Chapter 48&49
"You will need to drink this 6-ounce bottle of orange juice." A child with type 1 diabetes who has signs of hypoglycemia can drink juice as a quick source of sugar to raise the glucose level and stop the symptoms of hypoglycemia. The child should only have one serving of juice and wait to see if the hypoglycemic signs resolve. Another dose of insulin could drop the glucose to dangerous levels. Skipping the insulin dose or sitting in the office will not resolve the symptoms or help the child.
A nurse in the school office is seeing a 7-year-old child with type 1 diabetes after gym class. The child is jittery and appears sweaty. Which intervention would the nurse advise the child to do? "You will need to drink this 6-ounce bottle of orange juice." "You will need to have an extra shot of regular insulin." "You will need to sit in the office and rest after gym class." "You will need to skip your next dose of insulin."
Positive Kernig sign A positive Kernig sign can indicate irritation of the meninges. A positive Brudzinski sign also is indicative of the condition. A positive Chadwick sign is a bluish discoloration of the cervix indicating pregnancy.
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? Positive Kernig sign Negative Brudzinski sign Positive Chadwick sign Negative Kernig sign
Elevate the subcutaneous tissue before the injection. Insulin injections are always given subcutaneously. Elevating the skin tissue prevents injection into muscles when subcutaneous injections are given. The needle bevel should face upward. The skin is spread in intramuscular, not subcutaneous, injections. It is no longer recommended to aspirate blood for subcutaneous injections.
A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections? Place the needle with the bevel facing down before the injection. Spread the skin before the injection. Aspirate the syringe for blood return before the injection. Elevate the subcutaneous tissue before the injection.
Check blood glucose levels. The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.
A pediatric client has just been diagnosed with diabetes. What would the nurse do first? Educate the client on stress management. Regulate nutrition. Check blood glucose levels. Administer insulin.
Give the child a glass of orange juice. The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.
After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? Give the child one unit of regular insulin. Give the child a glass of orange juice. Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. Give the child a glass of orange juice with one unit regular insulin in it.
blood glucose level It is important to determine a blood glucose level on the adolescent because the adolescent is exhibiting signs of hypoglycemia and needs to be treated quickly. Serum ketone testing would be indicated if the adolescent were exhibiting symptoms of hyperglycemia. A CT scan or toxicology test may be needed if the adolescent's glucose level were within normal range. Blood sugar level & its symptoms Hypoglycemia - hunger, irritability, trouble concentrating, fatigue, sweating, confusion, fast heartbeat, shaking headache Hyperglycemia - extreme thirst, dry mouth, weakness, headache, frequent urination, blurry vision nausea, confusion, shortness of breath
An adolescent is found wandering around. The client is confused, sweaty, and pale. Which test will the nurse prepare to perform first? computed tomography (CT) scan serum ketone testing blood glucose level blood toxicology
never to discontinue the drug abruptly. Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.
Any individual taking phenobarbital for a seizure disorder should be taught: to brush his or her teeth four times a day. never to discontinue the drug abruptly. never to go swimming. to avoid foods containing caffeine.
Antidiuretic hormone (ADH) Central diabetes insipidus (DI) is a disorder of the posterior pituitary that results from deficient secretion of ADH. ADH is responsible for the concentration of urine in the renal tubules. Without ADH there is a massive amount of water loss and an increase in serum sodium. Nephrogenic DI occurs as a genetic problem or from end-stage renal disease. It is the result of the inability of the kidney to respond to ADH and not from a pituitary gland problem. LH is produced from the anterior pituitary. In females, it stimulates ovulation and the development of the corpus luteum. TSH is secreted by the thyroid gland. ACTH is secreted by the anterior pituitary.
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone? Adrenocorticotropic hormone (ACTH) Thyroid stimulating hormone (TSH) Luteinizing hormone (LH) Antidiuretic hormone (ADH)
Dramatic increase in head circumference A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel (fontanelle) would be frequently seen by this age.
During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which sign or symptom was observed? Dramatic increase in head circumference Pupil of one eye dilated and reactive Vertical nystagmus Posterior fontanel (fontanelle) is closed
intravenous Transmission of H. influenzae meningitis is by means of droplet infection from an infected person; other forms of meningitis are contracted by an invasion of the meninges via the bloodstream from an infection elsewhere. Fecal and contact transmission is not how H. influenzae meningitis is spread or transmitted.
Haemophilus influenzae meningitis is usually spread by which method of transmission? intravenous fecal droplet contact
Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Hypoglycemia is much more likely to occur than hyperglycemia; if there is any doubt as to whether the child is having a hypoglycemic or hyperglycemic reaction, it should be treated as hypoglycemia. While the pump may offer continuous insulin, it does not sense blood glucose level; insulin reactions can still occur. Careful monitoring of blood glucose is still needed. While repeating signs and symptoms may be helpful, caregivers of a recently diagnosed child have lots of information to absorb and the repetition may create more anxiety. Assuming that the caregivers can read and understand them, written materials and videos may be helpful but they should not take the place of an initial teaching session with a nurse.
The caregivers of a child just diagnosed with diabetes express concern that they won't remember the different signs and symptoms of hyperglycemia and hypoglycemia. As a result, they are afraid they won't handle an emergency correctly. What is the best initial response by the nurse to help ensure the child's safety? Instruct them to treat the reaction as if it's hypoglycemia, which is more likely. Repeat the signs and symptoms over and over until they seem to understand. Suggest that the child wear an insulin pump for continuous insulin administration. Give the caregivers educational pamphlets and videos about diabetes.
neurologic deficiencies Hypocalcemia (insufficient calcium) causes neurologic damage, including intellectual disability. Calcium is necessary for bone and tooth formation and is also needed for proper nerve and muscle function. Hypokalemia can cause cardiac issues. Kidney and urinary disorders are not likely to be caused by insufficiencies in the diet.
The child is diagnosed with hypocalcemia. The nurse should assess the child for which possible complication? cardiac arrhythmias neurologic deficiencies kidney failure urinary tract disorders
diabetes insipidus (DI) The most common symptoms of central DI are polyuria (excessive urination) and polydipsia (excessive thirst). Children with DI typically excrete 4 to 15 L per day of urine despite the fluid intake. The onset of these symptoms is usually sudden and abrupt. Ask about repeated trips to the bathroom, nocturia, and enuresis. Other symptoms may include dehydration, fever, weight loss, increased irritability, vomiting, constipation, and, potentially, hypovolemic shock.
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder? Syndrome of inappropriate antidiuretic hormone (SIADH) secretion Hypopituitarism Diabetes insipidus (DI) Precocious puberty
Bulging fontanels (fontanelles) Infants with increased ICP exhibit bulging fontanels (fontanelles). They typically have a decreased appetite, are restless, and have trouble sleeping.In children, increased ICP is most often a complication of traumatic brain injury; it may also occur in children who have hydrocephalus, brain tumors, intracranial infections, hepatic encephalopathy, or impaired central nervous system venous outflow
What finding is consistent with increased intracranial pressure (ICP) in an infant? Emotional lability Increased appetite Narcolepsy Bulging fontanels (fontanelles)
As the child grows, the gross and fine motor skills increase. As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.
What information is most correct regarding the nervous system of the child? The child's nervous system is fully developed at birth. As the child grows, the gross and fine motor skills increase. The child has underdeveloped fine motor skills and well-developed gross motor skills. The child has underdeveloped gross motor skills and well-developed fine motor skills.
Avoid making noise when in the child's room. Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? Avoid making noise when in the child's room. Rock the child frequently. Have the child's 2-year-old brother stay in the room. Keep the lights on brightly so that he can see his mother.
"I have all of a sudden noticed my child is always thirsty...even at night." Polydipsia (extreme thirst) is a sign of diabetes mellitus, an endocrine disorder. The other statements by the parent would indicate musculoskeletal, vision, or integumentary disorders. The nurse would further assess for polyuria, weight loss and polyphagia.
he nurse is assessing a child for signs of an endocrine disorder. Which statement by the parent would alert the nurse to further assess the child for an endocrine disorder? "My child's skin is red after a bath or shower." "I have all of a sudden noticed my child is always thirsty...even at night." "My child tells me that his knees hurt at night, especially after running around all day." "My child says he has trouble seeing the print in the chapter books the teacher sends home."
Facial muscle spasm when tapping the facial nerve. Chvostek sign is demonstrated when skin anterior to the external ear is tapped and the facial muscles around the eye, nose, and mouth unilaterally contract. Tapping the facial nerve in the parotid gland area can indicate heightened neuromuscular activity. This test is done to check for hypocalcemia. The parathyroid glands regulate serum calcium levels and help control the rate of bone metabolism. If calcium levels fall, parathyroid hormone secretion is increased, so it is important to identify a deficiency, if present.
A 13-year-old adolescent is seen in the office and appears very anxious. For the past 2 weeks, the adolescent has had some muscle twitching; upon examination, the client is found to have a positive Chvostek sign. Which would be an appropriate explanation of a Chvostek sign? Facial muscle spasm when tapping the facial nerve. Pain can be caused by touching the muscles. Increased intracranial pressure causes this sign. Excess intake of vitamin D can cause this sign.
"You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." Guidelines for successful long-term medication administration include making a dosing schedule/calendar that promotes a normal lifestyle. Avoid bribing kids; this is too hard to maintain. Involve the child in the purpose and administration of medication as early as possible to ensure interest, independence, and cooperation.
A 16-year-old adolescent is at the office for a checkup. The parent states, "My child keeps forgetting to take insulin. What can we do to make sure my child takes it?" Which is the best response by the nurse? "You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep." "You can offer your child prizes for taking the medication." "You can make sure that you are the only one who understands and is able to administer the medication." "You can remind your child that the medication is in the cabinet, and that the child should take it when needed."
"As endocrine functions become more stable throughout childhood, alterations become more apparent." The endocrine glands are all present at birth; however, endocrine functions are immature. As these functions mature and become stabilized during the childhood years, alterations in endocrine function become more apparent. Thus, endocrine disorders may arise at any time during childhood development.
A 2-year-old client is at the office for a follow-up visit. The client has had excessive hormone levels in recent bloodwork and the parents question why this was not found sooner. What is the best response by the nurse? "It takes time to determine the level of functioning of endocrine glands." "Have there been signs and symptoms that you should have reported to the doctor?" "As endocrine functions become more stable throughout childhood, alterations become more apparent." "Endocrine disorders are hard to detect and you are lucky that we have found it when we did."
Recent consumption of large amounts of cough medicine Radioimmunoassay of T4 and T3 is a specific blood study to determine how much protein-bound iodine (PBI) is present in serum. Ask if a child has recently taken large amounts of cough medicine containing iodide before the study or the PBI level may be abnormally elevated. The small amount of iodine ingested from iodized salt does not affect PBI levels. Children who have low circulating albumin levels can have abnormally low PBI levels, because iodine is carried bound to protein. Phenytoin, a common anticonvulsant medication prescribed for children with recurrent seizures, may displace thyroxine from binding globulin and further contribute to low PBI levels.
A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test? Recent consumption of large amounts of cough medicine Recent consumption of table salt Low circulating albumin levels Taking phenytoin
Diabetes insipidus is different from diabetes mellitus. Having all caregivers trained in injections ensures that medication will be given and the need to give it to the child will be understood. All children should wear a medical alert tag upon diagnosis. For the caregiver to have a good understanding and provide good management of the child's care, the difference between diabetes insipidus and diabetes mellitus must be established. This is a rare disorder that needs to be closely managed throughout the child's life, and it is not curable.
A 4-year-old diagnosed with diabetes insipidus is being discharged. Which information below is most important to emphasize to the parents? Children younger than 5 do not need to wear medical alert tags. Diabetes insipidus is different from diabetes mellitus. Children outgrow this diagnosis over time.
A private room near the nurses' station A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until he or she has received IV antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.
A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? A room with a 12-month-old infant with a urinary tract infection A room with an 8-month-old infant with failure to thrive A private room near the nurses' station A two-bed room in the middle of the hall
"Kids can usually be managed with an oral agent, meal planning, and exercise." Treating type 2 diabetes in children may require insulin at the outset if the child is acidotic and acutely ill. More commonly, the child can be managed initially with oral agents, meal planning, and increased activity. Telling the child that she is lucky she did not have to learn how to give a shot might scare her, so it will inhibit her from seeking future health care. The condition will not rectify itself if all orders are followed. A weight-loss program might need to be implemented but that is not always the case.
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? "You are lucky that you did not have to learn how to give yourself a shot." "Kids can usually be managed with an oral agent, meal planning, and exercise." "This will rectify itself if you follow all of the doctor's directions." "A weight-loss program should be implemented and maintained."
"You look funny. Well, both of you do. I see two of you." The caregiver should notify the health care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling nauseated is not a reason to notify the provider.
A child is home with the caregivers following a treatment for a head injury. The caregiver should contact the care provider if the child makes which statement? "You look funny. Well, both of you do. I see two of you." "My stomach is upset. I feel like I might throw up." "I am glad that my headache is getting better." "It will be nice when you will let me take a long nap. I am sleepy."
"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." The nurse should educate the parents about growth hormones before asking questions. The nurse needs to explain that a diagnosis of deficiency must be documented before growth hormones can be used. Only the long bones are affected. Growth hormone is given orally, IM, and SC.
A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the best response by the nurse? "Growth hormones work only if the child has short bones." "Will your child be able to swallow oral pills every day?" "Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age." "How tall would you like your child to be?"
nuchal rigidity Nuchal rigidity (stiff neck) is a symptom seen in Haemophilus influenzae meningitis that may progress to opisthotonos (arching of the back). Encephalopathy is an abnormal condition of the brain tissues. Bleeding under the skin causes a purpuric rash.
A symptom often seen in the child diagnosed with Haemophilus influenzae meningitis occurs when the child has a stiff neck. This symptom is referred to as which of the following? opisthotonos nuchal rigidity encephalopathy purpuric rash
It is difficult to keep the child awake. During the health history, the parents may state that it is difficult to keep the child awake. Physical examination would reveal that the child is below weight and height, that his skin is pale and mottled, and that he is lethargic and irritable.
The nurse is obtaining a health history from parents whose 4-month-old boy has congenital hypothyroidism. What would the nurse most likely assess? The child has above-normal growth for his age. The child is active and playful. The skin is pink and healthy looking. It is difficult to keep the child awake.
Institute safety precautions. A child who presents with an elevated temperature is at high risk for having a febrile seizure. Febrile seizures are convulsions that can happen when a young child has a fever above 100.4°F (38°C).The fevers that trigger febrile seizures are usually caused by a viral infection, and less commonly by a bacterial infection. The flu (influenza) virus and the virus that causes roseola, which often are accompanied by high fevers, appear to be most frequently associated with febrile seizuresActions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure. The fever should also be controlled. Age-appropriate activities and family teaching are important but they do not take priority over safety. An ill child can assist in care but may not be able to completely provide self-care.
The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2°F (39°C). What is the nurse's highest priority? Institute safety precautions. Offer age-appropriate activities. Provide family teaching related to the child's history. Encourage the child to do his or her own self-care.
Drowsiness and fruity odor to breath Diabetic ketoacidosis is characterized by drowsiness, decreased skin turgor, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.
The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which clinical manifestations would the nurse most likely note in this child? Pale and moist skin Drowsiness and fruity odor to breath Hyperactive and restless behavior Slow pulse and elevated blood pressure
Attempt to turn the child on their side to prevent aspiration. Safety measures include turning the child on their side or abdomen with their head turned to the side to prevent aspiration. Slight cyanosis may be noted but administration of oxygen is not needed due to the short time of the tonic-clonic stage.During the tonic phase of the seizure, they may temporarily stop breathing and their face may become dusky or blue, especially around the mouth. This period is usually brief (usually no more than 30 to 45 seconds) and does not require CPR.Do not attempt to restrain or place objects into the child's mouth. These actions may further injure the child.
The nurse is caring for a child who is having a seizure. What is the appropriate action by the nurse? Attempt to place oxygen on the child so they don't become cyanotic. Hold the child's arms and legs still so they aren't injured. Attempt to turn the child on their side to prevent aspiration. Place a bite block or oral airway into the child's mouth to prevent biting of the tongue.
"He was just staring into space and was totally unaware." Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness.. Focal onset impaired awareness seizures (formerly called complex partial seizure) cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.
The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure? "His arms had jerking movements in his legs and face." "He was just staring into space and was totally unaware." "He kept smacking his lips and rubbing his hands." "He usually is very coordinated, but he couldn't even walk without falling."
Polyphagia Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis) and polydipsia (increased thirst). Pica is eating nonfood substances.
The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has: Polyuria Pica Polyphagia Polydipsia
Polyuria Symptoms of type 1 diabetes mellitus include polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (increased thirst), and polyphagia (increased hunger and food consumption). Pica is eating nonfood substances.
The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has: Polyuria Pica Polyphagia Polydipsia
The child is in status epilepticus. Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes, or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.
The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be: The child is in status epilepticus. The child is having generalized seizures. The child's history indicates she has infantile seizures. The child may begin to have absence seizures every day.
Irritability, fever, and vomiting Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels (fontanelles) would be bulging as intracranial pressure rises, and Kernig sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis.
The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? Flat fontanel (fontanelle) Irritability, fever, and vomiting Jaundice, drowsiness, and refusal to eat Negative Kernig sign
Risk for situational low self-esteem related to short stature Children with short stature tend to report feeling of lower quality of life largely related to discrimination. The nurse may need to remind parents to assign duties and responsibilities to children that match their chronologic age, not their physical size, in order to promote children's feelings of maturity and self-esteem. A child that differs in any way from peers may be the victim of bullying. The nurse should alert the parent to this possibility and assess for this at well-child visits to help protect the child's quality of life. Tissue perfusion is not affected by this disorder. This disorder does not cause impaired skin integrity. There is no overproduction of epinephrine with this disorder.
The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem? Risk for situational low self-esteem related to short stature Ineffective tissue perfusion related to infantile blood vessels Impaired skin integrity related to overproduction of melanin Risk for self-directed violence related to oversecretion of epinephrine
Use a doll with electrodes attached to the head. An electroencephalogram (EEG) is a test to measure the electrical activity of the brain. It is conducted by attached electrodes over sections of the head and obtains an electrical reading via a monitor. There is no pain involved in the procedure, but the child must lie still. The best way for the nurse to explain the procedure to the child is via a doll with attached electrodes that the child can play with, feel, and manipulate. This helps to reduce the child's anxiety and aids in cooperation. Videos can help with the education process but they do not allow for interaction and physical touching. The child can take a nap during the procedure but this does not prepare the child for the procedure. Assuring the child that the procedure will not hurt is not the best way to prepare the child.
The nurse is preparing a child experiencing new-onset seizures for an electroencephalogram (EEG) test. How can the nurse best explain this procedure to the child? Use a doll with electrodes attached to the head. Show the child a video of the procedure. Tell the child he or she can take a nap during the procedure. Assure the child the procedure will not hurt.
Lying on one side, with the back curved Lumbar puncture (spinal tap) involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.Most often, doctors order a spinal tap to see if a child has meningitis (infection of the covering of the brain and spinal cord).A lumbar puncture is a test where a doctor uses a needle to get fluid from your child's lower back. This fluid is called cerebrospinal fluid, or CSF. Your child lies on their side and is held still, and a doctor puts a needle between the bones of the lower back. It does not go near the spinal cord.
The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? Lying prone, with the neck flexed Sitting up, with the back straight Lying on one side, with the back curved Lying prone, with the feet higher than the head
Diaphoresis Slurred speech Tachycardia Manifestations of hypoglycemia include behavioral changes, confusion, slurred speech, belligerence, diaphoresis, tremors, palpitation, and tachycardia. Blurred vision; dry, flushed skin; and fruity breath odor suggest hyperglycemia.
The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on what findings? Select all that apply. Blurred vision Dry, flushed skin Diaphoresis Slurred speech Fruity breath odor Tachycardia
taking oral hypoglycemic agents. Oral hypoglycemic agents, such as metformin, are often effective for controlling blood glucose levels in children diagnosed with type 2 diabetes. Insulin may be used for a child with type 2 diabetes if oral hypoglycemic agents alone are not effective, but "decreasing" the daily insulin would not help treat this disorder. Lifestyle changes such as increased exercise (not conserving energy by resting during the day), and limiting large amounts of carbohydrates are important aspects of treatment for the child.
The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: taking oral hypoglycemic agents. increasing carbohydrates in the diet, especially in the evening. conserving energy with rest periods during the day. decreasing amounts of daily insulin.
Graves disease Graves disease is hyperthyroidism and would result in a low TSH level, noted weight loss, and nervous behavior. Hashimoto thyroid disease is a hypothyroid disease, which would result in a high TSH level. Hypothyroidism would also show a high TSH level. Diabetes mellitus involves the pancreas.Graves' disease is an autoimmune disorder that can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way your body uses energy, so they affect nearly every organ in your body, even the way your heart beats.
The school nurse observes an 8th grader at school who suddenly is losing weight, is not participating in gym, and is in poor academic standing. The nurse takes a history and notes that the child seems very nervous. The nurse notifies the parent, who explains that the child has just been seen by the family health care provider and tested low for thyroid-stimulating hormone (TSH). For which condition will the nurse devise a plan of care? Hashimoto thyroid disease Graves disease Hypothyroidism Diabetes mellitus
Cerebral edema The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.
To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority? Cerebral edema Renal failure Left-sided heart failure Cardiogenic shock
Protect the child from hitting the arms against the bed. Keeping the child safe during a seizure is the highest priority. The nurse will protect the child from hitting the arms on the bed or other nearby objects. If the seizure continues, lorazepam may be indicated to stop the seizure. The client would be referred to a neurologist for follow-up care; however, this is not a priority. Dietary therapy is considered for clients with chronic seizure disorders who do not respond to medication therapy.
While in a pediatric client's room, the nurse notes that the client is beginning to have a tonic-clonic seizure. Which nursing action is priority? Administer lorazepam rectally to the client. Refer the client to a neurologist. Discuss dietary therapy with the client's caregivers. Protect the child from hitting the arms against the bed.