Unit 3
An infant is born with an omphalocele. Which explanation by the nurse is the best description of feeding plan for the infant?
the infant will be fed by TON to supply nutrient and keep the bowel from filling with air or stool
What do erythrocytes (RBC) do?
transport oxygen to the cells and carbon dioxide away from the cells
What type of infection and precaution is influenza?
viral - droplet
What is the treatment for the common cold?
viruses do not need antibiotics, antihistamines are not recommended, educate on hand washing-coughing into elbow-and staying home
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition?
"If the trait is inherited from both parents the child will have the disease."
What are S/S of graft vs host disease?
7 to 14 days after transplant, rash, high fever, liver or spleen enlargement
What are the types of blood cancers?
Acute lymphoblastic leukemia, acute myelogenous leukemia, hodgkin disease, non-hodgkin lymphoma
Immune response to an agent
An allergy
This anemia is caused by the bone marrow failing to produce adequate numbers of cells
Aplastic anemia
Reactive McBurney's point, N/V, low-grade temp unless perforation occurs, often requires surgical intervention
Appendicitis
What treatment can be done to improve gas exchange and open the lower alveoli?
CPAP
This therapy is beneficial to remove excess lead or iron from the blood.
Chelation therapy
Excessive blood loss leads to clotting cascade; uncontrolled bleeding from puncture sites, petechiae; emergent replacement of blood & platelets
DIC
What is a way to prevent iron deficiency anemia in premature infants
Delayed cord clamping at birth
Most common types of dietary allergens
Eggs, dairy, nuts, and fish
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?
Ensure neutropenic precautions are in place
A woman with hydramnios has just given birth. The nurse recognizes that the infant must be assessed for which of the following conditions?
Esophageal atresia
What is the most common type of congenital disorder?
Fanconi syndrome
What are signs of respiratory distress of the newborn?
Grunting, retractions, nasal flaring, tachypnea, hypoxia, cyanosis
Education points to children & families on allergic reactions
Having an action plan by knowing and avoiding triggers, how to treat a reaction, how to administer an epi-pen, & when to go to the ER
Prolonged PTT, easy bruising, spontaneous bleeding, GI bleeds, hemarthrosis, factor VII deficiency, passed from mothers to sons
Hemophillia
Segment of bowel telescoped into another segment causing vascular compromise that can lead to peritonitis, n/v/d, severe pain, a sausage-like mass, & currant jelly stools
Intussusception
What is ITP (idiopathic thrombocytopenia)?
Low platelets, immune response; treat by restricting activity, corticosteroids, acetaminophen
Bilious vomiting, abdominal pain, shock symptoms, hypoactive bowel sounds, and requires urgent surgical repair
Malrotation of bowel
Priority medical management of anaphylaxis
Managing the ABC's
What is chemotherapy?
Medication with 2 different ways of action: cell cycle-specific and cell cycle nonspecific; kills cancer cells and normal cells
What are pre op considerations for a EA or TEF?
NPO, elevate HOB to 60 degrees to prevent reflux, administer parenteral IV fluids, OG/NG tube
Occurs with a decreased level of B12
Pernicious Anemia
What are signs of Type I Diabetes Mellitus
Polyuria, fatigue, mood changes, weight loss, blurred vision
What are signs of a hyperglycemic episode
Polyuria, polydipsia, vomiting, flushing, dehydration
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?
Preterm infants are at risk for iron-deficiency anemia`
What are symptoms of pyloric stenosis?
Projectile vomiting, insatiable appetite with weight loss, nonbilious vomiting, olive shaped mass in epigastric region
Hypertrophic obstruction; symptoms appear 3-6 weeks old; good eater but projectile vomits then starving again, "olive" in RUQ, failure to thrive, hyperactive bowel sounds
Pyloric Stenosis
What are symptoms of appendicitis in infants?
RLQ pain with rebound tenderness @McBurneys point, N/V, frequent soft stools, low grade fever
A highly contagious virus that causes necrosis in the small airways, peribronchiolar infiltration, and plugging of the lumens with mucus and exudate
RSV
A highly contagious virus that is more severe in younger children, often leads to bronchiolitis, and common symptoms are hypoxemia and C02 retention
RSV
What most commonly causes broncholitis?
RSV
Most often discovered when parents note a cat's eye reflex
Retinoblastoma
Oncologic emergency related to neutropenia; fever, respiratory distress, poor perfusion, altered LOC
Sepsis
Suppressing the immune system then administering hematopoietic cells as a form of cancer treatment
Stem cell transplant
Oncologic emergency; dyspnea, cyanosis & edema of the upper body, and distended neck veins caused by a tumor compressing circulation
Superior Vena Cava Syndrome
What is the TNM staging system for tumors?
T: tumor size N: presence within the lymph nodes M: metastasis to other organs
What is radiation?
Targets a specific area or tumor, often used to shrink a tumor in conjunction with chemo or surgery
What is the most common hereditary bleeding disorder?
Von Willebrand
What is the best indication for the survival of leukemia
WBC on diagnosis
What is management for a sickle cell crisis
Warm compresses to painful areas, pain management, hydration, antibiotics, oxygenation
Parents may note a firm mass located on one side of the abdomen, and will present with elevated BP; requires surgical intervention
Wilms Tumor
What is a diaphragmatic hernia?
abdominal organs push up through diaphragm and invade the space needed for heart and lungs
What is the most common type of childhood cancer?
acute lymphoblastic leukemia
What type of infection is sinusitis?
bacterial infection of the sinuses
What is the treatment for intussusception?
barium or air enema, surgical repair if unsuccessful
What is intussusception?
bowel is telescoped into a more distal segment
What is meconium ileus?
bowel obstruction, abdominal distention, vomiting reflux, mostly occurs with cystic fibrosis
What are S/S of celiac disease?
bulky foul smelling fatty stools, malabsorption of food leading to malnutrition and failure to thrive, distended abdomen
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?
calling the doctor if the child gets a sore throat
What are complications in children with gastroschisis?
feeding intolerance, failure to thrive, and prolonged hospital stays
What are some methods of symptom relief for sinusitis?
humidity, normal saline nasal wash and suctioning
What is a high risk for infants with respiratory disorders?
hypoexemia and CO2 retention
Which site is most frequently used to perform a bone marrow aspiration?
iliac crest
The nurse is caring for a newborn diagnosed with a diaphragmatic hernia. The nurse will prepare to teach the parents concerning which potential treatment modality?
immediate surgery to correct
What must a patient have to undergo before a stem cell transplant?
immunosuppressive therapy
what are S/S of cushing syndrome?
increased glucose production, fat accumulation, muscle wasting, suppressed immune system
A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome?
increasing daily fluid intake
What is the epiglottis most often caused by?
influenza type B
What types of anemia may be caused by a nutritional deifciency?
iron deficiency, folic acid deficiency, pernicious anemia
A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus?
keeping the child pain free
Important teaching points for asthma
know triggers & how to avoid them, carry & know how to properly use a rescue inhaler, & know when to seek medical attention
What are symptoms of a common cold?
low grade fever, sore throat, enlarged lymph nodes, cough, headache
What are types of brain cancers?
medulloblastoma, brainstem glioma, ependymoma, astrocytoma
What are considerations a nurse needs to take when suctioning a child?
must allow for differences in lengths of the trachea to avoid slipping into the right bronchus
What are signs of decreased hydration?
oral mucosa, skin tenting, and sunken fontanelles
The nurse is developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion?
packed red blood cells
What is croup most often caused by?
parainfluenza
What are expiratory coughs with a strangled inspiration?
paroxysmal coughing
The nurse is assessing a child in the pediatric intensive care unit. Which assessment finding(s) warrants immediate action? Select all that apply.
petechiae, persistent oozing from venipuncture site, increased D dimer
Which disorder causes a white strawberry tongue?
pharyngitis
What are nursing considerations for an infant with an omphalocele or gastroschisis?
prevent hypothermia, monitor perfusion of organs, cover with non adherent sterile dressing, measure the size, keep supine or side lying, NPO with TPN, monitor I&Os and daily weights
What are typical treatments for cystic fibrosis
Chest physiotherapy, postural drainage, pancreatic enzymes, bronchodilators, and mucolytics
The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care?
abdominal palpation
What causes aplastic anemia?
an adverse reaction to medication or chemicals
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?
an enlarged spleen
What are early signs of respiratory distress?
anxiety and restlessness
What might be indicated with reoccurring/chronic pneumonia?
asthma and CF
What is included in family education for idiopathic thrombocytopenia purpura?
avoiding aspirin, NSAIDs, and antihistamines
Overproduction of cortisol, muscle-wasting & fat accumulations on trunk & face, immune system suppressed; remove pituitary and replace hormones
cushings
What are complications of a cleft lip or palate?
feeding difficulties, unable to achieve good suction, excessive air intake, nasal regurge, aspiration concerns
What are nursing considerations for EA and TEF?
frothy bubbles of mucous, abdominal distention, unable to pass NG tube, rattling respirations, excessive salivation, 3 C's coughing-choking-cyanosis
The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?
giving ferrous sulfate with orange juice between meals
What breath sound is produced by premature glottic closure and occurs on expiration?
grunting
What are signs of RDS in a newborn?
grunting, retractions, nasal flaring, tachypnea, hypoxia, and cyanosis
A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?
headache, vision changes, and vomiting
What is indicated by frequent swallowing post tonsillectomy?
hemorrhage
What is some important education to provide to child and parents of Type I DM
how to properly check blood sugars, proper diet, and how to recognize and manage hypoglycemic episodes
The nurse is caring for a newborn observes a cleft lip and palate. The parent plans to bottle feed the newborn. Which instruction will the nurse include when teaching the parent about feeding this newborn?
how to use special cleft palate nipples when feeding
What are some complications of Von Willebrands?
prolonged bleeding, epistaxis, heavy menstruation, higher risk for bleeding with childbirth
What is needed to reduce the risk of infection following a splenectomy?
prophylactic antibiotics
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?
protect the abdomen from manipulation
What is included in post tonsillectomy care?
protect the airway, place in side lying or prone to drain secretions, suctioning PRN, avoid trauma to surgical site, pain management
What is an umbilical hernia?
protrusion of bowel through abdominal wall
Bronchodilator used for croup and other respiratory problems
racemic epinephrine
What is the treatment for intussusception?
sudden onset of severe pain, V/D, currant jelly stools, sausage like mass in upper mid abdomen
What is the first sign of RDS?
tachypnea
What is an esophageal atresia?
the esophagus grows in 2 separate segments that do not connect and end in a blind pouch
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?
transfuse 1 unit of packed red blood cells
What is the treatment for a diaphragmatic hernia?
urgent surgical repair, post op requires elevated head of bed-suction PRN-and TPN nutrition
What education is needed for the use of an inhaler?
use spacer, wash weekly, air dry, breath in slow and steady, always carry a recuse inhaler
What breath sound might occur with asthma or viral infarctions?
wheezing
What is a tracheoesophageal fistula?
when the esophagus and trachea are 2 separate tubes that are not connected
Common viral infection in ages 3 mos-3 yrs, inflammation and edema of larynx and pharynx leading to obstructed airway, symptoms most common at night
Croup
Meconium ileus, Vitamin A, D, E, K malabsorption, failure to thrive, and chronic hyperglycemia may indicate the need to test for this disease
Cystic Fibrosis
Barrel chest, chronic cough, clubbing, chronic sinusitis, recurrent pneumonia, salty tasting skin, cor pulmonale may indicate the need to test for this disease
Cystic fibrosis
The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?
He can resume participation in football in 2 weeks
What are signs of a hypoglycemic episode
Lethargy, sweating, pallor, sweet breath
Management of this involves avoiding fresh fruits and vegetables, no fresh flowers or plants, wearing a mask when around people, and minimizing invasive procedures
Neutropenia
The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?
No routine live vaccines are administered while on chemotherapy
Affects lymph nodes deep within the body, spreads through the bloodstream, grows rapidly; symptoms include lymph swelling and possibly a history of abdominal pain
Non-Hodgkin Lymphoma
A common adverse effect to chemo or radiation; large, painful sores in and around mouth that inhibits the ability to eat and drink comfortably
Oral mucositis
Bone pain typically missed because it's assumed to be related to an injury; occurs most often in Caucasian males; most common in long bones; requires surgery, chemo, and often amputation
Osteosarcoma
A 1-year-old child is diagnosed with pernicious anemia due to lack of intrinsic factor and is prescribed vitamin B12 injections. After teaching the child's parents about this treatment, the nurse determines that the teaching was successful based on which statement?
We will give the injection once a month for the rest of our child's life
The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?
baseball
What is common immediately post tonsillectomy that parents should be educated on?
blood in and around mouth and some bloody emesis
What are airway maintenance considerations for babies with cleft lips?
burping is VERY important, will be fed with a special cleft lip nipple, fed in a high upright position
What indicates prolonged hypoxia?
clubbing
What is an omphalocele?
congenital anomaly in which the umbilical ring opens to an external peritoneal sac, bowel malformation is commin
What disorder causes a "barking" cough?
croup
What is a viral infection of the larynx, trachea, and bronchi?
croup
What causes pernicious anemia?
deficiency in the production of RBC through the lack of vitamin B12
What is the appropriate interventions for an anaphylactic reaction?
epi-pen and ER visit
Tri-pod position, high fever, difficulty speaking, drooling, anxiety/frightened appearance; this viral infection can quickly become life-threatening
epiglottis
What is Von Willebrand disease?
factor VIII and platelet deficiency
What bacteria causes pharyngitis?
group A strep
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)?
lethargy, bruises, and lymphadenopathy
What are signs of thrombocytopenia?
reduced platelet formation, bruises easily, petechiae, nose bleeds, and GI bleeds
What is the treatment for cushings?
remove the pituitary gland, hormone replacement, monitor for severe hypertension
When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?
risk for infection
What family education needs to be given in regards to chemotherapy?
safe handling, potential side effects, how to minimize/treat the side effects, when to come to the ED
What are S/S of fanconi syndrome?
skeletal and renal anomalies, short stature, and underdeveloped genitalia
What breath sound indicates and upper airway obstruction?
stridor