Pediatric Perfusion and PPH

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? "We can stop the penicillin when her symptoms disappear." "If she needs dental surgery, we might need additional medication." "She needs to take the drug for the full 14 days." "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear." For a child with rheumatic fever, drug therapy must be given for the full 10 to 14 days to ensure complete eradication of the infection. The drug must not be stopped when the signs and symptoms disappear. To prevent recurrent attacks, prophylactic antibiotic therapy is prescribed for at least 5 years or until the child is 18 years old. Additional prophylactic therapy should be instituted when dental or tonsillar surgery is planned.

A nurse is providing care to a postpartum woman. The woman gave birth vaginally at 2 a.m. The nurse would anticipate the need to catheterize the client if she does not void by which time? 3:30 a.m. 5:15 a.m. 7:45 a.m. 9:00 a.m.

9:00 a.m. If a woman has not voided within 4 to 6 hours after giving birth, catheterization may be needed because a full bladder interferes with uterine contraction and may lead to hemorrhage. Not voiding by 9 a.m. exceeds the 4 to 6 hour time frame.

A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have: acutely decreased. acutely increased. slightly decreased. slightly increased.

Acutely decreased Despite the decrease in blood volume, the hematocrit remains relatively stable and may even increase, reflecting the predominant loss of plasma. An acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.

A client in the intensive care unit is diagnosed with hypovolemic shock based on a blood pressure of 88/53 mm Hg, heart rate of 122 beats/min, respiratory rate of 26 breaths/min. Given these vital signs, what urine output should the nurse expect? Maintained between 30 to 50 mL/hour with no sediment in the bag. Increased to 60+ mL/hr with dilute urine. Decreased below 30 mL/hr with decrease glomerular filtration rate (GFR). Client's normal amount with dark, concentrated urine.

Decreased below 30 mL/hr with decrease glomerular filtration rate (GFR). Intense sympathetic stimulation, such as in shock and trauma, can produce marked decreases in renal blood flow (RBF) and GFR, even to the extent of causing blood flow to ceases altogether. Consequently, urine output can fall to almost zero. The urine output would not increase nor be normal.

The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis? Jerking movements of the arms and legs Scissoring of the legs with toes pointed down Failure to gain weight Spooning of the finger nails

Failure to gain weight In infants and older children, one of the first signs of CHF is tachycardia. Other signs of CHF often seen in the older child include failure to gain weight; weakness; fatigue; restlessness; irritability; and a pale, mottled, or cyanotic color. Rapid respirations or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and spooning of the fingernails is seen in iron-deficiency anemia.

In an acute care setting, the nurse is assessing an unstable client. When prioritizing the client's care, the nurse should recognize that the client is at risk for hypovolemic shock in which of the following circumstances? Fluid volume circulating in the blood vessels decreases. There is an uncontrolled increase in cardiac output. Blood pressure regulation becomes irregular. The client experiences tachycardia and a bounding pulse.

Fluid volume circulating in the blood vessels decreases Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.

A school nurse is caring for a child with a severe sore throat and fever. What is the nurse's best recommendation to the parent? Give acetaminophen for the fever and pain, and have the child rest. Have the child drink fluids that contain electrolytes. Have the child go to the emergency room. Have the child be seen by the primary care provider.

Have child seen by PCP Children with sore throats and fevers should be seen by their primary care provider to rule out strep throat. This is extremely important due to the fact they may contract an acquired heart disease called rheumatic fever. Taking acetaminophen, resting, and drinking fluids are all good recommendations, but the best recommendation is to see the provider. Going to the emergency room is not necessary at this time.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? Hypovolemic shock Osteomyelitis Urinary retention Atelectasis

Hypovolemic shock Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

A nurse is caring for an infant who is in critical condition. The nurse notes that the child weighs 11 lb (5 kg) and has had a blood loss of 100 mL. Assessment reveals a decreased urine output, mild tachycardia, and restlessness. Which of the following should be the priority action for the nurse to take? neurologic assessment with the Glasgow Coma Scale application of telemetry monitoring IV administration of lactated Ringer's insertion of a Foley indwelling catheter

IV administration of lactated Ringer's The loss of small volumes of blood in children is significant and can lead to hypovolemic shock. In this situation, the blood loss represents approximately 10% of the child's total blood volume. Because the child is exhibiting signs of early hypovolemic shock, the priority action should be the administration of Ringer's lactate for fluid resuscitation. The remaining options may need to be implemented, but the priority is to correct the fluid deficit.

The nurse is monitoring a client who has given birth and is now bonding with her infant. Which finding should the nurse prioritize and report immediately for intervention? The mother is unable to void after 4 hours. Maternal tachycardia and falling blood pressure Placental separation 15 minutes after birth Dark red lochia

Maternal tachycardia and falling blood pressure Maternal tachycardia and falling blood pressure may indicate fluid volume deficit or hemorrhage and require immediate assistance. The client needs further assessment and intervention. The final stages of labor may include uterine contractions, the delivery of the placenta, and the discharge of lochia as the uterus heals. These are normal and not an emergency.

The parents of a 13-year-old boy with a sore throat for a week, vomiting for two days, swollen lymph glands, and stiff achy joints is now seeking antibiotic treatment after herbal remedies were unsuccessful. Throat cultures reveal infection with group A streptococci. This child is at high risk for development of which cardiac complication? Myocarditis Mitral valve stenosis Infective endocarditis Vasculitis

Mitral valve stenosis Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune response-rheumatic fever that will damage his heart valves, ultimately causing mitral valve stenosis. Group A streptococcal infection is not known to predispose to myocarditis, endocarditis, or vasculitis and aneurysm of coronary arteries.

A client arrives via ambulance with a suspected pelvic fracture from a motor vehicle collision. The client's vital signs are: blood pressure 85/50 mm Hg, heart rate 120 beats/min, respiratory rate 22 breaths/min, and an oxygen saturation of 98% on room air. The client is afebrile. The health care provider has written several prescriptions. What is the nurse's priority action? Obtain STAT hemoglobin and group and match. Draw blood cultures and white blood cell count. Administer 5 mg morphine intravenously. Send client to diagnostic imaging for pelvic x-ray.

Obtain STAT hemoglobin and group and match. The client is hypotensive, tachycardic, and tachypneic. These signs in a client with pelvic fracture could indicate internal blood loss and impending hypovolemic shock. The nurse's priority out of the options listed is to determine if acute blood loss is occurring by examining a hemoglobin level and having blood matching done in anticipation of the need for transfusion. The client should not get the intravenous morphine until the blood pressure is stabilized, and a bolus of normal saline should be started while awaiting other test results. While the risk of infection if this is an open pelvic fracture is high, blood culture and white blood cell count is not actually diagnostic of sepsis. The initial treatment for sepsis will focus on correcting hypovolemic shock as well. The difference will be the addition of antibiotics rather than blood products to treat the underlying cause. In either case, the nurse's priority is still administration of a bolus of IV fluids. The nurse must stabilize the client prior to sending for an x-ray.

The nurse is caring for a 6-year-old with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? Place the child in a knee-to-chest position. Use a calm, comforting approach. Provide supplemental oxygen. Administer propranolol (0.1 mg/kg IV).

Place the child in a knee-to-chest position The priority nursing action is to place the infant or child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as ordered. A calm, comforting approach should be used but is not the priority action. Once a child is placed in the knee-to-chest position, supplemental oxygen would be provided as ordered. Once a child is placed in the knee-to-chest position, medications would be given as ordered.

The nurse is caring for a client who is developing hypovolemic shock from a duodenal ulcer bleed. What is the first intervention the nurse can provide to facilitate blood flow to the brain? Prepare the client for an endoscopy. Administer a crystalloid solution. Place the client in a modified Trendelenburg position. Test the client for blood in the stool.

Place the client in a modified Trendelenburg position. The first action by the nurse would be to place the client in a modified Trendelenburg position to facilitate blood flow to the brain. Administering a crystalloid solution and testing the client for blood in the stool may be later action but is not relevant in facilitating blood flow to the brain. Preparing the client for an endoscopy would be important after the physician obtains the informed consent but would not facilitate blood flow to the brain.

A nurse is caring for a client with a new diagnosis of rheumatic fever. What is the highest priority goal of treatment during the acute phase? Prevent cardiac complications Reduce inflammation Eliminate the infection Promote nutrition

Prevent cardiac complications Rheumatic fever poses great risk to the client for long-term heart disease. Interventions to prevent cardiac complications include anti-inflammatories and antibiotics. Adequate nutrition is appropriate for healing but is not the highest priority goal.

A child has been admitted to the inpatient unit to rule out acute Kawasaki disease. A series of laboratory tests have been ordered. Which findings are consistent with this disease? Select all that apply. Reduced hemoglobin levels Reduced white blood cell count Elevated erythrocyte sedimentation rate (ESR) Negative C reactive protein levels Reduced platelet levels

Reduced hemoglobin levels Elevated erythrocyte sedimentation rate (ESR) Kawasaki disease is an acute systemic vasculitis occurring mostly in children 6 months to 5 years of age. It is the leading cause of acquired heart disease among children. The CBC count may reveal mild to moderate anemia, an elevated white blood cell count during the acute phase, and significant thrombocytosis (elevated platelet count [500,000 to 1 million]) in the later phase. The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level are elevated.

A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? Croup Rheumatic fever Severe staphylococcal infection Medullary sponge kidney

Rheumatic fever Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures.

A teenager is seen in the emergency room with reports of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen 3 weeks before in the clinic and treated with antibiotics for strep throat. He was better for a few days but now he seems to have gotten worse in the last 2 days. What should the nurse suspect is wrong with this client? Flu Meningitis Rheumatic fever Mononucleosis

Rheumatic fever Rheumatic fever is an immune-mediated inflammatory disease that occurs a few weeks after a group A strep (sore throat). It can manifest as an acute, recurrent, or chronic disorder.

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? Serum sodium level Erythrocyte sedimentation rate Serum potassium level Oxygen saturation level

Serum sodium level Children receiving diuretics should have serum potassium levels obtained because diuretics tend to deplete the body of potassium. This is even more important if the child is also receiving digoxin because low serum potassium levels potentiate or increase the effect of the drug. Serum sodium levels may be obtained in children with heart failure to ensure that an increased sodium level is not causing edema. The erythrocyte sedimentation rate identifies inflammation and is unrelated to the use of diuretics and digoxin. Oxygen saturation levels may be done to evaluate for hypoxemia, but these results would be unrelated to the use of digoxin and diuretics.

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? Your child may need multiple surgeries to correct this defect. An IV for fluids will be started immediately. This is caused by an opening that usually closes by 1 week of age. This type of defect is caused by having a genetic predisposition for it.

This is caused by an opening that usually closes by 1 week of age. A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants.

A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation? This is due to the lack of oxygen to the brain. This is due to a decreased amount of oxygen to the peripheral tissue. This is a sign of heart failure. This is considered a medical emergency and the infant needs immediate surgery.

This is due to a decreased amount of oxygen to the peripheral tissue. Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and, in general, does not usually need immediate surgery nor is it a sign of heart failure.

Parents are told that their infant has a heart defect with a left-to-right shunt. What is the best way for the nurse to explain this type of shunting to the parents? This type of shunting causes an increase of blood to the lungs. This type of shunting causes an increase of blood to the systemic circulation. This type of shunting causes a decrease of blood to the lungs. This type of shunting causes a decrease of blood to the brain.

This type of shunting causes an increase of blood to the lungs. This type of shunting causes an increase of blood to the lungs. A right-to-left shunt causes an increase in blood to the systemic circulation that is mixed with deoxygenated blood.

Which assessment finding would be suggestive of adequate tissue perfusion in a client who has experienced a postpartum hemorrhage? Cool, clammy skin Capillary refill of 4 seconds Urinary output of 60 cc's over the last hour Oxygen saturation of 94%

Urinary output of 60 cc's over the last hour A client who is well perfused will have a urinary output of at least 30 mL/hr. If a client is not well perfused and experiencing a fluid deficit, the skin will be cool and clammy, not warm and dry. The capillary refill of a well-perfused client is 3 seconds or less and the oxygen saturation should be at least 95%.

The nurse in a rural nursing outpost will be receiving a client in hypovolemic shock due to a massive postpartum hemorrhage after her home birth. What principle should guide the nurse's administration of intravenous fluid? 5% albumin is preferred because it is inexpensive and is always readily available Dextran should be given because it increases intravascular volume and counteracts coagulopathy Whatever fluid is most readily available in the clinic should be given, due to the nature of the emergency Lactated Ringer's solution is ideal because it increases volume, buffers acidosis, and is the best choice for clients with liver failure

Whatever fluid is most readily available in the clinic should be given, due to the nature of the emergency The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to maximize intravascular volume. Both crystalloids and colloids can be administered to restore intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore intravascular volume. Albumin is very expensive and is a blood product so it is not always readily available for use. Dextran does increase intravascular volume, but it increases the risk for coagulopathy. Lactated Ringer's is a good solution choice because it increases volume and buffers acidosis, but it should not be used in clients with liver failure because the liver is unable to covert lactate to bicarbonate. This client does not have liver disease.

A 10-year-old child is admitted to the hospital with a temperature of 104°F (40°C) and is difficult to arouse. The child has history of Varicella two weeks ago. Reye's syndrome is suspected. Which objective data is supportive of the diagnosis? Select all that apply. dysuria an abnormal liver biopsy vomiting client states, "I have a headache." coma disorientation

an abnormal liver biopsy vomiting coma disorientation Reye's syndrome is an acute multisystem disorder that causes encephalopathy and predominately affects school-age children. Symptoms develop within a few days to weeks after a viral infection (Varicella), beginning with vomiting, sleepiness, and liver dysfunction. About 24 to 48 hours after onset of symptoms, the child's condition rapidly deteriorates, causing disorientation, hallucinations, and sometimes a coma with decorticate posturing. The coma may progress to a deepened coma with decerebrate posturing and, eventually, flaccid paralysis. The majority of children who survive the acute stage of illness completely recover. A client statement is subjective data.

Seven hours ago, a multigravida woman gave birth to a male infant weighing 4,133 g. She has voided once and calls for a nurse to check because she states that she feels "really wet" now. Upon examination, her perineal pad is saturated. The immediate nursing action is to: inspect the perineum for lacerations. increase the flow of an IV. assess and massage the fundus. call the primary care provider or the nurse-midwife.

assess and massage the fundus this woman is a multigravida who gave birth to a large baby and is at risk for hemorrhage. The other actions are to be done after the initial fundal massage.

Which factor puts a client on her first postpartum day at risk for hemorrhage? hemoglobin level of 12 g/dl uterine atony thrombophlebitis moderate amount of lochia rubra

uterine atony Loss of uterine tone places a client at higher risk for hemorrhage. Thrombophlebitis does not increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.