Pediatrics Ch. 26-28
The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child?
Risk for infection
alopecia
loss of hair
HTN: Drug therapy is only for children between ___ to ___years of age with very high risk factors
8 to 10
Between which two ages does the highest incidence of iron-deficiency anemia occur?
9 and 24 months
at what age should full term infants be screened for iron-deficiency anemia
9 and 24 months of age
children develop an understanding of death as permanent around age of
9-10 years old
Leukemia
Uncontrolled growth of immature WBC's. The count may be high but the cells do not function as they are supposed to.
hemarthrosis
bleeding into a joint space
Digoxin
cardiac glycoside; affects Na and K in heart cells; reduces strain of the heart
Treatment for hypoplastic left heart syndrome:
heart transplant
following a splenectomy, the child faces long term risk of serious
infection
thrombocytes
platelets
>170
total cholesterol in children
diagnosing pinworms
using tape and placing it outside the anal region at night and in the morning there will be eggs on it
Which statement by a mother may indicate a cause for her 9-month-olds iron deficiency anemia?
"Formula is so expensive. We switched to regular milk right away."
Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease?
"It is important for my child to drink plenty of fluids."
The nurse finds an adolescent with Hodgkins disease crying. The adolescent says, I am so scared. What is the most appropriate nursing response to this comment?
"Tell me what's got you scared."
A 6-year-old with leukemia asks, Who will take care of me in heaven? What is the best response by the nurse?
"Who do you think will take care of you?"
tetralogy of Fallot: The child rests in a ______position to breathe more easily.
"squatting"
Physiologically, defects can be organized into : (3)
(1) lesions that increase pulmonary blood flow, (2) lesions that restrict blood flow, and (3) lesions that decrease pulmonary blood flow. There are also lesions that result in mixed oxygenation and nonoxygenated blood
Kawasaki disease
(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms.
Diagnosis of tetralogy of Fallot
- is confirmed by a chest x-ray study that shows a typical boot-shaped heart. -an electrocardiogram, three demensional echocardiography, and cardiac catheterization aid in confirming diagnosis
Diagnosis of rheumatic fever
-Jones criteria; the presence of two major criteria or one major criteria and two minor criteria supported by evidence of recent streptococcal infection, indicates a high probability -physical and history -blood tests -erythrocyte sedimentation rate (ESR) is elevated -Abnormal proteins such as C-reactive protein may also be relevant in the blood serum -Leukocytosis may occur but is not regularly present -Antibodies against the streptococci (measured by ASO titer) may also be detected -Chest X-ray -Throat culture -Pulmonary function tests -Electrocardiogram, a graphic record of the electrical changes caused by the beating of the heart, is very useful. Changes inconductivity, particularly a prolonged P-R interval (indicating a first-degree heart block), may reflect carditis. The tests are repeated throughout the course of the disease so that the physician can determine when the active stage has subsided.
Treatment of Patent Ductus Arteriosus (PDA)?
-Premature infants with hypoxia often respond to indomethacin drug therapy that results in closure of the PDA. -heart surgery is performed in all full term newborns to prevent CHF, embolus formation, and other complications. -ductus May be ligated via thoracotomy (incision into the chest) or via the visually assisted thoracoscopic surgery (VATS) technique that eliminated the need for a large chest incision. -nonsurgical options include the insertion of coils to occlude the PDA, which is done in a cardiac catheterization lab. -prostaglandin E1 May be administered to maintain latency of the ductus arteriosus until surgery can be performed when an anomaly such as hyoplastic heath is diagnosed in the newborn
Complications of tetralogy of Fallot
-cerebral thrombosis caused by polycythemia (thickened blood as a result of increased RBCs), especially if dehydration occurs -iron deficiency anemia because of decreased appetite and increased energy required to suck or eat. -bacterial endocarditis; is prevented with prophylactic antibiotic therapy
Observations that should be reported that can show signs of congenital cardiac problems
-failure to thrive and/or poor weight gain -cyanosis, pallor -visually observed pulsations in the neck veins -tachypnea, dyspnea -irregular pulse rate -clubbing of fingers -fatigue during feeding or activity -excessive perspiration, especially over forehead
Treatment of HF
-infant is fed early if crying and late is asleep -knee-chest position to facilitate breathing; in other cases, a position with the head elevated (Fowler's position) -feedings are small and frequent; soft nipple with holes large enough to prevent tiring -formulas with increased caloric density -some cases nasogastric tube feedings because they are less tiring -oxygen to relieve dyspnea -Digitoxin And digoxin (Lanoxin) are common oral digitalis preparations. Lanoxin is Preferred for its rapid action and shorter half life. These agents slow and strengthen the heartbeat. Count pulse before administering; if below 100 beats/min med is withheld; in older children pulse should be more than 70 beats/min; symptoms of toxicity include nausea, vomiting, anorexia, irregularity in rate and rhythm of the pulse, and a sudden change in pulse. A single dose larger than 0.05 mg or 50 mcg should be reconfirmed with HCP -angiotensin converting enzyme inhibitors (ACE-Is); captopril, enalapril, And lisinopril are examples; observe for signs of hypotension, cough, renal dysfunction, and hypercalcemia. -diuretics such as furosemide (Ladin) or chlorothiazide (Diuril) to reduce edema; careful monitoring of serum electrolyte levels, particularly potassium depletion. Monitor I&O -eating iron-rich foods
Beta Blockers
-olol: slow HR, dilates blood vessels to decrease blood pressure
ACE inhibitors
-pril; slow activity of the enzyme angiotensin-converting enzyme to reduce BP
Goals to the care of children with HF:
-reduce the work of the heart -improve respiration -maintain proper nutrition -prevent infection -reduce anxiety -support and instruct parents
Cardiac output can be increased by one of two mechanisms:
-tachycardia or increased stroke volume. Stroke volume is the amount of blood ejected during one contraction. Because infants and small children have a limited ability to increase stroke volume, their heart rate must increase to meet the demand
digoxin. A single dose larger than _____mg, or ____ mcg, should be reconfirmed with the health care provider.
0.05 mg:50 mcg
four defects in tetralogy of Fallot.
1. Pulmonary artery stenosis 2. Hypertrophy of the right ventricle 3. Decrroposition of aorta 4. VSD
types of esophageal atresia
1. upper and lower esophagus end in a blind pouch 2. upper esophagus ends in a blind pouch and lower esophagus connects to trachea 3. upper and lower esophagus are attached to trachea 4. upper esophagus connects to trachea and lower esophagus ends in a blind pouch
Tetra means "four." In tetralogy of Fallot there are four defects:
1.Stenosis or narrowing of the pulmonary artery, which decreases the blood flow to the lungs 2.Hypertrophy of the right ventricle, which enlarges because it must work harder to pump blood through the narrow pulmonary artery 3.Dextroposition (dextro, "right," and position) of the aorta, in which the aorta is displaced to the right and blood from both ventricles enters it 4.VSD
by what age do children realize that death is final and permanent
10 years old
A resting apical pulse is most accurate. As a rule, if the pulse rate of an infant or child is below _____ beats/min the medication is withheld and the physician is notified. In older children the pulse rate should be more than ___beats/min.
100: 70
Parent teaching should be reinforced concerning the need to postpone active routine immunizations for ______ months after the administration of immune globulin, which is an immunosuppressant.
11
it is recommended that iron fortified formula be given to infants through age
12 months
Normal range for hemoglobin
12-18 g/dL
Normal Platelet Count
150,000-400,000
Children less than ____ years of age should not have a fat-restricted diet, because calories and fats are necessary for CNS growth and development.
2
Children with a parental history of cholesterol levels exceeding ___ mg/dL or a family history of early cardiac death (less than 55 years of age) should have their cholesterol levels tested because genetics can play a role in hypercholesterolemia
240
Regular follow-up of liver function tests and lipid levels is important when taking statins. If liver enzymes are ___ times normal, statin therapy should be discontinued
3
VSD Pulmonic Stenosis Overriding Aorta Right Ventricular hypertrophy
4 defects of tetralogy of Fallot
Normal range for RBC
4.5-11.0
Normal WBC Range
45,000-10,000
patient controlled analgesia can be used for the child older than ______ years of age to mange pain caused by sickle cell crisis
7
Significant hypertension is considered when measurements are persistently at or above the ____th percentile for the patient's age and sex
95
Hemophilia
A blood disorder where the blood does not clot normally. Inherited as a sex linked recessive trait.
What two things are characteristic of a ventricular septal defect (VSD) ?
A loud, harsh murmur combined with a systolic thrill
Cardiac catheterization
A radiopaque catheter is passed through the femoral artery directly into the heart and large vessels; done to show blood pressure within the heart; physician can examine the heart closely with the tip of the catheter to detect abnormalities; blood samples can be obtained to determine oxygen content
electrocardiogram
A recording of the electrical activity of the heart
18. A child has been diagnosed with ascariasis (roundworm). The statement made by her mother that may suggest a cause for her condition is:
A. "I've been airing out the house on these nice breezy days." B. "My child often goes out to the garden and pulls up a carrot to eat." C. "She runs barefoot so much I have to wash her feet at least twice a day." D. "We just remodeled our bathroom at home." ANS: B The child can ingest roundworm eggs from contaminated soil.
25. The statement by a mother that may indicate a cause of her son's vitamin C deficiency is:
A. "We get our fruits from homemade preserves." B. "We use milk from our own goats." C. "We grow all our own vegetables." D. "We're not big meat eaters." ANS: A Vitamin C is destroyed by heat.
33. What sign(s) indicate(s) moderate dehydration? Select all that apply.
A. 10% weight loss B. Dry mucous membranes C. Normal anterior fontanel D. Increased urinary output E. Lethargy ANS: A, B, C The child that is moderately dehydrated will have lost 10% of his body weight, will have dry mucous membranes, normal (nonsunken) anterior fontanelle, decreased urine output, and will be irritable.
30. The nurse is aware that the 18-pound child must take in _____ mL of oral fluid to make up the fluid loss from one stool of diarrhea.
A. 18 B. 36 C. 64 D. 81 ANS: D The formula for oral fluid replacement is 10 mL/kg. 18 pounds = 8.1 kg 10 = 81 mL.
12. The nurse explains that the treatment of choice for a child with intussusception is:
A. A barium enema. B. Immediate surgery. C. IV fluids until the spasms subside. D. Gastric lavage. ANS: A A barium enema is the treatment of choice for intussusception because the passage of the barium frequently "un-telescopes" the bowel. Surgery is scheduled only if reduction is not achieved.
10. A mother reports that her 2-year-old child experiences constipation frequently. The nurse would recommend to the mother to include what food in the child's diet?
A. Cooked vegetables B. Pretzels C. Whole-grain cereal D. Yogurt ANS: C Dietary modifications for constipation include eating more high-roughage foods such as whole-grain breads and cereals.
23. The nurse would expect a child admitted to the hospital for nonorganic failure to thrive to:
A. Cry to be picked up. B. Be limp like a rag doll. C. Be responsive to cuddling. D. Weigh in the 10th percentile for age. ANS: B Some children with failure to thrive have rag-doll limpness (hypotonia) and appear wary of their caregivers.
29. Following surgery for pyloric stenosis an infant awoke from anesthesia hungry and crying. The nurse should:
A. Delay feeding the child for 6 hours. B. Offer regular formula thinned with water. C. Give small amounts of regular formula thickened with cereal. D. Allow one ounce of glucose water at frequent intervals. ANS: D Small oral feedings of glucose water are given after recovery from anesthesia. Feedings are gradually increased to larger amounts of regular formula.
6. The nurse interviewing parents of an infant with pyloric stenosis would expect the parents to report if the infant has had:
A. Diarrhea. B. Projectile vomiting. C. Poor appetite. D. Constipation. ANS: B Vomiting is the outstanding symptom of pyloric stenosis. Food is ejected with considerable force, which is described as projectile vomiting.
8. The nurse that is teaching a parent about pyrvinium (Povan) would include the information that the drug will cause:
A. Diarrhea. B. Skin rash. C. Red stool. D. Metallic taste. ANS: C The nurse should advise parents that pyrvinium stains clothing and turns stools red.
1. The finding in a newborn suggestive of tracheoesophageal fistula is:
A. Failure to pass meconium in 24 hours. B. Choking on the first feeding. C. Palpable mass in the sternal area. D. Visible peristalsis across abdomen. ANS: B After birth, a newborn with tracheoesophageal fistula will vomit and choke when the first feeding is introduced.
21. A 7-month-old infant is admitted to the hospital with a diagnosis of acute gastroenteritis. The priority goal of the infant's care is to prevent:
A. Fluid and electrolyte imbalance. B. Nutritional deficiency. C. Skin breakdown. D. Malabsorption. ANS: A The priority goal of care in gastroenteritis is preventing fluid and electrolyte imbalance.
31. When feeding a child with pyloric stenosis, what interventions will the nurse perform? Select all that apply.
A. Give a formula thinned with water. B. Burp the infant before and during feeding. C. Give the feeding slowly. D. Refeed if the infant vomits. E. Position infant on left side after feeding. ANS: B, C, D Children with pyloric stenosis are given formula thickened with cereal; the infant is burped before and during feeding to get rid of any gas in the stomach; the infant is fed slowly and refeed if vomiting occurs. The infant is positioned on the right side to allow the weight of the feeding to stay in the stomach against the pyloric valve.
2. A child is brought to the pediatric clinic because he has been vomiting for the past 2 days. An acid-base imbalance that the nurse would expect to occur from this persistent vomiting is:
A. Hyperkalemia. B. Hypernatremia. C. Acidosis. D. Alkalosis. ANS: D Hydrochloric acid and sodium chloride from the stomach are lost from persistent vomiting. This results in alkalosis.
16. The nurse, planning a parent education program about lead poisoning prevention, would include the information that the sources of lead in the community are most likely:
A. Increased lead content of air. B. Use of aluminum cookware. C. Deteriorating paint in older buildings. D. Inhaling smog. ANS: C The primary source of lead is paint from old, deteriorating buildings.
17. A frightened mother calls the pediatrician's office because her child swallowed dishwashing detergent. The most appropriate action is to:
A. Induce vomiting by giving the child syrup of ipecac. B. Take the child to the local emergency department. C. Give the child activated charcoal mixed with juice. D. Give the child milk to soothe affected mucous membranes. ANS: B Inducing vomiting is no longer recommended because it may pose additional problems. The child should be taken immediately to the nearest emergency department along with the packaging of the ingested substance.
9. The instruction the nurse would give to parents about preventing the spread and reinfection of pinworms is to:
A. Keep children's nails short. B. Dress child in loose-fitting underwear. C. Clean the bathroom with bleach solution. D. Wash bed linens in cold water. ANS: A One intervention to prevent the further spread of pinworms is to keep the child's fingernails short. Pinworms are not spread from person to person.
14. An infant is admitted to the hospital with severe isotonic dehydration. In planning the infant's care, the nurse is aware the infant is at risk for:
A. Metabolic alkalosis. B. Hypocalcemia. C. Sepsis. D. Shock. ANS: D Shock is the greatest threat to life in isotonic dehydration.
7. A mother reports that her child has been scratching the anal area and complaining of itching. Based on this information, the nurse might suspect this child has:
A. Pinworms. B. Giardiasis. C. Ringworm. D. Roundworm. ANS: A With pinworms, the nurse or parent may notice that the child scratches the anal area and complains of itchiness. The other choices do not cause this reaction.
24. Nursing interventions for the mother of a 10-month-old infant with nonorganic failure to thrive would include:
A. Pointing out errors that the nurse observes when the mother is caring for the infant. B. Discussing negative characteristics of the infant with the mother. C. Having the nurse provide as much of the infant's care as possible. D. Teaching the mother about the developmental milestones to expect in the next few months. ANS: D The nurse can increase parent's knowledge of growth and development by providing anticipatory guidance about normal developmental milestones.
5. An appropriate intervention for a 3-month-old infant who has gastroesophageal reflux is to:
A. Position the infant in the crib on his or her abdomen, with the head elevated. B. Administer medication as ordered to stimulate the pyloric sphincter. C. Give thin rice cereal with formula before feeding solid foods. D. Place the infant in an infant seat after feedings. ANS: A After feedings, the infant is placed in a prone position to avoid increased intraabdominal pressure.
4. The nurse is aware that rapid respirations are a possible cause of dehydration because they:
A. Prevent the child from drinking. B. Increase circulation, thus increasing urine production. C. Cause evaporation of fluid on the mucous membranes. D. Often lead to vomiting. ANS: C Rapid respirations cause increased insensible fluid loss.
19. The nurse would expect the stools of a child with celiac disease to have which appearance?
A. Ribbon like B. Hard, constipated C. Bulky, frothy D. Loose, foul-smelling ANS: C Celiac disease causes malabsorption. Stools that are large, bulky, and frothy may indicate malabsorption.
32. What assessment(s) would lead a nurse to suspect Hirschsprung's disease in a 1-month-old infant? Select all that apply.
A. Ribbon-like stools B. Fever C. Failure to thrive D. Vomiting E. Diminished peristalsis ANS: A, B, C, D, E All options are significant indicators of Hirschsprung's disease.
22. The nurse, speaking to the parent of a 3-year-old child who has mild diarrhea, would advise the dietary modification of:
A. Soft foods with rice, bananas, toast, and applesauce. B. Small amounts of clear fluids such as gelatin. C. An oral rehydrating solution, such as Pedialyte. D. Chicken soup because it is high in sodium. ANS: C An oral rehydrating solution is recommended to replace fluids and electrolytes lost from frequent bowel movements.
13. Parents ask the nurse how their infant developed a Meckel's diverticulum. The nurse's response is based on the knowledge that this condition occurs when:
A. The yolk sac remains connected to the intestine. B. There is inflammation of the ileocecal valve. C. A pouch forms when the vitelline duct fails to disappear. D. There is a weakness in the abdominal wall. ANS: C If the vitelline duct fails to disappear completely after birth, a blind pouch may form.
3. On the second day of hospitalization for a 3-month-old brought in for treatment for gastroenteritis, the nurse makes all of the assessments listed below. Which assessment finding indicates ineffectiveness of treatment?
A. Weight loss of 4 ounces B. Dry mucous membranes C. Decreased skin turgor D. Depressed fontanelle ANS: A Weight loss is the most significant indicator of dehydration because an infant's weight is comprised of 77% water.
20. After reviewing dietary restrictions for celiac disease, the nurse determines that a parent understands the information when she states that a grain that can be eaten by a child with celiac disease is:
A. Wheat. B. Oats. C. Barley. D. Rice. ANS: D Rice is a gluten-free grain that can be eaten by children afflicted with celiac disease. These children will have a lifelong restriction of wheat, oats, barley, and rye.
15. A child is brought to the emergency department because he ingested an unknown quantity of acetaminophen (Tylenol). After gastric lavage is completed, the nurse might expect this child to receive:
A. activated charcoal. B. N-acetylcysteine. C. vitamin K. D. syrup of ipecac. ANS: B Gastric lavage is followed by N-acetylcysteine (Mucomyst), the antidote for acetaminophen.
11. Intussusception would be suspected when parents describe the child's stools as:
A. currant jelly. B. black and tarry. C. green liquid. D. greasy and foul-smelling. ANS: A Bowel movements of blood and mucus that contain no feces ("currant jelly" stools) are common about 12 hours after the onset of the obstruction.
28. An infant is admitted to the hospital with severe dehydration. Laboratory results show pH 7.32, PaCO2 40, HCO3- 21. The nurse interprets these values as:
A. metabolic acidosis. B. metabolic alkalosis. C. respiratory acidosis. D. respiratory alkalosis. ANS: A A pH lower than 7.35 indicates acidosis. If the child's pH falls in the same line as the HCO3-, the problem is metabolic (see Table 27-4).
26. The nurse instructing a mother how to administer oral nystatin suspension prescribed to treat thrush would teach her to:
A. pour the prescribed amount into a nipple and have the infant suck the medication. B. squirt the prescribed dose into the back of the mouth and have the infant swallow. C. give the medication mixed with a small amount of juice in a bottle. D. use a sterile applicator to swab the medication on the oral mucosa. ANS: D An appropriate way to administer nystatin is to moisten a sterile applicator with the medication and then swab it on the inside of the mouth.
27. One reason that infants are more vulnerable to fluid and electrolyte imbalances than adults is that:
A. they have a smaller surface area than adults in proportion to body weight. B. water needs and losses per kilogram are lower than those for adults. C. a greater percentage of body water in infants is extracellular. D. infants have a lower metabolic turnover of water. ANS: C A greater percentage of body water is contained in the extracellular compartment of children under 2 years of age.
33. To prevent ________________ ________________ the nurse warms the blood that is to be given as a transfusion through a central line.]
ANS: cardiac arrhythmias Cold blood entering the heart via a central line can trigger an irregular heartbeat.
31. The nurse shows slides of red blood cells from a child with sickle cell disease, noting that in addition to their sickle shape, the cells contain the abnormal element of ______________ _____.
ANS: hemoglobin S Hemoglobin S is the abnormal hemoglobin that makes red blood cells fragile and causes the walls of the cells to collapse, giving them the characteristic sickle shape.
2. The statement by a mother that may indicate a cause for her 9-month-old having iron deficiency anemia is: a. "Formula is so expensive. We switched to regular milk right away." b. "She almost never drinks water." c. "She doesn't really like peaches or pears, so we stick to bananas for fruit." d. "I give her a piece of bread now and then. She likes to chew on it."
ANS: A Because cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.
20. The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. Also, there is no record of a bowel movement for the last 2 days. These assessment findings suggest the possibility of: a. peripheral neuropathy. b. stomatitis. c. myelosuppression. d. hemorrhage.
ANS: A Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.
7. A child who is receiving a transfusion should be closely assessed for: a. fever. b. lethargy. c. jaundice. d. bradycardia.
ANS: A The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.
22. The most recent blood count for a child who received chemotherapy last week shows neutropenia. The priority nursing diagnosis for this child is: a. risk for infection. b. risk for hemorrhage. c. altered skin integrity. d. disturbance in body image.
ANS: A The child with neutropenia is at risk for infection.
19. The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. The lab value that would be consistent with these symptoms is: a. platelet count of 25,000/mm3. b. hemoglobin level of 8 g/dL. c. hematocrit level of 36%. d. leukocyte count of 14,000/mm3.
ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.
17. A 6-year-old with leukemia asks, "Who will take care of me in heaven?" The best response for the nurse to make is: a. "Who do you think will take care of you?" b. "Your grandparents and God will take care of you." c. "Your mom will know more about that than I do." d. "Why are you asking me that?"
ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.
5. A 2-year-old child has been diagnosed with hemophilia A. The information the nurse would include in a teaching plan about home care would be: a. if bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. children's aspirin in lowered doses may be given for joint discomfort. c. a firm, dry toothbrush should be used to clean teeth at least twice a day. d. do not permit interactive play with other children.
ANS: A When bleeding occurs, the traditional approach is to follow RICE—rest, ice, compression, and elevation.
8. On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. The priority nursing intervention is: a. assessing neurological status. b. inserting an intravenous line. c. monitoring vital signs during platelet transfusions. d. providing family education about how to prevent bleeding.
ANS: A When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.
26. What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? Select all that apply. a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development
ANS: A, B, C, D Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.
27. What are the classic symptoms of thalassemia major (Cooley's anemia)? Select all that apply. a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Cardiac failure
ANS: A, B, C, D, E All of the options are classic signs of thalassemia major.
25. Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? Select all that apply. a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel less helpless. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.
ANS: A, B, C, D, E All options are potential benefits to including the sibling in the care of a dying child.
29. The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? Select all that apply. a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases
ANS: A, B, C, E Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.
30. The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? Select all that apply. a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride
ANS: A, B, D, E The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.
28. How has synthetic recombinant antihemophilic factor improved the management of hemophilia? Select all that apply. a. Eliminates the need for frequent transfusions b. Can be administered by family at home c. Prevents hemorrhage d. Reduces cost of care of the hemophiliac e. Reduces risk of HIV and hepatitis A and B transmission
ANS: A, B, D, E The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.
16. The nurse would include in a teaching plan about mouth care of a child receiving chemotherapy to: a. use commercial mouthwash. b. clean teeth with a soft toothbrush. c. avoid use of a Water-Pik. d. inspect the mouth weekly for ulcerations.
ANS: B A soft toothbrush reduces capillary damage and mucous membrane breakdown, and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.
6. The nurse would teach the parents of a child with a low platelet count to avoid: a. ibuprofen. b. aspirin. c. caffeine. d. prednisone.
ANS: B Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.
1. When teaching the parents of a young child about iron deficiency anemia, the nurse would tell them that a rich source of iron is: a. an egg white. b. cream of Wheat. c. a banana. d. a carrot.
ANS: B Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.
24. The nurse takes into consideration that hemophilia A is a congenital disorder that is: a. seen in males and females equally. b. transmitted by symptom-free females. c. a sex-linked dominant trait. d. a defective gene located on the Y chromosome.
ANS: B Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.
11. The statement made by a parent indicating understanding of health maintenance of a child with sickle cell disease is: a. "I should give my child a daily iron supplement." b. "It is important for my child to drink plenty of fluids." c. "He needs to wear protective equipment if he plays contact sports." d. "He shouldn't receive any immunizations until he is older."
ANS: B Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.
3. The nurse would instruct the parent to give ferrous sulfate drops to the child: a. with milk. b. with orange juice. c. with water. d. on a full stomach.
ANS: B Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.
23. The nurse takes into consideration an important focus of nursing care for the dying child and the family, which is that: a. nursing care should be organized to minimize contact with the child. b. adequate oral intake is crucial to the dying child. c. families should be made aware that hearing is the last sense to stop functioning before death. d. it is best for the family if the nursing staff provides all of the child's care.
ANS: C Hearing is intact even when there is a loss of consciousness.
9. An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. The disease is in stage: a. I. b. II. c. III. d. IV.
ANS: C Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage III Hodgkin's disease.
18. When dealing with a preschool-age child with a life-threatening illness, the nurse should remember that at this age the child's concept of death includes: a. that it is final. b. only a fear of separation from her parents. c. that a person becomes alive again soon after death. d. an understanding based on simple logic.
ANS: C The preschooler views death as reversible and temporary.
12. A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.
ANS: C The sickle cell gene is inherited from both parents; therefore each offspring has a one in four chance of inheriting the disease.
10. A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. The nurse recognizes that the type of crisis the child is most likely experiencing is: a. aplastic. b. hyperhemolytic. c. vaso-occlusive. d. splenic sequestration.
ANS: C Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.
14. A child has just been diagnosed with acute lymphoblastic leukemia. The nurse is aware that the result of an overproduction of immature white blood cells in the bone marrow is: a. decreased T-cell production. b. decreased hemoglobin. c. increased blood clotting. d. increased susceptibility to infection.
ANS: D An overproduction of immature white blood cells increases the child's susceptibility to infection.
13. A child with thalassemia major receives blood transfusions frequently. The nurse is aware that a complication of repeated blood transfusions is: a. hemarthrosis. b. hematuria. c. hemoptysis. d. hemosiderosis.
ANS: D As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.
4. The nurse clarifies that the deficiency of factor IX results in: a. thalassemia. b. idiopathic thrombocytopenic purpura. c. hemophilia A. d. Christmas disease.
ANS: D Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.
15. When the child receiving a transfusion complains of back pain and itching, the nurse's initial action would be to: a. notify the charge nurse. b. disconnect intravenous lines immediately. c. give diphenhydramine (Benadryl). d. clamp off blood and keep line open with normal saline.
ANS: D If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.
21. The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." The most appropriate nursing response to this comment is: a. "I understand how you must feel." b. "You shouldn't feel that way." c. "Is this the strongest feeling you've had today?" d. "Tell me what's got you scared."
ANS: D The nurse should encourage the adolescent to express her feelings and concerns.
32. The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.
ANS: electrophoresis
atrial septal defect (ASD)
Abnormal opening in the atrial septum, resulting usually in left-to-right shunt and causing large increase in pulmonary blood flow
ventricular septal defect (VSD)
Abnormal opening in the septum between the ventricles; higher pressure in L side causes backflow into R side, increased volume pumped into lungs
sickle cell disease is most prevalent in people of what descents
African or Mediterranean
Atrial septal defect
An abnormal opening between the right and left atria. Blood that already contains oxygen is forced from the left atrium back to the right atrium. Most patients do not have symptoms. May produce a murmur. Cardiac catheterization, electrocardiogram, And echocardiography May be performed to confirm diagnosis. Surgical repair involves application of a surgical Dacron patch or repair with open cardiac surgery or robotic surgery. Low dose aspirin therapy is usually prescribed for 6 months after repair.
Idiopathic Thrombocytopenia Purpura (ITP)
An acquired platelet disorder. Platelets are perceived as foreign and the spleen will destroy them.
________ is one of the first signs of CHF.
An increase in pulse rate
what instructions would you give to a parent about administering an iron supplement to a toddler
An iron supplement is given orally two to three times a day between meals. Give with orange juice because vitamin C aids absorption. Liquid preparations are given through a straw to prevent temporary discoloration of the teeth. Include foods high in iron in the child's daily diet. Store the iron in a safe place to prevent accidental ingestion.
What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkins disease? (Select all that apply.)
Application of sunblock Appetite stimulation Conservation of energy Provision for expressions of anger
On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention?
Assessing neurological status
Treatment of ITP
Avoid salicylates and caffeine. Prednisone. IV IgG to elevate counts. Anti-D antibody if not active bleeding is present. (must be watched for 1hr for chills, HA, and change in vitals. Patient should use soft bristle tooth brush.
What are the stages of dying as detailed by Kubler-Ross (1975)?
Bargaining Denial Anger Acceptance Depression
Barium swallow
Barium given by mouth; done to show indentation of the esophagus by the aorta or other vessels
At what age is the highest incidence for iron deficiency anemia and why?
Between 9-24 months. This is a rapid growth period where the baby outgrows the limited iron reserve in the body.
Thalassemia
Blood disorder in which the patients body cannot produce sufficient hemoglobin. RBC's are abnormal in size and shape and are destroyed rapidly.
food sources with high iron content
Boiled egg yolk Liver Leafy greens Cream of Wheat Dried fruits (apricots, peaches, prunes, raisins) Dry beans Crushed nuts Whole-grain breads
Aplastic Crises
Bone marrow stops producing RBC's.
the child with sickle cell disease inherits the abnormality from which parent
Both parents
_______ may be a sign that cardiovascular arrest is imminent in children with hypoxia
Bradycardia
What is the classic symptom of idiopathic (immunological) thrombocytopenia purpura (ITP)?
Bruising
lab tests for GI
CBC with diff to show anemia, infection, or chronic illness ESR indicates inflammation CMP for electrolyte and and chem imbalances x-ray series like barium enemas
Signs and Symptoms of Hemophilia
Can be diagnosed at birth because the factor VIII cannot cross the placenta. Prolonged bleeding that can take up to 1 hour to clot. Hematomas after immunizations. Hemarthrosis (bleeding into the joints).
Rheumatic carditis
Carditis, an inflammation of the heart, is a manifestation of RF that can be fatal. It occurs more often in the young child. The tissues that cover the heart and the heart valves are affected. The heart muscle (myocardium) may be involved, as may the pericardium and endocardium. The mitral valce, which is located between the left atrium and the left ventricle is often involved. Vegitations form, which interfere with the proper closing of the valve and disturb its normal function. When this valve becomes narrowed, the conditional is called mitral stenosis. Myocardial lesions called Aschoff's bodies are also characteristic of the disease. The burden on the heart is great, because it must pump harder to circulate the blood. As a result, it may become enlarged. Symptoms of poor circulation and HF may appear. The child has an irregular, low-grade fever; is pale and listless; and has a poor appetite. Moderate anemia and weight loss are apparent. The child may experience dyspnea on exertion. The pulse and respiration rates are out of proportion to the body temperature. The physician may detect a soft murmur over the apex of the heart.
Leukemia Treatment
Chemotherapy and radiation. Adequate hydration to reduce kidney damage. Delayed immunizations, TPN.
Hemophilia patient teaching
Children should not participate in contact sports. Parents can place padding on play outfits to prevent cuts and scrapes. Use RICE when injury occurs. ***should not receive any salicylates***
signs of a transfusion reaction
Chills Itching Rash Fever Headache Pain in the back
Sydenham's chorea
Chorea is a disorder of the CNS characterized by involuntary, purposeless movements of the movements. It may occur as an acute rheumatic involvement of the brain. Sydenham's chorea is primarily seen in prepubertal girls. Attacks of chorea, which begins slowly, may be preceded by increased tension and behavioral problems. The child becomes "clumsy," stumble and spill things, and may have dificulty buttoning clothes and writing. When facial muscles are involved, grimaces occur. The child may laugh and cry inappropriately. In severe cases the patient may become completely incapacitated, and deterioration in speech may be noticeable. Treatment is directed toward the relief of symptoms. The condition usually disappears spontaneously within weeks to months. Medication may also be required. The presence of this alone can support the diagnosis of RF
_____ is a disorder of the CNS characterized by involuntary, purposeless movements of the muscles.
Choreae
What is the result of a deficiency of factor IX?
Christmas disease
The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse?
Clamp off blood and keep line open with normal saline.
What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy?
Clean teeth with a soft toothbrush.
Which are characteristics of sickle cell anemia?
Clinical symptoms present around 1 year of life Chronic anemia Pale and tires easily Potentially fatal crises can occur
Patient teaching for Leukemia
Commercial mouthwashes should be avoided because they alter normal flora. Use one part hydrogen peroxide and four parts normal saline instead.
An 8-year-old boy diagnosed with hemophilia presents at the emergency department with hemarthrosis from a fall on the school playground. What would be included when following a traditional approach to care?
Compression Ice Rest Elevation
Blood transfusions
Confirm the right pt and correct blood is being given. Administer slowly. Check site for infiltration. Check vitals q5mins for the fist 15 minutes. Signs of reaction include chills, fever, headache and back pain. Tubing should be clamped off and pt should be given normal saline.
A decrease in pulmonary blood flow occurs when a congenital heart anomaly allows blood that has not passed through the lungs (unoxygenated blood) to enter the aorta and the general circulation. ______ caused by the presence of unoxygenated blood in the circulation is a characteristic feature of the type of congenital heath anomaly
Cyanosis
What do we do if an infant hasn't passed any meconium?
DO NOT DISCHARGE UNTIL THEY PASS MECONIUM
atrioventricular canal defect
Defects with increased pulmonary blood flow; blood flows into all 4 chambers; most common with Down Syndrome
Hemophilia B (Christmas Disease)
Deficiency in factor IX
Hemophilia A
Deficiency in factor VIII.
Tratment of Hemophilia
Delayed procedures to newborns with family history. Replacement of missing factor. DDAVP is a nasal spray that increases factor VIII in the blood. Amicar can control bleeding in dental care.
Stages of Dying
Denial, anger, bargaining, depression, acceptance.
Treatment of Tetralogy of Fallot
Designed to increase pulmonary blood flow to relieve hypoxia. -Blakock-Taussig surgical procedure (temporary shunt) -open heart surgery using cardiopulmonary bypass provides total correction of all defects and is usually performed; nurse should observe for signs of CHF and an irregular heartbeat post op
Improve cardiac function (increase contractility and decrease afterload)
Digoxin, ACE Inhibitors, Beta-Blockers
Blood Dyscracias
Disorders where blood components fail to form correctly or when blood values exceed or fail to reach normal limits.
Remove accumulated fluid and sodium (decrease preload)
Diuretics (Lasix, Spironolactone), fluid and Na restrictions
A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the childrens risk of inheriting this disease?
Each child has a one in four chance of having the disease and a two in four chance of being a carrier.
How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.)
Eliminates the need for frequent transfusions Can be administered by family at home Reduces cost of care of the hemophiliac Reduces risk of HIV and hepatitis A and B transmission
Lymphadenopathy
Enlargement of the lymph nodes that may indicate infection or disease.
Splenomegaly
Enlargement of the spleen during infections, congenital and acquired hemolytic anemias, and liver malfunctions.
Skin eruptions in RF
Erythema marginatum, the rash seen in RF, consists of small red circles with red-colored margins, a pale center, and wavy lines appearing on the trunk and abdomen. They appear and disappear rapidly and are significant in diagnosing the disease.
hemophilia A is caused by a deficiency of _______, while hemophilia B is a _____ deficiency
Factor VIII; Factor IX
What important focus of nursing care for the dying child and the family should the nurse implement?
Families should be made aware that hearing is the last sense to stop functioning before death.
For elevated cholesterol, a fat intake reduction of ___ to ___% of total calories with less than ___% saturated fat and less than _____mg cholesterol per day is advised.
For elevated cholesterol, a fat intake reduction of 25% to 35% of total calories with less than 7% saturated fat and less than 200 mg cholesterol per day is advised.
Hematopoiesis
Formation of blood. Occurs in long bones. EX: Tibia and femur
Treatment of Thalassemia
Frequent blood transfusions to maintain hemoglobin levels above 9.5 g/dL. Balancing rest and energy. Desferal may cause red discoloration of the urine.
Subacute Bacterial Endocarditis (SBE)
Growth of bacteria in a heart or valves previously damaged by rheumatic fever
_____ ______ is defined as cardiac output inadequate to meet the metabolic needs of the body.
Heart failure
what test is done if the screening is positive and why?
Hemoglobin electrophoresis identifies those with the trait (one abnormal gene) and those with the disease (two abnormal genes)
what does this treatment maintain
Hemoglobin levels above 9.5 g/dL
A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions?
Hemosiderosis
What are the classic symptoms of thalassemia major (Cooleys anemia)? (Select all that apply.)
Hepatomegaly Jaundice Protruding teeth Pathological fractures
Sickle Cell Crisis Interventions
Hydration, rest, protection from infection, pain control with analgesics, blood transfusion, and emotional support.
An adolescent is diagnosed with Hodgkins disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this?
III
nursing care for pyloric stenosis
IV fluids pre-op, infant is burped before and during feedings, feedings are slow, handle infant as little as possible, Fowler's position, weights each morning, post-op care
Treatment of Kawaski disease
IV immune globulin (IVIG) administered early in the illness can prevent the development of coronary artery pathology. Salicylate therapy (aspirin) is prescribed for its antithrombus properties. If the child does not respond to IVIG therapy and aspirin, a second dose of IVIG may be prescribed or cyclosporine may be added to the treatment. Prednisolone may be used but its effectiveness has not been proven. -Long term, low dose aspirin therapy may be prescribed to prevent clot formation. Compliance may be a problem for any long-term regimen in which medication must be taken when the child feels "well".
A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care?
If bleeding occurs, apply pressure, ice, elevate, and rest the extremity.
A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.)
Impaired sense of belonging Decreased feelings of independence
explain the difference between sickle cell trait and sickle cell disease
In sickle cell trait, the child is a "carrier" of the disease. The child will not manifest the disease. In sickle cell disease, the child has inherited the trait from both parents and experiences the disorder.
coarctation of the aorta (CoA); coarctation means "a tightening"
In this, there is a construction or narrowing of the aortic arch or of the descending aorta (I.e., the blood meets an obstruction). Hemodynamics consist of increased pressure proximal to the defect and decreased pressure distally. The characteristic symptoms are a marked difference in the blood pressure and pulses of the upper and lower extremities. The patient may not develop symptoms until late in childhood. X-Ray exam may show cardiac enlargement and "notching" of the ribs caused by vessels developed as collateral circulation. Pulses and BP will differ in the upper and lower extremities. Two dimensional echocardiography can aid in diagnosis If the condition is untreated, hypertension, CHF, and infective endocarditis May develop.
Complications after cardiac transplants
Infection, hyperlipidemia, and rejection of the new tissue; are some causes of deaths
Thalassemia Major (Cooley's disease)
Inherited by both parents. Severe anemia is evident by the first 6 months of life.
Thalassemia Minor (B-thalassemia trait)
Inherited by one parent and considered mild anemia. Signs and symptoms are paleness and enlargement of the spleen.
Sickle Cell Anemia
Inherited from both parents and is chronic anemia.
Sickle Cell Trait
Inherited through one parent. RBC and hemoglobin counts are normal. This does not develop into the disease.
KD: _________ administered early in the illness can prevent the development of coronary artery pathology.
Intravenous immune globulin (IVIG)
Treatment of Iron deficiency anemia
Iron supplements and education on foods high in iron. EX: Boiled egg yolk, liver, leafy green veggies, cream of wheat, dried fruits, dry beans, crushed nuts, and whole grain bread.
Congenital heart defects
Is a problem at birth because the infants circulatory system must take over and provide for the child's own oxygen needs. Any heart defect or patent (open) fetal pathways in the cardiovascular system after birth produce signs and symptoms that indicate an anatomical heart defect. If the congenital anomalies, heart defects are the principal cause of death during the first year of life.
Sickle Cell Disease
Is inherited and is a defect in the formation of hemoglobin. Clumping of crescent shaped cells cause pile ups and can lead to a clot.
The nurse is presenting information on the congentital disorder of hemophilia A. What fact will the nurse include?
It is transmitted by symptom-free females.
Major Criteria:(5) diagnosis of RF
Joint (arthritis) Obvious carditis Nodules subcutaneous Erythema marginatum Sydenham's chorea
____ ____(mucocutaneous lymph node syndrome) occurs worldwide and is the leading cause of acquired cardiovascular disease in the United States. It usually affects children less than 5 years of age. Studies have shown that no known microbe is associated with this disease, although it may be a response to a mild asymptomatic viral infection in children with a genetic predisposition. This disease is not spread from person to person. It causes inflammation of the vessels in the cardiovascular system. The inflammation weakens the walls of the vessels and often results in an aneurysm (an abnormal dilation of the wall of a blood vessel). Aneurysms can cause thrombi (blood clots) to form, resulting in serious complications. Approximately 40% of untreated children develop aneurysms of the coronary vessels, which can be life-threatening. For this reason, it is essential that a diagnosis of this disease is made as early as possible.
Kawasaki disease (KD)
swollen hands and desquamation (peeling) of the palms and soles are signs of what?
Kawasaki disease (KD)
Left sided heart failure
L ventricle fails to pump into aorta causing back-up in the lungs
<100
LDL in children
atrial-septal defect ventricular septal defect atrioventricular canal defect patent ductus arteriosus
Left heart to right heart
What is the most common form of childhood cancer?
Leukemia
explain the pathologic changes that take place when a child has leukemia
Leukemia involves a disruption in bone marrow function due to the overproduction of immature white blood cells in the bone marrow. These cells do not function normally as healthy WBCs to fight infection; increased susceptibility to infection results. The WBCs take over the centers that are designed to form RBCs, and anemia results. When the WBCs infiltrate and take over the marrow centers that form platelets, the reduced platelet count causes bleeding tendencies. The invasion of the bone marrow causes weakening of the bone, and pathologic fractures can occur. Leukemia cells can infiltrate the spleen, liver, and lymph glands, resulting in fibrosis and diminished function. The cancerous cells invade the central nervous system and other organs, draining these organs of their nutrients and finally causing metabolic starvation of the body.
Signs and Symptoms of Leukemia
Low grade fever, pallor, bruising tendency, leg and joint pain, listlessness, abdominal pain, and enlargement of lymph nodes. Spleen and liver may enlarge as disease progresses. Petechiae and lesions around mucous membranes. Anorexia, vomiting, weight loss.
________ therapy is usually prescribed for 6 months after repair of atrial septal defect (ASD)
Low-dose aspirin
possible presenting signs and symptoms of leukemia
Low-grade fever Pallor Bruising tendency Leg and joint pain Listlessness Abdominal pain Enlargement of lymph nodes Objective signs of petechiae or purpura Anorexia Vomiting Weight loss Dyspnea Hematuria Lemon-yellow skin hue
A positive diagnosis of rheumatic fever cannot be made without the presence of two major criteria, or one major and two minor criteria, plus a history of streptococcal infection.
Major Criteria: Carditis, Polyarthritis, Erythema marginatum, Chorea, Subcutaneous nodules Minor Criteria: Fever, arthralgia, Previous history of rheumatic heart disease, Elevated erythrocyte sedimentation rate, Leukocytosis, Abnormal electrocardiogram (altered P-R interval), Positive test for C-reactive protein
Hodgkin's disease
Malignancy of the lymph nodes. Confirmed by the presence of Reed-Sternberg cells.
why is meperidine not recommended for children with sick cell disease
Meperidine (Demerol) is not recommended for children with sickle cell disease because of the risk of normeperidine-induced seizures.
Iron-Deficiency Anemia
Most common nutritional deficiency in children. Condition where there is a reduction in the amount and size of red blood cells, the amount of hemoglobin, or both.
Vasooclusive(painful) crises
Most common, some obstruction of blood flow. Abdominal pain and painful joints and extremities.
cineangiocardiography
Motion pictures of images recorded by fluoroscopy; done for useful recording and monitoring device
do we want to sit infants upright after feedings?
NO it can cause increased intraabdominal pressure
is drooling in the newborn normal?
NO- if happens before 3 months it is pathological
common side effects of chemotherapy
Nausea Diarrhea Rash Hair loss Fever Anuria Anemia bone marrow depression
The nurse is caring for a 5-year-old child with leukemia admitted to the hospital with the primary diagnosis of pneumonia. What does the nurse suspect as most likely cause of this child's pneumonia?
Neutropenia
MRI
Noninvasive imaging technique that uses low energy radio waves in combination with a magnetic field to generate signals that produce tomographic images; very useful in diagnosing coarctation of the aorta
Radionuclide angiocardiography
Noninvasive nuclear procedure that permits visualization of the course of blood through the heart. Value of this is that it may be used as a precardiac catheterization screening study; provides assessment of congenital and acquired cardiovascular lesions and monitors the effects of therapy; an IV device is necessary to permit injection of the radionuclide
The left side of the heart moves
Oxygenated blood from the pulmonary circulation to the systemic circulation. A failure results in backup into the lung.
Changes in conductivity, particularly a prolonged _________, may reflect carditis.
P-R interval (indicating a first-degree heart block)
Minor Criteria: (7) diagnosis of RF
P-R interval, Previous history of rheumatic heart disease ESR elevated Arthralgia CRP elevated Elevated temperature (fever) Leukocytosis
Hodgkin's Signs and Symptoms
Painless lumps around the neck, low grade fever, anorexia, unexplained weight loss, night sweats, general malaise, rash, and itching.
Thalassemia Major Signs ans Symptoms
Paleness, poor appetite, fever, jaundice that proceeds to bronze color from hemosiderosis, enlarged liver, and spleen becomes enormous. Abdominal distention, upper teeth may protrude due to overgrowth.
Sickle Cell Anemia Signs and Symptoms
Paleness, tiredness, and small appetite. Hemoglobin ranges from 6-9 g/dL or lower. May have unusual swelling of the fingers and toes.
Signs and Symptoms of Iron-deficiency anemia
Pallor, irritability, anorexia, and decrease in activity.
Anemia signs and symptoms
Pallor, weakness, tachypnea, SOB, and can result in congestive heart failure.
Prevention of systemic hypertension
Patient education; BP measurement; risk factors such as obesity, elevated serum cholesterol levels, sedentary lifestyle, and drug, alcohol, or tobacco use should be discussed. -aerobic exercise -reduction of sedentary activities such as computer, TV, and video games -Weight reduction -Dietary management with fresh vegetables and low-fat foods -Adequate intake of potassium and calcium -Avoidance of smoking and those who smoke
systemic venous congestion
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.)
Petichiae Purpura Ecchymosis Hematoma
The nurse notes that a 4-year-old childs gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms?
Platelet count of 25,000/mm3
Splenic Sequestration
Pooling of blood into the liver and spleen. Massive spleen enlargement, and signs of shock and circulatory collapse are present.
describe the preschooler's response to the death of a sibling
Preschoolers think death is temporary. The child may blame himself for a sibling's death.
Prevention of rheumatic fever
Prevention of infection and prompt treatment of group A beta-hemolytic streptococcal infections can prevent the occurence. All throat infections should be cultured. Importance of completing antibiotic therapy if infection present
Indomethacin
Prostaglandin inhibitor, may help to get the PDA closed
right sided heart failure
R ventricle fails to pump into pulmonary artery
Hodgkin's treatment
Radiation and chemotherapy. Patient should avoid direct sunlight exposure on treated areas. PABA may be used to prevent burning. Patient needs emotional support and should be given a coping mechanism for anger. Side effects of sterility should be discussed.
Chest x-ray film
Radiographic image of a body structure; don't go provide a permanent record; shows abnormalities in the shape and position of heart
The CLASSIC symptoms of RF are ______ (4)
Range from mild to severe and may not occur for 1-6 weeks after a strep throat infection. Classic symptoms are migratory polyarthritis (wandering joint pains), skin eruptions (small red circles with red-colored margins, a pale center, and wavy lines appearing on the trunk and abdomen), chorea(a nervous disorder) , and inflammation of the heart. Subcutaneous nodules May appear beneath the skin but are less common in children. Abdominal pain, often mistake for appendicitis sometimes occurs. Fever varies from slight to very high. Pallor, fatigue, anorexia, and unexplained nosebleeds may be seen. An elevated antistreptolysin O titer (ASO) is a standard diagnosis. This issue tends to recur, and each attack carries the threat of further damage to the heart. Recurrences are most frequent during the first 5 years after the initial attack, and they decline rapidly thereafter.
Hyperhemolytic
Rare. Rapid rate of hemolysis, causes spleen to reduce its function. Pt is susceptible to infection.
Erythropoietin
Regulation of RBC production.
____ ___ is a systemic disease involving the joints, heart, central nervous system (CNS), skin, and subcutaneous tissues. It belongs to a group of disorders known as collagen diseases. Their common feature is the destruction of connective tissue. Causes scarring of the mitral valves. Peak incidence is between 5 and 15 years of age. An autoimmune disease that cuts as a complication of group A beta-hemolytic streptococcus infection of the throat.
Rheumatic fever (RF)
angiocardiography (selective)
Serial x-ray filmed of the heart and great vessels after infection of an opaque substance; a radiopaque catheter is moved into the heart chambers, and contrast medium is injected in specific areas. The value of this is that abnormal communications in the heart can be observed; the course of the blood through the heath and great vessels can be traced
Sickle Cell Crisis
Severe abdominal pain, muscle spasms, leg pain, painful swollen joints, fever, vomiting, hematuria, convulsions, stiff neck, como or paralysis can also occur.
Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.)
She will feel less neglected by the parents. She can make amends for past hostilities to her brother. She can express her feelings through care. She can experience being supportive of her parents and brother.
Signs and Symptoms of ITP
Slow clotting time and bruising that occurs easily, and, petichiae. Platelet count is below 20,000. Confirmed by bone marrow aspiration to rule out leukemia.
Defects that restrict ventricular blood flow
Some congenital cardiac defects can restrict blood flow from the ventricles because of a stenosis (narrowing) of a vessel.
Paroxysmal hypercyanotic episodes, or "tet" spells, occur during the first 2 years of life. ____________ (4) occur.
Spontaneous cyanosis, respiratory distress, weakness, and syncope. They can last a few minutes to a few hours and are followed by lethargy and sleep. Parents and day care personnel must be instructed to place the child in a knee-chest position when this occurs. Often the child will pause and voluntary squat in position until the attack abates. Recovery is usually rapid
what should the nurse tell a parent about formula and milk intake during the first year of life
Stress the importance of breastfeeding for the first 6 months of life. The absorption of iron from human milk is much better than from cow's milk. If the infant is not breastfeeding, iron-fortified formula is given and continued throughout the first year of life. Cow's milk may be given only after those first 12 months.
Treatment of congenital heart defects
Surgery. A thoracotomy (chest incision) is performed, and the use of a cardiopulmonary bypass machine and hypothermia during the procedure minimize blood loss and enhance patient response. Hypothermia reduces the temperature of body tissues, resulting in a decreased need for oxygen. The cardiopulmonary bypass machine provides oxygenation of the body tissues while the surgeon stops the heart to perform surgery. Heart transplants may be the treatment of choice in cases such as a three-chambered heart. Interventional cardiac catheterization can correct some heart defects without open heart surgery.
As the child grows, what four symptoms may be experienced with Patent Ductus Arteriosus?
Symptoms may go unnoticed during infancy. As the child grows, dyspnea is experienced, the radial pulse becomes full and bounding on exertion, unusually wide pulse pressure. A characteristic machinery type of murmur may be heard.
Impaired myocardial function
Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output
pulmonary congestion
Tachypnea Dyspnea Retractions (infants) Flaring nares Exercise intolerance Orthopnea Cough, hoarseness Cyanosis Wheezing Grunting
Iron supplement patient teaching
Take iron with cup of orange juice because Vitamin C helps absorb the iron. If using liquid preparation, take with a straw because it stains the teeth. Stools may become tarry and green. Breast feed for the first 6 months and use iron based formula for the first year of life.
The nurse is dealing with a preschool-age child with a life-threatening illness. What should the nurse remember the childs concept of death is at this age?
That a person becomes alive again soon after death
describe the clinical manifestations of idiopathic (immunologic) thrombocytopenia purpura
The child has slow clotting and is easily bruised, resulting in petechiae and purpura. Lab work will show a platelet count of below 20,000/mm3. About 30% have frequent nosebleeds. There may be a recent history of rubella, rubeola, or viral respiratory infection.
Patent ductus arteriosus
The circulation of the fetus differs from that of the newborn in that most of the fetal blood bypasses the lungs. The ductus arteriosus is the passageway (shunt) through which the blood crosses from the pulmonary artery to the aorta and avoids the deflated lungs. This vessel closes shortly after birth; when it does not close, blood continues to pass from the aorta, where the pressure is higher, Into the pulmonary artery. This causes oxygenated blood to recycle through the lungs, overburdening the pulmonary circulation and making the heart pump harder.
Hemosiderosis
The deposit of iron into the tissues. Can be treated with deferoximine meslyte (Desferal).
Migratory polyarthritis
The polyarthritis seen in RF is distinctive in that it does not result in permanent deformity to the joint. It involves mainly the larger joints: knees, elbows, ankles, wrists, and shoulder. The joints become painful and tender and are difficult to move. The symptoms last for a few days, disappear without treatment, and frequently return in another joint. This pattern may continue for a few weeks. The symptoms tends to be more severe in older children. The joint may be visibly swollen and inflamed. On diagnosis, salicylates are administered to relieve pain.
What should the nurse include when educating parents regarding care of their child following a lymphangiogram?
The skin and urine may take on a bluish color.
Echocardiography
The use of ultrasound to produce an image of sound waves of the heart; transducer placed directly on chest; sounds are analyzed; is a noninvasive procedure and localized murmurs and determines if heart is structurally normal
electrocardiogram
Tracing of heart action by electrocardiography; detects variations in heart action and shows the condition of the heart muscle; may also be used as a monitoring device during cardiac catheterization
Treatment of coarctation of the aorta
Treatment depends on the type and severity of the defect -percutaneous balloon angioplasty is the treatment of choice for older children, and stents can be inserted to maintain patency. The surgeon respects the narrowed portion of the aorta and joins its ends. The joining is called an anastomosis. If the section removed is large, an end-to-end graft using tubes of synthetic polyester (Dacron) or similar material may be necessary. Some children complain of leg pain after exercise. -closed heart surgery is performed because the structures are outside the heart. -if restenosis occurs after surgery for coarctation, a balloon angioplasty can relieve the obstruction. Observe for the development of hypertension and abdominal pain associated with nausea and vomiting, leukocytosis, And gastrointestinal bleeding or obstruction after coarctation surgery. Antihypertensive drugs, steroids, and nasogastric tube decompression are the priority treatments for these complications.
Treatment of systemic hypertension
Treatment involves nutritional counseling, weight reduction, and an age-appropriate program of aerobic exercise. Adolescents should be counseled concerning the adverse effects of drugs, alcohol, and tobacco on blood pressure. Drug therapy to reduce high BP may not be effective in adolescents, who often are noncompliant with long-term regimens. The focus of treatment for secondary hypertension is the underlying disease causing the high BP
Treatment of Rheumatic Fever
Treatment is aimed at preventing permanent damage to the heart. This is accomplished by antibacterial therapy, physical and mental rest, relief of pain and fever and management of cardiac failure should it occur. Initial antibacterial therapy is directed toward eliminating the streptococcal infection. Penicillin is the drug of choice (given for a 10 day period) unless the patient is sensitive to it, in which case erythromycin is substituted. Elimination of infection through medication is followed by long-term chemoprophylaxis (prevention of disease by drugs); IM benzathine penicillin G is administered monthly to children with a history of RF or evidence of rheumatic heart disease for a minimum of a 5-year period or until an age of 18 years is attained. Oral administration is considered for patients with minimal involvement whose reliability about taking medictions can be confirmed. Erythromycin is recommended for long-term therapy for children who cannot tolerate penicillin. Antinflammatory drugs are used t decrease fever and pain. Aspirin is the drug of choice for joint disease without evidence of carditis. The use of steroids is reserved for severe cardiac symptoms or when aspirin does not relieve cardiac pain. Mild signs of Cushing's disease, such as moon face, acne, and hirsutism (increased hairiness), should be anticipated with the use of steroids. More severe reactions such as gastric ulcer, hypertension, overwhelming infection, and toxic psychosis can occur. Phenobarbital is effective in reducing chorea. Padded side rails are used to protect the patient who experiences spasms. Bed rest during the initial attack is recommended until the ESR returns to normal levels. -The patient with RF is particularly suscpetible to subacute bacteril endocarditis, which can occur as a complication of dental or other procedures likely to cause bleeding or infection. Prophylactic antibiotic treatment is required before any dental procedure.
_____ padded Kelly clamps must be available at all times for emergency clamping of tubes. These are applied to the tubes ________ if a break in the system occurs.
Two: as close as possible to the child's chest
The right side of the heart moves
Unoxygenated blood to the pulmonary circulation. A failure results in the backup of blood in the systemic venous system
The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the childs care? (Select all that apply.)
Using a support group Stimulating appetite Maintaining adequate hydration Reporting exposure to infectious diseases
A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing?
Vaso-occlusive
_________ is the most common heart anomaly. There is an opening between the right and left ventricles of the heart. Increased pressure within the left ventricle forces blood back into the right ventricle (left-to-right shunt). May be mild or severe and is often associated with other defects.
Ventricular septal defect (VSD)
The nurse explains that the COPP medical regimen for the treatment of Hodgkins disease uses a combination of which drugs? (Select all that apply.)
Vincristine Cyclophosphamide Prednisone Procarbazine hydrochloride
three nursing interventions appropriate for a 10 yearly old who is worried about her body image changes associated with chemotherapy
Wear wigs and scarves, etc. Stress that hair loss is temporary. Wear clothing that minimizes body changes and enhances appearance. Use eyebrow pencil and false eyelashes. Encourage child to ventilate feelings about appearance.
Tetralogy of Fallot
When venous blood enters the aorta, the infant displays symptoms of cardiac problems. Cyanosis increases with age, and clubbing of the fingers and toes is seen. The child rests in a "squatting" position to breathe more easily. This position alters systemic venous return. Feeding problems, growth retardation, frequent respiratory infections, and severe dyspnea on exertion are prevalent. The RBCs of the body increase, causing polycythemia to compensate for the lack of oxygen. Narrowing of the pulmonary artery causes CHF as a result of the increased muscular force necessary to propel blood through the narrowed orifice. When unoxygenated blood enters the general circulation, hypoxia occurs and may be manifested by cyanosis. The increased oxygen consumption and decreased energy and ability to eat, result in failure to thrive. Multiple hospitalizations, cyanotic skin, and limited energy can impede growth and development both physically and socially.
Aortography
X-ray films of the aorta after the injection of an opaque material. Value of this is it is useful in showing patent ductus arteriosus
Acquired heart disease
a cardiac problem that occurs after birth. It may be a complication of a congenital heart disease or a response to respiratory infection, sepsis, hypertension, or severe anemia
Thalassemia major (cooley's anemia) is treated primarily with:
a diet high in iron
hypoplastic left heart syndrome: Symptoms include _________ (5)
a grayish blue color of the skin and mucous membranes and signs of CHF, including dyspnea, weak pulses, and a cardiac murmur.
oncologist
a physician who specializes in treating cancer.
anemia
a reduction in the size of RBCs or in amount of circulating hemoglobin.
two priority goals when caring for a child with sickle cell disease
a. Control pain. b. Prevent dehydration, hypoxia, and infection.
factors that might trigger a sickle crisis
a. Dehydration b. Infection c. Physical or emotional stress d.Exposure to cold
five phases of chemotherapy for leukemia
a. Induction period b. CNS prophylaxis c. Maintenance d. Reinduction therapy e. Extramedullary disease therapy
major s/s of iron deficiency anemia
a. Pallor b. Irritability c. Anorexia d.Decrease in activity
when bleeding occurs from minor trauma in a child with hemophilia, the traditional approach is to use these four steps (RICE)
a. Rest b. Ice c. Compression d. Elevation
causes of iron-deficiency anemia
a. Severe hemorrhage b. Inability to absorb iron c. Excessive growth requirements d. Inadequate iron in diet
four types of sickle cell crises
a. Vasoocclusive: painful; related to obstruction of blood flow by abnormally shaped RBCs, infarctions, and vasospasm b. Splenic sequestration: blood pools in liver and spleen resulting in circulatory collapse and shock c. Aplastic crisis: RBC production in bone marrow stops, possibly related to infection d. Hyperhemolytic: rapid rate of hemolysis is superimposed on an already severe process; rare conditi
care for overhydration
accurate weight daily, VS, physical appearance, change in urine character, monitor IV therapy
pH change with diarrhea
acidosis
Which principle should the nurse teach the parent concerning administering liquid iron preparations to the child with iron-deficiency anemia?
administer between meals
pulmonary edema
affects of left sided heart failure
Peripheral edema and ascites
affects of right sided heart failure
hirschsprung's disease
aka aganglionic megacolon absence of ganglionic innervation to the muscle of a segment of the bowel, usually the sigmoid colon
celiac disease
aka gluten enteropathy and sprue autoimmune genetic illness that affects the small intestine and damages the cilia
lead poisoning
aka plumbism child repeatedly ingests or absorbs substances containing lead or have pica
pH from vomiting
alkalosis
nursing care of an adolescent with cancer who is refusing to cooperate with treatment should include
allowing the adolescent to make some choices
thrombocytes function
are involved with blood coagulation
s/sx of celiac disease
around 6 months-2 years old infant presents with failure to thrive, stools are large, bulky, foul smelling, and frothy, infant is irritable, abdominal distention with atrophy of the buttocks
What will the nurse teach the parents of a child with a low platelet count to avoid?
aspirin
childs gi system
at birth its incompletely developed higher nutritional, metabolic, and energy needs dehydration happens more quickly infant stomach is small and empties rapidly no saliva until 3 months old swallowing is a reflex for 3 months liver is immature so jaundice happens fat absorption is poor
Some defects that increase pulmonary flow are _____ (3)
atrial septal defect(in the fetus this allows blood to flow from the right atrium through the defect into the left atrium, providing a bypass of the lungs. After birth the pressure is higher in the left atrium; if the atrial opening persists, the blood flows back into the right atrium [left-to-right shunt] and then recirculates to the lungs, causing increased pulmonary flow.) , ventricular septal defect, and patent ductus arteriosus In heart defects that result in increased pulmonary flow because of a left-to-right shunt, the oxygenated blood recirculates to the lungs, and cyanosis is rare.
silent celiac disease
atrophy of the intestinal villi is discovered by endoscopy or biopsy that may be done for other reasons, or by a positive blood test
classic celiac disease
atrophy of the villi of the small intestine and characterized by malabsorption, diarrhea, and abdominal
foods high in potassium, such as __ (5)
bananas, oranges, milk, potatoes, and prune juice.
Immunizations are not recommended before cardiac surgery, why?
because immune-suppressants are used to prevent rejection of the transplanted heart, and the child's ability to manufacture antibodies in response to routine immunizations will be impaired.
Drainage systems are always kept___________ to prevent the backflow of secretions.
below the level of the chest
intramuscular ______ is administered monthly to children with a history of RF or evidence of rheumatic heart disease for a minimum of a 5-year period or until an age of 18 years is attained.
benzathine penicillin G
principal therapy for hemophilia is to prevent
bleeding
the diagnostic test that confirmed the diagnosis of leukemia
bone marrow aspiration
s/sx of rickets
bowlegs, knock-knees, beading of the ribs called rachitic rosary, improper formation of teeth
signs of malabsorption
bulky, frothy stool
Place the stages of dying in the usual order as detailed by Kbler-Ross (1975). Put a comma and space between each answer choice (a, b, c, d, etc.)
c. Denial d. Anger a. Bargaining f. Depression b. Acceptance e. Reaching out to help others
aortic stenosis
calcification of aortic valve cusps that restricts forward flow of blood during systole
roundworms
can be asymptomatic or cause abdominal pain thrive in warm climates and usually seen in southern states, caused by unsanitary disposal of human feces
To prevent ________________ ________________, the nurse warms the blood that is to be given as a transfusion through a central line.
cardiac arrhythmias
teaching for gastroesophageal reflux
careful burping, avoid overfeeding, proper positioning, feed the infant no more than the age in months plus 3 every 3-4 hours
care for vomiting
carefully feed and burp the infant, avoid treatment right after feeding, handle as little as possible, place infant on right side after feedings
causes of hypertonic dehydration
caused by DKA or heat stroke treat with hypotonic solution (1/2 NS)
acute sudden diarrhea
caused by inflammation, infection, or response to medication, food or poisoning
infectious diarrhea
caused by viral, bacterial, or parasitic infection and usually involves gastroenteritis
-fetal alcohol syndrome -rubella during pregnancy -viral infections -IDM's
causes of congenital heart defects
treating lead poisoning
chelating agents help excrete it from the blood treatment prevents further harm but doesn't reverse any harm already done
s/sx of pinworms
child scratches anal area or complains of itching weight loss, poor appetite, fretfulness during the night
capusle endoscopy
child swallows a capsule that contains a camera and it takes pictures of the GI tract takes 72 hours to pass
s/sx of hirschsprung's disease
chronic constipation, ribbon-like stools, abdominal distention, anorexia, vomiting, and failure to thrive
s/sx of roundworms
chronic cough without a fever dx made with O&P treat with albendazole
types of celiac disease
classic, atypical, silent, and latent
high BP and bounding pulse in arms weak femoral pulses cool legs
clinical manifestations of CoA
backs up into L ventricle causes hypertrophy and pulmonary edema
coarctation of the aorta's effect on the heart flow
activated charcoal
combines with many toxins in the stomach to prevent absorption and facilitate excretion from the body needs to be administered within 1 hour of ingestion
esophageal atresia
congenital failure of the tissues of the GI tract to separate properly from the respiratory tract
Tetralogy of Fallot
congenital malformation involving four distinct heart defects
conjunctiva rash strawberry tongue hands swell burning fever
crash and burn (s/s of Kawasaki)
The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron?
cream of wheat
Signs and symptoms of congestive heart failure are: (11)
cyanosis, pallor, rapid respiration(more than 60 breaths/min; accompanied by flaring of the nostrils, mouth breathing, grunting, and sternal retractions), rapid pulse, feeding difficulties(because they tire easily and inability to breathe), fatigue, a weak cry, excessive perspiration (especially on the forehead), failure to gain weight, edema(blood flow to the kidneys is decreased, and the glomerular filtration rate slows), and frequent respiratory infections.
Categories of congenital heart defects
cyanotic and acyanotic
constipation
defecation is difficult or infrequent with passage of hard, dry fecal material
rickets
deficiency in vitamin D we need the sun to help absorb and metabolize calcium and phosphorus
scurvy
deficiency of vitamin C manifested by joint pains, bleeding gums, loose teeth, and lack of energy
Parents should be instructed in the techniques of preventing ______ in children with polycythemia.
dehydration
a child with newly diagnosed leukemia does not have all immunizations up to date. Which is an essential step in response to this
delay active immunizations during chemotherapy
hemosiderosis
deposit of iron into organs and tissues of the body
concepts of poisoning
determine the volume of a swallow (3mL for a 2-3 year old), education for parents, know the poison control center phone number
when caring for a child on steroid therapy, it is important to seek immediate medical attention if the child
develops a fever
what would be the initial nursing action when a child receiving a transfusion packed with red blood cells complains of chills and back pain
discontinue the transfusion
atypical celiac disease
duodenum and includes mild GI symptoms like reflux and bloating malabsorption is manifested by anemia, fatigue, and peripheral nerve problems
KD: Abnormalities in an _______ can be detected by the tenth day and this observation is an important diagnostic tool
echocardiogram
The nurse confirms that sickle cell trait can be distinguished from sickle cell disease by a lab test called ________________.
electrophoresis
What is a characteristic manifestation of Hodgkin's disease?
enlarged lymph nodes
lymphadenopathy
enlargement of lymph nodes
spleenomegaly
enlargement of the spleen
The rate of RBC production is regulated by _________________.
erythropoietin
hyperlipidemia
excessive lipids (fat and catlike substances) in the blood. Lipoproteins contain lipids and proteins and include the following: -LDLs, which contain a low amount of triglycerides, high level of cholesterol, and some protein. LDL carries cholesterol to the cells, which aids in cellular metabolism and steroid production -HDL contain low amounts of triglycerides, little cholesterol, and high levels of protein. HDL carries cholesterol to the liver for excretion. Children with a parental history of cholesterol levels exceeding 240 mg/dL or a family history of early cardiac death (less than 55 years of age) should have their cholesterol levels tested because genetics can play a role in hypercholesterolemia. However screening only those children who are identified as high risk may not identify all children who need follow-up care. -Associated with obesity and a sedentary lifestyle; screening in cildren 9-11 to identify the genetic form of inherited familiar hypercholesterolemia. Lipid screening of younger children may be recommended if there is an established diagnosis of diabetes mellitus, hypertension, tobacco use, obesity, or a positive family history. -For elevated cholesterol, a fat intake reduction of 25% to 35% of total calories with less than 7% saturated fat and less than 200 mg cholesterol per day is advised. Reductio of calories, increase of fiber, and regular execise should be stressed in their education. -Drug therapy is only for children between 8 to 10 years of age with very high risk factors. There are 6 statin drugs approved for children: Lovastatin, pravastatin, atorvastatin, simvastatin, fluvastatin, and rosuvastatin. Regular follow-up of liver function tests and lipid levels is important. If liver enzymes are 3 times normal, statin therapy should be discontinued. -Children less than 2 years of age should not have a fat-restricted diet, because calories and fats are necessary for CNS growth and devlopment.
hypotonic dehydration causes
excessive vomiting, diarrhea, malnutrition, diuretics treat with hypertonic solution (D5NS or D5LR)
anxiety can be decreased in both the family and child who has cancer by
explaining all procedures before they are done
s/sx of diarrhea
explosive watery stools that are yellowish green infant is listless, refuses to eat, and loses weight temp may be elevated, signs of dehydration
meckel's diverticulum
failure of the vitelline duct to disappear during fetal life causing a blind pouch to form near the ileocecal valve and is subject to inflammation
s/sx of imperforate anus
failure to pass meconium in the first 24 hours and/or no anus or weird position of the anus on assessment
What should the nurse closely assess in a child receiving a transfusion?
fever
leukocytes function
fight infection and provide immunity
common noninfectious causes of diarrhea
food intolerance, overfeeding, improper formula preparation, ingestion of high amounts of sorbitol
hypoplastic left heart syndrome: The initial survival of the infant depends on a patent __ ___and ___ ___ to provide a pathway for oxygenated blood to the general body system. Infant is placed on a transplant list early so surgery can be performed soon after birth. Prostaglandin E1 May be administered to maintain patency of the ductus arteriosus. urvival begins the first few months of life without intervention is rare. Multistage shunting procedure can be done as a temporary holding measure until a new heart is available. After a transplant, immunosuppressive therapy to prevent organ rejection
foramen ovale and ductus arteriosus
the mainstay of treatment for thalassemia major is
frequent blood transfusions
CAM therapy with ______ (3) may interact with drugs used for congenital heart disease and should not be used
ginkgo, ginseng, and St. John's Wort
antidotes for beta-blockers
glucagon and insulin
Rubella and varicella vaccination family hx and child screening
health promotion for congenital defects
A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated?
heart failure
early intervention
helps to assess child for developmental milestones and making sure the family meets the needs of the child
classic symptoms of hemophilia is severe joint pain, which is caused by _____ which is also known as hemorrhage into a ______
hemarthrosis, joint cavity
The study of blood circulation is termed _______
hemodynamics
The nurse shows slides of red blood cells from a child with sickle cell disease, noting that in addition to their sickle shape, the cells contain the abnormal element of ______________ _____.
hemoglobin S
hemarthrosis
hemorrhage into joint cavity
children with thalassemia major develop _____ as a result of treatment
hemosiderosis, or excess iron stored in tissues
treatment for hernias
herniorrhaphy
Blood always flows from an area of _____ pressure to an area of ____ pressure and takes the path of least resistance.
high to low
breath tests
hydrogen breath test: abnormal bacterial growth urea breath test: detect the presence of H. pylori in the stomach
Systemic hypertension
hypertension, or high BP is being seen more often during childhood and adolescence. Blood pressure is a product of peripheral vascular resistance and cardiac output. An increase in cardiac output or peripheral resistance results in an increase in BP. Systemic BP increases with age and is correlated with height and weight throughout childhood and adolescence. Significant hypertension is considered when measurements are persistently at or above the 95th percentile for the patient's age and sex. Hypertension is referred to as secondary when a disease process can explain the increased pressure. Renal, congenital, vascular, and endocrine disorders represent the majority of illnesses that account for secondary hypertension. Primary, or essential, hypertension implies that no known underlying disease is present. Nevertheless, heredity, obesity, stress, and a poor diet and exercise pattern can contribute to any type of hypertension .
In _________ there is an underdevelopment of the left side of the heart, usually resulting in an absent or nonfunctional left ventricle and hypoplasia of the ascending aorta.
hypoplastic left heart syndrome
angiotensin converting enzyme inhibitors: The nurse should observe for signs of ____(4)
hypotension, cough, renal dysfunction, and hyperkalemia.
leukemia results in uncontrolled growth of
immature white blood cells
immediate nursing care of a child with hemophilia who has hemarthrosis includes
immobilization of the area of pain
CHF (congestive heart failure)
impaired myocardial function, pulmonary congestion, systemic venous congestion
treating hirschsprung's disease
impaired part of the colon is removed and a temporary colostomy is placed
causes of vomiting
improper feeding techniques, formula intolerance, foods of different consistencies, systemic illness
Congenital heart defects that cause the blood to return to the right ventricle and recirculate through the lungs before exiting the left ventricle through the aorta are known as defects that __________
increase pulmonary blood flow.
Hypotonic dehydration
increased electrolyte loss with decreased fluid loss very poor turgor, clammy skin, decreased urine output, very low bp
A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow?
increased susceptibility to infection
treating imperforate anus
infant is NPO and prepared for surgery diagnosis is confirmed by x-ray or MRI initial surgery is a colostomy
failure to thrive
infants who fail to gain weight and usually lose weight because of organic causes like pathological dysfunction or environmental factors like neglect
thrush
infection of the mucous membranes of the mouth caused by Candida
gastroenteritis
inflammation of the stomach and intestines #1 sign is diarrhea
s/sx of appendicitis
initial pain is periumbilical and increases within 4h pain localizes to RLQ, rebound pain in mcburney's point, guarding, pain on lifting the thigh while supine
the greatest concern of a nurse caring for child with ITP is
injuries that might initiate bleeding
antidotes for calcium chennel blockers
insulin and calcium salts
which of the following presents the greatest risk to the child with hemophilia
intracranial bleeding
Chorea
involuntary, irregular spasms of limb and facial muscles (more common in females); sign of RF
Desmopressin acetate (DDAVP)
is a nasal spray that can stop bleeding and may be the treatment of choice for mild cases of hemophilia
purpura
large hemorrhagic spots in the skin
purpura
large petechiae
whole bowel irrigation
large volumes of GoLytely to flush the entire GI tract
chronic diarrhea
lasts for more than 2 weeks and may indicate malabsorption problem, long-term inflammatory disease, or allergic responses
most common form of childhood cancer
leukemia
caring for the dehydrated pt
life-threatening deficits can occur within a few hours of dehydration and fluid loss close assessment is crucial
care for celiac disease
lifelong diet restrictions, teach to read all food labels and watch for words like "malt"
decrease cardiac demands
limit physical activity, maintain normal body temp, reduce effort of breathing, adequate nutrition
treating thrush
local application of nystatin suspension swab mouth 3-4x/day between feedings, drop into side of infants mouth to make sure med stay in contact with lesions newborns should be cared for in isolation precautions
Furosemide (Lasix)
loop diuretic; monitor K, Na, and Cl
isotonic dehydration
loss of equal parts fluid and electrolytes decreased elasticity, dry mucous membranes, sunken and soft fontanelles, decreased urine output, BUN increased, Na K Cl and pH decreased
High-density lipoproteins (HDL) contain_____(3). HDL carries cholesterol to the liver for excretion.
low amounts of triglycerides, little cholesterol, and high levels of protein
s/sx of overhydration
low protein levels leading to edema and/or anasarca usually seen around the eyes and genital areas
gastroesophageal reflux
lower esophageal sphincter is relaxed or not competent, which allows stomach contents to be easily regurgitated into esophagus
treating kwashiorkor
mainly preventative sprinkle protein powder on food
latent celiac disease
manifest a wheat sensitivity by a recurring rash at risk of developing celiac in the future
poisonous plants
marigolds, apricot pits, peach pits, poinsettias, tulips, violets
treatment of ventricular septal defect
may close spontaneously Open heart surgery under hypothermia. With the use of the heart-lung bypass machine the condition can be corrected in a fairly dry or bloodless field. The hole is ligated (closed) with sutures or a synthetic patch
A child who is in a vasoocculusive crisis caused by sickle cell anemia is experiencing acute pain. The nurse understands that demerol (meperidine) is not an appropriate pain medication to administer to this child because it:
may induce seizures
care for pinworms
mebendazole for kids over 2 wash hands thoroughly after BM, fingernails are kept short, wear clean undies, toilet seats are scrubbed daily, bed linens washed in hot water
fluid loss in the child
metabolic rate and heat production are 2-3x greater per kg of body weight waste production stimulates respiration and increase evaporation through the lungs
risk factors for developing pyloric stenosis
mom was treated with macrolide abx in pregnancy, hyperbilirubinemia, genetic predisposition
care for gastroenteritis
monitor I&O's, frequent skin care and diaper changes, good handwashing and food preparation techniques, weigh infant daily, observe for dehydration or overhydration
an appropriate nursing intervention for the child admitted to the hospital with sickle cell crisis would be to
monitor the child's response to analgesics
appendicitis
most common reason for emergency abdominal surgery in childhood serious complications can occur within 36h after onset of symptoms
C diff
most common type of diarrhea associated with antimicrobial therapy needs to be placed on contact precautions
pinworms
most common type of worm transmitted fecal-oral route
coarctation of the aorta (CoA)
narrowing of the aorta; results in increased pressure close and decreased pressure distal to obstruction
pulmonic stenosis
narrowing of the opening and valvular area between the pulmonary artery and right ventricle
Symptoms of Digitalis toxicity include______(5)
nausea, vomiting, anorexia, irregularity in rate and rhythm of the pulse, and a sudden change in pulse.
nursing care for hirschprungs disease
newborn=detection is high priority older child= careful attention to hx of constipation and diarrhea, signs of undernutrition, abdominal distention, and poor feedings enema with normal saline, NOT TAP WATER
1st 6-12 months prone to complications (rejection) immunosuppressive therapy teaching/supporting family follow-up
nursing considerations post-heart transplant
pyloric stenosis
obstruction at the lower end of the stomach caused by overgrowth of the circular muscles of the pylorus or spasm of the sphincter
In pediatric patients, Lanoxin is preferred because ___ (2)
of its rapid action and shorter half-life.
KD causes inflammation ________
of the vessels in the cardiovascular system.
s/sx of intussusception
onset is sudden, pain in the abdomen evidenced by loud cries, straining efforts, and kicking and drawing the legs toward the abdomen vomiting a green/yellow bile, no flatus is passed, currant jelly stools
iron supplement absorption is increased by taking it with
orange juice
s/sx of meckels diverticulum
painless bleeding from the rectum bright red/dark red blood
children with Hodgkins disease usually present with a
painless cervical neck lump
patent ductus arteriosus (PDA)
passageway between the aorta and the pulmonary artery remains open after birth
characteristics of gastroesophageal reflux
peak at 4 months and decrease at around 12 months old when infant starts to stand and eat upright may have some back arching accompanying spit up
poor feeding tachypnea, tachycardia failure to thrive/poor weight development delays positive prenatal hx positive family hx
pediatric indicators of cardiac dysfunction
s/sx of constipation
periods of diarrhea with encopresis
The nurse, caring for a child receiving chemotherapy, notes that the childs abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest?
peripheral neuropathy
s/s that might indicate that a child has ITP include
petechiae and purpura
petechiae
pinpoint hemorrhage spots beneath the skin
monitor at home (Holter) medications (cardiac, anti-coag, anti-rejection) follow-up care (cardiologist, surgeon, PT) community support teach parents CPR
planning for discharge and home care after heart surgery
s/sx of esophageal atresia
polyhydramnios in mom, absence of fetal gastric bubble on ultrasound, vomiting and choking after first feeding, drooling, abdominal distention
monitor I+O chest tube care assess for complications provide comfort/pain relief plan for d./c
post-op care for child/infant who required heart surgery
lie flat 3-4 hrs bulky dressing over insertion site VS q 15min check site q 15 check pulses distal to site
post-procedure care of cardiac catheterization
explain procedure in a way the child can understand
pre-procedure of cardiac catheterization
treatment for esophageal atresia
prevent pneumonia, choking, and apnea first feeding should be water or colostrum place on NPO, suction the airway, position to drain mucus from nose and throat surgery is necessary
s/sx of pyloric stenosis
projectile vomiting immediately after feeding usually starting around 2-3 weeks old, infant is immediately hungry after vomiting, dehydration, malnutrition, olive-shaped mass felt in RUQ
Acetaminophen quiet environment lip/mouth care (ointment, cool cloth, ice chips/popsicle)
promoting comfort for a child with Kawasaki disease
antidote for heparin
protamine sulfate
kwashiorkor
protein deficiency despite the fact that the number of calories consumed is adequate
umbilical hernia
protrusion of a portion of the intestine through the umbilical ring
inguinal hernia
protrusion of the part of the abdominal contents through the inguinal canal in the groin
Total anomalous pulmonary venous return (TAPVR)
pulmonary veins are abnormally connected to the systemic venous circulation via the R atrium instead of LEFT atrium, blood is mixed
backs up into R ventricle leads to peripheral edema
pulmonic stenosis effect on heart flow of blood
treatment for pyloric stenosis
pyloromyotomy Ramstedt surgery involves cutting into the hypertrophied muscle done ASAP
hematoma
raised ecchymosis
gastric lavage
rarely effective after one hour of ingestion
erythrocytes
red blood cells (RBCs)
treating diarrhea
reduce intake of solid food to allow intestine to rest, oral rehydration with pedialyte, avoid caffeinated sodas and chicken broth
erythropoietin
regulates the rate of RBC production
s/sx of hernias
relatively free of symptoms mass in the abdomen that appears from time to time, usually when the child cries or strains
goals for managing posioning
remove access to poison, prevent further absorption, call the poison control center, provide supportive care and seek medical help
developing CHF systolic murmur atrial dysrhythmias COPD later in life
s/s of ASD
dizziness fainting epistaxis
s/s of CoA in older children
fever malaise anorexia muscle aches stiff joints/back pain s/s of HF
s/s of SBE
decreased CO hypotension tachycardia poor feeding
s/s of aortic stenosis in newborn/infant
exercise intolerance chest pain dizzy when standing
s/s of aortic stenosis in older child
NSAID poisoning
s/sx cause GI irritation, reduced kidney function, and platelet dysfunction
children with hemophilia should avoid
salicylates
primary fear of dying in children younger than 5 years of age concerns
separation from their parents or abandonment
diagnosing celiac disease
serum IgA antibody test, antitissue transglutaminase, increased fecal fat content
hemophilia is inherited by the male as a
sex-linked recessive (the defective gene is on the X, or female, chromosome)
A _______ refers to the flow of blood through an abnormal opening between two vessels of the heart.
shunt
what is the most common test used to screen for sickle cell disease
sickledex
intussusception
slipping of one part of the intestine into another part just below it, usually seen at the ileocecal valve
What do Digitoxin and digoxin (Lanoxin) do?
slow and strengthen the heartbeat.
When the patient experiences apprehension and urticaria while receiving a blood transfusion, the nurse:
slows the transfusion and takes the patient's vital signs.
antidote for salicylate poisoning
sodium bicarb
According to the 2011 National Heart, Lung and Blood Institute (NHLBI), ______ are not the treatment choice for children with increased lipids associated with obesity and a sedentary lifestyle
statins
if a child shows signs of a transfusion reaction, the nurse initial action should be to
stop the blood transfusion by clamping off the tubing immediately; then keep the intravenous line open with normal saline solution and notify the nurse in charge
The patient with RF is particularly susceptible to ___ ____ ___, which can occur as a complication of dental or other procedures likely to cause bleeding or infection.
subacute bacterial endocarditis
vomiting
sudden contractions of the diaphragm and the muscles of the stomach persistent vomiting requires investigation causing dehydration and electrolyte imbalance
diarrhea
sudden increase in stools that differ from the infants normal pattern
s/sx of ruptured appendix
sudden relief of acute pain, rigid guarding of the abdomen, abdominal distention, tachycardia, chills, irritability
nursing care for failure to thrive
support mother and encourage her to help with the daily cares
s/sx of GI disorders
systemic: failure to thrive, jaundice, pruritus without allergy indicates liver dysfunction local: pain, vomiting, diarrhea, constipation, rectal bleeding, hematemesis
describe stools of a young child receiving an iron supplement
tarry, green
-weigh child weekly and record -administer meds -promote activity -nutrition, cardiac diets -prevent infections -use community support systems -monitor growth and development -know critical s/s and when to contact HCP
teach parents of children with congenital heart disease
Machinery like murmur bounding pulse
tell-tale sign of PDA
fetal echocardiogram
test to see if there is a heart defect BEFORE birth; ultrasound
The nurse should observe the child after coarctation surgery for ____(4)
the development of hypertension and abdominal pain associated with nausea and vomiting, leukocytosis, and gastrointestinal bleeding or obstruction.
administration of potassium
the nurse must document at least one void before starting IV potassium
s/s of Kawaski disease
the onset is abrupt with a sustained fever, sometimes above 40 C (104 F) that does not respond to antipyretics or antibiotics. The fever last more than 5 days. Conjunctivitis without discharge, fissured lips, a "strawberry tongue" (enlarged reddened papilla on the tongue), inflamed mouth and pharyngeal membranes, and enlarges nontender lymph nodes are seen. An erythematous skin rash develops, with swollen hands and desquamation (peeling) of the palms and soles. The child is very irritable and may develop signs of cardiac problems. Abnormalities in an echocardiogram can be detected by the tenth day and this observation is an important diagnostic tool. Lab results may show an elevated C-reactive protein, ESR, and WBC count.
The cardiovascular system develops between the ____ and _____ week of gestation. It is the first system to function in intrauterine life.
third and the eighth
purpose of the GI system
transport and metabolize nutrients necessary for cellular life extends from mouth to anus
erythrocytes function
transport oxygen and carbon dioxide to and from the lungs and tissues
IVIG, aspirin
treatment for Kawasaki disease
Tricuspid Atresia
tricuspid valve fails to develop so there's no connection between right atrium and right ventricle
Hodgkin's disease is a malignancy of the lymphatic system
true
treatment of Hodgkins disease involves chemotherapy and radiation therapy
true
vasoocclusive
type of sickle cell crisis caused by obstruction of blood flow by abnormally shaped cells
echocardiogram
ultrasound of the heart after birth
Hypoplastic Left Heart Syndrome
underdevelopment of the left side of the heart, usually resulting in an absent or nonfunctional left ventricle and hypoplasia of the ascending aorta
medication poisoning
usually acetaminophen because it can be given to kids antidote is mucomyst s/sx are usually related to the liver
s/sx of gastroesophageal reflux
vomiting, weight loss, failure to thrive, infant is fussy and hungry, respiratory problems can occur if aspiration happens
hypertonic dehydration
water loss exceeds electrolyte loss good skin turgor, parched mucous membranes, sunken fontanelles, marked thirst, elevated body temp
fluid balance in children
water needs and losses in the infant are greater per unit of body weight younger than 2 years old the surface area is particularly important because more water is lost through the skin than in the kidneys
s/sx of lead poisoning
weakness, weight loss, anorexia, pallor, irritability, vomiting, abdominal pain, constipation later stages=anemia and nervous system involvement
s/sx of failure to thrive
weight loss, failure to gain weight, irritability, anorexia, pica, child is below the third percentile in weight and height, development is delayed, "rag-doll limpness"
tub baths and strenuous exercise
what to avoid after cardiac catheterization
excessive salt lack of exercise obesity diets high in saturated fats
what to avoid to prevent acquired defects
foods containing gluten
wheat, barley, rye, and some oats because they are processed in the same factories
imperforate anus
when the lower end of the GI tract and anus end in blind pouches can just be stenosis or complete separation or failure to form the anus
below 4th intercostal space
where does the heart lay in infants to 7 yrs?
leukocytes
white blood cells (WBCs)
s/sx of thrust
white patches that resemble milk curds on the tongue, inner lips, gums, and oral mucosa painless but cannot be wiped away
s/sx of kwashiorkor
white streak in the hair, hair is thin and dry, apathetic and weak, muscles are weak and wasted, abdomen is distended
children who carry the sickle cell trait
will not develop any systems of the disease
What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit?
with orange juice
Early signs of CHF in infants that should be reported: 5
•Tachycardia at rest •Fatigue during feeding •Sweating around scalp and forehead •Dyspnea •Sudden weight gain
