Unit 5
The nurse is caring for a 4-year-old with oral vesicles and ulcers from herpangina. The child refuses fluids due to the pain and the mother is concerned about his hydration status. Which of the suggestions would be most appropriate?
""Offer 'magic mouthwash' followed by a popsicle."
The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse?
"Blowing cool air with a fan or hair dryer may relieve the feeling."
The nurse is teaching the mother of an infant with a temporary ileostomy about stoma care. What is the most important instruction to emphasize to the mother to avoid an emergency situation?
"Call the doctor immediately if the stoma is not pink/red and moist."
The nurse is teaching a client about peptic ulcers. The client understands the provided education when stating which of the following?
"Hemorrhage and gastritis are the most common complications."
The nurse has performed client education for a 15-year-old boy with Crohn disease and his parents regarding the cobblestone lesions in his small intestine. Which comment by the family indicates learning has occurred?
"I have to be careful because I am prone to not absorbing nutrients."
A nurse caring for an infant born with a cleft palate notices that the parents rarely interact with their child. The nurse overhears the mother telling her spouse that she "feels like crying" every time she looks at their infant. What would be the best response from the nurse?
"I sense you could use more information on caring for a cleft palate. Would you be interested in meeting with other parents who have dealt with this?"
The nurse is caring for an infant recently diagnosed with oral candidiasis (thrush) who has been prescribed nystatin. Which statement by the infant's mother would suggest a need for further education?
"I will add the nystatin to her bottle four times per day."
A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first?
"My toes are stiff."
The student nurse is preparing a presentation on celiac disease. What information should be included? Select all apply.
"Symptoms of celiac disease include diarrhea, steatorrhea, anemia, and dental disorders." "The only treatment for celiac disease is a strict gluten-free diet." "Gluten is found in most wheat products, rye, barley and possibly oats."
The nurse is speaking with a parent of a child diagnosed with scoliosis. The parent states, "I hate to think about my child having to wear a huge brace to treat this disorder. My best friend growing up had to wear one and she hated it." What is the best response by the nurse
"The newer type of braces fit under the arms and are made to fit under clothing. They aren't nearly as big as they used to be."
The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?
"The pain feels deep in my legs and keeps me awake at night."
The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education?
"This medication will cure my child of this disorder."
flaccid
(adj.) limp, not firm; lacking vigor or effectiveness
Management of GERD
- Lifestyle modification (maintain ideal body weight, eat smaller meals, no eating 3 hrs before sleep, stay upright after meals, elevated HOB, no smoking) - Nutritional therapy (no acidic food, peppermint, fatty foods, coffee, fruits, chocolate, alcohol)
Flat Foot (Pes Planus)
- has no arch and may cause pain and swelling of the foot surface. - medial border becomes convex - sole touches floor cannot join the army*
rhematoid arthritis
-autoimmune disorder -person's immune system attacks their joints that causes massive deformation
Bone healing stages
1. Hematoma Formation 2. Fibrocartilaginous Callus Formation 3. Bony Callus Formation 4. Remodeling Phase
Treatment of GERD
1. Lifestyle modifications 2. drug therapy 3. Surgical intervention
Pharmacologic therapy for osteoporosis?
1. calcium and vitamin D 2. calcitonin
Normal BMI (body mass index)
18.5-24.9
When is myelination complete?
2 years of age it is complete
Duchenne muscular dystrophy
3-7 years of age most common walking ability is lost at 9-12 years
How long does a patient taking bisphosphonates needto stay upright after administration?
30 minutes
Obesity BMI
30 or greater
Peak of GERD in infants?
4 months
new borns respiratory rate
40-60
Mild to moderate dehydration requires?
50-100 mL/kg of ORS over 4 hours
How many ml do you flush a feeding tube with?
60 mL Toomey syringe
infants are how much water
75%
Calcium level
8.8-10.4
Periosteum
A dense fibrous membrane covering the surface of bones (except at their extremities) and serving as an attachment for tendons and muscles.
creptius
A grating or grinding sensation caused by fractured bone ends or joints rubbing together
A patient is scheduled for a Billroth I procedure for ulcer management. What does the nurse understand will occur when this procedure is performed?
A partial gastrectomy is performed with anastomosis of the stomach segment to the duodenum.
joint
A place in the body where two bones come together
contracture
Abnormal shortening of a muscle
Why do we not GERD to become chronic in infants?
Acidic irritation Chronic ear infections Asthma Resp issues
Sucralfate (Carafate)
Adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hour, has no systemic effects. Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and do not administer within 30 minutes of antacids.
Risk factors for osteoarthritis?
Aging Obesity Genetics Joint injury female gender
Juvenile Idiopathic Arthritis
An autoimmune disorder 2- 4 years of age. More common in girls
Toddler 2-4 years causes of constipation?
Anal fissures withholding toilet refusal short-segment Hirschsprung disease Neurologic disorders Meningomyelocele tumors tethered cord
Scopolamine (Transderm Scop)
Anticholinergic prevent post-op nausea & and vomiting Side effects: visual impairment, confusion, pharyngitis
A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?
Apply a cold pack at the insertion site.
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
Arthroscopy
Clavicle fractures are more common in?
Babies
The nurse is caring for a pediatric client with idiopathic celiac disease. Which meal will the nurse select for this client?
Baked salmon, potato slices, vanilla ice cream, and apple juice
A client has been diagnosed with chronic gastritis. The nurse knows that which of the following symptoms are indicative of gastritis? Select all that apply.
Belching Early satiety Sour taste in the mouth
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?
Between 24 and 48 hours
A client with peptic ulcer disease has a blood pressure of 88/40 mm Hg, dizziness, and nausea. Which complication will the nurse suspect is occurring with this client?
Bleeding from the ulcer
osteoclast
Bone-destroying cells
Bryant traction
Both lower extremities flexed 90 degree at hips; rarely used because extreme elevation of lower extremities causes decreased peripheral circulation
What food can the nurse suggest to the client at risk for osteoporosis?
Broccoli
Always look at what lab value for bones?
Calcium levels
The nurse caring for children with neuromuscular disorders knows that which is the most common movement disorder of childhood?
Cerebral palsy
The nurse is administering an enteral feeding to a child with a gastrostomy tube (G-tube). Which action will the nurse take when administering a prescribed feeding through the client's G-tube?
Check for gastric residual before starting feeding.
Structural Anomalies of the GI Tract
Cleft Lip and palate Pyloric stenosis Hernias prevent injury to suture line promote adequate nutrition encourage infant-parent bonding provide emotional support
Which type of fracture produces several bone fragments?
Comminuted
Myelomeningocele (spina bifida)
Congenital disorder where the spinal cord does not close before birth
Tendon
Connects muscle to bone
Anorexia
Defined as a lack of appetite A common symptom of many physical conditions Side effects of certain drugs Emotional issues The aim of nutrition therapy is to stimulate the appetite maintain adequate nutritional intake
The younger they are of children they are prone to ?
Dehydration
Acute Gastrointestinal Disorders
Dehydration Vomiting Diarrhea Oral candidiasis and oral lesions Hypertrophic pyloric stenosis Necrotizing enterocolitis Intussusception, malrotation and volvulus Appendicitis
pectus excavatum (funnel chest)
Depression of the sternum
What would be signs or symptoms of intolerance to TPN?
Diarrhea, high glucose levels
plaster cast
Do not get wet
cast
Do not stick foreign objects into a cast
A preschooler has celiac disease. The parent is preparing a gluten-free diet. The nurse knows that the parent understands the diet when the parent prepares which breakfast foods?
Eggs and orange juice
Clavicle fracture what are we not going to do?
Elevate above arm for 6 weeks!!
Epiphysis
End of a long bone
Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.
Ensure the pins or wires are covered with caps. Position trapeze within the client's reach. Instruct the client on isometric exercises for immobilized extremity.
How often do you check residuals?
Every 4 hours
The nurse is caring for a child with diarrhea related to infectiousenteritis. The nurse accurately informs the parents that most cases ofdiarrhea are bacterial in nature and therapeutic management is usuallysupportive in nature?
False
Sliding esophageal hernia
GERD management
Steroids cause what in the GI?
GI bleeding
Simethicone
Gas-X relief of bloating
Halo traction
Halo type bar that encircles the head screws are inserted into the outer table of the skull. The halo is attached to bed or rods that is secured to a rest
A neonatal nurse teaches students how to recognize gastrointestinal disorders in infants. The nurse tells the students that failure of the newborn to pass meconium in the first 24 hours after birth may indicate what disease?
Hirschsprung disease
Any age constipation
Hypothyroidism withholding medication side-effects Previous anorectal sx Rapid change to sedentary state Dehydration
ICES
Ice, Compression, Elevation, Support
The nurse is teaching an in-service program to a group of nurses on the topic of gastrointestinal disorders. The nurses in the group make the following statements. Which statement is most accurate related to the diagnosis of gastroesophageal reflux?
In this disorder the sphincter that leads into the stomach is relaxed.
A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience:
Increased bone resorption.
Guarding
Involuntary muscle contractions (spasms) of the abdominal wall in an effort to protect an inflamed abdomen; a sign of peritonitis.
Which term refers to mature compact bone structures that form concentric rings of bone matrix?
Lamellae
insensible water loss
Loss of fluid from the body by evaporation, such as that which normally occurs during respiration.
LES
Lower esophageal sphincter
Newborn/infant causes of constipation?
Meconium plug Hirschsprung disease Cystic fibrous Congenital anorectal malformations hypothyroidism diabetes renal tubular acidosis withholding dietary changes
The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?
Never cross the affected leg when seated
Can you admister medication with tube feeding?
No
The nurse is auscultating the bowel sounds of a 4-year-old child anddocuments hypoactive bowel sounds. What might this finding indicate?
Obstruction
Proton Pump Inhibitors
Omeprazole Antacids H2 receptors antagonist Small frequent feedings Rice cereal for thicken Positional changes
What type of infection can we see on a x-ray?
Osteomyelitis
Which of the following is the most common and most fatal primary malignant bone tumor?
Osteosarcoma
Osteo in a child?
PICC line and 6- 8 weeks of antibiotics Fever, vancomycin
Five P's
Pain, pallor, pulse, parathesia, paralysis
S/s to report with a cast or splint
Pain, swelling
Geomycin
Peak & troff
Famotidine
Pepcid GERD Side effects: headache, constipation, diarrhea Prolonged QT intervals
Promethazine
Phenergan Motion sickness Side effects: Seizures, bradycardia, tachycardia, thrombocytopenia
What goes with calcium?
Phosphorus
In caring for an infant diagnosed with pyloric stenosis the nurse would anticipate which intervention?
Prepare the infant for surgery.
compartment syndrome
Pressure builds up usually after surgery
Vitamin B is a what?
Protein
Gathering information about infant vomiting?
Questions to ask include Could you wipe the vomitus off the child with a rag? Did the vomiting require a change of clothes? How big a circle did it make? Did it happen after every feeding? Did it look like what was eaten, or was it curdled? What color was it? Did it appear to be projected away from the child?
Which nursing intervention is essential in caring for a client with compartment syndrome?
Removing all external sources of pressure, such as clothing and jewelry
Lactobillus acidophilus
Restores normal bowel flora gave for: diarrhea Side effects: gas, hypersensitivity of lactulose products
Treatment of fractures in children
Retention and reduction methods.
bariatric procedures
Roux-en-Y gastric bypass (RYGB) Gastric banding Sleeve gastrectomy
A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?
Sharp and piercing
CPK
Skeletal muscle and muscle injury. It increases.
A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?
Sprain
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?
Surgical debridement
The nurse is working with a 6-year-old child recently diagnosed with Legg-Calvé-Perthes disease. The child's parents tells the nurse they understand exercise is important for their child but are not sure which activities are appropriate. Which activity will the nurse recommend for this client?
Swimming
joint capsule
The fibrous sac that encloses a joint.
Remodeling
The process of resorption and formation of bone
The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?
The skin may be covered with a yellowish crust that will shed in a few days.
Which condition causes a fat embolism?
Total hip arthroplasty
The nurse working in the emergency room knows that trauma orunintentional injury is a leading cause of childhood morbidity andmortality in the United States?
True
The nurse is talking with a pregnant client about cleft lips and palates. The client has asked if these can be tested for. What information should be included in the nurse's response? Select all that apply.
Ultrasounds can be used to assess for these conditions. Most cleft lips and palates are found at delivery.
cystic fibrosis
Usually have a peg tube gastrostomy or jejunostomy.
A nurse is providing care for a client recovering from gastric bypass surgery. During assessment, the client exhibits pallor, perspiration, palpitations, headache, and feelings of warmth, dizziness, and drowsiness. The client reports eating 90 minutes ago. What will the nurse suspect?
Vasomotor symptoms associated with dumping syndrome
What testing are we going to do for injury in a child?
X-rays.
Encopresis
a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing
spina bifida
a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it
traction
a pull to the arm or leg muscles to bring a bone back into place when it is dislocated or fractured
hammer toe
a toe that is curled due to a bend in the middle joint of the toe
developmental dysplasia of the hip
abnormal development of the hip joint found that is congenital Sx: fat rolls asymmetrical, abnormal leg length, AROM limited Tx: Cast, surgery, PT Tests: US (ultrasonogram), x-ray of hips, AROM testing of hips
Scoliosis
abnormal lateral curvature of the spine
plantar fasciitis
an inflammation of the plantar fascia on the sole of the foot
corn on foot
area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes).
callus
area of thick hard skin
Osteoclastomas
benign for long periods but may invade local tissue and cause destruction
Adolescent constipation
body issues; dieting, laxatives, IBS-C, anorexia, pregnancy
Osteoblasts
bone forming cells
Tibia Vara
bowing of the legs
osteogensis imperfecta
brittle bone disease shock & denial - family
What is a contusion?
bruise
protuberant
bulging
hallux valgus
bunion
callus
cartilaginous/fibrous tissue at fracture site
CSM
circulation, sensation, movement
atlectasis
collapsed lung after sx
Osteoid osteoma
common tumor in children & young adults
cortical bone
compact bone
spinal muscle atrophy
condition of progressive degeneration of anterior horn cell.
Metatarsal adductus
congenital curving inward of the feet
avascular necrosis
death of tissue due to insufficient blood supply
A child is scheduled for a urea breath test. The nurse understands that this test is being performed for which reason?
detect Helicobacter pylori
A child with cerebral palsy is referred for physical therapy. When describing the rationale for this therapy, the nurse would emphasize what as the primary goal?
development of gross motor movement
constipation
difficulty in passing stools
dysphagia
difficulty swallowing
effusion
excess fluid in joint
Halo traction
external fixation device
Polydactyly
extra digits
steatorrhea
fat in the feces
russell traction
femur or lower leg
The nurse is caring for a 12-year-old child with Crohn disease. What assessment finding will the nurse report to the health care provider when caring for the child?
fever
fascia
fibrous membrane of connective tissue supporting and separating muscles and body organs
bursa
fluid-filled sac that allows for easy movement of one part of a joint over another
osteogenesis
formation of bone
Diarthrosis
freely movable joint
Osteon
functional unit of compact bone
GERD
gastroesophageal reflux disease
Overweight BMI
greater than 25
Torticollis
head tilt due to shortening or spasm of one sternomastoid muscle
muscular dystrophy (MD)
hereditary condition causing progressive degeneration of skeletal muscles
Hirschsprung disease
hereditary defect causing absence of enteric nervous system
Meningocele
herniation of the meninges less serious than spina bifida
Manifestations of GERD
hiccups Vomit after meals Ear infections
kyphosis
hunchback
buck traction
immobilizes hip/femur fractues supine position with foot of bed raised
Synarthrosis
immovable joint
Alkaline phosphate
increases in bone diseases, tumors, sarcomas.
Osteomyelitis
infection of the bone
Osteoarthritis
inflammation of the bone and joint
Diverticulitis
inflammation of the diverticula
Morton's Neuroma
inflammation of the nerve typically between the 3rd and 4th metatarsals
The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?
inguinal hernia
sprain
injury to a ligament
strain
injury to muscle or tendon
congenital curved foot
inversion of the heel
Fasciculation
involuntary twitch of muscle fibers
S/S of dehydration in children
irritable/lethargy - cool skin - eyes sunken-no tears - poor skin turgor, dry mucous membranes, depressed fontanel - decreased U/O - urine SG >1.030 - delayed cap refill - weight loss
Icteric
jaundice
atonic
lacking normal muscle tone
cancellous bone
latticelike bone structure; trabecular bone
trabeculae
latticework of osseous tissue that makes up the structure of spongy or cancellous bone
The difference between a ligament and a tendon?
ligament- bone to bone tendon- muscle to bone
Osteocytes
mature bone cells
Lamellae
mature compact bone structures that form concentric rings of bone matrix; lamellar bone
external fixation devices
medical devices used to stabilize fractures without penetrating the skin (casts, for example)
Synovium
membrane in joint that secretes lubricating fluid
cerebral palsy (CP)
most common motor disorder in childhood High in premature & low weight infants
isotonic contraction
muscles contract and shorten
Zofran (ondansetron)
nausea and vomiting side effects: constipation, anxiety, angina
Tone
normal tension in resting muscle
parathesia
numbness and tingling
Sensible water loss
occurs through urine
ingrown toenail
onychocryptosis
stoma
opening
Lactulose
osmotic laxative decreases ammonia tx: constipation Side effects: diarrhea & vomiting
Which cells are involved in bone resorption?
osteoclasts
Two things you need to monitor when patients are on imunoglobulins?
ototoxic, and renal toxic. Kill the kidneys and renal
severely obese BMI
over 40
rebound tenderness
pain that increases when pressure (as from a hand) is removed
Odynophagia
painful swallowing
The nurse caring for an 18-month-old infant with Meckel diverticulum knows that the most common clinical manifestation of this condition is:
painless rectal bleeding.
PUD
peptic ulcer disease
Reglan (metoclopramide)
prevents nausea from chemo Side effects: tardive dyskinesia, bradycardia, tachycardia, hypotension
Ossification
process of bone formation
Protonix (pantoprazole)
proton pump inhibitor Heals esophagus Side effects: prolonged use causes low magnesium, thrombocytopenia, phlebitis in IV
hiatal hernia
protrusion of a part of the stomach upward through the opening in the diaphragm
osteopenic
refers to a reduction in bone mass to below normal levels
RICE
rest, ice, compression, elevation
Clonus
rhythmic contractions of a muscle
Ligament
ropelike bundles of collagen fibrils connecting bones
Diaphysis
shaft of a long bone
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.
sit in a straight back chair with armrests avoid hip extension Place feet flat on the floor sit with the buttocks tucked under.
A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.
skin breakdown wound infection pneumonia
Amphiarthrosis
slightly movable joint
Urinary Stasis
stagnation of urinary flow
hiatel hernia
stomach protrudes through diaphragm
Helicobacter pylori
stomach ulcers
lordosis
swayback
trendleburg gait
the childs trunk is shifted over the affected hip during ambulation.
hypertrophy
the enlargement of an organ or tissue from the increase in size of its cells.
Resorption
the process of removing or digesting old bone tissue
regurgitation
the return of swallowed food into the mouth
The faster the metabolic rate
the younger the child
Endosteum
thin membrane that lines the medullary cavity
Fundal blication
tightening
cervical skin traction
to decompress vertebrae or for muscle spasms (whiplash, cervical spasm). Head harness or halter.
atrophy
to waste away
school age constipation
toilet or bathroom access limited or unavailable limited ability to recognize physiologic cues, preoccupation with other activities tethered cord withholding
Clawfoot
too much arch occurs due to various pathologies
Cartilage
tough, elastic connective tissue that is more rigid than ligaments but less dense than bone
spastic
uncontrolled contractions of skeletal muscles
A child weighing 10 kg is admitted with severe vomiting for the past 3 days. The nurse writes a nursing diagnosis of Risk for deficient fluid volume related to vomiting. When the nurse reassesses the child, which outcomes would indicate the effectiveness of the treatment plan? Select all that apply.
urine specific gravity of 1.008 urine output of 15 mL/hour tolerating sips of clear fluids
Pavlik Harness
used for hip dysplasia in infants Remove only to take baths
Management of Osteoarthritis
weight loss
