Exam 4 Key Points

Painless lymph node enlargement, usually supraclavicular and cervical area, usually L side Fever > 38 degrees C, night sweats, weight loss seen in adolescents

Hodgkin disease characteristics

Radiation +/- chemo

Hodgkin disease treatments

Topical antifungals (Lotrimin, Miconazole) Until it is gone plus 7 days Have pets examined and treated

Tinea Corporis How do we treat it?

antifungal with antibiotic properties as well - econozole or ciclopirox Sitz baths may be soothing

Tinea Cruris How do we treat it?

Topical antifungals until clear plus 7 days May take 3 to 6 weeks Cotton socks Change shoes every other day Use shower shoes Dry feet well after bath if toenails are affected need oral meds

Tinea Pedis How do we treat it?

Avoid contact Cotton socks Change shoes every other day Use shower shoes Dry feet well after bath

Tinea Pedis How it is prevented?

tell you how bad it is AND determines the protocol that will be used.

Cancer is often staged or classified shortly after diagnosis. Why is this done and how might it impact nursing care?

Focus on pain relief and comfort measures Balance time for uninterrupted rest/family time with nursing assessments and procedures Focus on priority needs of the child and family - "What are you hoping for today?" Be available and sensitive to family Be honest Family presence Common fears Being alone with the child Painful death Time of death Giving the "last dose" Supporting siblings After death: Each family has unique way of dealing with death - expect varied emotions Quiet place, privacy Spiritual support Bathe and dress the body Time to say good-by Community support Nurses need to grieve also

How will you support the families of children who are dying?

Good hand washing (universal precautions) Keep fingernails short and clean Everyone needs their own towel

Impetigo How do you prevent it?

Topical Antibiotics- First Cleanse and remove crusts - soften with 1:20 Burow's solution OR water double antibiotic ointment (bacitracin/polysporin) OTC mupiricin is a RX ointment that is often used (do not use triple antibiotic such as neosporin) if > than 4 lesions- oral antibiotics

Impetigo How do you treat it?

Superficial bacterial skin infection Begins in area of broken skin Normal skin bacteria invades streptococci or staphylococci

Impetigo What causes it?

Lesion begins as papules -> vesicles -> ruptures -> serous fluid -> yellow or honey crusts

Impetigo What does it look like?

Decrease Lead in the Environment take off shoes when you go inside repaint damp dust wash kids hands and toys frequently rip up the carpet use cold water for cooking flush the pipes- run tap for 10-15 min

Lead poisoning: Prevention

Paint - before 1978 Lead pipes - before 1986 Contaminated soil - can affect gardens, yards, playgrounds Folk remedies, toys from other countries Oregon- based on zip code

Lead poisoning: Risk factors

Allow the child to go back to school after 24 hours of treatment. Impetigo involving several superficial lesions is usually treated topically, including washing the affected areas, removing crusts, and applying antibiotic ointment several times a day. The child can return to day care or school after being treated for 24 hours. The lesions do not need to be covered, they can remain open to the air. There is no need for follow-up unless the lesions have not resolved or have become more severe.

A 5-year-old child brought to the clinic with several superficial sores on the front of the left leg is diagnosed with impetigo. Which instruction should the nurse give the parent? Wash the child's legs gently once a day with a mild soap. Cover the sores with loose gauze. Allow the child to go back to school after 24 hours of treatment. Have the child return to the clinic the next week for a follow-up examination.

Fever, infection, fatigue, weakness, pallor, malaise, bruising, petechiae, bone pain

Leukemia characteristics

Chemotherapy

Leukemia treatments

itching, live lice or nits observed Inspect for bite marks, redness & nits Wear gloves, use 2 flat sticks (tongue depressors)

Lice How do we know someone has it?

Deficiency of Factor VIII X-linked recessive (boys get it, females carry it)

hemophilia: pathophysiology

"This vaccine protects against serious bacterial infections, such as meningitis." The Hib vaccine provides protection against serious childhood infections caused by H. influenzae type B virus, such as meningitis and bacterial pneumonia.

During a well-baby visit, a 2-month-old infant receives a diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine, inactivated poliovirus vaccine, hepatitis B vaccine, pneumococcal vaccine, and Haemophilus influenzae b (Hib) vaccine. The parents ask why the baby must have the Hib vaccine. The nurse responds by stating: "This vaccine prevents infection by the poliovirus." "This vaccine protects against serious bacterial infections, such as meningitis." "This vaccine prevents infection by the hepatitis B virus, which can cause liver damage." "This vaccine prevents susceptible children from getting chickenpox or smallpox."

Prevent and treat skin infections: Trim nails Manage skin care/prevent flare ups Monitor for impetigo, ezema herpeticum May need topical or oral antibiotics

Eczema (Atopic dermatitis) How do we prevent complications? (scarring and infection)

Pediculoside (permethrin, pyrethrin) Olive oil or mayonnaise x 1 hr Removal of nits with comb Launder clothes and bedding Hot water, hot dryer for laundering clothes and bedding Place stuffed animals in dryer for 20 min or in bag for 3 weeks. Vaccum Daily screening Use lice comb Continue to check for 2-3 weeks May retreat in 7 to 10 days if live lice or nits are found

Lice How do we treat it?

Hydrate and lubricate the skin: Bathing daily or twice daily Emollients right after bathing (thick tub- cetaphil) Emollients 3+ times/day Reduce itching: Prevent and treat flares (topical corticosteroids) Cotton clothing, keep cool and dry (pjs- cotton) Minimize inflammatory response: Topical corticosteroid ointments for short periods of time (will not cause skin thinning- important to treat can lead to scaring, infection) Topical immunomodulators - tacrolimus or pimecrolimus

Eczema (Atopic dermatitis) How do we treat it?

rash may look like ringworm, intense itching- can scratch so much they make themselves bleed infant- snuggly (trying to itch), restless sleeper (may use sedating antihistamines)

Eczema (Atopic dermatitis) What are the signs and symptoms of it?

combs, hats, contact

Lice (Pediculus humanus capitis) How is it spread?

Infant - 2 years • Unable to differentiate death from temporary separation and abandonment • Infant/toddler will note changes in the behavior of their caregivers, especially in emotion and routine Support: Maximize physical comfort, familiarity. Be consistent. Ages 2 - 4 • Believes that death is reversible or temporary • May have magical thinking • May personify death- bogeyman Support: Correct perception of illness a punishment. Reassure and lessen possible guilt about child leaving parents. Ages 5 - 9 • Begins to realize death is final, but not personal • May believe that death can be avoided Support: Be honest. Provide details if asked. Ages 9 - 12 • Knows that all living things die • May think death is a punishment • Understands more about the body • May become concerned with practical things Support: Provide details if asked. Support need for control. Encourage participation in decision making. Adolescents • Recognizes that death is inevitable and irreversible- self, friends, family • May spend time daydreaming, criticizing and philosophizing • May view death as an enemy. May see dying as failure or giving up. Support: Reinforce self-esteem and self-worth. Tolerate strong emotions. Respect privacy. Encourage participation in decision making.

Developmentally how do children of different ages understand death? How will you alter your plan of care based on this understanding?

Creating a therapeutic, homelike environment for the infant and his family The goal of palliative care is to make the infant and his family as comfortable as possible. Maintaining routines and structure doesn't support the principles of palliative care. Clustering care activities may allow the infant more rest, but this action isn't a principle of palliative care. Minimizing noise and disruption isn't specifically related to palliative care.

Which nursing activity supports the principles of palliative care for a dying infant and his family? Maintaining routines and structure for the infant and his family Clustering care activities to provide as much rest as possible for the infant Creating a therapeutic, homelike environment for the infant and his family Minimizing noise and disruption to decrease stress for the infant

abdominal mass, does not cross midline, usually unilateral, elevated BP, hematuria Peak 3-4 years of age, more common in males

Wilms Tumor characteristics

surgery +/- chemo and radiation Tumor can "seed" with abdominal manipulation

Wilms Tumor treatments

Risk for infection Risk for hemorrhage Anemia Nausea and vomiting Anorexia Mucosal ulceration/stomatitis/rectal irritation Hemorrhagic cystitis Alopecia

Cancer side effects of treatment

Chelation Therapy- IV infusion Careful monitoring ↓ lead in the environment- find and decease source

Lead poisoning: Treatment

firm, nontender abdominal mass, crosses the midline, urinary dysfunction, fever, lymphadenopathy Peak age: < 5 years, 50% < 2 years Often "silent" tumor, quite large on diagnosis- difficult to find due to round shape of child's stomach

Neuroblastoma characteristics

Surgical removal of tumor, radiation, chemo

Neuroblastoma treatments

Lice (nits- eggs, louse- bug)

Pediculus humanus capitis What is it?

heavy painless testicular swelling w/ smooth or nodular tumor

Testicular Tumor characteristics

Fungual infection

Tinea What causes it?

Administer the DTaP and IPV immunizations

An infant is to receive the diphtheria, tetanus, and acellular pertussis (DTaP) and inactivated polio vaccine (IPV) immunizations. The child is recovering from a cold and is afebrile. The child's sibling has cancer and is receiving chemotherapy. Which action is most appropriate? Give the DTaP and withhold the IPV. Administer the DTaP and IPV immunizations. Postpone both immunizations until the sibling is in remission. Withhold both immunizations until the infant is well.

Iron supplements Recheck lab values in 1 month Iron fortified formula & cereal Support/education

Anemia Treatment

Hg<11

Anemia diagnosis

--Have to obtain consent. -Large bore cath (If needing to get it in quickly) - large bore is relative - 24g really do work -Protocol - need to start within 30 min of arrival - if know you're going to administer blood - get everything together before blood arrives - VS equipment, special IV tubing and filters, NS -Transfuse slowly first 15 to 20 minutes & transfusion needs to be completed in less than 4 hours CHILDREN (ANYONE) RECEIVING MULTIPLE TRANSFUSIONS ARE AT HIGHER RISK FOR REACTIONS Use only NS to prime and flush line Use pump and blood filter Monitor frequently during administration Transfusion Reactions- Stop immediately, run NS, get help Get VS and keep taking them Follow protocol - everything gets rechecked - tubing, blood, etc.

Nursing considerations for administering Blood Transfusions

removal of affected testicle Chemo +/- radiation

Testicular Tumor treatments

Genetic, autosomal recessive The globin chain normally present in hemoglobin A is replaced by hemoglobin S Under certain circumstances the cells sickle The cells can also revert back to their normal donut-like shape- lifespan significantly- 20-45 days

sickle cell disease: pathophysiology

Prevent sickling : Minimize tissue deoxygenation- decrease stress and cold exposure, Promote hydration, Prevent infection Promote good nutrition Monitor growth & development Immunizations- high risk S/S that something is wrong and what to do- ER Administer medications Genetics - early testing, early treatment

sickle cell disease: prevention of complications

Hydroxyurea (increases Hg F) Prophylactic antibiotics Blood transfusions

sickle cell disease: treatment

Avoid direct contact

Tinea How it is prevented?

CDC vaccine schedule

read/interpret the CDC vaccine schedule

anemia

A mother brings a 15-month-old child to the well-baby clinic. She states the child has been taking approximately 18 to 20 oz (540 to 600 mL) of whole milk per day from a bottle with meals and at bedtime. The nurse should suggest that she begin weaning the child from the bottle to avoid risking: malnutrition. anemia dental caries malocclusion

Prepare the child and parents for diagnostic procedures. When a brain tumor is suspected, the child and parents are likely to be very apprehensive and anxious. It is unrealistic to expect to eliminate their fears; rather, the nurse's goal is to decrease them. Preparing both the child and family during hospitalization can help them cope with some of their fears. Although the nurse may be able to decrease some of the child's anxiety, it would be impossible to eliminate it. Children with infratentorial tumors seldom have seizures, so seizure precautions are not indicated. Although introducing the child to other children is a positive action, this action would be more appropriate once the nurse has decreased some of the child's and parents' anxiety by preparing them.

A school-age child is admitted to the hospital with the diagnosis of probable infratentorial brain tumor. During the child's admission to the pediatric unit, which action should the nurse anticipate taking first? Eliminate the child's anxiety. Implement seizure precautions. Introduce the child to other clients of the same age. Prepare the child and parents for diagnostic procedures.

Surgery, Radiation, Chemotherapy, HSCT

Brain Tumor treatments

providing an analgesic during the last days and hours is an ethically appropriate nursing action The nurse's action should be based on the fact that all clients, regardless of age, have the right to die with dignity and to be free of pain. Assisted suicide requires some action on the part of the client, which isn't possible in the case a 1-month-old infant. The parent's decision doesn't eliminate the nurse's ethical obligation to the infant and to the nursing profession. Withholding the opioid analgesic isn't appropriate because it isn't known that administering the drug would hasten death in this case.

A 1-month-old infant in the neonatal intensive care unit is dying. His parents request that a nurse give the infant an opioid analgesic. The infant's heart rate is 68 beats/minute and his respiratory rate is 18 breaths/minute. He is on room air; oxygen saturation is 92%. The nurse's response to the parents' request should be based on the fact that: providing an analgesic during the last days and hours is an ethically appropriate nursing action. withholding the opioid analgesic during the last days and hours is an ethical duty; administering it would represent assisted suicide. administering an analgesic during the last days and hours is the parents' ethical decision. withholding the opioid analgesic is clinically appropriate because administering it would hasten the infant's death.

Elevate the right knee. The goal is to decrease the bleeding. This can be aided by decreasing circulation to the area. Elevating the part and applying cold decreases circulation to the area. The child will also receive cryoprecipitate. Aspirin is contraindicated for a child with a bleeding disorder because it increases capillary fragility. The dependent position will increase bleeding and swelling, and the goal is to decrease bleeding.

A child with hemophilia is brought to the clinic with spontaneous soft tissue bleeding of the right knee. Immediately on the child's arrival, what should the nurse do? Administer aspirin for discomfort. Immobilize the knee in a dependent position. Elevate the right knee. Obtain a type and cross-match for platelets.

Drink plenty of fluids. Report a sore throat to an adult immediately. Wash hands before meals and after playing. Fluids would be encouraged to prevent stasis in the bloodstream, which can lead to sickling. Sore throats and all other cold symptoms would be reported promptly because they may indicate an infection, which can precipitate a crisis (red blood cells sickle and obstruct blood flow to tissues). Children with sickle cell anemia would learn appropriate measures to prevent infection, such as proper hand-washing techniques and good nutrition. Folic acid intake would be encouraged to help support new cell growth; new cells replace fragile sickled cells. Warm packs would be applied to promote comfort and relieve pain; cold packs cause vasoconstriction. The child would maintain an active, normal life but would avoid excessive exercise, which can precipitate an attack. When the child experiences a crisis, he/she will typically limit his/her own activity according to the pain level.

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises would the nurse provide to the child and family? Select all that apply. Avoid foods high in folic acid. Drink plenty of fluids. Use cold packs to relieve joint pain. Report a sore throat to an adult immediately. Restrict activity to quiet board games. Wash hands before meals and after playing.

The parents may be at different stages in dealing with the child's death. The dying child may become clingy and act like a toddler. The death of a child may have long-term disruptive effects on the family. The child does not fully understand the concept of death. When dealing with a dying child, parents may be at different stages of grief at different times. The child may regress in behaviors. The stress of a child's death commonly results in divorce of parents and behavioral problems in siblings. Preschoolers see illness and death as a form of punishment. They fear separation from parents and might worry about who will provide care for them. Preschoolers have only a rudimentary concept of time; thinking about the future is typical of an adolescent facing death, not a preschooler. Whispering in front of the child only increases fear of death.

A nurse is caring for a 5-year-old child who's in the terminal stages of cancer. Which statements are true? Select all that apply. The parents may be at different stages in dealing with the child's death. The child is thinking about the future and knows he may not be able to participate. The dying child may become clingy and act like a toddler. Whispering in the child's room will help the child to cope. The death of a child may have long-term disruptive effects on the family. The child does not fully understand the concept of death.

Usually occur below roof of cerebellum headache, morning vomiting, somnolence, irritability, dizziness, change in vision or hearing, loss of motor coordination, loss of milestones, increasing head circumference in young babies

Brain Tumor characteristics

teach TSE- in the shower, encourage them to have any abnormalities checked out- make sure they are comfortable reporting to provider

Testicular Tumor Nursing Care

Apply firm pressure for at least 5 minutes to puncture sites Administer immunizations subcutaneously Avoid aspirin-containing products With hemophilia, the child is high risk for bleeding. Rectal temperatures and intramuscular injections are contraindicated. Immunizations should be given subcutaneously and aspirin-containing products should be avoided. Pressure to any puncture site should have pressure applied for at least 5 minutes.

The nurse is caring for a child with hemophilia. What will the nurse include in the client's plan of care? Select all that apply. Take all temperatures rectally Apply firm pressure for at least 5 minutes to puncture sites Administer immunizations subcutaneously Administer all pain medications intramuscularly Avoid aspirin-containing products

Ensure a safe environment Providing a safe environment protects the child from injury. This is important because the child is at risk for bleeding due to the thrombocytopenia. The other options are important for a child with cancer, but are not the priority in relation to thrombocytopenia.

The nurse is caring for a young child on the oncology unit who has developed thrombocytopenia after cancer treatment. What is the priority action for the nurse to implement when caring for this client? Assess for signs of infection. Ensure a safe environment. Plan for extra nap times. Encourage high-protein foods.

Administration of hydromorphone for pain Administration of oxygen Administration of toradol intravenously Vaso-occulsion due to sickle cell disease is when the red blood cells (RBCs) morph into sickle cell shape and plug up the blood vessels causing extreme pain. The treatment of sickle cell includes administration of pain medication, administration of an anti-inflammatory, and administration of oxygen to prevent further sickling of other RBCs. Bed rest is encouraged and heat is applied to help vasodilation the venous system.

The nurse is caring for a 12-year-old child admitted for vaso-occlusion related to sickle cell disease. What interventions will the nurse expect to implement? Select all that apply. Application of ice to joints Administration of hydromorphone for pain Encourage ambulation 3 times a day Administration of oxygen Administration of toradol intravenously

Tinea Capitis- scalp Tinea Corporis- body Tinea Pedis- feet Tinea Cruris- groin

Tinea What are the different kinds - what areas are affected

Active Immunity- Natural/Vaccines body produces its own antibodies against disease-causing antigens. Passive Immunity- hort-term immunity that results from the introduction of antibodies from another person or animal. Breast milk, Placenta

different types of immunity

Killed virus vaccine Toxoid- toxin treated to weaken it's effects Live virus vaccine- live but weakened/attenuated Rcombinant- genetically altered Conjugated- altered organism is joined with substance to increase immune response

different types of vaccines

Safety issues, pad sharp corners, prevent falls, regular exercise no/limited contact sports Good oral hygiene, avoid constipation Teach how to administer factor replacement

hemophilia: prevention of complications

Prevent bleeding Replace missing factor: Pooled concentrate from human donors- risk for transfusion reaction/HIV Recombinant Factor 8- non-human DDAVP with milder forms (also used in bed wetting and diabetes insipidus) Prevent damage to joints

hemophilia: treatment

Frequently assessing the child's level of consciousness (LOC) In hemophilia, one of the factors required for blood clotting is absent, significantly increasing the risk of hemorrhage after injury. Therefore, the nurse must assess the child frequently for signs and symptoms of intracranial bleeding, such as an altered LOC, slurred speech, vomiting, and headache. To manage hemophilia, the absent blood clotting factor is replaced via I.V. infusion of factor, cryoprecipitate, or fresh frozen plasma; this may be done prophylactically or after a traumatic injury. Platelet transfusions aren't necessary. Clients with hemophilia aren't at increased risk for infection. Discussing a safe play environment with the parents is important but isn't the highest priority.

A toddler with hemophilia is hospitalized with multiple injuries after falling off a sliding board. X-rays reveal no bone fractures. When caring for the child, what is the nurse's highest priority? Administering platelets as ordered Taking measures to prevent infection Frequently assessing the child's level of consciousness (LOC) Discussing a safe play environment with the parents

Concern for their child's well-being Fear of a side effect Concerns over the chemical ingredients in vaccines Religious reasons Fear of overwhelming immune system Recognize that it doesn't come from a place of malice Don't make assumptions that parents are uneducated Work with parents Goal is to have children fully immunized and on schedule- when child gets off schedule less likely to get back on schedule

What are some reasons families choose not to immunize and what are some ways to respond to these families' concerns?

Thorough physical assessment: Vital signs - special attention to temperature Special attention to: Cancer site/systen Weight gain or loss Pain/intervention/response Child/family (behavioral/emotional) adaptation Risk for infection: Hand hygiene, watch for fever, antibiotic tx, support nutrition and rest, may give granulocyte colony stimulating factors Enhanced precautions during "respiratory" season Vaccination schedule interrupted. May give vaccines if 12 mo post chemo Decrease chances of bleeding: Soft bristle toothbrush, few fingersticks, minimal IM or venipuncture, no rectal temps Platelets as ordered, monitor platelet levels, Limit contact activities Teach child/parent how to manage bleeding Anemia: Check reticulocyte count Administer blood transfusions as ordered Monitor reactions to transfusions Educate parents/child to monitor activity/exercise Nausea and vomiting: Administer anti-emetic 30 min - 1 hr before tx then around the clock for 24 hrs after chemo Monitor hydration Anorexia: Stimulate appetite, light low-protein meals seem best before tx, hard candy may take away bad taste from chemo May need feeding tube Mucosal ulceration/stomatitis/rectal irritation: Assess daily Soft non-acidic foods Soft toothbrush Normal saline mouth rinses Magic mouthwash Ice cubes, popsicles Treat pain Hemorrhagic cystitis: Keep well hydrated, monitor for bloody urine, void frequently Alopecia: Hair will grow back in 3 to 6 months May be different color and texture

Cancer nursing care

Families will need a lot of education and support: - assess their level of understanding and clear up misconceptions -Teach family and pt about risk factors for transmission -Teach about preventing the spread of infections using standard precautions Protect child from infection: -Develop habit of washing hands, staying away from others who are ill -Make sure meds are given as scheduled - which itself can be overwhelming -May be on modified vaccine schedule but should get live vaccinations unless severely immunocompromised -Watch for oral lesions, skin lesions, thrush and other opportunistic infections. They need to seek care for high fever or respiratory difficulty -Need high calorie, high protein, small frequent meals - monitor if they're not gaining weight -Keep them hydrated -Developmental stimulation as possible - important to keep up with appropriate developmental activities

Care for a child with HIV

Anaphylactic reaction to previous vaccine Anaphylactic reaction to ingredients in vaccine Immunocompromised -> no live virus vaccines without checking with specialist

What are some true contraindications to vaccines, both live and killed?

one chance in four for each pregnancy Sickle cell disease is an autosomal recessive Mendelian disorder. Therefore, if both parents have the trait, there is a one-in-four chance that any child (each pregnancy) will have the disease and a one-in-two chance that a child (each pregnancy) will have the trait.

The parents of a child with sickle cell anemia ask about the chances of sickle cell disease occurring in future children. The nurse responds based on the knowledge that both parents are carriers. What is the risk of one of their children having the disease? one chance in five for each pregnancy one chance in four for each pregnancy one chance in three for each pregnancy one chance in two for each pregnancy

"If the child contracts the disease, it could be very serious, even life threatening." The varicella vaccine protects the child from chicken pox. Although most cases of chicken pox are not life threatening, children can die from the disease. It is highly contagious, and other children, or immunocompromised adult and children, may be exposed to the unvaccinated child. The vaccine is specific for chicken pox disease.

The parents of a toddler do not want their child to have a varicella immunization, stating, "My child will have better immunity if he or she gets the disease now." Which of the following is the nurse's best response? "You are correct and chicken pox is not fatal." "The antibodies in the vaccine are good for other communicable diseases as well." "If the child contracts the disease, it could be very serious, even life threatening." "Chicken pox is not very contagious, so it is unlikely your child will contract it naturally."

"When riding my bicycle, I will wear my helmet." "Hiking with my family is great exercise." A child with hemophilia should avoid contact sports even with protective equipment. Soccer and football would not be appropriate for this child. Swimming, hiking, and bicycle riding are good choices.

The school nurse is discussing with the parents of a 13-year-old child with hemophilia about sport/activity options. The education has been effective when the student makes which statements? Select all that apply. "I can participate in football as long as I wear a helmet." "Swimming is too dangerous for my health." "When riding my bicycle, I will wear my helmet." "Hiking with my family is great exercise." "Soccer would not work with my health condition."

Terbinafine and Azole Antifungal meds- Griseofulvin 6-8 weeks (systemic- fungus IN hair follicle) Selenium sulfide or ketoconazole shampoo (will not treat, will prevent spreading)

Tinea Capitis How do we treat it?

Why get vaccinated- what the vaccine protects against Number of doses- schedule Local pain, swelling, and reddnes are common- use ice on injection site to reduce swelling and pain. Acetaminophen or ibuprofen may be given to reduce fever and pain- symptoms should disappear in a day or two Child may have fever, joint pain, muscle aches, or fatigue within hours to day- Acetaminophen or ibuprofen Mild allergic reaction- hives around injection site Severe allergic reaction- flushed face, swelling of face, mouth, or throat, wheezing, difficulty breathing, shock- call 911

What general information do parents need regarding the immunizations their child will be receiving?

Local- erythema, swelling, pain, and induration at the injection site Systemic- fever, fussiness, irritability, malaise, and anorexia symptoms should disappear in a day or two rash, syncope (w/ anxiety) Allergic reactions

What general side effects might be expected after immunizations?

The children will be curious about the physical aspects of death. The children will know that death is inevitable and irreversible. Attitudes of the adults in their lives will influence the children. By age 10 years, most children know that death is universal, inevitable, and irreversible. School-age children are curious about the physical aspects of death and may wonder what happens to the body. Their cognitive abilities are advanced and they respond well to logical explanations. They should be encouraged to ask questions. The adults in their environment influence their attitudes toward death. Adults should be encouraged to include children in the family rituals and should be prepared to answer questions that might seem shocking. Teaching about death should begin early in childhood. Comparing death to sleep can be frightening for children and cause them to fear falling asleep.

When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply. Logical explanations are not appropriate. The children will be curious about the physical aspects of death. The children will know that death is inevitable and irreversible. Attitudes of the adults in their lives will influence the children. Teaching about death and dying should not start before age 11 years. Telling children that death is the same as going to sleep as a way of relieving fear is appropriate.

Begin I.V. fluids after obtaining the child's history. The nurse should obtain the child's history and then begin I.V.fluids. Fluids are one of the most important components of therapy for sickle cell crisis; they help increase blood volume and prevent sickling and thrombosis. A child experiencing a sickle cell crisis commonly has severe pain requiring the use of I.V. analgesics such as morphine, which would be administered after fluid therapy has been started. Instructing the parents about what to expect during hospitalization is important, but it isn't the first action the nurse should take. Oxygen therapy is used only if the child is hypoxic.

Which action should the nurse take first when admitting an 11-year-old child in sickle cell crisis? Administer oral pain medication while obtaining the child's history. Begin I.V. fluids after obtaining the child's history. Instruct the parents about what to expect during this hospitalization. Start oxygen therapy as soon as the child's vital signs are taken.

a maternal uncle with prolonged postoperative bleeding Hemophilia A is a genetically transmitted, X-linked recessive disorder characterized by a deficiency of plasma factor VIII. A hemophiliac man and a normal woman have normal male children and female children who carry the hemophilia trait. The carrier females pass the abnormal gene to half their sons and the carrier trait to half their daughters. The mother's brother most likely has hemophilia, as evidenced by the prolonged postoperative bleeding. Thus, the mother may be a carrier.

Which information obtained during the nursing history would help support a child's diagnosis of hemophilia? a brother and sister who are healthy Italian and German ethnic background a maternal uncle with prolonged postoperative bleeding paternal grandmother's death from chronic lymphocytic leukemia

one-piece cotton pajamas with long sleeves A short-sleeved shirt would be inappropriate because the infant could scratch the uncovered arms, exacerbating the condition

Which night clothes would the nurse recommend for an infant with atopic dermatitis (eczema)? a diaper and short-sleeved shirt one-piece cotton pajamas with long sleeves two-piece flannel pajamas with short sleeves a woolen sleeper with feet and mittens

contamination of the factor VIII replacement received during bleeding episodes Children with hemophilia were at risk for AIDS in the 1980s because the factor VIII concentrate infusions were made from pooled plasma. However, factor VIII is now a recombinant synthesized factor product, which virtually eliminates the risk of contacting HIV with an infusion.

While attending a support group, the parents of a child with hemophilia become concerned because they heard stories about how many children with hemophilia have died from acquired immunodeficiency syndrome (AIDS). They ask the nurse how these children got the AIDS virus. The nurse bases the response on which as the most likely route of transmission of AIDS to these children? contamination of the factor VIII replacement received during bleeding episodes casual contact with a child testing positive for human immunodeficiency virus use of a contaminated needle to obtain a blood sample for type and crossmatching exposure in the waiting room to children with AIDS attending the same hematology clinic