peds final

typhlitis

neutropenia enteroclitis, translocation of gut bacteria. Stomach pain- stupid nurses don't take it seriously then patients die. CT right away

The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate?

"This condition usually resolves spontaneously with no symptoms."

normal life of RBC

120 days, sickle cells have a shorter life

Treatment of tinea capitis

oral griseofulvin, may use selenium sulfide shampoo to decrease contagiousness.

medication for sickle cell common

hydroxyurea- helps to rebuild RBC and stimulates production of FHgb

When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply.

Abdominal mass Intermittent hematuria

common treatments for cancer (highlighted from slide)

Biopsy, leukapheresis, blood product transfusion, chemotherapy, hematopoietic stem cell transplant, biologic (monoclonal, chimeric — CART-cells). NOT highlighted on slide is surgery, radiation, clinical trial, PICC or PORT

A group of nursing students are reviewing the variations in the genitourinary system in children as compared with adults. The students demonstrate understanding of this information when they state:

Bladder capacity reaches adult capacity by age 1 year.

diagnostics for cancer

CBC with diff, AFP, CT, X-ray, MRI, bone scan, PET, MIBG (neuroblastoma and soft tissue malignancies), ultrasound, bone marrow aspiration, LP

Methotrexate

Crystallize and get trapped in kidneys, damage to kidneys. Give bicarbonate with fluid and dipstick every urine 7-9PH. Give leucovorin*** to clear and protect renal tubules.

The nurse is reviewing the health history of a client suspected of having vesicoureteral reflux. What findings in the health history are consistent with this disorder? Select all that apply.

Flank pain Urinary frequency History or repeated urinary tract infections. Hematuria

chemo med to stimulate bone marrow to produce more WBC (past nadir)

G-CSF (neupogen/neulasta) for WBC

Different phases meds can kill cancer cells

G0, G1, S phase, G2

The nurse is caring for a child diagnosed with acute post-streptococcal glomerulonephritis. When assessing the child, what findings does the nurse anticipate? Select all that apply.

Generalized edema Headache Weight gain

What immunization is given to reduce the effects of epiglottitis?

Hib vaccine

The parents of an 8-year-old child with nocturnal enuresis bring the child to the clinic for a follow-up. History reveals that the parents have tried numerous behavioral and motivational therapies without success. The nurse anticipates medication therapy. Which agents would the nurse identify as being used? Select all that apply.

Imipramine Desmopressin Oxybutynin

Priority nursing interventions for a child with meningitis

Isolation precautions and abx

medication to keep open and close PDA

Keep open with alprostadil (prostaglandins) , close with indomethacin (specific NSAID)

Cisplatin

Metal, weight post and pre administration. Give diuretic before admin to clear med from system, pt is on strict fluid replacement.

The nurse is triaging clients as they come in to an express care facility. Which assessment finding is clinically significant for early nephrotic syndrome?

Periorbital edema

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Risk for infection

tumor lysis syndrome electrolyte imbalances and consequences

hyperphosphatemia, hyperkalemia. calcium phosphate imbalance leading to ARF, hyperuricemia causes uric acid crystals in renal tubules, hyperkalemia causes arrhythmia, all leads to neuromuscular irritability.

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion?

Sudden onset of severe scrotal pain with significant hemorrhagic swelling

The nurse is assessing a hospitalized child diagnosed with nephrotic syndrome. What assessment(s) is most important for the nurse to complete to help identify hypoalbuminemia in this child?

The heart rate and blood pressure

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?

Testis cannot be "milked" down inguinal canal

Disorders with decreased pulmonary blood flow

Tetralogy of Fallot Tricuspid atresia

The nurse is educating the parents of an infant after a circumcision. The parents demonstrate understanding when they state that they need to report what to the physician?

The infant does not urinate within 6 to 8 hours

Digoxin beneficial effects r/t edema

improves contractility and increasing cardiac output therefore second hand benefit of decreasing edema.

cancer, what do we want to prevent

infection anemia hemorrhage

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching?

The parent indicates the child is fussy, but calms down when held on the parent's hip.

sickle cell complications

infections, stroke, URI, leg ulcers Splenomegaly

The nurse is reviewing the blood urea nitrogen (BUN) results of an assigned client. The test is elevated. What factors may be associated with this result? Select all that apply.

The child may be dehydrated. The child's diet contains high levels of protein. There may be an infectious process in the child.

what to monitor in reye syndrome

liver enzymes, ammonia levels, ICP

While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication?

Uremia

Disorders with increased pulmonary flow

Ventricular septal defects, Atrial defects, atrioventricular canal (pulmonary artery banding), patent ductus arteriosis.

Vincristine and vinplastine

Vincristine, causes peripheral neuropathy and costipation. NEVER give intrathecal** pharmacy can only give to physician. Strict, doctors bring to the bathroom with them

The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding?

White cottage cheese-like discharge

tumor lysis syndrome- what is it, process

lymphoma or leukemia is common. Excess production of immature white blood cell causing excess cell death —> intracellular content free floating causes electrolyte imbalances.

mercaptopurine

maintenance phase of chemo, people get casual and lazy and cancer comes back. take at home after discharge, compliance is key

Sickle cell patients high risk for what

major is stroke (ischemic), splenomegaly, blindness, hepatomegaly, priapism (painful erection in boys), avascular necrosis of the hip

number one brain tumor in children

medulla blastoma

Leukemia

abnormal uncontrolled proliferation of WBCs. Rapid production of immature WBC (blasts)

Most common leukemia in children

acute lymphocytic leukemia

symptoms of leukemia

anemia, neutropenia, thrombocytopenia

leading cause of death by disease in children

cancer (2nd overall cause of death in children)

An early subtle sign of hypoxia

change in LOC

biggest difference between child and adult cancer

child cancer mostly embryonal, rarely any prevention. Also mostly tissues (blood, lymph, brain,bone, kidney, muscle) rather than adult cancer mostly organ (breast, lung, prostate, bowel, etc.)

oncology emergencies

highlighted- sepsis, tumor lysis syndrome, typhlitis** others not highlighted- superior vena cava syndrome, spinal cord compression, hyperleukocytosis, increased ICP, massive hepatomegaly (resp distress, coagulopathy)

Cyclophosphamide, ifosfamide

damage to bladder and kidney. urine dipstick every void, always give Mesna ON TIME with this med. Prevent hemorrhagic cystitis, mesna protects the bladder.

S/S of kawasaki disease

petechiae, high fever (5 or more days), strawberry tongue, skin rash, erythematous, desquamation (especially fingers and toes), red swollen hands and feet, **CERVICAL LYMPHADENOPATHY (know the cervical chains)**, joints tenderness.

vaccinations to help prevent meningitis

pneumococcal, Hib, meningococcal

Three processes in HUS

thrombocytopenia, hemolytic anemia, acute renal failure.

Tetrology of Fallow (TOF) consists of

ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta

Absolute Neutrophil Count (ANC)

wbc x total neutrophil x 10 total neutrophil is segmented neutrophil % plus the segmented bands %

parents and nurse consideration for chemo kids

wear chemo gloves to care for diapers and stuff, don't touch meds, dispose in chemo bin, chemo spill kit in the room

nadir

when the drug starts to wipe out the bone marrow, it's the lowest point of immunity (like 5 days after med administration for example) tell pt to avoid crowds and stuff 5 days from now. pt often readmit for sepsis r/t nadir

Doxorubicin and daynomycin

antitumor antibiotic, cardiomyopathy side effect. can cause pt to go into HF later on. pt should be on cardiac monitor and should be on dexrazoxane (zinecard) to protect heart

three types of stem cell transplant

autologous (self, likely for relapse), allogenic (can have GVH disease), HLA match

most common cause of sickle cell crisis in children

dehydration, anything that may cause dehydration in children

medications for von willebrand

desmopressin, stimate(IM), IV of vWF

chemo drugs most likely to attack

bone marrow, digestive tract, reproductive system, hair follicles

ANC level for someone to be eligible for chemotherapy

750, or over 500 for someone who's already started chemo

L-asparaginase

enzymes from e. coli, can cause anaphylactic crisis. keep emergency drugs at bedside and emergency supplies at proximity

tumor lysis syndrome considerations and treatment

give amphogel and allopurinol, no fluids with K, requires hydration, keep urine PH 7.0-7.5 with admin of bicarb. Treat with rasburicase** converts uric acid to soluble compound

treatment of sickle cell

hydration, oxygenation, pain relief**** others are antibiotics, hydration

GVHD (graft versus host disease)

occurs 10 days to several months after transplantation, usually affect the liver, GI tract, skin

brain tumor that's advanced by the time it's found

neuroblastoma