intake from a child who is febrile can quickly lead to dehydration.

The American Academy of Pediatrics has issued guidelines for when a child with a fever should see the healthcare provider. For children under 3 months, a visit to the provider is recommended for any fever of 100.4°F or higher, even if the child shows no other symptoms of illness. A child of 3 to 6 months should be evaluated for any fever of 101°F or higher. Children over 6 months should be evaluated for any fever 103°F or higher. If symptoms including prolonged febrile seizures, respiratory symptoms, or pain accompany any fever, the child should be evaluated by a healthcare professional.

A nurse is teaching a client who is scheduled for a cardiac catheterization. Which of the following statements should the nurse include in the teaching? Correct: - "You will need to keep your affected leg straight following the procedure." The nurse should instruct the client to remain on bed rest in the supine position with the affected leg straight. The client that will be awake and sedated during the procedure and a local anesthetic is used at the catheter insertion site.

The nurse should instruct the client to increase fluids following a cardiac catheterization to promote excretion of the contrast dye and reduce the risk for hypovolemia. The nurse should ask the client about an allergy to iodine or shellfish due to the use of contrast dye.

Asthma ● Priority, report to provider a sudden decrease in wheezing (silent chest). It indicates ventilator failure and an imminent respiratory arrest. ● During hospitalization encourage rooming-in. To use a peak expiratory flow meter (PEFM). ● Check the PEFM by performing three attempts and recording the highest reading of the three. ● take a deep breath, place the lips around the mouthpiece, and then blow into the mouthpiece as hard and fast as possible. - Values in the green zone represent 80 to 100%. OK A nurse should provide a toddler with short, simple explanations. A long explanation might cause heightened anxiety in the child. When the nurse is speaking to a toddler, she should refrain from using the word "fix" because toddlers assume they are broken. Instead, the nurse should say, "I will help make you feel better."

Toddlers are not as concerned about privacy as school-age children and adolescents. These children prefer to be with someone during procedures.

Tonsillectomy Postoperative Nursing interventions: - Nurse's priority: Frequent swallowing that can be an indication of bleeding. - Use the FACES rating scale to assess a 3-year-old child's pain level. - Administer analgesics to the child on a routine schedule throughout the day and night. - Discourage the child from clearing their throat, blowing their nose, or coughing, which all can cause bleeding. - Assess the gag reflex prior to allowing the child to have fluids. - Offer an ice collar to provide nonpharmacological pain relief. - Cold, clear liquids such as crushed ice, cool water, diluted fruit juice, and flavored ice pops are well-tolerated following a tonsillectomy. - Liquids that are brown or red (cranberry juice,) should be avoided in order to tell the difference between liquid and fresh or old blood. - Avoid giving the adolescent orange juice, cranberry juice, ice cream, milk, or pudding as they can be ir

Tonsillectomy Postoperative: Client Education: - Report constant clearing of the throat that can be a manifestation of hemorrhage following a tonsillectomy -Notify the provider if bright red bleeding occurs in secretions - Eliminate the use of a straw when offering fluids as they can damage the surgical site - Encourage clear liquids and fluids after a return of the gag reflex, avoiding red‑colored liquids, citrus juice, and milk‑based foods initially. - Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site. The pressure from nose blowing can increase bleeding from the surgical site. Expected findings: - Nausea, a hoarse voice, a sore throat., old blood that is a dark brown color, an unpleasant odor, a low-grade fever for several days

Transposition of great arteries An infant who has transposition of great arteries will have severe cyanosis because reversal of the anatomic position of the aorta and pulmonary artery allows venous blood to enter the systemic circulation without oxygenation.

Ventricular-septal defect, Coarctation of the aorta, Patent-ductus arteriosus. Are unlikely to have cyanosis because oxygenation of the blood remains adequate for the systemic circulation.

The school nurse is teaching parents about communicable disease. She tells the group that encephalitis (aseptic meningitis) can result as a complication of: Correct: - Mumps Mumps is caused by a virus and may lead to encephalitis (aseptic meningitis).

Viral infections of the central nervous system result in aseptic meningitis or encephalitis Encephalitis occurs most frequently due to viruses, including herpes simplex viruses, which cause cold sores and genital herpes; varicella zoster virus, which causes chickenpox and shingles; measles, mumps, and rubella viruses.

MONONUCLEOSIS What is it? An infection caused by the Epstein-Barr virus and transmitted through oral secretions. Mildly contagious with a prolonged incubation phase of 30-50 days. What does it look like? Malaise, sore throat, fever, generalized lymphadenopathy, and splenomegaly. Instruct the adolescent to avoid taking aspirin because it increases the risk for Reye syndrome in children and adolescents who have viral infections. Acetaminophen is used to control fever and discomfort. If severe pain is present, hydrocodone can be prescribed during acute illness. The nurse should instruct the adolescent to gargle with warm water every 2 to 3 hr or use analgesic troches to soothe the discomforts associated with mouth soreness and pharyngitis associated with mononucleosis.

What actions should the nurse perform? Nursing interventions are focused on comfort measures to relieve manifestations. - Assess for airway obstruction during acute phase. - Ensure adequate fluid intake. - Administer antipyretics and analgesics as needed. - Teach child/parents to avoid strenuous activities until splenomegaly has resolved. - Limit exposure to sick individuals. - Avoid live vaccines for several months after recovery.