Peds EAQ (Infant)

What statement by the mother of a 6-week-old girl leads the nurse to assess the infant for the presence of a skeletal abnormality?

"It's hard to put the diaper between her legs. Difficulty with abduction may indicate developmental dysplasia of the hip. Flexion of extremities is a young infant's typical position when sleeping. Flat feet and failure to straighten the legs are both expected findings in a young infant.

A nurse is preparing for a teaching session with the parents of an infant with phenylketonuria (PKU). The parents are upset and want an explanation of why the child has this disease that they have never heard of. What should the nurse consider before responding?

This autosomal recessive disorder was inherited from parents who are carriers PKU is an inherited metabolic disorder; the parents do not have the disorder (autosomal recessive) because two copies of the gene (one from each parent) are necessary for expression of the disorder. PKU is not contracted during birth or as an infection; it is inherited. The origin, pathophysiology, treatment, and outcomes are known.

A home care nurse is visiting a family for the first time. The family's 4-week-old infant underwent surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

tell me about your daily routine Asking the client to describe her daily routine makes it possible to collect more data. Telling the client that she looks tired and asking whether everything is all right implies that things are not well and that the mother may be to blame. Asking when the baby last had a bottle may make the mother feel guilty about not meeting her baby's needs. Saying that it looks like the mother and child are having a bad day is a negative comment that closes off communication.

A father calls the clinic because he wants information about how to care for his child's severe diaper rash. The nurse asks the father what he has been doing so far and determines that the father needs further teaching when he says what

I direct a heat lamp at the buttocks." Heat lamps are not used because of the potential for burns. Exposing the diaper area will promote drying and healing. Soap may irritate excoriated skin. Ointment protects the buttocks from the irritating contents of stool.

A nurse is teaching the parents of an infant with eczema about the foods that are most allergenic. What foods should the nurse instruct the parents to eliminate from the diet? Select all that apply.

Milk and eggs contain protein to which the eczematous child may be allergic. Peanuts are highly allergenic. Apples and bananas rarely cause an allergic reaction.

4-day-old infant is admitted to the pediatric unit with a cleft lip and palate. Surgery to repair the lip is scheduled for later in the week. Which assessment finding requires notification of the surgeon and will probably result in cancellation of the surgery?

Oral candidiasis (thrush) is a fungal infection of the mouth that can be acquired from the maternal vagina during the birth process. Surgery involving the mouth would be delayed until the infection has cleared. Hypotonia (diminished or flaccid muscle tone) is not a reason to postpone surgery. Because the infant would be anesthetized during surgery, hypotonia is expected. Facial paralysis (brachial plexus palsy) is a birth injury. The paralysis disappears in several days, but it can take as long as several months. Surgery need not be delayed. A cephalohematoma is a collection of blood between the skull bone and the periosteum that does not cross the suture line. It may contribute to an increased bilirubin level as it resolves, which can take several months. This is not a reason to delay surgery.

What is the priority nursing intervention for an infant with a myelomeningocele before surgical correction?

Preventing trauma to the sac A meningomyelocele is thinly covered and fragile. Trauma to the sac can damage functioning neural tissue; an intact sac eliminates a potential portal of entry for microorganisms. Although minimizing infection is extremely important, it is not the priority; care of the sac is even more important, because an intact sac bars entry by microorganisms. Although observation for paralysis is an important nursing measure, it is not the priority. The extent of a meningomyelocele will influence the child's ability to control bowel and bladder function, but control is not developed until the toddler and preschool years.

A newborn has just been admitted to the pediatric surgical unit from the birth hospital with a diagnosis of tracheoesophageal fistula. In what position should this child be maintained?

Semi-Fowler, to reduce the risk of chemical pneumonia Because of the connection between the lower esophagus and the trachea, this child is maintained in a semi- to high Fowler position to reduce the risk of acidic stomach contents entering the trachea and causing inflammation of the lung tissues. Vomiting may or may not occur with this type of defect, because the esophagus does connect to the stomach. The semi-Fowler position would be more effective than the prone position in reducing aspiration. The Trendelenburg position will increase the risk of pneumonia. The concern is the tracheoesophageal fistula, not the risk of sudden infant death syndrome.

An infant with a diagnosis of hydrocephalus has just had a ventriculoperitoneal shunt inserted. In what position should the nurse place the infant?

Supine on the unaffected side Placing the infant flat will prevent complications from too-rapid reduction of intracranial fluid; placing the infant on the unaffected side will prevent pressure on the shunt valve. Placing the infant on the affected side will put pressure on the shunt valve, which may cause it to become obstructed, interfering with the outflow of cerebrospinal fluid. Raising the head of the bed will allow a too-rapid reduction in cerebrospinal fluid, which may cause the cerebral cortex to pull away from the dura, resulting in a subdural hematoma. Placing the infant on the affected side will put pressure on the shunt valve. Elevating the head to 90 degrees will permit too rapid a reduction in cerebrospinal fluid.

After surgery for repair of a myelomeningocele, the nurse places the infant in a side-lying position with the head slightly elevated. What is the main reason the nurse places the infant in this position after this particular surgery?

To reduce intracranial pressure The side-lying position with the head slightly elevated promotes venous return by gravity, which helps reduce intracranial pressure, a problem after myelomeningocele repair. Although preventing aspiration, promoting respiration, and maintaining cleanliness of the suture line are all important, the reason for this position that is unique with this type of surgery is that it minimizes intracranial pressure

A nurse who is assigned to care for a 6-month-old infant with diarrhea is reviewing the infant's medical history, assessment findings, laboratory reports, and practitioner prescriptions. The infant weighs 15½ lb (7 kg). The healthcare provider has written a prescription for potassium chloride to be added to the IV fluids. What assessment finding signals the nurse to question this prescription?

Urinary output of 4 mL over 2 hours An infant weighing 15½ lb (7 kg) should have a minimum urine output of 1 mL/kg/hr, or 7 mL/hr. This infant's output is only 2 mL/hr. Decreased urine output will result in retention of potassium, causing hyperkalemia. Intractable crying is the expected response of an ill 6-month-old infant. Inadequate tissue turgor is an indication of dehydration, which is the reason for the IV infusion. There is no reason to question the prescription for the oral fluid intake amount because the IV infusion is supplementing the oral rehydration therapy.