Peds unit 2 (cardio,hematology,cancer, communicable diseases)

B

A nurse is caring for a two year old child who has a heart defect and is scheduled for cardiac catheterization. Which action should the nurse take? A place on NPO status for 12 hours prior to the procedure B check for iodine are shellfish allergies prior to the procedure C elevate the affected extremity following the procedure D limit fluid intake following the procedure

B

A nurse is caring for an infant whose screening test reveals a potential diagnosis of sickle cell disease. Which test should be performed to distinguish of the infant has the trait or the disease? A sickle solubility test B hemoglobin electrophoresis C complete blood count D transcranial Doppler

B

A nurse is preparing to administer iron dextran IM to school age child, who has iron deficiency anemia. Which action by the nurse is appropriate? A administer the dose in the deltoid muscle B use the Z track method when administering the dose C avoid injecting more than 2 mL with each dose D massage the injection site for one minute after administering the dose

A,C

A nurse is providing teaching about epistaxis to the parent of school age child. Which actions to be taken should the nurse include with managing an episode of epistaxis? Select all that apply. A press the nares together for at least 10 minutes B breathe through the nose until bleeding stops C pack cotton or tissue into the naris that is bleeding D apply warm cloth across the bridge of the nose E insert petroleum into the naris after the bleeding stops

Tetralogy of fallot TOF

A six month old who has episodes of cyanosis after crying could have the CHD of decreased pulmonary blood flow called

Left to right

A three month old has been diagnosed with a VSD. The flow of blood through the heart is...

Be sure to give the iron with juice You can give the iron with a straw Be sure to bring him back in one month to recheck his hemoglobin Iron can cause constipation Do not give the iron supplement with milk

A toddler has been diagnosed with iron deficiency anemia, and is to start iron supplementation. What is appropriate parental teaching

Initial WBC count The higher the number, the poorer the prognosis >100,000 = hyperleukocytosis Under 2 y/o and over 10 y/o have the poorest prognosis Girls do better than boys

ALL most significant indicator

Damaged heart muscle resulting in decrease in pumping ability Can be dilated, hypertrophic, or restrictive

Cardiomyopathy

Low amount in diet Malabsorption G.I. bleeding, menses, or injury Rapid growth

Causes of iron deficiency anemia

mumps

Causes swelling and tenderness Viral illness Droplet precautions Possible male infertility Headache, earache, and aggravated by chewing Gland inflammation involvement Affects parotid salivary glands Usually self-limiting , Has to run its course

Pallor and fever Lethargy Anorexia Weight Loss Hemorrhage, petechiae Hepatomegaly, splenomegaly

Clinical manifestations of leukemia

PDA

Indomethacin may be given to close which CHD in newborns?

Anorexia Petechiae Unsteady gait

Early manifestations of leukemia in a child

Continues through the treatment phase, it's maintained in the post-survival years, and/or there is support upon the patient's death, if the child dies

Education begins at diagnosis and

Ambulation and mobility Dressing and grooming Personal hygiene Bladder and bowel management(possibly retraining) Language and communication Eating Acquiring vocational skills Adaptive an assistive devices(such as a supportive seat for a child with cerebral palsy)

Focus of pediatric rehabilitation

Manifestations of infection Bleeding precautions Hand hygiene

Home care instructions to the parent of a child who is receiving chemotherapy should include information about

Limited fluid intake Promote energy conservation Positioning Give meds on time

How do we manage CHF?

28

How many days should be between vaccinations, unless given together?

Anergy

Immune system so deficient that it cannot mount a reaction to the TST

The longer we wait to intervene with congenital heart defects

Mortality and morbidity rates decrease

Ectoparasites (lice) Foodborne illnesses Upper respiratory infections Pharyngitis (strep)

Most prevalent infections in middle childhood

Thalassemia Major (Cooley's Anemia)

Most severe form Pallor Fatigue Weakness Poor feeding Failure to thrive Delayed growth and development

Carvedilol

My child with cardiomyopathy is prescribed a beta blocker. Which drug is the nurse teach the parents about? Carvedilol Flecainide Quinidine Verapamil

Dietary counseling Instructions on administration of supplement Stressing Importance of follow up labs studies Monitoring growth and development for appropriate milestones

Nursing responsibilities pertaining to children with iron deficiency anemia

Initial temp Doctor ordered Axillary temp below 96 twice

Only obtain temperature rectally when

Chronic hypoxia

Severe anemia leads to

Supraventricular tachycardia SVT

The most common cardiac dysrhythmia in the pediatric population is

Drug resistance

The most important reason healthcare providers prescribe a combination of antiretroviral drugs to children with HIV is to delay

A lipid profile

The mother of a toddler reports that the child's father has just had an MI. Because of this information to nurse recommend the child have.

Chronic hypoxia and iron overload

The nurse informs the parent of a child with beta thalassemia (Cooley anemia) is at risk for

The flowers from your garden are beautiful, but should not be placed in the room at this time

The nurse is caring for a 10 year old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. What should the nurse say?

Aplastic crisis Vaso-occlusive crisis

The nurse is taken care of a child with sickle cell disease. The nurse is aware that these problems are associated with sickle cell disease

It is an X-linked recessive disorder

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. What is the nurses best response

Do not palpate the abdomen

The parent of a four year old brings the child to the clinic and tells the nurse that the child's abdomen is distended After a complete examination, a diagnosis of Wilms tumor is suspected. What is most important when doing a physical examination of this child.

Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent

The parent of a teen diagnosed with Hodgkin disease ask what the child's prognosis will be with treatment. What should the nurse say?

The child can go to daycare without restrictions and should be allowed to participate in all activities

The parent of a two-year-old who is HIV+ questions the nurse about placing the child in daycare. What is the nurses best response

You are concerned about your child receiving immunizations. Let me explain why your child will not receive routine immunizations today.

The parents of a 12 month old with HIV are concerned about his receiving routine immunizations. what will the nurse tell them about immunizations?

Your babies defect is small, and will likely close on its own by one year of age

The parents of a three month old ask why their baby will not have an operation to correct a VSD. The nurses best response is...

Gain because of fluid and interstitial spaces Loss because of not eating or too much energy expenditure

Weight gain or loss because of heart failure

Depends on the anatomical site and extent of involvement

What are the clinical manifestations of non-Hodgkin lymphoma?

Stenosis

What is the narrowing of a valve called?

Foramen ovale

What serves as the septal opening between the Atria of the fetal heart?

Chemotherapy and radiation may be necessary for treatment Your child will need a bone marrow biopsy Your child we need surgery for resection of the tumor

What should the nurse tell the parent of a child who has neuroblastoma?

Your a baby can be immunized with the polio vaccine; he will not be contagious

What should the nurse's response be to a mother of a two month old who is going to get the polio immunization when the mother tells the nurse the older brother is immuno compromise?

Either pulmonary edema Or Peripheral edema with Ascites

When blood backs up the result will be

Aggressive chemotherapy with central nervous system prophylaxis will give a child a good prognosis

When caring for a child with lymphoma, the nurse needs to be aware that

Prepare the child for surgery

When caring for a toddler who has Wilms tumor, what action should the nurse take?

I understand you are afraid. Can we talk about your concerns?

The pregnant mother of a child diagnosed with fifth disease is crying and says "I'm afraid. Will my unborn baby die? I have a plan cesarean section next week ". What is a therapeutic response?

Foramen ovale ductus arteriosus

These bypass the lungs in fetal circulation

Rubeola Pertussis Varicella

These communicable diseases can lead to pneumonia

Dilated Hypertrophic Restrictive

Three types of cardiomyopathy

Metabolic Hematologic Space occupying lesions

Three types of oncologic emergencies

low platelet count

Thrombocytopenia

tetanus

Transmission via wounds in the skin Systemic manifestations: neck or jaw stiffness, facial spasms, prolonged muscle contraction Treatment: tetanus IG Respiratory monitoring and ventilation Nursing: wound care, monitor respiratory status, hydration

diptheria

Transmission: contact with nasal or eye discharge Systemic manifestations: fever, anorexia, rhinorrhea, cough, stridor Treatment: IV antibiotics, IV antitoxin Nursing: isolation, monitor for respiratory distress, administer antibiotics

Examine record (up-to-date?) Consult catch-up schedule of child is behind Make full use of opportunities to vaccinate -Minor illness or fever is not a contraindication to vaccination Ask about past reactions to vaccines, pregnancy, and allergy to vaccine components (allergy to Eggs, neomycin, gelatin)

Immunization assessment

Physical development Achieving developmental milestones Psychological development The earlier we intervene, the better the outcome

Impact of a chronic condition on a child/adolescent

The malignancy originates in the lymphoid system Mediastinal involvement is typical The disease is diffuse, rather than nodular Treatment includes chemotherapy and radiation

A nurse is caring for a 15-year-old. He's just been diagnosed with non-Hodgkin lymphoma. The following should be included in teaching the parents about this lymphoma.

Continuous cardiac monitoring

A nurse is caring for a child hospitalized with possible KD. What nursing action is most important for this child? Continuous cardiac monitoring Frequent blood pressures Total bed rest until corrected Treatment of hypertension

A,E

A nurse is caring for a child of a suspected of having rheumatic fever. Which findings should the nurse expect? Select all that apply A erythema marginatum B continuous joint pain of the digits C tender, subcutaneous nodules D decreased erythrocyte sedimentation rate E elevated C-reactive protein

A

A nurse is providing teaching about the management of epistaxis to an adolescent. Which position should the nurse instruct the adolescent to take when experiencing a nosebleed? A sit up and lean forward B sit up and tilt their head back C lie in a supine position D lie in a prone position

C

A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instruction should the nurse include? A do not offer your baby fluids after giving the medication B digoxin increases your baby's heart rate C give the correct dose of medication at regularly scheduled times D if your baby vomits a dose, you should repeat the dose to ensure that the correct amount is received

D

A nurse is providing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which statement by the parent indicates an understanding of the teaching? A I should take my child to the emergency department if his stools become dark B my child should avoid eating citrus fruits while taking the supplements C I should give the iron with milk to help prevent upset stomach D my child to take the supplement through a straw

Hand foot syndrome

A nurse is reviewing a chart on a child who has sickle cell disease and notes the diagnosis dactylitis. what does a nurse understand about this condition?

Moderately anemic

A nurse is reviewing the lab values for a toddler. The child's hemoglobin is 7.7 g/dL. How would the nurse characterize the child's results?

Heart transplant

A nurse is teaching parents of a child who has an atrial septal defect ASD about the possible treatment options. Which treatment option does the nurse not include in the teaching session? A heart transplant B spontaneous closure C surgical repair D use of a closure device

Enlarged liver

A nurse suspects an infant of having advanced heart failure. Which clinical manifestation of heart failure did the nurse assess to reach this conclusion? Enlarged liver Feeding problems Poor growth Sweating excessively

Treat the underlying conditions

A pediatric intensive care nurse is providing care to a patient with disseminated intravascular coagulation. Which treatment option is most appropriate for this patient?

HSP

A preschooler presents to the emergency department with the following signs and symptoms: bilateral leg purpura, eyelid edema, edema and arthralgia of the left knee, mild bloody diarrhea What is the most likely diagnosis?

Anemia

A reduction in the number of RBCs, the quantity of hemoglobin, and the volume of packed red cells to below-normal levels Can be caused by loss or destruction of existing RBCs, or by impaired or decreased rates of red cell production Can also be a clinical manifestation of an underlying disorder

Give your child whole milk instead of low fat milk

A student nurse is teaching the mother of an infant ways to prevent iron deficiency anemia. Which instruction causes the registered nurse to intervene and correct the teaching?

Enlarged, painless, and movable lymph nodes in the cervical area

A teen is seen in the clinic for possible diagnosis of Hodgkin disease. The nurse is aware that which symptom should make the healthcare provider suspect Hodgkin disease?

Supraventricular tachycardia SVT

A toddler who has been hospitalized for vomiting because of gastroenteritis, is sleeping and difficult to wake up. Assessment reveals vital signs of regular HR 220 bpm, RR of 30 per minute, BP of 84/72, and capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?

Provide local anesthetic Give child as much control as possible (do you want a sticker or a sucker after?) Be honest with a child (it does hurt) Provide sucrose drink and pacifier, if appropriate Use age-appropriate distraction techniques

Implementing strategies to minimize pain during administration of immunizations

The ventricles

In a normal heart of a pediatric patient, what is most responsible for the pumping work of the heart?

Lungs Liver

In fetal circulation, Oxygenated blood is diverted away from these

COA

In which CHD will with the nurse need to take upper and lower extremity BPs?

Retinoblastoma

Intraocular malignancy of the retina Treatment: almost always radiation , sometimes chemotherapy, but it's often ineffective Removal of the eye, if other treatments fail Examination is done under anesthesia using an ophthalmoscope It's evidenced by leukocoria (white pupillary reflex) On the Reese Ellsworth, group staging classification of retinoblastoma, the higher the stage, the less favorable the outcome

Hypoplastic Left Heart Syndrome

Left side of heart not developed Decreased systemic blood flow Treatment is staged surgery First at 24 hours Second at 3 to 6 months Third at a year Used to be a little defect, but children can survive this The first surgery is the most dangerous because they are so small

In the lungs

Left sided heart failure presents

Family -Spend as much time as desired with child -Prepare for possible bleeding of sites or urine/bowel evacuation -foot/handprints, lock of hair -Bathe the child -Clergy Siblings -May want to be present

After death care

No lifting No tub bath Site checks Bed rest 4-6 hours Neurovascular assessment Allergies V/S, O2 sat Comfort item (toy)

After pediatric cardiac catheterization

CMV (cytomegalovirus)

CMV (cytomegalovirus)

Depends on the child's age Infants and toddlers: limited understanding Preschooler: may believe they caused the illness School-age: improved understanding, they like to talk about it Adolescent: they like to talk with other adolescents

Cancer diagnosis: reaction of the child

-Disbelief, shock, denial, anger -Must gather resources, make treatment decisions because it is usually already a stage III or IV Diagnosis -Travel often required for treatment -Financial strain, potential job loss -Adaptation

Cancer diagnosis: reaction of the parents

Clinical assessment Laboratory and radiologic tests Biopsy of tissue or fluid for pathologic confirmation

Cancer evaluation process involves

rheumatic fever

Carditis caused by group A beta-hemolytic strep

Focus on the child developmental age versus chronological age Assist child/family to return to normal pattern of living Determine how child is/was Cared for at home prior to Promote child's maximum level of growth and development Assess family response to child illness Involve Family in care Encourage self-care

Care of a chronically ill child

Tissue/organ donation Autopsy Post Mortem care

Caring for terminally ill or dying child

rhematic fever

Caused by a group A beta-hemolytic strep Can develop cardiomyopathy if allowed to continue S/s : usually 20 days after a URI Diagnosis : JONES CRITERIA Major : carditis, polyarthritis, Chorea, SQ nodules, erythema marginatum Minor: polyarthralgia, fever, previous history Acute: elevated ESR, C-reactive, protein, leukocytosis, and prolonged PR interval(too long for conduction to move through the myocardium) Treatment : Inotropes, diuretics, vasodilators, steroids

Fecal oral Respiratory

Common transmission routes for communicable diseases in children

An illness passed by direct or indirect contact

Communicable disease

Bleeding Circulation Infection

Complications after cardiac catheterization

Privacy -Stop unnecessary testing -Encourage spending time Oral intake/care -Diminished intake is normal -Loss of ability to swallow days before death -Fluids may cause discomfort -Provide oral care -If thirsty, offer ice/water -Dry lips (use lip balm or petroleum jelly) -Include parents in providing care

Dying process

Hands ,foot,mouth disease

Fever vascular rash on buccal mucosa and tongue Papillar rash on the hands and feet, which can become vesicular Patho: spread by respiratory, droplets, fecal - oral, or from mother to infant during peripartal period Assess for group B coxsackievirus, active virus can cause serious disseminated disease in a newborn which can ultimately be fatal

Acetaminophen 10 to 15 mg/kg/dose every 4 to 6 hours not to exceed 5 doses in 24 hours (daily maximum for children 12 and older is 4 g) Ibuprofen 4 to 10 mg/kg/dose every 6 to 8 hours, not to exceed 40 mg/kg daily No ibuprofen for infants

Fever management OTC medications

Administer antipyretics Remove unnecessary clothing Monitor temperature (usually axillary) Encourage extra fluids (because of insensible fluid loss) (do not encourage milk or OJ because they can cause stomach upset)

Fever management treatment

Administer only one antipyretic at a time (acetaminophen and ibuprofen, can be alternated every 3 hours) Use correct dosage (infant medications are more concentrated than childrens medications) Use the correct administration intervals

Fever management, parent education

Immediate attention

Fever with neutropenia needs

Onset, sequence, and duration of current symptoms Whether culturally based remedies were tried first Pertinent information about each body system Child's past medical history Any history of previous malignancy Family medical history History of environmental exposures Social history Baseline physical and developmental milestones

Focused health history for a child with cancer

Improving the lives of children with disabilities by relearning previous skills and abilities and returning to the community

Goal of pediatric rehabilitation

Preserve the integrity of the oral cavity Promote oral comfort Promptly treat any oral problems that occur

Goals of oral care

Vasculitis — raised purpuric lesions — joint pain — colicky, abdominal pain — G.I. bleeding — renal involvement

HSP (Henoch-Schonlein Purpura)

Within 10 days of induction of chemo

Hair loss usually begins

Too much fluid, volume for the heart to handle Reasons for development : Increase in volume Pressure gradient Decreased contractility Increased cardiac demand

Heart failure

dilated cariomyopathy

Heart muscle is stretched out because blood is pooling, typically in one of the ventricles. The dilation of that chamber prevents the heart from squeezing properly.

Thalassemia intermedia

Hematologic abnormalities Hyperbilirubinemia Splenomegaly Hepatomegaly Delayed growth in sexual maturation Abnormal facial appearance

CMV EBV HSV-1 (fever blister) HSV-2 (genital) HHV7 VZV (chicken pops are shingles)

Herpes viruses

Respiratory tract infections (repeated or persistent) Otitis or sinusitis (repeated or persistent) Severe bacterial infections Opportunistic infections, such as candidiasis or thrush Poor response to appropriate therapy (immune compromised)

Highly indicative signs of HIV

Peripheral blood smear Lumbar puncture Bone marrow analysis

How to diagnose ALL

Increased R-L shunting

Hypercyanotic spell (TET spell)

Treated with: Exercise Diet Medication

Hypertension and hyperlipidemia

Polycythemia Blood clots CVA Developmental delays Brain damage

Hypoxic spells in the infant with the HD can cause

Autoimmune disorder Destruction of platelets after a viral illness 90% of pediatric resolved without treatment Followed by a pediatric hematologist

ITP idiopathic thrombocytopenia purpura

neutropenia

Low absolute blood cell count < 1000 in infants two weeks to one year of age Or <1500 in children, older than one year of age Severe ANC=<500 or 500-1000 when chemo is being administered

German Measles (Rubella)

Low-grade fever, malaise, tiredness Red pinpoint rash, starts on face spreads downward Rash last 3 to 5 days Isolate for 7 days after the onset Blueberry muffin baby due to purpura 50% develop muscle and joint pain Infection during pregnancy can cause, severe birth defects, miscarriages, and stillbirths

The third most common type of childhood cancer -Hodgkin lymphoma -Non-Hodgkin lymphoma

Lymphomas are the ...

Maalox, Viscous Xylocaine, & Benadryl Mixed together and painted in the mouth with a swab

Magic medicine for mucositis

Prostaglandin-keeps DA and FO open Indomethacin or ibuprofen -closes DA FO Digoxin - increases contractility/decreases workload (Inotropic) Slows HR to increase filling Furosemide/spironolactone -diuretics Spironolactone spares K Heparin/ASA -blood thinners prevent clots ACE inhibitors, beta blockers, and hydralazine decrease work load of the heart ACE drops blood pressure decreases work load Beta blockers slow and cause vasodilation Hydralazine cause vasodilation

Medications for heart failure

Direct: physical contact between a source of infection, and a new host Indirect: pathogens survive outside humans before causing infection

Modes of transmission

Currently no cure for pediatric HIV disease(may not die of it, but they will die with it) Disease prevention of great importance, immunization against common childhood illnesses is recommended Early recognition and improved medical care have changed HIV disease from a rapidly fatal to a chronic but terminal, disease of childhood Children, diagnosed with AIDS in early infancy are more likely to die at an earlier age Pain management is a serious concern for AIDS patients and pain is often under treated in pediatrics

Therapeutic management of HIV

Administer analgesics as needed for pain

This intervention should be implemented after a bone marrow aspiration?

Induction Consolidation Maintenance

Three phases of cancer treatment

C

Three week old infant, residing in a homeless shelter, has a mild cough, poor appetite, low-grade fever, weight loss, and fussiness over the past two weeks. Which nursing intervention would be the highest priority? A weigh the baby to have an accurate weight using standard precautions B reassure the mother that the baby may have a cold, which can last a few weeks C immediately initiate droplet, facemask precautions and isolate the infant D take a rectal temperature while completing the assessment using standard precautions

There is an increase in pulmonary blood flow as a result of the blood shunting from the left to the right ventricle

VSD

Vaccines introduce antigens into the body Antigens trigger immune response to a foreign substance Antibodies are made by the body in response to the antigen This is a 28 day process

Vaccines: basic concepts

Adenovirus infection Enterovirus infection Herpes virus infection HIV/AIDS Measles Mumps Parvovirus B19 infection Viral hepatitis

Viral infections

Neutrophils: phagocytosis Eosinophils: allergic reaction Basophils: inflammatory reaction Monocytes (macrophages): phagocytosis, antigen processing Lymphocytes: humoral immunity B cell,cellular immunity T cell

WBCs and their functions

Pediatric : brachial artery to access left heart and vein to access right heart in adults, the femoral artery and vein are used

What blood vessel is used for cardiac catheterization?

Ischemia Injury Dysrhythmias Conduction delay

What can ECG detect?

Blood backs up so the heart and vascular system can't handle the volume

What causes CHF?

Reed Sternberg cells in the lymph nodes

What confirm a diagnosis of Hodgkin disease in a 15-year-old?

All of them

What defects are associated with heart failure?

TEE TTE Echocardiogram Ultrasound Cardiac catheterization

What diagnostic tests evaluate congenital heart defects?

It Eliminates excess iron Hydration is necessary for the process to be effective

What information should the nurse provide to a parent of a child diagnosed with thalassemia major who is receiving the first chelation therapy

Increase fluid volume Increase in Cardiac demand Increase in cardiac pulmonary pressure decreasing myocardial contractility

What is CHF cause in children?

The initial white blood cell count on diagnosis

What is a prognostic factors for determining survival for a child newly diagnosed with ALL

To assess the central nervous system for infiltration

What is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia?

Narrowing of the aorta past the arch This defect may be fixed in the Cath Lab

What is coarctation of the aorta?

Have people wash their hands prior to contact with the child

What is the best method to prevent the spread of infection to an immuno suppressed child?

Control fluid and maintain oxygenation

What is the goal when diagnosed with CHF?

Morphine Behavioral techniques Acetaminophen with codeine

What is the most effective treatment for pain in a child with sickle cell crisis?

A hard raised knot

What is the presence of bleeding feel like under the skin?

Long-term low oxygenation results in polycythemia They cause an increased risk of thrombi and stroke

What is true about Cyanotic heart defects?

Risk for fluid volume deficit, because of possible n/v, and diarrhea

What nursing diagnosis is most important for a child with Ewing sarcoma who will be undergoing chemotherapy?

Provide the vaccine information sheet hand out and answer all questions

What nursing intervention should take place before all vaccination administrations?

Are you currently taking corticosteroid medication?

What question should the nurse ask when preparing to administer the varicella vaccine to an adolescent?

Intrathecal chemotherapy

What should be done to protect the central nervous system from the invasion of malignant cells in a child, newly diagnosed with leukemia

Sucrose solution on a pacifier

What should be provided for comfort when Administering immunizations to a four month old

Apical pulse rate

What should the nurse assess before administering digoxin?

Offer soft foods Use a soft, disposable toothbrush for oral care Encourage gargling with warm saline mouthwash

What should the nurse do for a child who has mucositis?

Restrain the infant during the procedure to prevent movement

What should the nurse do when preparing an infant for lumbar puncture?

Apply pressure to the nose for at least 10 minutes

What should you do for a child with von Willebrand disease who has a nose bleed?

PTT

What will be abnormal in a child with a diagnosis of hemophilia?

Would you mind if we discussed your concerns?

What would be a therapeutic response for a mother who tells the nurse she does not want her six month old infant to have a DTaP vaccine because the infant had a localized redness the last time she received the vaccine?

PDA

While assessing a newborn with respiratory distress, the nurse auscultates a machine like heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2 the nurse suspects that the newborn has.

Polycythemia

While looking through the chart of an infant with CHD of decreased pulmonary blood flow, the nurse would expect which laboratory finding?

A child of Mediterranean descent

Who is at greater risk for developing beta thalassemia

Immature immune system Limited prior exposure Poor hygiene behaviors Poor health and immunodeficiency Passively acquire antibodies from mother, so protection is limited and fades after birth Immunizations have not been received, so protection is incomplete

Why are children at risk for communicable diseases?

For Immunosuppression so the chemo will work Toslow cell division To help prevent allergic reaction To Decrease inflammation

Why are steroids used in cancer treatment?

Can protect children in your care Contains protection against tetanus, diphtheria and pertussis Single dose is recommended for adults and adolescents

Why do I need a Tdap immunization?

Hypoplastic Left Heart Syndrome

underdevelopment of the left side of the heart Decreased systemic blood flow Used to be a little defect, Critical/ life threatening 3 stage surgery - 24 hours -3-6 months -1 year Goal of surgery is to make them be able to live off their right ventricle First surgery is the most dangerous because they are so small If defect is detected in utero, they will be born at a specialty hospital

radiation therapy

use of ionizing radiation to break apart bonds within a cell causing cell damage and death External beam therapy accounts for the majority of treatments in children Used for local and regional control of cancer, often in combination with surgery and chemotherapy Problems: radiation beams cannot distinguish between malignant cells and healthy cells It Is harsh on the skin

The child needs to be taken to a physician when sick Emotional stress should be avoided Is important to keep the child well hydrated Is important to make sure the child gets adequate nutrition

what needs to be included in a teaching plan for a child with sickle cell disease

rhandomyosarcoma

Most common SOFT TISSUE TUMOR in children Especially common in children under 5 Locations: muscles around eyes; (produce swelling, ptosis, visual disturbances, and eye-movement abnormalities) In neck, and less commonly in abdomen (seem to be completely asymptomatic) how long GU tract; (urinary obstruction, hematuria, dysuria, vaginal discharge and protruding vaginal mass ) And extremities treatment: surgery when possible Widefield radiation Chemotherapy Has a rapid metastasis to lungs, bones, bone marrow and distant lymph nodes

Bleeding secondary to thrombocytopenia

Most common clinical presentation of aplastic anemia

Rocky mountain spotted fever Human monocytotropic Ehrlichiosis (HME) Lyme disease

Most common tickborne diseases

wilms tumor

Most common type of renal, tumor and children 6% of cancers in children younger than 15 years of age Most diagnosed by 5 y/o, with average age of diagnosis at 2 - 3 Approximately 500 new cases each year Children with hypospadias (urethral opening misplacement ) or cryptorchidism (undescended testicle) have a slightly higher incidence African-American females are at highest risk

consolidation phase

Most intensive phase Last 4 to 8 months Several drugs are used in combination to prevent remaining cells from developing resistance Drugs: methotrexate and 6-Mercaptopurine, vinchristine, and prednisone Intensive therapy is given to destroy remaining cancer cells

Sexually transmitted infections Mononucleosis

Most prevalent infections in adolescence

Upper respiratory infections Enteric infections Communicable diseases, transmitted by adults and other caregivers Soil borne diseases Foodborne illnesses

Most prevalent infections in early childhood

Upper respiratory infections Enteric infections Vaccine - preventable diseases Gastroenteritis Diseases, transmitted by fecal-oral route

Most prevalent infections in infancy

Below 150,000

My child is diagnosed with chronic immune thrombocytopenia. Which diagnostic platelet count supports this diagnosis?

hypertrophic cardiomyopathy

Myocardium has become second Affects squeezing and/or filling Treatment : Digoxin Activity restriction Control CHF Transplant -can't correct hypertrophy once it has occurred you can only treat the symptoms

Altered growth and development Risk for altered family process Anxiety/fear related to test, procedure Risk for injury Diversional activity deficit Impaired social interaction Body image disturbance

Nursing diagnosis for the chronically ill child

Imbalanced nutrition, less than body requirements, especially after starting chemo Risk for infection Risk for injury Activity intolerance Pain Disturbed sleep pattern Anxiety

Nursing diagnosis of child with cancer

Parent fully informed and consent to immunization Immunizations are appropriate for the child's age Parents are prepared to manage my reactions at home Advil can be given before and after for the first 24 hours

Nursing evaluation of immunizations

Be efficient, but support child Longer needle used to ensure IM administration Do not lie, the immunization will hurt Give injections in multiple extremities if needed, and document what went where Allow parent to comfort child

Nursing implementation for immunizations

Energy conservation -Quiet play -Small frequent feeding -Cluster care Positioning - Fowlers (at least 30°) Decrease work load -Allow 30 minutes for feeding then NG tube Watch for ⬆️ respiratory rate ⬆️ heart rate ⬇️ O2 sats nutritional support -Formula more concentrated with less water Control fluids -Ice chips or 1️⃣ popsicle to help control fluid volume

Nursing interventions for heart failure

Assess for infection Monitor blood values I&O, nutrition Complications of chemotherapy Meticulous washing Aseptic technique for blood draws

Nursing interventions for the child with leukemia

Advocate for Inform if possible side effects Provide written and verbal information Obtain consent

Nursing planning for immunizations

radiation and chemotherapy

Often curative, but can be palliative A tumor can be shrunk for comfort measures if it cannot be removed surgically

The fever increased the intensity of the murmur

On examination, a Nurse hears a murmur at the LSB in a child with diarrhea and fever. The parent asked why the healthcare provider never mentioned the murmur. The nurse explains.

Hyperleukocytosis Tumor lysis syndrome Septic shock DIC Typhlitis (bacterial infection in the cecum) Spinal cord compression SIADH Superior vena cava syndrome Anaphylaxis

Oncologic emergencies

Low-grade tumors are slow-growing, contain a few mitotic cells, and show no evidence of necrosis or vascular proliferation Although they are less malignant than high-grade tumors, their progress may go undetected for sometime, causing major damage to adjacent tissue High-grade tumors are rapidly growing, contain multiple mitotic cells, and show evidence of necrosis and endothelial and vascular proliferation

Pathophysiology of CNS tumors

Pinworm Infestations

Perianal itching with localized irritation Sleeplessness Hyperactivity Weight Loss Tooth grinding Abdominal pain Vomiting Rx: mebendazole Albendazole OTC: pyrantel pamoate Diagnosed by direct visualization of worms

Child's overall appearance Skin color Presence of ecchymoses or petechiae Nutritional status Asymmetry a facial features or extremities Lymph nodes (enlarged) Level of activity (decreased) Presence of pain, limping, or decreased range of motion (guarding) Complaint of headache

Physical assessment parameters for a child with cancer

Children do not fear death like adults do Children fear abandonment, and separation from their parents Usually aware of death Process even if they have not been told

Psychological issues with death

Truncus arteriosus

Pulmonary artery and aorta fail to split -critical/life-threatening -Increased pulmonary blood flow -Blood completely mixed — oxygenated and deoxygenated blood in systemic circulation Treatment = surgery

A narrowing of the pulmonary artery Not enough blood flow to the lungs The amount of narrowing affects the degree of signs and symptoms

Pulmonary stenosis

Total anomalous pulmonary venous return (TAPVR)

Pulmonary veins empty into right atrium Decreases systemic blood flow Critical/life-threatening Treatment:surgery

varicella

Rash begins a small red spots that develop into itchy fluid filled. Vesicles or blisters. Rash presents as vesicles on macules or dewdrops on rose petals Usually begins on the body, face, and scalp, then spreads to the arms, legs Very itchy Most infectious 12 to 14 hours before the rash appears Cannot return to school before all lesions are crusted over Airborne and contact precautions

Rubella (German Measles)

Rash starts on face Highly contagious viral illness Vaccination available 3 Cs: cough, coryza, conjunctivitis Airborne precautions Koplik spots in the mouth

Compression infiltration or obstruction caused by tumor (bone pain, abdominal pain, mediastinal mass) Changes in blood cell production, such as decreased, hemoglobin, hematocrit, white blood cell count or platelets Metabolic, electrolyte, hormonal, or immunologic alterations, caused by tumor, metabolism, or cell death (increased frequency of infections, hypercalcemia)

S/s of child cancers

Respiratory: cold-like symptoms, sore throat, herpangina, stomatitis, pneumonia Skin: rash Neurologic: aseptic meningitis, encephalitis Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain Eye: conjunctivitis Heart: myopericarditis

S/s of enteroviruses

Plasma factor activity

School-age child is diagnosed with hemarthrosis after tripping and falling. Which diagnostic testing is a priority for this child?

Encouraged them to wear a wig similar to their own hairstyle Help them find a special friend who understands what they are experiencing

School-age children with cancer often have a body image disturbance related to their hair loss, moon face, and their debilitation. what interventions are most appropriate

mucositis

Progressive, inflammatory, ulcerative condition of the oral and gastric mucosa due to the interruption of cell renewal process leading to Mocosal atrophy and ulceration Thrombocytopenia, or physical trauma, may lead to bleeding and further mucosal damage Neutropenia and poor dental hygiene, predispose the oral mucosa to secondary infection Orthodontics may need to be removed from the adolescent as a precaution Adequate hydration is essential to prevent drying and cracking Detailed dental history is needed Meticulous oral care, rinsing with water, no brushing

Left out forgotten, neglected Changes in day-to-day family routine (having to adapt to the ill child) Jealousy, resentment, anger Regression May fear becoming ill themselves Encourage them to visit Referre to child life therapy to lower anxiety and fear

Sibling response to the chronically ill child

Need validation that they suffered a loss as well Resolve issues of guilt/blame Same emotions as parents Unresolved grief into adulthood

Siblings of Terminally ill or dying child

Difficulty swallowing Cheyne stokes respirations

Signs of impending death

Habilitation

Similar to rehabilitation as it involves the same professional supervised services to the child and family The focuses on helping a child with acquired and developmental disabilities to learn new skills and first time abilities to achieve his or her maximum potential

Thalassemia minor/trait

Some asymptomatic abnormal hematologic findings

leukemia

The most common childhood, cancer, and accounts for approximately 1/3 of all cases diagnosed in children younger than 15 years of age Increased incident in those with chromosomal disorders, such as down syndrome High survival rate

The absolute neutrophil count is 400/mm3 and the child is neutropenic.

The nurse is caring for a child being treated for ALL laboratory results indicate that the child has a white blood cell count of 5000/mm3 with 5% polys and 3% bands. Which is an appropriate analysis.

Apply direct pressure 1 inch above the puncture site

The nurse is caring for a child who has undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurses first action is to...

Fever Oliguria Hypotension

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if a child has a hemolytic reaction to the blood, the signs and symptoms will include.

Provide adequate rest, because the child may experience excessive malaise and lack of energy

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. what intervention should be implemented?

Immunoglobulin G and aspirin

The nurse is caring for a child with KD. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is.

A soft toothbrush should be used for mouth care

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy the nurse notes that the child platelet count is 20,000/ mm3. based on this laboratory finding what information should the nurse provide to the child and parents

Anemia Infection Bleeding tendencies

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience the following complications

To prevent splenic sequestration

The nurse is caring for a child with sickle cell disease, who is scheduled to have a splenectomy. The nurse should tell the parents the reason for the splenectomy is

The procedure is done to prevent further sickling during a vaso-occlusive crisis

The nurse is caring for a child with sickle cell disease, who is scheduled to have an exchange transfusion. What information should the nurse teach the family?

CHF

The nurse is caring for a nine month old, who is born with a CHD. Assessment reveals HR 160, capillary refill 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of...

RF

The nurse is caring for an eight year old girl whose parents indicate she has developed spastic movements of extremities and trunk, facial grimace, and speech disturbances. They state It seems worse when she is anxious and does not occur while sleeping. The nurse questions to parents about which recent illness?

I will take a rectal temperature daily and report a temperature greater than 101°F immediately to the healthcare provider

The nurse is discharging a child.who has just received chemotherapy for neuroblastoma. If the parent says this, they need further teaching.

Pneumococcal and influenza vaccines are recommended Meningitis immunization can be administered on the regular schedule Hepatitis B vaccine is administered according to the immunization schedule Varicella vaccine is avoided in the child who is HIV infected, not in other family members.

The nurse is instructing the parent of a child with HIV about immunizations. What should the nurse tell the parent

Surgery is done usually within 48 hours of diagnosis Palpating the tumor could cause spread of the cancer Further treatment will start immediately after surgery

The nurse is teaching the parent of a child who has a Wilms tumor. She should say the following.

The child has had two varicella immunizations, but is no longer immune after chemotherapy You need to bring the child to the clinic for a varicella immunoglobulin vaccine

The nurse receives a call from a parent of a child with leukemia in remission. The parents as a child has been exposed to chickenpox and has never had it. What response is most appropriate for the nurse?

Intravenous immunoglobulin Prednisolone

The nurse should expect to administer this to a child with ITP in a platelet count of 5000/mm3

Avoid individuals who have colds Provide nutritional supplements Obtain yearly influenza vaccination

The nurse should teach the parent of a child who has HIV to

Administer factor per the home care protocol

The nurse should teach the parent of a child with hemophilia to do this first of the child sustains an injury to a joint causing bleeding.

The child will go to surgery for removal of the tumor & the kidney and will then start chemo therapy

The parent of a child diagnosed with Wilms tumor asked the nurse what the treatment plan will be. The nurse explains that the usual protocol for this condition is...

Vasculitis affecting all organs of the body

The parents of a child diagnosed with Kawasaki disease, asked the nurse to explain the disease and symptoms. Which response by the nurse is most appropriate? A bacterial infection after an invasive procedure B chronic viral infection of unknown origin C genetic defect, causing vessel abnormalities D vasculitis affecting all organs of the body

Check his stool for worms Perform the tape test tonight

The parents of an 18 month old bring him to the emergency department with the complaint that the toddler scratches his bottom. What should the nurse recommend?

Otitis media Laryngitis

The patient has a rubeola. What should the nurse monitor for?

Runny nose Mild fever Cough with whooping sound

The patient has pertussis. What should the nurse expect?

Beta thalassemia

The pediatric nurse is aware that which disease process is the most commonly inherited genetic disease worldwide?

giardiasis

Protozoal organism that lives in freshwater streams The cyst form is infectious The cyst must be ingested ranges from asymptomatic to severe LIFE-THREATENING DIARRHEA Acute watery, foul, smelling, diarrhea with abdominal pain, particularly if they have been hiking or camping May last a few days to years Treatment: 5 to 7 day course of metronidazole or a 3 day course of nitazoxanide

COA

The school nurse has been following a child who comes to the office frequently for vague complaints of dizziness and headache. Today she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding the nurse suspect she has.

CNS tumors

The second most common malignancy in childhood. In the United States, approximately 2500 to 3500 children younger than 20 years of age are newly diagnosed each year. Brain tumors all the rare during the first year of life, tend to occur,, most frequently and children younger than 10 years of age Approximately 74% of all children with CNS tumors demonstrate a five-year survival rate ( with the exception of the rapidly growing diffuse intrinsic Pontine glioma DIPG, which does not have a good survival rate)

Sarcomas, leukemias, and lymphomas

92% of childhood cancers

Tachycardia Tachypnea Pallor/cyanosis Grunting Nasal flaring Retractions

S/a heart failure (late)

Feeding formula that is supplemented with additional calories

Nursing action for most ideal nutrition in an infant with CHF is

The child bruises easily Excessive menstruation The child has frequent nose bleeds

A nurse is caring for a child with von Willebrand disease. The nurse is aware that the following is a clinical manifestation of von Willebrand disease.

Fatigue Weight loss or gain Diaphoresis Irritability Dyspnea/crackles/productive cough/respiratory infections Pallor/mottling Abdominal pain/distention Peripheral edema

S/s heart failure (early)

Repeated respiratory infections Intermittent diarrhea Poor weight gain

The following can lead to a possible diagnosis of HIV in a child

Meperidine (Demerol) 25 mg IV q4 hours PRN pain Restrict oral fluids Apply oxygen per nasal cannula to keep oxygen saturations above 94%

A nurse is caring for a five-year-old with sickle cell vaso-occlusive crisis. She should question the following orders.

Fanconi anemia

Café au lait spots and other pigmentation abnormalities Short stature Anomalies of the hands and forearms Microcephaly Other anomalies-Reno, broad, nasal base, small eyes and jaw, epicanthal folds Only left to their 30s

Bone marrow aspirate

A five-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The healthcare provider suspects that the child has ALL. The nurse informed the parents that the diagnosis will be confirmed by.

Hypoplastic left heart syndrome

A heart transplant may be indicated for a child with severe heart failure, and

PDA

A newborn is diagnosed with a CHD. The test results revealed that the lumen of the duct between the aorta and the pulmonary artery remains open. This defect is known as what?

Biopsy

Absolute confirmation of cancer can only be diagnosed with

Reduce joint inflammation

Aspirin has been ordered for the child with RF in order to:

Supportive therapy

Management of mild to moderate aplastic anemia

Machine-like murmur

S/S of patent ductus arteriosus

In the body

Right sided heart failure presents

Cyanotic events that worsen with crying and excitement

Tet spells

Boys and girls are affected equally often

When teaching the parents of a child diagnosed with von Willebrand's disease, which information is most appropriate for the nurse to provide?

Ankle and knee joint pain

s/s expected in a child with rheumatic fever

pancytopenia

deficiency of all types of blood cells

Children surviving one cancer are at a higher risk for a second cancer

A child has completed treatment for leukemia and comes to the clinic for a check up with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. What is the best response from the nurse?

Maintain strict handwashing

A child is admitted with neutropenia. Which nursing action takes priority?

Oral candidiasis Hepatomegaly Lymphadenopathy

A child who is mildly symptomatic with HIV may have

Kaposi sarcoma Wasting syndrome Pulmonary candidiasis

A child who is severely symptomatic with HIV may have

Spend time with them to answer any questions

A child with a new diagnosis of osteosarcoma may need the nurse to

Extremity should be immobilized Extremity should be elevated Factor VIII should be administered

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. What should be done to stop the bleeding?

Offer cool, clear liquids

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled anti-emetic. What should the nurse do when a child is nauseated

Immediate evaluation by a medical professional

A child's complaint of headache associated with n/v necessitates

KD

A child, who has red eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a strawberry tongue most likely has

Susceptibility to infection

A nurse expects which clinical manifestation in a child diagnosed with SCID

Overhydration

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. What factor would not cause a pain crisis

A,B,E

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? Select all that apply. A weak femoral pulses B cool skin of lower extremities C severe cyanosis D clubbing of the fingers E low blood pressure

Rheumatic fever

A 10 year old child is recovering from a severe sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on their fingers, and a rash on the chest. The likely cause is ?

Pulses

A 10 year old is undergoing a cardiac catheterization. At the end of the procedure, the nurse should first assess.

An IV infusion of factor VIII

A 10 year old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED the nurse should prepare what

CHD

A child born with down syndrome should be a evaluated for which associated cardiac manifestation

Hypokalemia

A child diagnosed with CHF is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 BPM. The nurse expect which laboratory finding?

It helps reduce uric acid level caused by cell destruction

A child diagnosed with leukemia is receiving allopurinol as part of the treatment plan. The parents ask while their child is receiving this medication. The nurse should provide the following information.

Left ventricular failure

A child has aortic stenosis. Which manifestation does the nurse assess for? Aortic aneurysm Left ventricular failure Right ventricular atrophy Tricuspid regurgitation

Parents and all siblings

A child has been diagnosed with long QT syndrome. The nurse counseled the family to have genetic testing. Which family members does the nurse encourage to be tested?

She will need to take antibiotics when she has such procedures for the rest of her life

A child has been diagnosed with valvular disease following RF. during patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents indicate they understand when they say.

B,C,E

A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? Select all that apply. A bradycardia B cool extremities C peripheral edema D increased urinary output E nasal flaring

Exposed in utero to an infected mother Those who received blood transfusion Adolescents who are infected because of sexual activity

3 populations primarily affected by HIV in pediatrics

CBC with differential Blood culture Urine culture Lumbar puncture Chest x-ray

5 test sepsis workup

Strokes, which result in neurodevelopmental delay, or cognitive impairment

5% to 10% of children with sickle cell disease will experience

physiological anemia

6-9 weeks after birth Resolves itself

roseola

6th disease Transmission: possibly respiratory secretions of healthy individuals Rash first develops on the neck and chest, and then spreads to the rest of the body Spots on rash turn white, if pressed (blanchable) Spots may have a lighter color ring around them Most common in kids, 3 to 5 years of age Febrile seizures due to high fever, otherwise mild to few issues High fever for three days, then fever drops, and they develop the rosy pink rash AKA 3 day measles (once the rash shows the disease is over)

From vaccination and actually having a disease

Acquired immunity

Cause left to right shunting

Acyanotic Defects

12 months

According to the American Academy of pediatrics, at which age should an infant, have their first blood draw to test for lead level?

The child does not need to be isolated from the other siblings

An 18 month old is discharged from the hospital after having a febrile seizure secondary to roseola. On discharge, the mother asked the nurse if her six year old twins will get sick. What is an accurate teaching about the transmission of roseola?

What does your child eat every day? How much milk does your child drink per day?

An 18 month old male client is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. These questions will assist the nurse in making a diagnosis.

Latex

An 18 month old with a myelomeningocele is undergoing a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies. In addition to concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?

Heart healthy diet Lifestyle modifications

An adolescent has been diagnosed with hyper lipidemia on a screening laboratory test. Which of the following with the nurse recommend to decrease is hyper lipidemia?

Transposition of the great arteries

Aorta comes off RV Pulmonary artery comes off LV

maintenance phase

As long as the cancer is still in remission, this therapy can be started Lasts up to three years ANC checked Drugs: vinchristine and steroids over a brief period every 4 to 8 weeks This is the Designated period during which treatment is continue to destroy any residual cancer cells.

Bone pain Periorbital ecchymoses Proptosis Weight loss

Assessing a child with neuroblastoma of the adrenal gland, what indicates metastasis from the primary site?

Measure temperature, heart, and respiratory rate Check laboratory values that denote systemic inflammatory response and sepsis Automatically Suspect any ill infant during the first 90 days of life Infant presenting with non-specific symptoms Perform the 5 tests for sepsis

Assessing for sepsis

The most common complaint in children older than two years of age associated with increased ICP is headache Any headache associated with vomiting or lethargy should be a valuated immediately by physician to rule out increased ICP The head pain may be more vague and nonspecific

Assessment for CNS tumors

Because most lymphomas are generalized at the time of diagnosis, most children are diagnosed with stage III or IV disease The most common sites of nodal involvement are intra-abdominal, mediastinal, peripheral nodal, and nasopharyngeal Intussusception (telescoping of the bowel) may be caused by lymphoma. As a rule, symptoms of intussusception in children older than 5 years of age are highly suspicious for NHL

Assessment for non-Hodgkin lymphoma

SYMPTOMS: General questions regarding the presenting symptoms of illness (fever, rash, enlarged lymph nodes, and cough) EXPOSURE: Information regarding the child, recent illness, daycare, or school, exposures, environmental, or animal, exposures, or recent travel VACCINES: Document immunization status in history of past infections SPECIFICS: Ask specific questions about the presenting illness COMPROMISED: Determine whether the child has an impaired host defense ACUTE OR CHRONIC: Check if infections resolve completely between episodes

Assessment parameters for infectious disease

Acute Chest Syndrome (ACS)

Associated with sickle cell disease Similar to pneumonia VOC or infection results in the sickling in the lungs Chest pain, fever, cough, tachypnea, wheezing, and hypoxia Repeated episodes may lead to pulmonary hypertension, which damages the lungs

Hold the child in the knee-chest position to decrease venous blood return

During a well- child check up for an infant with TOF, the child develops severe respiratory distress and becomes cyanotic. The nurses first action should be to.

Handicapped Compromised Impaired Technology dependent

Avoid using the following terminologies for chronic conditions

3 years

BP screenings to detect organ damage should be done routinely, beginning at what age

Low WBC count with infection

Babies and immune compromised people may have

Results from a bacterial infection Usually after dental cleaning or surgery More common in children with damaged heart valves, her heart disease Fever of unknown origin Malaise Fatigue Decreased appetite

Bacterial endocarditis

Mycobacterial infections (non-tuberculosis mycobacteria (NTM) and tuberculosis(TB) Pertussis Pneumococcal disease Staphylococcal disease Streptococcal disease - group A streptococcal infections (GAS) and Group B streptococcal infections (GBS)

Bacterial infections

Economic factors (expensive/not covered by insurance) Limited access to healthcare (rural) Lack of convenient primary care (working parents/kids in school) Parental knowledge deficit (don't understand benefits/have heard false information) Religious/cultural prohibitions

Barriers to immunization compliance

Family visit Comfort item (toy) V/S, O2 sat Void Allergies Neurovascular assessment

Before pediatric cardiac catheterization

Poor hygiene, leaking diapers(fecal-oral route) Poor handwashing (fecal-oral and contact route) Don't blow their nose often (nasal secretions) Daycare staff may not use proper handwashing techniques

Behaviors of children that contribute to disease transmission

75ml newborn 2650ml 80lb child 4500-5700ml adult (4.5-5.7L)

Blood volume

Defects with increased pulmonary blood flow Defects with decreased pulmonary blood flow Mixed defects Obstructive defects

CHDs are classified by which of the following?

Squatting

During play a toddler with a history of TOF might assume which position?

pertusis

Causes nasal discharge and fever Causes Wheezy breathing and occasional vomiting Symptoms commonly worse at night Droplet precautions Bacterial infection, use antibiotics Hallmark symptom is a long whooping sounding cough Transmission by respiratory droplets/direct contact with secretions Treated with antibiotics, steroids, and supportive care Infectious period 6weeks or longer Incubation period 7-10 days

Maybe localized or systemic May have rapid onset or a car longer after exposure , may lay dormant May mimic other diseases May manifest in different ways

Characteristics of infections

Least common form

Child has restrictive cardiomyopathy. What information given to the parents by the nurse is correct? A caused by toxic agents B least common form C most common form D often of familial disorder

Hereditary spherocytosis

Child's lab value shows red blood cells that are small, dense , and round with a hemoglobin value of 8.5 g/dL. Based on these laboratory findings which disease process does nurse suspect?

Immature immune system Limited prior exposure Poor hygiene behaviors Poor health in immunodeficiency increase risk Passively acquire antibodies from mother -Protection is limited -Protection face after birth Have not received immunizations, yet, so protection is incomplete

Children are at an increased risk for communicable disease, because

LBW infants Infants with certain congenital required defects Infants with respiratory distress syndrome Infants with maternal perinatal risk factors, such as maternal infection or prolonged ROM

Children at risk for sepsis

Characteristics : Long-term Limits ADLs May or may not be physically apparent Goals for the child: Achieve and maintain normalization (routine) Adapt environment (to fit their needs) Promote coping skills Obtain the highest level of health and function possible (early intervention on any deficit) Goals for the family : Remain intact Achieve and maintain normalization Maximus function throughout the illness Shared decision-making (sometimes a struggle between parents, if they are separated)

Chronic illness characteristics and goals

ALL acute lymphoblastic leukemia is the most common at 78% incidence but slightly over 85% will survive at least five years past their diagnosis AML acute myeloid leukemia, 15% to 20% incidence, but 60% of patients under 15 years old have a five-year survival rate CML has a 5% incidence CLL almost never affects children

Classifications of leukemia

Firm, nontender, painless mass in the abdomen Hematuria Hypertension (because it's affecting the kidney) DO NOT PALPATE THE ABDOMEN

Clinical manifestations of Wilms tumor

Non-specific symptoms Fever (most common) Fatigue Malaise Weakness Aches Decreased appetite Nausea/vomiting/diarrhea

Clinical manifestations of communicable diseases

Prostaglandin inhibitor (ibuprofen) Surgery Spontaneous

Closure of the ductus arteriosus

PDA ASD VSD

Congenital heart Disorders that increase pulmonary blood flow

Hypoplastic left heart Total anomalous pulmonary venous return Coarctation of the aorta

Congenital heart disorders that decrease systemic blood flow

History of anaphylactic reaction to the vaccine or one of its components Moderate to severe acute illness on the day of For specific vaccines, pregnancy or allergy to some components (example: allergy to eggs, no flu vaccine)

Contraindications to vaccine administration

Rapid, cellular growth and development

Contributing factor to childhood cancers

Beliefs about death Beliefs about post Mortem care Death of a child -emotionally charged Withdrawing or withholding treatment Parental treatment refusal DNR orders

Cultural considerations and ethical issues

cardiomyopathy

Damaged heart muscle resulting in decrease in pumping ability Usually secondary to another disease process

cardiomyopathy

Damaged heart muscle resulting in decreased pumping ability

Causes excessive destruction of platelets Children will have normal bone marrow Petechiae are common

Describe ITP

They suppress the function of normal lymphocytes in the immune system They interrupt the cell cycle, therefore causing cell death Prednisone is a natural hormone

Describe the action of chemotherapeutic agents used in the treatment of cancer in children

Cord blood in newborns Newborn screening done in all 50 states Genetic testing to identify carriers and children, who have disease Sickle turbidity test -Quick screening purposes and children older than six months

Diagnosis of sickle cell

-Core temperature > 101°F or < 96°F -tachycardia (two standard deviations above normal without external stimuli) -Bradycardia and children < 1 y/o (<10th percentile for age, not caused by external agents) -Mean respiratory rate more than two standard deviations above age norms -Leukocyte count: depressed, or elevated for age, > 10% immature, neutrophils -Infant WBC count maybe⬇️

Diagnostic criteria for sepsis

95% can be detected with CT scan MRI is the image of choice for a medically stable and cooperative child because of its safety and its ability to collect detailed information. It's particularly useful in diagnosing infiltrate of tumors of the brainstem. PET scan is also used to image the tumor and assess its level of activity A lumbar puncture is usually performed to obtain CSF for analysis with no signs of obstructive hydrocephalus or increased ICP are present. The fluid is tested for the presence of tumor cells, as well as for ⬇️ sugar, ⬆️ protein, and ⬆️enzymes.

Diagnostic tests for CNS tumors

X-ray CT scan MRI PET scan Ultrasound Bone marrow aspiration

Diagnostic tests for cancer

Each drug works in a different stage of cellular development or destruction

Different types of chemotherapy agents are used because

Monitoring patterns of disease occurrence

Disease surveillance by the CDC

Maintain contact with a Family after their loss Develop a professional support system Take time off work

Do you maintain professional effectiveness, a nurse, caring for dying children should

1. Pathophysiology, (in layman's terms, so they understand what is happening in the body ) prognosis, (usually good for leukemia, it's very treatable ) and signs and symptoms of the malignancy 2. Diagnostic testing methods and procedures (labs, scans, poking, and prodding, fear of the unknown is a major cause of noncompliance) 3. Disease-specific treatment, options and outcomes, treatment-induced side effects 4. Tumor and treatment related pain management (what will Pain be treated with, this is very important to the parents) 5. Infection prevention measures (meticulous, handwashing in neutropenic precautions, reverse isolation) 6. Management of treatment side effects 7. Nutritional needs and measures.(small frequent meals, let them choose.) 8. Care of devices.(such as CVCs) 9. Promotion of growth and development. (FaceTime, zoom, video, games, coloring books.) 10. Home management of medication's, medical equipment, and assistive devices.(02 tanks, breathing treatments.) 11. Needs of child and other family members.(keep sibling routines as normal as possible.) 12. Coping techniques. 13. Management of long-term sequelae related to the child's tumor in specific therapy regime

Educational topics for the child (and family) undergoing cancer treatment

Experiences separation anxiety Displays intense emotions Exhibit regressive behavior's

Effects of hospitalization on a toddler

Infection of the heart tissue S/s: fever UKO Malaise Fatigue Decreased appetite Diagnosis: echocardiogram TTE 1st then TEE Valves will look fuzzy, then eventually goes down into the ventricles Debris will be seen Treatment: Antibiotics or antifungal, or anti-microbial, depending on the cause

Endocarditis

Prevention of infection Adequate hydration Normal urine output Normal Blood values Adaptation to illness

Evaluation: Expected outcomes for a child with cancer

Infective endocarditis Rheumatic fever Cardiomyopathy KD

Examples of acquired heart disease

Magical thinking

Expected behavior of a preschool aged child is to relate fears to

Pain Lymph node enlargement Palpable mass

Expected symptoms of a child who has rhabdomyosarcoma of the upper arm

Chickenpox or influenza

Exposure to which illness should be a cause to discontinue therapy and substitute dipyridamole (persantine) in a child receiving aspirin therapy for KD?

I know she will be irritable for 2 months after her symptoms started

Family discharge teaching has been effective in the parent of a toddler diagnosed with KD states

Bowel sounds are absent

Following the removal of a Wilms tumor, the child should stay NPO if

Prostaglandin E

For a child with hypoplastic left heart syndrome, which drug maybe given to allow the PDA to remain open until surgery

Monitor for manifestations of bleeding Avoid peripheral venipunctures

For a child with thrombocytopenia, the nurse should

Hemosiderosis (iron in the tissues) -Treat with iron chelation therapy — parenterally-deferoxamine — oral-deferasirox or deferiprone — used alone or in combination — + vitamin C to promote iron Excretion

Frequent transfusion to treat sickle cell anemia can lead to

Skin lesions FTT Chronic diarrhea Thrush Hepatosplenomegaly Anemia, thrombocytopenia, neutropenia

Frequently present, somewhat Suggestive signs of HIV

STREP A

GAS Transmission: contact with respiratory secretions - direct contact Manifestations: pharyngeal(sore throat, fever) Skin manifestations : impetigo(honey, colored lesions) Treatment: antibiotics (penicillin for 10 days) Uncomplicated impetigo treated topically Nursing: usually careful at home with fever management, warm fluids(to soothe a sore throat)

Kawasaki disease

Generalized vasculitis: coronary artery abnormalities, leading to MI (damages vascular space, and coronary arteries develop aneurysms Predominantly Asian S/s Fever> 5 days & At least 4 of the following: Conjunctivitis Oral mucosal changes Extremity changes Erythematous rash (first occurs on hands and feet then spreads) Lymph node swelling Diagnosis: heart Cath,echocardiogram Treatment: ASA and IVIG Long-term aspirin, Plavix, heparin

Hodkin's Lymphoma

Generally fairly localized and can be treated as a solid tumor Assessment : Painless, progressive lymph node enlargement, with 2/3 of the cases involving a site above the diaphragm, and 1/3 of the cases involving a site below the diaphragm Cervical or supraclavicular lymphadenopathy, 60% to 90% Painless, firm nodes that are movable in surrounding tissue Hepatomegaly, splenomegaly, or both Anorexia Malaise Lethargy Drenching night sweats Fever of 100.4° or higher occurring for at least 3 consecutive days. It disseminates, and may involve any organ in the body, but particularly involves the spleen, liver, bone, lungs, and bone marrow Rare before the age of 10 5% happened between the ages of 10 and 15 and 15% between the ages of 15 and 19

chronic illness

Individuals are perceived as being sick, and not in a state of wellness, but they can recover Example: cancer

chronic condition

Individuals do not have an illness from which they can recover and should not be treated as such Example: cystic fibrosis

Rapid growth

Infants and adolescents may have iron deficiency anemia because of

Interrupt transmission (example: isolate the infected person) Eliminate the Reservoir or habitat (example: empty, standing water were mosquitoes breed to prevent WNV)

Infection control goals

LTBI

Infection in an asymptomatic person with a positive TST No clinical findings of disease Normal chest x-ray (TB carrier)

endocarditis

Infection of heart tissue

Anti-emetics (phenergan, and Thorazine) Granisetron and Zofran (>3 years) Anti-histamines : Benadryl

Interventions for n/v

Physical comfort -Pain management -Nonpharmacologic methods Decision making Emotional comfort -Support group referral -Presence of family at time of death Preparations for death Involve whole family (siblings)

Interventions for the dying child and their family

Adherence to medication regimen(it's expensive, hard to get and sometimes the caregivers are not responsible) Can requires primary in specialty care practices (a whole team) Family, beliefs and cultural influences must be included in care

Issues associated with HIV

Signs of bruising, bleeding, or infection Renal function (Wilms tumor, chemo) Mucosal sores in mouth Central nervous system infiltration -Decreased level of consciousness -Irritability -Vomiting -Lethargy -Headache

Nursing assessment of the child with cancer

Non-Hodgkin's Lymphoma

Malignant disorder of the lymphocytes that affects the sales in organs of the immune system Generally, there is rapid onset with wide spread disease noted at the time of diagnosis Peak incidence occurs at ages 7 to 11 years Incidence in boys is 3 to 4 times greater compared to girls Higher incidence has been noted in patients with HIV, EBV, and those with congenital immuno deficiency syndrome, such as Wiskott-Aldrich syndrome, Bloom syndrome, severe combined immunodeficiency syndrome Tumor burden: the number and size of tumor present determined by laboratory analysis of LDH, uric acid, and lactic acid. This is generally determined to be the most important prognostic factor at time of presentation

osteogenic sarcoma

Malignant tumor of bone 400 new cases each year Peak incidence yes, in the second decade of life, adolescents gaining vertical height rapidly Approximately 20% have metastases at diagnosis HIGH RATE OF METASTASIS TO LUNGS

Bone marrow transplant Immunosuppressive therapy or androgen therapy if no donor available Platelets PRBCs only if hemoglobin is dangerously low Preventive antibiotic therapy Meticulous handwashing (these patients are compromised) Prevention of infection and bleeding

Management of severe aplastic anemia

Ecchymoses Petechiae Purpura Bleeding from gums Possibly intracranial bleeding -Check LOC, Neuro(AAO), pupils, gait, motor responses

Manifestations of ITP

Pallor Fatigue Irritability Pica

Manifestations of iron deficiency anemia

Constipation Foot drop Jaw pain

Manifestations of neuropathy

Enlarged neck lymph nodes Pain Epistaxis

Manifestations of rhabdomyosarcoma of the nasopharynx include

military TB

Massive numbers of tubercle bacilli are released into the bloodstream and then disseminated to other organs CNS involvement Meningitis is a serious and often fatal complication seen almost exclusively in children younger than 4 years and

1. Provide children with choices in their daily care as much as possible.(medicine with apple juice or grape juice., or therapy, at 10 o'clock or 2 o'clock) 2. Establish a schedule of daily activities with the child and try to stick to it as best as you can. 3 if the child is hospitalized, ensure that the schedule provides opportunities for visits from school friends and activities with other hospital as children 4 if the child requires isolation, ensure that visitors and items are screened , so that activities and schoolwork can be brought to the child's room

Measures to promote growth and development

Aggressive treatment of infection Possibly prophylactic with oral penicillin from age 2 months to five years Pain medications for sickle cell crisis Hydration to prevent and treat pain crisis Blood transfusion(for anemia, to prevent stroke, to treat acute chest syndrome, splenic sequestration, and other emergencies) Folic acid (to help prevent severe anemia) Bone marrow transplant

Medical management of sickle cell disease

Mycobacterium Infections

NTM species are found everywhere in nature: soil, food, water, animals NTM may also be known as atypical mycobacterial infections or mycobacterium avium complex The most common presentation in children is cervical lymphadenitis that does not respond to typical antibiotic therapy An otherwise healthy child typically presents with cervical lymph nodes that are usually firm, mobile, and nontender. history shows that the lymph node continues to enlarge overtime and the overlying skin has turned a bluish purple color TB skin test can confirm diagnosis since NTM and TB be sure many of the same antigens, but NTM induration reaction is usually less than 10 mm Chest x-ray will rule out TB if the TST is reactive Treatment: excision of the infected lymph nodes is considered curative Drug therapy: involves 2 to 3 drugs over 6 to 12 month period (like TB) Children with HIV should receive antibiotic prophylaxis for NTM

coarctation of the aorta

Narrowing of the aorta pass the arch Decreases systemic blood flow Flushed face, Bounding hand pulses, feet will be cold and pale, blood pressure high up top, low below Treatment : surgery (balloon angioplasty) repair in the Cath Lab High blood pressure before the point of coarctation Low blood pressure beyond the point of coarctation Hypertension >=< hypotension

Erythema Infectiosum (Fifth Disease)

No cure Last around 14 days Commonly happens in children ages 4 to 12 Harmful during pregnancy Flu like symptoms due to infection with parvovirus B19 Lacy rash, not itchy Characteristic slapped red cheek appearance, then red spots appear on different parts of the body

Thalassemia minima

No hematologic abnormalities

Music therapy Hand holding Imagery, hypnosis, relaxation Diversion, rest and sleep Massage, heat Breathing exercises Biofeedback

Nonpharmacologic measures for pain

Be available to assist both child and family Avoiding posing personal beliefs and expectations Provide time and attention to the dying child Recognize the need to talk about illness and death Provide adequate pain control, oral care, privacy and information about signs of imminent death After death, allow family members as much time as they desire with the child

Nurses role in Caring for a dying child and family

Conduct ongoing assessment of the families ability to care for the child in the home (not everybody is capable of caring for a child with a chronic condition) Provide needed healthcare interventions Coordinate delivery of homecare services by other members of the team Collaborate with interdisciplinary treatment team members to ensure child's developmental support Establish a trusting relationship with the child by communicating honestly, and answering questions directly Provide age-appropriate explanations for daily routines and procedures Encourage the child verbalize fears and concerns regarding disease and treatment Advocate for the patient participating and drug trials or research studies Serve as an additional source of information and support for the family as needed

Nurses role in home care of the child with cancer

Feel sense of loss, grief Deeper loss the longer the nurse has cared for the child Feelings of helplessness Distance self from family Reluctant to form close connection with other children in unit Reaction may be more intense if nurse has own children

Nurses' response to death of a child

Risk for infection (if they don't get vaccines) Knowledge deficit Risk for injury Risk for impaired skin integrity (localized) Ineffective health maintenance (if they elect to not receive vaccines)

Nursing Diagnosis for immunizations

toxoplasmosis

Oocytes are the Highly infectious form Transmission by eating food contaminated with, or inhaling dust that contains oocytes from cat feces Causes fetal demise Usually asymptomatic Ocular toxoplasma infection can result from congenital or acquired infection. You can cause tissue necrosis in the retina, vitreotis, iridocyclitis, and Cataracts Untreated/undetected, congenital infections usually manufacturing adolescence is ocular disease(Chorioretinitis.) Treatment with pyrimethamine and sulfadiazine. They work synergistically and serve, along with leucovorin , as standard therapy. Infants with a congenital disease are treated for 12 months Teaching: Wash all fruits and vegetables Freeze all meats and cooked thoroughly before consuming Avoid steak tartar and other raw meat pates Do not allow pregnant women to empty cat litter boxes

Left to right

PDA causes what type of shunt

-Children still need discipline -Behavioral expectations should be the same as a healthy child within that developmental age

Parental response to developmental issues

Pale Tired Bruises easily Possibly petechiae

S/S of changes in blood cell production

Prevent infection Skin and mouth care Attention to Renal function (chemotherapy extremely toxic to the kidneys) Monitor IV site for extravasation even with a Central line Red blood cell, platelet administration Chemotherapy administration Psychosocial interventions (schoolwork, friends)

Planning an implementation for the child with cancer

It destroys abnormal lymphocytes

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan?

Ductus arteriosus Foramen ovale Ductus venosus

Pressure changes at birth cause the closure of

Handwashing Standard precautions Avoid exposure to infected individuals Promote immunizations Decrease/eliminate pathogens

Prevention of the spread of infectious disease

Systemic, inflammatory disease that occurs after group A beta hemolytic streptococcal infection Untreated, infection can cause, bacteria or fungi to travel to the lungs, brain, kidneys, or other organs, and even cause damage to the heart valves Abdominal pain, nosebleeds, chest pain with heart palpitations, and waking from sleep with the need to sit or stand will be revealed on assessment

Rheumatic, heart disease

Oral, subcutaneous, IM, IV, or intrathecal (spinal) IV push and IV piggyback are the most common.

Routes of chemotherapy administration

scarlet fever

Sore throat, flush face, pallor, moderate fever Allergy-like red rash, appears in the groin and armpits, then spreads to the neck, torso and beyond Red rash looks like a sunburn, and feels like sandpaper Keep calm, limit contact, monitor for secondary infections Rheumatic fever and carditis are complications Droplet precautions Has a strawberry like tongue and peeling skin caused by the strep bacterium Treat with antibiotics

lyme disease

Spirochete (infected when the tick draws blood) Malaise, headache, fever, joint aches Red BULLSEYE rash around bite Treatment: 14 to 28 days of antibiotics (doxycycline) Nursing: discuss prevention of tick bites and proper tick removal Treatment usually occurs at home Rest and completion of antibiotics

arboviral infections

Spread by mosquitoes, text, sandflies, and other biting arthropods Can cause CNS disease, fever with rash and headache, joint pain, and occasionally hemorrhagic fever with hepatitis Birds and small mammals are the primary Reservoir Humans and domestic animals are infected incidentally when an arthropod bites an infected animal, picks up the virus and then bites a person or pet. Person-to-person transmission does not occur except through blood, transfusions, interuterine transmission, and possibly through human breastmilk

After culture is collected, but before results are in

Start antibiotics

Administration of immunizations at healthcare visits, hospitalizations, and schools -Vaccines can be administered when children have a mild illness -Gift combinations of vaccines at the same visit Provide parents with information -VIS required for each vaccination -must document that it was given Legal issues -Informed consent must be obtained before immunization administration -A record of the administration should be given to the patient's parent (form 121)

Strategies for increasing the rate of immunization compliance

Managing pain, nausea, and vomiting (PCA pumps, anti-emetics before chemo & radiation therapy, then around the clock while being treated) Infection prevention (handwashing, reverse, isolation) Providing psychosocial support (for parents) Promoting growth and development (coloring books, video, games, quiet, play, and isolation room

Supportive care measures for children with cancer

Caused by an infection with Mycobacterium tuberculosis Spread person to person in respiratory droplets And children and adolescents most infections are asymptomatic (this type of infection is called LTBI : latent TB infection) history of exposure is often the most vital piece of information obtained Assess for non-specific symptoms such as fever, growth delay or weight loss, persistent cough, fatigue, and night sweats (rare in children) The first obvious sign after an asymptomatic, pulmonary infection, may be extrapulmonary (outside the lungs) -Most commonly cervical lymphadenitis, meningitis, bone infection, and military TB

TB

TST with a wheal of 6mm to 10 mm is crucial for accurate testing ( usual minimum 8mm)

TB diagnosis

Hypercyanotic episode (An acute severe cyanosis spell)

TET spell

Crying BM feeding

TET spell or hypercyanotic episode caused by

VSD Right ventricular hypertrophy PS Overriding aorta

TOF involves which defects?

4 defects Ventricular septal defect VSD Pulmonary stenosis Overriding aorta Secondary hypertrophy of the right ventricle, causing left or right shunting Hallmark sign is cyanosis with crying or playing, which can progress to fainting

Tetralogy of Fallot (TOF)

Frequent bacterial infections may occur due to immunocompromise

The #1 problem in people with sickle cell disease

Hypoplastic left heart syndrome

The Norwood procedure is used to correct

Obtaining immunizations

The best method to prevent a communicable disease is

Left to right

The blood flow through the heart with an ASD is

Leg pain Fever Bruising Enlarged lymph nodes

The following can be manifestation of leukemia in a child?

Pulmonary veins empty into right atrium

Total anomalous pulmonary venous return

rocky mountain spotted fever

Transmitted by infected text May be mild (malaise, fever) to severe(encephalitis, shock) Maculopapular rash (extremities, then trunk) Treatment: doxycycline Nursing: prevent tick bites , standard precautions, administer antibiotics, monitor for worsening symptoms

West Nile Virus (WNV)

Transmitted through the bite of an infected mosquito Also transmitted through blood transfusions and organ transplantation Intrauterine transmission and transmission in human breast. Milk have been described by such cases are Reyer and transmission in human breast milk has not been confirmed. Occurs in late spring, summer, and early fall Sudden onset of fever, headache, muscle ache, weakness Abdominal pain with nausea, vomiting, or diarrhea Some have a rash If CNS disease, present, with typical signs of meningitis are encephalitis Treatment is supportive Standard precautions recommended PREVENTION IS KEY

Aorta comes off, right ventricle and pulmonary artery comes off left ventricle -incompatible with life -Maintain FO and DA with prostaglandins -Surgery

Transposition of the great arteries

A cyanotic defect which presents within 24 hours of birth as an emergency Upper extremities have decreased O2 saturation compared with lower extremities Resulting in lack of oxygenated blood, circulating and perfusing the body and tissues Profound cyanosis with crying, tachypnea, and heart murmur may be present Signs of CHF are seen on assessment Surgical correction must be performed Prognosis is good with correction

Transposition of the great vessels

1 cc/kg/hour

Treatment for CHF in an infant began three days ago, and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 BPM, while the child sleeps. The nurse is confident that the child has diuresed successfully and has good Renal perfusion when the nurse notes that the child urine output is.

Administer NSAIDs for pain Monitor BP Monitor for renal involvement

Treatment for a four-year-old with HSP includes

Not all require treatment Steroids decrease the rate of platelet destruction Intravenous gammaglobulin slows destruction Treat infection if it is the cause of ITP Hormone therapy and teenage girls to stop menses Splenectomy if the spleen is the site of platelet destruction(more common with older children with chronic ITP)

Treatment of ITP

Surgery: Nephrectomy preventing rupture of the capsule and a Sample is sent to pathology for biopsy Chemotherapy and radiation are giving based on the stage of the disease Monitor output after surgery

Treatment of Wilms tumor

Limb salvage Amputation Chemotherapy

Treatment of osteogenic sarcoma

Requires emergency intervention No tricuspid valve, so no blood flow through the pulmonary artery to the lungs Requires prostaglandins

Tricuspid artresia

Exposure to a stressor (even good stress) Excessive sunlight Extreme cold Labor Loss of a job or a loved one Chemotherapy Other forms of immune suppression

Triggers for varicella reactivation

Autologous (self) Allogenic (donor)

Two types of stem cell transplantation

Knees to chest

Tx for TET spell or hypercyanotic episode

Astrocytomas account for 50% of all childhood brain tumors, however, some can be benign Medulloblastomas account for 20% of our childhood brain tumors and are the most common malignant CNS tumor (Other gliomas account for 15%, ependymomas account for 10%, and all others account for 3%) In children, 50% to 60% of brain tumors are infratentorial (located in the cerebellum, fourth ventricle, or brain stem) whereas in adults, they are primarily supratentorial (in the cerebrum) 75% or more of brain tumors in children occur in the midline (third and fourth ventricles, optic chiasm, and brain stem)

Types of CNS tumors

Bacteria: antibiotics Viruses: antivirals Fungus: antifungals Parasites: anti-parasitics

Types of infectious agents, and what they are treated with

Killed virus (inactivated, polio) Toxoid Live virus (measles, varicella) Recombinant form (DNA antigen stimulates the response into the bacteria or mammalian cell then it is purified) Conjugated form (weak antigen with strong antigen as a carrier)

Types of vaccines

weight loss, abdominal distention, and fatigue

Typical signs and symptoms of Wilms tumor

Upper left quadrant

Where is the pain from a splenic sequestra felt

Abdomen

Where is the primary site of origin of the tumor and children who have neuroblastoma?

Swimming Golf Hiking Fishing

Which activity should a nurse suggest for a client diagnosed with hemophilia

Certain anticonvulsant medications Certain chemotherapeutic agents Idiopathic causes

Which are the common causes of acquired aplastic anemia?

Coronary thrombosis Coronary stenosis Coronary artery aneurysm

Which are the most serious complications for a child with KD?

50th percentile height and weight for age Playing basketball with other children his age

Which assessments indicate that the parent of a seven year old is following the prescribed treatment for CHF?

Diastolic and continuous type

Which cardiac murmurs are usually pathologic?

Infant with CHF Infant with significant PS

Which client could require feeding by gavage?

Severe diaper rash

Which finding might delay a cardiac catheterization procedure on a one year old?

Pulmonary

Which heart valve prevents regurgitation of blood from the pulmonary artery into the right ventricle?

Prostaglandin

Which hormone is partly responsible for ensuring that the ductus arteriosus closes normally?

Allow parents to hold and rock their child Make frequent position changes Feed the child when sucking the fists Change bed linens only when necessary Organize nursing activities

Which interventions decrease cardiac demands in an infant with CHF?

Remove pressure dressing the day after the catheterization Avoid strenuous exercise for several days Resume the child's normal diet once home

Which is appropriate family discharge teaching following a child's cardiac catheterization

Standard

Which isolation precaution should the nurse implement for a child who has AIDS?

p24 antigen assay

Which laboratory test will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose mother is HIV+

Give an anti-emetic 30 minutes prior to the start of therapy Continue the anti-emetic as ordered until 24 hours after the therapy is complete Remove food that has a lot of odor

Which measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy

Epinephrine 1:1000 injection (EpiPen)

Which medication is most important to have available in all clinics and offices of immunizations are administered?

Prostaglandin E

Which medication should the nurse give to an infant diagnosed with transposition of the great vessels?

Pneumocystic pneumonia

Which of the following is the most common opportunistic infection in children infected with HIV

Polycythemia and clubbing

Which physiological changes occur as a result of hypoxemia in CHF?

Feeding in semi fowler position

Which plan would be appropriate and helping to control CHF in an infant?

Contact and droplet precautions

Which precautions would be the priority intervention for a child suspected of having varicella?

All dental procedures Invasive procedures of the respiratory tract All procedures on infective skin or musculoskeletal tissue

Which procedures require preventive antibiotics for children with high risk, cardiac disease

I will mix the digoxin in some formula to make it taste better

Which statement by parent of an infant with CHF, who is being sent home digoxin indicates the need for further education?

I will give him his oral anti-inflammatory medication for pain and inflammation I will take my child every month to the healthcare provider's office for his penicillin shot

Which statement by the mother of a child with RF ensures she has good understanding of the care of her child?

If their culture is positive for group A streptococcus, I will give them their antibiotic

Which statement by the mother of a child with RF shows an understanding of prevention for her other children?

Bone marrow aspiration

Which test provides a definitive diagnosis of aplastic anemia

ductus arteriosus

communication between the aorta and pulmonary artery

Infant -No concept of death -May sense caregivers are tense -May sense routines are altered Toddler -Unable to distinguish fact from fantasy -No understanding of true concept of death -Senses separation -Equates death to separation or abandonment Preschoolers -Believe death is temporary -Believe dead person can come back to life" magical thinking" -Believes bad thoughts cause death -Has beginning concept of death (death of plants, animals, etc.) School-age children -More realistic understanding of death -By 8 to 10 years know death is permanent and irreversible -know people die from external and internal causes -Believe death is universal -May have exaggerative concerns about death Adolescent -Capable of understanding death -Understand the connection between illness and death -May feel invincible -Understands that death impacts other people deeply

concept of death

aplastic anemia

failure of blood cell production in the bone marrow

Goal is to achieve remission (lasts about one month) Drugs: L-asparaginase, vinchristine, and a steroid, (dexamethasone). for high-risk children fourth drug (daunorbucin) Intensive therapy is given to kill enough cancerous cells to induce a remission

induction phase of cancer treatment

Epstein-Barr virus (EBV)

infectious mononucleosis Presents with fever and sore throat Swollen lymph glands and possible rash or jaundice Lethargy and exhaustion are common Often called kissing disease Avoid contact activities because of hepatosplenomegaly Spread through direct and indirect contact with nose and throat secretions of infected child or person They need rest Associated with malignancies: Burkett's lymphoma Nasopharyngeal cancer Hotchkin disease And some auto immune disorder such as sjorgen syndrome